(Acta Paediutr Jpn 1990;32: 315

- 318)

Intrauterine Chlamydia Trachomatis Infection in a Premature Infant Atsuko Niwa, M.D., Harumi Ohtsuka, M.D., Takao Inoue, M.D., Hiroshi Noguchi, M.D. and So Hashizume, M.D. Departments of Neonatology, Chiba Municipal Sea-side Hospital (AN, HO, TI and HN) and Pathobiology, School of Nursing, Chiba University (SH), Chiba

Intrauterine Chlamydia trachomatis infection was strongly suspected in a premature infant born in the 32nd week of gestation. The membranes were artificially ruptured at the time of delivery. This infant showed a high titer of specific IgM antibody to Chlamydia trachomatis at one hour after birth. He showed mild respiratory distress and was treated with oral erythromycin for three weeks. He was discharged home at the age of 46 days. Key Words

Intrauterine infection, Chlamydia trachomatis, Premature infant

Introduction ChLzmydiu trachonurtis (C. truchomutis) in fection is a sexually transmitted disease, and infection of the genital tract of the mother with this organism is a major cause of neonatal conjunctivitis and pneumonia. The mother-tochild infection of C. trachomatis has been documented since the first report by Thygeson et a l [ l ] in 1942. The organism is transmitted from the mother to the child primarily by passage through the infected birth canal or postpartum contact, and intrauterine infection is considered to be very rare without premature rupture of membranes (PROM). We noted respiratory distress and an elevated serum IgM antibody against C. trachomatis by

Received December 5,1989 Revised March 2, 1990 Accepted March 9,1990 Correspondence address: Atsuko Niwa, M.D., Chiba Municipal Kaihin Hospital, 3-3 1-1, Isobe, Chiba-shi, Chiba 260, Japan

micro-immunofluorescence antibody assay (micro-IF) and indirect immunofluorescence antibody assay using infected L2 cells, in a premature male infant with no PROM, from immediately after birth, and strongly suspected intrauterine infection by C. trachomatis. This rare case of mother-to-child infection is described.

Case Report The mother was a 31-year-old gravida-3, para-1 woman. She had a history of spontaneous abortion and stillbirth at 29 years of age. During the present gestation, she consulted us with impending labour at the 22nd week and underwent the Shirodkar operation at the 23rd week, but delivered a 1,998 g boy vaginally at the 32nd week. The membranes were artificially ruptured at delivery. Amniotic fluid was slightly stained. The infant showed a 1-minute Apgar score of 8, and was admitted due to the low birth weight. He was afebrile, had moderate chest

3 16 (90) Niwa et a1 retractions, with 65 respirations per minute, and showed no eye discharge. Respiratory sounds were clear and no cyanosis was noted. Laboratory fiidings on admission included: blood gases; pH 7.276, PO, 186.2 mmHg, PCOz 52.8 mmHg with 40% oxygen supplementation; blood leukocyte count 23,000/mm3 (4% eosinophils, 68% neutrophils, 27% lymphocytes, and 1% monocytes); hemoglobin 15.5 g/dl; thrombocyte count 135,000/mm3; Creactive protein 432 ng/ml (negative); serum IgG 948 mg/dl, and IgM 231 mg/dl. Chest X-ray showed interstitial infiltrates and mild hyperinflation (Fig. 1). Bacterial cultures of urine, external ear, stools, gastric aspirates, throat, and blood were all negative on admission, and viral cultures of urine and throat were also negative. Tachypnea continued and 30% oxygenation was needed. 25 mg/Kg cephotaxime was given intravenously twice a day for 2 days and aminophylline orally from the 9th day of illness. The anti-chlamydial antibody titers 1 hour after birth were IgG 1:128 and IgM 1:4096 (micro-IF). The titers were reexamined by another technique and were IgG 1:512, IgA < 1: 16 (by indirect immunoperoxidase

assay-Ipazyme), and IgM 1:64 (by indirect immunofluorescence assay). Nasopharyngeal chlamydial cultures obtained on the 8th, 19th, and 29th days of age were all negative. A three-week course of oral erythromycin (40 mg/kg/day) was initiated on the 14th day of illness. Gradual improvements were observed, and oxygen was stopped on the 31st day. Eye discharge was noted at 3 weeks of age with negative chlamydial cultures, and was treated with topical erythromycin. (Fig. 2). The maternal anti-chlamydia1 antibody titers were: IgC 1:512, IgA 1:16, and IgM

Intrauterine Chlamydia trachomatis infection in a premature infant.

Intrauterine Chlamydia trachomatis infection was strongly suspected in a premature infant born in the 32nd week of gestation. The membranes were artif...
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