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Medical Edge Newspaper Column from Mayo Clinic

SOURCE OF INFANT STREP INFECTION OFTEN A MYSTERY

DEAR MAYO CLINIC: How does a 4-month-old baby who was in fine health contract late onset Group B Streptococcus infection? — Chipley, Fla.

ANSWER: Group B Streptococcus is a widespread germ that lives in the birth canal of about one of every five normal, healthy pregnant women. There are two forms of GBS infection: early-onset and late-onset disease.

Early-onset is the most common form of GBS. Seventy-five percent of infants who are infected with GBS develop it within the first week after birth. Nearly all early-onset cases are passed on from the mother.

Late-onset GBS is less common. It develops in a child after the first week of life, and only rarely beyond 2 months of age. About 50 percent of the late-onset cases are passed on from the mother. The source of the remaining 50 percent is unknown.

Both early- and late-onset forms of GBS can be fatal, and infected infants require immediate intravenous antibiotics. According to the U.S. Centers for Disease Control, up to one in 25 babies with GBS infection dies despite treatment. Those who survive may have long-term consequences, such as hearing problems.

In both types, the newborn can develop serious bloodstream infections, pneumonia and meningitis — an infection of the membranes that surround the spinal cord and brain. Signs of these illnesses include high fever and lethargy. If an infant has a bloodstream infection, symptoms can also include shock, change in heart rate and labored breathing. In late-onset GBS, symptoms occur later — typically weeks to months after birth — and meningitis is the more common problem.

Fortunately, preventive treatment can be given during labor to mothers who carry the germs, and as a result, newborn illness is much less common than it used to be. Many older infants who get sick from GBS were born prematurely. Like you, we often wonder where these germs come from. Although no one knows for sure, we suspect that a child becomes infected by being touched by a healthy person who carries GBS without ever getting sick.

Phil Fischer, M.D., Pediatrics , and Thomas Boyce, M.D.,
Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minn.

Additional Resources:
Child and Adolescent Medicine
Appointment Information
Group B Streptococcus Infection

DEAR MAYO CLINIC: I am in need of information regarding surgery for herniated disks and for degenerative disk disease. What can be done? — Altamonte Springs, Fla.

ANSWER: Surgery for a herniated or degenerative disk is an option for some patients — depending on their symptoms — but it’s not the only solution.

First, a little background on disks may help. A disk is made up of an outer ring of tough, fibrous tissue (annulus fibrosus) that has a jellylike substance in the center (nucleus pulposus). Disks serve as shock absorbers between the vertebrae in your spine, preventing the hard and bony vertebrae from hitting one another when you walk, run or jump. Over time, the outer covering of the disk becomes more prone to developing tiny tears. Eventually, the nucleus pulposus may poke out through a crack, resulting in a herniation or rupture. If the substance pokes out far enough to irritate a nearby nerve, it can cause pain.

But studies also show that as people go through their third, fourth and fifth decades of life, they naturally experience some herniation or disc degeneration — but they do not necessarily experience painful symptoms. Often, treatment is not required.

So, if you’re experiencing pain in your back or leg, the first step is to see your doctor for a comprehensive medical history and physical exam. If your doctor pinpoints disk degeneration or a herniated disc as the cause of the problem, then there are several solutions to consider.

The first line of treatment often is a regimen of anti-inflammatory (or other analgesic) drugs in combination with stretching and strengthening exercises. Activity modification also can help: When you carry groceries, don’t overload. Make two trips instead of one. Buy a good chair that supports the back, allows you to place your feet flat on the floor and has armrests.

If these activities don’t provide significant relief, consider pain-relief injections. A selective nerve-root block, a trigger-point injection, a facet-joint block or an epidural-steroid injection are commonly used to treat people who have disk problems. In addition, massage and acupuncture — practiced by trained personnel in a medical setting — can provide relief for some patients.

After you have pursued all these other avenues, then discuss surgical intervention with your doctor.

Michael Yaszemski, M.D., Ph.D., Orthopedics, Mayo Clinic, Rochester, Minn.

Additional Resources:
Department of Orthopedic Surgery
Appointment Information
Herniated or Degenerative Disk

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.