Abnormal Development - Bacterial Infection
|Embryology - 21 Mar 2019 Expand to Translate|
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|Educational Use Only - Embryology is an educational resource for learning concepts in embryological development, no clinical information is provided and content should not be used for any other purpose.|
- 1 Introduction
- 2 Some Recent Findings
- 3 Neisseria Gonorrhea
- 4 Listeria Monocytogenes
- 5 Lyme Disease
- 6 Mycoplasma
- 7 Syphilis
- 8 Mycobacterium Tuberculosis
- 9 Melioidosis
- 10 Bacterial Meningitis
- 11 Pertussis
- 12 Salmonella
- 13 Staphylococcus aureus
- 14 Cholera
- 15 Chlamydia
- 16 Bacterial Vaginosis
- 17 Gram Stain
- 18 Antibiotics
- 19 Australian NHMRC Recommendations
- 20 References
- 21 External Links
- 22 Glossary Links
The variety of bacterial infections that can occur during pregnancy is as variable as the potential developmental effects, from virtually insignificant to major developmental, abortive or fatal in outcome. Some bacteria are common and are part of the normal genital tract flora (Lactobacillus sp), while other bacterial infections are less common or even rare and initially infect/transmit by air or fluids through the different epithelia (genital tract, lungs, gastrointestinal tract).
Note that some infections may have historic or alternative common names, for example Pertussis "whooping cough".
Maternal uterine tubal damage by bacterial infection (Chlamydia trachomatis) can also lead to Ectopic Implantation.
Many common pregnancy related bacterial infections, such as maternal urinary tract infection (UTI), are safely treated with antibiotics that can also cross the placenta. Most antibiotics have good data available on their teratogenic and toxic risks, while some antibiotics have limited data available. This should also be considered postnatally, with transfer from mother to infant through lactation and breast milk. Note that pregnant and breastfeeding women are generally excluded from drug clinical trials and most data comes from animal studies.
|Bacterial Links: bacterial infection | syphilis | gonorrhea | tuberculosis | listeria | salmonella | TORCH | Environmental | Category:Bacteria|
Some Recent Findings
|More recent papers|
This table allows an automated computer search of the external PubMed database using the listed "Search term" text link.
<pubmed limit=5>Bacterial Teratogen</pubmed>
|The gram-negative bacterium Neisseria gonorrhoeae causes the disease Gonorrhea which is a sexually transmitted disease (STD). Maternal infection increases the risk of premature birth and ophthalmia neonatorum (infantile purulent conjunctivitis).
A recent paper has described in the rat mother to the fetus during pregnancy, suggesting this as a model for human transmission.
The bacterium Listeria monocytogenes is the pathogenic form of the 7 listeria species. Infection is generally through ingestion of organisms in contaminated food. Maternal symptoms may be mild, fetal effects can range from insignificant through to major abnormalities. Maternal treatment relates to potential developmental effects. Pregnancy greatly increases the risk of listeriosis, with pregnant women about 60% of all cases (male and female) aged 10 to 40 years. Similar effects are seem in other mammalian species. and the Guinea pig placenta listeria model Generalized suppression of immunity during pregnancy is suggest to have a role in susceptibility, though recent results in a mouse model suggest that susceptibility can occur very early in a pregnancy and may relate to enteric carriage rate.
- ingestion of contaminated food
- colonization of the intestine
- intestinal translocation
- replication in the liver and spleen
- either the resolution of infection or spread to other organs resulting in a systemic infection
The bacterium spirochete Borrelia Burgdorferi causes Lyme disease. Infection can be through the blood by tick bite.
- Links: CDC (USA) - Lyme Disease
Mycoplasmas come in many different varieties, occur as part of the normal human flora, and lack a bacterial cell wall. Infection is generally through the female genital tract.
- Links: NCBI Bookshelf Medical Microbiology - Mycoplasma | CDC Mycoplasmas: Sophisticated, Reemerging, and Burdened by Their Notoriety
BCG vaccination is not recommended for general use in the Australian population.
BCG is recommended for:
- Aboriginal neonates in areas of high incidence of TB (e.g. Northern Territory, Far North Queensland, northern areas of Western Australia and South Australia)
- neonates and children 5 years and under who will be travelling or living in countries or areas with a high prevalence of TB for extended periods
- neonates born to parents with leprosy or a family history of leprosy
In addition to these recommendations BCG may be considered in the following:
- Children over 5 years who will be travelling or living in countries or areas with a high prevalence of TB for extended periods
- Health care workers (HCWs) who may be at high risk of exposure to drug resistant cases.
(Text Source: Communicable Diseases Intelligence Volume 30 Number 1, March 2006 - The BCG vaccine: information and recommendations for use in Australia)
(Greek, melis = distemper of asses, oeidēs, resemblance, and osis, a suffix indicating an abnormal condition or disease. The bacteria Burkholderia pseudomallei is normally found in soil surface layers and in muddy surface waters.
- 1912 - Alfred Whitmore, a British pathologist serving in Burma, and his assistant C. S. Krishnaswami first described melioidosis. The infection became known as Whitmore’s disease.
- 1925 - Ambrose T. Stanton and William Fletcher identified Burkholderia pseudomallei as the infection’s causative agent, renamed the infection melioidosis because of its clinical resemblance to glanders. Glanders is an infectious disease that is caused by another bacterium Burkholderia mallei.
The bacterium Neisseria meningitidis or Haemophilus influenzae type B (Hib) can cause the disease bacterial meningitis.
Hib immunization for infants and children are generally recommended.
Recently a universal vaccine for serogroup B meningococcus has been developed (See meningococcal vaccine 2001)
The bacterium Bordetella pertussis can cause the disease Pertussis (Whooping Cough) can lead to infant mortality.
May 2005 - First Combination Vaccine Approved to Help Protect Adolescents Against Whooping Cough USA Food and Drug Administration has approved booster immunization against pertussis (whooping cough) in combination with tetanus and diphtheria for adolescents. Pertussis is a highly contagious bacterial disease. (FDA 03 May 2005)
Links: CDC (USA) - Pertussis | Medline Plus - Pertussis | Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children Recommendations of the Advisory Committee on Immunization Practices (ACIP) |
Salmonellosis is the infection caused bacterial genus Salmonella, these are mainly associated with foodborne transmission from contaminated animal–derived meat and dairy products. Though infection can also occur after handling pets, particularly reptiles like snakes, turtles and lizards.
Staphylococcus aureus a gram-positive bacterium commonly present (25% of healthy people and animals) on the skin and nasal surfaces, no vaccines are available. Staphylococcus aureus bacteraemia (SAB), commonly known as ‘golden staph’ and has risk factors including injectable drug use, haemodialysis, indwelling vascular catheters and immunosuppression. Strains of this bacteria can produce toxins related to food poisoning and be resistant to various antibiotics.
Methicillin-resistant Staphylococcus aureus (MRSA) bacteria are resistant to various antibiotics including Methicillin, there are other strains which are resistant to specific antibiotics (vancomycin).
About 2% of Staphylococcus aureus produce a toxin Panton-Valentine leucocidin (PVL) which can be fatal in neonates.
- Links: CDC (USA) - Staphylococcus | CDC (USA) - emerging infectious diseases | Medline Plus - Staph aureus food poisoning | Medical Microbiology - Staphylococcus
Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae. The cholera bacterium is usually found in water or food contaminated by faeces and the incubation period ranges from less than one day to five days. The bacteria produces an enterotoxin that causes a watery diarrhoea, leading to severe dehydration and death if treatment is not promptly given. Vomiting also occurs in most patients. Outbreaks are generally associated with poor sanitation and water supply. Recent outbreaks have been identified in Haiti and Mexico.
[[File:Female_genital_tract_chlamydia_trachomatis_infection_02.jpg|thumb|Chlamydia trachomatis developmental cycle
A genus of bacteria commonly as a sexually transmitted disease. Chlamydia trachomatis is a a gram-negative bacterium associated with uterine tube damage and infections are a risk factor for ectopic implantation. An infected mother can during childbirth also pass chlamydia to the neonate.
Female genital tract chlamydia trachomatis infection
|Originally called Chlamydia psittaci A Chlamydiae species (C. abortus) gram-negative bacteria associated with genital tract infections that causes abortion (chlamydiosis in pregnancy) and fetal death in mammals, including humans, and a major cause of fetal loss in sheep (ovine enzootic abortion) and cattle.
Chlamydia life cycle
Infection begins with the attachment of the elementary bodies (EB) to the surface of target epithelial cells. These cells promote a pseudopod formation to engulf the EB. Inside the cytoplasm this bacterium inhibits the fusion of the vesicle with the cell lysosomes. The nascent inclusion is accompanied by the transition from EBs to reticulate bodies (RB). Late in the cycle, RBs replicate by binary fission to generate both RBs and intermediate bodies (IB). At this stage, antigenic proteins are exposed into the cell surface. An elongated, aberrant RB could be formed at this time with an arrest on chlamydia cycle originating a persistent infection, or continuing the cycle. The various intracytoplasmic inclusions with bacterium inside, can also be fused in this phase, and the agent develop into intermediate bodies (IB), before DNA condensation and RB transformation into a newly EB. The mature inclusion increases in size with EB formation, until becoming infectious and released into the extracellular space to continue a new intracellular cycle.
N – nucleus; G – Golgi apparatus: EB – elementary bodies; RB – reticulate bodies; IB – intermediate bodies. (modified text from figure legend)
- Links: Ectopic Implantation
- Bacterial vaginosis imbalance of the normal vaginal flora (more anaerobic bacteria and less normal gram-positive bacteria Lactobacillus sp).
- Maternal infection is associated with a variety of pregnancy abnormalities including preterm birth and poor perinatal outcome.
- Smear Image Links: L. crispatus | L. crispatus | non-L. crispatus with thin lactobacilli | non-L. crispatus with thin lactobacilli | mixture non-L. crispatus with L. crispatus | mixture non-L. crispatus with L. crispatus | irregular-shaped Gram positive rod | irregular-shaped Gram positive rod | mixture Lactobacillus and bacterial vaginosis-associated | mixture Lactobacillus and bacterial vaginosis-associated | bacterial vaginosis | bacterial vaginosis
- Links: Menstrual Cycle - Histology | Histology - Gram Stain | Bacterial Vaginosis | CDC (USA) Fact Sheet - Bacterial Vaginosis
Bacterial staining procedure named after Hans Christian Gram (1853 - 1938). Generally divides bacteria into either:
- Gram-positive bacteria - purple crystal violet stain is trapped by layer of peptidoglycan (forms outer layer of the cell).
- Gram-negative bacteria - outer membrane prevents stain from reaching peptidoglycan layer in the periplasm, outer membrane then permeabilized and pink safranin counterstain is trapped by peptidoglycan layer.
Many common pregnancy related bacterial infections, such as maternal urinary tract infection (UTI), are safely treated with antibiotics that can also cross the placenta. Most antibiotics have good data available on their teratogenic and toxic risks, while some antibiotics have limited data available. Teratogenic potential below is based upon the availability of published data from a 2006 literature study.
- none - penicillin G and VK
- unlikely - amoxicillin, chloramphenicol, ciprofloxacin, doxycycline, levofloxacin, and rifampin
- undetermined - clindamycin, gentamicin, and vancomycin
Assessments were based on "good data" (penicillin G and VK), "fair data" (amoxicillin, chloramphenicol, ciprofloxacin, doxycycline, levofloxacin, and rifampin), "limited data" (clindamycin and gentamicin), and "very limited data" (vancomycin).
Antibiotic use should also be considered postnatally, with transfer from mother to infant through lactation and breast milk. There has also been recent public concern about the persistence of antibiotics in animals used for human food production, with very little teratogenic data available for this concept.
Note that pregnant and breastfeeding women are generally excluded from drug clinical trials and most data comes from animal studies.
Australian NHMRC Recommendations
The Australian NHMRC (1988) recommends neonates be assessed for follow-up care under the following conditions.
- Birthweight less than 1500g or gestational age less than 32 weeks
- Small-for-gestational-age neonates
- Perinatal asphyxia
- Apgar score less than 3 at 5 minutes
- clinical evidence of neurological dysfunction
- delay in onset of spontaneous respiration for more than 5 minutes and requiring mechanical ventilation
- Clinical evidence of central nervous system abnormalities ie., seizures, hypotonia
- Hyperbilirubinaemia of greater than 350umol/l in full term neonates
- Genetic, dysmorphic or metabolic disorders or a family history of serious genetic disorder
- Perinatal or serious neonatal infection including children of mothers who are HIV positive
- Psychosocial problems eg., infants of drug-addicted or alcoholic mothers.
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- Illamola SM, Bucci-Rechtweg C, Costantine MM, Tsilou E, Sherwin CM & Zajicek A. (2018). Inclusion of pregnant and breastfeeding women in research - efforts and initiatives. Br J Clin Pharmacol , 84, 215-222. PMID: 28925019 DOI.
- McHugh L, Marshall HS, Perrett KP, Nolan T, Wood N, Lambert SB, Richmond P, Ware RS, Binks P, Binks MJ & Andrews RM. (2019). The Safety of Influenza and Pertussis Vaccination in Pregnancy in a Cohort of Australian Mother-Infant Pairs, 2012-2015: The FluMum Study. Clin. Infect. Dis. , 68, 402-408. PMID: 30475988 DOI.
- Fricke EM, Elgin TG, Gong H, Reese J, Gibson-Corley KN, Weiss RM, Zimmerman K, Bowdler NC, Kalantera KM, Mills DA, Underwood MA & McElroy SJ. (2018). Lipopolysaccharide-induced maternal inflammation induces direct placental injury without alteration in placental blood flow and induces a secondary fetal intestinal injury that persists into adulthood. Am. J. Reprod. Immunol. , 79, e12816. PMID: 29369434 DOI.
- Jana N, Barik S & Arora N. (2011). Tuberculosis in pregnancy--a major maternal and perinatal challenge. BJOG , 118, 1145-6; author reply 1146. PMID: 21749618 DOI.
- Knight M, Kurinczuk JJ, Nelson-Piercy C, Spark P & Brocklehurst P. (2009). Tuberculosis in pregnancy in the UK. BJOG , 116, 584-8. PMID: 19250368 DOI.
- Giuliani MM, Adu-Bobie J, Comanducci M, Aricò B, Savino S, Santini L, Brunelli B, Bambini S, Biolchi A, Capecchi B, Cartocci E, Ciucchi L, Di Marcello F, Ferlicca F, Galli B, Luzzi E, Masignani V, Serruto D, Veggi D, Contorni M, Morandi M, Bartalesi A, Cinotti V, Mannucci D, Titta F, Ovidi E, Welsch JA, Granoff D, Rappuoli R & Pizza M. (2006). A universal vaccine for serogroup B meningococcus. Proc. Natl. Acad. Sci. U.S.A. , 103, 10834-9. PMID: 16825336 DOI.
- Colombo DF, Lew JL, Pedersen CA, Johnson JR & Fan-Havard P. (2006). Optimal timing of ampicillin administration to pregnant women for establishing bactericidal levels in the prophylaxis of Group B Streptococcus. Am. J. Obstet. Gynecol. , 194, 466-70. PMID: 16458647 DOI.
- Nowicki S, Selvarangan R & Anderson G. (1999). Experimental transmission of Neisseria gonorrhoeae from pregnant rat to fetus. Infect. Immun. , 67, 4974-6. PMID: 10456962
- Suyemoto MM, Spears PA, Hamrick TS, Barnes JA, Havell EA & Orndorff PE. (2010). Factors associated with the acquisition and severity of gestational listeriosis. PLoS ONE , 5, e13000. PMID: 20885996 DOI.
- Bakardjiev AI, Stacy BA & Portnoy DA. (2005). Growth of Listeria monocytogenes in the guinea pig placenta and role of cell-to-cell spread in fetal infection. J. Infect. Dis. , 191, 1889-97. PMID: 15871123 DOI.
- Morley SL, Cole MJ, Ison CA, Camaraza MA, Sotolongo F, Anwar N, Cuevas I, Carbonero M, Campa HC, Sierra G & Levin M. (2001). Immunogenicity of a serogroup B meningococcal vaccine against multiple Neisseria meningitidis strains in infants. Pediatr. Infect. Dis. J. , 20, 1054-61. PMID: 11734711
- Mitchell DH & Howden BP. (2005). Diagnosis and management of Staphylococcus aureus bacteraemia. Intern Med J , 35 Suppl 2, S17-24. PMID: 16271058 DOI.
- Brunham RC & Rey-Ladino J. (2005). Immunology of Chlamydia infection: implications for a Chlamydia trachomatis vaccine. Nat. Rev. Immunol. , 5, 149-61. PMID: 15688042 DOI.
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Guerra B, Ghi T, Quarta S, Morselli-Labate AM, Lazzarotto T, Pilu G & Rizzo N. (2006). Pregnancy outcome after early detection of bacterial vaginosis. Eur. J. Obstet. Gynecol. Reprod. Biol. , 128, 40-5. PMID: 16460868 DOI.
Giuliani MM, Adu-Bobie J, Comanducci M, Aricò B, Savino S, Santini L, Brunelli B, Bambini S, Biolchi A, Capecchi B, Cartocci E, Ciucchi L, Di Marcello F, Ferlicca F, Galli B, Luzzi E, Masignani V, Serruto D, Veggi D, Contorni M, Morandi M, Bartalesi A, Cinotti V, Mannucci D, Titta F, Ovidi E, Welsch JA, Granoff D, Rappuoli R & Pizza M. (2006). A universal vaccine for serogroup B meningococcus. Proc. Natl. Acad. Sci. U.S.A. , 103, 10834-9. PMID: 16825336 DOI.
Colombo DF, Lew JL, Pedersen CA, Johnson JR & Fan-Havard P. (2006). Optimal timing of ampicillin administration to pregnant women for establishing bactericidal levels in the prophylaxis of Group B Streptococcus. Am. J. Obstet. Gynecol. , 194, 466-70. PMID: 16458647 DOI.
Goffinet F, Maillard F, Mihoubi N, Kayem G, Papiernik E, Cabrol D & Paul G. (2003). Bacterial vaginosis: prevalence and predictive value for premature delivery and neonatal infection in women with preterm labour and intact membranes. Eur. J. Obstet. Gynecol. Reprod. Biol. , 108, 146-51. PMID: 12781402
Morley SL, Cole MJ, Ison CA, Camaraza MA, Sotolongo F, Anwar N, Cuevas I, Carbonero M, Campa HC, Sierra G & Levin M. (2001). Immunogenicity of a serogroup B meningococcal vaccine against multiple Neisseria meningitidis strains in infants. Pediatr. Infect. Dis. J. , 20, 1054-61. PMID: 11734711
Nowicki S, Selvarangan R & Anderson G. (1999). Experimental transmission of Neisseria gonorrhoeae from pregnant rat to fetus. Infect. Immun. , 67, 4974-6. PMID: 10456962
- Approved Lists of Bacterial Names Edited by VBD Skerman, Vicki McGowan, and PHA Sneath. Washington (DC): ASM Press; 1989. ISBN-13: 978-1-55581-014-6 http://www.ncbi.nlm.nih.gov/books/NBK814 PMID 20806452
- Search Jan2006 "bacterial infection" 547,445 reference articles of which 45,020 were reviews.
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- Royal College of Obstetricians and Gynaecologists (UK) Infection and Pregnancy - study group recommendations (Jun 2001)
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Cite this page: Hill, M.A. (2019, March 21) Embryology Abnormal Development - Bacterial Infection. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Bacterial_Infection
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