title: Intrauterine Tuberculosis Manifesting as Acute Chorioamnionitis: A Case Report and Review of the Literature.
abstract: Congenital tuberculosis involving the placenta is an infrequent diagnosis, and the typical features of tuberculous placentitis involve a granulomatous reaction, reflecting a delayed hypersensitivity immune response in the host. However, the first reaction of the placenta to organisms hematogenously transmitted from the maternal circulation typically involves the innate immune response, manifesting as an acute neutrophilic villitis or intervillositis or both. This acute pattern of response to mycobacteria has only been documented rarely. We present a case of acute mycobacterial infection occurring in a preterm female with 28-weeks gestation, who was delivered by cesarean section because of fetal distress and who was subsequently confirmed to have congenital tuberculosis. The placenta showed an acute chorioamnionitis associated with acid-fast bacilli consistent with Mycobacteria tuberculosis. The mother was found to have a necrotizing granulomatous deciduitis, and that was postulated to have resulted in the direct spread of mycobacteria to the amniotic cavity. Thus, our case extends the acute placental response to mycobacteria to include chorioamnionitis. Although extremely rare, mycobacteria should be considered in the differential diagnosis of infectious agents causing acute chorioamnionitis, especially in geographic areas where tuberculosis is more prevalent.
authors: 1 Department of Pathology, Faculty of Medicine, Chulalongkorn University, 1873 King Rama IV Street, Pathumwan, Bangkok 10330, Thailand.
authors: Mana
authors: M
authors: Taweevisit
authors: 2 Department of Anatomical Pathology, Queen Savang Vadhena Memorial Hospital, Thai Red Cross Society, 290 Si Racha District, Chon Buri 20110, Thailand.
authors: Charuwan
authors: C
authors: Nisagornsen
authors: 1 Department of Pathology, Faculty of Medicine, Chulalongkorn University, 1873 King Rama IV Street, Pathumwan, Bangkok 10330, Thailand.|3 Department of Pathology and Laboratory Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8, Canada.|4 University of Toronto, 27 King's College Circle, Toronto, ON M5G1X8, Canada.
authors: Paul Scott
authors: PS
authors: Thorner
mesh_terms: D000208:Acute Disease; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D002585:Cesarean Section; D002821:Chorioamnionitis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005865:Gestational Age; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D014384:Tuberculosis, Female Genital / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000635:transmission; D014591:Uterine Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: acute chorioamnionitis; innate immunity; placenta; tuberculosis