title: Chorioamnionitis caused by Staphylococcus aureus with intact membranes in a term pregnancy: A case of maternal and fetal septic shock.
abstract: Chorioamnionitis is usually caused by migration of cervicovaginal flora through the cervical canal in women with ruptured membranes. Common causative pathogens are genital mycoplasmas, anaerobes, enteric gram-negative bacilli, and group B streptococcus. There have been only seven previous reports of chorioamnionitis due to Staphylococcus aureus and their clinical courses are characterized by rapid disease progression and poor prognosis. This case report describes a case of acute chorioamnionitis due to S. aureus, which was successfully managed with immediate cesarean section and postoperative intensive care. A 22-year-old woman presented at 39 weeks' gestation with a fever and acute lower abdominal pain. Fetal heart monitoring showed fetal distress. Immediate cesarean delivery was performed under general anesthesia. A male infant weighing 2450 g was born. He had Apgar scores of 3 and 7 at 1 and 5 min, respectively. He was immediately intubated and admitted to the neonatal intensive care unit. Maternal blood culture, vaginal culture, neonatal nares, and blood and gastric fluid culture all showed methicillin-sensitive S. aureus. Histopathology of the placenta demonstrated focal acute funisitis and acute chorioamnionitis. Interestingly, most of the patients in the previous reports developed chorioamnionitis due to S. aureus despite the presence of intact membranes, as in our case. Bacterial spread in the absence of membrane rupture and the presence of bacteremia suggests hematogenous, rather than ascending, etiology of S. aureus chorioamnionitis.
authors.affiliation: Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Fukuoka, Japan.
authors.forename: Sumire
authors.initials: S
authors.lastname: Sorano
authors.affiliation: Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Fukuoka, Japan. Electronic address: mgotoh2@aih-net.com.
authors.forename: Maki
authors.initials: M
authors.lastname: Goto
authors.affiliation: Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Fukuoka, Japan.
authors.forename: Sakiko
authors.initials: S
authors.lastname: Matsuoka
authors.affiliation: Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Fukuoka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tohyama
authors.affiliation: Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Fukuoka, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Fukuoka, Japan.
authors.forename: Sumie
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Fukuoka, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Fukami
authors.affiliation: Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Fukuoka, Japan.
authors.forename: Ryoei
authors.initials: R
authors.lastname: Matsuoka
authors.affiliation: Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Fukuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tsujioka
authors.affiliation: Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Fukuoka, Japan.
authors.forename: Fuyuki
authors.initials: F
authors.lastname: Eguchi
mesh_terms: D002585:Cesarean Section; D002821:Chorioamnionitis / Q000382:microbiology* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D003422:Critical Care; D005260:Female; D005315:Fetal Diseases / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010920:Placenta / Q000473:pathology; D011182:Postoperative Care; D011247:Pregnancy; D012772:Shock, Septic / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000473:pathology; D013211:Staphylococcus aureus; D055815:Young Adult
keywords: Chorioamnionitis; Intact membrane; Septic shock; Staphylococcus aureus