Group B streptococcal colonization and transmission dynamics in pregnant women and their newborns in Nigeria: implications for prevention strategies

OBJECTIVES

Because few studies have been conducted on group B Streptococcus (GBS) in Nigeria, we sought to estimate GBS colonization and transmission frequencies for 500 women and their newborns and identify risk factors for both outcomes.

METHODS

GBS strains were characterized for antibiotic susceptibilities, capsule (cps) genotype, pilus island profile and multilocus sequence type (ST).

RESULTS

In all, 171 (34.2%) mothers and 95 (19.0%) of their newborns were colonized with GBS; the vertical transmission rate was 48.5%. One newborn developed early-onset disease, yielding an incidence of 2.0 cases per 1000 live births (95% CI 0.50-7.30). Rectal maternal colonization (OR 26.6; 95% CI 13.69-51.58) and prolonged rupture of membranes (OR 4.2; 95% CI 1.03-17.17) were associated with neonatal colonization, whereas prolonged membrane rupture (OR 3.4; 95% CI 1.04-11.39) and young maternal age (OR 2.0; 95% CI 1.22-3.39) were associated with maternal colonization. Women reporting four or more intrapartum vaginal examinations (OR 6.1; 95% CI 3.41-10.93) and douching (OR 3.7; 95% CI 2.26-6.11) were also more likely to be colonized. Twelve STs were identified among 35 mother-baby pairs with evidence of transmission; strains of cpsV ST-19 (n = 9; 25.7%) and cpsIII ST-182 (n = 7; 20.0%) predominated.

CONCLUSIONS

These data demonstrate high rates of colonization and transmission in a population that does not use antibiotics to prevent neonatal infections, a strategy that should be considered in the future.

Risk factors for group B streptococcal colonization: potential for different transmission systems by capsular type

PURPOSE

Group B Streptococcus (GBS) is a common inhabitant of the bowel and vaginal flora, with known transmission routes including sexual contact and vertical transmission from mother to infant. Food-borne transmission is also possible, as GBS is a known fish and bovine pathogen. We conducted a prospective cohort study in order to identify risk factors for acquisition.

METHODS

We identified risk factors for GBS acquisition among college women (n = 129) and men (n = 128) followed at 3-week intervals for 3 months.

RESULTS

A doubling in sex acts significantly increased incidence of GBS capsular type V by 80% (95% confidence interval [CI]: 1.19, 2.58), and other non-Ia or -Ib types combined by 40% (95% CI: 1.00, 2.06; incidence of capsular type Ia (odds ratio [OR] = 1.2; 95% CI: 0.71, 1.88; p = 0.57) and Ib (OR = 1.5, 95% CI: 0.75, 2.86; p = 0.27) were elevated, although not significantly. After adjustment for sexual activity and sexual history, gender, and eating venue, fish consumption increased risk of acquiring capsular types Ia and Ib combined 7.3 fold (95% CI: 2.34, 19.50), but not of acquiring other capsular types. Beef and milk were not associated with GBS incidence.

CONCLUSIONS

Different GBS capsular types may have different transmission routes.

Frequency of antibiotic resistance among group B Streptococcus isolated from healthy college students

We report resistant rates to erythromycin and clindamycin among Streptococcus agalactiae (group B Streptococcus) isolated from a random sample of healthy male and nonpregnant female college students. Observed resistance rates were twice as high as those reported among pregnant women from the same geographic area 2 years prior.

Prevalence of known P-fimbrial G alleles in Escherichia coli and identification of a new adhesin class

Screening a large Escherichia coli collection for P-fimbrial adhesin classes identified 20 unclassifiable strains. Cloning and sequencing of papG from an unclassifiable strain identified another G allele. The novel adhesin gene has 65% identity to the class I adhesin gene, 44% identity to the class II adhesin gene, and 43% identity to the class III adhesin gene.

Molecular epidemiologic approaches to urinary tract infection gene discovery in uropathogenic Escherichia coli

Urinary tract infection (UTI) is one of the most frequently acquired bacterial infections. The vast majority of UTIs are caused by a large, genetically heterogeneous group of Escherichia coli. This genetic diversity has hampered identification of UTI-related genes. A three-step experimental strategy was used to identify genes potentially involved in E. coli UTI transmission or virulence: epidemiologic pairing of a UTI-specific strain with a fecal control, differential cloning to isolated UTI strain-specific DNA, and epidemiologic screening to identify sequences among isolated DNAs that are associated with UTI. The 37 DNA sequences initially isolated were physically located all over the tester strain genome. Only two hybridized to the total DNA of the sequenced E. coli K-12 strain; eight sequences were present significantly more frequently in UTI isolates than in fecal isolates. Three of the eight sequences matched to genes for multidrug efflux proteins, usher proteins, and pathogenicity island insertion sites, respectively. Using population characteristics to direct gene discovery and evaluation is a productive strategy applicable to any system.

Polychaetoid is required to restrict segregation of sensory organ precursors from proneural clusters in Drosophila

Reduction of wild-type activity of the polychaetoid (pyd) gene results in formation of extra mechanosensory bristles on the head and notum of adult Drosophila. Loss of pyd function results in decreased ability to restrict sensory organ precursor (SOP) formation to a single cell per proneural cluster. Although the initial proneural cluster pattern of achaete expression is not altered in pyd mutants, extra cells within proneural clusters express the high levels of achaete characteristic of SOPs. This observation suggests that pyd+ functions as a negative regulator of achaete-scute complex expression within the proneural cluster. Synergistic interactions between pyd and Notch, Delta and extramacrochaetae mutations support this model. We also demonstrate that pyd is required for normal eye development.

Parasite-host coevolution and geographic patterns of parasite infectivity and host susceptibility

Ebert (1994) has proposed the rule that parasites are, with few exceptions, more infective to sympatric hosts than to allopatric hosts. We test this rule using field data for schistosome infections of planorbid snails and find that, although sympatric parasite-host combinations do tend to be more compatible, there are exceptions where particular allopatric parasite-host populations are significantly more compatible. We develop a mathematical model of the dynamics of the parasite-host interaction where parasite infectivity and host susceptibility are defined by the matching of genotypes in a diploid system, The model predicts dynamic polymorphisms where parasite allele frequencies track host allele frequencies but with a lag. Because of this lag, it is possible for allopatric combinations to be more compatible than sympatric combinations. Any 'rule' that precludes this possibility is unlikely to prove robust.

Geographic compatibility of the freshwater snail Bulinus globosus and schistosomes from the Zimbabwe highveld

Populations of Bulinus globosus were sampled from two rivers, 60 km apart, in northern Zimbabwe, and offspring from each geographic strain reared in the laboratory. Schistosomes were harvested from each strain and also maintained in the laboratory. Cross-infection experiments were conducted, whereby snails of both geographic strains were exposed to parasites of both geographic strains. Compatibility was found to be related to: (i) the geographic origin of the snail, and (ii) an interaction between the geographic origin of snail and parasite, such that sympatric combinations of snails and parasites produced a greater proportion of compatible infections than allopatric combinations. Cercarial output of infected snails was found to be related to the geographic origin of the parasite, but not of that of the snail. It is suggested that, as the snails used were laboratory bred and naive to schistosome infection, differences in snail-schistosome compatibility were genetically determined, rather than an adaptive response. This study supports earlier work which suggests the existence of geographic compatibility amongst natural populations of snails and trematodes, indicative of either increased infectivity by the parasite, or decreased resistance by the snail.

Characterization of a Ca(2+)-dependent anion channel from sheep tracheal epithelium incorporated into planar bilayers

1. Anion-selective channels from the apical membrane of respiratory epithelia are involved in the secretion of chloride into the airway lumen. In cystic fibrosis (CF) there is an abnormality of phosphorylation-regulated chloride transport in this tissue, whilst a calcium-dependent pathway appears to function normally. 2. Using incorporation of apical membrane vesicles into planar phospholipid bilayers, we have characterized the most commonly seen anion-selective channel from sheep tracheal epithelium. 3. In symmetrical 200 mM-NaCl solutions the channel showed rectification, with a chord conductance at negative voltages of 107 pS and at positive voltages of 67 pS. The channel characteristically demonstrated subconductance states at 1/3 and 3/4 of the fully open level. Selectivity for chloride over sodium was approximately 6:1. 4. The channel required a minimum of approximately 100 microM-calcium on the presumed cytoplasmic surface (cis) for opening events to be observed. Open probability (Po) of the fully open state was markedly voltage dependent, but little effect of voltage was seen on the 1/3 subconductance state. 5. The relative permeabilities of monovalent anions monitored under bi-ionic conditions gave the following sequence: NO3- greater than I- greater than Cl- = Br- much much greater than F-. The order of conductances in symmetrical solutions was Cl- = NO3- greater than Br- greater than I- much much greater than F-. 6. The chloride channel blocker 5-nitro-2-(3-phenylpropylamino)-benzoate (NPPB) produced a dose-related reduction in Po with a flickering block at 10-50 microM and complete block at higher concentrations. 7. ATP produced a dose-related reduction in Po with effects at 1 microM and complete closing at 1 mM. These effects were only seen with addition to the cis chamber. 8. The catalytic subunit of protein kinase A, either when incubated with vesicles prior to incorporation into bilayers, or when added directly to either chamber, produced no effect. 9. Channels with very similar properties were seen from transfected human tracheo-bronchial cells. 10. Recent whole-cell patch-clamp studies have suggested a distinct calcium-activated chloride current in secretory epithelia. The described channel has properties in common with this current and may be a candidate for its single-channel basis.

Monovalent cation conductance in the ryanodine receptor-channel of sheep cardiac muscle sarcoplasmic reticulum

1. The ryanodine receptor protein of sheep cardiac muscle sarcoplasmic reticulum membranes functions as a ligand-regulated ion channel following solubilization with the zwitterionic detergent CHAPS (3-[(3-cholamidopropyl)-dimethylammonio]-1- propane sulphonate); purification by density gradient centrifugation, reconstitution into proteo-liposomes and incorporation into planar phospholipid bilayers. 2. In the absence of divalent cations, measurable conductance is observed with the group 1a cations and with some larger organic cations. In symmetric 210 mM solutions the following conductance sequence was determined: K+ greater than Rb+ = NH4+ greater than Na+ = Cs+ greater than Li+ much greater than Tris+. 3. Other organic cations, e.g. TEA+, do not produce measurable current under these conditions. 4. Single-channel conductance saturates with increasing ionic activities of K+, Na+ and Li+. Saturation curves are described by Michaelis-Menten kinetic schemes with the following values of maximal conductance and apparent dissociation constant: K+ 900 pS, 19.9 mM; Na+ 516 pS, 17.8 mM; Li+ 248 pS, 9.1 mM. 5. The channel displays only minor differences in permeability amongst the group 1a cations. Relative permeability, monitored under bi-ionic conditions, yields the following sequence: Na+, 1.15 greater than K+, 1.00 = Li+, 0.99 greater than Rb+, 0.87 greater than Cs+, 0.61. Under similar conditions the permeability ratio of NH4+ to K+ was found to be 1.32 and that for Tris+ to K+ was 0.22. 6. The K+ conductance is reduced by low concentrations of the impermeant cation TEA+. Block appears as a smooth reduction in single-channel current amplitude and the degree of block is dependent upon applied voltage. These observations are consistent with a single-site blocking scheme in which TEA+ has access to a site within the voltage drop of the channel from only the cytosolic face of the channel protein and interacts with a site located approximately 90% of the electrical distance across the channel. The zero-voltage dissociation constant for TEA+ block is 50 mM. 7. Single-channel conductance measurements in mixtures of K(+)-Na+ and K(+)-Li+ reveal no anomalous behaviour as the mole fraction of the ions is varied. 8. With monovalent cations as permeant species, the sheep cardiac sarcoplasmic reticulum ryanodine receptor protein functions as a poorly selective, ligand-regulated channel. Under the conditions described here the channel functions as a single-ion pore. It is proposed that discrimination is largely dependent upon the strength of interaction of the permeant ion with a binding site in the conduction pathway.

Conduction and blocking properties of a predominantly anion-selective channel from human platelet surface membrane reconstituted into planar phospholipid bilayers

We have investigated the basic properties of a predominantly anion-selective channel derived from highly purified human platelet surface membrane. Single channels have been reconstituted into planar phospholipid bilayers by fusion of membrane vesicles and recorded under voltage-clamp conditions. The channel is found to have the following properties: (i) Channel activity occurs in bursts of openings separated by long closed periods. (ii) The current-voltage relationship is nonlinear. Channel current is seen to rectify, with less current flowing at positive than at negative voltages. Rectification may be due to asymmetric block by HEPES/Tris buffers. In 450 mM KCl, 5 mM HEPES/Tris, pH 7.2, the single channel conductance at -40 mV is approximately 160 pS and at +40 mV is approximately 90 pS. (iii) The conductance-concentration relationship follows a simple saturation curve. Half maximal conductance is achieved at a concentration of approximately 1000 mM KCl, and the curve saturates at a conductance of approximately 500 pS. (iv) Reversal potentials interpreted in terms of the Goldman-Hodgkin-Katz equation indicate a Cl: K permeability ratio of 4:1. (v) The channel accepts all of the halides as well as a number of other anions. The following sequence of relative anion permeabilities (in the presence of K+) is obtained: F- less than acetate- less than gluconate- less than Cl- less than Br- less than I- less than NO3- less tha SCN-.(vi) Cations as large as TEA+ are permeant. (vii) Current through the channel is blocked in the presence of DIDS, SITS and ATP, but not by Zn2+.