Leptotrichia amnionii, an Emerging Pathogen of the Female Urogenital Tract

Abstract

Leptotrichia amnionii, a recently described, very fastidious, gram-negative anaerobic bacterium, is an opportunistic pathogen of the female urogenital tract. We report a case of second-trimester abortion in a patient with chorioamnionitis and L. amnionii bacteremia and a case of renal abscess in a female 5 weeks postpartum. CASE REPORTS Case 1.A 33-year-old, previously healthy female presented in the second trimester of pregnancy with a 2-to 3-day history of vaginal bleeding, lower back pain, fatigue, and fever. On admission, her blood pressure was 95/50, her pulse was 80/min, and her temperature was 39.6°C. Abdominal examination revealed tenderness in the lower right and left quadrants on palpation. There was no guarding or rebound tenderness. There was no vaginal discharge. Ultrasound examination showed a viable normal fetus of approximately 13 weeks gestation. Initial laboratory values showed a normal white blood cell count and differential, a hemoglobin level of 11.1 g/dl, and a C-reactive protein level (CRP) of 88 mg/liter. Urinalysis results were positive for nitrites, ketones, leukocytes, and blood. Urosepsis was suspected. Three sets of blood cultures from peripheral veins (BACTEC Plus aerobic/F and anaerobic/F culture vials) and a urine sample for culture were obtained prior to initiating treatment with intravenous mecillinam (an amidinopenicillin). On the second day of admission, an ultrasound of the urinary tract was reported as normal, urine culture yielded no significant bacterial growth, and the CRP peaked at 178 mg/liter. Gram-negative bacteria were detected in the blood cultures. Chorioamnionitis was suspected. The antibiotic regimen was changed to cefotaxime and metronidazole, after which the patient became afebrile and the CRP fell to 42 mg/liter. The episodes of vaginal bleeding continued, however, and a spontaneous abortion occurred on day 9. Curettage was performed. None of the products were sent for culture, but chorioamnionitis was diagnosed on the basis of the histopathology of the placenta. The patient was discharged from the hospital 2 days later on amoxicillin therapy and made a full recovery. She delivered a healthy baby 1 year later after an uncomplicated pregnancy.Microbiological findings. Two anaerobic and two aerobic BACTEC Plus blood culture vials were flagged as positive after 2 and 3 days, respectively, of incubation. Gram staining showed gram-negative/gram-variable pleomorphic rods and coccobacilli. After 48 to 72 h of incubation of the chocolate agar plates under anaerobic conditions, gray convex colonies of less than 1 mm in size were seen. In comparison, there was less growth on the anaerobic blood agar plates. Under aerobic conditions (37°C, 5% CO 2 ), growth was detected on chocolate agar plates only after 48 to 72 h of incubation. Catalase and indole spot tests were negative. The isolate was sensitive to kanamycin, brilliant green, and oxgall (Diatabs; Rosco). Antimicrobial susceptibility was determined by Etest (AB Biodisk, Solna, Sweden) on Isosensitest chocolate agar ...

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“…We also noticed that there was a serious increase of the abundance of Leptotrichia in VD group. The Leptotrichia, which was a member of the phylum Fusobacteria (Leptotrichia amnionii, an emerging pathogen of the female urogenital tract), could be found in the mouth, intestinal tract, and genitalia, and caused gingivitis, periodontitis, abscesses, endocarditis, chorioamnionitis and arthritis, especially in immunocompromised patients [6,25]. Recently, it was reported that Fusobacterium nucleatum may play a vital role in the pathogenesis of various diseases of the gut, such as adverse pregnancy outcomes [8,9] and colon cancer [11,19].…”

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