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The inflammatory response in candidal chorioamnionitis
Abstract:
Fetal infection with Candida organisms has not commonly been reported. Umbilical cords and placentas from 23 cases of chorioamnionitis collected over a nine-year period were examined by electron microscopy and immunoperoxidase staining. Gross features, especially of the umbilical cord, were distinctive and included the pale yellow plaques pathognomonic of candidal funisitis. Histopathologically, the lesions were found to be focal and subamniotic and were often embedded in a "fibrinoid" exudate and surrounded by inflammatory cells. In some cases the exudate and inflammatory cells were deposited in dense bands. Immunoperoxidase staining showed the lesions to contain IgG, IgM, and IgA, which probably originated in dense-staining plasmacytoid and immunoblastic cells in the inflammatory infiltrates. Additional findings in two fetal cases of giant cell pneumonitis suggested that the fetus can mount a brisk inflammatory and immune response to Candida organisms as early as 18 weeks' gestation and that mucosal exposure to this antigen can result in production of IgA by the lung.
Insights
Fetal infection with Candida, known as candidal funisitis, is rare but presents distinct umbilical cord plaques. The fetus can mount an immune response to Candida as early as 18 weeks gestation.
Area of Science:
- Perinatal pathology
- Fungal infections
- Immunology
Background:
- Fetal Candida infections are infrequently documented.
- Chorioamnionitis cases provide insight into fetal responses.
- Umbilical cord and placental examination is crucial.
Purpose of the Study:
- To characterize the pathological features of fetal Candida infection.
- To investigate the fetal immune response to Candida organisms.
- To identify diagnostic markers for candidal funisitis.
Main Methods:
- Examination of umbilical cords and placentas from 23 chorioamnionitis cases.
- Utilized electron microscopy and immunoperoxidase staining.
- Histopathological analysis of fetal tissue lesions.
Main Results:
- Distinctive pale yellow plaques on umbilical cords indicated candidal funisitis.
- Lesions were focal, subamniotic, embedded in exudate, and surrounded by inflammatory cells.
- Immunoperoxidase staining revealed IgG, IgM, and IgA in lesions, originating from inflammatory cells.
- Two cases of fetal giant cell pneumonitis suggested an early fetal immune response (from 18 weeks gestation).
Conclusions:
- Candidal funisitis has characteristic gross and histopathological findings.
- The fetus demonstrates an inflammatory and immune response to Candida, including IgA production in the lung.
- Early gestational immune response to Candida is possible.