Background Group B streptococci (Streptococcus agalactiae) area major cause of meningitis and septicemia in neonates and pregnantwomen, but the importance of group B streptococcal disease innonpregnant adults has not been clearly defined.
Methods We conducted a prospective surveillance of the pathogensresponsible for meningitis for a period of 24 months in 35 hospitalsand a referral laboratory in metropolitan Atlanta. We reviewedthe clinical and laboratory records of all the nonpregnant adultsidentified as having invasive group B streptococcal diseaseduring this period.
Results During 1989 and 1990 there were 424 patients with invasivegroup B streptococcal disease (annual incidence, 9.2 cases per100,000 population). Of these patients, 46 percent were 1 monthof age or younger, 6 percent were older than 1 month but youngerthan 18 years of age, and 48 percent were 18 or older. Men andnonpregnant women accounted for 68 percent (n = 140) of allcases among adults (annual incidence, 4.4 per 100,000). Clinicaland laboratory records were available for 137.
In the nonpregnant adult patients (age, 18 to 99 years), themost common clinical diagnoses were skin, soft-tissue, or boneinfection (in 36 percent); bacteremia with no identified source(30 percent); urosepsis (14 percent); pneumonia (9 percent);and peritonitis (7 percent). Risk factors included older age( 60 years), the presence of diabetes mellitus, the presenceof malignant neoplasms, and infection with the human immunodeficiencyvirus. The mortality rate in nonpregnant adults was 21 percent,accounting for 67 percent of all deaths related to group B streptococcalinfection during the surveillance period.
Conclusions Invasive group B streptococcal infection is a majorproblem not only in pregnant women and neonates but also innonpregnant adults, especially those who are elderly and thosewho have chronic diseases.
Source Information
From the Department of Medicine, Emory University School of Medicine (M.M.F., R.C.H., T.S., D.S.S.); Veterans Affairs Medical Center (M.M.F., D.S.S.); Georgia Department of Human Resources (J.D.S.); and Meningitis and Special Pathogens Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention (A.S., J.D.W.) -- all in Atlanta.
Address reprint requests to Dr. Farley at the Veterans Affairs Medical Center (151), 1670 Clairmont Rd., Decatur, GA 30033.
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