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Hu Z, Zeng D, Yang Y, Liu H, Wang A, Li D, Liu M, Feng Y. Pathomorphological characteristics of tuberculous placenta and its clinical implication. Diagn Pathol 2023; 18:128. [PMID: 38031157 PMCID: PMC10685481 DOI: 10.1186/s13000-023-01419-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The study of pathologic diagnosis of placental TB is rare. The aim of this study is analyzing the pathomorphological characteristics of tuberculosis (TB) placenta during pregnancy and its clinical significance. METHODS Nineteen cases of placental tissue specimens during pregnancy were collected from June 2015 to February 2022 at Shanghai Public Health Clinical Center, the only inpatient center for pregnant women with TB in Shanghai, China. Hematoxylin-eosin staining, acid-fast staining, and molecular testing were applied to analyze them comprehensively in combination with clinical information. RESULTS Among the 19 cases, 7 cases caused intrauterine stillbirth, 3 cases received artificial abortion required by the pregnant woman, the other 9 cases received standard delivery and the infants survived, however, 3 of them were low-weight preterm infants, and another 1 case suffered mild intrauterine asphyxia. The 9 surviving infants were followed-up, of which 3 cases got congenital TB. For pathological characteristics of placental tissues under light microscopy, there were 3 cases of epithelioid granuloma formation, 13 cases of acute fetal membranitis, 4 cases of caseous necrosis, 7 cases of inflammatory necrosis, 10 cases of coagulative necrosis, and 6 cases with small focal calcifications. All placental tissues were positive for acid-fast staining and polymerase chain reaction (PCR). Molecular pathological diagnosis showed that 18 cases were positive for Mycobacterium tuberculosis, with 1 case not having received examination. CONCLUSIONS Combining acid-fast staining and molecular pathological testing is helpful for accurately diagnosing placental TB.
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Affiliation(s)
- Zhidong Hu
- Department of Scientific Research, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Dong Zeng
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuexiang Yang
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Huijun Liu
- Department of Pathology, The Fifth People's Hospital of Puyang, Puyang, Henan Province, China
| | - Ao Wang
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Duoduo Li
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Min Liu
- Department of Obstetrics and Gynecology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
| | - Yanling Feng
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
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Schaaf HS, Bekker A, Rabie H. Perinatal tuberculosis-An approach to an under-recognized diagnosis. Front Public Health 2023; 11:1239734. [PMID: 38026389 PMCID: PMC10661895 DOI: 10.3389/fpubh.2023.1239734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Tuberculosis (TB) in young infants (<3 months of age), often referred to as perinatal TB, is underdiagnosed, leading to severe morbidity and high mortality. Perinatal TB includes both congenital and postnatal transmission of Mycobacterium tuberculosis. We aimed to increase an awareness of TB in neonates and young infants and to provide guidance on the assessment and management when in contact with mothers with TB during or soon after pregnancy. Approximately 217,000 pregnant women develop TB annually; if they are not diagnosed and treated during pregnancy, their infants are at high risk of adverse birth outcomes and TB disease. Although safe and effective antituberculosis treatment regimens are available during pregnancy, the diagnosis of TB is challenging. Infants born to mothers newly diagnosed with TB, not receiving any effective treatment or with cultures not yet negative, should be assessed for TB disease or M. tuberculosis infection. TB preventive therapy should be instituted if the infant is clinically well but exposed to TB, while prompt initiation of TB treatment is essential if TB disease is presumed. HIV status of mother and infant should be considered as this will affect the management. Further research is needed for the diagnosis and prevention of TB during pregnancy, an early diagnosis of TB in infants, and antituberculosis drug pharmacokinetics in young infants.
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Affiliation(s)
- H. Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Helena Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Walles J, Otero LG, Tesfaye F, Abera A, Jansson M, Balcha TT, Sturegård E, Winqvist N, Hansson SR, Björkman P. Tuberculosis infection and stillbirth in Ethiopia—A prospective cohort study. PLoS One 2022; 17:e0261972. [PMID: 35404930 PMCID: PMC9000061 DOI: 10.1371/journal.pone.0261972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis is among the leading causes of death among infectious diseases. Regions with a high incidence of tuberculosis, such as sub-Saharan Africa, are disproportionately burdened by stillbirth and other pregnancy complications. Active tuberculosis increases the risk of pregnancy complications, but the association between latent tuberculosis infection (LTBI) and pregnancy outcomes is unknown. We explored the effect of latent tuberculosis infection on the risk of stillbirth in women attending antenatal care clinics in Ethiopia, a country with >170 000 annual cases of active tuberculosis. Method Pregnant women were enrolled from antenatal care at three health facilities in Adama, Ethiopia, during 2015–2018, with assessment for previous and current active tuberculosis and testing for LTBI using QuantiFERON-TB-GOLD-PLUS. Proportions of stillbirth (≥ 20 weeks of gestation) and neonatal death (< 29 days of birth) were compared with respect to categories of maternal tuberculosis infection (tuberculosis-uninfected, LTBI, previous-, and current active tuberculosis). Multivariable logistic regression was performed for stillbirth. Results Among 1463 participants enrolled, the median age was 25 years, 10.2% were HIV-positive, 34.6% were primigravidae, and the median gestational age at inclusion was 18 weeks. Four (0.3%) were diagnosed with active tuberculosis during pregnancy, 68 (4.6%) reported previous treatment for active tuberculosis, 470 (32.1%) had LTBI, and 921 (63.0%) were tuberculosis-uninfected. Stillbirth was more frequent in participants with LTBI compared to tuberculosis-uninfected participants, although not reaching statistical significance (19/470, 4.0% vs 25/921, 2.7%, adjusted [for age, gravidity and HIV serostatus] odds ratio 1.38, 95% confidence interval 0.73–2.57, p = 0.30). Rates of neonatal death (5/470, 1.1% vs 10/921, 1.1%) were similar between these categories. Conclusion Latent tuberculosis infection was not significantly associated with stillbirth or neonatal death in this cohort. Studies based on larger cohorts and with details on causes of stillbirth, as well as other pregnancy outcomes, are needed to further investigate this issue.
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Affiliation(s)
- John Walles
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Central Hospital, Kristianstad, Sweden
- * E-mail:
| | - Laura García Otero
- Fetal Medicine Research Center, BCNatal—Barcelona Center for Maternal-Fetal and Neonatal Medicine, University of Barcelona, Barcelona, Spain
- Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), University of Barcelona, Barcelona, Spain
| | - Fregenet Tesfaye
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Asmamaw Abera
- Ethiopia Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marianne Jansson
- Medical Microbiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Taye Tolera Balcha
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Erik Sturegård
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Clinical Microbiology, Division of Laboratory Medicine, Lund, Sweden
| | - Niclas Winqvist
- Skåne Regional Office for Infectious Disease Control and Prevention, Malmö, Sweden
| | - Stefan R. Hansson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
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Diagnosing Common Deadly Infections in the Era of COVID-19: A Case Report. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021; 29:e462-e464. [PMID: 34803352 PMCID: PMC8594391 DOI: 10.1097/ipc.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic has challenged clinicians to recognize COVID-19 as one of the diagnostic explanation for common presentations, including fever, cough, and shortness of breath. Latent tuberculosis is responsible for 80% of active tuberculosis cases in the United States, and presentation can vary from asymptomatic to disseminated disease. This potential diagnosis should be thoroughly investigated in foreign-born patients in US hospitals, regardless of travel history and presenting symptoms. We report a patient diagnosed with postpartum disseminated tuberculosis with hematogenous spread to the fetus.
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Li H, Wu Q, Hu J, Feng L, Wu Q, Yu H, Li L, Li X. Application of loop-mediated isothermal amplification and next-generation sequencing in the diagnosis of maternal tuberculosis with multiple negative tests: A case report. Medicine (Baltimore) 2021; 100:e27387. [PMID: 34596161 PMCID: PMC8483829 DOI: 10.1097/md.0000000000027387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Tuberculosis (TB) is one of the top 10 causes of death worldwide and is the leading infectious cause of death. The incidence of TB, especially active TB, is increased in pregnant and postpartum women. Newborns can be infected with TB from their mothers through several routes. Diagnosis of TB in pregnant women and infants is difficult. Here, we report the simultaneous postdelivery diagnosis of TB in a mother and infant pair. PATIENT CONCERNS A 28-year-old woman presented with a sudden onset of convulsions, loss of consciousness, coughing, fever, and breathing difficulty. Her 18-day-old infant daughter developed cough and wheezing. DIAGNOSIS The mother's chest computed tomography showed diffuse interstitial changes and both lungs' exudation. Enhanced cranial magnetic resonance imaging showed scattered nodular intracranial lesions. A tuberculin skin test and an interferon-gamma release assay were negative. Xpert MTB/RIF (Xpert) testing and acid-fast bacilli smear of bronchoalveolar lavage (BAL) fluid of the mother were negative. Loop-mediated isothermal amplification of BAL fluid was positive for Mycobacterium tuberculosis, and next-generation sequencing confirmed the diagnosis of TB. A biopsy specimen also showed characteristic TB findings. The mother was diagnosed with TB and TB encephalitis. The infant's BAL fluid was positive for acid-fast bacilli and Xpert and, therefore, was diagnosed with TB. INTERVENTIONS The mother was treated with rifampicin and isoniazid for 9 months, ethambutol and pyrazinamide for 3 months, and prednisolone acetate for 8 weeks. The infant received ventilator-assisted ventilation for 10 days and anti-tuberculous therapy for 11 months. OUTCOMES After anti-tuberculous therapy, the mother and infant both gradually recovered. The mother's chest computed tomography showed significant recovery 9 months after discharge. The infant developed normally during the 11-month follow-up. LESSONS This mother-child case pair highlights the value of loop-mediated isothermal amplification and next-generation sequencing as new diagnostic technologies for diagnosing TB in patients with multiple negative tests.
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Affiliation(s)
- Hongwei Li
- Department of Respiratory and Critical Care Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Qian Wu
- Department of Respiratory and Critical Care Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Jinmiao Hu
- Department of Respiratory and Critical Care Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Liting Feng
- Department of Respiratory and Critical Care Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Qi Wu
- Department of Respiratory and Critical Care Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Hongzhi Yu
- Department of Respiratory and Critical Care Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Li Li
- Department of Respiratory and Critical Care Medicine, Haihe Hospital, Tianjin University, Tianjin, China
| | - Xinhui Li
- Guangzhou Sagene Biotech Co., Ltd., Guangzhou, China
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Bruce-Brand C, Schubert PT, Wright CA. HIV, placental pathology and birth outcomes - a brief overview. J Infect Dis 2021; 224:S683-S690. [PMID: 33987644 DOI: 10.1093/infdis/jiab240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The spectrum of placental pathology in human immunodeficiency virus (HIV) is vast. Features observed are not only limited to the effects of the virus itself but may include that of coinfections such as tuberculosis and syphilis. The presence of other comorbidities and changes as a result of antiretroviral therapy may further confound the histologic findings. There is a paucity of unbiased information of the effects of maternal HIV on the placenta and how these changes relate to birth outcomes. Antiretroviral therapy, now in widespread use, has altered the course of maternal HIV disease and it is unknown whether this has altered the pathophysiology of HIV on the placenta. HIV-associated placental findings that have been most well described include acute chorioamnionitis, low placental weight and maternal vascular malperfusion, with a tendency towards lower rates of chronic villitis.
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Affiliation(s)
- Cassandra Bruce-Brand
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pawel T Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Miranda L, Kugasia I, Han L, Chandy D, Epelbaum O. Tuberculous placenta: a rare bird but not extinct. Postgrad Med J 2021; 98:e27-e28. [PMID: 37066564 DOI: 10.1136/postgradmedj-2021-139902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/20/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Laura Miranda
- Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Irfanali Kugasia
- Department of Pulmonary and Critical Care, Baylor Scott and White Medical Center, Waxahachie, Texas, USA
| | - Liying Han
- Department of Pathology, Westchester Medical Center, Valhalla, New York, USA
| | - Dipak Chandy
- Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care and Sleep Medicine, Westchester Medical Center Health Network, Valhalla, New York, USA
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Raj T, Pierce B, Brady R. Decidual Granulomata of Unclear Significance. Pediatr Dev Pathol 2020; 23:352-355. [PMID: 32340561 DOI: 10.1177/1093526620912638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Granulomatous inflammation is a histologic finding with a relatively wide variety of causes. In general, considerations include infectious etiologies, autoimmune conditions, or foreign body reactions. Granulomatous inflammation is uncommonly seen in the placenta. We present a unique case of a young woman with preterm labor and rupture of membranes whose placenta demonstrated perivascular decidual granulomata in the membranes and the basal plate.
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Affiliation(s)
- Thomas Raj
- Department of Pathology, Tripler Army Medical Center, Honolulu, Hawaii
| | - Brian Pierce
- Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii
| | - Robert Brady
- Department of Pathology, Brooke Army Medical Center, San Antonio, Texas
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Taweevisit M, Nisagornsen C, Thorner PS. Intrauterine Tuberculosis Manifesting as Acute Chorioamnionitis: A Case Report and Review of the Literature. Pediatr Dev Pathol 2015; 18:335-8. [PMID: 25856142 DOI: 10.2350/15-02-1607-cr.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Congenital tuberculosis involving the placenta is an infrequent diagnosis, and the typical features of tuberculous placentitis involve a granulomatous reaction, reflecting a delayed hypersensitivity immune response in the host. However, the first reaction of the placenta to organisms hematogenously transmitted from the maternal circulation typically involves the innate immune response, manifesting as an acute neutrophilic villitis or intervillositis or both. This acute pattern of response to mycobacteria has only been documented rarely. We present a case of acute mycobacterial infection occurring in a preterm female with 28-weeks gestation, who was delivered by cesarean section because of fetal distress and who was subsequently confirmed to have congenital tuberculosis. The placenta showed an acute chorioamnionitis associated with acid-fast bacilli consistent with Mycobacteria tuberculosis. The mother was found to have a necrotizing granulomatous deciduitis, and that was postulated to have resulted in the direct spread of mycobacteria to the amniotic cavity. Thus, our case extends the acute placental response to mycobacteria to include chorioamnionitis. Although extremely rare, mycobacteria should be considered in the differential diagnosis of infectious agents causing acute chorioamnionitis, especially in geographic areas where tuberculosis is more prevalent.
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Affiliation(s)
- Mana Taweevisit
- 1 Department of Pathology, Faculty of Medicine, Chulalongkorn University, 1873 King Rama IV Street, Pathumwan, Bangkok 10330, Thailand
| | - Charuwan Nisagornsen
- 2 Department of Anatomical Pathology, Queen Savang Vadhena Memorial Hospital, Thai Red Cross Society, 290 Si Racha District, Chon Buri 20110, Thailand
| | - Paul Scott Thorner
- 1 Department of Pathology, Faculty of Medicine, Chulalongkorn University, 1873 King Rama IV Street, Pathumwan, Bangkok 10330, Thailand.,3 Department of Pathology and Laboratory Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada.,4 University of Toronto, 27 King's College Circle, Toronto, ON M5G1X8, Canada
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Labarrere CA, Hardin JW, Haas DM, Kassab GS. Chronic villitis of unknown etiology and massive chronic intervillositis have similar immune cell composition. Placenta 2015; 36:681-6. [PMID: 25911290 DOI: 10.1016/j.placenta.2015.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Chronic villitis of unknown etiology (CVUE) and massive chronic intervillositis (MCI) are placental lesions associated with infiltration of mononuclear cells in the chorionic villi and the intervillous spaces, respectively. It is not well known whether immune cells in CVUE and MCI have similar phenotypic characteristics. METHODS A cross-sectional study of third trimester placentas was conducted to identify immune cell subpopulations in CVUE and MCI (n = 17/group). CVUE was diagnosed with H&E staining and antibody to CD3 in serial sections; and MCI, by the presence of massive infiltration of mononuclear cells in the intervillous spaces. Immune cells, ICAM-1 expression and nuclear factor κB (NF-κB) activation were determined immunohistochemically. RESULTS CVUE and MCI showed similar infiltrates, mainly CD68+ and CD3+ cells. Most cells (>80%) were CD45RB+, and one third were CD45RO+ in both lesions. There were slightly more CD8+ than CD4+ cells in both CVUE and MCI. More than 90% of cells in CVUE and MCI were ICAM-1+ with NFκB nuclear localization. Syncytiotrophoblast ICAM-1 expression was significantly (p < 0.001) higher in MCI (mean of 81.0; range of 71.6-86.0) than in CVUE (52.4; 36.4-59.4) or normal placentas (0.2; 0.0-0.6). Both, failure of physiologic transformation of spiral arteries and placental atherosclerosis-like lesions of atherosis were significantly more frequent in MCI than in CVUE or normal placentas (p = 0.044 and p = 0.007, respectively). DISCUSSION These finding suggest that MCI and CVUE have very similar infiltration of immune cells although MCI has more severe placental lesions.
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Affiliation(s)
- C A Labarrere
- CBL Partners for Life, Indianapolis, IN, USA; California Medical Innovations Institute, San Diego, CA, USA.
| | - J W Hardin
- Epidemiology and Biostatistics, Columbia, SC, USA
| | - D M Haas
- Obstetrics and Gynecology, Indiana University School of Medicine Wishard-Eskenazi Hospital, Indianapolis, IN, USA
| | - G S Kassab
- California Medical Innovations Institute, San Diego, CA, USA
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Vogel M, Schroten H, Kahl P, Müller A. High latency of tuberculosis manifestation in a premature extremely low birth weight infant with favorable outcome. Neonatology 2014; 105:91-4. [PMID: 24296485 DOI: 10.1159/000355538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/29/2013] [Indexed: 12/14/2022]
Abstract
We report a case of possible congenital tuberculosis in a 22+2 weeks, 460 g, vaginally delivered female infant born to a mother suffering from tuberculous endometritis, diagnosed soon after delivery. At 156 days of age, Mycobacterium tuberculosis was detected via PCR from the infant's gastric juice and was subsequently isolated. There was no evidence for horizontal transmission. Mother and child were treated successfully. This case illustrates the possibility of significant latency between infection and clinical manifestation in preterm infants and also emphasizes the need for urgent treatment of neonates in such situations.
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Affiliation(s)
- Markus Vogel
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital of Düsseldorf, Düsseldorf, Germany
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Abstract
Villitis of unknown etiology (VUE) is a common lesion affecting from 6.6% to 33.8% of third-trimester placentas. VUE needs to be distinguished from villitis of infectious etiology, most commonly cytomegalovirus and syphilis. Clinically, this lesion is associated with intrauterine growth retardation, intrauterine fetal demise, fetal neural impairment, maternal alloimmune and autoimmune disease, and maternal hypertension. It has a tendency to recur in subsequent pregnancies. Massive chronic intervillositis (MCI), also known as chronic histiocytic intervillositis, is a rare lesion that has an unclear relationship with VUE. MCI is associated with recurrent abortions.
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Affiliation(s)
- Joanna S Y Chan
- Department of Pathology, Anatomy, and Cell Biology; Thomas Jefferson University Hospital; 132 South 10th Street, Main Building; Philadelphia, PA 19123.
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Abstract
Acute chorioamnionitis is a major cause of spontaneous preterm birth, accounting for more than 40% of deliveries complicated by preterm premature rupture of membranes or preterm labor. In the majority of cases, especially in preterm births, acute chorioamnionitis is caused by ascending polymicrobial infection. Recent evidence suggests that in some cases acute chorioamnionitis may have a noninfectious cause. In addition to the nonspecific patterns of conventional acute chorioamnionitis, this article describes characteristic inflammatory patterns indicative of a specific infectious cause. Several inflammatory entities of putative immunologic (noninfectious) etiology are addressed, including eosinophilic/T-cell vasculitis and chronic chorioamnionitis.
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Affiliation(s)
- Füsun Gündoğan
- Department of Pathology, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA; Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02905, USA
| | - Monique E De Paepe
- Department of Pathology, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA; Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02905, USA.
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