High incidence of group B streptococcal infection in infants born to HIV-infected mothers.
Article Type: Letter to the editor
Subject: Streptococcal infections (Diagnosis)
Streptococcal infections (Risk factors)
Streptococcal infections (Research)
HIV patients (Health aspects)
Infants (Newborn) (Health aspects)
Authors: Goetghebuer, Tessa
Adler, Catherine
Epalza, Cristina
Levy, Jack
Pub Date: 03/01/2012
Publication: Name: Emerging Infectious Diseases Publisher: U.S. National Center for Infectious Diseases Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 U.S. National Center for Infectious Diseases ISSN: 1080-6040
Issue: Date: March, 2012 Source Volume: 18 Source Issue: 3
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: Belgium Geographic Code: 4EUBL Belgium
Accession Number: 283455657
Full Text: To the Editor: In their cross-sectional study comparing group B streptococcus (GBS) carriage among HIV-infected and HIV-uninfected women in Malawi, Gray et al. found no differences in GBS carriage between both groups but found a higher carriage rate for HIV-infected women with high CD4 cell counts (1). They proposed that a GBS-specific immune defect might exist in HIV-infected pregnant women and suggested that this defect could be blurred by competitive exclusion of GBS as a consequence of changes in microbial flora at lower CD4 counts.

We recently reported an increased incidence of neonatal GBS sepsis in HIV-exposed uninfected (HEU) infants born in Belgium, compared with the general population (2). In our cohort, the risk for GBS infection was 20x higher in HEU infants than in infants born to HIV-uninfected mothers. Moreover, the episodes of GBS sepsis in HEU infants, compared with the general population, were more severe and mostly of late onset. We are currently looking prospectively at GBS carriage in HIV-infected and control uninfected pregnant women to learn whether our observation can be explained by a higher carriage rate in HIV-infected women or by increased susceptibility of HEU infants to this capsulated bacteria. The latter hypothesis would be in line with the higher susceptibility of HEU children to other types of severe infections, as has been described in several studies from sub-Saharan Africa and Latin America (3-5).

The incidence of GBS sepsis in HIV-exposed infants born in Africa is unknown. In addition to the need for further investigation of anti-GBS immunity in HIV-infected pregnant women, we believe that studies comparing the incidence of neonatal GBS sepsis in HEU and HIV-unexposed infants are warranted. If the increased risk for GBS sepsis is confirmed, prophylaxis should be implemented in the population concerned.

References

(1.) Gray KJ, Kafulafula G, Matemba M, Ka mdolozi M, Membe G, French N, et al. Streptococcus and HIV infection in pregnant women, Malawi, 2008-2010. Emerg Infect Dis. 2011;17:1932-5.

(2.) Epalza C, Goetghebuer T, Hainaut M, Prayez F, Barlow P, Dediste A, et al. High incidence of invasive group B streptococcal infections in HIV-exposed uninfected infants. Pediatrics. 2010;126:e631-8. http://dx.doi.org/10.1542/peds.2010-0183

(3.) Mussi-Pinhata MM, Freimanis L, Yamamoto AY, Korelitz J, Pinto JA, Cruz ML, et al. Infectious disease morbidity among young HIV-1-exposed but uninfected infants in Latin American and Caribbean countries: the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study. Pediatrics. 2007;119:e694-704. http://dx.doi.org/10.1542/peds.2006-1856

(4.) Koyanagi A, Humphrey JH, Ntozini R, Nathoo K, Moulton LH, Iliff P, et al. Morbidity among human immunodeficiency virus-exposed but uninfected, human immunodeficiency virus-infected, and human immunodeficiency virus-unexposed infants in Zimbabwe before availability of highly active antiretroviral therapy. Pediatr Infect Dis J. 2011;30:45-51. http://dx.doi. org/10.1097/INF.0b013e3181ecbf7e

(5.) Filteau S. The HIV-exposed, uninfected African child. Trop Med Int Health. 2009;14:276-87. http://dx.doi. org/10.1111/j.1365-3156.2009.02220.x

Tessa Goetghebuer, Catherine Adler, Cristina Epalza, and Jack Levy

Author affiliation: Saint-Pierre University Hospital, Brussels, Belgium

DOI: http://dx.doi.org/10.3201/eid1803.111630

Address for correspondence: Tessa Goetghebuer, Hopital Saint-Pierre-Department of Pediatrics, 322 Rue Haute, Brussels 1000, Belgium; email: tessa_goetghebuer@stpierre-bru.be
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