Streptococcus in pregnant women (Streptococcus group B)

Streptococci belong to the group widely distributed in the environment of pathogens, they can live on the skin, the mucous membranes, including in pregnant women.

But due to changes in the immune system, the unfavorable course of pregnancy, these pathogenic microbes can lead to certain problems like the mother and the fetus, and then newborn baby.

The greatest importance is attached to Streptococcus group B that can generate various kinds of infections ranging from skin and ending with system failures.

General data on streptococci and infection

Streptococci belong to the group of coccal flora (spherical germs). They actively inhabit the human body and live freely in the environment, and most of these germs to people is not dangerous. Some of the members belong to conditionally pathogenic or pathogenic, causing them in certain special circumstances can cause infections of varying severity – from food poisoning and purulent-septic processes, to the provocation of autoimmune and allergic pathologies in the body – rheumatic fever, glomerulonephritis. During pregnancy may cause intrauterine infection of the fetus and in the newborn period provoke meningitis or sepsis, especially in weak, premature babies.

Of greatest interest is Streptococcus group B, it is widely distributed among other coccal microbes, and can generate a number of infectious diseases. For adults, it’s usually no danger if they do not have problems with the immune system.

In the period of gestation may stimulate the pregnant women, some complications, as well as threatening the fetus and then the baby during birth. Carriage of group b Streptococcus In was observed in about one quarter of new moms. Individual representatives can lead to angina, urinary system or some other types of infections.

How is group b Streptococcus In

Bacteria can dwell in the oral cavity, the intestine, the mucous membranes of the urinary system and the genitals. Enter the body in various ways – in contacts with the media, the use of common items, utensils, foodsthat obsemenjajutsja Streptococcus, and with a current of air. Sexually streptococci are not transmitted, they usually fall on the mucous membranes of the genitals and urinary tract by ascending from the skin or hematogenous, from foci of infection.

Causes infections: characteristics of microbes

Streptococci extensive family of spherical microbes, not forming spores. They belong to gram-positive bacteria, genus Streptococcus, the family of Streptococcaceae. These microbes have flagella to move independently, able to survive in environments without oxygen. Under the microscope they can appear in pairs, groups or chains.

Habitat for these microbes are diverse – the soil, plants, animals and the human body. They well survive the sudden changes in temperature, can actively multiply in the soil, on food. Not stand boiling, direct ultraviolet radiation, antimicrobial drugs of several of the groups of penicillins, sulfonamides or macrolides. On nutrient media capable of active reproduction and planting of the colonies, based on what methods of their diagnostics. They are exploring the laboratory, defining the properties and sensitivity to antibiotics, which is important in the subsequent treatment.

Basis of classification: how dangerous different types of streptococci

Their properties are allocated to two groups: beta-hemolytic streptococci and alpha-hemolytic streptococci.

Among the group a beta-hemolytic germs allocated a number of types assigned to the Latin capital letters.

• group a is the most pathogenic strains of Streptococcus. They affect the skin and mucous membranes, penetrating wounds and cracked skin forming suppurative inflammation. The penetration of these bacteria into the body leads to tissue necrosis and infectious-toxic shock may also have the characteristics of lesions of the myocardial cells.
• Group refers to the opportunistic, being active only in conditions of low immunity and diseases. Live in the region of the nasopharynx, digestive tract, and vagina in women. Against the background of reduced immunity in pregnant women can proliferate, forming certain diseases, during pregnancy is able to cross the placenta, affecting the embryo or fetus is dangerous to the newborn baby, they can cause serious brain damage and sepsis. Can women lead to pharyngitis, tonsillitis or bronchitis.
• Group C and group G during pregnancy is not relevant.

To alpha gemoliticeski streptococci include pneumococcal germs which threaten pneumonia, and Streptococcus viridans, which is able to provocations bacterial endocarditis.

The most dangerous for pregnant women streptococci of groups that may live in a part of the microbial flora of the vagina, they are identified according to the strokes during the inspection, a field which requires doctor’s consultation and decision on treatment, usually with antibiotics.

Manifestations of streptococcal infections during pregnancy

Manifestations of streptococcal infection depend on where the pathogen begins active replication and which organs and tissues he is actively striking:

• The most often form of infection of the upper respiratory tract and ENT-organs. If the bacteria are actively developing in the nasopharynx, formed the increase of temperature to high values of acute pain while swallowing food, enlargement of lymph nodes in the neck strong and marked weakness. Arise the signs of sore throat with swelling of the tonsils, and white deposits on them, as well as profuse sweat and chills, a stiff neck. When such processes are possible complications in pregnant women in the form of otitis or sinusitis, and bronchitis with pneumonia.
• It is also possible cutaneous lesions, which is formed by erysipelas or impetigo. Their main manifestations are redness in the affected area of the skin with clear boundaries between it and healthy portions, touching the affected skin is sharply painful, typically the presence of edema and glossy appearance, high temperature, joins expressed malaise. Often erysipelas is formed in the region of the extremities or face.
• The formation of streptococcalbubble lesions, which inside is filled with purulent turbid contents. Over time, the bubbles are opened, forming a crust. In the area of the bubbles causes severe itching of the skin, leading to scratching and the spread of infection on the skin.
• Possible additional localization of streptococcal lesions, including bone lesions with the development of osteomyelitis. In the affected area of bone is destroyed, place it in a cavity filled with purulent contents, formed fistula in the region of the skin, where the pus flowing out.
• On the background of rheumatic aggression relative to the connective tissue of different localizations of the joints, blood vessels, kidney tissue, liver.
• On the background of the boils in the hair follicles pouches are formed, filled with pus with a rod in the center that is brewing, opened and forms scars. The most dangerous process will become sepsis, breakthrough of microbes in the blood with the spacing of their organs and tissues, which leads to the formation of secondary foci, General intoxication and even death.

Pregnancy can be a vulnerable urinary system, infection of the bladder and kidneys, lesions of the uterus and the amniotic SAC, the placenta, which threatens to lose the fetus to miscarriage in the early stages or late stillbirth. At birth against streptococcal infection, including in the cesarean section may develop endometritis and pelvioperitonitis.

The symptoms are not specificity is a typical high temperature and weakness, pain in the lower abdomen, discharge from the uterus and a sharp increase in pain when her probing, bleeding. If you suspect such infection need a full diagnosis and determination of the causative agent and its sensitivity to antibiotics.

The effects of Streptococcus in pregnancy for the mother

During pregnancy the immune protection of women declining to bear fruit, consisting of half of the antigens of the father. This leads to the fact that a woman can become more vulnerable to various infections, including Streptococcus group B.

For typical pregnancy such effects as premature birth prematurity of the fetus, rupture of the placenta and early detachment , bleeding, intrauterine fetal death, early miscarriage and fading of pregnancy. Infection of the membranes leads to tears and ruptures, discharge of amniotic fluid or infection with transfer agents on the fetus. No less dangerous in pregnancy the formation of kidney infection and urinary tract, which also complicate the course of pregnancy.

The impact of strep on the fetus, child

Streptococcus in pregnancy is dangerous for the embryo and fetus and then newborn. He might get infected in utero or during childbirth, which is much more common. Often the signs of infection do not occur immediately, and this largely depends on the type of pathogen that infected baby at birth.

There are two different types of infection caused by the Streptococcus group B.

• with early infection, for which the leading to be signs of severe fever, respiratory disorder and constant depression baby during the first weeks of life. Usually all signs are starting to emerge in the first day. Such early onset streptococcal infection often leads to damage of the lungs with the formation of pneumonia and meningitis, and septic complications.

Half of newborn infection is early onset and unfavorable prognosis.

• later onset, in which symptoms may be specific. These include the presence of cough with nasal congestion and a violation of suckling, persistent high fever and severe drowsiness, convulsions. Symptoms may occur within 1 week to 3 months after childbirth. Often such type of infection in children leads to septic complications and meningitis.

About 5% of children have lethal complications of this infection among premature infants, this percentage is higher. If the child recovers, previous infection caused by hemolytic streptococci type b can form a residual (residual) effects of cerebral palsy, leading to problems of brain development that leads to violations of posture, motor function and muscle tone. Also possible problems with the development of the organ of hearing and visual defects, impairment of learning.

The strep in pregnant women: normal and decoding

Only on the basis of complaints and General symptoms of infection, to accurately determine the nature of streptococcal infections is difficult, but in some cases, the infection manifests itself clearly enough – if erysipelas or streptococcal.

The basis of the diagnosis is bacteriological examination of the PAP smears with their crops on nutrient media and the identification of the pathogen. Swabs are taken from affected areas or vagina, cervix, urethra, to determine the carrier of Streptococcus. Also shown is the urine and blood in cases of suspected infection and sepsis. For localization of pulmonary and bronchial lesions is sputum. Identify not only the pathogen, but its sensitivity to antibiotics.

Normal Streptococcus in pregnant women may be in an amount of not more than 10*4 CFU/ml, its detection in large volumes during pregnancy requires rehabilitation of all areas where they are found.

To clarify the nature of the infection and severity of pathology the doctor may conduct blood tests using the PCR method with detection of Streptococcus and screening tests with determination of the titer of antibodies and agglutinins, which make the conclusions.

Treatment of strep during pregnancy

In case of positive test results and identifying hazardous concentrations of Streptococcus in the skin, mucous membranes or at other sites, the need for active treatment during pregnancy. Most often, mothers suffer from a Streptococcus In two types – pyogenic and agalactic. According to the results of crops is issued to a range of antibiotics to which sensitive germs identified, and from them select those that are as safe during pregnancy.

Usually in the acute stage and in severe conditions the drug is administered intravenously or infusion, or intramuscularly, with the improvement of the status, you can switch to oral forms of drugs.

Therapy for a bad smears administered after 35 weeks of gestation and continues to birth. In the presence of streptococcal infections in pregnant women can apply antibiotics after the 12th week of pregnancy.

Most often choose antibiotics of penicillin group, with the intolerances used macrolides. These drugs are not harmful to the fetus and can give minimal side effects in future mothers. Can also be applied drugs streptococcal bacteriophages are biological tools that are increasingly in relation to specific types of pathogen.

Before labor 4 hours before they start can also be used antibiotics for prophylactic purposes.

Infection complications after childbirth

On the background of streptococcal infection possible postpartum infection of the uterine cavity, especially in complicated childbirth. It can manifest itself in several days after birth abdominal pain and bleeding, purulent secretions and fever, a sharp deterioration of General condition, tachycardia, shortness of breath. In these cases need hospitalization. And if a woman is still in the hospital – active treatment with antibiotics and the control of contractility of the uterus and secretions.