Molecular detection and genotypic characterization of toxoplasma gondii in paraffin-embedded fetoplacental tissues of women with recurrent spontaneous abortion

Background: Congenital toxoplasmosis is an important cause of spontaneous abortion worldwide. However, there is limited information on detection and genotypic characterization of Toxoplasma gondii [T. gondii] in women with recurrent spontaneous abortion [RSA]. The aim of this study is the molecular detection and genotypic characterization of T. gondii in formalin-fixed, paraffin-embedded fetoplacental tissues [FFPTs] of women with RSA that have referred to the Avicenna Research Institute in Tehran, Iran

Materials and Methods: This experimental research was undertaken on 210 FFPTs of women with RSA. The information of the patients was collected from the archives of Avicenna Research Institute in Tehran, Iran. After DNA extraction, the presence of T. gondii was examined by nested polymerase chain reaction targeting the GRA6 gene. Genotyping was performed on positive samples using polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP] that targeted the GRA6 and SAG3 genes. Sequencing was conducted on two GRA6 positive samples

Results: T. gondii DNA was detected in 3.8% [8/210] of the samples. Genotyping showed that all positive samples belonged to type III of the T. gondii genotype. Sequencing two genomic DNAs of the GRA6 gene revealed 99% similarity with each other and 99-100% similarity with T. gondii sequences deposited in GenBank. There were six patients with histories of more than three abortions; one patient had a healthy girl and another patient had two previous abortions. Abortions occurred in the first trimester of pregnancy in seven patients and in the second trimester of pregnancy in one patient

Conclusion: The results of this study have indicated that genotype III is the predominant type of T. gondii in women with RSA in Tehran, Iran. Also, our findings suggest that toxoplasmosis may play a role in the pathogenesis of RSA. However, further studies are needed to elucidate a clear relationship between T. gondii infection and RSA

Infeccoes de transmissao vertical em material abortivo e sangue com enfase em Toxoplasmose gondii / Vertical transmission from abortive material and blood with emphasis on Toxoplasma gondii

OBJETIVO: Analisar os resultados sorológicos, anatomopatológicos e parasitológicos de material abortivo para infecções com risco de transmissão vertical, com ênfase na toxoplasmose. MÉTODOS: Foi realizado um estudo coorte-transversal tratando da prevalência das doenças infectoparasitárias. Participaram da pesquisa 105 mulheres que sofreram aborto espontâneo completo e/ou incompleto; elas foram entrevistadas por meio de um questionário, e foram coletadas amostras de sangue e material abortivo. Foram realizados testes imunológicos para toxoplasmose, doença de Chagas, rubéola, citomegalovírus e sífilis e análise anatomopatológica nos restos ovulares. RESULTADOS: 55% das mulheres tinham entre 20 e 30 anos de idade. A maioria (68%) apresentou idade gestacional entre a 7ª e a 14ª semanas. 54,3% das mulheres tinham o ensino médio completo ou incompleto. Pela análise da sorologia, a infecção com risco de transmissão vertical mais frequente foi o citomegalovírus (CMV) com 97,1% de positividade, e em seguida a rubéola, com 95,2%. A toxoplasmose teve um percentual de 54,3%, a doença de Chagas, de 1,9% e a sífilis, de 0,95%. A análise dos laudos de biópsia demonstrou que 63,1% apresentaram inflamação e 34%, ausência de inflamação. Das análises sorológica, anatomopatológica e parasitológica das 105 mulheres, 57 foram soropositivas para T. gondii, e nenhuma teve resultado positivo para a Reação em Cadeia da Polimerase (PCR) e para inoculação em camundongos. CONCLUSÕES: A prevalência de doenças com risco de transmissão congênita nas mulheres com abortamento espontâneo é importante, sendo necessárias pesquisas visando esclarecer a etiologia do aborto. .

PURPOSE: To analyze the serological, anatomopathological and parasitological results obtained from abortive material in order to detect infections with the risk of vertical transmission, with emphasis on toxoplasmosis. METHODS: A cross-sectional cohort study was conducted in order to determine the prevalence of infectoparasitic diseases. A total of 105 women who suffered spontaneous complete or incomplete abortion participated in the study. The women were interviewed, answered a questionnaire and had their blood and abortive material collected. Immunological tests were carried out in order to detect toxoplasmosis, Chagas disease, rubeola, cytomegalovirus and syphilis, and anatomopathological analysis of the ovular remains was performed. RESULTS: 55% of the women studied were 20 to 30 years old. Most of them (68%) presented a gestational age between the 7th and 14th week. 54.3% of the women had complete or incomplete high school education. Serological analysis showed cytomegalovirus (CMV) as the most common vertically transmitted infection with 97.1% positivity, followed by rubeola with 95.2%. Toxoplasmosis showed 54.3% positivity, Chagas disease 1.9% and syphilis 0.95%. Anatomopathological analysis showed inflammation in 63.1% of the cases and absence of inflammation in 34%. The results of the serological, anatomopathological and parasitological analysis of the 105 participants showed that 57 women were T. gondii positive. However, none showed positivity in the polymerase chain reaction (PCR) or in mouse inoculation. CONCLUSIONS: The prevalence of diseases with the risk of vertical transmission is important in women with spontaneous abortion, indicating the need for more research in order to investigate the etiology of abortion. .

Perinatal morbidity and mortality associated with chlamydial infection: a meta-analysis study

OBJECTIVE: To evaluate the effect of Chlamydia trachomatis infection during pregnancy on perinatal morbidity and mortality. METHODS: Systematic review and meta-analysis in an electronic database and manual, combining high sensitivity specific descriptors seeking to answer the research objective. The articles considered to be of high methodological quality (score above 6 on the Newcastle-Ottawa Scale) were assessed by meta-analysis. RESULTS: Summary estimates of 12 studies were calculated by means of Mantel-Haenszel test with 95 percent confidence interval. It was observed that Chlamydia infection during pregnancy increased risk of preterm labor (relative risk (RR) = 1.35 [1.11, 1.63]), low birth weight (RR = 1.52 [1.24, 1.87]) and perinatal mortality (RR = 1.84 [1.15, 2.94]). No evidence of increased risk was associated with Chlamydia infection in regard to premature rupture of membranes (RR = 1.13 [0.95, 1.34]), abortion and postpartum endometritis (RR = 1.20 [0.65, 2.20] and 0.89 [0.49, 1.61] respectively). CONCLUSION: The diagnosis and treatment of Chlamydia cervicitis during pregnancy can reduce perinatal morbidity and mortality associated with this infection. However, clinical trials are needed to confirm these findings.

Seroprevalence of Brucella species among women with miscarriage in Jordan

Results differ as to whether Brucello infection during pregnancy increases a woman's risk of miscarriage. We determined the seroprevalence of Brucella spp. among a sample of women with miscarriage and women with no history of miscarriage in Jordan during January-July 2003. Serum samples were collected from 445 women with miscarriage and a similar number of women with no history of miscarriage, matched on age, socioeconomic status and residence. Sera were tested using the Rose Bengal plate test and complement fixation test. The true seroprevalence among women with miscarriage was 1.8% [95% Cl: 0.6-3.0], while the true seroprevalence among women with no history of miscarriage was 1.0% [95% CI: 0.08-1.9], There was no significant difference between seroprevalences of Brucello spp. among women with miscarriage and those with no history of miscarriage [P= 0.6]

Qual deve ser o rastreamento de doenças infecciosas em casos de perda gestacional recorrente?: [revisão] / What should be the screening of infectious diseases in cases of recurrent pregnancy loss?: [review]

A perda gravídica de repetição ocorre em cerca de 1 a 2% das gestações, e em cerca de em 2% das vezes tem quadros infecciosos como agentes etiológicos. A necessidade de rastreio de causa infecciosa tem sido muito discutida na literatura. Com objetivo de avaliar o que se conhece sobre esta necessidade, foi realizada uma revisão sistemática de trabalhos em inglês, português e espanhol em bases de dados do Pubmed, Highwire, Lilacs e biblioteca Cochrane. Observou-se que, de todos os agentes, o mais estudado foi a Chlamydia trachomatis, em especial seu efeito imunológico tardio. Outros agentes têm sido associados ao aborto habitual, no entanto, as infecções bacterianas, virais e parasitárias podem interferir na evolução da gestação, mas não parece ser uma causa significante de aborto de repetição. O valor do rastreio parece ser limitado na investigação de perda gravídica de repetição fora de um episódio infeccioso agudo. No entanto, mais estudos se fazem necessários, em especial para avaliar efeitos tardios, como das infecções por Chlamydia trachomatis.

The recurrent pregnancy loss occurs in about 1-2% of pregnancies, and in about 2% the etiology would be infectious. The need for tracking infectious causes has been much discussed in the literature. In order to evaluate what is known about this need, we conducted a systematic review of papers in English, Portuguese and Spanish on this subject available in the databases of Pubmed, Highwire, Lilacs and Cochrane Library. Chlamydia trachomatis was mostly studied, especially with regard to its late immunological effect. Other agents have been associated with habitual abortion; however, bacterial infections, viral and parasitic diseases can interfere with the course of gestation, but does not seem to be a significant cause of recurrent abortion. The value of screening seems to be limited for the investigation of recurrent pregnancy loss if acute infection does not occur. However, further studies are needed, especially to evaluate late effects such as infections by Chlamydia trachomatis.

Chlamydia trachomatis and rubella antibodies in women with full-term deliveries and women with abortion in Baghdad

The seroprevalences of Chlamydia trachomatis and rubella IgG antibodies were measured in women with full-term deliveries [n = 198] and with abortion [n = 79] in a hospital in Baghdad city, Iraq. Positive rubella antibody titres were found in 42.9% of mothers with full-term deliveries and 34.2% with abortion. C. trachomatis infection was found in 13.6% of mothers with full-term deliveries and 6.4% with abortion, with a significant difference in mean antibody levels between the 2 groups. Routine screening for C. trachomatis and rubella is needed for pregnant women in Iraq

Artificial insemination encountered with haemophilus somnus infection in cattle

During a period of artificial insemination in cattle in several farms around Tehran, Iran, the animals were involved with endometritis and abortion. In order to investigate the cause, bacterial culture was done on 23 samples of artificial prepared semen. Haemophilus sp. was isolated from 20 out of 23 samples and the findings were confirmed through serologic tests. Biochemical tests were also set up to diagnose the strain of the bacteria. These tests revealed the presence of H. somnus in the artificially prepared semen. This species was never before reported in Iran, in genital tract of cattle [male and female] nor H. agni in sheep. Attempts to culture this bacteria from genital tract has not been very successful because of cultural difficulties. This was the first diagnosis of H. somnus in this country and helped the practitioners to be aware of the possible problems in running the artificial insemination procedure from infected semen

Identificação de Listeria monocytogenes em placentas humanas e espécimes de aborto pela técnica de imunoistoquímica / Identification of Listeria monocytogenes in human placentas and abortion species through immunohistochemical technique

A listeriose é causada por um microrganismo que se encontra amplamente disseminado na natureza e tem sido isolado do solo, de fezes humanas e de animais e pode, eventualmente, contaminar os alimentos. A Listeria monocytogenes é patogênica para o homem e tornou-se o principal patógeno nas doenças transmitidas pelos alimentos. Tendo-se em vista que a incidência de listeriose humana näo é bem conhecida e as placentites possuem aspecto morfológico inespecífico e näo säo, muitas vezes, investigadas para este fator etiológico, surgiu a motivaçäo para desenvolver a técnica de imunoistoquímica para o diagnóstico de Listeria monocytogenes em placentas ou produtos de aborto, utilizando um anticorpo policlonal anti-Listeria (Biodesign). Um projeto-piloto foi realizado a partir do material encontrado em dez placentas provenientes de abortos ou partos prematuros ocorridos no ano de 2000 no Hospital de Clínicas de Porto Alegre (HCPA). As lâminas foram analisadas através do exame microscópico convencional (HE) e de imunoistoquímica (IHQ). Os resultados deste projeto revelaram a presença de Listeria monocytogenes em cinco dos dez (50%) casos estudados. Todos os casos apresentaram alterações sugestivas de processo inflamatório agudo supurativo. Frente a estes achados torna-se importante considerar a infecçäo por Listeria monocytogenes detectável por IHQ como um elemento no diagnóstico da patogenia do aborto ou das infecções perinatais, podendo este achado contribuir para o tratamento dos recém-nascidos ou das parturientes. As características microscópicas de listeriose na placenta, embora näo-patognomônicas, permitem ao patologista um diagnóstico presuntivo, e a confirmaçäo pode ser realizada pelo método de imunoistoquímica

[Evaluation of relation between Ureaplasma Urealyticum infection with abortion]

Since long time ago, abortion has been considered as one of the most important medical problems. Bacteria and infectious agents are one of its causes. Possible etiologic role of ureaplasma urealyticum in abortion has been suggested for years ago, but it has not been approved completely yet. Therefore, this study has been designed for approving of this hypothesis and prevention of spontaneous abortion. This study was a case control type of investigation done over women referred to private Gyn and Obs clinic, which had spontaneous abortion. Control group was selected among referred women who did not have any previous abortion. To investigate the presence of ureaplama urealyticum, vaginal and cervical culture was performed in both groups. Other interfering variable factors were also assessed and if there was any intervention factor in any one of two groups, sample was removed. After recording of results of study in questionnaire, central indexes were analyzed by K [2], fisher exact test. 7 persons were eliminated from this study due to intervention factors, so, study was done over 34 patients as case [27 with one abortion and 7 with recurrent abortion] and 47 patients as control group. Mean age in case group was 26.3 +/- 4.6 years and in control group was 23.4 +/- 3.6 years. Positive vaginal and cervical culture for ureaplasma urealyticum in case group was 35% [12 persons] and in control group was 6% [3 persons] [P<0.0001]. In patients with spontaneous recurrent abortion, positive culture for ureaplasma urealyticum was 71% [5 persons] and in patients with only one spontaneous abortion was 26% [7 persons] [P<0.034]. In comparison with similar studies, positive culture of ureaplama urealyticum in patients of case group were a lot more in this study. Prevalence of ureaplama urealyticum in control group was 6% which is less than similar studies. Proportion of positive culture of ureaplasma urealyticum in patients with recurrent abortion was higher than those with only one abortion. Therefore, it is recommended that pregnant women specially those who have high risk pregnancy and also in women with history of abortion, should be examined for contamination with ureaplasma urealyticum. In case of positive results, proper treatment will reduce probable recurrent abortions

Cervicovaginal aerobic microflora of women with spontaneous abortion or preterm delivery in Araraquara-Brazil

Microbiological routine exams of endocervix and vaginal specimens of 22 women with clinical history of recent spontaneous abortion or premature rupture of membranes were accomplished. "Chlamydia thachomatis", "Streptococcus pyogenes", "Streptococcus agalactie", "Candida" sp and "Gardnerela vaginalis" were recovered from 54.5 (per cent) (12) of the women. "Ureoplasma urealyticum" was frequently isolated (45.5 (per cent)) but 5 out of 22 qualitative investigation on genital microflora in pregnant women, since it is likely to influence onm pregnancy outcome.

Aborto de 2º trimestre y campylobacter jejuni / Abort of second trimester and campylobacter jejuni

Campylobacter jejuni es agente frecuente de infecciones entéricas en todo el mundo. Ocasionalmente puede producir aborto en la mujer. Tiene un mecanismo de transmisión fecal-oral. Posee características de cultivo exigentes y requiere para su aislamiento incubación prolongada. La infección por este microorganismo en Chile es infrecuente y no representa un problema de Salud Pública, no obstante se comunica este caso clínico por las consecuencias que tiene en la gestación. Además se recuerdan las medidas a tomar frente a cuadro febril que aparece durante el embarazo