group B strep in urine of 11 month old child

[colleenrn]

I recently got copies of all my children's lab results over the past several years in preparation for my 3rd child's ENT evaluation for possible T&A. I was shocked when I saw a lab result on my youngest child when he was 11 months old (he is now 3 1/2).

 

My recollection was that he was very ill- high unexplained fever. We did a rapid strep which was negative. We also did a culture, which turned out negative. The physicain I saw that day was not my regular one. He wanted to do a urine culture just to rule out any infection in trying to find the cause of his high fever. I never heard back that there was any infection in his urine so I assumed (BIG mistake that I no longer make) I did not call to confirm this.

 

It turns out that the urine culture came back positive for beta hemolytic group B strep (25,000 colonies). This is the same child that we have gotten 2 upper respiratory cultures that are positive for group B strep when I saw PANDAS symptoms. I also found an old lab result on my oldest child for a positive upper respiratory culture for group B strep and the physician who reviewed that finding wrote "do not treat this strep", so no one ever even let me know it was positive.

 

I was GBS positive in all my pregnancies and also on 2 upper respiratory cultures during the same time my children had big flareups in their PANDAS symptoms.

 

I am wondering if anyone has gotten any positive streps on urine? Any input would be greatly appreciated.

 

Colleen

[reactive]

I recently got copies of all my children's lab results over the past several years in preparation for my 3rd child's ENT evaluation for possible T&A. I was shocked when I saw a lab result on my youngest child when he was 11 months old (he is now 3 1/2).

 

My recollection was that he was very ill- high unexplained fever. We did a rapid strep which was negative. We also did a culture, which turned out negative. The physicain I saw that day was not my regular one. He wanted to do a urine culture just to rule out any infection in trying to find the cause of his high fever. I never heard back that there was any infection in his urine so I assumed (BIG mistake that I no longer make) I did not call to confirm this.

 

It turns out that the urine culture came back positive for beta hemolytic group B strep (25,000 colonies). This is the same child that we have gotten 2 upper respiratory cultures that are positive for group B strep when I saw PANDAS symptoms. I also found an old lab result on my oldest child for a positive upper respiratory culture for group B strep and the physician who reviewed that finding wrote "do not treat this strep", so no one ever even let me know it was positive.

 

I was GBS positive in all my pregnancies and also on 2 upper respiratory cultures during the same time my children had big flareups in their PANDAS symptoms.

 

I am wondering if anyone has gotten any positive streps on urine? Any input would be greatly appreciated.

 

Colleen

Hi there...

I'm not sure this helps at all in your situation. But, I work as an NP in OBGYN. In our patients (who are teens or adults, the youngest pt I had was a pregnant 11 year old) we do a lot of urine cultures. Not sure how this works in a 11 month old, but a definition of a positive urine culture for infection for us is at least 100,000 colonies. We usually do not treat for less than that unless there is some clinical suspicion for UTI or if pt is pregnant. In our pregnant patients we treat for at least 50,000 colonies.

 

There is another, earlier thread on here about group B strep. I replied to some of those comments. I would assume that group B strep can be harbored in the area of the rectum, vagina ect of kids as it can be in adults. With the low count of 25,000 I find it hard to believe that could haved caused a high fever (disclaimer: I do not work in pediatrics so I could be wrong). We see GBS all the time in urine cultures, if it is >100,000 I treat, if lower I ignore it unless the pt is pregnant and even then I do not treat the pregnant pt unless it is in the UTI range...I just note it for when she is in labor.

 

It would be hard to determine back or flank pain, or pain with urination in an 11 month old. But, if he had an untreated UTI that was causing a high fever, (aka probable kidney infection), you would have known then is my guess. So, I'm not surprised your doc didn;t do anything about it.

[reactive]

I recently got copies of all my children's lab results over the past several years in preparation for my 3rd child's ENT evaluation for possible T&A. I was shocked when I saw a lab result on my youngest child when he was 11 months old (he is now 3 1/2).

 

My recollection was that he was very ill- high unexplained fever. We did a rapid strep which was negative. We also did a culture, which turned out negative. The physicain I saw that day was not my regular one. He wanted to do a urine culture just to rule out any infection in trying to find the cause of his high fever. I never heard back that there was any infection in his urine so I assumed (BIG mistake that I no longer make) I did not call to confirm this.

 

It turns out that the urine culture came back positive for beta hemolytic group B strep (25,000 colonies). This is the same child that we have gotten 2 upper respiratory cultures that are positive for group B strep when I saw PANDAS symptoms. I also found an old lab result on my oldest child for a positive upper respiratory culture for group B strep and the physician who reviewed that finding wrote "do not treat this strep", so no one ever even let me know it was positive.

 

I was GBS positive in all my pregnancies and also on 2 upper respiratory cultures during the same time my children had big flareups in their PANDAS symptoms.

 

I am wondering if anyone has gotten any positive streps on urine? Any input would be greatly appreciated.

 

Colleen

Hi there...

I'm not sure this helps at all in your situation. But, I work as an NP in OBGYN. In our patients (who are teens or adults, the youngest pt I had was a pregnant 11 year old) we do a lot of urine cultures. Not sure how this works in a 11 month old, but a definition of a positive urine culture for infection for us is at least 100,000 colonies. We usually do not treat for less than that unless there is some clinical suspicion for UTI or if pt is pregnant. In our pregnant patients we treat for at least 50,000 colonies.

 

There is another, earlier thread on here about group B strep. I replied to some of those comments. I would assume that group B strep can be harbored in the area of the rectum, vagina ect of kids as it can be in adults. With the low count of 25,000 I find it hard to believe that could haved caused a high fever (disclaimer: I do not work in pediatrics so I could be wrong). We see GBS all the time in urine cultures, if it is >100,000 I treat, if lower I ignore it unless the pt is pregnant and even then I do not treat the pregnant pt unless it is in the UTI range...I just note it for when she is in labor.

 

It would be hard to determine back or flank pain, or pain with urination in an 11 month old. But, if he had an untreated UTI that was causing a high fever, (aka probable kidney infection), you would have known then is my guess. So, I'm not surprised your doc didn;t do anything about it.

Sorry...just wanted to add...I've never seen a + throat culture on my kids for group B strep; I don't know much about that. Now I want to look it up.

[colleenrn]

From what I have been reading, if the GBS is in the urine, that means it has colonized at a high enough rate in order for it to be in the urine. I am understanding this incorrectly?

 

I know adults can carry it in different places in their bodies, but a baby?

 

I also read that in a healthy uncompromised person it probably is benign, but it can make an immunocompromised person very ill. I think all of my children are immunocompromised due to their frequent illnesses, strep and viral.

 

Thanks!

Colleen

[mom md]

I agree with the above statement by reactive. In 2002 the guidelines were changed to screen all pregnant patients for rgoup B strep at 35-37 weeks. Approximately 30% of all women are colonized in the GI or vagina. Prior to 2002 only infants thought to be high risk (preterm <37 weeks) were treated with IV antibiotics in labor or if they had the prescence of group B strep in their urine. The recommendation is to only treat if the patient is symptomatic or if the colony count is >100,000 (unless they are pregnant). As there were some severly effected full term infants with GBS induced pneumonia at term, the screening recommendations were changed. All newborns are somewhat immunocompromised so this also played into the decision to change the recommendations. So basically, if you delivered prior to 2002 you may have been GBS positive and not known.

If you were GBS positive it could explain his colonization, but he could have been colonized by anyone he came in contact with the first 11 months of life too. Often urine cultures grow out small colony counts of other bacteria and according to the CDC there is no reason to treat unless they are symptomatic.

ACOG and the CDC have a lot of info on GBS and the studies done so far. From what I have seen though from babies infected with GBS, it like group A strep, should not be underestimated.

www.cdc.gov

www.ACOG.org

[sf_mom]

Plus group B can manifest group A:

 

The type of hemolytic reaction displayed on blood agar has long been used to classify the streptococci. Beta -hemolysis is associated with complete lysis of red cells surrounding the colony, whereas alpha-hemolysis is a partial or "green" hemolysis associated with reduction of red cell hemoglobin. Nonhemolytic colonies have been termed gamma-hemolytic. Hemolysis is affected by the species and age of red cells, as well as by other properties of the base medium. Group A streptococci are nearly always beta-hemolytic; related Group B can manifest alpha, beta or gamma hemolysis. Most strains of S. pneumoniae are alpha-hemolytic but can cause ß-hemolysis during anaerobic incubation. Most of the oral streptococci and enterococci are non hemolytic. The property of hemolysis is not very reliable for the absolute identification of streptococci, but it is widely used in rapid screens for identification of S. pyogenes and S. pneumoniae.

 

http://www.tjclarkinc.com/bacterial_diseas...us_pyogenes.htm

[kim]

Would a throat culture for Strep work the same way? I had noticed the last 2 times my youngest son had a culture grown, I was told that it was "within normal limits." Does that mean that strep was seen but not in what would be considered a high enough level to treat? He is the one that cultured postivie constantly and was labeled a carrier when he was younger, sometimes after 2 or 3 rounds of antibiotics. Amox was almost exclusively what we were given back then (he's 13 now).