Reporting detection of <i>Chlamydia trachomatis</i>DNA in tissues of neonatal death cases

Trejo, Maria Hernandez; Gonzalez, Norma E. Herrera; Guerra, Marcos R. Escobedo; Cruz, M. de Jesus de Haro; Moreno-Verduzco, Elsa R.; Lopez-Hurtado, Marcela; Guerra-Infante, Fernando M.

doi:10.1016/j.jped.2013.09.002

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Original Articles • J. Pediatr. (Rio J.) 90 (02) • Mar-Apr 2014 • https://doi.org/10.1016/j.jped.2013.09.002 copy

Reporting detection of Chlamydia trachomatisDNA in tissues of neonatal death cases^☆ ☆ Please cite this article as: Hernandez-Trejo M, Herrera-Gonzalez NE, Escobedo-Guerra MR, de Haro-Cruz MJ, Moreno-Verduzco ER, Lopez-Hurtado M, et al. Reporting detection ofChlamydia trachomatis DNA in tissues of neonatal death cases. J Pediatr (Rio J). 2014;90:182-9.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

to determine whether C. trachomatis was present in neonates with infection, but without an isolated pathogen, who died during the first week of life.

METHODS:

early neonatal death cases whose causes of death had been previously adjudicated by the institutional mortality committee were randomly selected. End-point and real-time polymerase chain reaction of the C. trachomatis omp1 gene was used to blindly identify the presence of chlamydial DNA in the paraffinized samples of five organs (from authorized autopsies) of each of the dead neonates. Additionally, differential diagnoses were conducted by amplifying a fragment of the 16S rRNA of Mycoplasma spp.

RESULTS:

in five cases (35.7%), C. trachomatis DNA was found in one or more organs. Severe neonatal infection was present in three cases; one of them corresponded to genotype D of C. trachomatis. Interestingly, another case fulfilled the same criteria but had a positive polymerase chain reaction for Mycoplasma hominis, a pathogen known to produce sepsis in newborns.

CONCLUSION:

the use of molecular biology techniques in these cases of early infant mortality demonstrated that C. trachomatis could play a role in the development of severe infection and in early neonatal death, similarly to that observed with Mycoplasma hominis. Further study is required to determine the pathogenesis of this perinatal infection.

Chlamydia trachomatis ; Polymerase chain reaction; Newborn; Sepsis; Mortality

Case	Maternal risk factor	Autopsy diagnosis	Placental diagnosis	Bacterial cultures outcomes	PCR	Previous diagnosis ^a	New diagnosis
1	PROM eight days	Congenital pneumonia	Chorioamnionitis	All negative	C. trachomatisin liver, brain, and bronchus	Neonatal sepsis UEA	Infection by C. trachomatis
2	Preterm delivery. Previous stillbirth	Moderate pneumothorax, 40% atelectasis	Normal	CSF PM P rettgeri + E gergoviae	C. trachomatisin liver and brain and real-time PCR in liver	Pneumothorax	Probable infection by C. trachomatis
3	PROM six days	Acute pneumonia, hyaline membrane	Chorioamnionitis	First day: hemoculture S haemolyticus	C. trachomatisin liver, kidney and brain	Neonatal sepsis UEA	Infection by C. trachomatis
				Third day: CSF and hemoculture negative
4	PROM 26 h Previous tubal obstruction, abortion, and stillbirth	Severe congenital pneumonia	Necrotizing chorioamnionitis. Funisitis	NM	C. trachomatisin liver and bronchus	Neonatal sepsis UEA	Infection by C. trachomatis
5	Previous abortion	Multiple major structural defects	Small	All negative	All negative	Multiple congenital structural defects	Multiple congenital structural defects
6	None	Renal right agenesis Pulmonary hemorrhage	Normal	NM	C. trachomatisin kidney	Surfactant pulmonary hemorrhage	Complications of prematurity
7	PROM 26 h	33% Hyaline membrane 70% atelectasis	Normal	All negative	All negative	Hyaline membrane Pulmonary hypertension	Complications of prematurity
8	PROM 8 h	Congenital pneumonia	Severe chorioamnionitis and funisitis	All negative	Mycoplasma hominis in lung and kidney	Congenital neonatal sepsis UEA	Infection byMycoplasma hominis
9	No	Hydrops fetalis	Signs of hypoxia	Hemoculture:Staphylococcusspp. All the other negative	All negative	NonimmuneHydrops fetalis	NonimmuneHydrops fetalis
10	Previous abortion	Immaturity systemic	Normal	NM	All negative	Immaturity Obstetric trauma	Extreme prematurity
11	Two previous stillbirth and an infant death	Erythroblastosis. Pulmonary emphysema	Erythroblastosis	All negative	All negative	Hydrops fetalisfrom Rh isoimmunization	Hydrops fetalisfrom Rh isoimmunization
12	PROM 1 h	Multiple major structural defects	Normal	All negative	All negative	Multiple major structural defects	Multiple major structural defects
13	None	Immaturity	Mild subchorionitis and deciduitis	NM	All negative	Immaturity	Extreme prematurity
14	An infant death	Thanatophoric dysplasia	Normal	NM	All negative	Severe bone dysplasia	Severe bone dysplasia

	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6	Case 7	Case 8	Case 9	Case 10	Case 11	Case 12	Case 13	Case 14
Age	3d 7h 12m	42m	2d 1h 47m	1h 2m	5d 20h 5m	3h 1m	1d 20h 48m	1d 12h 46m	1d 2h 45m	20m	18h	5d 19m	41m	1h 20m
Maternal age (years)	33	28	30	35	26	26	15	23	36	23	30	27	18	23
Duration of PROM	8d	0	6d	26h	0	0	1d 2h	8h	0	0	0	1h	0	0
Delivery	C	C	C	ED	C	C	C	ED	C	ED	C	C	ED	DD
Gender	Male	Male	Male	Female	Male	Male	Female	Female	Female	Female	Male	Male	Female	Female
Apgar 1 and 5 minutes	2-5	5-4	3-7	1-2	7-8	4-7	4-9	4-8	4-8	0-1	3-7	8-9	1-1	1-1
Weight (g)	590	1,050	740	710	2,000	910	1,840	750	850	520	1,290	2,350	890	1,480
Height (cm)	29	37	33	34	44	33	43	36	31.5	30	38	45	34	32
Gestational age (weeks)	25	29	27	26	41	26	32	25	27	25	27	32	25	31
Maternal diagnostic	Hyp	PD	PROM Ch	PROM Ch	IGR	UTI Ch	PROM	PROM Ch	Severe Pre-eclam	PD UTI	Isoimm	Hydrops fetalis	PD	PD
Neonatal antibiotic treatment	Ampi Amika	-	Ampi Amika	-	-	-	Ampi Amika	Ampi Amika	-	-	Dicloxa Amika	-	-	-
Growth for gestational age	SGA	AGA	SGA	AGA	SGA	AGA	AGA	AGA	AGA	SGA	AGA	LGE	AGA	AGA

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[1] * Corresponding author. E-mail: fguerra_96@yahoo.com ^{F.M. Guerra-Infante.}