Madhu M Ouseph1,2, Hannah Krigman3, Mai He2,3,4. 1. a Department of Pathology and Laboratory Medicine, Rhode Island Hospital , Providence , RI , USA. 2. b Warren Alpert Medical School of Brown University , Providence , RI , USA. 3. c Department of Pathology & Immunology, Washington University School of Medicine , St. Louis , MO , USA. 4. d Department of Pathology and Laboratory Medicine, Women and Infants Hospital of Rhode Island , Providence , RI , USA.
Abstract
Background: Streptococcus pneumoniae (S. pneumoniae) is an uncommon cause of amniotic fluid infection and intrauterine fetal demise. Case report: A 39-year-old G8P2052 presented with preterm premature rupture of membrane at 22 weeks gestation and had a spontaneous vaginal delivery of a neonate who soon expired. Placental examination revealed retroplacental hematoma, acute necrotizing chorioamnionitis, acute three-vessel vasculitis and necrotizing funisitis of the umbilical cord. Postmortem examination demonstrated features of amniotic fluid infection syndrome with blood culture growing S. pneumoniae. Antenatal screening does not typically quantify S. pneumoniae infection, but small series have found vaginal colonization in fewer than 1% of women. Intrauterine or peritoneal infection derives primarily from ascending infection although other routes are hypothetically possible. Intra-amniotic and neonatal infections by S. pneumoniae are associated with high morbidity and mortality. Conclusion: S. pneumoniae should be considered in perinatal death of immature fetus with severe amniotic fluid infection syndrome and acute necrotizing funisitis.
Background: Streptococcus pneumoniae (S. pneumoniae) is an uncommon cause of amniotic fluid infection and intrauterine fetal demise. Case report: A 39-year-old G8P2052 presented with preterm premature rupture of membrane at 22 weeks gestation and had a spontaneous vaginal delivery of a neonate who soon expired. Placental examination revealed retroplacental hematoma, acute necrotizing chorioamnionitis, acute three-vessel vasculitis and necrotizing funisitis of the umbilical cord. Postmortem examination demonstrated features of amniotic fluid infection syndrome with blood culture growing S. pneumoniae. Antenatal screening does not typically quantify S. pneumoniae infection, but small series have found vaginal colonization in fewer than 1% of women. Intrauterine or peritoneal infection derives primarily from ascending infection although other routes are hypothetically possible. Intra-amniotic and neonatal infections by S. pneumoniae are associated with high morbidity and mortality. Conclusion:S. pneumoniae should be considered in perinatal death of immature fetus with severe amniotic fluid infection syndrome and acute necrotizing funisitis.
Authors: Eunjung Jung; Roberto Romero; Bo Hyun Yoon; Kevin R Theis; Dereje W Gudicha; Adi L Tarca; Ramiro Diaz-Primera; Andrew D Winters; Nardhy Gomez-Lopez; Lami Yeo; Chaur-Dong Hsu Journal: J Perinat Med Date: 2021-07-07 Impact factor: 2.716