Second Trimester Fetal Loss Due to Citrobacter koseri Infection: A Rare Cause of Preterm Premature Rupture of Membranes (PPROM)

Citrobacter enshiensis sp. nov., isolated from seleniferous soil

Two Gram-stain-negative, facultative anaerobic, rod-shaped bacterial strains, S171T and S2-9, were isolated from seleniferous soil in China. Comprehensive phylogenetic analyses based on 16S rRNA genes, multilocus sequences and whole genome sequences indicated that the two strains belonged to the genus Citrobacter. The average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) values of strains S171T and S2-9 with the closest relative Citrobacter koseri NCTC 10786T were 83.6-83.7% and 27.7-27.8 %, respectively, which were below the species cutoff values. The ANI and dDDH values between the two strains were 97.9% and 84.8 %, respectively. The biochemical characteristics revealed that selenite tolerance, H2S and indole production, arginine dihydrolase, ornithine decarboxylase, as well as acid production from carbon sources such as d-sorbitol and arbutin are distinctive features of the two strains. Based on these results, strain S171T and strain S2-9 represent a novel species of the genus Citrobacter, for which the name Citrobacter enshiensis sp. nov. is proposed, with strain S171T (=GDMCC 1.3637T=JCM 35851T) as the type strain. The genome size of strain S171T was 4.92 Mb with a G+C content of 52.6 mol%. The genome size of strain S2-9 was 4.89 Mb with a G+C content of 52.6 mol%.

Chorioamnionitis: An Update on Diagnostic Evaluation

Chorioamnionitis remains a major cause of preterm birth and maternal and neonatal morbidity. We reviewed the current evidence for the diagnostic tests of chorioamnionitis and how this relates to clinical practice today. A comprehensive literature search and review was conducted on chorioamnionitis and intra-uterine inflammation. Data from randomized control trials and systematic reviews were prioritized. This review highlights that sterile inflammation plays an important role in chorioamnionitis and that the current tests for chorioamnionitis including clinical criteria, maternal plasma and vaginal biomarkers lack diagnostic accuracy. Concerningly, these tests often rely on detecting an inflammatory response after damage has occurred to the fetus. Care should be taken when interpreting current investigations for the diagnosis of chorioamnionitis and how they guide obstetric/neonatal management. There is an urgent need for further validation of current diagnostic tests and the development of novel, accurate, minimally invasive tests that detect subclinical intra-uterine inflammation.