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Necrotizing funisitis associated with Actinomyces meyeri infection: a case report
J R Wright1, D Stinson, A Wade
1Department of Pathology and Surgery, Izaak Walton Killam Children's Hospital, Halifax, Nova Scotia, Canada.
Abstract:
Necrotizing funisitis is associated with an increased rate of stillbirth, perinatal infection, and preterm delivery. No one organism has been associated with necrotizing funisitis, although this condition has been linked with congenital syphilis in some studies. We report a case of necrotizing funisitis in a 24-year-old G2P0A2 woman who experienced preterm labor at 31 weeks of gestation. Examination of the placenta revealed severe chorioamnionitis and necrotizing funisitis; large numbers of gram-positive filamentous branching organisms could be seen on the surface of the cord and within Wharton jelly. Initial cultures of the placenta, which had not been maintained under anaerobic conditions after delivery, were negative. A fragment of the cord was then homogenized; anaerobic culture on brain-heart infusion agar yielded Actinomyces meyeri. This organism usually resides in the periodontal sulcus and has not been previously reported in the female genital tract. The mother gave a history of a dental abscess that flared up and drained with each of her three pregnancies; the pain was particularly severe during the last 2 months of this pregnancy, so she had the tooth removed after delivery. The infant was treated for prematurity and presumed sepsis and did well.
Insights
Necrotizing funisitis, a placental condition linked to adverse pregnancy outcomes, was identified in a preterm delivery case. The study isolated Actinomyces meyeri, a novel bacterium, from the umbilical cord, suggesting a new cause for this obstetric complication.
Area of Science:
- Obstetrics and Gynecology
- Microbiology
- Neonatal Perinatal Medicine
Background:
- Necrotizing funisitis is a placental pathology associated with stillbirth, perinatal infection, and preterm delivery.
- The specific causative organism for necrotizing funisitis has not been definitively identified, though associations with congenital syphilis exist.
Observation:
- A case of necrotizing funisitis was observed in a 24-year-old woman presenting with preterm labor at 31 weeks gestation.
- Placental examination revealed severe chorioamnionitis and necrotizing funisitis, with numerous gram-positive filamentous branching organisms on the umbilical cord and in Wharton jelly.
Findings:
- Initial placental cultures were negative, but anaerobic culture of umbilical cord homogenate identified Actinomyces meyeri.
- Actinomyces meyeri, typically found in the periodontal sulcus, has not been previously reported in the female genital tract.
- The mother had a history of recurrent dental abscesses, with increased pain during the recent pregnancy.
Implications:
- This case suggests Actinomyces meyeri as a potential causative agent of necrotizing funisitis.
- The findings expand the understanding of microbial causes of adverse pregnancy outcomes.
- Early identification and appropriate treatment of maternal infections may be crucial in preventing severe perinatal complications.