Recurrent late-onset group B Streptococcus sepsis in extremely preterm infant: a case report and literature review / 中华围产医学杂志

Objective To discuss the controversial role of breast milk in late-onset group B Streptococcus (GBS) infections.Methods This study reported a case of recurrent late-onset GBS sepsis with the suspicion of breast milk transmission in an extremely preterm infant born at 22+6 weeks who was treated at the University of Hong Kong-Shenzhen Hospital in September 2016.Literatures about late-onset GBS cases associated with contaminated breast milk were reviewed to investigate whether GBS could be transmitted through breast milk.Results (1) Case report:A breast-fed extremely preterm infant born at 22+6 gestational weeks suffered from GBS sepsis along with meningitis for the first time on 100 d.The mother was negative for rectovaginal GBS screening.Breast milk wasn't tested as no signs of mastitis were found.The neonate recovered from the first GBS sepsis after 14 days of antibiotic treatment,then returned to breastfeeding.On 126 d,GBS sepsis reoccurred in this baby.Fresh breast milk culture yielded GBS which was identical with the GBS strains isolated from the neonatal blood in antimicrobial susceptibility.After recovery from the second episode,the baby was partially breastfed again without further relapses of late-onset GBS sepsis.(2) Literature review:64 cases of late-onset GBS infections that transmitted via breast milk were retrieved from PubMed,while no Chinese cases had been reported.Clinical data of the 65 cases (including this case) were reviewed and the results revealed that contaminated breast milk was associated with late-onset GBS infections.The reported relapse rate of GBS infections transmitted via breast milk was 25％ for two episodes and 7％ for three episodes.Conclusions GBS contaminated breast milk could potentially cause late-onset GBS sepsis in infants and further studies are required to identify the underlying mechanisms.

Evaluation of group B Streptococcus (GBS) screening in late pregnancy and intrapartum antibiotic prophylaxis for prevention of neonatal early-onset GBS disease / 中华围产医学杂志

Objective To study the colonization rate and antibiotic resistance of group B Streptococcus (GBS) in gravidas during late pregnancy,and to evaluate the effectiveness of GBS screening in late pregnancy and intrapartum antibiotic prophylaxis (IAP) for the prevention of neonatal early-onset GBS disease (EOGBS).Methods A retrospective study was conducted to analyze the colonization rate and antibiotic resistance pattern of GBS in 14 204 gravidas who were screened for GBS at 35-37 gestational weeks during March 2016 to March 2018 in the University of Hongkong-Shenzhen Hospital (HKU-SZH).Differences in the incidence of EOGBS before and after GBS screening and IAP were analyzed using Chi-square or Fisher's exact test.Results Among the 14 204 gravidas,2 027 cases were GBS positive with a colonization rate of 14.27％.Incidence rates of EOGBS before and after GBS screening were 0.6‰ (4/6 356) and 0.07‰ (1/14 403),respectively (Fisher's exact test,P=0.033).GBS isolates were 100％ (2 027/2 027) sensitive to penicillin and vancomycin.Resistance rates to clindamycin and erythromycin were 67.2％(1 363/2 027) and 65.7％ (1 332/2 027),respectively.Conclusions Routine GBS screening in late pregnancy and IAP can significantly decrease the incidence of EOGBS.Penicillin is the optimal choice for prevention and treatment of GBS infection.

Transcription factor GATA2 regulates the expression of Tie2 gene in TNF-? mediated inflammatory response / 中国病理生理杂志

AIM: To explore the possibility that the transcription factor GATA family member is involved in the regulation of Tie2 gene expression in the tumor necrosis factor-?(TNF-?) mediated inflammatory response.METHODS: The mRNA expression of GATA family members GATA2 and GATA3 was determined in primary human aortic endothelial cells(HAECs) and primary human pulmonary artery endothelial cells(HPAECs) before and after TNF-? treatment by real-time quantitative PCR.The activation of Tie2 gene promoter by GATA transcription factor was detected by luciferase assay.The electrophoretic mobility shift assays(EMSAs) and supershift assay were performed for verifying whether Tie2 gene expression was activated by the binding of GATA factors to Tie2 promoter.RESULTS: TNF-? increased the expression of GATA2 in HAECs and HPAECs.The highly expressed GATA2 was bound to the sequence(T/A) GATA(A/G) of Tie2 promoter,activated Tie2 gene promoter and up-regulated Tie2 gene expression.CONCLUSION: GATA transcription factor family member GATA2 up-regulates the expression of Tie2 gene in TNF-? mediated inflammatory response.