Infection of the fetus by Candida in a spontaneous abortion

A predicting model of child-bearing-aged women' spontaneous abortion by co-infections of TORCH and reproductive tract

To develop a predicting model of child-bearing-aged women' spontaneous abortion (SA) by co-infections of TORCH and reproductive tract, in order to provide a reference tool for accurately predicting the risk of SA and guide the early prevention, diagnosis and treatment of SA. A prospective cohort study was designed based on 218 958 child-bearing-aged women following up in Hebei province in China from 2010 to 2017. Multivariable logistic regression analysis was used to select candidate predictive variables. Fisher's discriminant analysis was performed to build a predictive model, and the validity of the model was evaluated. The incidence rate of SA was 2.4%. Multivariable logistic regression analysis showed that age (OR = 3.507), adverse pregnancy history (OR = 1.509), co-infections status of Candida and HBsAg (OR_{Candida positive×HBsAg negative}  = 4.091, OR_{Candida negative×HBsAg positive}  = 3.327, and OR_{Candida positive×HBsAg positive}  = 13.762), and co-infections status of HBsAg, Rubella (IgG) and CMV (IgG) (OR_{HBs-Ag negative×Rubella (IgG) negative×CMV (IgG) positive}  = 1.789, OR_{HBs-Ag positive×Rubella (IgG) positive×CMV (IgG) negative}  = 3.809, and OR_{HBsAg positive×Rubella (IgG) positive×CMV (IgG) positive}  = 11.919) were the independent predictors of SA. The total discriminant rate reached 91%, with 82% of the sensitivity and 91% of the specificity. The predicting model of child-bearing-aged women' SA by co-infections status has a good performance. The co-infection status of TORCH and reproductive tract are suggested to be considered in pre-pregnancy physical examination.

Congenital systemic candidiasis: a comprehensive literature review and meta-analysis of 44 cases

Systemic candidiasis is a frequent complication in neonatal units, but congenital systemic candidiasis is an unusual diagnosis, observed in both full-term and preterm infants, with less than 50 cases reported to date. Congenital candidiasis presents with a wide spectrum of symptoms, ranging from diffuse skin eruptions to severe systemic disease, resulting in fetal demise or early neonatal death. Although management guidelines have been published almost two decades ago, due to the rarity of this type of infection, conclusive recommendations are difficult to establish, since they are based on anecdotal experience. In this paper, we present a comprehensive meta-analysis of the current scientific knowledge regarding congenital candidiasis, which spans 54 years and includes a total of 44 cases.

Kurt Aterman, MUDR, MB, BCh BAO HONS, DCH, MRCP, PhD, DSc, FRCPath: "A Small Man With a Very Large Cerebrum and a Soul to Match"

Kurt Aterman was raised in the Czech-Polish portions of the former Austro-Hungarian Empire during World War I and the interwar period. After completing medical school and beginning postgraduate pediatrics training in Prague, this Jewish Czech physician fled to England as a refugee when the Nazis occupied his homeland in 1939. He repeated/completed medical training in Northern Ireland and London, working briefly as a pediatrician. Next, he served in the Royal Army Medical Corp in India, working as a pathologist. After the war and additional pathology training, he spent the next decade as an experimental pathologist in Birmingham, England. After completing a fellowship with Edith Potter in Chicago, Aterman spent the next 2 decades as a pediatric-perinatal pathologist, primarily working in Halifax, Canada. Fluent in many European languages, he finished his career as a medical historian. Aterman published extensively in all 3 arenas; many of his pediatric pathology papers were massive encyclopedic review articles, accurately recounting ideas from historical times. Aterman was a classical European scholar and his papers reflected this. Aterman was one of the founding members of the Pediatric Pathology Club, the predecessor of the Society for Pediatric Pathology. This highly successful refugee's writings are important and memorable.

Candida Chorioamnionitis Leads to Preterm Birth and Adverse Fetal-Neonatal Outcome

Candida chorioamnionitis is rare but can lead to neonatal infection, high mortality, and neurodevelopmental impairment. We aimed to investigate maternal clinical features and perinatal outcomes and discuss future management strategies. We reviewed the medical records of women with Candida chorioamnionitis at our hospital over a 10-year period (n = 9) and previous published case reports and case series. The most prevalent Candida species was C. albicans (71.3% of the all cases). The most prevalent predisposing condition was preterm premature rupture of membranes (31/123, 25.2%), followed by pregnancy with a retained intrauterine contraceptive device (26/123, 21.1%) and pregnancy after in vitro fertilization (25/123, 20.3%). Preterm labor was the most common symptom (52/123, 42.3%), and only 13% of cases involved fever. Of the infants, 27% of the singletons and 23.8% of the twins were born before 22 gestational weeks, while 60% of the singletons and 76.2% of the twins were born at 22-36 weeks. The median birth weight of the babies born after 22 weeks was 1230 g. The mortality rates of the singletons and twins born after 22 weeks of gestation in the year 2000 or later were 28.6% and 52.4%, respectively. Antenatal treatment for Candida chorioamnionitis has not been established.

Congenital cutaneous candidiasis: clinical presentation, pathogenesis, and management guidelines

We describe a term infant with congenital cutaneous candidiasis (CCC), and review all cases in the English literature that reported birth weight and outcome. Presence of an intrauterine foreign body was a predisposing factor for development of CCC and subsequent preterm birth. The most common presentation of CCC in neonates weighing >1000 g was a generalized eruption of erythematous macules, papules, and/or pustules that sometimes evolved to include vesicles and bullae. Extremely low birth weight, premature neonates weighing <1000 g most often presented with a widespread desquamating and/or erosive dermatitis (10 of 15 [67%]), and were at greater risk for systemic infection with Candida spp (10 of 15 [67%]) and death (6 of 15 [40%] than those weighing >1000 g (5 of 48 [10%]; 4 of 48 [8%], respectively). Systemic antifungal therapy is recommended for neonates with burn-like dermatitis attributable to Candida spp, or positive blood, urine, and/or cerebrospinal fluid cultures. Systemic treatment also should be considered for all infants with CCC who have respiratory distress in the immediate neonatal period and/or laboratory signs of sepsis such as an elevated leukocyte count with an increase in immature forms or persistent hyperglycemia and glycosuria.

Fetal Candida infection associated with an intrauterine contraceptive device

Fetal Candida infection is rarely described but is often associated with a retained intrauterine contraceptive device (IUCD). A case of abortion due to Candida infection in a patient wearing an IUCD is reported.

The prevalence and clinical significance of intraamniotic infection with Candida species in women with preterm labor

Intraamniotic infection is considered a major etiologic factor of preterm birth. Positive amniotic fluid cultures are rarely contaminated with Candida species. The presence of this microorganism is associated with a poor pregnancy outcome. Out of 773 transabdominal amniocenteses performed in women presenting with preterm labor and intact membranes, 77 patients (9.9%) had positive amniotic fluid cultures and in 5 women (6.5%) Candida species were identified. On the other hand, 625 amniocenteses were performed in women with preterm premature rupture of membranes and 178 (28%) had positive cultures. Only in 4 patients was Candida isolated (2.2%) (P = 0.13 Fisher's exact test). The importance of early and accurate diagnosis of intraamniotic infection with Candida is pointed out. A transabdominal amniocentesis for microbiological examination is suggested for every woman presenting with preterm labor or preterm premature rupture of membranes and especially for those who conceived with a retained IUD or cervical cerclage.

Congenital cutaneous candidiasis: report of four cases and review of the literature

Congenital cutaneous candidiasis (CCC) is a rare disease acquired by an ascending route, liable to affect the offspring of pregnant women suffering from vulvovaginitis. The cutaneous lesions are present at birth or within the first hours of life. Some infants may present with respiratory distress or clinical signs of sepsis during the first 2 days of life. We report four new cases of CCC, three of which presented transient respiratory distress and clinical signs of sepsis with hepatosplenomegaly. The evolution was favourable in all three cases with topical and oral therapy. We emphasize the self-limited character of this disease, although preterm infants may be at risk of systemic spread. Only one infant presented paronychia as a late complication.

Intra-uterine Candida infection: a report of four infected fetusses from two mothers

Although Candida albicans is a frequent inhabitant of the female genital tract, chorioamnionitis is rarely caused by this fungal organism. In this report we present two cases with manifest Candida chorioamnionitis. The first case is a twin pregnancy with premature delivery and survival of both twins. The second case is a pregnancy with intra-uterine contraceptive device in situ ending in a midtrimester abortion, followed by the next pregnancy also ending in an abortion in the second trimester. Possible triggers responsible for the increased invasiveness of otherwise benign Candida vaginitis are discussed. Foreign intra-uterine bodies such as contraceptive devices and cerclage sutures necessitate repetitive search for Candida species infection, and prompt adequate antifungal treatment in cases of documented infection. Both cases of the present report add further substantial evidence to the hypothesis of amniotic infection by ascending transcervical infection. The frequent concomitant cervical infections with other infectious agents as well as antibiotherapy influencing the normal Lactobacillary defence mechanisms are both likely to increase the risk. Systemic debilitating diseases that promote invasiveness are briefly discussed.

Intrauterine fetal death apparently due to Candida chorioamnionitis

There is an increasing awareness of the association between Candida albicans chorioamnionitis and preterm labor. We present a case of intrauterine fetal death caused by Candida chorioamnionitis at the 21 weeks gestation in a patient with an intrauterine device (IUD).

Intraamniotic infection with Candida albicans associated with a retained intrauterine contraceptive device: a case report

Intrauterine infection with Candida albicans is a rare occurrence in pregnancy. We report the association of an intrauterine contraceptive device with such an infection in an asymptomatic patient. This infection, discovered incidentally at the time of genetic amniocentesis for advanced maternal age, resulted in a spontaneous abortion at 18 weeks' gestation.

Placental and fetal candidiasis. Presentation of a case of an abortus

The authors present a case of intrauterine fetal infection by candida, in an abortion of four months, associated with an I.U.D. In the placenta and adnexa we observed an acute inflammation consisting of extraplacental membranitis, omphalitis, chorio-amnionitis and choriovasculitis with a marked villitis and intervillitis. In the fetus, involvement of the skin, lungs and pharynx was observed. This case represents, probably the 15th reported instance of congenital fetal candidiasis, and the first case of a candida hematogenic placental infection acquired from the fetal blood. The fetus undoubtedly acquired its infection by an ascending route, through the contamined amniotic fluid.

The inflammatory response in candidal chorioamnionitis

Fetal infection with Candida organisms has not commonly been reported. Umbilical cords and placentas from 23 cases of chorioamnionitis collected over a nine-year period were examined by electron microscopy and immunoperoxidase staining. Gross features, especially of the umbilical cord, were distinctive and included the pale yellow plaques pathognomonic of candidal funisitis. Histopathologically, the lesions were found to be focal and subamniotic and were often embedded in a "fibrinoid" exudate and surrounded by inflammatory cells. In some cases the exudate and inflammatory cells were deposited in dense bands. Immunoperoxidase staining showed the lesions to contain IgG, IgM, and IgA, which probably originated in dense-staining plasmacytoid and immunoblastic cells in the inflammatory infiltrates. Additional findings in two fetal cases of giant cell pneumonitis suggested that the fetus can mount a brisk inflammatory and immune response to Candida organisms as early as 18 weeks' gestation and that mucosal exposure to this antigen can result in production of IgA by the lung.

The clinical management of repeated early pregnancy wastage

A rational systematic evaluation is essential to the management of a couple with repeated early pregnancy wastage. Psychologic support in the form of frequent discussions and sympathetic counseling are crucial to the successful evaluation and treatment of the anxious couple. A prompt and orderly evaluation will relieve anxiety. When no etiologic factor is identified, a 60% to 80% fetal salvage rate may be expected. Once a patient conceives, serial ultrasonography, beta-hCG determination, and estradiol determination may be useful in detecting the stage of the embryonic death if subsequent abortion occurs. A karyotypic analysis of the products of conception should be performed if fetal loss occurs.

Antenatal infections with Candida species

The clinical, pathological, and microbiological features of 18 pregnancies complicated by intrauterine infection with Candida sp. are described. Chorioamnionitis with Candida sp. can be recognised macroscopically at birth. Penetration of the umbilical cord and membranes is associated with an intense fetal inflammatory response. The infection characteristically presents in infants of very low birthweight as pneumonia or a skin infection. In nearly every case the organism can be recovered from the gastric aspirate. A case control study showed that there is a striking association between chorioamnionitis caused by Candida sp. and the presence of a foreign body (an intrauterine contraceptive device or a cervical suture) in the mother's genital tract in pregnancy. This feature in the perinatal history of an infant of short gestation who exhibits a very high neutrophil count should alert the clinician to the possible presence of chorioamnionitis due to Candida sp.

Placental candidiasis: report of three cases with a review of the literature

Three new cases of placental candidiasis are reported. Two were associated with fetal cutaneous candidiasis and one with fetal systemic candidiasis. The systemic case was associated with an intrauterine contraceptive device. Infection of the placenta results in small 'granulomata' under the surface of the cord and a diffuse chorioamnionitis of the membranes and chorionic plate. In reviewing the 24 previously reported cases it can be seen that systemic. Candida infection of the fetus results in prematurity and death, infection can occur across intact membranes, and systemic candidiasis in the fetus is likely to be associated with an intrauterine device.

Abortion associated with intrauterine infection by candida albicans. Case report

A 27-year-old patient who became pregnant whilst fitted with an intrauterine contraceptive device developed an intrauterine Candida albicans infection and aborted. The diagnostic (and other inconspicuous) features of C. Albicans infection in the fetus are described. The presence of the intrauterine contraceptive device may have predisposed to the establishment of the infection.

Immature delivery after intrauterine Candida albicans infection

The case is presented of a patient who delivered an immature infant after an intrauterine candidial infection in the presence of an intrauterine contraceptive device (IUD). 8 other cases of intrauterine Candida infection leading to immature deliveries were gathered from the literature. On the basis of the pathologic findings, the medium of infection is thought to be the amniotic fluid.

Adrenal changes in chorioamnionitis

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Candida albicans septicaemia during first half of pregnancy successfully treated with 5-fluorocytosine

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