Identification of a gene in Mycoplasma hominis associated with preterm birth and microbial burden in intraamniotic infection

Allen-Daniels, Matthew Josiah; Serrano, Myrna G.; Pflugner, Lindsey P.; Fettweis, Jennifer M.; Prestosa, Melissa A.; Kopardé, Vishal N.; Brooks, J. Paul; Strauss, Jerome F.; Romero, Roberto; Chaiworapongsa, Tinnakorn; Eschenbach, David A.; Buck, Gregory A.; Jefferson, Kimberly K.

doi:10.1016/j.ajog.2015.01.032

Cited by 59 publications

(50 citation statements)

References 81 publications

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“…Hence, most of these infections are undetected unless the amniotic fluid is analyzed. The most frequent microorganisms found in the amniotic cavity are genital mycoplasmas 93, 103, 122, 142, 144-147 , and in particular, Ureaplasma species 135, 148-155 , Gardnerella vaginalis 15, 90, 127, 156-158 , Fusobacteria species, etc. 11, 110, 127 .…”

Section: Pathways Of Microbial Invasion Of the Amniotic Cavitymentioning

confidence: 99%

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

Kim

Romero

Chaemsaithong

et al. 2015

American Journal of Obstetrics and Gynecology

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724

652

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Acute inflammatory lesions of the placenta consist of diffuse infiltration of neutrophils at different sites in the organ. These lesions include acute chorioamnionitis, funisitis, and chorionic vasculitis, and represent a host response (maternal or fetal) to a chemotactic gradient in the amniotic cavity. While acute chorioamnionitis is evidence of a maternal host response, funisitis and chorionic vasculitis represent fetal inflammatory responses. Intra-amniotic infection has been generally considered to be the cause of acute histologic chorioamnionitis and funisitis; however, recent evidence indicates that “sterile” intra-amniotic inflammation, which occurs in the absence of demonstrable microorganisms but can be induced by “danger signals”, is frequently associated with these lesions. In the context of intra-amniotic infection, chemokines (such as interleukin-8 and granulocyte chemotactic protein) establish a gradient favoring the migration of neutrophils from maternal or fetal circulation into the chorioamniotic membranes or umbilical cord, respectively. Danger signals released during the course of cellular stress or cell death can also induce the release of neutrophil chemokines. The prevalence of chorioamnionitis is a function of gestational age at birth, and is present in 3-5% of placentas delivered at term, but in 94% of placentas delivered between 21-24 weeks of gestation. The frequency is higher in patients with spontaneous labor, preterm labor, clinical chorioamnionitis (preterm or term), or ruptured membranes. Funisitis and chorionic vasculitis are the hallmarks for the fetal inflammatory response syndrome, a condition characterized by an elevation in fetal plasma concentrations of interleukin-6, associated with the impending onset of preterm labor, a higher rate of neonatal morbidity (after adjustment for gestational age), and multi-organ fetal involvement. This syndrome is the counterpart of the systemic inflammatory response syndrome in adults; however, in fetuses, it is a risk factor for short- and long-term complications (i.e. neonatal sepsis, bronchopulmonary dysplasia, periventricular leukomalacia, and cerebral palsy). This article reviews the definition, pathogenesis, grading and staging, and clinical significance of the most common lesions in placental pathology. Illustrations of the lesions and diagrams of the mechanisms of disease are provided.

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Section: Pathways Of Microbial Invasion Of the Amniotic Cavitymentioning

confidence: 99%

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

Kim

Romero

Chaemsaithong

et al. 2015

American Journal of Obstetrics and Gynecology

Self Cite

724

652

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“…The rapid and accurate diagnosis of maternal intra-amniotic infection is important to guide the management of neonates exposed to intrapartum fever [24–34]. The gold standard for the diagnosis of intra-amniotic infection is amniotic fluid analysis with the use of cultivation and molecular microbiologic methods to identify the presence of bacteria [35–52] and to assess the inflammatory response [13, 35–37, 53–59]. …”

Section: Introductionmentioning

confidence: 99%

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Romero¹,

Chaemsaithong²,

Docheva³

et al. 2015

Journal of Perinatal Medicine

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Objective Neonates born to mothers with clinical chorioamnionitis at term are at an increased risk of infection. Acute subchorionitis, chorioamnionitis, and funisitis are considered placental histologic features consistent with acute inflammation according to the Society for Pediatric Pathology. The objectives of this study were to examine the performance of placental histologic features in the identification of: 1) microbial-associated intra-amniotic inflammation (intra-amniotic infection); and 2) a fetal inflammatory response syndrome (FIRS). Methods and Materials This retrospective cohort study included women with the diagnosis of clinical chorioamnionitis at term (n=45), who underwent an amniocentesis to determine: 1) the presence of microorganisms using both cultivation and molecular biologic techniques [polymerase chain reaction (PCR) with broad range primers]; and 2) interleukin (IL)-6 concentrations by enzyme-linked immunosorbent assay (ELISA). The diagnostic performance (sensitivity, specificity, accuracy, and likelihood ratios) of placental histologic features consistent with acute inflammation was determined for the identification of microbial-associated intra-amniotic inflammation and FIRS. Results 1) The presence of acute histologic chorioamnionitis and funisitis was associated with the presence of proven intra-amniotic infection assessed by amniotic fluid analysis; 2) funisitis was also associated with the presence of FIRS; 3) the negative predictive value of acute funisitis ≥ stage 2 for the identification of neonates born to mothers with intra-amniotic infection was less than 50%, and therefore, suboptimal to exclude fetal exposure to bacteria in the amniotic cavity; and 4) acute funisitis ≥ stage 2 had a negative predictive value of 86.8% for the identification of FIRS in a population with a prevalence of 20%. Conclusion Acute histologic chorioamnionitis and funisitis are associated with intra-amniotic infection and the presence of FIRS. However, current pathologic methods have limitations in the identification of the fetus exposed to microorganisms present in the amniotic cavity. Further studies are required to determine whether molecular markers can enhance the performance of placental pathology in the identification of neonates at risk for neonatal sepsis.

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“…Important strain-to-strain differences that can influence the role of vaginal bacterial species in health and disease can occur (Allen-Daniels et al, 2015). We therefore hypothesized that different strains of L. crispatus vary in their stability and/or protective capacity, possibly explaining the observation that some women colonized by L. crispatus still develop BV (Teixeira et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Lactobacillus crispatus isolates from Lactobacillus-dominated vaginal microbiomes with isolates from microbiomes containing bacterial vaginosis-associated bacteria

et al. 2016

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Vaginal lactobacilli can inhibit colonization by and growth of other bacteria, thereby preventing development of bacterial vaginosis (BV). Amongst the lactobacilli, Lactobacillus crispatus appears to be particularly effective at inhibiting growth of BV-associated bacteria. Nonetheless, some women who are colonized with this species can still develop clinical BV. Therefore, we sought to determine whether strains of L. crispatus that colonize women with lactobacillidominated vaginal microbiomes are distinct from strains that colonize women who develop BV. The genomes of L. crispatus isolates from four women with lactobacilli-dominated vaginal microbiomes (,1 % 16S rRNA reads above threshold from genera other than Lactobacillus) and four women with microbiomes containing BV-associated bacteria (.12 % 16S rRNA reads from bacterial taxa associated with BV) were sequenced and compared. Lactic acid production by the different strains was quantified. Phage induction in the strains was also analysed. There was considerable genetic diversity between strains, and several genes were exclusive to either the strains from Lactobacillus-dominated microbiomes or those containing BV-associated bacteria. Overall, strains from microbiomes dominated by lactobacilli did not differ from strains from microbiomes containing BV-associated bacteria with respect to lactic acid production. All of the strains contained multiple phage, but there was no clear distinction between the presence or absence of BV-associated bacteria with respect to phage-induced lysis. Genes found to be exclusive to the Lactobacillus-dominated versus BV-associated bacteria-containing microbiomes could play a role in the maintenance of vaginal health and the development of BV, respectively.

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Identification of a gene in Mycoplasma hominis associated with preterm birth and microbial burden in intraamniotic infection

Cited by 59 publications

References 81 publications

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Comparison of Lactobacillus crispatus isolates from Lactobacillus-dominated vaginal microbiomes with isolates from microbiomes containing bacterial vaginosis-associated bacteria

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