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Group B streptococcus is a common cause of postpartum infection, but breast abscess in a lactating woman has not been reported. Seven days postpartum, a woman developed mastitis resulting from type Ib/c group B streptococcus. She was treated with oral antibiotics for 1 week, with apparent resolution. Breast-feeding was continued, but at reduced frequency on the affected side. Two days later, local and systemic symptoms recurred, and a large breast abscess was surgically drained. Five days into the mother's initial episode of mastitis, her infant developed type Ib/c group B streptococcal mastitis, requiring hospitalization and parenteral antibiotic therapy. It is likely that the pathogenesis of infection in this mother-infant pair was circular, and that either early abscess formation during the mother's first clinical infection and/or milk stasis due to decreased frequency of breast-feeding resulted in transient group B streptococcal bacteremia, with seeding of breast tissue in the newborn.

Postpartum infection remains a cause of considerable maternal morbidity and occasional maternal mortality. Puerperal sepsis mediated by what is now known as group A beta-hemolytic streptococci or Streptococcus pyogenes was once a common and lethal nosocomial scourge. Fortunately, multiple developments have decreased the incidence and ameliorated the clinical course of group A beta-hemolytic streptococcal postpartum sepsis. Despite these developments, epidemic group A streptococcal sepsis still jeopardizes modern mothers. We describe an epidemic of five women with group A beta-hemolytic streptococci-mediated postpartum infections which occurred at Mather Air Force Base Hospital, Sacramento, California. The remarkable, yet characteristic signs, symptoms, and clinical course of these patients are briefly reviewed along with the epidemiologic methods which led to the discovery of the common nosocomial source. Familiarization of the clinical aspects of these patients and the methods used to eradicate this epidemic will facilitate the protection and care of other women. Unfortunately, modern mothers still remain in jeopardy from "childbed fever."

A Streptococcus species biochemically and serologically identical to the rainbow trout pathogenic Streptococcus species was isolated from the internal organs of the fish specific leech, Batracobdelloides tricarinata. These leeches were obtained from Roodeplaat Dam, near Pretoria, in which rainbow trout do not occur. This is the first isolation of this bacterium from an environmental source not related to rainbow trout and it is proposed that this leech is a possible reservoir of the rainbow trout pathogenic Streptococcus sp. in South Africa.

The mechanisms by which Streptococcus pneumoniae spreads from person to person are poorly understood. In this study, optimal methods for sampling, isolation, and identification of S. pneumoniae from healthy carriers were investigated. Factors influencing carriage rates were analyzed. Findings included the importance of pharyngeal rather than of nasal sampling in adults, the greater sensitivity of mouse inoculation compared with direct streaking of blood agar plates, and the superiority of the Quellung reaction with omniserum over the optochin disk as a means of identification of S. pneumoniae. Carriage rates were highest in children of preschool (35%) or grammar school (29%) age and in adults with preschool children in the family (18%). Rates were lowest in adults without preschool children in the family (2%-9%).

This investigation was undertaken to determine the prevalence of group B streptococcal vaginal and throat colonization among lower socioeconomic pregnant women and the antibody concentration to the capsular polysaccharide antigen of type III group B streptococcus in their sera. Group B streptococci were recovered from 28.6 per cent of the 112 women studied; vaginal colonization was detected in 23.4 per cent, throat colonization in 4.7 per cent, and colonization at both sites in 0.9 per cent of the patients, respectively. Among these isolates of group B streptococci, serotypes III (39.5 per cent) and II (30.3 per cent) predominated. No differences were found between colonized and noncolonized women with respect to age, race, marital status, or parity. The majority of all women studied had low concentration of antibody in serum (less than 1.0 microgram per milliliter). However, women with isolation of type III group B streptococci from cultures at the time sera were collected had significantly higher concentrations than did women without group B streptococci from cultures at the time sera were collected had significantly higher concentrations than did women without group B streptococcal colonization.

Maternity patients and their newborn infants were cultured for group B streptococci (GBS) at Tampa General Hospital, Tampa, Fla., from September 1982 to May 1983. Culture swabs were placed into Lim Group B Strep Broth (GIBCO Laboratories, Madison, Wis.) and quantitated for GBS. A strong correlation was found between the numbers of GBS in the maternal vagina and the infant rectum. Infants symptomatic for early-onset GBS disease were delivered by mothers heavily colonized (greater than or equal to 3 X 10(4) GBS per swab) at the vagina. Such mothers were identified as GBS carriers by slide coagglutination and latex agglutination after their broth cultures had been incubated for 5 h. These data indicate that maternity patients at high risk of delivering infants heavily colonized with GBS and potentially symptomatic for early-onset GBS disease can be rapidly and selectively identified.

We present 2 cases of early onset group G streptococcal septicaemia in full term neonates, together with a review of 15 previously reported cases, including 3 late onset cases. Most likely the neonates were infected during passage through the birth canal or had been exposed in utero. In one neonate, meconium aspiration occurred, while in the other prolonged rupture of maternal membranes was a risk factor. Both responded well to treatment with benzylpenicillin and gentamicin. Among the 12 previously reported early onset cases, 5 (43%) had a fulminant course with complications such as progressive respiratory distress, shock, and disseminated intravascular coagulation.

The relative rarity (1 to 5 cases for 1,000 births) of neonatal infections secondary to B Streptococcus, the epidemiological characteristics of this germ, especially the unstable vaginal carriage, make it difficult to select a therapeutic approach. Systematic screening of B Streptococcus and the treatment of all carriers or only of high-risk patients, present several practical problems, are complex to implement but the cost/benefit ratio seems however acceptable. Prophylactic intrapartum antibiotic treatment of known carriers of B Streptococcus does not seem debatable any longer, at least the treatment of those presenting other risk factors: premature delivery, premature rupture of the membranes, fever occurring during delivery. Today, the best prophylaxis of neonatal infections seems to be the intrapartum antibiotic treatment (ampicillin) resulting in a spectacular decrease of the frequency of neonatal contamination.

In a maternity clinic the circulation of group B streptococci among the newborns, their mothers and the personnel was established during the period of 1982-1985. Group B streptococci were detected at different biotypes of newborns (the pharynx, the imbilical stump, external suditory meatus, nasal and oral mucosa, eyes and feces), their mothers (the vagina, the perianal area, breast milk, the pharynx, urine, the umbilical cord, amniotic fluid) and in the pharynx of the personnel. In this maternity clinic 15 combinations of type antigens were detected, two combinations (1a/c and 1 b/c) prevailing among them. These results confirmed earlier data concerning two possible ways of transferring infection to newborn infants: vertical, i.e. from the mother to the child during parturition, and nosocomial, i.e. from contaminated newborns or members of the personnel.

Group B streptococcal infections in newborn infants are increasing in frequency. Infection takes two forms--early-onset, developing in the first 24 hours, and late-onset, developing after the first week. Early-onset disease, a fulminating septicaemia, has a mortality of 40-70%. Late-onset disease, usually meningitis, has a mortality of 20-30%, with a high incidence of neurological damage in survivors. Early-onset disease is acquired during delivery from organisms colonizing the vagina. Up to 25% of women are colonized in late pregnancy. So far, no effective programmes for prevention have been developed.

Two epidemics of pseudobacteremia are reported. The first, due to Staphyloccus aureus, was caused by a physician who had active staphylococcal skin infection and nasal colonization. Because the blood culture system in use at the time was open, and used screw cap bottles, we assume that the physician contaminated the bottles at the time of inoculation. The second outbreak, caused by Aerococcus viridans, was traced to contamination of the blood culture bottle tops as they were received from the manufacturer. We assume that there was inadequate disinfection of the bottle tops by the physicians prior to their use.