Detection of a microbial biofilm in intraamniotic infection

Objective Microbial biofilms are communities of sessile microorganisms formed by cells that are attached irreversibly to a substratum or interface or to each other and embedded in a hydrated matrix of extracellular polymeric substances. Microbial biofilms have been implicated in >80% of human inf...

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Bibliographic Details
Published in:	American journal of obstetrics and gynecology 2008, Vol.198 (1), p.135.e1-135.e5
Main Authors:	Romero, Roberto, MD, Schaudinn, Christoph, MSc, Kusanovic, Juan Pedro, MD, Gorur, Amita, MSc, Gotsch, Francesca, MD, Webster, Paul, PhD, Nhan-Chang, Chia-Ling, MD, Erez, Offer, MD, Kim, Chong Jai, MD, Espinoza, Jimmy, MD, Gonçalves, Luis F., MD, Vaisbuch, Edi, MD, Mazaki-Tovi, Shali, MD, Hassan, Sonia S., MD, Costerton, J. William, PhD
Format:	Article
Language:	eng
Subjects:	Amniocentesis Amniotic Fluid - microbiology amniotic fluid sludge Aspergillus flavus - physiology Biofilms Biological and medical sciences Chorioamnionitis - diagnosis Chorioamnionitis - microbiology clinical chorioamnionitis Cohort Studies Female Gynecology. Andrology. Obstetrics Humans In Situ Hybridization, Fluorescence intraamniotic infection Medical sciences microbial invasion of the amniotic cavity Microscopy, Electron, Scanning Mycoplasma hominis - physiology Obstetrics and Gynecology Pregnancy Pregnancy Complications, Infectious - diagnostic imaging Pregnancy Complications, Infectious - microbiology Pregnancy Outcome Pregnancy Trimester, Second preterm labor Risk Assessment Sensitivity and Specificity Streptococcus mutans - physiology Ultrasonography, Prenatal
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Summary:	Objective Microbial biofilms are communities of sessile microorganisms formed by cells that are attached irreversibly to a substratum or interface or to each other and embedded in a hydrated matrix of extracellular polymeric substances. Microbial biofilms have been implicated in >80% of human infections such as periodontitis, urethritis, endocarditis, and device-associated infections. Thus far, intraamniotic infection has been attributed to planktonic (free-floating) bacteria. A case is presented in which “amniotic fluid sludge” was found to contain microbial biofilms. This represents the first report of a microbial biofilm in the amniotic cavity. Study Design “Amniotic fluid sludge” was detected by transvaginal sonography and retrieved by transvaginal amniotomy. Bacteria were identified with scanning electron microscopy and fluorescence in situ hybridization for conserved regions of the microbial genome; the exopolymeric matrix was identified by histochemistry by the wheat germ agglutinin lectin method. The structure of the biofilm was imaged with confocal laser scanning microscopy. Results “Amniotic fluid sludge” was imaged with scanning electron microscopy, which allowed the identification of bacteria embedded in an amorphous material and inflammatory cells. Bacteria were demonstrated with fluorescent in situ hybridization using a eubacteria probe. Extracellular matrix was identified with the wheat germ agglutinin lectin stain. Confocal microscopy allowed 3-dimensional visualization of the microbial biofilm. Conclusion Microbial biofilms have been identified in a case of intraamniotic infection with “amniotic fluid sludge.”
ISSN:	0002-9378 1097-6868