Group B Streptococcal (GBS) Disease in Non-pregnant Adults
by Monica M. Farley, MD
A Vaccine!
The Group B Strep Association (GBSA)
Introduction:GBS has been well established as a leading cause of bloodstream infections and meningitis in newborn infants and genital tract and bloodstream infections in pregnant women. In recent years, serious GBS infections occurring in non-pregnant adults, particularly the elderly, have been more frequently recognized. Almost 70% of invasive GBS infections in adults are unrelated to pregnancy or genital tract infections.
What kind of GBS infections are seen in non-pregnant adults?
- Skin and soft tissue infections (such as infections of skin ulcers caused by
poor circulation and diabetes or pressure sores in patients confined to bed). This
form of infection can sometimes spread to the underlying bone.
- Bloodstream infections
- Urinary tract infections (such as kidney, bladder or prostate infections)
- Pneumonia
The incidence of GBS disease in non-pregnant adults is highest in the elderly (>60 years) and increased rates have been noted among African-American individuals. Most adults with invasive GBS that is not associated with pregnancy, have other illnesses that may put them at increased risk for infection. Some examples of other illnesses are listed below:
- Diabetes
- Liver disease such as cirrhosis
- History of a stroke
- Breast cancer
- Pressure sores
- Abnormal bladder function
How often does it occur?
Invasive GBS disease is generally uncommon in non-pregnant adults (less than
1 case for every 10,000 adults). However, the risk of GBS disease may increase
as much as 40-fold in patients with other illnesses such as diabetes and liver disease.
Less serious GBS disease such as urinary tract infections (kidney, bladder or prostate)
occur more frequently.
How serious is GBS disease in nonpregnant adults?
Although uncommon, invasive GBS disease in non-pregnant adults can be very serious.
In a recent study, 21% of the adults with non-pregnancy associated invasive GBS
disease, died. The high death rate may be influenced by the older age and presence
of other illnesses in these patients, but death was usually felt to be directly related
to the infection.
How is it treated?
A number of antibiotics are available that have good activity for the treatment
of GBS infections, including penicillin and ampicillin. In some cases of skin and
soft tissue infections, surgery may be necessary to drain infected sites and remove
damaged tissue. Early recognition of GBS infection and initiation of appropriate
therapy is important to successful treatment.
Can GBS disease be prevented in non-pregnant adults?
A number of general preventive measures can be recommended on the basis of the
kinds of GBS infections seen in non-pregnant adults, particularly the elderly. Careful
attention to skin care in diabetic patients, including avoidance of extremes of temperature,
protective footwear, and aggressive early treatment of infected foot ulcers, may
prevent serious, invasive GBS disease. In bedridden patients, measures should be
taken to prevent pressure sore formation such a frequent turning to avoid pressure
points and use of specialized bed cushions.
Group B streptococcal vaccines are being developed for the prevention of newborn
infant and pregnancy-related GBS disease. The possibility of using a vaccine to
prevent serious GBS disease in non-pregnant adults at high risk for GBS (for example,
in diabetic patients) is an exciting area that will require additional research.
