{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:25:10Z","timestamp":1776273910763,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.17804.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T00:00:00Z","timestamp":1669334400000}}],"reference-count":13,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T00:00:00Z","timestamp":1669334400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome","doi-asserted-by":"publisher","award":["220211"],"award-info":[{"award-number":["220211"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns4:p><ns4:bold>Background:<\/ns4:bold> <ns4:italic>Streptococcus agalactiae <\/ns4:italic>is a normal commensal of the human gastro-intestinal and female genital tracts. It causes serious disease in neonates and pregnant women, as well as non-pregnant adults. Food-borne outbreaks have also been described. A link between invasive Group B streptococcus (GBS) infection in humans caused by <ns4:italic>S. agalactiae<\/ns4:italic> serotype III-4, sequence type 283 (ST283) and the consumption of raw fresh-water fish was first described in Singapore in 2015.<\/ns4:p><ns4:p> <ns4:bold>Case presentation:<\/ns4:bold> We report the simultaneous occurrence of acute fever and myalgia in two sisters who were visiting Laos. Both were found to have invasive GBS ST283 infection, confirmed by blood culture. Infection was temporally linked to fish consumption. They responded well to intravenous antibiotics within 48 hours.<\/ns4:p><ns4:p> <ns4:bold>Conclusions: <\/ns4:bold>Food-borne transmission of <ns4:italic>Streptococcus agalactiae <\/ns4:italic>is an important and under-recognised source of serious<ns4:bold> <\/ns4:bold>human disease throughout Southeast Asia and possibly beyond.<\/ns4:p>","DOI":"10.12688\/wellcomeopenres.17804.2","type":"journal-article","created":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T11:25:55Z","timestamp":1669375555000},"page":"148","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Invasive Streptococcus agalactiae ST283 infection after fish consumption in two sisters, Lao PDR"],"prefix":"10.12688","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8801-5738","authenticated-orcid":false,"given":"Manophab","family":"Luangraj","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmin","family":"Hiestand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Othila","family":"Rasphone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swaine L.","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viengmon","family":"Davong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0975-2244","authenticated-orcid":false,"given":"Timothy","family":"Barkham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1239-0782","authenticated-orcid":false,"given":"Andrew J.H.","family":"Simpson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9189-7244","authenticated-orcid":false,"given":"David A.B.","family":"Dance","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valy","family":"Keoluangkhot","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2022,11,25]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.3389\/fmicb.2019.01447","article-title":"Genomic Insights Into the Distribution and Evolution of Group B Streptococcus.","volume":"10","author":"S Chen","year":"2019","journal-title":"Front Microbiol."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1186\/1471-2334-11-149","article-title":"Streptococcus agalactiae in adults at Chiang Mai University Hospital: a retrospective study.","volume":"11","author":"R Chaiwarith","year":"2011","journal-title":"BMC Infect Dis."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"e182-6","DOI":"10.1016\/j.ijid.2011.11.008","article-title":"Group B Streptococcus infections in non-pregnant adults: the role of immunosuppression.","volume":"16","author":"B Sunkara","year":"2012","journal-title":"Int J Infect Dis."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"2056-62","DOI":"10.1161\/CIRCULATIONAHA.113.001545","article-title":"Endocarditis in adults with bacterial meningitis.","volume":"127","author":"M Lucas","year":"2013","journal-title":"Circulation."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"1970-3","DOI":"10.3201\/eid2211.160210","article-title":"Group B Streptococcus Serotype III Sequence Type 283 Bacteremia Associated with Consumption of Raw Fish, Singapore.","volume":"22","author":"S Tan","year":"2016","journal-title":"Emerg Infect Dis."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"S145-S152","DOI":"10.1093\/cid\/cix021","article-title":"2015 Epidemic of Severe Streptococcus agalactiae Sequence Type 283 Infections in Singapore Associated With the Consumption of Raw Freshwater Fish: A Detailed Analysis of Clinical, Epidemiological, and Bacterial Sequencing Data.","volume":"64","author":"S Kalimuddin","year":"2017","journal-title":"Clin Infect Dis."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"1974-7","DOI":"10.3201\/eid2211.160252","article-title":"Group B Streptococcus Sequence Type 283 Disease Linked to Consumption of Raw Fish, Singapore.","volume":"22","author":"P Rajendram","year":"2016","journal-title":"Emerg Infect Dis."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"e0007421","DOI":"10.1371\/journal.pntd.0007421","article-title":"One hypervirulent clone, sequence type 283, accounts for a large proportion of invasive Streptococcus agalactiae isolated from humans and diseased tilapia in Southeast Asia.","volume":"13","author":"T Barkham","year":"2019","journal-title":"PLoS Negl Trop Dis."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"105-11","DOI":"10.1016\/j.actatropica.2013.03.016","article-title":"Raw fish consumption in liver fluke endemic areas in rural southern Laos.","volume":"127","author":"V Xayaseng","year":"2013","journal-title":"Acta Trop."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.ijid.2018.04.3843","article-title":"Streptococcus agalactiae ST283 has been present in Laos for over 18 years.","volume":"73","author":"T Barkham","year":"2018","journal-title":"Int J Infect Dis."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"854-62","DOI":"10.1016\/j.annepidem.2007.05.014","article-title":"Risk factors for group B streptococcal colonization: potential for different transmission systems by capsular type.","volume":"17","author":"B Foxman","year":"2007","journal-title":"Ann Epidemiol."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"1800-3","DOI":"10.3201\/eid2210.151436","article-title":"Hypervirulent Clone of Group B Streptococcus Serotype III Sequence Type 283, Hong Kong, 1993-2012.","volume":"22","author":"M Ip","year":"2016","journal-title":"Emerg Infect Dis."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"2002-2010","DOI":"10.3201\/eid2312.170596","article-title":"Group B Streptococcus Infections Caused by Improper Sourcing and Handling of Fish for Raw Consumption, Singapore, 2015-2016.","volume":"23","author":"M Chau","year":"2017","journal-title":"Emerg Infect Dis."}],"container-title":["Wellcome Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-148\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-148\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-148\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T11:25:58Z","timestamp":1669375558000},"score":1,"resource":{"primary":{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-148\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,25]]},"references-count":13,"URL":"https:\/\/doi.org\/10.12688\/wellcomeopenres.17804.2","relation":{},"ISSN":["2398-502X"],"issn-type":[{"value":"2398-502X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,25]]},"assertion":[{"value":"Indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-148\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.19710.r50375, Ho-Man Yeung, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA, 11 May 2022, version 1, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-148\/v1#referee-response-50375","order":0,"name":"referee-response-50375","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Manophab Luangraj<\/b>; \n<i>Posted: 09 Nov 2022<\/i>; Thanks for your great comments and suggestions through our case report. Regarding to&nbsp;your comments and queries,&nbsp;please see our answers below the questions.  \n<b>Q1: What was the clinical outcome after treatment? I presume they were discharged and returned to the USA.<\/b> \n<i>The two patients improved clinically after IV treatment with 4 doses of ceftriaxone. They were discharged on oral cefixime to complete a 2-week course as outpatients. We heard later from their Lao cousin that they returned to the USA a few days after discharge. We have added this information into the case report (\u201ccase report\u201d section, line 11 of 6<sup>th<\/sup> paragraph)<\/i>  \n<b>Q2:<i>&nbsp;<\/i>Did the younger patient also have septic arthritis? Her exam finding in the setting of bacteremia would be suspicious.<\/b> \n<i>Even though the younger patient had underlying osteo-arthritis, on admission to hospital she did not have clinical signs and symptoms consistent with established acute septic arthritis and there was no evidence of joint effusions. In the circumstances, aspiration of the joint was not performed. We cannot therefore exclude very early stage septic arthritis and have added a comment to this effect in the case report (\u201ccase report\u201d section, line 5-7 of 5<sup>th<\/sup> paragraph).<\/i>  \n<b>Q3: It would&nbsp;be&nbsp;useful to include information about the virulence factors of GBS leading to gastrointestinal infection.<\/b> \n<i>Substantial sequencing of ST283 has been done on opportunistic collections from both human and non-human sources throughout Southeast Asia. Initial large-scale genomic comparisons have shown several thousand genetic changes (including both SNPs and larger changes such as gene gain\/loss and prophage gain\/loss) that are conserved among all human disease-causing ST283; from a simple sequence analysis point of view, any individual or combination of these changes could be related to virulence. The addition of these two cases does not offer substantial additional data to answer this question of ST283 virulence, which will likely require experimental models of infection. Therefore, we prefer not to use these two genome sequences to speculate on virulence. The value of this case report instead is in terms of validating the hypothesis of foodborne transmission in countries outside Singapore, which is currently the only place where it has been confirmed.<\/i>","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-148\/v2#referee-comment-5173","order":1,"name":"referee-comment-5173","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.19710.r51098, Kirsty Le Doare, Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK, 20 Jun 2022, version 1, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-148\/v1#referee-response-51098","order":2,"name":"referee-response-51098","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Manophab Luangraj<\/b>; \n<i>Posted: 09 Nov 2022<\/i>; Thanks for your great comments and suggestoins. Regarding to your comments and queries, please see our responses below.  \n<b>For the 55 year old sister, she had steroid injections prior to arrival in Laos. How long before and was she also investigated for septic arthritis as she had fever and pain in these joints? Could the infection be due to seeding following the steroid injections?<\/b> \n<i>We do not have details as to precisely how long before coming to Laos she had the injections, although it was shortly before travel. As noted in our response to Reviewer one, she did not have clinical signs and symptoms consistent with established acute septic arthritis and there was no evidence of joint effusions. In the circumstances, aspiration of the joint was not performed. She also did not report any exacerbation of her joint symptoms following the injections.&nbsp; We therefore feel that it is unlikely that her infection was the result of seeding her joints during the injections and have added a comment to this effect in the case report. (\u201cDiscussion\u201d section, line 9-13 of 1<sup>st<\/sup> paragraph)<\/i>","URL":"https:\/\/wellcomeopenresearch.org\/articles\/7-148\/v2#referee-comment-5174","order":3,"name":"referee-comment-5174","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by Wellcome [220211]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission, funded by the Wellcome Trust. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}