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Necrotizing funisitis associated with Ureaplasma urealyticum infection: A clinicopathologic analysis of 14 cases
Juan Li1, Yanxue Yin1, Robert Bendon2
1Department of Pathology, Jinan Maternity and Child Care Hospital, Jinan, Shandong, 250001, China.
Introduction:
Necrotizing funisitis is a distinct lesion of the umbilical cord associated with chorioamnionitis and bloodborne fetal infection. The lesion may be a response to microorganisms in Wharton's jelly. A common microorganism detected in chorioamnionitis is Ureaplasma urealyticum (U. urealyticum). This study hypothesizes that U. urealyticum DNA will be present in Wharton's jelly in necrotizing funisitis.
Methods:
Necrotizing funisitis was identified retrospectively from a 2-year pathology database and confirmed in review. Paraffin fixed embedded tissue sections of the lesion were prepared for polymerase chain reaction (PCR) by using primers to identify U. urealyticum. Twenty matched controls without funisitis were similarly processed. Clinical data included serological tests of common bloodborne infections in the mothers and infants, and U. urealyticum PCR results in the urine of the neonates.
Results:
Fourteen cases of necrotizing funisitis were identified in 7,416 examined placentas. Nine of these umbilical cords were positive by PCR for U. urealyticum (64.3%). Nineteen of twenty control cases were negative. Eight of ten neonates (80%) also had positive urine PCR tests for U. urealyticum. No infants or mothers had evidence of bloodborne fetal infection.
Discussion:
U. urealyticum DNA was present in Wharton's jelly by PCR testing in the majority of the necrotizing funisitis lesions tested. This result supports a possible causative role for U. urealyticum in many cases of necrotizing funisitis.
Insights
Ureaplasma urealyticum (U. urealyticum) DNA was detected in the majority of necrotizing funisitis umbilical cord lesions. This finding supports U. urealyticum as a potential cause of this serious placental condition.
Area of Science:
- Perinatal pathology
- Microbiology
- Molecular diagnostics
Background:
- Necrotizing funisitis is an umbilical cord lesion linked to chorioamnionitis and fetal infections.
- Microorganisms in Wharton's jelly may trigger this lesion.
- Ureaplasma urealyticum (U. urealyticum) is frequently found in chorioamnionitis.
Purpose of the Study:
- To investigate the presence of U. urealyticum DNA in Wharton's jelly of necrotizing funisitis lesions.
- To determine if U. urealyticum plays a causative role in necrotizing funisitis.
Main Methods:
- Retrospective analysis of 14 necrotizing funisitis cases and 20 controls.
- Polymerase chain reaction (PCR) used to detect U. urealyticum DNA in umbilical cord tissue.
- Neonatal urine samples and maternal/infant serology for other infections were analyzed.
Main Results:
- U. urealyticum DNA was found in 64.3% of necrotizing funisitis cases.
- U. urealyticum was absent in 95% of control cases.
- 80% of neonates with necrotizing funisitis had positive U. urealyticum urine PCR results.
Conclusions:
- U. urealyticum DNA is frequently present in Wharton's jelly associated with necrotizing funisitis.
- These findings suggest a significant role for U. urealyticum in the pathogenesis of necrotizing funisitis.
