Letter to the Editor
Acute necrotizing chorioamnionitis caused by Actinomyces neuii
Corioamnionitis aguda necrotizante causada por Actinomyces neuii
Elisa Nuez-Zaragoza
, Isabel Sanfeliu
Corresponding author
Department of Microbiology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
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White colonies of <span class="elsevierStyleItalic">Actinomyces neuii</span> isolated on blood agar after 48<span class="elsevierStyleHsp" style=""></span>h of incubation (B).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 41-year-old female patient who was admitted to the hospital at week 25 of her pregnancy for uterine dynamics and foetal lung maturity control. After five days of hospitalization, she began treatment with atosiban (oxytocin antagonist) due to increased uterine dynamics. Previous significant medical history presented in vitro fertilisation and gestational diabetes with insulin treatment. A cerclage was placed 22.3 weeks into the pregnancy due to prolonged cervical length.</p><p id="par0010" class="elsevierStylePara elsevierViewall">During the hospitalization (week 27.5), the patient began experiencing an increased clear vaginal discharge without uterine dynamics resulting in a premature rupture of membranes. Laboratory blood test revealed an increase in C-reactive protein of 5.47<span class="elsevierStyleHsp" style=""></span>mg/dL (0–0.5<span class="elsevierStyleHsp" style=""></span>mg/dL). Based on the findings, a presumptive diagnosis of chorioamnionitis was made leading to amniocentesis for study of amniotic fluid.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The results of the amniotic fluid study were as follows: glucose<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mg/dL, proteins 4<span class="elsevierStyleHsp" style=""></span>g/L and a count of 1720 nucleated cells/mm<span class="elsevierStyleSup">3</span> with a predominance of polimorfonuclear cells. The Gram stain showed unbranched Gram-positive bacilli (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Based on the laboratory data, the patient was diagnosed with chorioamnionitis starting with antibiotic dosage (intravenous piperacillin-tazobactam and oral clarithromycin). The obstetrician decided to induce labour and stopped the atosiban bolus. A baby weighing 1200<span class="elsevierStyleHsp" style=""></span>g was born by spontaneous delivery at week 28.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The anatomical pathology study of the placenta showed acute necrotizing chorioamnionitis but the patient did not exhibit signs of fever or sepsis after delivery, and the antibiotic treatment was concluded 24<span class="elsevierStyleHsp" style=""></span>h postpartum. Due to the premature birth, the new-born was admitted to paediatric intensive care and was treated with ampicillin and gentamicin. Antibiotic treatment concluded after 5 days without further signs of bacterial infection.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Microbiological studies used amniotic fluid and two placenta samples. All the samples were cultured in selective (MacConkey and Columbia CNA agar) and enrichment media (chocolate agar, blood agar, and thioglicolate broth) in aerobic conditions. We also used Anaerobe Schaedler and Schaedler neomycin vancomycin agar under anaerobic conditions (bioMérieux®). Two types of colonies were isolated in the amniotic fluid culture. Some colonies had a circular and smooth white colour and were identified as <span class="elsevierStyleItalic">Actinomyces neuii</span> by mass spectrometry (log score: +2.06, MALDI-TOF MS, Microflex®, Bruker). The other colonies were smaller and darker and were identified as <span class="elsevierStyleItalic">Streptococcus anginosus</span> by MALDI-TOF MS (log score: +2.16) as well. In both placenta samples, only <span class="elsevierStyleItalic">Actinomyces neuii</span> was isolated and identified (both log score: +2.16) (Fig. 1).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Susceptibility testing used the minimum inhibitory concentration (MIC) microdilution method (Pos MICroSTREP plus 6 panel, MicroScan WalkAway, Beckman Coulter). The sensitivity analysis showed that both strains were susceptible to all antibiotics tested: ampicillin <span class="elsevierStyleItalic">A. neuii</span> (≤0.06<span class="elsevierStyleHsp" style=""></span>mg/L)/<span class="elsevierStyleItalic">S. anginosus</span> (0.12<span class="elsevierStyleHsp" style=""></span>mg/L), cefotaxime (≤0.25<span class="elsevierStyleHsp" style=""></span>mg/L), meropenem (≤0.25<span class="elsevierStyleHsp" style=""></span>mg/L), levofloxacin <span class="elsevierStyleItalic">A. neuii</span> (1<span class="elsevierStyleHsp" style=""></span>mg/L)/<span class="elsevierStyleItalic">S. anginosus</span> (≤0.5<span class="elsevierStyleHsp" style=""></span>mg/L), clindamycin (≤0.06<span class="elsevierStyleHsp" style=""></span>mg/L), clarithromycin (≤0.12<span class="elsevierStyleHsp" style=""></span>mg/L), vancomycin (0.5<span class="elsevierStyleHsp" style=""></span>mg/L), and daptomycin (≤0.25<span class="elsevierStyleHsp" style=""></span>mg/L).</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus anginosus</span> was not seen in the Gram stain, and it grew at low CFU counts in the inoculated amniotic fluid samples. The placenta samples did not reveal its presence; thus, it was considered to be a contaminant of the sample extraction.</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Actinomyces neuii</span> is a facultative anaerobic Gram-positive and rod-shaped bacteria. It has an unbranched morphology in contrast to other species of <span class="elsevierStyleItalic">Actinomyces</span>.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a><span class="elsevierStyleItalic">Actinomyces</span> species are considered normal flora of the oral cavity, gastrointestinal tract, and female genital tract; they rarely cause disease in humans.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–8</span></a> Nevertheless, they can cause chronic and slowly progressive infections including abscess formation in skin and soft tissues.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,6,9</span></a><span class="elsevierStyleItalic">Actinomyces neuii</span> is a lesser-known species first described in 1994 by Funke et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> It does not cause typical actinomicosis. The infections are related to abscesses, skin lesions, and infections of the genitourinary tract and mostly associated with the use of intrauterine contraceptive devices (IUD).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4,7–10</span></a> Rare cases of pericarditis, osteomyelitis, breast infections, ophthalmic infections, prostatitis, and bacteraemia have also been previously reported.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3,5–8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Actinomyces neuii</span> has also been involved in causing premature labour, chorioamnionitis, and neonatal sepsis associated with a previous resolution of a vaginal device (IUD or vaginal cerclage).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4–10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In our patient, chorioamnionitis was suspected to be related to the cerclage placement at week 22 of pregnancy. Other authors reported similar conclusions of <span class="elsevierStyleItalic">Actinomyces neuii</span> infections associated with the use of this device.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,8</span></a> Only two cases reported the presence of <span class="elsevierStyleItalic">Actinomyces neuii</span> in amniotic fluid.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">This case demonstrates the need to consider <span class="elsevierStyleItalic">Actinomyces</span> infection in patients who carried a vaginal device. Amniotic fluid should be examined in patients with suspected chorioamnionitis for an early diagnosis to avoid further complications to the mother and the new-born.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 629 "Ancho" => 1255 "Tamanyo" => 173679 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Direct Gram stain from the amniotic fluid revealed unbranched gram-positive bacilli (A). White colonies of <span class="elsevierStyleItalic">Actinomyces neuii</span> isolated on blood agar after 48<span class="elsevierStyleHsp" style=""></span>h of incubation (B).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neonatal sepsis secondary to chorioamnionitis by <span class="elsevierStyleItalic">Actinomyces neuii</span> in a 25 weeks pregnant woman" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Giron de Velasco-Sada" 1 => "H. Peinado" 2 => "M.P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 36 | 5 | 41 |
| 2024 September | 48 | 11 | 59 |
| 2024 August | 50 | 12 | 62 |
| 2024 July | 42 | 6 | 48 |
| 2024 June | 37 | 6 | 43 |
| 2024 May | 47 | 8 | 55 |
| 2024 April | 35 | 6 | 41 |
| 2024 March | 74 | 5 | 79 |
| 2024 February | 70 | 6 | 76 |
| 2024 January | 78 | 2 | 80 |
| 2023 December | 68 | 5 | 73 |
| 2023 November | 82 | 5 | 87 |
| 2023 October | 146 | 8 | 154 |
| 2023 September | 58 | 1 | 59 |
| 2023 August | 49 | 3 | 52 |
| 2023 July | 103 | 0 | 103 |
| 2023 June | 69 | 3 | 72 |
| 2023 May | 65 | 2 | 67 |
| 2023 April | 48 | 26 | 74 |
| 2023 March | 4 | 3 | 7 |
| 2023 February | 1 | 0 | 1 |
| 2023 January | 7 | 0 | 7 |
| 2022 December | 4 | 0 | 4 |
| 2022 November | 2 | 2 | 4 |
| 2022 October | 262 | 28 | 290 |
| 2022 March | 0 | 2 | 2 |
| 2022 January | 0 | 1 | 1 |
| 2021 September | 0 | 2 | 2 |
| 2021 August | 0 | 2 | 2 |
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