1
|
Chen X, Huang X, Lin Y, Lin B, Yang C, Huang Z, Yang C. Association of Ureaplasma infection pattern and azithromycin treatment effect with bronchopulmonary dysplasia in Ureaplasma positive infants: a cohort study. BMC Pulm Med 2023; 23:229. [PMID: 37365524 DOI: 10.1186/s12890-023-02522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND It is unclear whether Ureaplasma-associated pneumonia and azithromycin treatment affect the risk for bronchopulmonary dysplasia (BPD). METHODS A retrospective cohort study was performed in very low birth weight (VLBW) infants who tested positive for Ureaplasma within 72 h after birth in a tertiary unit. Chest X-ray (CXR) and laboratory test were performed before and after azithromycin treatment. Multivariate logistic regression analysis was used to identify the independent association between BPD and Ureaplasma-associated pneumonia, as well as BPD and effective azithromycin treatment. RESULTS A total of 118 infants were included in the current study, of whom 36 developed BPD (defined as supplemental oxygen needed at postmenstrual age 36 weeks or discharge). The rate of BPD was significantly higher in infants with Ureaplasma-associated pneumonia (44.6%) compared to infants with Ureaplasma colonization (17.7%, P = 0.002). After adjusting for confounders, an effective azithromycin treatment was significantly associated with reduced risk of BPD [odd ratio (OR) 0.011; 95% confidence interval (CI): 0.000-0.250), whereas Ureaplasma-associated pneumonia was not significantly associated with BPD (OR 1.835; 95% CI: 0.548-6.147). CONCLUSION Effective Azithromycin treatment in Ureaplasma positive VLBW infants was associated with a reduced risk of BPD.
Collapse
Affiliation(s)
- Xueyu Chen
- Department of Neonatology, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xuemei Huang
- Department of Neonatology, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
- Department of Neonatology, Liuzhou Maternity and Child Healthcare Hospital, Affiliated Maternity Hospital and Affiliated Children's Hospital of Guangxi University of Science and Technology, Guangxi, China
| | - Yanqing Lin
- Department of Neonatology, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Bingchun Lin
- Department of Neonatology, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Chunyu Yang
- Department of Radiology, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Guangzhou, China
| | - Zhifeng Huang
- Department of Neonatology, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Chuanzhong Yang
- Department of Neonatology, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China.
| |
Collapse
|
2
|
Viscardi RM, Magder LS, Terrin ML, Davis NL. Predicting the likelihood of lower respiratory tract Ureaplasma infection in preterms. Arch Dis Child Fetal Neonatal Ed 2023; 108:250-255. [PMID: 36261143 PMCID: PMC10113605 DOI: 10.1136/archdischild-2022-324192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/06/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop predictive models of Ureaplasma spp lower airway tract infection in preterm infants. METHODS A dataset was assembled from five cohorts of infants born <33 weeks gestational age (GA) enrolled over 17 years (1999-2016) with culture and/or PCR-confirmed tracheal aspirate Ureaplasma status in the first week of life (n=415). Seventeen demographic, obstetric and neonatal factors were analysed including admission white blood cell (WBC) counts. Best subset regression was used to develop three risk scores for lower airway Ureaplasma infection: (1) including admission laboratory values, (2) excluding admission laboratory values and (3) using only data known prenatally. RESULTS GA and rupture of membranes >72 hours were significant predictors in all 3 models. When all variables including admission laboratory values were included in the regression, WBC count was also predictive in the resulting model. When laboratory values were excluded, delivery route was found to be an additional predictive factor. The area under the curve for the receiver operating characteristic indicated high predictive ability of each model to identify infants with lower airway Ureaplasma infection (range 0.73-0.77). CONCLUSION We developed predictive models based on clinical and limited laboratory information available in the perinatal period that can distinguish between low risk (<10%) and high risk (>40%) of lower airway Ureaplasma infection. These may be useful in the design of phase III trials of therapeutic interventions to prevent Ureaplasma-mediated lung disease in preterm infants and in clinical management of at-risk infants.
Collapse
Affiliation(s)
- Rose Marie Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Laurence S Magder
- Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael L Terrin
- Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Natalie L Davis
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
3
|
Van Mechelen K, van Westering-Kroon E, Hütten M, Mahieu L, Villamor E. Placing Ureaplasma within the Context of Bronchopulmonary Dysplasia Endotypes and Phenotypes. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020256. [PMID: 36832386 PMCID: PMC9955705 DOI: 10.3390/children10020256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 02/03/2023]
Abstract
Different pathophysiological pathways (endotypes), leading to very preterm birth may result in distinct clinical phenotypes of bronchopulmonary dysplasia (BPD). Ureaplasma is a unique player in the pathogenesis of BPD. The interaction between factors inherent to Ureaplasma (virulence, bacterial load, duration of exposure), and to the host (immune response, infection clearance, degree of prematurity, respiratory support, concomitant infections) may contribute to BPD development in a variable manner. The data reviewed herein support the hypothesis that Ureaplasma, as a representative of the infectious/inflammatory endotype, may produce pulmonary damage predominantly in parenchyma, interstitium, and small airways. In contrast, Ureaplasma may have a very limited role in the pathogenesis of the vascular phenotype of BPD. In addition, if Ureaplasma is a key factor in BPD pathogenesis, its eradication by macrolides should prevent BPD. However, various meta-analyses do not show consistent evidence that this is the case. The limitations of current definitions and classifications of BPD, based on respiratory support needs instead of pathophysiology and phenotypes, may explain this and other failures in strategies aimed to prevent BPD. The precise mechanisms through which Ureaplasma infection leads to altered lung development and how these pathways can result in different BPD phenotypes warrant further investigation.
Collapse
Affiliation(s)
- Karen Van Mechelen
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Elke van Westering-Kroon
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Matthias Hütten
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Ludo Mahieu
- Department of Neonatology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center, School for Oncology and Reproduction (GROW), Maastricht University, 6229 HX Maastricht, The Netherlands
- Correspondence:
| |
Collapse
|
4
|
Zöllkau J, Pieper DH, Pastuschek J, Makarewicz O, Mentzel HJ, Dawczynski K, Schleußner E. Lethal Neonatal Respiratory Failure by Perinatal Transmission of Ureaplasma Parvum after Maternal PPROM. Z Geburtshilfe Neonatol 2020; 225:361-365. [PMID: 33339061 DOI: 10.1055/a-1326-2719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A primiparous pregnant woman was admitted due to preterm premature rupture of membranes (PPROM) at 27+0 week of gestational age (WGA). Conventional vaginal microbiological analysis had no pathological finding. Management decisions based on national guidelines included antenatal corticoids, tocolytics and antibiotics. Unstoppable efforts of preterm labor in 28+0 WGA and supposed amniotic infection syndrome necessitated emergency cesarean section. The preterm infant underwent NICU therapy, developed an early-onset neonatal sepsis and therapy-refractory pulmonary insufficiency with consecutive right heart failure, resulting in death on the 36th day of life. Microbiota analyses by 16Sr DNA sequencing was performed from maternal vaginal swabs and from neonatal pharyngeal swabs. Maternal antibiotic treatment resulted in depletion of physiological vaginal colonization with Lactobacillus crispatus. Ureaplasma parvum became the dominant vaginal microorganism at delivery and was detected in high relative abundance in the neonatal specimen. Progressive radiological air-space changes and interstitial pathologies associated with Ureaplasma infection (bronchopulmonary dysplasia type III) were seen early at the 3rd and distinctly from 14th day of life. This clearly demonstrates the need of vaginal colonization diagnostics in PPROM patients and awareness of the consecutive risks in the preterm. Vaginal microbiome analysis may allow individualized and targeted maternal and fetal diagnostic, prophylactic and therapeutic strategies to identify, protect and treat the high-risk neonates after PPROM.
Collapse
Affiliation(s)
- Janine Zöllkau
- Obstetrics, Jena University Hospital, Jena, Germany.,Center for Sepsis Control and Case (CSCC), Jena University Hospital, Jena, Germany
| | - Dietmar H Pieper
- Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Jana Pastuschek
- Obstetrics, Jena University Hospital, Jena, Germany.,Center for Sepsis Control and Case (CSCC), Jena University Hospital, Jena, Germany
| | - Oliwia Makarewicz
- Center for Sepsis Control and Case (CSCC), Jena University Hospital, Jena, Germany.,Institute for Infectious Diseases and Infection Control (IIMK), Jena University Hospital, Jena, Germany
| | - Hans-Joachim Mentzel
- Department of Radiology, Section Pediatric Radiology, Jena University Hospital, Jena, Germany
| | - Kristin Dawczynski
- Center for Sepsis Control and Case (CSCC), Jena University Hospital, Jena, Germany.,Department of Pediatrics, Section Neonatology, Jena University Hospital, Jena, Germany
| | - Ekkehard Schleußner
- Obstetrics, Jena University Hospital, Jena, Germany.,Center for Sepsis Control and Case (CSCC), Jena University Hospital, Jena, Germany
| |
Collapse
|
5
|
Viscardi RM, Kallapur SG. Role of Ureaplasma Respiratory Tract Colonization in Bronchopulmonary Dysplasia Pathogenesis: Current Concepts and Update. Clin Perinatol 2015; 42:719-38. [PMID: 26593075 PMCID: PMC4662049 DOI: 10.1016/j.clp.2015.08.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Respiratory tract colonization with the genital mycoplasma species Ureaplasma parvum and Ureaplasma urealyticum in preterm infants is a significant risk factor for bronchopulmonary dysplasia (BPD). Recent studies of the ureaplasmal genome, animal infection models, and human infants have provided a better understanding of specific virulence factors, pathogen-host interactions, and variability in genetic susceptibility that contribute to chronic infection, inflammation, and altered lung development. This review provides an update on the current evidence supporting a causal role of ureaplasma infection in BPD pathogenesis. The current status of antibiotic trials to prevent BPD in Ureaplasma-infected preterm infants is also reviewed.
Collapse
Affiliation(s)
- Rose Marie Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, 110 South Paca Street, 8th Floor, Baltimore, MD 21093, USA.
| | - Suhas G Kallapur
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333, Burnet Avenue, Cincinnati, OH 45229, USA
| |
Collapse
|
6
|
Resch B, Gutmann C, Reiterer F, Luxner J, Urlesberger B. Neonatal Ureaplasma urealyticum colonization increases pulmonary and cerebral morbidity despite treatment with macrolide antibiotics. Infection 2015; 44:323-7. [PMID: 26518581 DOI: 10.1007/s15010-015-0858-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/17/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the influence of Ureaplasma urealyticum (UU) colonization on neonatal pulmonary and cerebral morbidity. METHODS Single-center case-control study including all preterm infants with positive UU tracheal colonization between 1990 and 2012. Cases were matched with controls by birth year, gestational age, birth weight, and sex. All cases had received macrolide antibiotics for UU infection starting at the time of first positive culture results from tracheal aspirates. Main outcome parameters included presence and severity of hyaline membrane disease (IRDS), duration of ventilation, bronchopulmonary dysplasia at 36 postmenstrual age and neurological morbidities (seizures, intra-/periventricular hemorrhages-I/PVH, periventricular leukomalacia-PVL). RESULTS Of 74 cases identified 8 died and 4 had to be excluded; thus, 62 preterm infants were compared to 62 matched controls. UU was significantly associated with IRDS (79 vs. 61 %, p = 0.015), BPD (24 vs. 6 %, p = 0.003), seizures (23 vs. 5 %, p = 0.002) and I/PVH (45 vs. 24 %, p = 0.028). Cases had longer duration of mechanical ventilation and total duration of invasive and non-invasive ventilation (median 11 vs. 6 days p = 0.006 and 25 vs. 16.5 days p = 0.019, respectively). CONCLUSION UU was found to be significantly associated with pulmonary short- and long-term morbidity and mild cerebral impairment despite treatment with macrolide antibiotics.
Collapse
Affiliation(s)
- Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria. .,Division of Neonatology, Department of Pediatrics, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
| | - C Gutmann
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - F Reiterer
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - J Luxner
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - B Urlesberger
- Division of Neonatology, Department of Pediatrics, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| |
Collapse
|
7
|
Hirata K, Nishihara M, Shiraishi J, Hirano S, Matsunami K, Sumi K, Wada N, Kawamoto Y, Nishikawa M, Nakayama M, Kanazawa T, Kitajima H, Fujimura M. Perinatal factors associated with long-term respiratory sequelae in extremely low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2015; 100:F314-9. [PMID: 25783193 DOI: 10.1136/archdischild-2014-306931] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 02/19/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess lung function at 8 years old in extremely low birthweight (ELBW) survivors and to identify perinatal determinants associated with impaired lung function. DESIGN Retrospective cohort study. SETTING Level III neonatal intensive care unit. PATIENTS ELBW survivors born in 1990-2004 with available spirometry at 8 years old were studied. Children were excluded if they had a Wechsler Intelligence Scale for Children Third Edition full IQ <70. MAIN OUTCOME MEASURES Multivariate logistic regression analysis was used to identify perinatal determinants associated with airway obstruction (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <80%) at school age and the predictive power of potential determinants. Potential risk factors and predictors assessed in this study were gestational age, birth weight, small for gestational age, sex, chorioamnionitis, premature rupture of membranes, antenatal steroids, surfactant administration, respiratory distress syndrome, postnatal steroids, severe bronchopulmonary dysplasia and bubbly/cystic appearances of the lungs by X-ray during the neonatal period. RESULTS Of 656 ELBW survivors, 301 (45.9%) had attended a school-age follow-up at 8 years old. A total of 201 eligible children completed the lung function test. Bubbly/cystic appearance of the lungs (OR 4.84, 95% CI 1.26 to 18.70) was associated with a low FEV1/FVC ratio. Children with bubbly/cystic appearance had characteristics of immaturity and intrauterine inflammation. CONCLUSIONS Within a cohort of ELBW infants, a bubbly/cystic appearance of the lungs in the neonatal period was the strongest determinant of a low FEV1/FVC ratio at school age.
Collapse
Affiliation(s)
- Katsuya Hirata
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Masahiro Nishihara
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Jun Shiraishi
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Shinya Hirano
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Katsura Matsunami
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Kiyoaki Sumi
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Norihisa Wada
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Yutaka Kawamoto
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Masanori Nishikawa
- Department of Radiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Masahiro Nakayama
- Clinical Laboratory Medicine and Anatomic Pathology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Tadahiro Kanazawa
- Department of Comparative and Developmental Psychology, Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Hiroyuki Kitajima
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| | - Masanori Fujimura
- Department of Neonatal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan
| |
Collapse
|
8
|
Abstract
The genital mycoplasma species, Ureaplasma parvum and Ureaplasma urealyticum are the most common organisms isolated from infected amniotic fluid and placentas, and they contribute to adverse pregnancy outcomes including preterm birth and neonatal morbidities. In our institution, almost half of the preterm infants of less than 32 weeks gestation are Ureaplasma-positive in one or more compartment (respiratory, blood and/or cerebrospinal fluid), indicating that these organisms are the most common pathogens affecting this population. This review will focus on the compelling epidemiological and experimental evidence linking perinatal Ureaplasma species exposure to important morbidities of prematurity, such as bronchopulmonary dysplasia, intraventricular haemorrhage and necrotising enterocolitis.
Collapse
Affiliation(s)
- Rose Marie Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
9
|
Yada Y, Honma Y, Koike Y, Takahashi N, Momoi MY. Association of development of chronic lung disease of newborns with neonatal colonization of Ureaplasma and cord blood interleukin-8 level. Pediatr Int 2010; 52:718-22. [PMID: 20136721 DOI: 10.1111/j.1442-200x.2010.03095.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the present study was to investigate the association of chronic lung disease (CLD), neonatal Ureaplasma colonization, and interleukin-8 (IL-8) level of cord blood in preterm infants. METHODS In 77 infants of <32 weeks gestation, the relationship between IL-8 level of cord blood, neonatal colonization of Ureaplasma, histological chorioamnionitis (CAM), and development of CLD was studied. RESULTS Five infants died and 29 infants developed CLD. The CLD group had significantly lower gestation (mean ± SD: 26.6 ± 1.8 weeks) compared with the infants without CLD (28.9 ± 1.9 weeks, P < 0.0001). Logistic analysis showed that the development of CLD was associated with gestational age (odds ratio [OR], 0.5; 95% confidence interval (CI): 0.4-0.8) and Ureaplasma colonization (OR, 4.1; 95%CI: 1.2-14.4). Ureaplasma colonization was also associated with CAM (OR, 6.5; 95%CI: 1.8-23.5), absence of respiratory distress syndrome (OR, 6.2; 95%CI: 1.3-30.5), and development of CLD (OR, 4.0; 95%CI: 1.1-15.3). Elevated cord blood IL-8 ≥100 pg/mL was associated with female sex and the isolation of microorganisms (OR, 49.4; 95%CI: 4.6-525). CONCLUSION The development of CLD defined by oxygen requirement at 36 weeks was associated with neonatal Ureaplasma colonization but not with IL-8 level of cord blood. Elevated cord blood IL-8 was associated with neonatal microorganisms isolation.
Collapse
Affiliation(s)
- Yukari Yada
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | | | | | | | | |
Collapse
|
10
|
Riggs MA, Maunsell FP, Reyes L, Brown MB. Hematogenous infection of Sprague-Dawley rats with Mycoplasma pulmonis: development of a model for maternal and fetal infection. Am J Obstet Gynecol 2008; 198:318.e1-7. [PMID: 18068142 PMCID: PMC7118712 DOI: 10.1016/j.ajog.2007.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 08/16/2007] [Accepted: 09/24/2007] [Indexed: 11/02/2022]
Abstract
OBJECTIVES The specific objective of this study was to conduct a dose response experiment with Mycoplasma pulmonis in Sprague-Dawley rats to develop a reproducible animal model of maternal and fetal infection that would provide a versatile mechanism to address the innate fetal immune response during intrauterine infection. STUDY DESIGN Pregnant rats were infected intravenously at gestation day 14 with 0 (control), 10(1), 10(3), 10(5), and 10(7) colony forming units of M. pulmonis and necropsied at gestational day 18. Quantitative culture of maternal and fetal tissues as well as histopathologic examination of the placenta were performed. RESULTS We have characterized a rat model of maternal and fetal infection that can be manipulated by alteration of infectious dose. Colonization of Sprague-Dawley rat dam and fetal tissues by M. pulmonis occurred in a dose-dependent manner after intravenous inoculation (P < .001). Placental lesion severity increased with infection dose (P = .0001). The minimum threshold dose required to establish infection of the dam and fetus was at least 10(3) colony forming units, with consistent colonization of maternal and fetal tissues achieved only with 10(7) colony forming units. In some instances, rat fetal tissues could be colonized in the absence of concomitant amniotic fluid colonization. Interestingly, there appeared to be a predilection for colonization of the reproductive tissues. CONCLUSIONS In the Sprague-Dawley rat, the infection rate of both the dam and fetus can be controlled by the inoculum dose. Our data support the concept that hematogenous spread of M. pulmonis to the rat fetus can occur without amniotic fluid infection and suggest that the fetus itself can potentially seed the amniotic fluid with microorganisms. Importantly, manipulation of both the route of infection as well as infection dose provide a reproducible way to study both maternal and fetal immune response to infection during pregnancy.
Collapse
Affiliation(s)
- Margaret A. Riggs
- Department of Infectious Diseases and Pathology, University of Florida College of Veterinary Medicine, Gainesville, FL,Kentucky Department for Public Health, United States Public Health Service, Frankfort, KY
| | - Fiona P. Maunsell
- Department of Infectious Diseases and Pathology, University of Florida College of Veterinary Medicine, Gainesville, FL
| | - Leticia Reyes
- Department of Infectious Diseases and Pathology, University of Florida College of Veterinary Medicine, Gainesville, FL
| | - Mary B. Brown
- Department of Infectious Diseases and Pathology, University of Florida College of Veterinary Medicine, Gainesville, FL
| |
Collapse
|
11
|
Moss TJ, Knox CL, Kallapur SG, Nitsos I, Theodoropoulos C, Newnham JP, Ikegami M, Jobe AH. Experimental amniotic fluid infection in sheep: effects of Ureaplasma parvum serovars 3 and 6 on preterm or term fetal sheep. Am J Obstet Gynecol 2008; 198:122.e1-8. [PMID: 18166324 DOI: 10.1016/j.ajog.2007.06.065] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 03/16/2007] [Accepted: 06/28/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the study was to determine the effects in late gestation of Ureaplasma parvum serovar 3 colonization and the effects, preterm, of U. parvum serovar 6. STUDY DESIGN Ewes received an intraamniotic (i.a.) injection of U. parvum serovar 6 (20 x 10(6) colony-forming units [cfu]; n = 9), U. parvum serovar 3 (20 x 10(3) cfu; n = 6), vehicle (n = 10), or saline (n = 4) on day 80 of pregnancy (d). The lambs were delivered at 125 d (U. parvum serovar 6, n = 9; saline or media controls, n = 9) or 145 d (U. parvum serovar 3, n = 6; media controls, n = 5) for assessment of inflammation and lung maturation. RESULTS I.a. ureaplasmas caused histologic chorioamnionitis but not preterm delivery. Fetal lung epithelium was colonized with ureaplasmas at both gestational ages, and pulmonary interleukin-8 levels had doubled in the ureaplasma-colonized animals, compared with the controls at 145 d. Surfactant levels in bronchoalveolar lavage fluid had increased 8-fold and 2.5-fold at 125 and 145 d, respectively, after ureaplasma injection. CONCLUSION Fetal lung inflammation and altered development accompanies ureaplasma colonization, regardless of age at delivery.
Collapse
|
12
|
Honma Y, Yada Y, Takahashi N, Momoi MY, Nakamura Y. Certain type of chronic lung disease of newborns is associated with Ureaplasma urealyticum infection in utero. Pediatr Int 2007; 49:479-84. [PMID: 17587272 DOI: 10.1111/j.1442-200x.2007.02391.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent studies of chronic lung disease (CLD) of newborns emphasize the contribution of antenatal infection. However, the association of Ureaplasma urealyticum infection and CLD has been controversial. The purpose of the present paper was to determine whether U. urealyticum is associated with chorioamnionitis (CAM) and a certain type of CLD. METHODS One hundred and five infants <32 weeks of gestation who were admitted to the neonatal intensive care unit at Jichi Medical School Hospital, who underwent both histological and microbiological examinations and who survived to discharge were included. CAM was determined by histological examination. Placenta, gastric and tracheal aspirates, and nasopharyngeal swabs were cultured for Mycoplasma and other microorganisms. CLD was defined as oxygen needed at 28 days of age with symptoms of persistent respiratory distress and hazy or emphysematous and fibrous appearance upon X-ray. CLD was further divided into two subtypes according to the presence of antenatal infection. RESULTS CAM was associated with premature rupture of membrane (odds ratio [OR], 10.19; 95% confidence interval [CI]: 3.10-33.56), placental colonization of U. urealyticum (OR 6.73, 95%CI: 1.89-23.91), neonatal colonization of other microorganisms (OR 7.33, 95%CI: 1.22-44.13) and level of IgM (OR 1.06, 95%CI: 1.01-1.11). Comparisons between CLD and non-CLD patients showed that gestational age (OR 0.43, 95%CI: 0.30-0.61) and white blood cell count (WBC) at birth (OR 1.06, 95%CI: 1.01-1.11) were risk factors for CLD, while gestational age (OR 0.38, 95%CI: 0.23-0.64), neonatal colonization of U. urealyticum (OR 5.98, 95%CI: 1.17-30.6) and WBC (OR 1.08, 95%CI: 1.01-1.15) were independent risk factors for infection-related CLD compared with non-CLD. Within CLD, infection-related CLD was associated with neonatal colonization of U. urealyticum (OR 43.7, 95%CI: 2.84-673.8) and WBC (OR 1.27, 95%CI: 1.07-1.50). CONCLUSIONS Placental colonization of U. urealyticum was significantly related to CAM; and neonatal colonization of U. urealyticum and leukocytosis at birth were risk factors for infection-related CLD.
Collapse
Affiliation(s)
- Yoko Honma
- Department of Pediatrics, Jichi Medical School, Tochigi, Japan
| | | | | | | | | |
Collapse
|
13
|
Abstract
Infection with the ureaplasmas may occur in utero or perinatally in prematurely born infants. For some infants, infection with these organisms triggers a vigorous pro-inflammatory response in the lungs and increases the risk of developing bronchopulmonary dysplasia (BPD). At present, there is insufficient evidence from clinical trials to determine whether antibiotic treatment of Ureaplasma has any influence on the development of BPD and its comorbidities. Future investigation in the context of well-designed, adequately powered controlled clinical trials should focus on determining whether treatment of ureaplasmal infection lessens lung inflammation, decreases rates of BPD, and improves long-term, neurodevelopmental outcome.
Collapse
Affiliation(s)
- Robert L Schelonka
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
| | | |
Collapse
|
14
|
Ogihara T, Hirano K, Morinobu T, Kim HS, Ogawa S, Hiroi M, Oue S, Ban R, Hira S, Hasegawa M, Yamaoka S, Yasui M. Plasma KL-6 predicts the development and outcome of bronchopulmonary dysplasia. Pediatr Res 2006; 60:613-8. [PMID: 16988187 DOI: 10.1203/01.pdr.0000242361.47408.51] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Circulating KL-6 is a specific indicator of pulmonary injury affecting the alveolar epithelium and interstitium. Our preliminary study suggested the usefulness of plasma KL-6 as a marker of bronchopulmonary dysplasia (BPD). To confirm the diagnostic value of KL-6 for BPD as well as to determine the reference range, we conducted a larger prospective study in 135 preterm infants <32 wk GA. Among the infants without oxygen dependence at a postconceptional age of 36 wk, the plasma KL-6 level showed no significant association with GA at any time. Among 42 infants <28 wk GA, plasma KL-6 levels were significantly higher in those with moderate/severe BPD compared with those with no/mild BPD. A plasma level of 199 U/mL at 1 wk or 232 U/mL at 2 wk was an excellent predictor of moderate/severe BPD <28 wk GA (positive predictive value of 83% and 80%, respectively). Unlike nonspecific markers of inflammation or fibrosis, KL-6 objectively reflects the severity of pulmonary injury irrespective of the treatment or the radiographic changes. Therefore, not only as a good marker, measurement of KL-6 may also help to provide new insights into the pathogenesis of BPD.
Collapse
Affiliation(s)
- Tohru Ogihara
- Department of Neonatal Medicine, Perinatal Center, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Agrons GA, Courtney SE, Stocker JT, Markowitz RI. From the archives of the AFIP: Lung disease in premature neonates: radiologic-pathologic correlation. Radiographics 2006; 25:1047-73. [PMID: 16009823 DOI: 10.1148/rg.254055019] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary disease is the most important cause of morbidity in preterm neonates, whose lungs are often physiologically and morphologically immature. Surfactant deficiency in immature lungs triggers a cascade of alveolar instability and collapse, capillary leak edema, and hyaline membrane formation. The term respiratory distress syndrome (RDS) has come to represent the clinical expression of surfactant deficiency and its nonspecific histologic counterpart, hyaline membrane disease. Historically, chest radiographs of infants with RDS predictably demonstrated decreased pulmonary expansion, symmetric generalized reticulogranular lung opacities, and air bronchograms. Refinements in perinatal medicine, including antenatal glucocorticoid administration, surfactant replacement therapy, and increasingly sophisticated ventilatory strategies have decreased the prevalence of RDS and air leak, altered familiar radiographic features, and lowered the threshold of potential viability to a gestational age of approximately 23 weeks. Alveolar paucity and pulmonary interstitial thickness in these profoundly premature neonates impair normal gas exchange and may necessitate prolonged mechanical ventilation, increasing the risk of lung injury. Bronchopulmonary dysplasia (BPD), alternatively termed chronic lung disease of infancy, is a disorder of lung injury and repair originally ascribed to positive-pressure mechanical ventilation and oxygen toxicity. Before the advent of surfactant replacement therapy, chest radiographs of infants with classic BPD demonstrated coarse reticular lung opacities, cystic lucencies, and markedly disordered lung aeration that reflected alternating regions of alveolar septal fibrosis and hyperinflated normal lung parenchyma. In the current era of surfactant replacement, BPD is increasingly a disorder of very low-birth-weight neonates with arrested alveolar and pulmonary vascular development, minimal alveolar septal fibrosis and inflammation, and more subtle radiographic abnormalities.
Collapse
Affiliation(s)
- Geoffrey A Agrons
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th St NW, Washington, DC 20306, USA.
| | | | | | | |
Collapse
|
16
|
Prävention und Therapie der bronchopulmonalen Dysplasie. Monatsschr Kinderheilkd 2005. [DOI: 10.1007/s00112-005-1259-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
17
|
Abstract
The genital mycoplasmas represent a complex and unique group of microorganisms that have been associated with a wide array of infectious diseases in adults and infants. The lack of conclusive knowledge regarding the pathogenic potential of Mycoplasma and Ureaplasma spp. in many conditions is due to a general unfamiliarity of physicians and microbiology laboratories with their fastidious growth requirements, leading to difficulty in their detection; their high prevalence in healthy persons; the poor design of research studies attempting to base association with disease on the mere presence of the organisms in the lower urogenital tract; the failure to consider multifactorial aspects of diseases; and considering these genital mycoplasmas only as a last resort. The situation is now changing because of a greater appreciation of the genital mycoplasmas as perinatal pathogens and improvements in laboratory detection, particularly with regard to the development of powerful molecular nucleic acid amplification tests. This review summarizes the epidemiology of genital mycoplasmas as causes of neonatal infections and premature birth; evidence linking ureaplasmas with bronchopulmonary dysplasia; recent changes in the taxonomy of the genus Ureaplasma; the neonatal host response to mycoplasma and ureaplasma infections; advances in laboratory detection, including molecular methods; and therapeutic considerations for treatment of systemic diseases.
Collapse
Affiliation(s)
- Ken B Waites
- Department of Pathology, University of Alabama, Birmingham, Alabama 35249, USA.
| | | | | |
Collapse
|
18
|
Aujard Y, Maury L, Doit C, Mariani-Kurkdjian P, Baud O, Farnoux C, Bingen E. Ureaplasma urealyticum, Mycoplasma hominis et pathologiesnéonatales : Données personnelles et revue de la littérature. Arch Pediatr 2005; 12 Suppl 1:S12-8. [PMID: 15893230 DOI: 10.1016/s0929-693x(05)80004-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ureaplasma urealyticum and Mycoplasma hominis colonized 20-40% of newborns and are more frequent in premature. They are responsible for localized infections such as pleural effusion, pneumopathy, adenopathy, abscess or systemic sepsis. An important hyperleukocytosis is often associated with pulmonary infections. Their responsibility, as pathogen agents, is questionable in some non bacterial meningitis. There is large controversy for their role as cofactor, in chronic lung disease (bronchopulmonary dysplasia) and periventricular leukomalacia, because of a too low number of newborns in prospective trials. Genital mycoplamas are resistant to beta lactamines. Macrolides have a good sensitivity, particularly josamycine, but Mycoplasma hominis is resistant to erythromycin. For systemic sepsis, fluoroquinolones such as ciprofloxacine have less deleterious effects than IV erythromycin.
Collapse
Affiliation(s)
- Y Aujard
- Laboratoire de microbiologie, hôpital Robert-Debré, assistance publique-hôpitaux de Paris, 48, boulevard Sérurier, 75019 Paris, France.
| | | | | | | | | | | | | |
Collapse
|