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Tonen-Wolyec S, Otuli NL, Otsatre-Okuti M, Atenyi-Kasemire R, Dupont R, Bélec L. Analytical performances of a point-of-care loop-mediated isothermal amplification assay to detect Group B Streptococcus in intrapartum pregnant women living in the Democratic Republic of the Congo. Int J Infect Dis 2024; 142:106972. [PMID: 38387704 DOI: 10.1016/j.ijid.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES Group B Streptococcus (GBS) is the leading infectious cause of stillbirth and neonatal morbidity and mortality in sub-Saharan Africa. METHODS Vaginal and rectovaginal swab samples were obtained from 274 intrapartum pregnant women in the Democratic Republic of the Congo to be analyzed for GBS DNA detection in parallel by the point-of-care BIOSYNEX AMPLIFLASH® GBS assay (Biosynex SA, Illkirch-Graffenstaden, France) and by reference quantitative polymerase chain reaction (qPCR). RESULTS Rectovaginal swabbing, nearly two-fold more positive for GBS than vaginal swabbing alone, showed a high prevalence of GBS DNA positivity in 20.1% of eligible intrapartum pregnant women. In the event of significant bacterial carriage (i.e., cycle threshold ≤33 by reference qPCR), the AMPLIFLASH® GBS assay with rectovaginal swabbing showed high sensitivity (98.1%) and specificity (100.0%) for GBS DNA detection, with excellent concordance, reliability, and accuracy with the reference qPCR, and positive predictive values and negative predictive values above 99.0%. CONCLUSIONS The study demonstrates a high rate of female rectogenital GBS colonization in pregnant Congolese women. The AMPLIFLASH® GBS assay harbored excellent analytical performances in the field, which makes it suitable to be used as point-of-care molecular assay in various hospital and non-hospital settings where rapid diagnosis of GBS is necessary.
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Affiliation(s)
- Serge Tonen-Wolyec
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of the Congo; Faculté de Médecine, Université de Bunia, Bunia, Democratic Republic of the Congo.
| | - Noel Labana Otuli
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of the Congo
| | - Monde Otsatre-Okuti
- Faculté de Médecine, Université de Bunia, Bunia, Democratic Republic of the Congo
| | | | - Raphael Dupont
- Laboratoire d'analyses médicales, Centre Cardiologique du Nord (CCN), Saint-Denis, France
| | - Laurent Bélec
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université Paris Cité, Paris, France
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Charfi R, Guyonnet C, Untrau M, Giacometti G, Paper T, Poyart C, Plainvert C, Tazi A. Performances of two rapid LAMP-based techniques for the intrapartum detection of Group B Streptococcus vaginal colonization. Ann Clin Microbiol Antimicrob 2024; 23:37. [PMID: 38664821 PMCID: PMC11046945 DOI: 10.1186/s12941-024-00695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE Group B Streptococcus (GBS) is the leading cause of invasive infections in newborns. The prevention of GBS neonatal disease relies on the administration of an intrapartum antibiotic prophylaxis to GBS-colonized women. In recent years, rapid intrapartum detection of GBS vaginal colonization using real-time nucleic acid amplification tests (NAATs) emerged as an alternative to antenatal culture screening methods. METHODS We compared the performances of two loop-mediated isothermal amplification (LAMP) tests, the Ampliflash® GBS and the PlusLife® GBS tests, to standard culture for GBS detection in vaginal specimens from pregnant women. The study was conducted from April to July 2023 in a French hospital of the Paris area. RESULTS A total of 303 samples were analyzed, including 85 culture-positive samples (28.1%). The Ampliflash® GBS test and the PlusLife® GBS tests gave a result for 100% and 96.3% tests, respectively. The performances of the tests were as follows: sensitivity 87.1% (95% confidence interval (CI) 78.3-92.6) and 98.7% (95% CI 93.0-99.8), specificity 99.1% (95% CI 96.7-99.8), and 91.9% (95% CI 87.3-95.0), respectively. False negative results of the Ampliflash® GBS test correlated with low-density GBS cultures. Time-to-results correlated with GBS culture density only for the PlusLife® GBS test (p < 0.001). CONCLUSION Both techniques provide excellent analytical performances with high sensitivity and specificity together with a short turnaround time and results available in 10 to 35 min. Their potential to further reduce the burden of GBS neonatal disease compared with antenatal culture screening needs to be assessed in future clinical studies.
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Affiliation(s)
- Rym Charfi
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - Cécile Guyonnet
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France
| | | | | | | | - Claire Poyart
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France
| | - Céline Plainvert
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France
| | - Asmaa Tazi
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France.
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France.
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France.
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Campisciano G, Sorz A, Cason C, Zanotta N, Gionechetti F, Piazza M, Carli P, Uliana FM, Ballaminut L, Ricci G, De Seta F, Maso G, Comar M. Genital Dysbiosis and Different Systemic Immune Responses Based on the Trimester of Pregnancy in SARS-CoV-2 Infection. Int J Mol Sci 2024; 25:4298. [PMID: 38673883 PMCID: PMC11050260 DOI: 10.3390/ijms25084298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Respiratory infections are common in pregnancy with conflicting evidence supporting their association with neonatal congenital anomalies, especially during the first trimester. We profiled cytokine and chemokine systemic responses in 242 pregnant women and their newborns after SARS-CoV-2 infection, acquired in different trimesters. Also, we tested transplacental IgG passage and maternal vaginal-rectal microbiomes. IgG transplacental passage was evident, especially with infection acquired in the first trimester. G-CSF concentration-involved in immune cell recruitment-decreased in infected women compared to uninfected ones: a beneficial event for the reduction of inflammation but detrimental to ability to fight infections at birth. The later the infection was acquired, the higher the systemic concentration of IL-8, IP-10, and MCP-1, associated with COVID-19 disease severity. All infected women showed dysbiosis of vaginal and rectal microbiomes, compared to uninfected ones. Two newborns tested positive for SARS-CoV-2 within the first 48 h of life. Notably, their mothers had acute infection at delivery. Although respiratory infections in pregnancy are reported to affect babies' health, with SARS-CoV-2 acquired early during gestation this risk seems low because of the maternal immune response. The observed vaginal and rectal dysbiosis could be relevant for neonatal microbiome establishment, although in our series immediate neonatal outcomes were reassuring.
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Affiliation(s)
- Giuseppina Campisciano
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Alice Sorz
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
| | - Carolina Cason
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Nunzia Zanotta
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Fabrizia Gionechetti
- Department of Life Sciences, University of Trieste, Via Licio Giorgieri 5, 34127 Trieste, Italy;
| | - Maria Piazza
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
| | - Petra Carli
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Francesca Maria Uliana
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Lisa Ballaminut
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
| | - Giuseppe Ricci
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Francesco De Seta
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milano, Italy
| | - Gianpaolo Maso
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (A.S.); (M.P.); (G.R.); (F.D.S.); (G.M.)
| | - Manola Comar
- Department of Advanced Translational Microbiology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Via dell’Istria 65, 34137 Trieste, Italy; (C.C.); (N.Z.); (P.C.); (F.M.U.); (L.B.); (M.C.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
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Sung J, Larsen P, Halverson TM, Waters TP, Goodman JR, Wolfe AJ. First trimester "clean catch" urine and vaginal swab sample distinct microbiological niches. Microbiol Spectr 2024; 12:e0263823. [PMID: 38088549 PMCID: PMC10782990 DOI: 10.1128/spectrum.02638-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE Untreated asymptomatic bacteriuria (ASB) has been associated with adverse pregnancy outcomes, including pyelonephritis, preterm labor, and low birth weight infants. Thus, routine screening by standard urine culture (SUC) and treatment of ASB are currently recommended for all pregnant women. For this purpose, some researchers claim that vaginal swabs and urine samples can be used as proxies for each other. Because SUC often misses microbes, we used two more sensitive, recently validated detection methods to compare the composition of the urinary and vaginal microbiomes of pregnant females in their first trimester. Both methods yielded similar results. Vaginal and urinary microbial compositions for the same individual were significantly correlated; however, they were not equivalent. We argue that first trimester urinary and vaginal microbiomes are distinct enough to preclude their use as proxies for each other.
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Affiliation(s)
- Juliana Sung
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Peter Larsen
- Loyola Genomics Facility, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, USA
| | - Thomas M. Halverson
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, USA
| | - Thaddeus P. Waters
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jean R. Goodman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Alan J. Wolfe
- Loyola Genomics Facility, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, USA
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, USA
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5
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Coleman M, Orvis A, Brokaw A, Furuta A, Sharma K, Quach P, Bhullar A, Sanghavi R, Nguyen S, Sweeney E, Seepersaud R, Armistead B, Adams Waldorf KM, Rajagopal L. GBS hyaluronidase mediates immune suppression in a TLR2/4- and IL-10-dependent manner during pregnancy-associated infection. mBio 2023; 14:e0204923. [PMID: 37747229 PMCID: PMC10653848 DOI: 10.1128/mbio.02049-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
IMPORTANCE Bacteria such as GBS can cause infections during pregnancy leading to preterm births, stillbirths, and neonatal infections. The interaction between host and bacterial factors during infections in the placenta is not fully understood. GBS secretes a hyaluronidase enzyme that is thought to digest host hyaluronan into immunosuppressive disaccharides that dampen TLR2/4 signaling, leading to increased bacterial dissemination and adverse outcomes. In this study, we show that GBS HylB mediates immune suppression and promotes bacterial infection during pregnancy that requires TLR2, TLR4, and IL-10. Understanding the interaction between host and bacterial factors can inform future therapeutic strategies to mitigate GBS infections.
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Affiliation(s)
- Michelle Coleman
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Austyn Orvis
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Alyssa Brokaw
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Anna Furuta
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kavita Sharma
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Phoenicia Quach
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Avneet Bhullar
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Rhea Sanghavi
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Shayla Nguyen
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Erin Sweeney
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Ravin Seepersaud
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Blair Armistead
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Kristina M. Adams Waldorf
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Lakshmi Rajagopal
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Devaraju M, Li A, Ha S, Li M, Shivakumar M, Li H, Nishiguchi EP, Gérardin P, Waldorf KA, Al-Haddad BJS. Beyond TORCH: A narrative review of the impact of antenatal and perinatal infections on the risk of disability. Neurosci Biobehav Rev 2023; 153:105390. [PMID: 37708918 PMCID: PMC10617835 DOI: 10.1016/j.neubiorev.2023.105390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
Infections and inflammation during pregnancy or early life can alter child neurodevelopment and increase the risk for structural brain abnormalities and mental health disorders. There is strong evidence that TORCH infections (i.e., Treponema pallidum, Toxoplasma gondii, rubella virus, cytomegalovirus, herpes virus) alter fetal neurodevelopment across multiple developmental domains and contribute to motor and cognitive disabilities. However, the impact of a broader range of viral and bacterial infections on fetal development and disability is less well understood. We performed a literature review of human studies to identify gaps in the link between maternal infections, inflammation, and several neurodevelopmental domains. We found strong and moderate evidence respectively for a higher risk of motor and cognitive delays and disabilities in offspring exposed to a range of non-TORCH pathogens during fetal life. In contrast, there is little evidence for an increased risk of language and sensory disabilities. While guidelines for TORCH infection prevention during pregnancy are common, further consideration for prevention of non-TORCH infections during pregnancy for fetal neuroprotection may be warranted.
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Affiliation(s)
- Monica Devaraju
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA; University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Amanda Li
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA; Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, USA
| | - Sandy Ha
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Miranda Li
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA; University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Megana Shivakumar
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Hanning Li
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Erika Phelps Nishiguchi
- University of Hawaii, Department of Pediatrics, Division of Community Pediatrics, 1319 Punahou St, Honolulu, HI, USA
| | - Patrick Gérardin
- INSERM CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, Réunion, France; Platform for Clinical and Translational Research, Centre Hospitalier Universitaire, Saint Pierre, Réunion, France
| | - Kristina Adams Waldorf
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Benjamin J S Al-Haddad
- University of Minnesota, Department of Pediatrics, Division of Neonatology, Academic Office Building, 2450 Riverside Ave S AO-401, Minneapolis, MN 55454, USA; Masonic Institute for the Developing Brain, 2025 E River Pkwy, Minneapolis, MN 55414, USA.
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Mejia ME, Robertson CM, Patras KA. Interspecies Interactions within the Host: the Social Network of Group B Streptococcus. Infect Immun 2023; 91:e0044022. [PMID: 36975791 PMCID: PMC10112235 DOI: 10.1128/iai.00440-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Group B Streptococcus (GBS) is a pervasive neonatal pathogen accounting for a combined half a million deaths and stillbirths annually. The most common source of fetal or neonatal GBS exposure is the maternal microbiota. GBS asymptomatically colonizes the gastrointestinal and vaginal mucosa of 1 in 5 individuals globally, although its precise role in these niches is not well understood. To prevent vertical transmission, broad-spectrum antibiotics are administered to GBS-positive mothers during labor in many countries. Although antibiotics have significantly reduced GBS early-onset neonatal disease, there are several unintended consequences, including an altered neonatal microbiota and increased risk for other microbial infections. Additionally, the incidence of late-onset GBS neonatal disease remains unaffected and has sparked an emerging hypothesis that GBS-microbe interactions in developing neonatal gut microbiota may be directly involved in this disease process. This review summarizes our current understanding of GBS interactions with other resident microbes at the mucosal surface from multiple angles, including clinical association studies, agriculture and aquaculture observations, and experimental animal model systems. We also include a comprehensive review of in vitro findings of GBS interactions with other bacterial and fungal microbes, both commensal and pathogenic, along with newly established animal models of GBS vaginal colonization and in utero or neonatal infection. Finally, we provide a perspective on emerging areas of research and current strategies to design microbe-targeting prebiotic or probiotic therapeutic intervention strategies to prevent GBS disease in vulnerable populations.
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Affiliation(s)
- Marlyd E. Mejia
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Clare M. Robertson
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Kathryn A. Patras
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
- Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, Texas, USA
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8
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Xiao X, Zheng Z, Sun H. Study on the Correlation between Genital Tract Microenvironment and GBS Carrier Rate of Late-Stage Pregnant Women in Dongguan. Clin Lab 2023; 69. [PMID: 37057926 DOI: 10.7754/clin.lab.2022.220742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND The carrier rate of group B Streptococcus (GBS) in the genital tract of women in the late stage of pregnancy and its correlation with the genital tract microenvironment were investigated in a group of pregnant women in Dongguan, China, to provide a basis for the clinical prevention and treatment of GBS. METHODS A retrospective analysis was done of the results of routine testing for GBS, leucorrhea and bacterial vaginosis (BV) in 6,166 women in the late stage of pregnancy (35 - 37 weeks of gestation) who underwent a prenatal examination at Dongguan Southeast Central Hospital from January 2018 to December 2020. GBS positivity was detected by RT-PCR. Normal saline floating microscopy was used to detect routine indicators of leucorrhea, including white blood cells (WBCs), Lactobacillus (Lab), vulvovaginal Candida (VVC), and trichomoniasis (TV). BV was detected based on an enzymatic reaction. The correlation between GBS infection and age and the vaginal microenvironment was determined statistically. RESULTS The rate of GBS positivity was 10.53% (649/6,166) and was statistically significant for women 20 years of age (p < 0.05). Logistic regression showed that abnormal VVC, TV, BV, WBCs, and Lactobacillus were associated with GBS infection. The results of a rank sum test of the WBC group showed that the infection risk in groups with < 15 WBCs/hpf increased as the WBC count increased, but there was no statistical difference between groups with > 15 WBCs/hpf. The rank sum test results for Lactobacillus showed a significant difference between the abnormal and normal and other groups, but no significant difference between the other groups. CONCLUSIONS The overall carrier rate of GBS in the genital tract of late-stage pregnant women in Dongguan was 10.53%. GBS infection is related to the genital tract microenvironment. Our results provide a basis for the prevention and treatment of clinically confirmed GBS.
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Koliwer‐Brandl H, Nil A, Birri J, Sachs M, Zimmermann R, Zbinden R, Balsyte D. Evaluation of two rapid commercial assays for detection of Streptococcus agalactiae from vaginal samples. Acta Obstet Gynecol Scand 2023; 102:450-456. [PMID: 36772902 PMCID: PMC10008276 DOI: 10.1111/aogs.14519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Streptococcus agalactiae, also known as group B streptococci (GBS), is associated with invasive infections in neonates. Identification of GBS vaginal colonization in pregnant women before delivery is essential for treatment with antibiotics to prevent intrapartum vertical transmission to the newborn. This study was designed to evaluate applicability of two rapid real-time PCRs in comparison to standard culture identification. MATERIAL AND METHODS We compared the Xpert GBS assay, hereafter referred to as Xpert, and GenomEra GBS PCR, hereafter referred to as GenomEra. The standard culture identification consisted of two different agar plates as well as an enrichment broth. RESULTS We analyzed vaginal samples of 260 pregnant women; 42 samples were tested GBS-positive by using standard culture as a gold standard, 30 by Xpert, and 37 by GenomEra. Xpert and GenomEra assays performed with sensitivities of 71.4% and 88.1% as well as specificities of 98.6% and 99.1%, respectively. Twelve vaginal samples were false-negative by Xpert and five samples by GenomEra. Interestingly, three negative Xpert results of standard culture-positive samples exhibited high Ct-values indicating the presence of GBS. If higher Ct-values are taken into consideration, the sensitivity of Xpert increases up to 78.6%. Moreover, only three Xpert PCRs had to be repeated, whereas two Genomera were invalid even after repetition and further 15 GenomEra PCRs were repeated because of borderline results or inhibition of the PCR test. CONCLUSIONS In this study, GenomEra assay performed with a higher sensitivity than the Xpert PCR. On the other hand, the Xpert assay needs less hands-on-time for a sample preparation and requires approximately four-fold less repetitions as compared to the GenomEra assay. This robust performance of the Xpert assay make it applicable as a rapid intrapartum point-of-care test, although a higher sensitivity would be desirable. Therefore, culture in the 35-37 week of gestation remains the gold standard to detect vaginal colonization.
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Affiliation(s)
| | - Ahmed Nil
- Institute of Medical MicrobiologyUniversity of ZurichZurichSwitzerland
| | - Jana Birri
- Division of ObstetricsUniversity Hospital of ZurichZurichSwitzerland
| | - Maike Sachs
- Division of ObstetricsUniversity Hospital of ZurichZurichSwitzerland
| | - Roland Zimmermann
- Division of ObstetricsUniversity Hospital of ZurichZurichSwitzerland
| | - Reinhard Zbinden
- Institute of Medical MicrobiologyUniversity of ZurichZurichSwitzerland
| | - Dalia Balsyte
- Division of ObstetricsUniversity Hospital of ZurichZurichSwitzerland
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Severgnini M, Morselli S, Camboni T, Ceccarani C, Salvo M, Zagonari S, Patuelli G, Pedna MF, Sambri V, Foschi C, Consolandi C, Marangoni A. Gardnerella vaginalis clades in pregnancy: New insights into the interactions with the vaginal microbiome. PLoS One 2022; 17:e0269590. [PMID: 35700195 PMCID: PMC9197028 DOI: 10.1371/journal.pone.0269590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/25/2022] [Indexed: 12/03/2022] Open
Abstract
Gardnerella vaginalis (GV) is an anaerobic bacterial species involved in the pathogenesis of bacterial vaginosis (BV), a condition of vaginal dysbiosis associated with adverse pregnancy outcomes. GV strains are categorized into four clades, characterized by a different ability to produce virulence factors, such as sialidase. We investigated the distribution of GV clades and sialidase genes in the vaginal ecosystem of a cohort of pregnant women, assessing the correlations between GV clades and the whole vaginal microbiome. A total of 61 Caucasian pregnant women were enrolled. Their vaginal swabs, collected both at the first and third trimester of pregnancy, were used for (i) evaluation of the vaginal status by Nugent score, (ii) vaginal microbiome profiling by 16S rRNA sequencing, (iii) detection and quantification of GV clades and sialidase A gene by qPCR assays. DNA of at least one GV clade was detected in most vaginal swabs, with clade 4 being the most common one. GV clade 2, together with the presence of multiple clades (>2 simultaneously), were significantly associated with a BV condition. Significantly higher GV loads and sialidase gene levels were found in BV cases, compared to the healthy status. Clade 2 was related to the major shifts in the vaginal microbial composition, with a decrease in Lactobacillus and an increase in several BV-related taxa. As the number of GV clades detected simultaneously increased, a group of BV-associated bacteria tended to increase as well, while Bifidobacterium tended to decrease. A negative correlation between sialidase gene levels and Lactobacillus, and a positive correlation with Gardnerella, Atopobium, Prevotella, Megasphaera, and Sneathia were observed. Our results added knowledge about the interactions of GV clades with the inhabitants of the vaginal microbiome, possibly helping to predict the severity of BV and opening new perspectives for the prevention of pregnancy-related complications.
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Affiliation(s)
- Marco Severgnini
- Institute of Biomedical Technologies – National Research Council, Segrate, Milan, Italy
| | - Sara Morselli
- Microbiology, DIMES, University of Bologna, Bologna, Italy
| | - Tania Camboni
- Institute of Biomedical Technologies – National Research Council, Segrate, Milan, Italy
| | - Camilla Ceccarani
- Institute of Biomedical Technologies – National Research Council, Segrate, Milan, Italy
| | - Melissa Salvo
- Microbiology, DIMES, University of Bologna, Bologna, Italy
| | | | | | - Maria Federica Pedna
- Unit of Microbiology, Greater Romagna Hub Laboratory, Pievesestina di Cesena, Italy
| | - Vittorio Sambri
- Microbiology, DIMES, University of Bologna, Bologna, Italy
- Unit of Microbiology, Greater Romagna Hub Laboratory, Pievesestina di Cesena, Italy
| | - Claudio Foschi
- Microbiology, DIMES, University of Bologna, Bologna, Italy
- * E-mail:
| | - Clarissa Consolandi
- Institute of Biomedical Technologies – National Research Council, Segrate, Milan, Italy
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11
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Akpaka PE, Ashraph K, Ivey MA, Unakal C, Kurhade A. Epidemiological evaluation of risk factors associated with vaginal candidiasis in a cross section of pregnant women in Trinidad and Tobago. Afr J Reprod Health 2022; 26:46-53. [PMID: 37585111 DOI: 10.29063/ajrh2022/v26i3.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Vaginal Candidiasis and associated epidemiological risk factors prevalent among a cross section of pregnant women attending tertiary hospital in Trinidad and Tobago was evaluated. Standardized questionnaire was used to survey 492 pregnant women over a period of 10 months in 2019. Vaginal swab was collected and processed using standard microbiological laboratory methods for phenotypic identification. Data were analyzed using SPSS to identify potential risk factors. Chi-squared (ꭓ2) test and logistic regression tests examined associations and odds ratios with corresponding 95% confidence intervals. Prevalence of vulvovaginal candidiasis was 44.9% with Candida albicans as predominant species identified (62%, N=492). Vaginal candidiasis was statistically significant for several risk factors, including second trimester (p = 0.03), age group 26 - 34 years (p=003), history of masturbation especially during the last 48hours prior to the swabbing (p=0.05), and wearing of pants as opposed to skirt clothes (p=0.04). In conclusion, several epidemiological risk factors are associated vaginal candidiasis among cross section of pregnant women in the country. Patient education, microbiological investigations and appropriate treatment will improve antenatal healthcare delivery in the country.
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Affiliation(s)
- Patrick Eberechi Akpaka
- Pathology and Microbiology Unit, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
- Microbiology Laboratory Section, Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Trinidad and Tobago
| | - Khalil Ashraph
- Pathology and Microbiology Unit, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Marsha A Ivey
- Public Health & Primary Care Unit, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago3
| | - Chandrashekhar Unakal
- Pathology and Microbiology Unit, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Arvind Kurhade
- Pathology and Microbiology Unit, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
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12
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Nahab HM, Akeel Hamed Al-Oebady M, Aqeel Abdul Munem H. Bacteriological Study of Urinary Tract Infections among Pregnant Women in Al Samawa City of Iraq. Arch Razi Inst 2022; 77:117-122. [PMID: 35891717 PMCID: PMC9288592 DOI: 10.22092/ari.2021.356676.1889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/04/2021] [Indexed: 06/15/2023]
Abstract
Pregnancy causes some changes in pregnant women due to mechanical and hormonal changes that lead to ureteral dilatation and urinary stasis which in turn contribute to an increased risk of developing urinary tract infection (UTI). This study aimed to determine the frequency of urinary tract infections among pregnant women in Samawa city, Iraq, and examine the isolated organisms. In total, 210 and 55 urine samples were collected from pregnant and non-pregnant women with clinical signs and symptoms of UTI who were hospitalized in the Obstetric and Pediatric Hospital in Samawa, Iraq, respectively. The data collected from each woman included their age, gestational period, parity, level of education, and residence. The frequency of urinary tract infections among the studied woman was 86%. Escherichia coli (38.6%), staphylococcus aureus (20.4%), and Proteus mirabilis (12.7%) were the most frequently isolated bacteria in the current study. According to the recorded data in this study, 86% of the infections in pregnant women occurred in the age group of 25-34 years (52.4%) and the 3rd trimester of pregnancy (49.1%). On the other hand, the results revealed that the infection rate in women with one to three pregnancies was 50.2% more than non-pregnant women. The findings of the current study showed that the highest rate of infection was observed in women who were in the age range of 25-34 years (52.4%). This can be explained by the fact that women often experience the highest reproductive activity during this period. In fact, in this period of life, women are most prone to sexual activity which predisposes them to the introduction of microorganisms to the urinary tract which causes infection. The recorded data showed that UTI became more prevalent with the progress of pregnancy, accounting for 49.1% of infections occurring in the third trimester of pregnancy. Parity and frequent pregnancies are other factors that account for 50.2% of UTI. The prevalence of UTI in women with 1 to 3 children was 58.5%. Moreover, the rate of UTI was 61.3% among pregnant women who attended the antenatal care unit, which was the highest risk of UTI among the pregnant participants. In the non-pregnant women, the prevalence of UTI was 50.2 at the age range of 6-12 years. Based on the obtained results, pregnant women were more vulnerable to renal infection. On the other hand, the concurrence of UTI was positively influenced by sexual activity and pregnancy.
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Affiliation(s)
- H M Nahab
- Department of Biology, College of Science, Al-Muthanna University, Samawah, Iraq
| | | | - H Aqeel Abdul Munem
- Department of Biology, College of Science, Al-Muthanna University, Samawah, Iraq
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13
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Gilmour LS, Best EJ, Duncanson MJ, Wheeler BJ, Sherwood J, Thirkell CE, Walls T. High Incidence of Congenital Syphilis in New Zealand: A New Zealand Pediatric Surveillance Unit Study. Pediatr Infect Dis J 2022; 41:66-71. [PMID: 34889872 DOI: 10.1097/inf.0000000000003233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Syphilis, a disease once in decline, has made a resurgence worldwide. New Zealand has had increasing syphilis rates since enhanced syphilis surveillance was initiated in 2013. This study reports epidemiologic, descriptive and treatment data on management of infants prenatally exposed or vertically infected with syphilis across New Zealand as reported by pediatricians. METHODS Over a 26-month period from April 2018 to May 2020 (inclusive), pediatricians throughout New Zealand notified potential, probable and confirmed cases of congenital syphilis to the New Zealand Pediatric Surveillance Unit. National reporting numbers were concurrently ascertained to demonstrate reporting accuracy. RESULTS Thirty-two cases were notified, comprised of 25 infants born to women with positive antenatal syphilis serology (5 whom developed congenital syphilis), and 7 infants diagnosed with congenital syphilis after birth where syphilis was not diagnosed in pregnancy. There were 12 cases of congenital syphilis; an incidence rate of 9.4 cases per 100,000 live births. Nine of the 12 infants had clinical features of congenital syphilis. One-third of maternal infections were early syphilis, and the women who gave birth to infected infants were less likely to have received antenatal care, adequate treatment and follow-up monitoring of treatment for syphilis during pregnancy. CONCLUSIONS This study quantifies an important burden of disease from congenital syphilis in our population. Case finding and treatment of syphilis in pregnancy are critical to prevent this. Our findings support the urgent need for measures such as repeat maternal syphilis screening in early third trimester; whether by affected region or instituted for all, in the context of rising cases.
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Affiliation(s)
| | - Emma Joanne Best
- Department of Paediatric Infectious Diseases, Starship Children's Health, Auckland
- Department of Paediatrics: Child and Youth Health
- National Immunisation Advisory Centre, University of Auckland
| | - Mavis Joy Duncanson
- New Zealand Paediatric Surveillance Unit, Women's and Children's Health, Otago Medical School Dunedin Campus, University of Otago
| | - Benjamin John Wheeler
- New Zealand Paediatric Surveillance Unit, Women's and Children's Health, Otago Medical School Dunedin Campus, University of Otago
| | - Jill Sherwood
- New Zealand Institute of Environmental Science and Research Limited (ESR)
| | | | - Tony Walls
- From the Department of Paediatrics, Christchurch Public Hospital
- Department of Paediatrics, University of Otago, Christchurch
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Périllaud-Dubois C, Belhadi D, Laouénan C, Mandelbrot L, Picone O, Vauloup-Fellous C. Current practices of management of maternal and congenital Cytomegalovirus infection during pregnancy after a maternal primary infection occurring in first trimester of pregnancy: Systematic review. PLoS One 2021; 16:e0261011. [PMID: 34860861 PMCID: PMC8641894 DOI: 10.1371/journal.pone.0261011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Congenital CMV infection is the first worldwide cause of congenital viral infection but systematic screening of pregnant women and newborns for CMV is still debated in many countries. OBJECTIVES This systematic review aims to provide the state of the art on current practices concerning management of maternal and congenital CMV infection during pregnancy, after maternal primary infection (PI) in first trimester of pregnancy. DATA SOURCES Electronically searches on databases and hand searches in grey literature. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS Primary outcome was listing biological, imaging, and therapeutic management interventions in two distinct populations: population 1 are pregnant women with PI, before or without amniocentesis; population 2 are pregnant women with congenitally infected fetuses (after positive amniocentesis). Secondary outcome was pregnancy outcome in population 2. RESULTS Out of 4,134 studies identified, a total of 31 studies were analyzed, with 3,325 pregnant women in population 1 and 1,021 pregnant women in population 2, from 7 countries (Belgium, France, Germany, Israel, Italy, Spain and USA). In population 1, ultrasound (US) examination frequency was 0.75/month, amniocentesis in 82% cases, maternal viremia in 14% and preventive treatment with hyperimmune globulins (HIG) or valaciclovir in respectively 14% and 4% women. In population 2, US examination frequency was 1.5/month, magnetic resonance imaging (MRI) in 44% cases at 32 weeks gestation (WG), fetal blood sampling (FBS) in 24% at 28 WG, and curative treatment with HIG or valaciclovir in respectively 9% and 8% patients. CONCLUSIONS This systematic review illustrates management of maternal and congenital CMV during pregnancy in published and non-published literature, in absence of international consensus. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019124342.
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Affiliation(s)
- Claire Périllaud-Dubois
- Département de Virologie, AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Paris, France
- Université de Paris, INSERM UMR1137, IAME, Paris, France
- GRIG, Groupe de Recherche sur les Infections pendant la Grossesse, Paris, France
- * E-mail:
| | - Drifa Belhadi
- Université de Paris, INSERM UMR1137, IAME, Paris, France
- Department of Epidemiology, Biostatistic and Clinical Research, AP-HP, Hôpital Bichat, Paris, France
| | - Cédric Laouénan
- Université de Paris, INSERM UMR1137, IAME, Paris, France
- Department of Epidemiology, Biostatistic and Clinical Research, AP-HP, Hôpital Bichat, Paris, France
| | - Laurent Mandelbrot
- Université de Paris, INSERM UMR1137, IAME, Paris, France
- GRIG, Groupe de Recherche sur les Infections pendant la Grossesse, Paris, France
- AP-HP, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France
| | - Olivier Picone
- Université de Paris, INSERM UMR1137, IAME, Paris, France
- GRIG, Groupe de Recherche sur les Infections pendant la Grossesse, Paris, France
- AP-HP, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France
| | - Christelle Vauloup-Fellous
- GRIG, Groupe de Recherche sur les Infections pendant la Grossesse, Paris, France
- Laboratoire de Virologie, AP-HP.Université Paris-Saclay, Hôpital Paul Brousse, Villejuif, France
- Université Paris-Saclay, INSERM U1193, Villejuif, France
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15
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Mulinganya G, De Vulder A, Bisimwa G, Boelens J, Claeys G, De Keyser K, De Vos D, Hendwa E, Kampara F, Kujirakwinja Y, Mongane J, Mubalama I, Vaneechoutte M, Callens S, Cools P. Prevalence, risk factors and adverse pregnancy outcomes of second trimester bacterial vaginosis among pregnant women in Bukavu, Democratic Republic of the Congo. PLoS One 2021; 16:e0257939. [PMID: 34695126 PMCID: PMC8544863 DOI: 10.1371/journal.pone.0257939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is the most common gynecological condition in women of reproductive age and associated with adverse pregnancy outcomes. In the Democratic Republic of the Congo (DRC), neonatal mortality rate is as high as 2.8 percent with preterm birth (PTB) and low birth weight (LBW) as leading causes. Because no studies have addressed BV in DRC, we aimed to investigate the prevalence of BV, the risk factors and the association between BV and adverse pregnancy outcomes in a population of pregnant women from Bukavu, DRC. METHODS A total of 533 pregnant women in the second trimester of pregnancy were recruited in the Provincial Reference Hospital of Bukavu, DRC, between January and October 2017, and followed until delivery. Clinical and sociodemographic data of mother and newborn, and data on (vaginal) hygiene practices, sexual behavior and reproductive history were collected. BV was diagnosed by Nugent scoring of Gram-stained vaginal smears. Two multivariate regression models were built to identify risk factors for BV and to investigate BV as a risk factor for adverse pregnancy outcomes. RESULTS The prevalence of BV was 26.3% and approximately half of the women with BV were asymptomatic. Independent risk factors for BV were the use of alternatives to water for intravaginal washing, concurrent partners, unemployed status, the presence of vaginal Candida and clay consumption. BV was independently associated with both LBW and PTB of an infant with LBW. CONCLUSION The prevalence of BV in Bukavu is high but in line with the global average. BV was associated with adverse pregnancy outcomes in our study population. Hence, research on modifiable risk factor-based interventions to reduce the prevalence of BV, and on screening/treatment of BV during antenatal care should be explored to reduce neonatal mortality and morbidity.
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Affiliation(s)
- Guy Mulinganya
- Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of The Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of The Congo
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Annelies De Vulder
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ghislain Bisimwa
- Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of The Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of The Congo
| | - Jerina Boelens
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - Geert Claeys
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Karen De Keyser
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Daniel De Vos
- Laboratory for Molecular and Cellular Technology, Burn Wound Center, Queen Astrid Military Hospital, Brussels, Belgium
| | - Erick Hendwa
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of The Congo
| | - Freddy Kampara
- Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of The Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of The Congo
| | - Yvette Kujirakwinja
- Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of The Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of The Congo
| | - Jules Mongane
- Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of The Congo
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of The Congo
| | - Innocent Mubalama
- Department of Obstetrics and Gynecology, Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of The Congo
| | - Mario Vaneechoutte
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Steven Callens
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Piet Cools
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Selvarajah S, Ran S, Roberts NW, Nair M. Leptospirosis in pregnancy: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009747. [PMID: 34520461 PMCID: PMC8462732 DOI: 10.1371/journal.pntd.0009747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/24/2021] [Accepted: 08/20/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Leptospirosis is a leading zoonotic disease worldwide with more than 1 million cases in the general population per year. With leptospirosis being an emerging infectious disease and as the world’s environment changes with more floods and environmental disasters, the burden of leptospirosis is expected to increase. The objectives of the systematic review were to explore how leptospirosis affects pregnancy, its burden in this population, its effects on maternal and fetal outcomes and the evidence base surrounding treatment options. Methods We performed a systematic review of published and unpublished literature using automated and manual methods to screen nine electronic databases since inception, with no language restriction. Two reviewers independently screened articles, completed the data extraction and assessment of risk of bias. Due to significant heterogeneity and paucity of data, we were unable to carry out a meta-analysis, but we conducted a pooled analysis of individual patient data from the case reports and case series to examine the patient and disease characteristics, diagnostic methods, differential diagnoses, antibiotic treatments, and outcomes of leptospirosis in pregnancy. The protocol for this review was registered on the International Prospective Register of Systematic Reviews, PROSPERO: CRD42020151501. Results We identified 419 records, of which we included eight observational studies, 21 case reports, three case series and identified four relevant ongoing studies. Overall the studies were with moderate bias and of ‘fair’ quality. We estimated the incidence of leptospirosis in pregnancy to be 1.3 per 10,000 in women presenting with fever or with jaundice, but this is likely to be higher in endemic areas. Adverse fetal outcomes were found to be more common in pregnant patients who presented in the second trimester compared with patients who presented in the third trimester. There is overlap between how leptospirosis presents in pregnancy and in the general population. There is also overlap between the signs, symptoms and biochemical disturbances associated with leptospirosis in pregnancy and the presentation of pregnancy associated conditions, such as Pre-Eclampsia (PET), Acute Fatty Liver of Pregnancy (AFLP) and HELLP Syndrome (Haemolysis Elevated Liver enzymes Low Platelets). In 94% of identified cases with available data, there was an indicator in the patient history regarding exposure that could have helped include leptospirosis in the clinician’s differential diagnosis. We also identified a range of suitable antibiotic therapies for treating leptospirosis in pregnancy, most commonly used were penicillins. Conclusion This is the first systematic review of leptospirosis in pregnancy and it clearly shows the need to improve early diagnosis and treatment by asking early, treating early, and reporting well. Ask early—broaden differential diagnoses and ask early for potential leptospirosis exposures and risk factors. Treat early—increase index of suspicion in pregnant patients with fever in endemic areas and combine with rapid field diagnosis and early treatment. Report well—need for more good quality epidemiological studies on leptospirosis in pregnancy and better quality reporting of cases in literature. There are more than 1 million cases of leptospirosis in the general population each year. Leptospirosis is an emerging infectious disease and as the world’s environment changes with more floods and environmental disasters, the impact of leptospirosis on the world is expected to increase. Leptospirosis is a zoonotic disease passed onto humans and can cause a range of illness from mild symptoms to severe organ failure and death. It is typically underreported and understudied, hence its classification as a ‘Neglected Tropical Disease’. This is the first systematic review on Leptospirosis in Pregnancy looking at how common it is in pregnancy, how it affects maternal and fetal outcomes, and options for management. We found there to be overlap between how leptospirosis presents in the general population and in pregnancy, and that it can mimic non-infectious conditions that only present in pregnancy such as Pre-Eclampsia, Acute Fatty Liver of Pregnancy and other syndromes where liver and platelet function is affected. Adverse fetal outcomes were found to be more common in pregnant patients who presented in the second trimester compared with patients who presented in the third trimester. In 94% of identified cases with available data, there was a clue in the patient’s history that could have indicated possible exposure to leptospirosis, which is very important in raising suspicion of a diagnosis of leptospirosis in pregnancy. We also identified a range of suitable antibiotic therapies for treating leptospirosis in pregnancy, most commonly used were penicillins. Our recommendations are: Ask early—broaden differential diagnoses and ask early for potential leptospirosis exposures and risk factors. Treat early—combine considering leptospirosis as a cause of fever in pregnant patients in endemic areas with prompt diagnosis and treatment. Report well—there is a need for more good quality epidemiological studies on leptospirosis in pregnancy and better quality reporting of cases in literature.
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Affiliation(s)
- Sujitha Selvarajah
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
- * E-mail:
| | - Shaolu Ran
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nia Wyn Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
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Olmos-Ortiz A, Olivares-Huerta A, García-Quiroz J, Avila E, Halhali A, Quesada-Reyna B, Larrea F, Zaga-Clavellina V, Díaz L. Cord Serum Calcitriol Inversely Correlates with Maternal Blood Pressure in Urinary Tract Infection-Affected Pregnancies: Sex-Dependent Immune Implications. Nutrients 2021; 13:nu13093114. [PMID: 34578991 PMCID: PMC8467737 DOI: 10.3390/nu13093114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
Urinary tract infections (UTI) during pregnancy are frequently associated with hypertensive disorders, increasing the risk of perinatal morbidity. Calcitriol, vitamin D3’s most active metabolite, has been involved in blood pressure regulation and prevention of UTIs, partially through modulating vasoactive peptides and antimicrobial peptides, like cathelicidin. However, nothing is known regarding the interplay between placental calcitriol, cathelicidin, and maternal blood pressure in UTI-complicated pregnancies. Here, we analyzed the correlation between these parameters in pregnant women with UTI and with normal pregnancy (NP). Umbilical venous serum calcitriol and its precursor calcidiol were significantly elevated in UTI. Regardless of newborn’s sex, we found strong negative correlations between calcitriol and maternal systolic and diastolic blood pressure in the UTI cohort (p < 0.002). In NP, this relationship was observed only in female-carrying mothers. UTI-female placentas showed higher expression of cathelicidin and CYP27B1, the calcitriol activating-enzyme, compared to male and NP samples. Accordingly, cord-serum calcitriol from UTI-female neonates negatively correlated with maternal bacteriuria. Cathelicidin gene expression positively correlated with gestational age in UTI and with newborn anthropometric parameters. Our results suggest that vitamin D deficiency might predispose to maternal cardiovascular risk and perinatal infections especially in male-carrying pregnancies, probably due to lower placental CYP27B1 and cathelicidin expression.
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Affiliation(s)
- Andrea Olmos-Ortiz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas-Virreyes, Lomas de Chapultepec IV Sección, Miguel Hidalgo, Ciudad de Mexico 11000, Mexico
| | - Alberto Olivares-Huerta
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Janice García-Quiroz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Euclides Avila
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Ali Halhali
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Braulio Quesada-Reyna
- División de Obstetricia, UMAE Hospital de Gineco-Obstetricia No. 4 “Luis Castelazo Ayala”, IMSS, Rio de la Magdalena 289, Tizapán San Ángel, Progreso Tizapán, Álvaro Obregón, Ciudad de Mexico 01090, Mexico;
| | - Fernando Larrea
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Verónica Zaga-Clavellina
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas-Virreyes, Lomas de Chapultepec IV Sección, Miguel Hidalgo, Ciudad de Mexico 11000, Mexico
- Correspondence: (V.Z.-C.); (L.D.)
| | - Lorenza Díaz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
- Correspondence: (V.Z.-C.); (L.D.)
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Matsui H, Uchiyama J, Ogata M, Nasukawa T, Takemura-Uchiyama I, Kato SI, Murakami H, Higashide M, Hanaki H. Use of Recombinant Endolysin to Improve Accuracy of Group B Streptococcus Tests. Microbiol Spectr 2021; 9:e0007721. [PMID: 34378963 PMCID: PMC8552716 DOI: 10.1128/spectrum.00077-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/09/2021] [Indexed: 12/17/2022] Open
Abstract
Group B Streptococcus (GBS) causes serious neonatal infection via vertical transmission. The prenatal GBS screening test is performed at the late stage of pregnancy to avoid risks of infection. In this test, enrichment culture is performed, followed by GBS identification. Selective medium is used for the enrichment; however, Enterococcus faecalis, which is a potential contaminant in swab samples, can interfere with the growth of GBS. Such bacterial contamination can lead to false-negative results. Endolysin, a bacteriophage-derived enzyme, degrades peptidoglycan in the bacterial cell wall; it is a promising antimicrobial agent for selectively eliminating specific bacterial genera/species. In this study, we used the recombinant endolysin EG-LYS, which is specific to E. faecalis; the endolysin potentially enriched GBS in the selective culture. First, in the false-negative model (coculture of GBS and E. faecalis, which disabled GBS detection in the subsequent GBS identification test), EG-LYS treatment at 0.1 mg/ml improved GBS detection. Next, we used 548 vaginal swabs to test the efficacy of EG-LYS treatment in improving GBS detection. EG-LYS treatment (0.1 mg/ml) increased the GBS-positive ratio to 17.9%, compared to 15.7% in the control (phosphate-buffered saline [PBS] treatment). In addition, there were an increased number of GBS colonies under EG-LYS treatment in some samples. The results were supported by the microbiota analysis of the enriched cultures. In conclusion, EG-LYS treatment of the enrichment culture potentially improves the accuracy of the prenatal GBS screening test. IMPORTANCE Endolysin is a bacteriophage-derived enzyme that degrades the peptidoglycan in the cell wall of host bacteria; it could be used as an antimicrobial agent for selectively eliminating specific bacterial genera/species. Group B Streptococcus (GBS) causes neonatal infection via vertical transmission; prenatal GBS screening test, in which enrichment culture is followed by bacterial identification, is used to detect the presence of GBS in pregnant women. However, the presence of commensal bacteria such as Enterococcus faecalis in clinical specimens can inhibit GBS growth in the selective enrichment culture, resulting in false-negative result. Here, we demonstrated that the application of originally isolated endolysin in the enrichment culture improved the test accuracy by inhibiting unwanted E. faecalis growth and therefore avoiding false-negative results, not only in experimental settings, but also in tests using vaginal swabs.
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Affiliation(s)
- Hidehito Matsui
- Ōmura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Jumpei Uchiyama
- Department of Bacteriology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
- School of Veterinary Medicine, Azabu University, Sagamihara, Kanagawa, Japan
| | - Masaya Ogata
- School of Veterinary Medicine, Azabu University, Sagamihara, Kanagawa, Japan
| | - Tadahiro Nasukawa
- School of Veterinary Medicine, Azabu University, Sagamihara, Kanagawa, Japan
| | | | | | - Hironobu Murakami
- School of Veterinary Medicine, Azabu University, Sagamihara, Kanagawa, Japan
| | | | - Hideaki Hanaki
- Ōmura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
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Abstract
BACKGROUND Prevention strategies can reduce the incidence of early-onset group B Streptococcus (GBS) neonatal sepsis (EOGBS). Rates of GBS colonization and infection vary among regions within China. China has not adopted a unified prevention strategy. METHODS To assess strategies to reduce EOGBS in China, models were developed to quantify residual EOGBS rates with intrapartum antibiotic prophylaxis in infants ≥ 35 weeks' gestation in risk factor-based and antepartum screening-based strategies. Maternal GBS colonization rates and EOGBS incidence in 3 regions of China (A: Xiamen of Fujian province, B: Shanghai and C: Liuzhou of Guangxi province) were estimated from published data. RESULTS Estimates for GBS colonization and attack rates were 21.6%, 11.7% and 6.1% and 1.79, 1.79 and 0.58 per 1000 live births for regions A, B and C, respectively. Modeling predicted that strategies including screening cultures beginning at 36 weeks' gestation and intrapartum antibiotic prophylaxis in 90% of eligible parturients could reduce EOGBS incidence to 0.44, 0.50 and 0.16 per 1000 live births in these regions. In region C, the expected EOGBS rate could be reduced to 0.28 per 1000 using a risk factor-based strategy. CONCLUSIONS Different strategies for preventing EOGBS may be needed in different regions of mainland China. Screening strategies may be most appropriate in regions with higher attack rates, even with moderate levels of maternal GBS colonization. In areas with low attack rates, risk factor strategies that reduce morbidity by at least one-third may suffice.
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Affiliation(s)
- Yan Wang
- From the Department of Obstetrics and Gynecology, Peking University Third Hospital
| | - Yangyu Zhao
- From the Department of Obstetrics and Gynecology, Peking University Third Hospital
| | - Liying Zou
- Department of Obstetrics and Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing, People's Republic of China
| | - Jie Qiao
- From the Department of Obstetrics and Gynecology, Peking University Third Hospital
| | - William E Benitz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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20
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Moon CJ, Kwon TH, Lee KS, Lee HS. Recurrent neonatal sepsis and progressive white matter injury in a premature newborn culture-positive for group B Streptococcus: A case report. Medicine (Baltimore) 2021; 100:e26387. [PMID: 34160417 PMCID: PMC8238304 DOI: 10.1097/md.0000000000026387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Group B Streptococcus (GBS) remains a principal pathogen causing neonatal sepsis and meningitis, particularly in premature infants with relatively insufficient immunity. Recurrence may occur uncommonly, largely associated with subclinical mucosal persistence or repetitive exposure to exogenous sources. White matter injury (WMI) including cystic periventricular leukomalacia (PVL) has been associated with intrauterine infection/inflammation, and neonatal infection as a more significant predictor including postnatal sepsis and recurrent infection, even without microbial neuroinvasion. Furthermore, clinical and experimental evidence of WMI by some bacteria other than GBS without central nervous system invasion has been reported. However, there is little evidence of WMI associated with neonatal GBS sepsis in the absence of meningitis in the literature. PATIENT CONCERNS A newborn at 30+4 weeks' gestation with low birthweight presented with 2 episodes (with a 13-day interval with no antibiotic therapy) of neonatal sepsis culture-proven for GBS with early-onset presentation after clinical chorioamnionitis via vertical GBS transmission and the associated conditions including prematurity-related neonatal immunodeficiency and persistent mucosal GBS carriage after the first antibiotic treatment. The perinatal GBS infection was complicated by progressive WMI presenting with ventriculomegaly and cystic PVL without a definite evidence of meningitis, intraventricular hemorrhage, and documented cerebral hypoxia or hypoperfusion conditions including septic shock. DIAGNOSES Recurrent group B streptococcal sepsis and cystic PVL with ventriculomegaly. INTERVENTIONS Two episodes of GBS sepsis were treated with 15-day parenteral antibiotic therapy, respectively. OUTCOMES Resolution of the recurrent GBS sepsis without further relapses, however, complicated by WMI and subsequent about 6 months delay in motor development at 12 months' corrected age. LESSONS This case suggests WMI associated with GBS bacteremia without central nervous system entry by viable GBS and also shows that in premature infants, intrauterine GBS infection with no interventions may lead to extensive and persistent GBS colonization, early-onset and recurrent GBS disease, and WMI. Postnatal as well as intrauterine infection/inflammation controls with maternal prophylaxis may be pivotal for prevention and limiting the magnitude of neurologic injury.
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MESH Headings
- Administration, Intravenous
- Anti-Bacterial Agents/administration & dosage
- Chorioamnionitis/diagnosis
- Chorioamnionitis/microbiology
- Developmental Disabilities/diagnosis
- Developmental Disabilities/microbiology
- Drug Therapy, Combination/methods
- Female
- Humans
- Hydrocephalus/diagnosis
- Hydrocephalus/microbiology
- Infant
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infectious Disease Transmission, Vertical
- Leukomalacia, Periventricular/diagnosis
- Leukomalacia, Periventricular/microbiology
- Leukomalacia, Periventricular/pathology
- Magnetic Resonance Imaging
- Male
- Maternal Age
- Neonatal Sepsis/diagnosis
- Neonatal Sepsis/microbiology
- Neonatal Sepsis/therapy
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/microbiology
- Recurrence
- Streptococcal Infections/complications
- Streptococcal Infections/diagnosis
- Streptococcal Infections/microbiology
- Streptococcal Infections/transmission
- Streptococcus agalactiae/isolation & purification
- White Matter/diagnostic imaging
- White Matter/microbiology
- White Matter/pathology
- Young Adult
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Affiliation(s)
- Cheong-Jun Moon
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea
| | - Tae Hee Kwon
- Department of Radiology, Cha Gangnam Medical Center, Cha University School of Medicine
| | - Kyung Sang Lee
- Department of Radiology, Cha Gangnam Medical Center, Cha University School of Medicine
| | - Hyun-Seung Lee
- Department of Pediatrics, Incheon Worker‘s Compensation Hospital, Incheon
- Department of Pediatrics, Cha Gangnam Medical Center, Cha University School of Medicine, Seoul, Republic of Korea
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21
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Girma L, Geteneh A, Amenu D, Kassa T. Isolation and characterization of Listeria monocytogenes among women attending Jimma University medical center, Southwest Ethiopia. BMC Infect Dis 2021; 21:564. [PMID: 34118865 PMCID: PMC8199527 DOI: 10.1186/s12879-021-06254-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Listeria monocytogenes (LM) has come to be a major public health issue of at-risk groups, causing high morbidity and mortality. Despite this data, studies are very limited in developing countries like Ethiopia. Thus, we aimed to isolate and characterize LM in terms of antibiogram and biofilm formation among pregnant women with fever, women with a history of spontaneous abortion, women with a history of fetal loss, and women with preterm delivery at Jimma University Medical Center (JUMC), southwest Ethiopia. METHODS A cross-sectional study was done among 144 women from June to August 2019. Isolates were tested for antibiotic susceptibility and biofilm formation using disc diffusion and microtiter plate method, respectively. Data were collected using a structured questionnaire, entered into Epidata 3.1 and logistic regression was done by SPSS v25.0. RESULTS LM was isolated in 8 (5.56%) of 144 screened women. The isolation rate of LM was relatively higher among women with a history of fetal loss (9.7%), followed by women with preterm delivery (6.25%). One of the six cord blood was positive for LM, indicating that the transplacental transmission rate at JUMC was 16.7%. More than 2% of women with an ongoing pregnancy were found to have LM septicemia, which could hurt their fetus. All of the isolates tested were susceptible to Ampicillin. However, all of the isolates were resistant to Penicillin and Meropenem and were biofilm producers. CONCLUSIONS The high magnitude of pregnancy-related listeriosis in the current study setting appears that implementation of educational programs targeting risk reduction and more studies to identify sources of LM are warranted. The choice of antibiotics should be after susceptibility testing.
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Affiliation(s)
- Lencho Girma
- Department of Medical Laboratory Science, Mizan Aman College of Health Sciences, Aman, Ethiopia
| | - Alene Geteneh
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Demisew Amenu
- Department of Obstetrics and Gynecology, School of Medicine, Jimma University, Jimma, Ethiopia
| | - Tesfaye Kassa
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
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22
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Narice BF, Trzeszcz M, Cohen M, Anumba DO. Acute Villitis and Intravascular Microorganisms in Fetal Vessels: A Case Report and Literature Review of an Unusual Histopathological Finding. Pediatr Dev Pathol 2021; 24:246-251. [PMID: 33617361 PMCID: PMC8120628 DOI: 10.1177/1093526621993333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Optimal management of intrauterine infection to avoid serious adverse perinatal outcomes entails prompt administration of antibiotics and consideration of early delivery of the fetus to remove the focus of infection. We report an unusual case of preterm chorioamnionitis which did not improve with sensitive antibiotics, or delivery of the fetus, and ultimately required an emergency hysterectomy to save the mother's life. Interestingly, subsequent histopathological analysis of the post-hysterectomy specimen did not reveal myometrial necrosis or infectious microorganisms. The placental pathological examination, on the other hand, showed evidence of necrotising chorioamnionitis accompanied by a rarely reported lesion: acute villitis with abundant intravascular Escherichia coli, a finding which is strongly associated with fetal demise and adverse maternal outcomes.
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Affiliation(s)
- Brenda F Narice
- Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield and Sheffield Teaching Hospitals, The Jessop Wing, Sheffield, UK
- Brenda F Narice, Academic Unit of Reproductive and Developmental Medicine. The University of Sheffield and Sheffield Teaching Hospitals, The Jessop Wing, Sheffield, UK.
| | - Martyna Trzeszcz
- Department of Pathology and Clinical Cytology, University Hospital of Jan Mikulicz-Radecki, Wroclaw, Poland
- Histopathology Department, Sheffield Children's NHS Trust, Sheffield, UK
| | - Marta Cohen
- Histopathology Department, Sheffield Children's NHS Trust, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield and Sheffield, Sheffield, UK
| | - Dilly O Anumba
- Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield and Sheffield Teaching Hospitals, The Jessop Wing, Sheffield, UK
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23
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Lai TJ, Wang YH, Chong E, Lin YM, Huang CC, Feng KJ, Teng SW. The impact of prenatal use of oral Clostridium butyricum on maternal group B Streptococcus colonization: A retrospective study. Taiwan J Obstet Gynecol 2021; 60:442-448. [PMID: 33966725 DOI: 10.1016/j.tjog.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to examine the effect of taking Clostridium butyricum (Miyarisan BM) orally for 4 weeks since the 32+0 weeks of gestation on preventing Group B Streptococcus colonization. MATERIALS AND METHODS We retrospectively collected data on the pregnancy outcomes of 1602 women between October 2017 and August 2019. The control group received standard antenatal care, and the intervention group received standard antenatal care with a daily oral dose of probiotics since the 32+0 weeks of gestation. The daily dose was one pack of C. butyricum (Miyarisan BM) once or twice a day. A vaginal Group B Streptococcus swab was collected between 36+0 and 36+6 weeks of gestation. RESULTS After applying the designated exclusion criteria, the total number of participants was 1576. The Group B Streptococcus colonization rate was significantly decreased in the intervention group (P = 0.0338; adjusted OR: 0.66 (0.45-0.97)). CONCLUSION Probiotics can reduce the colonization rate of Group B Streptococcus in the vagina and rectum under three conditions: (1) intervention of adequate length, (2) sufficient probiotic dose, and (3) effective probiotics.
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Affiliation(s)
- Ting-Jung Lai
- Department of Obstetrics and Gynecology, Cardinal Tien Hospital, Xindian, New Taipei City, Taiwan
| | - Ya-Hui Wang
- Medical Research Center, Cardinal Tien Hospital, Xindian, New Taipei City, Taiwan
| | - Eva Chong
- Department of Obstetrics and Gynecology, Cardinal Tien Hospital, Xindian, New Taipei City, Taiwan
| | - Ying-Mei Lin
- Department of Obstetrics and Gynecology, Cardinal Tien Hospital, Xindian, New Taipei City, Taiwan
| | - Chao-Chi Huang
- Department of Obstetrics and Gynecology, Cardinal Tien Hospital, Xindian, New Taipei City, Taiwan
| | - Kuan-Jen Feng
- Department of Obstetrics and Gynecology, Cardinal Tien Hospital, Xindian, New Taipei City, Taiwan
| | - Sen-Wen Teng
- Department of Obstetrics and Gynecology, Cardinal Tien Hospital, Xindian, New Taipei City, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
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Kahlig P, Neumayr A, Paris DH. Louse-borne relapsing fever-A systematic review and analysis of the literature: Part 2-Mortality, Jarisch-Herxheimer reaction, impact on pregnancy. PLoS Negl Trop Dis 2021; 15:e0008656. [PMID: 33705387 PMCID: PMC7951929 DOI: 10.1371/journal.pntd.0008656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Louse-borne relapsing fever (LBRF) is a classical epidemic disease, which in the past was associated with war, famine, poverty, forced migration, and crowding under poor hygienic conditions around the world. The disease's causative pathogen, the spirochete bacterium Borrelia recurrentis, is confined to humans and transmitted by a single vector, the human body louse Pediculus humanus corporis. Since the disease was at its peak before the days of modern medicine, many of its aspects have never been formally studied and to date remain incompletely understood. In order to shed light on some of these aspects, we have systematically reviewed the accessible literature on LBRF since the recognition of its mode of transmission in 1907, and summarized the existing data on mortality, Jarisch-Herxheimer reaction (JHR), and impact on pregnancy. Publications were identified by using a predefined search strategy of electronic databases and a subsequent review of the reference lists of the obtained publications. All publications reporting patients with a confirmed diagnosis of LBRF published in English, French, German, and Spanish since 1907 were included. Data extraction followed a predefined protocol and included a grading system to judge the certainty of the diagnosis of reported cases. The high mortality rates often found in literature are confined to extreme scenarios. The case fatality rate (CFR) of untreated cases is on average significantly lower than frequently assumed. In recent years, a rise in the overall CFRs is documented, for which reasons remain unknown. Lacking standardized criteria, a clear diagnostic threshold defining antibiotic treatment-induced JHR does not exist. This explains the wide range of occurrence rates found in literature. Pre-antibiotic era data suggest the existence of a JHR-like reaction also in cases treated with arsenicals and even in untreated cases. LBRF-related adverse outcomes are observed in 3 out of 4 pregnancies.
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Affiliation(s)
- Pascal Kahlig
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia
| | - Daniel H. Paris
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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25
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Wen Y, Chen H, Ming X, Chen X, Zhou W. Analysis of risk factors, pathogenic bacteria of maternal sepsis in term pregnant women with positive blood culture during hospitalization. Medicine (Baltimore) 2021; 100:e24847. [PMID: 33607856 PMCID: PMC7899873 DOI: 10.1097/md.0000000000024847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/28/2021] [Indexed: 01/05/2023] Open
Abstract
The objective of this study was to evaluate the risk factors, pathogenic bacteria and drug sensitivity of maternal sepsis, and provide evidence for clinical prevention and treatment.A retrospective investigation of pregnant women with full-term maternal sepsis was performed to analyze the risk factors, pathogenic bacteria, and drug sensitivity of maternal sepsis.Univariate analysis showed that temperature, serum procalcitonin (PCT) and C-reactive protein (CRP) at admission, white blood cell count (WBC), PCT, CRP and neutrophilic granulocyte percentage (N%) during fever, premature rupture of membranes (PROM), antibiotic use within 1 week, mode of production, onset and duration of fever, between groups were statistically significant (P < .05). Logistic regression analysis showed that cesarean section was an independent risk factor for sepsis (OR = 11.839, 95%CI: 3.121-44.906). Apparent increase was found in body temperature (OR = 3.664, 95%CI: 1.722-7.795), duration of fever (OR = 1.953, 95%CI: 1.242-3.071), and PCT (OR = 1.080, 95%CI: 1.002-1.163). Also, increasing neutrophil ratio (OR = 1.180, 95%CI: 1.073-1.297) indicated a high possibility of maternal sepsis. The organism Escherichia coli (E. coli) was the most common pathogenic bacteria in the positive blood culture group (90%), and the sensitivity to carbapenems (meropenem and imipenem/cilastatin) was 100%, that to piperacillin-tazobactam and amoxicillin sulbactam was over 90%, and that to ceftazidime was 95%.Cesarean section was an independent risk factor for maternal sepsis in term pregnant women with positive blood culture. Besides, the E. coli was the most common pathogenic bacteria in the positive blood culture group. Antibiotics should be used in time and reasonably when the temperature was significantly increased with elevated PCT and N% after a cesarean section.
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Rajput D, Gupta A, Roshan R, Kumar A. Stillbirth as the primary manifestation of disseminated tuberculosis in a young immunocompetent mother with multiple perforations of the ileum. BMJ Case Rep 2021; 14:e239386. [PMID: 33563666 PMCID: PMC7875273 DOI: 10.1136/bcr-2020-239386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 11/04/2022] Open
Abstract
Tuberculosis (TB), a significant cause of morbidity and mortality worldwide, is particularly relevant in low/middle-income countries like India, where the disease is endemic. The female reproductive system is very vulnerable to this infection with, the clinical presentation being utterly silent in most patients. Symptoms of TB in pregnancy may initially be attributed to the gravidity itself besides temporary concealment of associated weight loss by the normally occurring weight gain during the pregnancy. Untreated TB may cause pregnancy loss by either placental damage or direct harm to both the mother and child. We report a case of latent disseminated TB in a young immunocompetent female that was revealed in the postpartum state (after full-term stillbirth delivery at home) as 20 ileal perforations secondary to intestinal TB. Due to ongoing sepsis and delayed presentation to the hospital, the patient could not be salvaged despite the best possible efforts.
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Affiliation(s)
- Deepak Rajput
- General Surgery, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
| | - Amit Gupta
- General Surgery, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
| | - Ravi Roshan
- General Surgery, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
| | - Arvind Kumar
- Pathology, All India Institute of Medical Sciences - Rishikesh, Rishikesh, Uttarakhand, India
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Abstract
PURPOSE OF REVIEW This review provides an update of nonviral, curable sexually transmitted infections (STIs) in pregnancy and summarizes our understanding of the current issues and controversies surrounding risk factors, screening, and treatment of STIs in pregnancy primarily in high-income countries (using the United States and the United Kingdom as examples). The infections covered in this review are syphilis, gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium infections. RECENT FINDINGS Overall, limited modern data is available to update researchers and clinicians on the epidemiology and care of STIs in pregnancy. Though common risk factors can be identified among these STIs, like socioeconomic status and inadequate antenatal care, specific screening and treatment challenges vary by geography and pathogen. Wherever available, surveillance data and research evidence are often limited to nonpregnant patients, leading to imperfect pregnancy-specific risk estimates and obstetric lags in the development and adoption of new guidelines. We have identified three areas of opportunity that may enhance the effectiveness of current approaches and inform new ones: improved data collection and evidence-based screening practices; prompt and comprehensive therapy, including partner services, and evaluations of new treatment modalities; and equitable antenatal and sexual healthcare for all pregnant persons and their partners. SUMMARY These findings highlight the need to revisit standards of screening and management of STIs in pregnancy in high-income countries.
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Affiliation(s)
- Andreea Waltmann
- Institute for Global Health and Infectious Disease, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tyler R McKinnish
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St Louis, Missouri
| | - Joseph A Duncan
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Grech A, Collins CE, Holmes A, Lal R, Duncanson K, Taylor R, Gordon A. Maternal exposures and the infant gut microbiome: a systematic review with meta-analysis. Gut Microbes 2021; 13:1-30. [PMID: 33978558 PMCID: PMC8276657 DOI: 10.1080/19490976.2021.1897210] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 02/04/2023] Open
Abstract
Early life, including the establishment of the intestinal microbiome, represents a critical window of growth and development. Postnatal factors affecting the microbiome, including mode of delivery, feeding type, and antibiotic exposure have been widely investigated, but questions remain regarding the influence of exposures in utero on infant gut microbiome assembly. This systematic review aimed to synthesize evidence on exposures before birth, which affect the early intestinal microbiome. Five databases were searched in August 2019 for studies exploring pre-pregnancy or pregnancy 'exposure' data in relation to the infant microbiome. Of 1,441 publications identified, 76 were included. Factors reported influencing microbiome composition and diversity included maternal antibiotic and probiotic uses, dietary intake, pre-pregnancy body mass index (BMI), gestational weight gain (GWG), diabetes, mood, and others. Eleven studies contributed to three meta-analyses quantifying associations between maternal intrapartum antibiotic exposure (IAP), BMI and GWG, and infant microbiome alpha diversity (Shannon Index). IAP, maternal overweight/obesity and excessive GWG were all associated with reduced diversity. Most studies were observational, few included early recruitment or longitudinal follow-up, and the timing, frequency, and methodologies related to stool sampling and analysis were variable. Standardization and collaboration are imperative to enhance understanding in this complex and rapidly evolving area.
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Affiliation(s)
- Allison Grech
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales(NSW), Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Holmes
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- School of Life and Environmental Sciences, Faculty of Science, University of Sydney, Camperdown, NSW, Australia
| | - Ravin Lal
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales(NSW), Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
| | - Kerith Duncanson
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Rachael Taylor
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia
| | - Adrienne Gordon
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales(NSW), Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
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Schindler Y, Rahav G, Nissan I, Madar-Shapiro L, Abtibol J, Ravid M, Maor Y. Group B Streptococcus serotypes associated with different clinical syndromes: Asymptomatic carriage in pregnant women, intrauterine fetal death, and early onset disease in the newborn. PLoS One 2020; 15:e0244450. [PMID: 33382792 PMCID: PMC7774942 DOI: 10.1371/journal.pone.0244450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 12/09/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives To study Group B Streptococcus (GBS) isolates associated with different clinical syndromes: asymptomatic carriage in pregnant women, intrauterine fetal death (IUFD), and early onset disease (EOD) in the newborn. Methods GBS isolates were collected from asymptomatic pregnant women admitted for labor, IUFD cases, and neonates with EOD. Serotypes and antibiotic susceptibilities were determined. Multilocus sequence typing (MLST) was performed to assess genetic epidemiology. Results GBS carriage rate was 26.1% (280/1074). The dominant serotype among asymptomatic pregnant women was VI [98/240 women (40.8%)], followed by serotypes III, V and IV in 42/240 (17.5%), 30/240 (12.5%) and 28/240 (11.7%) women, respectively. The dominant serotype in IUFD cases was serotype VI [10/13 (76.9%)]. In contrast the prevalent serotype among EOD cases was III [16/19 (84.2%)]. ST-1 was associated with IUFD [7/13 (53.8%)], ST-17 was associated with serotype III and EOD in the newborn 14/19 (73.7%)]. Erythromycin and clindamycin resistance reached 36.8%, 7.7% and 20.0%among EOD, vaginal carriage and IUFD, respectively. Conclusions Serotypes VI and ST-1 were dominant among asymptomatic pregnant women and in IUFD cases while EOD was associated with serotype III and ST-17. Invasive mechanisms thus may differ between IUFD and EOD in the newborn and virulence may be related to capsule serotype. Resistance rates to erythromycin and clindamycin were high in EOD cases.
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Affiliation(s)
- Yulia Schindler
- Microbiology laboratory, Maayaney Hayeshua, Bney Brak, Israel
- The Sackler School of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Rahav
- The Sackler School of medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Disease Unit, Sheba Medical Center, Tel Hahomer, Israel
| | - Israel Nissan
- Infectious Disease Unit, Sheba Medical Center, Tel Hahomer, Israel
- Infectious Disease Unit, Wolfson Medical Center, Holon, Israel
| | | | - Julia Abtibol
- Microbiology laboratory, Maayaney Hayeshua, Bney Brak, Israel
| | - Moti Ravid
- Microbiology laboratory, Maayaney Hayeshua, Bney Brak, Israel
- The Sackler School of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Maor
- The Sackler School of medicine, Tel Aviv University, Tel Aviv, Israel
- National Public Health Laboratory, Ministry of Health (Israel), Tel-Aviv, Israel
- * E-mail: ,
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Adetunji SA, Faustman DL, Adams LG, Garcia-Gonzalez DG, Hensel ME, Khalaf OH, Arenas-Gamboa AM. Brucella abortus and Pregnancy in Mice: Impact of Chronic Infection on Fertility and the Role of Regulatory T Cells in Tissue Colonization. Infect Immun 2020; 88:e00257-20. [PMID: 32690635 PMCID: PMC7504963 DOI: 10.1128/iai.00257-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/10/2020] [Indexed: 01/18/2023] Open
Abstract
Stealthy intracellular bacterial pathogens are known to establish persistent and sometimes lifelong infections. Some of these pathogens also have a tropism for the reproductive system, thereby increasing the risk of reproductive disease and infertility. To date, the pathogenic mechanism involved remains poorly understood. Here, we demonstrate that Brucella abortus, a notorious reproductive pathogen, has the ability to infect the nonpregnant uterus, sustain infection, and induce inflammatory changes during both acute and chronic stages of infection. In addition, we demonstrated that chronically infected mice had a significantly reduced number of pregnancies compared to naive controls. To investigate the immunologic mechanism responsible for uterine tropism, we explored the role of regulatory T cells (Tregs) in the pathogenesis of Brucella abortus infection. We show that highly suppressive CD4+FOXP3+TNFR2+ Tregs contribute to the persistence of Brucella abortus infection and that inactivation of Tregs with tumor necrosis factor receptor II (TNFR2) antagonistic antibody protected mice by significantly reducing bacterial burden both systemically and within reproductive tissues. These findings support a critical role of Tregs in the pathogenesis of persistence induced by intracellular bacterial pathogens, including B. abortus Results from this study indicate that adverse reproductive outcomes can occur as sequelae of chronic infection in nonpregnant animals and that fine-tuning Treg activity may provide novel immunotherapeutic and prevention strategies against intracellular bacterial infections such as brucellosis.
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Affiliation(s)
- Shakirat A Adetunji
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, USA
| | - Denise L Faustman
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - L Garry Adams
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, USA
| | | | - Martha E Hensel
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, USA
| | - Omar H Khalaf
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, USA
- Department of Veterinary Pathology & Poultry Diseases, College of Veterinary Medicine, University of Baghdad, Baghdad, Iraq
| | - Angela M Arenas-Gamboa
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, USA
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Hensel ME, Chaki SP, Stranahan L, Gregory AE, van Schaik EJ, Garcia-Gonzalez DG, Khalaf O, Samuel JE, Arenas-Gamboa AM. Intratracheal Inoculation with Brucella melitensis in the Pregnant Guinea Pig Is an Improved Model for Reproductive Pathogenesis and Vaccine Studies. Infect Immun 2020; 88:e00204-20. [PMID: 32690632 PMCID: PMC7504952 DOI: 10.1128/iai.00204-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/10/2020] [Indexed: 11/20/2022] Open
Abstract
Reproductive failure is the hallmark of brucellosis in animals. An uncommon but important complication in pregnant women who become acutely infected with Brucella melitensis is spontaneous pregnancy loss or vertical transmission to the fetus. Unfortunately, the mechanism behind reproductive failure is still obscure, partially due to the lack of a proper study model. Recently, it was demonstrated that intratracheal (IT) inoculation of nonpregnant guinea pigs would replicate features of clinical disease in humans. To determine if IT inoculation would induce reproductive disease, guinea pigs were infected at mid-gestation and monitored daily for fever and abortions. Fever developed between day 14 to 18 postinoculation, and by 3 weeks postinoculation, 75% of pregnant guinea pigs experienced stillbirths or spontaneous abortions mimicking natural disease. Next, to investigate the guinea pig as a model for evaluating vaccine efficacy during pregnancy, nonpregnant guinea pigs were vaccinated with S19, 16MΔvjbR + Quil-A, or 100 μl PBS + Quil-A (as control). Guinea pigs were bred and vaccinated guinea pigs were challenged at mid-gestation with B. melitensis IT inoculation and monitored for fever and abortions. Vaccination with both vaccines prevented fever and protected against abortion. Together, this study indicates that pregnant guinea pigs are an appropriate animal model to study reproductive disease and offer an improved model to evaluate the ability of vaccine candidates to protect against a serious manifestation of disease.
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Affiliation(s)
- Martha E Hensel
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Sankar P Chaki
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Lauren Stranahan
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Anthony E Gregory
- Department of Microbial Pathogenesis and Immunology, College of Medicine, Texas A&M University, College Station, Texas, USA
| | - Erin J van Schaik
- Department of Microbial Pathogenesis and Immunology, College of Medicine, Texas A&M University, College Station, Texas, USA
| | - Daniel G Garcia-Gonzalez
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Omar Khalaf
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
- Department of Veterinary Pathology and Poultry Diseases, College of Veterinary Medicine, University of Baghdad, Baghdad, Iraq
| | - James E Samuel
- Department of Microbial Pathogenesis and Immunology, College of Medicine, Texas A&M University, College Station, Texas, USA
| | - Angela M Arenas-Gamboa
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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Egloff C, Sibiude J, Couffignal C, Mandelbrot L, Picone O. Causes and consequences of fever during pregnancy: A retrospective study in a gynaecological emergency department. J Gynecol Obstet Hum Reprod 2020; 49:101899. [PMID: 32853830 PMCID: PMC7444605 DOI: 10.1016/j.jogoh.2020.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Fever is a very common reason for emergency consultation during pregnancy, and may be associated with maternal, obstetrical and/or fetal adverse outcomes. The aim of this study was to determine the etiologies and to analyze the maternal or fetal complications of fever in pregnancy. STUDY DESIGN A retrospective single center study including all patients who consulted for fever above 38 °C during pregnancy in the gynecological emergency ward from August 2016 to July 2017. RESULTS A total of 100 pregnant women who consulted for fever were included. The etiologies were common viral infections (37 %), influenza (21 %), pyelonephritis (11 %), viral gastroenteritis (6%), chorioamnionitis (5%), other (5%). The etiology was unknown for 15 %. Fever was confirmed during consultation in 45/100 patients (45 %). Among patients with confirmed fever, 21/45 (47 %) were hospitalized with a median stay of 3 days [IQR 2-4] and 10/45(22 %) developed fetal or maternal complications. Probabilistic antibiotics were delivered for 34/45, 76 % patients. Only 14/45, 31 % had confirmed bacterial infections. Of the 32 patients with confirmed fever who had no etiologic diagnosis at the initial work-up in the emergency room, 19/32, 59 % received presumptive treatment with amoxicillin against Listeria monocytogenes. None had confirmed listeriosis, and all were probably common viral infections. Among all patients, the complications rate was 13 % and 22 % in the subgroup with fever confirmed at presentation. CONCLUSIONS This study quantifies the main etiologies and complications of fever during pregnancy. A challenge is to reduce excessive antibiotic use by improving rapid diagnosis of bacterial and viral infections. Prospective studies are needed to target patients at risk of complications in an optimal way and to study new management strategies.
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Affiliation(s)
- C Egloff
- Assistance Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, France; FHU PREMA, France; Université de Paris, Paris, France; INSERM, IAME, UMR 1137, Paris, France.
| | - J Sibiude
- Assistance Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, France; FHU PREMA, France; Université de Paris, Paris, France; INSERM, IAME, UMR 1137, Paris, France
| | - C Couffignal
- Unité de recherche clinique Paris Nord Val de Seine, URC PNVS, France; Université de Paris, Paris, France; INSERM, IAME, UMR 1137, Paris, France
| | - L Mandelbrot
- Assistance Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, France; FHU PREMA, France; Université de Paris, Paris, France; INSERM, IAME, UMR 1137, Paris, France
| | - O Picone
- Assistance Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, France; FHU PREMA, France; Université de Paris, Paris, France; INSERM, IAME, UMR 1137, Paris, France
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Plainvert C, Anselem O, Joubrel C, Marcou V, Falloukh A, Frigo A, Magdoud El Alaoui F, Ancel PY, Jarreau PH, Mandelbrot L, Goffinet F, Poyart C, Tazi A. Persistence of group B Streptococcus vaginal colonization and prevalence of hypervirulent CC-17 clone correlate with the country of birth: a prospective 3-month follow-up cohort study. Eur J Clin Microbiol Infect Dis 2020; 40:133-140. [PMID: 32812077 DOI: 10.1007/s10096-020-04011-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/11/2020] [Indexed: 01/10/2023]
Abstract
To identify factors associated with vaginal colonization and persistence by group B Streptococcus (GBS) and by the hypervirulent neonatal CC-17 clone in late pregnancy and after delivery, a multicentre prospective observational cohort with 3-month follow-up was established in two university hospitals, Paris area, France. Pregnant women were recruited when antenatal screening for GBS vaginal colonization at 34-38 weeks of gestational age was positive. Vaginal samples were analysed by conventional culture methods at antenatal screening, delivery, and 21 and 60 days following delivery. Identification of the hypervirulent neonatal GBS CC-17 was performed. Colonization was defined as persistent when all vaginal samples were positive for GBS. A total of 754 women were included. GBS vaginal colonization was persistent in 63% of the cases (95% CI 59%-67%). Persistent colonization was more likely in women born in Sub-Saharan Africa compared with women born in France (OR = 1.88, 95% CI 1.05-3.52), and GBS CC-17 was overrepresented in women born in Sub-Saharan Africa (OR = 2.09, 95% CI 1.20-3.57). Women born in Sub-Saharan Africa are at higher risk for GBS vaginal persistence than women born in France. This observation correlates with an increased prevalence of the hypervirulent GBS CC-17 in the former group, which likely reflect variations linked to ethnicity and vaginal community-state types and might account for the increased susceptibility of black neonates to GBS infections.
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Affiliation(s)
- Céline Plainvert
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Olivia Anselem
- FHU Prema, Paris, France
- Department of Obstetrics and Gynaecology, Port-Royal Maternity, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Caroline Joubrel
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Valérie Marcou
- FHU Prema, Paris, France
- Department of Neonatal Medicine, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Amiel Falloukh
- Department of Neonatal Medicine, Louis Mourier Hospital, AP-HP, Colombes, France
| | - Amandine Frigo
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Fatma Magdoud El Alaoui
- Department of Microbiology, Louis Mourier Hospital, AP-HP, Colombes, France
- Université de Paris, Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Paris, France
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), INSERM UMR 1153, Paris, France
- URC-CIC P1419, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Pierre Henri Jarreau
- FHU Prema, Paris, France
- Department of Neonatal Medicine, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
- Université de Paris, Paris, France
| | - Laurent Mandelbrot
- FHU Prema, Paris, France
- Université de Paris, Paris, France
- Department of Obstetrics and Gynaecology, Louis Mourier Hospital, AP-HP, Colombes, France
| | - François Goffinet
- Department of Obstetrics and Gynaecology, Port-Royal Maternity, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
- Université de Paris, Paris, France
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), INSERM UMR 1153, Paris, France
| | - Claire Poyart
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
- Université de Paris, Paris, France
| | - Asmaa Tazi
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France.
- FHU Prema, Paris, France.
- Université de Paris, Paris, France.
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He W, Jin Y, Zhu H, Zheng Y, Qian J. Effect of Chlamydia trachomatis on adverse pregnancy outcomes: a meta-analysis. Arch Gynecol Obstet 2020; 302:553-567. [PMID: 32643040 DOI: 10.1007/s00404-020-05664-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/18/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze the effect of Chlamydia trachomatis (C. trachomatis) on adverse pregnancy outcomes based on the currently available evidence. METHODS Multiple databases were comprehensively searched from the available date of inception through December 9, 2019. The effect of C. trachomatis on adverse pregnancy outcomes was assessed using pooled odds rations (ORs) and 95% confidence intervals (CIs). Egger's test was used for publication bias. RESULTS Fifty studies involving 502,141 participants were identified. C. trachomatis infection was found to be associated with preterm birth in antibody detection [OR (95% CI): 1.571 (1.112-2.220), P = 0.010] and high-quality assessment [OR (95% CI): 1.734 (1.295-2.321), P < 0.001], preterm premature rupture of membranes (PPROM) in culture detection [OR (95% CI): 4.339 (1.806-10.424), P = 0.001] and high-quality assessment [OR (95% CI): 2.822 (1.333-5.973), P = 0.007], stillbirth [OR (95% CI): 1.585 (1.219-2.062), P = 0.001], low-birthweight babies [OR (95% CI): 2.205 (1.137-4.274), P = 0.019], and babies small for gestational age [OR (95% CI): 1.193 (1.091-1.305), P < 0.001]. No publication bias was exhibited in miscarriage (P = 0.170), preterm birth (P = 0.303), PPROM (P = 0.341), stillbirth (P = 0.533), and low-birthweight babies (P = 0.535). CONCLUSIONS C. trachomatis infection during pregnancy is associated with a higher risk of preterm birth, PPROM, stillbirth, low-birthweight babies, and babies small for gestational age.
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MESH Headings
- Abortion, Spontaneous
- Chlamydia Infections/diagnosis
- Chlamydia Infections/epidemiology
- Chlamydia Infections/microbiology
- Chlamydia trachomatis/isolation & purification
- Female
- Fetal Membranes, Premature Rupture/epidemiology
- Fetal Membranes, Premature Rupture/microbiology
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Small for Gestational Age
- Obstetric Labor, Premature/epidemiology
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/microbiology
- Pregnancy Outcome/epidemiology
- Premature Birth/epidemiology
- Stillbirth
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Affiliation(s)
- Weihua He
- Department of Gynecology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Yue Jin
- Department of Gynecology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Haibin Zhu
- Department of Gynecology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Yan Zheng
- Department of Gynecology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Jianhua Qian
- Department of Gynecology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, People's Republic of China.
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35
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Abstract
Purpose To study the prevalence of group B streptococci (GBS) in Indian pregnant women and associated risk factors. Methods Four hundred and fifty pregnant women attending antenatal outpatient/inpatient department between 35-38 weeks of gestation were enrolled in the study. All enrolled subjects were assessed by a predefined proforma for their demographics, socio-economic characteristics, education, toilet habits, obstetric history and clinical outcome. Two cotton swabs each from lower vagina and rectum were collected and plated on selective solid media CHROM agar Strept B (CHROMagarTM) and selective Enrichment Broth LIM RambaQUICK StreptB broth (CHROMagarTM). Presumptive identification of GBS was growth of 1-3 mm grayish white β-hemolytic colonies on BAP or mauve coloured colonies on CHROM agar Strept B. All presumptively identified GBS were confirmed as group B streptococcus by automated identification system-Vitek MS (Bio Merieux). Results The recto vaginal colonization rate of GBS in this study was observed as 3.3% (n=15). GBS colonization was significantly associated with nulliparous women (p= 0.026) and use of western style toilet (p=0.017). GBS urinary tract infections was also seen more commonly in women with GBS rectovaginal colonization (p=0.002). Conclusion Due to the low GBS prevalence and no significant association with major risk factors, we recommend to institute universal screening of GBS in pregnant women, instead of risk based screening. Since this was a single centric study with low prevalence of GBS, its applicability may be limited, therefore further larger multi-centric prospective studies are required to understand the true GBS prevalence in Indian society.
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Affiliation(s)
- Neeraj Goel
- Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Chand Wattal
- Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Kanwal Gujral
- Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Nehal Dhaduk
- Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Chandra Mansukhani
- Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Pankaj Garg
- Institute of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
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Abstract
This study aimed to analyze the clinical characteristics, responsible pathogens, and antibiotic sensitivity of aerobic vaginitis (AV) infection in women in late pregnancy in western China.We enrolled 246 pregnancy with AV (≥35 weeks gestation) and 204 reproductive non-pregnancy with AV from West China between January 2019 and December 2019. Then, bacterial culture, identification and antibiotic sensitivity testing were performed. Subsequently, we retrospectively analyzed the vaginal microbiota of 250 healthy pregnant women with no AV and compared the maternal features and pregnancy outcomes.Regarding bacterial diversity, Streptococcus and Lactobacillus were highly abundant in women with AV in late pregnancy, whereas Staphylococcus spp. and other bacteria were significantly more abundant in reproductive non-pregnant women with AV. In addition, 82.5% (343/416) of the single isolate comprised Escherichia coli, group B Streptococcus, Enterococcus faecalis, and Staphylococcus aureus. Among the top 4 isolates, 13.4% (46/343) were multidrug-resistant, but all isolates were highly susceptible to nitrofurantoin. Escherichia coli was 100% susceptible to amikacin, meropenem, ertapenem, and imipenem (100%, 157/157), and gram-positive cocci were 100% (186/186) susceptible to vancomycin and linezolid. Finally, we found that pregnant women with AV had high rates of histories of vaginitis, premature rupture of membranes and neonatal infection.Our study reveals new insights into AV infection during pregnancy and highlights the different vaginal bacterial microbiome compositions between pregnant and reproductive non pregnant women with AV, these results may translate to treatments that are more cost-effective than current standard treatments.
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Affiliation(s)
- Yuanting Tang
- Department of Laboratory Medicine, West China Second University Hospital
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Fan Yu
- Department of Laboratory Medicine, West China Second University Hospital
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Zhengqiang Hu
- Department of Laboratory Medicine, West China Second University Hospital
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Luyun Peng
- Department of Laboratory Medicine, West China Second University Hospital
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yongmei Jiang
- Department of Laboratory Medicine, West China Second University Hospital
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
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Serventi L, Curi B, Johns R, Silva J, Bainbridge R, Gaither K. Pregnancy Complicated by Listeria Monocytogenes: A Case Report and Review of the Literature. J Natl Med Assoc 2020; 112:428-432. [PMID: 33526229 DOI: 10.1016/j.jnma.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/27/2020] [Accepted: 05/02/2020] [Indexed: 11/18/2022]
Abstract
Listeria Monocytogenes, a small facultative anaerobic, gram positive, motile bacillus is a rare, but consequential etiologic agent of food borne illness which inordinately impacts immunocompromised individuals. The organism infects many types of animals and contaminates a multitude of foodstuffs such as milk, chicken, beef and vegetables. This microbe additionally has a distinct proclivity to infect the maternal-fetoplacental unit with resultant adverse perinatal outcomes inclusive of spontaneous abortion, preterm delivery, chorioamnionitis, neonatal meningitis and death. We present a case of Listeriosis complicating pregnancy with a subsequent comprehensive review of the literature.
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Affiliation(s)
- Lisa Serventi
- NYC Health+ Hospitals/Lincoln, Department of Ob/Gyn, 234 East 149th Street, Bronx, 10451, NY
| | - Berenice Curi
- NYC Health+ Hospitals/Lincoln, Department of Ob/Gyn, 234 East 149th Street, Bronx, 10451, NY
| | - Rochelle Johns
- NYC Health+ Hospitals/Lincoln, Department of Ob/Gyn, 234 East 149th Street, Bronx, 10451, NY
| | - Jessica Silva
- NYC Health+ Hospitals/Lincoln, Department of Ob/Gyn, 234 East 149th Street, Bronx, 10451, NY
| | - Ronald Bainbridge
- NYC Health+ Hospitals/Lincoln, Department of Ob/Gyn, 234 East 149th Street, Bronx, 10451, NY
| | - Kecia Gaither
- NYC Health+ Hospitals/Lincoln, Department of Ob/Gyn, 234 East 149th Street, Bronx, 10451, NY.
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Biset S, Moges F, Endalamaw D, Eshetie S. Multi-drug resistant and extended-spectrum β-lactamases producing bacterial uropathogens among pregnant women in Northwest Ethiopia. Ann Clin Microbiol Antimicrob 2020; 19:25. [PMID: 32493343 PMCID: PMC7268622 DOI: 10.1186/s12941-020-00365-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 05/25/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Above 80% of urinary tract infections are caused by enteric bacteria, which are known for years by their drug-resistant ability. Though the prevalence of drug-resistant strains is increasing in the world, it is not well known in low-income countries. The aim of this study was to assess the prevalence of Multi-drug resistance, Extended-spectrum β-lactamases production, and associated risk factors among pregnant women in Northwest Ethiopia. METHODS A hospital-based cross-sectional study was conducted among pregnant women from March to May 2017. A total of 384 clean-catch midstream urine sample was collected from study participants. Bacterial identification and drug susceptibility testing were done following standard microbiological techniques; Extended-spectrum β-lactamase production was screened using a disc diffusion test and confirmed by a combination disc test. The data were entered and analyzed by using SPSS version 20, and a p-value of less than 0.05 was considered as statistically significant. RESULT The overall prevalence of urinary tract infection was 15.9% (95% CI 12.8-20.1%). E. coli (49.2%), CoNS (27.9%), and S. aureus (18%) were the main uropathogens. The prevalence of MDR uropathogens was 60.65%. The prevalence of ESBLs production among cases caused by Enterobacteriaceae was 18.2%. The drug resistance rate of Gram-negative isolates was higher for ampicillin (90.9%), cephalothin (84.8%), and augmentin (57.6%). The drug nitrofurantoin showed the highest activity (100%) against Gram-negative isolates. Gram-positive isolates were showed low susceptibility to penicillin (89.3%) and cotrimoxazole (75%); however highest susceptibility rate for gentamicin (100%), amikacin (100%), and nitrofurantoin (98.36%) was recorded. Prior antibiotic therapy (AOR = 5.46, 95% CI 1.38-21.65) was a risk factor for the presence of multi-drug resistant bacteria. CONCLUSION AND RECOMMENDATION The multi-drug resistance prevalence was high among uropathogen, thus treatment of urinary tract infection during pregnancy; should be based on the antibacterial susceptibility testing result. The isolation of drug-resistant strains like Extended-spectrum β-lactamases in this study calls for the need of periodic and continuous follow-up of antibiotic usage among pregnant women. Nitrofurantoin, gentamicin, amikacin, and ciprofloxacin/norfloxacin showed higher activity against bacterial uropathogen.
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Affiliation(s)
- Sirak Biset
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196 Gondar, Ethiopia
| | - Feleke Moges
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196 Gondar, Ethiopia
| | - Demeke Endalamaw
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196 Gondar, Ethiopia
| | - Setegn Eshetie
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196 Gondar, Ethiopia
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Siles-Guerrero V, Cardona-Benavides I, Liébana-Martos C, Vázquez-Alonso F, Expósito-Ruiz M, Navarro-Marí JM, Gutiérrez-Fernández J. Recent clinical relevance of mono-genital colonization/infection by Ureaplasma parvum. Eur J Clin Microbiol Infect Dis 2020; 39:1899-1905. [PMID: 32436116 DOI: 10.1007/s10096-020-03928-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022]
Abstract
Ureaplasma parvum is the most prevalent genital mycoplasma in women of childbearing age. There is debate around the relevance of its presence in male or female genitals for disease development and as a cofactor. The objective of this study was to determine the prevalence of colonization/infection by U. parvum and its possible relationship with reproductive tract infections. We retrospectively analyzed the presence of U. parvum in patients referred by specialist clinicians for suspicion of genitourinary tract infection. U. parvum was detected in 23.8% of samples, significantly more frequently in females (39.9%) than in males (6%). Among the males, U. parvum was found alone in 68.4% of episodes, with Ct < 30. Among the females, U. parvum was detected in 88.6% of cases, with Ct < 30, including 22 cases with premature rupture of membranes and 6 cases with threat of preterm labor. Co-infection was significantly more frequent in females (62.6%) than in males (31.6%). Given the high prevalence of U. parvum as sole isolate in males and females with genitourinary symptoms, it should be considered in the diagnosis and treatment of genital infections, although its pathogenic role in some diseases has not been fully elucidated.
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Affiliation(s)
- Víctor Siles-Guerrero
- Department of Microbiology, School of Medicine, University of Granada-Instituto de Investigación Biosanitaria de Granada.ibs, Granada, Spain
| | - Inmaculada Cardona-Benavides
- Department of Obstetrics and Gynecology, University Hospital Virgen de las Nieves- Instituto de Investigación Biosanitaria de Granada, ibs Granada, Granada, Spain
| | - Carmen Liébana-Martos
- Department of Microbiology, University Hospital Ciudad de Jaén -Instituto de Investigación Biosanitaria de Granada, ibs Granada, Jaén, Spain
| | - Fernando Vázquez-Alonso
- Department of Urology, University Hospital Virgen de las Nieves-Instituto de Investigación Biosanitaria de Granada, ibs Granada, Granada, Spain
| | - Manuela Expósito-Ruiz
- Research and Biostatistics Methodology Unit, University Hospital Virgen de las Nieves- Instituto de Investigación Biosanitaria de Granada, ibs Granada, Granada, Spain
| | - José María Navarro-Marí
- Department of Microbiology, University Hospital Virgen de las Nieves-Instituto de Investigación Biosanitaria de Granada, ibs Granada, Granada, Spain
| | - José Gutiérrez-Fernández
- Department of Microbiology, School of Medicine, University of Granada-Instituto de Investigación Biosanitaria de Granada.ibs, Granada, Spain.
- Department of Microbiology, University Hospital Virgen de las Nieves-Instituto de Investigación Biosanitaria de Granada, ibs Granada, Granada, Spain.
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Hasperhoven GF, Al‐Nasiry S, Bekker V, Villamor E, Kramer BWW. Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset group B streptococcal disease: a systematic review and meta-analysis. BJOG 2020; 127:680-691. [PMID: 31913562 PMCID: PMC7187465 DOI: 10.1111/1471-0528.16085] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Early-onset group B streptococcal (EOGBS) disease (including sepsis, meningitis, and pneumonia) causes significant morbidity and mortality in newborn infants worldwide. Antibiotic prophylaxis can prevent vertical streptococcal transmission, yet no uniform criteria exist to identify eligible women for prophylaxis. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening-based protocol), whereas others employ risk-based protocols. OBJECTIVES To compare the effectiveness of screening-based versus risk-based protocols in preventing EOGBS disease. SEARCH STRATEGY Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture-based, risk-based. SELECTION CRITERIA Studies were included if they investigated EOGBS disease incidence in newborn infants and compared screening or risk-based protocols with each other or with controls. DATA COLLECTION AND ANALYSIS Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel-Haenszel analyses with random effects. MAIN RESULTS Seventeen eligible studies were included. In this meta-analysis, screening was associated with a reduced risk for EOGBS disease compared either with risk-based protocols (ten studies, RR 0.43, 95% CI 0.32-0.56) or with no policy (four studies, RR 0.31, 95% CI 0.11-0.84). Meta-analysis could not demonstrate a significant effect of risk-based protocols versus no policy (seven studies, RR 0.86, 95% CI 0.61-1.20). In studies reporting on the use of antibiotics, screening was not associated with higher antibiotic administration rates (31 versus 29%). CONCLUSIONS Screening-based protocols were associated with lower incidences of EOGBS disease compared with risk-based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking. TWEETABLE ABSTRACT Meta-analysis: general screening is associated with lower rates of early-onset group B strep. neonatal sepsis compared with risk-based protocols.
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Affiliation(s)
- GF Hasperhoven
- Faculty of Health Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | - S Al‐Nasiry
- Department of Gyneacology and ObstetricsMaastricht University Medical CentreMaastrichtthe Netherlands
| | - V Bekker
- Department of PaediatricsLeiden University Medical CentreLeidenthe Netherlands
| | - E Villamor
- Department of PaediatricsMaastricht University Medical CentreMaastrichtthe Netherlands
| | - BWW Kramer
- Department of PaediatricsMaastricht University Medical CentreMaastrichtthe Netherlands
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Jisuvei SC, Osoti A, Njeri MA. Prevalence, antimicrobial susceptibility patterns, serotypes and risk factors for group B streptococcus rectovaginal isolates among pregnant women at Kenyatta National Hospital, Kenya; a cross-sectional study. BMC Infect Dis 2020; 20:302. [PMID: 32321444 PMCID: PMC7178604 DOI: 10.1186/s12879-020-05035-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Estimates of Group B Streptococcus (GBS) disease burden, antimicrobial susceptibility, and serotypes in pregnant women are limited for many resource-limited countries including Kenya. These data are required to inform recommendations for prophylaxis and treatment of infections due to GBS. METHODS We evaluated the prevalence, antimicrobial susceptibility patterns, serotypes, and risk factors associated with rectovaginal GBS colonization among pregnant women receiving antenatal care at Kenyatta National Hospital (KNH) between August and November 2017. Consenting pregnant women between 12 and 40 weeks of gestation were enrolled. Interview-administered questionnaires were used to assess risk factors associated with GBS colonization. An anorectal swab and a lower vaginal swab were collected and cultured on Granada agar for GBS isolation. Positive colonies were tested for antimicrobial susceptibility to penicillin G, ampicillin, vancomycin, and clindamycin using the disk diffusion method. Serotyping was performed by latex agglutination. Logistic regression was used to identify factors associated with GBS colonization. RESULTS A total of 292 women were enrolled. Median age was 30 years (Interquartile range {IQR} 26-35) and a median gestational age of 35 weeks (IQR 30-37). Overall GBS was identified in 60/292 (20.5%) of participants. Among the positive isolates, resistance was detected for penicillin G in 42/58 (72.4%) isolates, ampicillin in 32/58 (55.2%) isolates, clindamycin in 14/46 (30.4%) isolates, and vancomycin in 14/58 (24.1%) isolates. All ten GBS serotypes were isolated, and 37/53 (69.8%) of GBS positive participants were colonized by more than one serotype. None of the risk factors was associated with GBS colonization. CONCLUSION The prevalence of GBS colonization was high among antenatal women at KNH. In addition, a high proportion of GBS isolates were resistant to commonly prescribed intrapartum antibiotics. Hence, other measures like GBS vaccination is a potentially useful approaches to GBS prevention and control in this population. Screening of pregnant mothers for GBS colonization should be introduced and antimicrobial susceptibility test performed on GBS positive samples to guide antibiotic prophylaxis.
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Affiliation(s)
- Salano Clayton Jisuvei
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Research and Programs Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Alfred Osoti
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Maina Anne Njeri
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
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Hill AV, Perez-Patron M, Tekwe CD, Menon R, Hairrell D, Taylor BD. Chlamydia trachomatis Is Associated With Medically Indicated Preterm Birth and Preeclampsia in Young Pregnant Women. Sex Transm Dis 2020; 47:246-252. [PMID: 32004256 PMCID: PMC8096198 DOI: 10.1097/olq.0000000000001134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Studies on Chlamydia trachomatis-associated pregnancy outcomes are largely conflicting, ignoring the heterogeneous natures of pregnancy complications and potential effect modification by maternal age. This study determined if prenatal C. trachomatis infection is associated with preterm birth (PTB) and preeclampsia subtypes. METHODS A retrospective cohort study was conducted using 22,772 singleton pregnancies with a prenatal C. trachomatis diagnostic test. Spontaneous and medically indicated PTBs, and term and preterm preeclampsia were outcomes. Modified Poisson regression calculated relative risk (RR) and 95% confidence intervals (CI) with propensity score adjustments stratified by maternal ages <25 and ≥25 years. RESULTS Overall, C. trachomatis was significantly associated with term preeclampsia (adjusted RR [RRadj], 1.88; 95% CI, 1.38-2.57). Among young women (age <25 years), C. trachomatis was significantly associated with medically indicated PTB (RRadj, 2.29; 95% CI, 1.38-3.78) and term preeclampsia (RRadj, 1.57; 95% CI, 1.05-2.36) in propensity-adjusted models. No significant associations in older women were detected. CONCLUSION C. trachomatis was associated with medically indicated PTB and term preeclampsia in young women. Associations between chlamydia and perinatal outcomes may depend on the subtype of PTB and preeclampsia, which should be investigated through mechanistic studies.
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Affiliation(s)
- Ashley V. Hill
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX USA
| | - Maria Perez-Patron
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX USA
| | - Carmen D. Tekwe
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN USA
| | - Ramkumar Menon
- Division of Maternal-Fetal Medicine & Perinatal Research, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX USA
| | - Deanna Hairrell
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX USA
| | - Brandie D. Taylor
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX USA
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA USA
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Pastick KA, Nalintya E, Tugume L, Ssebambulidde K, Stephens N, Evans EE, Ndyetukira JF, Nuwagira E, Skipper C, Muzoora C, Meya DB, Rhein J, Boulware DR, Rajasingham R. Cryptococcosis in pregnancy and the postpartum period: Case series and systematic review with recommendations for management. Med Mycol 2020; 58:282-292. [PMID: 31689712 PMCID: PMC7179752 DOI: 10.1093/mmy/myz084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/03/2019] [Accepted: 07/18/2019] [Indexed: 01/21/2023] Open
Abstract
Cryptococcal meningitis causes 15% of AIDS-related deaths. Optimal management and clinical outcomes of pregnant women with cryptococcosis are limited to case reports, as pregnant women are often excluded from research. Amongst pregnant women with asymptomatic cryptococcosis, no treatment guidelines exist. We prospectively identified HIV-infected women who were pregnant or recently pregnant with cryptococcosis, screened during a series of meningitis research studies in Uganda from 2012 to 2018. Among 571 women screened for cryptococcosis, 13 were pregnant, one was breastfeeding, three were within 14 days postpartum, and two had recently miscarried. Of these 19 women (3.3%), 12 had cryptococcal meningitis, six had cryptococcal antigenemia, and one had a history of cryptococcal meningitis and was receiving secondary prophylaxis. All women with meningitis received amphotericin B deoxycholate (0.7-1.0 mg/kg). Five were exposed to 200-800 mg fluconazole during pregnancy. Of these five, three delivered healthy babies with no gross physical abnormalities at birth, one succumbed to meningitis, and one outcome was unknown. Maternal meningitis survival rate at hospital discharge was 75% (9/12), and neonatal/fetal survival rate was 44% (4/9) for those mothers who survived. Miscarriages and stillbirths were common (n = 4). Of six women with cryptococcal antigenemia, two received fluconazole, one received weekly amphotericin B, and three had unknown treatment courses. All women with antigenemia survived, and none developed clinical meningitis. We report good maternal outcomes but poor fetal outcomes for cryptococcal meningitis using amphotericin B, without fluconazole in the first trimester, and weekly amphotericin B in place of fluconazole for cryptococcal antigenemia.
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Affiliation(s)
- Katelyn A Pastick
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Nalintya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lillian Tugume
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kenneth Ssebambulidde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nicole Stephens
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emily E Evans
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jane Frances Ndyetukira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edwin Nuwagira
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Caleb Skipper
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Conrad Muzoora
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - David B Meya
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joshua Rhein
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David R Boulware
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Radha Rajasingham
- Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Koningstein FN, Schneeberger C, van der Ven AJ, van Os MA, Pajkrt E, de Groot CJM, Mol BWJ, Geerlings SE, Kazemier BM. Is asymptomatic bacteriuria associated with short cervical length in women with a singleton pregnancy, a secondary analysis of two national cohort studies with small embedded randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2020; 248:172-176. [PMID: 32220693 DOI: 10.1016/j.ejogrb.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/25/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the association between asymptomatic bacteriuria (ASB) and short cervical length (CL), since they are both associated with preterm delivery. STUDY DESIGN In two prospective multicentre cohort studies, pregnant women were screened for the presence of ASB and short CL (≤25 mm). We compared CL in women with and without ASB. Both studies had a small randomised clinical trial embedded. RESULTS Our study population comprised 1 610 women, of whom 114 were ASB positive. Median cervical length was similar in women with and without ASB (44.0 vs 44.0 mm, P = 0.60). More women in the ASB positive group had a short CL compared to the ASB negative group (1.8 % versus 0.4 %, P = 0.047)). The gestational age at delivery did not differ between the groups (ranging from 38 + 3 in women with ASB and short CL to 39 + 5 in women without ASB with a short CL P = 0.52). No preterm births occurred in women with a short cervical length (regardless of ASB status). In the women without ASB and no short CL 4.8 % had a preterm birth, in the women with ASB but not a short CL 4.1 % had a preterm birth. CONCLUSION While ASB status did not influence median cervical length, we found a significant relationship between a short CL and ASB positive women. We found no statistical significant difference on the preterm birth rate and mean gestational age.
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Affiliation(s)
- Fiona N Koningstein
- Amsterdam University Medical Center, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands.
| | - Caroline Schneeberger
- Amsterdam University Medical Center, Department of Medical Microbiology Amsterdam, the Netherlands
| | - A Jeanine van der Ven
- Amsterdam University Medical Center, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Melanie A van Os
- Amsterdam University Medical Center, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Eva Pajkrt
- Amsterdam University Medical Center, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Christianne J M de Groot
- Amsterdam University Medical Center, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Susanne E Geerlings
- Amsterdam University Medical Center, Department of Internal Medicine: Infectious Diseases, Amsterdam, the Netherlands
| | - Brenda M Kazemier
- Amsterdam University Medical Center, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
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Suff N, Karda R, Diaz JA, Ng J, Baruteau J, Perocheau D, Taylor PW, Alber D, Buckley SMK, Bajaj-Elliott M, Waddington SN, Peebles D. Cervical Gene Delivery of the Antimicrobial Peptide, Human β-Defensin (HBD)-3, in a Mouse Model of Ascending Infection-Related Preterm Birth. Front Immunol 2020; 11:106. [PMID: 32117260 PMCID: PMC7026235 DOI: 10.3389/fimmu.2020.00106] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/15/2020] [Indexed: 11/13/2022] Open
Abstract
Approximately 40% of preterm births are preceded by microbial invasion of the intrauterine space; ascent from the vagina being the most common pathway. Within the cervical canal, antimicrobial peptides and proteins (AMPs) are important components of the cervical barrier which help to prevent ascending vaginal infection. We investigated whether expression of the AMP, human β-defensin-3 (HBD3), in the cervical mucosa of pregnant mice could prevent bacterial ascent from the vagina into the uterine cavity. An adeno-associated virus vector containing both the HBD3 gene and GFP transgene (AAV8 HBD3.GFP) or control AAV8 GFP, was administered intravaginally into E13.5 pregnant mice. Ascending infection was induced at E16.5 using bioluminescent Escherichia coli (E. coli K1 A192PP-lux2). Bioluminescence imaging showed bacterial ascent into the uterine cavity, inflammatory events that led to premature delivery and a reduction in pups born alive, compared with uninfected controls. Interestingly, a significant reduction in uterine bioluminescence in the AAV8 HBD3.GFP-treated mice was observed 24 h post-E. coli infection, compared to AAV8 GFP treated mice, signifying reduced bacterial ascent in AAV8 HBD3.GFP-treated mice. Furthermore, there was a significant increase in the number of living pups in AAV HBD3.GFP-treated mice. We propose that HBD3 may be a potential candidate for augmenting cervical innate immunity to prevent ascending infection-related preterm birth and its associated neonatal consequences.
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Affiliation(s)
- Natalie Suff
- Gene Transfer Technology Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
- Preterm Birth Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
- Preterm Birth Group, Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Rajvinder Karda
- Gene Transfer Technology Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
| | - Juan Antinao Diaz
- Gene Transfer Technology Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
| | - Joanne Ng
- Gene Transfer Technology Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
| | - Julien Baruteau
- Gene Transfer Technology Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
- Metabolic Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Dany Perocheau
- Gene Transfer Technology Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
| | - Peter W. Taylor
- University College London School of Pharmacy, London, United Kingdom
| | - Dagmar Alber
- Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Suzanne M. K. Buckley
- Gene Transfer Technology Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
| | - Mona Bajaj-Elliott
- Preterm Birth Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
- Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Simon N. Waddington
- Gene Transfer Technology Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
- SA/MRC Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Donald Peebles
- Preterm Birth Group, Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, United Kingdom
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Yang S, Reid G, Challis JR, Gloor GB, Asztalos E, Money D, Seney S, Bocking AD. Effect of Oral Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on the Vaginal Microbiota, Cytokines and Chemokines in Pregnant Women. Nutrients 2020; 12:nu12020368. [PMID: 32019222 PMCID: PMC7071157 DOI: 10.3390/nu12020368] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/19/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022] Open
Abstract
Spontaneous preterm birth is associated with vaginal microbial dysbiosis. As certain strains of lactobacilli help restore homeostasis in non-pregnant women, the goal was to determine the effect of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 administered orally, twice daily for 12 weeks on the vaginal microbiota, cytokines and chemokines of low-risk pregnant women. A double-blind, placebo-controlled, randomized trial comparing probiotic lactobacilli to placebo daily was performed in 86 asymptomatic pregnant women who had an Intermediate or Bacterial Vaginosis Nugent score at 13 weeks. After drop outs, 32 women receiving probiotics and 34 receiving placebo completed the study. The Nugent score returned to normal in 30% of the women in both groups at 28 weeks and was maintained until 35 weeks. The majority of subjects had normal pregnancy outcomes. Ninety-three bacterial species were detected at 13 weeks, with Lactobacillus iners, Lactobacillus crispatus, Gardnerella vaginalis and Atopobium vaginae being the most abundant across pregnancy. There was no difference in the Shannon diversity index between the probiotic and placebo groups at 13, 28 or 35 weeks. Almost all subjects consumed fermented foods and many of the organisms in the vagina are also known to be present in fermented foods. Interleukin-4 in the placebo group and Interleukin-10 in both probiotic and placebo groups increased slightly at 28 weeks but were not different at 35 weeks when compared to 13 weeks. In conclusion, this study showed no adverse issues resulting from 12 week use of probiotic Lactobacillus strains GR-1 and RC-14 during pregnancy in women at low risk for premature birth. The vaginal microbiota demonstrated flux irrespective of this oral probiotic administration.
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Affiliation(s)
- Siwen Yang
- Departments of Physiology and Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada; (S.Y.); (J.R.G.C.); (A.D.B.)
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5G 1X5, Canada
| | - Gregor Reid
- Departments of Microbiology and Immunology, The University of Western Ontario, London, ON N6A 5C1, Canada
- Lawson Health Research Institute, 268 Grosvenor Street, London, ON N6A 4V2, Canada; (G.B.G.); (S.S.)
- Correspondence: ; Tel.: +1-519-854-3022
| | - John R.G. Challis
- Departments of Physiology and Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada; (S.Y.); (J.R.G.C.); (A.D.B.)
- Western Australian Health Translation Network, Perth, WA 6009, Australia
| | - Gregory B. Gloor
- Lawson Health Research Institute, 268 Grosvenor Street, London, ON N6A 4V2, Canada; (G.B.G.); (S.S.)
- Department of Biochemistry, The University of Western Ontario, London, ON N6A 5C1, Canada
| | - Elizabeth Asztalos
- Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M5A 1B2, Canada;
| | - Deborah Money
- Department of Obstetrics and Gynecology, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada;
| | - Shannon Seney
- Lawson Health Research Institute, 268 Grosvenor Street, London, ON N6A 4V2, Canada; (G.B.G.); (S.S.)
| | - Alan D. Bocking
- Departments of Physiology and Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada; (S.Y.); (J.R.G.C.); (A.D.B.)
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON M5G 1X5, Canada
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Bhatti G, Romero R, Rice GE, Fitzgerald W, Pacora P, Gomez-Lopez N, Kavdia M, Tarca AL, Margolis L. Compartmentalized profiling of amniotic fluid cytokines in women with preterm labor. PLoS One 2020; 15:e0227881. [PMID: 31945128 PMCID: PMC6964819 DOI: 10.1371/journal.pone.0227881] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/31/2019] [Indexed: 12/14/2022] Open
Abstract
Objective Amniotic fluid cytokines have been implicated in the mechanisms of preterm labor and birth. Cytokines can be packaged within or on the surface of extracellular vesicles. The main aim of this study was to test whether the protein abundance internal to and on the surface of extracellular vesicles changes in the presence of sterile intra-amniotic inflammation and proven intra-amniotic infection in women with preterm labor as compared to the women with preterm labor without either intra-amniotic inflammation or proven intra-amniotic infection. Study design Women who had an episode of preterm labor and underwent an amniocentesis for the diagnosis of intra-amniotic infection or intra-amniotic inflammation were classified into three groups: 1) preterm labor without either intra-amniotic inflammation or proven intra-amniotic infection, 2) preterm labor with sterile intra-amniotic inflammation, and 3) preterm labor with intra-amniotic infection. The concentrations of 38 proteins were determined on the extracellular vesicle surface, within the vesicles, and in the soluble fraction of amniotic fluid. Results 1) Intra-amniotic inflammation, regardless of detected microbes, was associated with an increased abundance of amniotic fluid cytokines on the extracellular vesicle surface, within vesicles, and in the soluble fraction. These changes were most prominent in women with proven intra-amniotic infection. 2) Cytokine changes on the surface of extracellular vesicles were correlated with those determined in the soluble fraction; yet the magnitude of the increase was significantly different between these compartments. 3) The performance of prediction models of early preterm delivery based on measurements on the extracellular vesicle surface was equivalent to those based on the soluble fraction. Conclusions Differential packaging of amniotic fluid cytokines in extracellular vesicles during preterm labor with sterile intra-amniotic inflammation or proven intra-amniotic infection is reported herein for the first time. The current study provides insights into the biology of the intra-amniotic fluid ad may aid in the development of biomarkers for obstetrical disease.
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Affiliation(s)
- Gaurav Bhatti
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit Michigan, United States of America
- Department of Biomedical Engineering, Wayne State University College of Engineering, Detroit, Michigan, United States of America
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, United States of America
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, United States of America
- Detroit Medical Center, Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Florida International University, Miami, Florida, United States of America
- * E-mail: (RR); (GER); (ALT)
| | - Gregory Edward Rice
- Centre for Clinical Research, University of Queensland, Herston, Queensland, Australia
- * E-mail: (RR); (GER); (ALT)
| | - Wendy Fitzgerald
- Section on Intercellular Interactions, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Mahendra Kavdia
- Department of Biomedical Engineering, Wayne State University College of Engineering, Detroit, Michigan, United States of America
| | - Adi L. Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, United States of America
- * E-mail: (RR); (GER); (ALT)
| | - Leonid Margolis
- Section on Intercellular Interactions, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, United States of America
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Akadri AA, Odelola OI. Determinants of Asymptomatic Bacteriuria in HIV-positive and Negative Pregnant Women in Sagamu, South-West Nigeria. West Afr J Med 2020; 37:1-6. [PMID: 32030704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Pregnant women with asymptomatic bacteriuria are at increased risk of developing symptomatic urinary tract infections. HIV infection may modify the acquisition of bacteriuria in pregnancy. OBJECTIVE To identify the determinants of asymptomatic bacteriuria in HIV-positive and HIV-negative pregnant women in Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. METHODS A cross-sectional study involving 211 HIV-positive pregnant women and 422 HIV-negative pregnant women attending their first antenatal clinic between October 2017 and March 2018. Information on socio-demographic characteristics and risk factors for asymptomatic bacteriuria in study participants was recorded. Microbial culture was carried out on aseptically collected urine samples. RESULTS Asymptomatic bacteriuria was found in 66(31.3%) and 118(28.0%) in HIV-positive and negative women respectively. Advanced maternal age, gestational age above 20 weeks, low socioeconomic status, history of urinary tract infections in previous pregnancies and low CD4 cell count had statistically significant association with increased prevalence of asymptomatic bacteriuria among HIV positive women. Binary logistic regression analysis showed that low socioeconomic status and history of urinary tract infections in previous pregnancies were strong determinants of asymptomatic bacteriuria among HIV positive women (AOR 4.1, CI 1.9-8.7, P < 0.001; AOR 5.8, CI 2.5-13.6, P < 0.001 respectively). In HIV negative women, gestational age above 20 weeks had statistically significant association with increased prevalence of asymptomatic bacteriuria (AOR= 2.34, CI 1.3-4.1, P= 0.002). CONCLUSION Low socioeconomic status and previous history of urinary tract infections are determinants of asymptomatic bacteriuria in HIV positive women while gestational age above 20 weeks is a determinant in HIV negative women. These determinants could be used to identify women at high risk of asymptomatic bacteriuria for targeted screening.
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Affiliation(s)
- A A Akadri
- Departments of Obstetrics and Gynaecology, Babcock University, Ilishan-Remo, Ogun State, Nigeria
| | - O I Odelola
- Department of Obstetrics and Gynecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
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Lee AC, Mullany LC, Koffi AK, Rafiqullah I, Khanam R, Folger LV, Rahman M, Mitra DK, Labrique A, Christian P, Uddin J, Ahmed P, Ahmed S, Mahmud A, DasGupta SK, Begum N, Quaiyum MA, Saha SK, Baqui AH. Urinary tract infections in pregnancy in a rural population of Bangladesh: population-based prevalence, risk factors, etiology, and antibiotic resistance. BMC Pregnancy Childbirth 2019; 20:1. [PMID: 31892316 PMCID: PMC6938613 DOI: 10.1186/s12884-019-2665-0] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Urinary tract infection (UTI) in pregnancy, including asymptomatic bacteriuria, is associated with maternal morbidity and adverse pregnancy outcomes, including preterm birth and low birthweight. In low-middle income countries (LMICs), the capacity for screening and treatment of UTIs is limited. The objective of this study was to describe the population-based prevalence, risk factors, etiology and antimicrobial resistance patterns of UTIs in pregnancy in Bangladesh. METHODS In a community-based cohort in Sylhet district, Bangladesh, urine specimens were collected at the household level in 4242 pregnant women (< 20 weeks gestation) for culture and antibiotic susceptibility testing. Basic descriptive analysis was performed, as well as logistic regression to calculate adjusted odds ratios (aOR) for UTI risk factors. RESULTS The prevalence of UTI was 8.9% (4.4% symptomatic UTI, 4.5% asymptomatic bacteriuria). Risk factors for UTI in this population included maternal undernutrition (mid-upper arm circumference <23 cm: aOR= 1.29, 95% CI: 1.03-1.61), primiparity (aOR= 1.45, 95% CI: 1.15-1.84), and low paternal education (no education: aOR= 1.56, 95% CI: 1.09-2.22). The predominant uro-pathogens were E. coli (38% of isolates), Klebsiella (12%), and staphyloccocal species (23%). Group B streptococcus accounted for 5.3% of uro-pathogens. Rates of antibiotic resistance were high, with only two-thirds of E. coli susceptible to 3rd generation cephalosporins. CONCLUSIONS In Sylhet, Bangladesh, one in 11 women had a UTI in pregnancy, and approximately half of cases were asymptomatic. There is a need for low-cost and accurate methods for UTI screening in pregnancy and efforts to address increasing rates of antibiotic resistance in LMIC.
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Affiliation(s)
- Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Iftekhar Rafiqullah
- Department of Microbiology and Immunology, University of Mississippi Medical Center (UMMC), 2500 N State St, Jackson, MS, 39216, USA
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Lian V Folger
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Mahmoodur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Dipak K Mitra
- North South University, Plot #15, Block #B, Bashundhara R/A, Dhaka, 1229, Bangladesh
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Bill and Melinda Gates Foundation, 440 5th Avenue North, Seattle, WA, 98109, USA
| | - Jamal Uddin
- Save the Children Bangladesh, House No. CWN (A) 35, Road No. 43 Gulshan 2, Dhaka, 1212, Bangladesh
| | - Parvez Ahmed
- Institute of Epidemiology Disease Control and Research, Mohakhali, Dhaka, 1212, Bangladesh
| | - Salahuddin Ahmed
- Projahnmo Research Foundation, House: 37, Road:27, Block: A, Banani, Dhaka, 1213, Bangladesh
| | - Arif Mahmud
- School of Community Health and Policy, Morgan State University, Baltimore, MD, 21251, USA
| | - Sushil K DasGupta
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Nazma Begum
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Mohammad A Quaiyum
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Samir K Saha
- Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Child Health Research Foundation, Dhaka, 1207, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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Chen Z, Kuang Y, Jiang H, Zhang W, Shi Y, Chokkakula S, Chen H, Li J, Wang H. Intact Mycobacterium leprae Isolated from Placenta of a Pregnant Woman, China. Emerg Infect Dis 2019; 25:1604-1607. [PMID: 31310204 PMCID: PMC6649342 DOI: 10.3201/eid2508.190114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Whether Mycobacterium leprae transmits from placenta to fetus remains unknown. We describe the case of a pregnant woman with untreated histoid leproma. Although her newborn was healthy, laboratory examination revealed intact M. leprae present in the placenta, suggesting that the placental barrier might prevent vertical dissemination of M. leprae.
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