The importance of chlamydia and mycoplasmas in perinatology

Chlamydia

 * obligatory intracellular small Gram-negative bacteria;
 * Chlamydia trachomatis
 * most common cause of sexually transmitted infections, mostly asymptomatic;
 * diagnosis: gold standard – culture on epithelial cells, PCR from smear;
 * infections during pregnancy: urethritis, cervititis, salpingitis → treatment: azithromycin or amoxicillin;
 * perinatal complications: increased risk of premature birth and premature outflow of amniotic fluid (PPROM); chronic salpingitis → infertility and increased risk ectopic pregnancy;
 * child infection: conjunctivitis, pneumonia; asymptomatic colonization of the nasopharynx, rectum or vagina;
 * pathogenesis: infection during childbirth, rarely during rupture of the fetal membranes (PROM) before caesarean section;
 * conjunctivitis of the newborn typically between the 5th and 14th day of life (between the 2nd and 5th day of life is the typical Neisseria gonorrhoeae conjunctivitis);
 * neonatal/infant pneumonia typically between 4 and 12 weeks of life; first, nasal obstruction/nasal secretions, cough, respiratory distress, X-ray of the lungs (atypical pneumonia – lung hyperinflation, bilateral diffuse interstitial or alveolar infiltrates), eosinophilia in the blood count;
 * treatment: p.o. erythromycin or azithromycin.

Mycoplasma

 * the smallest free-living organisms; they have an extremely small genome;
 * do not have a cell wall → naturally resistant to beta-lactam antibiotics;
 * ID: PCR; demanding sample transport conditions (special transport media) → cultivation is not routinely performed;
 * Mycoplasma pneumoniae, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum and Ureaplasma parvum
 * Ureaplasma urealyticum
 * pregnant infections: asymptomatic colonization of the lower genital tract (vulva, vagina, cervix);
 * perinatal complications: premature birth, premature ejaculation (PPROM), intra-amniotic infection, postpartum fever and endometritis;
 * child infection: congenital pneumonia, bacteremia, meningitis, bronchopulmonary dysplasia/chronic lung disease (controversial).
 * pathogenesis: ascending intrauterine infection, passage through the infected birth canal, hematogenous dissemination through the placenta → colonization of the skin, mucous membranes and respiratory tract; possibly dissemination to the bloodstream and CNS.

Related Articles

 * Chlamydia • Chlamydia trachomatis • Chlamydia pneumoniae • Chlamydia genital infections
 * Mycoplasma • Mycoplasma genital infections • Atypical pneumonia • Sexually transmitted infections