title: Transabdominal collection of amniotic fluid "sludge" and identification of Candida albicans intra-amniotic infection.
abstract: A G3P2 patient who conceived while using an intrauterine contraceptive device (IUD) presented at 20 weeks of gestation with mild irregular uterine contractions and vaginal bleeding. Sonographic examination at admission showed the presence of dense amniotic fluid "sludge" and a long sonographic uterine cervix (42 mm). To assess the microbiologic significance of amniotic fluid "sludge", we performed a transabdominal amniocentesis. The procedure was performed under real-time ultrasound, and fluid resembling pus at gross examination was noted. Rapid amniotic fluid analysis showed the presence of a high white blood cell count and structures resembling hyphae. Amniotic fluid cultures were positive for Candida albicans. Treatment was begun with broad-spectrum antibiotics, including Fluconazole, upon the visualization of pus in the "sludge" material because of the presence of hyphae in the Gram stain. Despite treatment, the patient went into spontaneous preterm labor and delivered five days after admission. Placental examination revealed acute fungal histologic chorioamnionitis and funisitis. This represents the first report of transabdominal collection and analysis of amniotic fluid "sludge" and the microbiologic detection of Candida albicans in this material. This report provides evidence that transabdominal retrieval of "sludge" is possible and may be of significant value for patient management and selection of antimicrobial agents.
authors.affiliation: a Department of Obstetrics and Gynecology, Sótero del Río Hospital , Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF) , Santiago , Chile.|b Division of Obstetrics and Gynecology, Faculty of Medicine , Pontificia Universidad Católica de Chile , Santiago , Chile.|c Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research , Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit , MI , USA.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Kusanovic
authors.affiliation: c Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research , Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit , MI , USA.|d Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA.|e Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA.|f Department of Molecular Obstetrics and Genetics , Wayne State University , Detroit , MI , USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.affiliation: a Department of Obstetrics and Gynecology, Sótero del Río Hospital , Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF) , Santiago , Chile.
authors.forename: Carolina
authors.initials: C
authors.lastname: Martinovic
authors.affiliation: a Department of Obstetrics and Gynecology, Sótero del Río Hospital , Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF) , Santiago , Chile.
authors.forename: Karla
authors.initials: K
authors.lastname: Silva
authors.affiliation: c Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research , Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit , MI , USA.|g Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA.
authors.forename: Offer
authors.initials: O
authors.lastname: Erez
authors.affiliation: c Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research , Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit , MI , USA.|g Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA.
authors.forename: Eli
authors.initials: E
authors.lastname: Maymon
authors.affiliation: a Department of Obstetrics and Gynecology, Sótero del Río Hospital , Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF) , Santiago , Chile.
authors.forename: Francisco
authors.initials: F
authors.lastname: Díaz
authors.affiliation: a Department of Obstetrics and Gynecology, Sótero del Río Hospital , Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF) , Santiago , Chile.|b Division of Obstetrics and Gynecology, Faculty of Medicine , Pontificia Universidad Católica de Chile , Santiago , Chile.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ferrer
authors.affiliation: a Department of Obstetrics and Gynecology, Sótero del Río Hospital , Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF) , Santiago , Chile.
authors.forename: Rafael
authors.initials: R
authors.lastname: Valdés
authors.affiliation: a Department of Obstetrics and Gynecology, Sótero del Río Hospital , Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF) , Santiago , Chile.
authors.forename: Víctor
authors.initials: V
authors.lastname: Córdova
authors.affiliation: a Department of Obstetrics and Gynecology, Sótero del Río Hospital , Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF) , Santiago , Chile.|b Division of Obstetrics and Gynecology, Faculty of Medicine , Pontificia Universidad Católica de Chile , Santiago , Chile.
authors.forename: Paula
authors.initials: P
authors.lastname: Vargas
authors.affiliation: a Department of Obstetrics and Gynecology, Sótero del Río Hospital , Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF) , Santiago , Chile.
authors.forename: María Elena
authors.initials: ME
authors.lastname: Nilo
authors.affiliation: h Department of Pathology , Sótero del Río Hospital , Santiago , Chile.
authors.forename: Patricio
authors.initials: P
authors.lastname: Le Cerf
mesh_terms: D000328:Adult; D000649:Amniocentesis; D000653:Amniotic Fluid / Q000737:chemistry / Q000000981:diagnostic imaging / Q000382:microbiology*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy*; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000473:pathology; D002821:Chorioamnionitis / Q000175:diagnosis; D005260:Female; D005313:Fetal Death / Q000209:etiology; D015725:Fluconazole / Q000627:therapeutic use*; D005865:Gestational Age; D006801:Humans; D025301:Hyphae / Q000302:isolation & purification; D007434:Intrauterine Devices; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D016216:Ultrasonography, Prenatal
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole
keywords: Amniocentesis; biofilms; chorioamnionitis; funisitis; intra-amniotic infection/inflammation; intrauterine contraceptive device; microbial invasion of the amniotic cavity; preterm prelabor rupture of the membranes; spontaneous preterm labor; transvaginal ultrasound