This article is more than 5 years old. Information may no longer be current.

Incidence of group B streptococcal high among infants exposed to HIV

Epalza C. Pediatrics. 2010;doi:10.1542/peds.2010-0183.

Infants who do not have HIV but are born to mothers with the disease may be at a higher risk for developing group B streptococcal infections, according to study data published online.

An abnormally high number of group B streptococcal infections among infants born to mothers with HIV at St. Pierre Hospital in Brussels, Belgium, prompted researchers to examine potential correlations between exposure to HIV in infancy and the development of group B streptococcal infection. They reviewed the hospital’s medical records and laboratory results for infants born between 2001 and 2008 with group B streptococcal infection.

For comparison of group B streptococcal infection among infants born to mothers with HIV and those born to mothers without the disease, the researchers only analyzed infants born at St. Pierre Hospital. They identified 16 infants who presented with group B streptococcal infection among the 20,158 mothers who did not have HIV and five born to 322 mothers with HIV during the study period.

Results indicated that 80% of mothers with HIV whose infants developed group B streptococcal infection were of sub-Saharan African origin. Infections appeared more severe in infants born to mothers with HIV, the researchers said, with two cases of group B streptococcal meningitis and one case of recurring infection occurring in this population.

Two infants had septic shock, four had sepsis, one had bacteremia and two infants had meningitis-associated infections. Patients generally responded well to IV antibiotics, although one patient died.

Late-onset disease and leukopenia were also significantly more common among infants with maternal exposure to HIV when compared with infants born to mothers without HIV.

Analysis indicated that incidence of group B streptococcal infection was 1.55% among infants born to mothers with HIV and 0.08% among those born to mothers without the disease. The researchers noted, however, that the high number of late-onset infections among infants with maternal exposure to HIV is most likely responsible for this difference (RR=125.2; 95% CI, 26.3-620.2).

“Our observation of increased susceptibility of HIV-exposed uninfected infants to [group B streptococcal] infection is an additional piece of evidence, the first from an industrialized country, that HIV-exposed uninfected infants might be more susceptible to infection than infants who are born to HIV-uninfected mothers,” the researchers wrote.

The researchers added that further research is needed. “Prospective investigations are needed to confirm this suceptibility and to demonstrate possible immune dysfunction,” they wrote. “Identification of surrogate markers of susceptibility might help to prevent early-life infectious morbidity in this population.”

PERSPECTIVE

Almost all of the infections in the group of infants born to mothers with HIV were late-onset (day of onset from 9 to 72 days of life) infections, with one infant having two episodes. The illnesses in the infants born to HIV-positive mothers tended to be of greater severity than the group B streptococcal infections in the control group, but this was not a statistically significant difference. The authors focus on the possibility that the HIV-uninfected babies of HIV-infected women may be immunologically impaired, but they do not fully analyze the likelihood that socioeconomic factors likely play a huge role in the susceptibility of these babies to group B streptococcal infection. Eighty-eight percent of the HIV-infected mothers of group B streptococcal-infected babies were of sub-Saharan African origin, recent immigrants to Belgium and living in very poor socioeconomic conditions. Comparable information on the total cohort of more than 20,000 HIV-uninfected women is not provided, but undoubtedly they are very different. Based on this information, I think it is premature to conclude that environmental/demographic factors do not contribute greatly to the observed differences in group B streptococcal in these two populations.

– Standford T. Schulman, MD
Infectious Diseases in Children Editorial Board

Follow the PediatricSuperSite.com on Twitter.