h Group B Streptococcus (GBS) is a common commensal bacterium in adults, but is also the leading cause of invasive bacterial infections in neonates in developed countries. The -hemolysin/cytolysin (-h/c), which is always associated with the production of an orange-to-red pigment, is a major virulence factor that is also used for GBS diagnosis. A collection of 1,776 independent clinical GBS strains isolated in France between 2006 and 2013 was evaluated on specific medium for -h/c activity and pigment production. The genomic sequences of nonhemolytic and nonpigmented (NH/NP) strains were analyzed to identify the molecular basis of this phenotype. Gene deletions or complementations were carried out to confirm the genotype-phenotype association. Sixty-three GBS strains (3.5%) were NH/NP, and 47 of these (74.6%) originated from invasive infections, including bacteremia and meningitis, in neonates or adults. The mutations are localized predominantly in the cyl operon, encoding the -h/c pigment biosynthetic pathway and, in the abx1 gene, encoding a CovSR regulator partner. In conclusion, although usually associated with GBS virulence, -h/c pigment production is not absolutely required to cause human invasive infections. Caution should therefore be taken in the use of hemolysis and pigmentation as criteria for GBS diagnosis in routine clinical laboratory settings.
S treptococcus agalactiae, or group B Streptococcus (GBS), is aGram-positive bacterium that is usually an asymptomatic member of the human intestinal and vaginal microbiota. However, GBS is also the leading cause of neonatal sepsis and meningitis in developed countries (1-3) and an emerging pathogen in adults, mostly in the elderly (4, 5). Neonatal infections occur predominantly during delivery by inhalation or ingestion of contaminated secretions of the mother's vagina. Rapid invasive infections may follow, with a mortality rate of up to 10% during the first week of life (early-onset disease [EOD], age of 0 to 6 days) or during the first 3 months of life (late-onset disease [LOD], age of 7 to 89 days). Systematic GBS screening prior to delivery and intrapartum antibiotic prophylaxis have efficiently reduced EOD but not LOD (6), highlighting the need to further improve the diagnosis and treatments.GBS is an extracellular pathogen and one of its characteristics is the secretion of a potent -hemolysin/cytolysin (-h/c) (7-9). This -h/c has a central role in balancing the pro-and anti-inflammatory responses of the infected host and is necessary to breach the epithelial and endothelial barriers and the phagolysosome membrane (10-15). Remarkably, the GBS -h/c is unique among Gram-positive pathogens and its production is linked to that of a characteristic orange-to-red pigment. This dual and specific -h/c and pigment phenotype is routinely used in clinical settings to identify GBS isolates (16,17).It was initially proposed that the GBS protein CylE was, in fact, -h/c and that the pigment was a distinct carotenoid-like molecule (18,19). However, it was rece...