Aurea E. Flores

Invasive Disease Due to Group B Streptococcus in Pregnant Women and Neonates from Diverse Population Groups

From 1993 through 1996, surveillance for invasive disease due to group B Streptococcus (GBS) in neonates aged <7 days and in peripartum pregnant women was performed in a racially and ethnically diverse cohort in 4 cities in the United States. In a birth population of 157,184, 130 neonatal cases (0.8 per 1000) and 54 maternal cases (0.3 per 1000) were identified. Significant correlates with neonatal disease were black or Hispanic race and a birth weight <2500 g. The attack rate for peripartum maternal infection varied widely by city and may have been influenced by the frequency of administration of intrapartum antibiotics or of evaluating febrile women by performance of blood cultures. Pregnancy loss or GBS disease in the infant occurred in 28% of these maternal cases. Among neonatal and maternal GBS isolates, serotypes Ia (34%-37%) and III (25%-26%) predominated, and type V was frequent (14%-23%). These results provide a description of invasive GBS perinatal infection during the period in which guidelines for prevention were actively disseminated.

Clonal Analysis of Colonizing Group B Streptococcus, Serotype IV, an Emerging Pathogen in the United States

ABSTRACT Colonizing group B Streptococcus (GBS) capsular polysaccharide (CPS) type IV isolates were recovered from vaginal and rectal samples obtained from 97 (8.4%) nonpregnant women of 1,160 women enrolled in a U.S. multicenter GBS vaccine study from 2004 to 2008. Since this rate was much higher than the rate of prevalence of 0.4 to 0.6% that we found in previous studies, the isolates were analyzed by using surface protein profile identification, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) to characterize them and identify trends in DNA clonality and divergence. Of the 101 type IV isolates studied, 53 expressed α and group B protective surface (BPS) proteins, 27 expressed BPS only, 20 expressed α only, and 1 had no detectable surface proteins. The isolates spanned three PFGE macrorestriction profile groups, groups 37, 38, and 39, of which group 37 was predominant. The isolates in group 37 expressed the α and BPS proteins, while those in groups 38 and 39 expressed the α protein only, with two exceptions. MLST studies of selective isolates from the four protein profile groups showed that isolates expressing α,BPS or BPS only were of a new sequence type, sequence type 452, while those expressing α only or no proteins were mainly of a new sequence type, sequence type 459. Overall, our study revealed a limited diversity in surface proteins, MLST types, and DNA macrorestriction profiles for type IV GBS. There appeared to be an association between the MLST types and protein expression profiles. The increased prevalence of type IV GBS colonization suggested the possibility that this serotype may emerge as a GBS pathogen.

Serotype IV and Invasive Group B Streptococcus Disease in Neonates, Minnesota, USA, 2000–2010

Serotype predominance has shifted, and drug resistance is emerging.

Molecular Characterization of Nontypeable Group B Streptococcus

ABSTRACT Traditionally, the capsular polysaccharide (CPS) antigen has been used to distinguish between the nine known serotypes of group B streptococcus (GBS) by classical antibody-antigen reactions. In this study, we used PCR for all CPSs and selected protein antigens, multilocus sequencing typing (MLST), and pulsed-field gel electrophoresis (PFGE) to molecularly characterize 92 clinical isolates identified as nontypeable (NT) by CPS-specific antibody-antigen reactivity. The PCR and MLST were performed on blinded, randomly numbered isolates. All isolates contained the cfb gene coding for CAMP factor. While most (56.5%) contained a single CPS-specific gene, 40 isolates contained either two or three CPS-specific genes. Type V CPS-specific gene was present in 66% of the isolates, and all serotypes except types IV, VII, and VIII were represented. Most (44.5%) of the isolates contained a single protein antigen gene (bca, bac, rib, alp1, or alp3), and the remaining isolates had multiple protein antigen genes. Of the 61 isolates that had the V CPS-specific gene, 48 (78.6%) had the alp3 gene. PFGE analysis classified the isolates into 21 profile groups, while MLST analysis divided the isolates into 16 sequence types. Forty-two (69%) of 61 isolates with the V CPS-specific gene were in PFGE profile group 4; 41 of these 42 were sequence type 1 by MLST. These data shed new light on the antigenic complexity of NT GBS isolates, information that can be valuable in the formulation of an effective GBS vaccine.

Surface protein expression in group B streptococcal invasive isolates.

Results from characterization of 211 GBS isolates from early-onset disease indicated that serotypes Ia, III and V accounted for almost 80% of the isolates, and that alpha was the protein most often expressed. Each of the common polysaccharide types had a characteristic predominant protein expression pattern: alpha for Ia, R4 for type III and R1+R4 for type V isolates. Expression of alpha protein was always mutually exclusive of R proteins. The presence of more than one species of R by a given isolate was confirmed by IEP. In addition, PAGE/WB studies verified the multiple MW forms of R1, and the variation from strain to strain in the highest form of R4 that we had previously reported. Our data not only showed the great complexity of the GBS cell surface but also demonstrated the advantage of using both type polysaccharides and surface-localized proteins as markers for characterization of GBS strains.

Molecular Diversity Among the Trypsin Resistant Surface Proteins of Group B Streptococc

The alpha (alpha) component of the c protein and R proteins are trypsin resistant, but antigenically distinct, proteins on the cell surface of some but not all strains of group B streptococci (GBS). These two classes of proteins, along with the group and type polysaccharide, can be used to characterize strains of GBS. Four species of R protein (R1 through R4) have been described. We studied trypsin extracts from numerous strains of GBS by immunodiffusion in agarose and polyacrylamide gel electrophoresis/Western blot. Sera monospecific for alpha, R1 and R4 were used to immunoprecipitate/blot the proteins. The molecular weight of the blotted proteins was determined. Although by immunodiffusion the proteins within a class were identical to each other, great heterogeneity in size and blotting pattern was found within each class. Variation was independent of the polysaccharide serotype. Multiple molecular weight species were seen for alpha, R1 and R4 proteins. For a given strain, the various forms of alpha or R1 appeared to form a multiple size ladder; those of R4 were fewer and closer in size. The highest form of alpha ranged from 85 to 170 kDa, with 45 kDa being the highest form for some rare GBS strains. For R4 the predominant and highest form varied from 84 to 197 kDa, whereas some strains with R1 had the highest form over 200 kDa. Our results indicated that despite similarities, there is great diversity among the alpha, R1 and R4 trypsin resistant proteins of GBS.

Molecular Analysis of Group B Protective Surface Protein, a New Cell Surface Protective Antigen of Group B Streptococci

ABSTRACT Group B streptococci (GBS) express various surface antigens designated c, R, and X antigens. A new R-like surface protein from Streptococcus agalactiae strain Compton R has been identified by using a polyclonal antiserum raised against the R protein fraction of this strain to screen a lambda Zap library. DNA sequence analysis of positive clones allowed the prediction of the primary structure of a 105-kDa protein designated BPS protein (group B protective surface protein) that exhibited typical features of streptococcal surface proteins such as a signal sequence and a membrane anchor region but did not show significant similarity with other known sequences. Immunogold electron microscopy using a BPS-specific antiserum confirmed the surface location of BPS protein on S. agalactiae strain Compton R. Anti-BPS antibodies did not cross-react with R1 and R4 proteins expressed by two variant type III GBS strains but reacted with the parental streptococcal strain in Western blot and immunoprecipitation analyses. Separate R3 and BPS immunoprecipitation bands were observed when a cell extract of strain Compton R was tested with an antiserum against Compton R previously cross-absorbed to remove R4 antibodies. Immunization of mice with recombinant BPS protein by the subcutaneous route produced an efficient antigen-specific response, and immunized animals survived challenge with a lethal dose of a virulent strain. Therefore, BPS protein represents a new R-like protective antigen of GBS.

DNA Macrorestriction Analysis of Nontypeable Group B Streptococcal Isolates: Clonal Evolution of Nontypeable and Type V Isolates

ABSTRACT Group B streptococci (GBS) are serotyped according to capsular polysaccharide (CPS) type (Ia to VIII); an isolate is classified as nontypeable (NT) if no detectable CPS is found. Surface-localized protein antigens (α, β, R1, and R4) serve as additional markers to classify GBS isolates, which is particularly useful since NT isolates often express one or more of these proteins. To compare genetic resemblance among isolates with similar protein profiles, we studied 58 NT isolates digested with the SmaI macrorestriction enzyme prior to pulsed-field gel electrophoresis (PFGE). Of these 58, 15.5% expressed α only, 20.7% expressed α+β, 15.5% expressed R4, and 25.8% expressed R1,R4, while 22.4% of the isolates expressed no detectable proteins. The largest PFGE profile group, with 48% of the isolates, was group 4, composed primarily of isolates that expressed R1,R4 or no proteins. The second most common profiles were 3 and 32, each with 13.8% of the isolates. Since NT isolates in profile group 4 were highly related to type V isolates, as demonstrated by PFGE profiles, we investigated 45 type V isolates. Two-thirds of the type V isolates within profile group 4 were classified into subgroup 4a, compared to 28.2% of 39 NT isolates. Only 11% of the V/R1,R4 isolates were identical to the prototype group 4 profile, in contrast to 75% of the NT/R1,R4 isolates. A shift of type V isolates into profile 4 subgroups may be indicative of a genetic change over time. PFGE is a valuable approach for comparison of GBS isolate relatedness and for monitoring of NT and typeable GBS isolates for potential clonal divergence.

Improved methods for typing nontypeable isolates of group B streptococci.

Group B streptococci (GBS) are classified by capsular polysaccharide (CPS) type and by cell surface-expressed proteins (c and R). Isolates lacking detectable CPS are considered nontypeable (NT) although they frequently express surface proteins. Immunological and genetic methods were used to study 91 NT GBS isolates collected during surveillance studies for invasive disease or colonization in pregnant or non-pregnant women and neonates less than seven days of age. CPS production was upregulated by the addition of glucose and sodium phosphate to Todd-Hewitt broth (THB) and cells were extracted using hot HCl or mutanolysin. Extracts were tested with antisera for specific CPS types Ia, Ib, and II - VIII by double immunodiffusion (DD) in agarose. By mutanolysin extraction, 12 (13.2%) of the 91 isolates were typeable. In contrast, only four of these 12 newly typeable isolates tested positive for CPS with the HCl extracts of cells grown in modified THB. DNA was analyzed by pulsed-field gel electrophoresis (PFGE) using SmaI restriction with NT isolates grouped by protein profile to facilitate analysis. PFGE results of the NT isolates were compared to DNA profiles of typeable isolates and were correlated with the DD results. The DNA profiles of the newly typeable isolates were similar to profiles of isolates with corresponding defined CPS type. Of the remaining 78 NT isolates digested by SmaI, 63 (80.8%) had DNA profiles that resembled those of specific types of GBS. These approaches will be useful for classification of NT isolates in continued epidemiological surveillance associated with GBS vaccine trials.

DNA restriction profiles of nontypable Group B streptococcal clinical isolates

Group B streptococci (GBS) have been antigenically characterized by the capsular polysaccharide or “type” polysaccharide, and these have been designated Ia, Ib, II, III, IV, V, VI, VII, and VIII. Other antigenic constituents of GBS are surface localized proteins. The major ones for human GBS isolates are the β protein, which is IgA binding, the α protein, which is trypsin-resistant, and the R family of trypsin-resistant proteins.2, 3, 4 The major species of R proteins that we have identified in GBS are the R1 and R4 proteins, as recently reported.3, 4 Of 1586 total GBS isolates examined in our laboratory from recent clinical epidemiologic studies from five American cities (Houston, Minneapolis/St. Paul, Pittsburgh and Seattle), 67 or 4.2% were nontypable for capsular polysaccharide, using antisera to the established nine serotypes plus an antiserum to a proposed new type, courtesy of J. Henrichsen. This report describes further molecular characterization of these nontypable GBS clinical isolates.