Candida Chorioamnionitis After Serial Therapeutic Amniocenteses: A Possible Association

Abstract

BACKGROUND:Reduction amniocentesis is used in cases of severe polyhydramnios to decrease maternal discomfort and the risk of preterm labor. In a MED-LINE search (1966 to present, English language, keywords: amniocentesis, chorioamnionitis), no report of Candida chorioamnionitis after serial reduction amniocentesis exists.

Neonatal leukemoid reaction associated with Candida albicans chorioamnionitis

“…Chorioamnionitis due to Candida species is relatively rare, despite the high prevalence (20–25%) of Candida vulvovaginitis during pregnancy . It is generally accepted that congenital candidiasis is acquired in utero via an ascending infection although the exact mechanism by which this occurs is currently unknown.…”

“…It is generally accepted that congenital candidiasis is acquired in utero via an ascending infection although the exact mechanism by which this occurs is currently unknown. Four possible explanations have been proposed for Candida species reaching the upper genital tract and causing chorioamnionitis: (i) direct invasion from the vagina after PROM; (ii) the sealing of ruptured amniotic membranes; (iii) migration across an intact amnion; and (iv) the presence of foreign bodies, such as an intrauterine contraceptive device or cerclage, in the genital tract . It is worth noting that most previous cases have involved clinically intact chorioamniotic membranes .…”

“…The organisms involved are usually common inhabitants of the lower genital tract. Despite the high frequency of maternal vaginal candidal colonization, there are only a few reports of chorioamnionitis caused by Candida species …”

Successful Management of an Extremely Premature Infant with Congenital Candidiasis

“…Congenital candidiasis is very rare in both term and preterm infants, despite the high prevalence (20-25%) of Candida vulvovaginitis during pregnancy. [1][2][3][4] Congenital candidiasis causes a variety of clinical symptoms, ranging from diffuse erythematous skin eruptions with or without vesicles and pustules to systemic disease, in which the lungs are usually affected and the skin may or may not be affected. [1][2][3][4] In addition, hematological abnormalities, for example, an increased number of immature granulocytes, have also been reported to occur in congenital candidiasis.…”

Chorioamnionitis

“…20 Second, iatrogenic inoculation can occur following invasive procedures such as amniocentesis. 21 Third, hematogenous spread can occur with migration of organisms from the maternal bloodstream across the placenta. 22 Listeria monocytogenes in particular has been described to cause infiltration of the placenta following maternal infection.…”