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1.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563666

RESUMO

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.


Assuntos
Doenças do Íleo/microbiologia , Perfuração Intestinal/microbiologia , Complicações Infecciosas na Gravidez/microbiologia , Natimorto , Tuberculose Gastrointestinal/complicações , Adulto , Evolução Fatal , Feminino , Humanos , Gravidez
2.
BMC Infect Dis ; 20(1): 958, 2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33327946

RESUMO

BACKGROUND: Group B Streptococcus (GBS) is the leading cause of invasive neonatal disease in the industrialized world. We aimed to genomically and phenotypically characterise invasive GBS isolates in Slovenia from 2001 to 2018 and contemporary colonising GBS isolates from screening cultures in 2018. METHODS: GBS isolates from 101 patients (invasive isolates) and 70 pregnant women (colonising isolates) were analysed. Basic clinical characteristics of the patients were collected from medical records. Antimicrobial susceptibility and phenotypic capsular serotype were determined. Whole-genome sequencing was performed to assign multilocus sequence types (STs), clonal complexes (CCs), pathogenicity/virulence factors, including capsular genotypes, and genome-based phylogeny. RESULTS: Among invasive neonatal disease patients, 42.6% (n = 43) were females, 41.5% (n = 39/94) were from preterm deliveries (< 37 weeks gestation), and 41.6% (n = 42) had early-onset disease (EOD). All isolates were susceptible to benzylpenicillin with low minimum inhibitory concentrations (MICs; ≤0.125 mg/L). Overall, 7 serotypes were identified (Ia, Ib, II-V and VIII); serotype III being the most prevalent (59.6%). Twenty-eight MLST STs were detected that clustered into 6 CCs. CC-17 was the most common CC overall (53.2%), as well as among invasive (67.3%) and non-invasive (32.9%) isolates (p < 0.001). CC-17 was more common among patients with late-onset disease (LOD) (81.4%) compared to EOD (47.6%) (p < 0.001). The prevalence of other CCs was 12.9% (CC-23), 11.1% (CC-12), 10.5% (CC-1), 8.2% (CC-19), and 1.8% (CC-498). Of all isolates, 2.3% were singletons. CONCLUSIONS: A high prevalence of hypervirulent CC-17 isolates, with low genomic diversity and characteristic profile of pathogenicity/virulence factors, was detected among invasive neonatal and colonising GBS isolates from pregnant women in Slovenia. This is the first genomic characterisation of GBS isolates in Slovenia and provides valuable microbiological and genomic baseline data regarding the invasive and colonising GBS population nationally. Continuous genomic surveillance of GBS infections is crucial to analyse the impact of IND prevention strategies on the population structure of GBS locally, nationally, and internationally.


Assuntos
Genótipo , Doenças do Recém-Nascido/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Sorogrupo , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/genética , Adulto , Antibacterianos/farmacologia , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/microbiologia , Masculino , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Penicilina G/farmacologia , Filogenia , Polimorfismo de Nucleotídeo Único , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Prevalência , Estudos Retrospectivos , Eslovênia/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/efeitos dos fármacos , Streptococcus agalactiae/isolamento & purificação , Sequenciamento Completo do Genoma
3.
Zhonghua Fu Chan Ke Za Zhi ; 55(11): 770-777, 2020 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-33228348

RESUMO

Objective: To investigate the clinical features, etiology, and prognosis of sepsis during pregnancy and the postpartum period. Methods: Sixty-eight pregnant women with maternal sepsis treated in Peking Union Medical College Hospital from January 1997 to December 2019 were collected, and divided into obstetric infection group (30 cases) and non-obstetric infection group (38 cases) according to different infection sources. Clinical manifestations, types of infection sources, microbiological characteristics, treatment and outcomes were studied and analyzed. Results: (1) General conditions and clinical features: sepsis occurrence rate was 57% (39/68) and 43% (29/68) in prenatal and postpartum period, repectively. Statistical analysis showed that incidence of respiratory, renal, liver and coagulation dysfunction in non-obstetric infection group were significantly higher than those in obstetric infection group, and multiple organ dysfunction, cardiac arrest and blood lactate≥4 mmol/L were more common (all P<0.05). Sequential organ failure score in non-obstetric infection group was also significantly higher than that in obstetric infection group (P<0.05). (2) Types of infection sources and microbiological characteristics: the most common maternal sepsis was genital tract sepsis (37%, 25/68). Chorioamnionitis was the most common cause in obstetric sepsis (40%, 12/30), while intra-abdominal infection was the most common cause in non-obstetric sepsis (34%, 13/38). Thirty-seven patients (54%, 37/68) were diagnosed as bloodstream infection (BSI). Gram-negative bacteremia accounted for 70% (26/37), the most common pathogen of which was Escherichia coli. BSI was most commonly secondary to a genital tract infection (65%, 17/26). (3) Treatment: the ICU hospitalization rates and the utilization rate of mechanical ventilation and vasoactive agents in non-obstetric group were higher than those in obstetric group with significant differences (all P<0.05). Thirty-two patients (47%, 32/68) underwent surgery to remove the infection sources, including 5 cases of hysterectomy. (4) Prognosis: the case fatality rate of maternal sepsis was 19% (13/68), which was significantly higher in the non-obstetric infection group (29%,11/38) compared with the obstetric infection group (7%,2/30; P=0.020). The time from diagnosis of sepsis to termination of pregnancy was (5.5±8.6) days in prenatal women, and time in obstetric infection group [(1.9±2.2) days] was significantly less than that of non-obstetric infection group [(7.7±10.3) days, P=0.029]. Adverse pregnancy outcomes were higher in the first and second trimester (72%, 18/25) than in the third trimester (21%, 3/14), and the difference was statistically significant (P=0.002). Conclusions: Sepsis during pregnancy and the postpartum period is a potentially life-threatening disease. Pregnant women with non-obstetric sepsis have more complications, more serious condition and worse prognosis than those with obstetric infection. Timely detection of risk factors, early identification and active treatment are helpful to improve maternal and fetal prognosis.


Assuntos
Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Complicações Infecciosas na Gravidez/microbiologia , Sepse/microbiologia , Adulto , Estudos de Casos e Controles , China/epidemiologia , Corioamnionite/epidemiologia , Feminino , Bactérias Gram-Negativas , Bactérias Gram-Positivas , Hospitalização , Humanos , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Infecções do Sistema Genital/microbiologia , Infecções do Sistema Genital/mortalidade , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/epidemiologia
4.
Ann Afr Med ; 19(3): 176-181, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32820729

RESUMO

Objectives: The study sought to determine the prevalence and risk factors associated with Hepatitis B surface antigenemia (HBsAg) positivity among pregnant women in Jos, Nigeria. Methodology: This was a cross-sectional study carried out among the pregnant population in five healthcare facilities in Jos, between November 1, 2017 and April 30, 2018. Informed consent was obtained, and data on sociodemographic and risk factors for hepatitis B virus (HBV) infection were collected. Hepatitis B viral infection was assessed using the in vitro HBsAg diagnostic rapid kit (Acon Laboratories, USA). Descriptive statistics, Chi-square test, and logistic regression were performed to identify predictors of HBV infection in the study population. All statistical analyses were carried out on STATA version 15. Results: Of the 3,238 women enrolled, 7.4% (241/3238) (95% confidence interval [CI] = 6.6% to 8.4%) were HBsAg positive. The absence of HBV vaccination (adjusted odds ratio [AOR] = 2.49; 95% CI = 1.49-4.09; P < 0.001), co-infection with HIV (AOR = 1.90; 95% CI = 1.18-3.08; P = 0.009), and higher parity (AOR = 1.37; 95% CI = 1.04-1.79; P = 0.024) were independently associated with HBV infection in pregnancy. Conclusions: The prevalence of HBV infection among pregnant women was high, especially among those without prior vaccination for HBV, those with HIV co-infection and higher parity.


Assuntos
Antígenos de Superfície da Hepatite B/sangue , Hepatite B/epidemiologia , Adulto , Coinfecção/complicações , Coinfecção/epidemiologia , Coinfecção/virologia , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Hepatite B/diagnóstico , Hepatite B/imunologia , Anticorpos Anti-Hepatite B/sangue , Vírus da Hepatite B/isolamento & purificação , Humanos , Nigéria/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Prevalência , Fatores de Risco , Adulto Jovem
5.
Arch Gynecol Obstet ; 302(3): 553-567, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32643040

RESUMO

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.


Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Ruptura Prematura de Membranas Fetais/epidemiologia , Trabalho de Parto Prematuro/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Aborto Espontâneo , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/microbiologia , Feminino , Ruptura Prematura de Membranas Fetais/microbiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Natimorto
6.
Medicine (Baltimore) ; 99(25): e20732, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569213

RESUMO

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.


Assuntos
Bactérias Aeróbias/isolamento & purificação , Vaginose Bacteriana/microbiologia , Adulto , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , China , Feminino , Humanos , Testes de Sensibilidade Microbiana , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/microbiologia , Estudos Retrospectivos , Esfregaço Vaginal , Vaginose Bacteriana/tratamento farmacológico
7.
Artigo em Inglês | MEDLINE | ID: mdl-32247771

RESUMO

Abnormal liver function tests during pregnancy are common. While hepatic injury during pregnancy mostly has minimal adverse influence on maternal and fetal outcomes, severe maternal and fetal morbidities, and even death, sometimes occur. Here, we review the epidemiology, clinical features, diagnosis, and management of hepatitis during pregnancy caused by the less common pathogens, including Epstein-Barr virus (EBV), cytomegalovirus (CMV), herpes simplex viruses (HSVs), dengue fever, malaria, leptospirosis, Q fever, typhoid fever, and other occasional infections, as well as the implications on breastfeeding of the infants. Hepatitis during pregnancy with fever and systemic clinical presentations, which are not attributable to the common infectious agents, should raise the suspicion of infection with above-mentioned pathogens, and appropriate laboratory tests are required. Early recognition of severe hepatitis or acute liver failure is critical in initiating appropriate and specific therapy, together with systemic supportive care, to reduce maternal and fetal mortality and long-term sequelae.


Assuntos
Coxiella burnetii , Citomegalovirus , Vírus da Dengue , Herpesvirus Humano 4 , Leptospira , Plasmodium , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/virologia , Salmonella typhi , Simplexvirus , Feminino , Hepatite , Vírus de Hepatite , Humanos , Gravidez
8.
Obstet Gynecol ; 135(5): 1121-1135, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32282589

RESUMO

Despite a national plan to eliminate syphilis by 2005, recent trends have reversed previously achieved progress in the United States. After a nadir between 2000 and 2013, rates of primary and secondary syphilis among women and congenital syphilis rose by 172% and 185% between 2014 and 2018, respectively. Screening early in pregnancy, repeat screening in the third trimester and at delivery among women at high risk, adherence to recommended treatment regimens, and prompt reporting of newly diagnosed syphilis cases to local public health authorities are strategies that obstetrician-gynecologists can employ to fight the current epidemic. In this report, clinical manifestations and management of syphilis in pregnancy are reviewed, and both traditional and reverse sequence screening algorithms are reviewed in detail in the context of clinical obstetrics.


Assuntos
Obstetrícia/normas , Complicações Infecciosas na Gravidez/diagnóstico , Diagnóstico Pré-Natal/normas , Sífilis Congênita/epidemiologia , Sífilis/epidemiologia , Adulto , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Terceiro Trimestre da Gravidez , Sífilis/diagnóstico , Sífilis Congênita/diagnóstico , Treponema pallidum , Estados Unidos/epidemiologia
9.
BMC Infect Dis ; 20(1): 302, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321444

RESUMO

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.


Assuntos
Testes de Sensibilidade Microbiana , Complicações Infecciosas na Gravidez/epidemiologia , Reto/microbiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/classificação , Streptococcus agalactiae/isolamento & purificação , Vagina/microbiologia , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Quênia/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Prevalência , Fatores de Risco , Sorogrupo , Sorotipagem , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/efeitos dos fármacos
10.
Arch Gynecol Obstet ; 301(5): 1189-1198, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32274638

RESUMO

PURPOSE: This cross-sectional case-control study of post-partum women aimed to estimate whether maternal periodontitis was a predictive contributor to preterm birth and to identify other risk factors associated with preterm birth in our target population. METHODS: The case group included women who delivered preterm (74 cases) and the control group included women who had a normal term delivery (120 controls). Medical records, a 16-item questionnaire, and a full-mouth periodontal examination were used to collect information about socio-demographic characteristics, general health problems, birth-related information, behavioral factors and periodontal status. Logistic regression analysis was used to estimate the strength of the relationship between predictors and the categorical outcome variable, preterm birth. RESULTS: The bivariate analysis revealed the significant associations between preterm birth and socio-demographic factors (educational level, p = 0.003), antepartum smoking habit (p = 0.001) and birth weight lower than 2500 g (p < 0.001). The multivariate analysis highlighted that the presence of post-partum maternal periodontitis and its severity remained independent risk factors of preterm birth in the presence of antepartum smoking habit and route of delivery [adjusted OR 2.26, 95% CI (1.06; 4.82), respectively, OR 3.46, 95% CI (1.08; 11.15)]. CONCLUSION: Post-partum maternal periodontal disease and its severity might, in part, be considered as contributor to preterm deliveries before 37 weeks of gestation.


Assuntos
Retardo do Crescimento Fetal/etiologia , Periodontite/complicações , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Fumar/efeitos adversos , Adulto , Peso ao Nascer , Estudos de Casos e Controles , Estudos Transversais , Feminino , Hospitais , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Índice Periodontal , Periodontite/epidemiologia , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Fatores de Risco , Romênia/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos
12.
Nutrients ; 12(2)2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32019222

RESUMO

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.


Assuntos
Lactobacillus reuteri , Lactobacillus rhamnosus , Complicações Infecciosas na Gravidez/terapia , Probióticos/administração & dosagem , Vaginose Bacteriana/terapia , Administração Oral , Adulto , Quimiocinas/sangue , Citocinas/sangue , Método Duplo-Cego , Disbiose/sangue , Disbiose/complicações , Disbiose/terapia , Feminino , Humanos , Microbiota , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/microbiologia , Nascimento Prematuro/microbiologia , Nascimento Prematuro/prevenção & controle , Resultado do Tratamento , Vagina/microbiologia , Vaginose Bacteriana/sangue , Vaginose Bacteriana/complicações
13.
West Afr J Med ; 37(1): 1-6, 2020.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-32030704

RESUMO

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.


Assuntos
Bactérias/isolamento & purificação , Bacteriúria/microbiologia , Bacteriúria/urina , Infecções por HIV/complicações , Soronegatividade para HIV , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/urina , Urina/microbiologia , Adulto , Bacteriúria/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/virologia , Humanos , Nigéria/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Infecções Urinárias/urina
14.
BMC Infect Dis ; 20(1): 98, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005177

RESUMO

BACKGROUND: Potentially pathogenic bacteria that colonise the lower genital tract of women in labour can be passed to the baby during birth. While many babies become colonised with these bacteria after delivery, a few develop neonatal infections. The lower genital tract is a reservoir for potential pathogens and a source of infection for neonates. We determined the prevalence of vaginal colonisation of potentially pathogenic bacteria among women in labour in Central Uganda and identified potential risk factors associated with this colonisation. METHODS: We conducted a cross sectional study at three primary health care facilities and collected vaginal swabs from HIV-1 negative women in labour. Specimens were cultured on different selective microbiological media, and biochemical tests were used to classify bacterial isolates on the species level. Multivariable logistic regression analyses were used to estimate the association between relevant exposures and colonisation with potentially pathogenic bacteria. RESULTS: We recruited 1472 women in labour whose mean age was 24.6 years (standard deviation [SD] 4.9). Of these, 955 (64.9%; 95% Confidence Interval [CI] 62.4, 67%) were vaginally colonised with at least one potentially pathogenic bacterial species. The most commonly isolated species were Escherichia coli (n = 508; 34.5%), Klebsiella pneumoniae (n = 144; 9.8%) and Staphylococcus aureus (n = 121; 8.2%). Results from exploratory multivariable regression analyses indicated that having had ≥5 previous pregnancies (adjusted odds ratio [aOR] 0.59; 95% CI 0.35, 0.97) or being ≥30 years old (aOR 1.52; 95% CI 1.03, 2.23) could be associated with vaginal colonisation with any potentially pathogenic bacteria, as well as with vaginal colonisation with S. aureus (aOR 0.33; 95% CI 0.12, 0.88, and aOR 2.17; 95% CI 1.17, 4.00, respectively). Possession of domestic animals in a household (aOR 0.57; 95% CI 0.35, 0.92) could be associated with vaginal colonisation with E. coli. CONCLUSIONS: Two-thirds of HIV-1 negative women in labour were vaginally colonised by potentially pathogenic bacteria, mainly E. coli, K. pneumoniae, and S. aureus.


Assuntos
Infecções por Escherichia coli/epidemiologia , Infecções por Klebsiella/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Infecções Estafilocócicas/epidemiologia , Vagina/microbiologia , Adulto , Estudos Transversais , Feminino , Soropositividade para HIV/epidemiologia , Humanos , Trabalho de Parto , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Atenção Primária à Saúde , Fatores de Risco , Uganda/epidemiologia , Adulto Jovem
15.
BMC Infect Dis ; 20(1): 152, 2020 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-32070308

RESUMO

BACKGROUND: Brucellosis is a zoonotic disease transmitted to humans through contact with infected animals, animal products or consumption of infected dairy products. Brucella infection during pregnancy is of special interest due to association with adverse pregnancy outcomes. This study determined the seroprevalence and factors associated with Brucella infection among pregnant women around the human-wildlife-livestock interface area in Ngorongoro ecosystem, Northern Tanzania. METHODS: A facility-based cross-sectional study was conducted between May and June 2018 at six health facilities that provide antenatal services. Pregnant women receiving antenatal care were invited to participate. A structured questionnaire was used to collect socio-demographic and obstetric characteristics in addition to behavior and practices related to the occurrence of human brucellosis. The presence of serum immunoglobulin against Brucella was determined using Rose Bengal Plate Test (RBPT). The positive samples were further assayed for the presence of IgG and IgM using The enzyme-linkedimmunosorbent assay. Bivariate analysis was conducted to determine the variables associated with Brucella seropositivity. Multivariable logistic regression analysis was performed to examine the factors independently associations with Brucella seropositivity after adjustment for other explanatory variables. RESULTS: A total of 313 participants were enrolled in the study. The overall seroprevalence of Brucella infection was 10.9% (34/313) determined by Rose Bengal plate test. Of 34 positive individuals, 27(79.4%) and 8(23.5%) were positive in the ELISA specific for IgG and IgM Brucella antibodies respectively. Regular contact with manure (AOR 3.16, 95%CI 1.27-7.83) and preference for animal fresh milk (AOR 3.80, 95% CI 1.23-11.69), raw meat (AOR 2.58, 95% CI 1.14-5.81) and raw animal blood (AOR 2.71, 95% CI 1.15-6.35) increased the odds of being Brucella seropositive. Contact with the animal placenta were not associated with Brucella seropositivity after adjustment. CONCLUSION: This study has found that brucellosis is an important public health problem among pregnant women in areas with interactions of humans; livestock and wildlife. The risk of infection increased with the regular contact with manure and preference of raw foodstuffs like animal blood, meat, and milk. We emphasize the need for interventional strategies to reduce the risk of exposure.


Assuntos
Brucelose/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Animais , Animais Selvagens , Anticorpos Antibacterianos/sangue , Estudos Transversais , Ecossistema , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Gado , Esterco , Carne , Leite , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Resultado da Gravidez , Cuidado Pré-Natal , Fatores de Risco , Estudos Soroepidemiológicos , Inquéritos e Questionários , Tanzânia/epidemiologia , Zoonoses/epidemiologia
16.
PLoS One ; 15(1): e0227881, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945128

RESUMO

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.


Assuntos
Citocinas/genética , Trabalho de Parto Prematuro/genética , Complicações Infecciosas na Gravidez/genética , Nascimento Prematuro/genética , Adulto , Amniocentese , Líquido Amniótico/química , Líquido Amniótico/metabolismo , Citocinas/isolamento & purificação , Feminino , Humanos , Inflamação/genética , Inflamação/microbiologia , Inflamação/patologia , Trabalho de Parto Prematuro/microbiologia , Trabalho de Parto Prematuro/patologia , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/patologia , Nascimento Prematuro/microbiologia , Nascimento Prematuro/patologia
17.
BJOG ; 127(6): 680-691, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31913562

RESUMO

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.


Assuntos
Antibioticoprofilaxia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/diagnóstico , Sepse/prevenção & controle , Infecções Estreptocócicas/prevenção & controle , Streptococcus agalactiae/isolamento & purificação , Feminino , Humanos , Recém-Nascido , Unidade Hospitalar de Ginecologia e Obstetrícia , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/microbiologia , Medição de Risco , Fatores de Risco , Sepse/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico
18.
Eur J Obstet Gynecol Reprod Biol ; 245: 168-173, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923737

RESUMO

Spontaneous Preterm birth (SPTB) is a common obstetric complication affecting 12.9 million births worldwide and is the leading cause of neonatal morbidity and mortality. Disruption in the vaginal microbiota has an impact on the maternal immunological profile leading to SPTBs. Scientists have struggled to link maternal infectious agents with the dysregulation of the maternal immune response in cases of SPTBs. Throughout the last decade, important findings regarding the role of microbiota and its genome, the so-called microbiome, have linked alterations within the population of the microorganisms in our bodies with changes in nutrition, immunity, behaviour and diseases. In this review, evidence regarding the female genital tract microbiota and microbiome has been examined to help further our understanding of its role in disrupting the maternal immune system resulting in spontaneous preterm birth.


Assuntos
Genitália Feminina/microbiologia , Microbiota/imunologia , Complicações Infecciosas na Gravidez/microbiologia , Nascimento Prematuro/microbiologia , Disbiose/complicações , Disbiose/microbiologia , Feminino , Humanos , Gravidez , Fatores de Risco , Vaginose Bacteriana/complicações , Vaginose Bacteriana/microbiologia
19.
J Obstet Gynaecol Res ; 46(1): 167-172, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31595595

RESUMO

We report a case of Group A streptococcal infection-induced toxic shock syndrome (GAS-TSS) with severe acute respiratory distress syndrome (ARDS), successfully treated with venoarterial extracorporeal membrane oxygenation (V-A ECMO). A 31-year-old woman was transferred due to high fever, continuous uterine contractions and fetal bradycardia at 31 weeks of gestation. She was in a shock status on arrival, and as fetal heart beat disappeared, we canceled the cesarean section and took priority in maternal rescue. At 21 h after the admission, pulseless ventricular tachycardia occurred, and V-A ECMO was introduced after defibrillation, which dramatically improved her respiratory and circulatory conditions. On the 3rd day, GAS was isolated from blood culture. The patient was freed from V-A ECMO on the 5th day and was discharged on the 25th day without permanent impairment. V-A ECMO should be considered as an effective therapeutic option against ARDS and circulation failure in GAS-TSS during pregnancy.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Complicações Infecciosas na Gravidez/terapia , Choque Séptico/terapia , Infecções Estreptocócicas/complicações , Streptococcus pyogenes , Adulto , Bradicardia/microbiologia , Feminino , Morte Fetal , Doenças Fetais/microbiologia , Humanos , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Terceiro Trimestre da Gravidez , Choque Séptico/microbiologia , Infecções Estreptocócicas/microbiologia , Resultado do Tratamento
20.
BJOG ; 127(2): 275-284, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30932317

RESUMO

OBJECTIVE: To determine the effects on the vaginal microbiota of an oral probiotic preparation administered from early pregnancy. DESIGN: Randomised, double blind, placebo-controlled trial. SETTING: Four maternity units in the UK. POPULATION: Women aged 16 years or older recruited at 9-14 weeks' gestation. METHODS: Participants were randomly allocated to receive oral capsules of probiotic containing Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 each at 2.5 × 109 colony-forming units (CFUs) or placebo once daily from recruitment until the end of pregnancy. MAIN OUTCOME MEASURE: Rates of bacterial vaginosis (BV, defined as Nugent score ≥7) at 18-20 weeks' gestation compared by logistic regression adjusted for possible confounders. RESULTS: The primary analysis included 78% (238/304) of participants who initially consented (probiotic group 123, placebo group 115). Of these participants, 95% (227/238) reported an intake of 93% or more of the required number of capsules. The rates of BV did not differ between groups at 18-20 weeks' gestation (15% (19/123) in the probiotic group vs. 9% (10/115) in the placebo group, adjusted odds ratio 1.82, 95% confidence interval 0.64-5.19). There were also no differences between the groups in the proportion of women colonised with the probiotic strains, Escherichia coli, group B streptococci or other vaginal microbiota. There were no differences in the alpha diversity or composition of the bacterial communities between or within the probiotic and placebo groups at 9-14 and 18-20 weeks' gestation. CONCLUSIONS: Oral probiotics taken from early pregnancy did not modify the vaginal microbiota. TWEETABLE ABSTRACT: The oral probiotic preparation used in this study does not prevent BV in pregnant women.


Assuntos
Microbiota/fisiologia , Complicações Infecciosas na Gravidez/microbiologia , Probióticos/uso terapêutico , Vagina/microbiologia , Adulto , Método Duplo-Cego , Feminino , Humanos , Lactobacillus reuteri/efeitos dos fármacos , Lactobacillus rhamnosus/efeitos dos fármacos , Gravidez , Primeiro Trimestre da Gravidez , Vaginose Bacteriana/complicações , Vaginose Bacteriana/tratamento farmacológico , Vaginose Bacteriana/microbiologia , Adulto Jovem
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