Original Article
A Population-Based Assessment of Invasive Disease Due to Group B Streptococcus in Nonpregnant Adults
N Engl J Med 1993; 328:1807-1811June 24, 1993
- Abstract
Background
Group B streptococci (Streptococcus agalactiae) are a major cause of meningitis and septicemia in neonates and pregnant women, but the importance of group B streptococcal disease in nonpregnant adults has not been clearly defined.
Methods
We conducted a prospective surveillance of the pathogens responsible for meningitis for a period of 24 months in 35 hospitals and a referral laboratory in metropolitan Atlanta. We reviewed the clinical and laboratory records of all the nonpregnant adults identified as having invasive group B streptococcal disease during this period.
Results
During 1989 and 1990 there were 424 patients with invasive group B streptococcal disease (annual incidence, 9.2 cases per 100,000 population). Of these patients, 46 percent were 1 month of age or younger, 6 percent were older than 1 month but younger than 18 years of age, and 48 percent were 18 or older. Men and nonpregnant women accounted for 68 percent (n = 140) of all cases among adults (annual incidence, 4.4 per 100,000). Clinical and laboratory records were available for 137.
In the nonpregnant adult patients (age, 18 to 99 years), the most common clinical diagnoses were skin, soft-tissue, or bone infection (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 presence of malignant neoplasms, and infection with the human immunodeficiency virus. The mortality rate in nonpregnant adults was 21 percent, accounting for 67 percent of all deaths related to group B streptococcal infection during the surveillance period.
Conclusions
Invasive group B streptococcal infection is a major problem not only in pregnant women and neonates but also in nonpregnant adults, especially those who are elderly and those who have chronic diseases.
Media in This Article
Figure 1
Distribution of Invasive Group B Streptococcal Disease, According to Age.Figure 2
Incidence of Invasive Group B Streptococcal Infection in Adults, According to Age and Race.Article Activity
- Article
Group B streptococci (Streptococcus agalactiae)1,2 are the leading cause of sepsis and meningitis in newborn infants, affecting at least 1.8 infants less than 90 days old per 1000 live births, or approximately 9600 infants annually in the United States3. Group B streptococcal infections also cause substantial pregnancy-related morbidity in at least 50,000 American women each year4-6. The development of polysaccharide-protein conjugate vaccines for the prevention of neonatal group B streptococcal disease is currently a major focus of research4,7-11. However, group B streptococcal disease may also be an emerging public health problem among nonpregnant adults. Several case reports or small hospital-based series and a recent retrospective surveillance study have suggested that such infections cause substantial morbidity and mortality in nonpregnant adults,12-16 particularly those with serious underlying diseases. The objectives of this study were to obtain prospective population-based incidence data on the frequency of invasive group B streptococcal disease in nonpregnant adults and to define the risk factors and clinical characteristics of these infections.
Methods
Infections were diagnosed on the basis of the isolation of group B streptococci from normally sterile sites (e.g., blood, peritoneal fluid, and cerebrospinal fluid). Strains were identified as group B streptococci at local hospital laboratories with standard, commercially available diagnostic kits. All kits were based on the extraction of streptococcal-group antigens in soluble form and their identification with use of latex particles coated with group-specific antibodies. Patients with urinary tract infections and those with placental isolates were not included unless they had bacteremia. All the patients were living in the metropolitan Atlanta area at the time of infection. Surveillance was performed prospectively for 24 months (from January 1, 1989, to December 31, 1990) as part of an active bacteremia and meningitis surveillance project carried out in conjunction with the Georgia Department of Human Resources and the Centers for Disease Control and Prevention. The study area included all 35 hospitals and a major referral laboratory serving eight metropolitan Atlanta counties with a combined population of 2.3 million, including 1.65 million adults (those 18 years of age or older). Approximately 70 percent of the adults in the study area were white, 27 percent were black, and 3 percent were of other races or ethnic groups. During the study period, there were 131,534 pregnancies and 82,515 live births in the surveillance area (Vital Statistics, Georgia Department of Human Resources), and 6772 adults were estimated to be infected with the human immunodeficiency virus (HIV) (AIDS Registry, Georgia Department of Human Resources, Rimland D, and AIDS Research Consortium of Atlanta: unpublished data).
Initial case reports of invasive group B streptococcal disease were obtained from two independent sources: the hospital microbiology laboratories that provided isolates and hospital infection-control practitioners. Laboratory audits at all hospitals were performed every six months during the study period to evaluate reporting accuracy and to identify any cases that were not reported originally. The complete clinical and laboratory records of all men and nonpregnant women with invasive group B streptococcal disease were reviewed. Incidence calculations used population data obtained from the 1990 census. For estimations of relative risk, the age-specific prevalence of diabetes mellitus was obtained from the Georgia Department of Human Resources and the Diabetes Surveillance Report issued by the Centers for Disease Control and Prevention17. We calculated the prevalence of cancer in Atlanta by adjusting the incidence of cancer in metropolitan Atlanta in 1990 (figures provided by the American Cancer Society Tumor Registry) using a ratio of the national prevalence of cancer (reported by the National Cancer Institute)18 to the incidence of cancer in the United States in 1990 (figures provided by the American Cancer Society Tumor Registry). The prevalence was adjusted according to age groups with the use of a report of the Connecticut Tumor Registry19. Relative risk was calculated as previously described12.
Results
Invasive Group B Streptococcal Disease in the Metropolitan Atlanta Population
From January 1, 1989, through December 31, 1990, we identified 424 cases of invasive group B streptococcal disease in metropolitan Atlanta: 219 cases (52 percent) in children and 205 (48 percent) in adults. The annual incidence was 9.2 per 100,000 in the total population, 17 per 100,000 in children (including 2.6 cases in infants per 1000 live births), and 6.2 per 100,000 in adults. The annual incidence in nonpregnant adults was 4.4 per 100,000. Figure 1Figure 1
Distribution of Invasive Group B Streptococcal Disease, According to Age. shows the distribution of the infections according to age. The 140 nonpregnant adults who were infected were selected for further study.Invasive Group B Streptococcal Disease in Nonpregnant Adults
The nonpregnant adults with group B streptococcal disease ranged in age from 18 to 99 years, with a mean age of 62 years; 22 (16 percent) of the infections occurred in patients 18 to 39 years of age (annual incidence, 1.1 per 100,000), 38 (27 percent) in patients 40 to 59 years of age (4.2 per 100,000), and 80 (57 percent) in patients 60 years of age or older (18 per 100,000). Women accounted for 32 percent of the cases among patients younger than 60 years of age, and for more than half the cases among the elderly ( ≥ 60 years of age). However, the overall rate of invasive group B streptococcal disease was slightly lower in women than in men (3.3 per 100,000 per year vs. 4.9 per 100,000 per year). The in-hospital mortality rate among nonpregnant adults was 21 percent (30 of a total of 45 deaths in all age groups [67 percent]).
The rate of invasive group B streptococcal infection was twice as high in black adults (6.5 per 100,000) as in white adults (3.2 per 100,000); the incidence increased with age and was particularly high in older blacks (Figure 2Figure 2
Incidence of Invasive Group B Streptococcal Infection in Adults, According to Age and Race.), although there was a relatively small black population older than 70 years (20,700). Seventy-three percent of the cases of group B streptococcal disease occurred in nonpregnant adult residents of two inner-city counties that accounted for only 52 percent of the total population. Adults residing in Fulton County, which includes the urban center of Atlanta, had a relative risk of group B streptococcal disease of 2.9, as compared with adults in the other seven counties (95 percent confidence interval, 2.1 to 4.0; P<0.001). In that county the risk was increased in both whites (relative risk, 2.6; 95 percent confidence interval, 1.6 to 4.1; P<0.001) and blacks (relative risk, 1.9; 95 percent confidence interval, 1.1 to 3.3; P ≤ 0.04), as compared with whites and blacks in the other seven counties.Clinical Diagnoses
The clinical and laboratory records of 137 nonpregnant adults were available for review. Table 1Table 1
Clinical Diagnoses in 137 Men and Nonpregnant Women with Invasive Group B Streptococcal Infection. lists the clinical diagnoses. Skin, soft-tissue, and bone infections occurred in 50 (36 percent) of the patients and included cellulitis, foot ulcers, and decubitus ulcers. More than half the patients with such infections had diabetes mellitus (56 percent). Seven patients (all with diabetes mellitus) had osteomyelitis complicating a foot ulcer. Four patients with breast cancer had cellulitis of the arm or chest wall on the side on which a mastectomy had been performed 1 month to 10 years earlier. One of these patients had a breast implant infected with group B streptococcus removed. Four patients had scrotal cellulitis or abscess, two of whom were diabetics with penile implants (one implant was infected).Bacteremia with no identified source was the next most common diagnosis (41 patients). Other common clinical syndromes included urosepsis (19 patients), pneumonia (13 patients), and peritonitis (10 patients). Four of the 10 patients with peritonitis had gastrointestinal abnormalities (e.g., diverticulitis and appendicitis), 4 were undergoing long-term peritoneal dialysis, and 2 with cirrhosis and ascites had spontaneous bacterial peritonitis. Seventeen percent of the cases of invasive group B streptococcal disease (24 of 140) appeared to have been acquired nosocomially (i.e., the first positive culture was obtained more than 48 hours after admission).
Group B streptococcus was cultured from the blood in 132 of the 140 nonpregnant adults (94 percent). Additional sites from which group B streptococcus was cultured include urine (18 patients), soft tissue or bone (12 patients), peritoneal fluid (7 patients), pleural fluid or sputum (4 patients), cerebrospinal fluid (4 patients), and synovial fluid (2 patients). In 42 patients, group B streptococcus was one of the agents in a polymicrobial bacteremia (Table 2Table 2
Additional Organisms Isolated from the Blood of 42 Patients with Invasive Group B Streptococcal Disease and Polymicrobial Bacteremia.). Staphylococci were the most common additional isolates from blood (29 cases) and were often the only other organism cultured (24 of 29 cases). The clinical diagnoses in patients with polymicrobial bacteremia were similar to those in patients with group B streptococcus as the only blood isolate.Underlying Diseases or Conditions
Of the 137 patients for whom clinical records were available, all but 2 had one or more serious underlying diseases or conditions (Table 3Table 3
Underlying Diseases or Conditions in 137 Nonpregnant Adults with Invasive Group B Streptococcal Infection.), most commonly diabetes mellitus. Among the 43 diabetic patients, 19 required insulin and 16 did not require insulin; no information on insulin requirements was available for 8 patients. Neurologic disease resulting in alterations of mental status, paraplegia or quadriplegia, or other major deficits was present in 41 patients (30 percent). Acute or chronic renal failure (18 percent), liver disease (15 percent) (cirrhosis, hepatitis, and hepatic failure), and atherosclerotic vascular disease (cerebrovascular, coronary artery, and peripheral) were also common; 23 patients had malignant neoplasms (15 solid tumors and 8 hematologic cancers), including 5 patients with multiple myeloma. Eighteen patients (13 percent) had a history of urinary tract infections. Invasive group B streptococcal infection occurred in five HIV-infected patients and three additional patients with a history of intravenous drug use whose HIV status was unknown.Risk of Invasive Group B Streptococcal Disease in Nonpregnant Adults
The well-defined study population allowed us to determine the relative risk of invasive group B streptococcal disease in specific groups. The age-specific incidence and relative risk of disease in adults with diabetes mellitus, cancer, and HIV infection are shown in Table 4Table 4
Age-Stratified Risk of Invasive Group B Streptococcal Infection in Nonpregnant Adults with Selected Underlying Diseases.. Persons infected with HIV and young adults with diabetes mellitus or cancer were at significantly increased risk of invasive group B streptococcal infections (28 to 30 times the risk in patients without such underlying conditions). The relative risk of infection in diabetics decreased with advancing age but remained significantly elevated in all age groups. The relative risk of group B streptococcal infection in patients with cancer also decreased with advancing age. However, in contrast to diabetics, elderly patients with cancer were at no greater risk than elderly patients without cancer.Discussion
We found group B streptococcal infection to be a significant and apparently increasing cause of invasive disease in nonpregnant adults. In our prospective, population-based study, infection in nonpregnant adults accounted for 66 percent of the total cases in adults. The annual incidence in adults of 4.4 per 100,000 is almost twice as high as that reported retrospectively in the same population six years earlier12. Importantly, 67 percent of all deaths related to group B streptococcal infection that occurred during the study occurred in men and nonpregnant women. Invasive group B streptococcal infections were seen with greater frequency in nonpregnant adults in our surveillance area than were cases of invasive disease due to Neisseria meningitidis, Listeria monocytogenes, or Haemophilus influenzae combined. The incidence approaches that of bacteremia due to Streptococcus pneumoniae in adults20.
In our large series, invasive group B streptococcal infections occurred almost exclusively in adults with serious underlying medical conditions. Although many of these conditions have previously been identified as risk factors,21-23 population-based data allow estimates of the risks for specific groups of adults. The risk was increased in older patients, patients with diabetes mellitus, and those with cancer. In addition, infection with HIV was associated with an age-specific risk of group B streptococcal infection that was 30 times the rate in the population without HIV infection. These data indicate that high-risk groups of nonpregnant adults as well as neonates and pregnant women should be a focus for improved prevention, diagnosis, and therapy of group B streptococcal disease.
The rate of invasive group B streptococcal infection was twice as high in black adults as in whites, and was particularly high in older blacks. Black race has been identified as an independent risk factor for both early-onset and late-onset group B streptococcal disease in neonates2. However, these associations may be due to socioeconomic factors. Most of the increase we observed in the black adults was associated with residence in Fulton County, the urban center of Atlanta. The evidence of a role for socioeconomic status is supported by the finding that whites living in the same area also had a significantly increased risk, as compared with whites living in the other counties studied. The increased prevalence of diabetes and other chronic conditions in blacks may also contribute to the increased rates of group B streptococcal disease.
Variable descriptions of the clinical spectrum and source of invasive group B streptococcal infection have resulted from hospital-based series that included only one or a few centers. These variations are most probably due to differences in patient populations. For example, the genitourinary tract was noted as a major source of group B streptococcal bacteremia by Bayer et al.,22 but not by Gallagher and Watanakunakorn13. Other series have emphasized pneumonia, endocarditis, polymicrobial bacteremia, nosocomial infection, and decubitus ulcers as primary clinical presentations in patients with invasive group B streptococcal disease13-15,21-23.
Population-based data provide a better perspective on the clinical spectrum of invasive group B streptococcal infection. In our study, skin and soft-tissue infections, including osteomyelitis, were the most common clinical presentation (36 percent). These infections were often complications of chronic diabetic or decubitus ulcers. Group B streptococcal bacteremia without any identified focus (30 percent) was the second most common presentation. One quarter of such patients with bacteremia had cirrhosis or hepatic failure, and 20 percent had renal failure. Many of the patients with group B streptococcal bacteremia of uncertain source also had indwelling intravenous catheters. In addition, polymicrobial bacteremia with group B streptococcus -- often in combination with Staphylococcus aureus -- was present in 41 percent, suggesting that catheter-related infection may be the focus in some cases.
Obstructive uropathy, recurrent urinary tract infections, and diabetes mellitus were the most common underlying illnesses in patients with group B streptococcal urosepsis. Peritonitis occurred as spontaneous bacterial peritonitis in patients with liver disease, as a complication of a ruptured abdominal viscus in some patients, or in patients undergoing long-term peritoneal dialysis. The majority of patients with pneumonia had documented aspiration or debilitating neurologic conditions that increase the likelihood of aspiration. The rate of nosocomial infections with group B streptococcus in our study (17 percent) was somewhat lower than the rates of 21 to 70 percent reported previously14,15,23.
Group B streptococci have been classified serologically into five major serotypes (Ia, Ia/c, Ib, II, and III) on the basis of differences in capsular polysaccharide. Work is under way to develop group B streptococcal vaccines4,7-11 directed against specific capsular polysaccharides associated with neonatal infection, particularly serotype III6,24. The group B streptococcal isolates in our study were not serotyped, and the limited data on the serotypes of isolates from adults are difficult to interpret. For example, of 25 group B streptococcal isolates from nonpregnant adults collected before and after the study from a major teaching hospital in our surveillance area, approximately 90 percent were Ia, Ia/c, or nontypable strains (Blumberg HM: personal communication). However, in a small sample from a multistate study,24 each of the serotypes was equally represented in adults with invasive disease, and in recent group B streptococcal isolates from other hospitals in our area, multiple serotypes were associated with disease in adults.
A major determinant of the susceptibility of infants to group B streptococcal disease is the level of capsular-type-specific antibodies in maternal serum7,25. Women who have group B streptococcal bacteremia post partum also have low levels of capsular-type-specific antibodies to the infecting strain25. However, the role of capsular-type-specific antibody levels in nonpregnant adults with invasive group B streptococcal disease remains unclear and must be evaluated before vaccines can be targeted to this population.
These population-based data indicate that invasive group B streptococcal infection is a major problem, not only in pregnant women and neonates but also in nonpregnant adults who are elderly or who have chronic diseases. Until now, the development of group B streptococcal vaccines has focused on perinatal disease. A clearer definition of the molecular epidemiology and host susceptibility in all risk groups is critical to future decisions about the development and use of these vaccines.
We are indebted to the infection-control practitioners, clinical microbiologists, and hospitals in Georgia Health District III for their help in identifying cases; to Dr. Henry M. Blumberg for helpful discussions and unpublished data; to Dr. David Rimland for data on HIV-infected patients; to Kathy Boring for helpful discussions and information on cancer prevalence; and to Dr. Anne LeMoine and Ms. Lane Pucko for assistance in the preparation of the manuscript.
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.
- References
References
1
Baker CJ, Edwards MS. Group B streptococcal infections. In: Remington JL, Klein JO, eds. Infectious diseases of the fetus and newborn infant. 3rd ed. Philadelphia: W.B. Saunders, 1990:742-811.
2
Schuchat A ,Oxtoby M ,Cochi S , et al. Population-based risk factors for neonatal group B streptococcal disease: results of a cohort study in metropolitan Atlanta. J Infect Dis 1990;162:672-677
CrossRef | Web of Science | Medline3
Zangwill KM ,Schuchat A ,Wenger JD . Group B streptococcal disease in the United States, 1990: report for a multistate active surveillance system. MMWR Morb Mortal Wkly Rep 1992;41:(SS-6):25-324
Baker CJ ,Rench MA ,Kasper DL . Response to type III polysaccharide in women whose infants have had invasive group B streptococcal infection. N Engl J Med 1990;322:1857-1860
Full Text | Web of Science | Medline5
Dillon HC Jr ,Khare S ,Gray BM . Group B streptococcal carriage and disease: a 6-year prospective study. J Pediatr 1987;110:31-36
CrossRef | Web of Science | Medline6
Institute of Medicine. New vaccine development: establishing priorities. Vol. 1. Diseases of importance in the United States. Washington, D.C.: National Academy Press, 1985:423-39.
7
Baker CJ ,Kasper DL . Group B streptococcal vaccines. Rev Infect Dis 1985;7:458-467
CrossRef | Medline8
Baker CJ ,Rench MA ,Edwards MS ,Carpenter RJ ,Hays BM ,Kasper DL . Immunization of pregnant women with a polysaccharide vaccine of group B streptococcus. N Engl J Med 1988;319:1180-1185
Full Text | Web of Science | Medline9
Lagergard T ,Shiloach J ,Robbins JB ,Schneerson R . Synthesis and immunological properties of conjugates composed of group B streptococcus type III capsular polysaccharide covalently bound to tetanus toxoid. Infect Immun 1990;58:687-694
Web of Science | Medline10
Paoletti LC ,Kasper DL ,Michon F , et al. An oligosaccharide-tetanus toxoid conjugate vaccine against type III group B Streptococcus. J Biol Chem 1990;265:18278-18283
Web of Science | Medline11
Wessels MR ,Paoletti LC ,Kasper DL , et al. Immunogenicity in animals of a polysaccharide-protein conjugate vaccine against type III Group B Streptococcus. J Clin Invest 1990;86:1428-1433
CrossRef | Web of Science | Medline12
Schwartz B ,Schuchat A ,Oxtoby MJ ,Cochi SL ,Hightower A ,Broome CV . Invasive group B streptococcal disease in adults: a population-based study in metropolitan Atlanta. JAMA 1991;266:1112-1114
CrossRef | Web of Science | Medline13
Gallagher PG ,Watanakunakorn C . Group B streptococcal bacteremia in a community teaching hospital. Am J Med 1985;78:795-800
CrossRef | Web of Science | Medline14
Verghese A ,Mireault K ,Arbeit RD . Group B streptococcal bacteremia in men. Rev Infect Dis 1986;8:912-917
CrossRef | Medline15
Opal SM ,Cross A ,Palmer M ,Almazan R . Group B streptococcal sepsis in adults and infants: contrasts and comparisons. Arch Intern Med 1988;148:641-645
CrossRef | Web of Science | Medline16
Eykyn SJ ,Young SEJ ,Cookson BD . Increased community-acquired septicaemia infection with group B streptococci in adults. Lancet 1991;338:446-446
CrossRef | Web of Science | Medline17
Centers for Disease Control. Diabetes surveillance, 1991. Washington, D.C.: Department of Health and Human Services, 1992:60-3.
18
The prevalence of cancer: estimated number of persons diagnosed with cancer, United States, 1990. In: NCI fact book, 1990. Bethesda, Md.: National Cancer Institute, 1990:46.
19
Feldman AR ,Kessler L ,Myers MH ,Naughton MD . The prevalence of cancer: estimates based on the Connecticut Tumor Registry. N Engl J Med 1986;315:1394-1397
Full Text | Web of Science | Medline20
Mufson MA. Streptococcus pneumoniae. In: Mandell GL, Douglas RG Jr, Bennett JE, eds. Principles and practice of infectious diseases. 3rd ed. New York: Churchill Livingstone, 1990:1539-50.
21
Lerner PI . Meningitis caused by Streptococcus in adults. J Infect Dis 1975;131:Suppl:S9-S16
CrossRef | Web of Science | Medline22
Bayer AS ,Chow AW ,Anthony BF ,Guze LB . Serious infections in adults due to group B streptococci: clinical and serotypic characterization. Am J Med 1976;61:498-503
CrossRef | Web of Science | Medline23
Dworzack DL ,Hodges GR ,Barnes WG ,Rosett W . Group B streptococcal infections in adult males. Am J Med Sci 1979;277:67-73
CrossRef | Web of Science | Medline24
Wenger JD, Hightower AW, Facklam RR, Gaventa S, Broome CV, Bacterial Meningitis Study Group
CrossRef | Web of Science | Medline25
Baker CJ ,Edwards MS ,Kasper DL . Role of antibody to native type III polysaccharide of group B Streptococcus in infant infection. Pediatrics 1981;68:544-549
Web of Science | Medline
- Citing Articles (115)
Citing Articles
1
Bharath Sunkara, Suchitha Bheemreddy, Bibi Lorber, Paul R. Lephart, Kayoko Hayakawa, Jack D. Sobel, Keith S. Kaye, Dror Marchaim. (2012) Group B Streptococcus infections in non-pregnant adults: the role of immunosuppression. International Journal of Infectious Diseases
CrossRef2
Melisa Shah, Natali Aziz, Natalia Leva, Deborah Cohan. (2011) Group B Streptococcus Colonization by HIV Status in Pregnant Women: Prevalence and Risk Factors. Journal of Women's Health 20:11, 1737-1741
CrossRef3
K. Kimura, N. Nagano, Y. Nagano, J.-i. Wachino, S. Suzuki, K. Shibayama, Y. Arakawa. (2011) Predominance of sequence type 1 group with serotype VI among group B streptococci with reduced penicillin susceptibility identified in Japan. Journal of Antimicrobial Chemotherapy 66:11, 2460-2464
CrossRef4
Antonio Reguera, Miguel Ángel González, Adriana Sánchez, Carmen Aguayo. (2011) Meningitis por Streptococcus agalactie en un varón inmunocompetente. Enfermedades Infecciosas y Microbiología Clínica 29:9, 707-708
CrossRef5
P. Harris, D.-A. Siew, M. Proud, P. Buettner, R. Norton. (2011) Bacteraemia caused by beta-haemolytic streptococci in North Queensland: changing trends over a 14-year period. Clinical Microbiology and Infection 17:8, 1216-1222
CrossRef6
M. Deutscher, M. Lewis, E. R. Zell, T. H. Taylor, C. Van Beneden, S. Schrag, . (2011) Incidence and Severity of Invasive Streptococcus pneumoniae, Group A Streptococcus, and Group B Streptococcus Infections Among Pregnant and Postpartum Women. Clinical Infectious Diseases 53:2, 114-123
CrossRef7
Reimar Wernich Thomsen, Anders Hammerich Riis, Sia Kjeldsen, Henrik Carl Schønheyder. (2011) Impact of diabetes and poor glycaemic control on risk of bacteraemia with haemolytic streptococci groups A, B, and G. Journal of Infection 63:1, 8-16
CrossRef8
Romanee Chaiwarith, Waree Jullaket, Manasanant Bunchoo, Nontakan Nuntachit, Thira Sirisanthana, Khuanchai Supparatpinyo. (2011) Streptococcus agalactiae in adults at chiang mai university hospital: a retrospective study. BMC Infectious Diseases 11:1, 149
CrossRef9
Min Ju Song, Won Ho Kim, Sun Hwa Lee, Sang Rok Lee, Kyoung-Suk Rhee, Jei Keon Chae, Jae Ki Ko. (2011) Infective Endocarditis due to Streptococcus Agalactiae in Young and Immunocompetent Woman: A Case of Structurally Normal Valve Endocarditis Presented with Major Stroke. Journal of Cardiovascular Ultrasound 19:1, 38
CrossRef10
Morven S. Edwards, Victor Nizet. 2011. Group B Streptococcal Infections. , 419-469.
CrossRef11
P.J. Jenkins, N.D. Clement, P. Gaston, S. Breusch, H. Simpson, J. Dave. (2010) Invasive group B streptococcal disease in an orthopaedic unit. Journal of Hospital Infection 76:3, 231-233
CrossRef12
R. Ivanova Georgieva, M.V. García López, J. Ruiz-Morales, F.J. Martínez-Marcos, J.M. Lomas, A. Plata, M. Noureddine, C. Hidalgo-Tenorio, J.M. Reguera, J. De la Torre Lima, J. Gálvez Aceval, M. Márquez, A. de Alarcón. (2010) Streptococcus agalactiae left-sided infective endocarditis. Analysis of 27 cases from a multicentric cohort. Journal of Infection 61:1, 54-59
CrossRef13
Rinaldo Focaccia Siciliano, Daiane Patricia Cais, Roberto Carrasco Navarro, Tânia Mara Varejão Strabelli. (2010) Acute Streptococcus agalactiae endocarditis: Outcomes of early surgical treatment. Heart & Lung: The Journal of Acute and Critical Care 39:4, 331-334
CrossRef14
S.-Y. Moon, D. R. Chung, S.-W. Kim, H. H. Chang, H. Lee, D. S. Jung, Y.-S. Kim, S. I. Jung, S. Y. Ryu, S. T. Heo, C. Moon, H. K. Ki, J. S. Son, K. T. Kwon, S. Y. Shin, J. S. Lee, S. S. Lee, J.-Y. Rhee, J.-A. Lee, M. K. Joung, H. S. Cheong, K. R. Peck, J.-H. Song. (2010) Changing etiology of community-acquired bacterial meningitis in adults: a nationwide multicenter study in Korea. European Journal of Clinical Microbiology & Infectious Diseases 29:7, 793-800
CrossRef15
Rooyen Tinago Mavenyengwa, Sylvester Rogers Moyo, Svein Arne Nordbø. (2010) Streptococcus agalactiae colonization and correlation with HIV-1 and HBV seroprevalence in pregnant women from Zimbabwe. European Journal of Obstetrics & Gynecology and Reproductive Biology 150:1, 34-38
CrossRef16
Harald Seifert, Hilmar Wisplinghoff. 2010. Bloodstream Infection and Endocarditis. .
CrossRef17
M. D. Parkins, D. B. Gregson, J. D. D. Pitout, T. Ross, K. B. Laupland. (2010) Population-Based Study of the Epidemiology and the Risk Factors for Pseudomonas aeruginosa Bloodstream Infection. Infection 38:1, 25-32
CrossRef18
Yong Soo Seo, Usha Srinivasan, Kwan-Young Oh, Jung-Hwan Shin, Jeong Don Chae, Moon Young Kim, Jae Hyug Yang, Hye-Ryung Yoon, Brady Miller, Joan DeBusscher, Betsy Foxman, Moran Ki. (2010) Changing Molecular Epidemiology of Group B Streptococcus in Korea. Journal of Korean Medical Science 25:6, 817
CrossRef19
Nathalie van der Mee-Marquet, Anne-Sophie Domelier, Mazen Salloum, Jérémie Violette, Laurence Arnault, Nicolas Gaillard, Jean-Louis Bind, Marie-Frédérique Lartigue, Roland Quentin. (2009) Molecular Characterization of Temporally and Geographically Matched Streptococcus agalactiae Strains Isolated from Food Products and Bloodstream Infections. Foodborne Pathogens and Disease 6:10, 1177-1183
CrossRef20
J. Jiménez-Jaimez, J.A. Ramírez-Hernández, J.R. Castro-Arias, C. Hidalgo-Tenorio, J. Jiménez-Alonso. (2009) Morbimortalidad de la endocarditis aguda por Streptococcus agalactiae. Revista Clínica Española 209:11, 536-539
CrossRef21
Kousaku Matsubara, Go Yamamoto. (2009) Invasive group B streptococcal infections in a tertiary care hospital between 1998 and 2007 in Japan. International Journal of Infectious Diseases 13:6, 679-684
CrossRef22
M. Rivero Marcotegui, A. Hidalgo Ovejero, M. Cía Lecumberri, I. Otermin Maya, A. Pereda García. (2009) Osteomielitis vertebral por Streptococcus agalactiae en adultos sanos: descripción de 2 nuevos casos. Revista Clínica Española 209:9, 424-427
CrossRef23
Valérie Zeller, Marina Lavigne, David Biau, Philippe Leclerc, Jean Marc Ziza, Patrick Mamoudy, Nicole Desplaces. (2009) Outcome of group B streptococcal prosthetic hip infections compared to that of other bacterial infections. Joint Bone Spine 76:5, 491-496
CrossRef24
Peter H. DeNoble, David Gonzalez. (2009) Septic arthritis of the shoulder following elective termination of pregnancy. Journal of Shoulder and Elbow Surgery 18:5, e5-e6
CrossRef25
M.A. Villena Ruiz, J. Olalla Sierra, J. de la Torre Lima, J. García-Alegría. (2009) Neumonía cavitada causada por Streptococcus agalactiae. Revista Clínica Española 209:5, 252-254
CrossRef26
S. Rantala, J. Vuopio-Varkila, R. Vuento, H. Huhtala, J. Syrjänen. (2009) Clinical presentations and epidemiology of β-haemolytic streptococcal bacteraemia: a population-based study. Clinical Microbiology and Infection 15:3, 286-288
CrossRef27
Kevin B. Laupland, Deirdre L. Church, Jeanne Vidakovich, Melissa Mucenski, Johann D.D. Pitout. (2008) Community-onset extended-spectrum β-lactamase (ESBL) producing Escherichia coli: Importance of international travel. Journal of Infection 57:6, 441-448
CrossRef28
Bruno Hoen. (2008) Non-staphylococcal Gram-positive bacteraemia without a known source. International Journal of Antimicrobial Agents 32, S15-S17
CrossRef29
Paloma Merino, Benjamín Herreros, Israel Gestoso, Juan Picazo. (2008) Viajero con lesiones cutáneas diseminadas en la extremidad inferior. Enfermedades Infecciosas y Microbiología Clínica 26:7, 471-472
CrossRef30
James R. Hull, Glen S. Tamura, David G. Castner. (2008) Interactions of the streptococcal C5a peptidase with human fibronectin. Acta Biomaterialia 4:3, 504-513
CrossRef31
P. Sendi, L. Johansson, A. Norrby-Teglund. (2008) Invasive Group B Streptococcal Disease in Non-pregnant Adults. Infection 36:2, 100-111
CrossRef32
M. Cisse, M. Keïta, A. Toure, A. Camara, L. Machet, G. Lorette. (2007) Dermohypodermites bactériennes : étude monocentrique rétrospective de 244 cas observés en Guinée. Annales de Dermatologie et de Vénéréologie 134:10, 748-751
CrossRef33
Bernard C. Camins, Monica M. Farley, John J. Jernigan, Susan M. Ray, James P. Steinberg, Henry M. Blumberg. (2007) A Population‐Based Investigation of Invasive Vancomycin‐Resistant Enterococcus Infection in Metropolitan Atlanta, Georgia, and Predictors of Mortality • . Infection Control and Hospital Epidemiology 28:8, 983-991
CrossRef34
John L. Brusch. 2007. Microbiology of Infective Endocarditis and Clinical Correlates: Gram-Positive Organisms. , 13-50.
CrossRef35
Nick I. Batalis, Michael J. Caplan, Cynthia A. Schandl. (2007) Acute Deaths in Nonpregnant Adults Due to Invasive Streptococcal Infections. The American Journal of Forensic Medicine and Pathology 28:1, 63-68
CrossRef36
James R. Hull, Jared J. Shannon, Glen S. Tamura, David G. Castner. (2007) Atomic force microscopy and surface plasmon resonance investigation of fibronectin interactions with group B streptococci. Biointerphases 2:2, 64
CrossRef37
Hidetaka Ota, Yasuhiro Yamaguchi, Taro Kojima, Yumiko Ohike, Masato Eto, Masahiro Akishita, Yasuyoshi Ouchi. (2007) An elderly case with group B streptococcal bacteremia, subcutaneous abscess and reactive polyarthritis. Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics 44:6, 761-766
CrossRef38
Suzannah M. Bero, Mary S. Brady. (2006) Streptococcal Septic Shock after Inguinal Lymphadenectomy. Surgical Infections 7:6, 547-550
CrossRef39
G. Peralta, E. Padrón, M. P. Roiz, I. Benito, J. C. Garrido, F. Talledo, M. J. Rodríguez-Lera, L. Ansorena, M. B. Sánchez. (2006) Risk factors for bacteremia in patients with limb cellulitis. European Journal of Clinical Microbiology & Infectious Diseases 25:10, 619-626
CrossRef40
P. Del Giudice, N. van der Mee‐Marquet, F. David‐Rubin, F. Le Duff, K. Benchia, E. Counillon, A. S. Domelier, R. Quentin. (2006) Severe Relapsing Erysipelas Associated with Chronic Streptococcus agalactiae Vaginal Colonization. Clinical Infectious Diseases 43:7, e67-e70
CrossRef41
K. B. Laupland, T. Ross, D. L. Church, D. B. Gregson. (2006) Population-based surveillance of invasive pyogenic streptococcal infection in a large Canadian region. Clinical Microbiology and Infection 12:3, 224-230
CrossRef42
K. D. Sims, T. D. Barton. (2006) Group B streptococcal toxic shock syndrome in an asplenic patient: case report and literature review. European Journal of Clinical Microbiology & Infectious Diseases 25:3, 208-210
CrossRef43
I. Conscience, G. Perceau, P.-Y. Le Berruyer, P. Bernard. (2006) Dermohypodermite bactérienne mammaire bilatérale, secondaire à une septicémie à Streptococcus agalactiae. Annales de Dermatologie et de Vénéréologie 133:2, 171-173
CrossRef44
Morven S. Edwards, Victor Nizet, Carol J. Baker. 2006. Group B Streptococcal Infections. , 403-464.
CrossRef45
S. Casallo Blanco, A.I. Muñoz Ruiz, F. Marcos Sánchez, A. Aragón Díez, A.I. Franco Moreno. (2005) Poliartritis y osteomielitis vertebral debida a Streptococcus agalactiae. Revista Clínica Española 205:12, 630
CrossRef46
Guilherme Santoro-Lopes, Márcia Halpern, Renato Torres Gonçalves. (2005) Perinephric abscess caused by Streptococcus agalactiae after renal transplantation. Journal of Infection 51:3, e145-e147
CrossRef47
K. P. High, M. S. Edwards, C. J. Baker. (2005) Group B Streptococcal Infections in Elderly Adults. Clinical Infectious Diseases 41:6, 839-847
CrossRef48
Hagit Matz, Edith Orion, Ronni Wolf. (2005) Bacterial infections: uncommon presentations. Clinics in Dermatology 23:5, 503-508
CrossRef49
N.-Y. Lee, J.-J. Yan, J.-J. Wu, H.-C. Lee, K.-H. Liu, W.-C. Ko. (2005) Group B streptococcal soft tissue infections in non-pregnant adults. Clinical Microbiology and Infection 11:7, 577-579
CrossRef50
K. Ekelund, P. Skinhoj, J. Madsen, H. B. Konradsen. (2005) Invasive group A, B, C and G streptococcal infections in Denmark 1999-2002: epidemiological and clinical aspects. Clinical Microbiology and Infection 11:7, 569-576
CrossRef51
Kevin B. Laupland, John B. Kortbeek, Christi Findlay, S. Morad Hameed. (2005) A population-based assessment of major trauma in a large Canadian region. The American Journal of Surgery 189:5, 571-576
CrossRef52
Carey-Ann D. Burnham, Sandra E. Shokoples, Gregory J. Tyrrell. (2005) Phosphoglycerate kinase inhibits epithelial cell invasion by group B streptococci. Microbial Pathogenesis 38:5-6, 189-200
CrossRef53
KEVIN C. BRINKMANN, AJAY J. TALATI, RAUMINA E. AKBARI, ELIZABETH A. MEALS, B KEITH ENGLISH. (2005) Group B Streptococci Exposed to Rifampin or Clindamycin (versus Ampicillin or Cefotaxime) Stimulate Reduced Production of Inflammatory Mediators by Murine Macrophages. Pediatric Research 57:3, 419-423
CrossRef54
K. Fluegge, O. Schweier, E. Schiltz, S. Batsford, R. Berner. (2004) Identification and immunoreactivity of proteins released from Streptococcus agalactiae. European Journal of Clinical Microbiology & Infectious Diseases 23:11, 818-824
CrossRef55
E. Persson, S. Berg, B. Trollfors, P. Larsson, E. Ek, E. Backhaus, B. E. B. Claesson, L. Jonsson, G. Radberg, T. Ripa, S. Johansson. (2004) Serotypes and clinical manifestations of invasive group B streptococcal infections in western Sweden 1998-2001. Clinical Microbiology and Infection 10:9, 791-796
CrossRef56
Javier Narváez, Cesar Pérez-Vega, Francisco J Castro-Bohorquez, Jaime Vilaseca-Momplet. (2004) Group B streptococcal spondylodiscitis in adults: 2 case reports. Joint Bone Spine 71:4, 338-343
CrossRef57
Kevin B. Laupland, Daniel B. Gregson, David A. Zygun, Christopher J. Doig, Garth Mortis, Deirdre L. Church. (2004) Severe bloodstream infections: A population-based assessment*. Critical Care Medicine 32:4, 992-997
CrossRef58
Richard J. Everts, Stephen T. Chambers, David R. Murdoch, Alastair G. Rothwell, John McKie. (2004) Successful antimicrobial therapy and implant retention for streptococcal infection of prosthetic joints. ANZ Journal of Surgery 74:4, 210-214
CrossRef59
Rene A. Amaya, Carol J. Baker, Wendy A. Keitel, Morven S. Edwards. (2004) Healthy Elderly People Lack Neutrophil-Mediated Functional Activity to Type V Group B Streptococcus. Journal of the American Geriatrics Society 52:1, 46-50
CrossRef60
Carey-Ann D Burnham, Gregory J Tyrrell. (2003) Virulence factors of group B streptococci. Reviews in Medical Microbiology 14:4, 109-118
CrossRef61
Lawrence C Paoletti, Dennis L Kasper. (2003) Glycoconjugate vaccines to prevent group B streptococcal infections. Expert Opinion on Biological Therapy 3:6, 975-984
CrossRef62
Mats S. Dahl, Ingemar Tessin, Birger Trollfors. (2003) Invasive group B streptococcal infections in Sweden: incidence, predisposing factors and prognosis. International Journal of Infectious Diseases 7:2, 113-119
CrossRef63
Sanjeev Managoli, Pushpa Chaturvedi, Krishna Y. Vilhekar. (2003) Group B Streptococcal Meningitis in a 5-year-old boy. The Indian Journal of Pediatrics 70:6, 509-511
CrossRef64
Joan M. Nolla, Carmen Gómez-Vaquero, Xavier Corbella, Sergi Ordóñez, Carmen García-Gómez, Albert Pérez, Javier Cabo, Josep Valverde, Javier Ariza. (2003) Group B Streptococcus (Streptococcus agalactiae) Pyogenic Arthritis in Nonpregnant Adults. Medicine 82:2, 119-128
CrossRef65
Gary D. Overturf. (2003) Indications for the Immunological Evaluation of Patients with Meningitis. Clinical Infectious Diseases 36:2, 189-194
CrossRef66
Theresa O. Harris, Daniel W. Shelver, John F. Bohnsack, Craig E. Rubens. (2003) A novel streptococcal surface protease promotes virulence, resistance to opsonophagocytosis, and cleavage of human fibrinogen. Journal of Clinical Investigation 111:1, 61-70
CrossRef67
Antonio Crespo, Avi S. Retter, Bennett Lorber. (2003) Group B Streptococcal Endocarditis in Obstetric and Gynecologic Practice. Infectious Diseases in Obstetrics & Gynecology 11:2, 109-115
CrossRef68
Axel Schubert, Katherina Zakikhany, Mark Schreiner, Ronald Frank, Barbara Spellerberg, Bernhard J. Eikmanns, Dieter J. Reinscheid. (2002) A fibrinogen receptor from group B Streptococcus interacts with fibrinogen by repetitive units with novel ligand binding sites. Molecular Microbiology 46:2, 557-569
CrossRef69
E. Pacios, J. M. Garcia-Lechuz, A. Turrion, J. Lopez Longo. (2002) Clinical microbiological case: a firm, right infraclavicular mass in an adult woman with connective tissue disease. Clinical Microbiology and Infection 8:10, 684-685
CrossRef70
A. Sambola, J. M. Miro, M. P. Tornos, B. Almirante, A. Moreno‐Torrico, M. Gurgui, E. Martinez, A. Del Rio, M. Azqueta, F. Marco, J. M. Gatell, . (2002) Streptococcus agalactiae Infective Endocarditis: Analysis of 30 Cases and Review of the Literature, 1962–1998. Clinical Infectious Diseases 34:12, 1576-1584
CrossRef71
Michael T. Flannery, Lara Winters. (2002) Relapsing Group B Streptococcal Bacteremia in an Adult. The American Journal of the Medical Sciences 323:2, 112-114
CrossRef72
Chester Choi. (2001) Bacterial Meningitis in Aging Adults. Clinical Infectious Diseases 33:8, 1380-1385
CrossRef73
Susan J. Sickler, Morven S. Edwards. (2001) Group B Streptococcal Cellulitis In A Child With Steroid-Responsive Nephrotic Syndrome. The Pediatric Infectious Disease Journal 20:10, 1007-1009
CrossRef74
Monica M. Farley. (2001) Group B Streptococcal Disease in Nonpregnant Adults. Clinical Infectious Diseases 33:4, 556-561
CrossRef75
Cristina Ferreira Teixeira, Neide Lemos Azevedo, T
cia Maria Ulisses Carvalho, Jemima Fuentes, Prescilla Emy Nagao. (2001) Cytochemical study ofStreptococcus agalactiae and macrophage interaction. Microscopy Research and Technique 54:4, 254-259
CrossRef76
Tetsuro Matsumoto. (2001) Urinary tract infections in the elderly. Current Urology Reports 2:4, 330-333
CrossRef77
Mettassebia Kanno, Girish Pore, Donald P. Levine. (2001) Recurrent Group B Streptococcus Bacteremia Associated with Menstruation. Infectious Disease in Clinical Practice 10:2, 103-105
CrossRef78
J. J. Auletta, C. C. John. (2001) Spinal Epidural Abscesses in Children: A 15-Year Experience and Review of the Literature. Clinical Infectious Diseases 32:1, 9-16
CrossRef79
Manuela Puliti, Christina Von Hunolstein, Francesco Bistoni, Paolo Mosci, Graziella Orefici, Luciana Tissi. (2000) Influence of interferon-γ administration on the severity of experimental group B streptococcal arthritis. Arthritis & Rheumatism 43:12, 2678-2686
CrossRef80
P. J. Deziel, N. McGuire, P. D. Brown. (2000) Group B Streptococcal Meningitis Complicating Elective Abortion: Report of 2 Cases. Clinical Infectious Diseases 31:5, e23-e25
CrossRef81
W. M. Tang, P. L. Ho, W. P. Yau, J. W. K. Wong, D. K. H. Yip. (2000) Report of 2 Fatal Cases of Adult Necrotizing Fasciitis and Toxic Shock Syndrome Caused by Streptococcus agalactiae. Clinical Infectious Diseases 31:4, e15-e17
CrossRef82
J. Solı́s-Garcia del Pozo, E. Martinez-Alfaro, L. Abad, J. Solera. (2000) Vertebral Osteomyelitis Caused by Streptococcus agalactiae. Journal of Infection 41:1, 84-90
CrossRef83
Barbara Spellerberg, Simone Martin, Carmen Franken, Reinhard Berner, Rudolf Lütticken. (2000) Identification of a novel insertion sequence element in Streptococcus agalactiae. Gene 241:1, 51-56
CrossRef84
Pamela S. McCloskey, Richard J. Salo. (2000) Flow cytometric analysis of group B streptococci phagocytosis and oxidative burst in human neutrophils and monocytes. FEMS Immunology & Medical Microbiology 27:1, 59-65
CrossRef85
Jiro ARATA. (2000) Nishi Nihon Hifuka 62:3, 357-360
CrossRef86
S. Berg, B. Trollfors, T. Lagergard, G. Zackrisson, B. A. Claesson. (2000) Serotypes and clinical manifestations of group B streptococcal infections in western Sweden. Clinical Microbiology and Infection 6:1, 9-13
CrossRef87
Joshi, Nirmal, Caputo, Gregory M., Weitekamp, Michael R., Karchmer, A.W., . (1999) Infections in Patients with Diabetes Mellitus. New England Journal of Medicine 341:25, 1906-1912
Full Text88
Bezalel Perl, Nathan P. Gottehrer, David Raveh, Yechiel Schlesinger, Bernard Rudensky, Amos M. Yinnon. (1999) Cost‐Effectiveness of Blood Cultures for Adult Patients with Cellulitis. Clinical Infectious Diseases 29:6, 1483-1488
CrossRef89
David H. Spach, Lisa A. Jackson. (1999) BACTERIAL MENINGITIS. Neurologic Clinics 17:4, 711-735
CrossRef90
P. Blanco, J.F. Viallard, E. Ellie, R. Denisi, M. Stoll, J.L. Pellegrin, B. Leng. (1999) Méningite à streptocoque du groupe B révélatrice d'une malformation congénitale de l'oreille interne. À propos d'un cas chez un adulte. La Revue de Médecine Interne 20:8, 701-704
CrossRef91
Juan M. Garcia-Lechuz, Pablo Bachiller, Francisco J. Vasallo, Patricia Munoz, Belen Padilla, Emilio Bouza. (1999) Group B Streptococcal Osteomyelitis in Adults. Medicine 78:3, 191-199
CrossRef92
H R Yusuf, R W Rochat, W S Baughman, P M Gargiullo, B A Perkins, M D Brantley, D S Stephens. (1999) Maternal cigarette smoking and invasive meningococcal disease: a cohort study among young children in metropolitan Atlanta, 1989-1996.. American Journal of Public Health 89:5, 712-717
CrossRef93
KREESTEN MELDGAARD MADSEN, HENRIK CARL SCHØNHEYDER, BRIAN KRISTENSEN, HENRIK TOFT SØRENSEN. (1999) Secular trends in incidence and mortality of bacteraemia in a Danish county 1981-1994. APMIS 107:1-6, 346-352
CrossRef94
Charlotte Larsson, Margaretha Stålhammar-Carlemalm, Gunnar Lindahl. (1999) Protection against experimental infection with group B streptococcus by immunization with a bivalent protein vaccine. Vaccine 17:5, 454-458
CrossRef95
Anne Schuchat. (1999) Group B streptococcus. The Lancet 353:9146, 51-56
CrossRef96
Colin R Mackenzie, Christian B Willberg, Walter Däubener. (1998) Inhibition of group B streptococcal growth by IFNγ-activated human glioblastoma cells. Journal of Neuroimmunology 89:1-2, 191-197
CrossRef97
Satu Koskiniemi, Mats Sellin, Mari Norgren. (1998) Identification of two genes, cpsX and cpsY , with putative regulatory function on capsule expression in group B streptococci. FEMS Immunology & Medical Microbiology 21:2, 159-168
CrossRef98
A.C. Bateman, M. Richards, A.P. Pallett. (1998) Fatal myocarditis associated with a Lancefield group B streptococcus. Journal of Infection 36:3, 354-355
CrossRef99
Ami Schattner, Kenneth L. Vosti. (1998) Bacterial Arthritis due to Beta-Hemolytic Streptococci of Serogroups A, B, C, F, and G. Medicine 77:2, 122-139
CrossRef100
L.Mary Smith, Valerie Laganas, Thomas G Pistole. (1998) Attachment of group B streptococci to macrophages is mediated by a 21-kDa protein. FEMS Immunology & Medical Microbiology 20:2, 89-97
CrossRef101
D. S. STEPHENS, E. R. MOXON, J. ADAMS, S. ALTIZER, J. ANTONOVICS, S. ARAL, R. BERKELMAN, E. BOND, J. BULL, G. CAUTHEN, M. M. FARLEY, A. GLASGOW, J. W. GLASSER, H. P. KATNER, S. KELLEY, J. MITTLER, A. J. NAHMIAS, S. NICHOL, V. PERROT, R. W. PINNER, S. SCHRAG, P. SMALL, P. H. THRALL. (1998) Emerging and Reemerging Infectious Diseases: A Multidisciplinary Perspective. The American Journal of the Medical Sciences 315:2, 64-75
CrossRef102
T. M. Bauer, H. Pippert, W. Zimmerli. (1997) Vertebral osteomyelitis caused by group B streptococci (Streptococcus agalactiae) secondary to urinary tract infection. European Journal of Clinical Microbiology & Infectious Diseases 16:3, 244-246
CrossRef103
(1997) Invasive Group A Streptococcal Infections. New England Journal of Medicine 336:7, 513-515
Full Text104
Burke A. Cunha, M. Vanessa Gill, Jason M. Lazar. (1996) ACUTE INFECTIVE ENDOCARDITIS. Infectious Disease Clinics of North America 10:4, 811-834
CrossRef105
Beatriz Rosón, Jordi Carratalà, Carmen Peña, Francisco Gudiol. (1996) Endogenous endophthalmitis due to Streptococcus agalactiae : case report and revie. Clinical Microbiology and Infection 2:2, 147-149
CrossRef106
S. Ellis, M. Kotiw, S.M. Garland. (1996) Restriction endonuclease analysis of group B streptococcal isolates from two distinct geographical regions. Journal of Hospital Infection 33:4, 279-287
CrossRef107
Sasithorn Likitnukul, Sasinee Pokato, Pongpun Nunthapisud. (1996) GROUP B STREPTOCOCCAL SEPSIS AND MENINGITIS COMPLICATED WITH SEVERE SENSORINEURAL HEARING LOSS IN A FOURTEEN-YEAR-OLD BOY. The Pediatric Infectious Disease Journal 15:5, 468-469
CrossRef108
J. Clive Graham, Peter J. Moss, Michael W. McKendrick. (1996) Group B streptococcal meningitis associated with cerebrospinal fluid rhinorrhoea. Journal of Infection 32:1, 69-70
CrossRef109
T.J. MacConnell, A. Ferro. (1995) A sore eye and meningitis. The Lancet 346:8985, 1269
CrossRef110
JOHN M. COLFORD, JANET MOHLE-BOETANI, KENNETH L. VOSTI. (1995) Group B Streptococcal Bacteremia in Adults. Medicine 74:4, 176-190
CrossRef111
JOHN B. ROBBINS, RACHEL SCHNEERSON, WILLIE F. VANN, DOLORES A. BRYLA, ALI FATTOM. (1995) Prevention of Systemic Infections Caused by Group B Streptococcus and Staphylococcus aureus by Multivalent Polysaccharide-Protein Conjugate Vaccines. Annals of the New York Academy of Sciences 754:1 Combined Vacc, 68-81
CrossRef112
Glen S. Tamura, Craig E. Rubens. (1995) Group B streptococci adhere to a variant of fibronectin attached to a solid phase. Molecular Microbiology 15:3, 581-589
CrossRef113
(1993) Group B Streptococcal Disease in Adults. New England Journal of Medicine 329:22, 1658-1659
Full Text114
Wessels, Michael R., , Kasper, Dennis L., . (1993) The Changing Spectrum of Group B Streptococcal Disease. New England Journal of Medicine 328:25, 1843-1844
Full Text115
(1993) Mitteilung. LaboratoriumsMedizin 17:10, 473-488
CrossRef
- Letters
