Severe systemic candidiasis following immunomodulation therapy in in vitro fertilisation-embryo transfer (IVF-ET)

Akhanoba, Folasade; MacDougall, Jane; Mathur, Raj; Hassan, Wassim A.

doi:10.1136/bcr-2013-203202

Cited by 15 publications

(12 citation statements)

References 23 publications

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“…of Health) can blockade Fc receptors on other immune cells, alter cytokine production and neutralize complement components, thereby possibly interfering with maternal immune defence mechanisms to pathogens. A salutary report describes a case of systemic candidiasis presenting at 18 weeks gestation resulting in fetal loss following administration of TNFα inhibitor, prednisolone and Intralipid during assisted reproduction ( Akhanoba, 2014 ). Around 40% of IVIg users will experience mild adverse events, and in serious cases can suffer from anaphylaxis ( Berger, 2013 ).…”

Section: Range Of ‘Immune’ Treatmentsmentioning

confidence: 99%

First do no harm: uterine natural killer (NK) cells in assisted reproduction

2015

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Natural killer (NK) cells are a type of lymphocyte circulating in peripheral blood named because of their effector functions in killing target cells. Immune cells that share similar phenotypic characteristics but are poor killers populate the uterine lining at implantation and during early pregnancy when the placenta is established. The functions of these uterine NK (uNK) cells are essentially unknown but available data point to a role in regulating placentation in concert with other elements of the decidua and invading trophoblast cells. Despite the lack of scientific rationale and advice from clinical governing bodies, such as the Human Fertilisation and Embryology Authority, an increasing range of tests and therapies are still offered to women undergoing IVF or attending recurrent miscarriage clinics based on the myth that uterine NK cells need suppressing to prevent damage to the embryo. New treatments can be introduced at whim with subsequent demands for expensive trials to prove/disprove their efficacy. The evidence that targeting uNK or peripheral blood NK cells assists women with recurrent pregnancy failure is lacking. Healthcare professionals and patients should very carefully evaluate the practice of immunomodulation to enhance pregnancy outcome. A discussion on how to move towards stricter regulation of immunotherapy in non-hospital settings is now needed because it is clear that the potential risks and costs of these therapies outweigh any benefits.

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Section: Range Of ‘Immune’ Treatmentsmentioning

confidence: 99%

First do no harm: uterine natural killer (NK) cells in assisted reproduction

2015

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“…The advantages of amphotericin B include that it crosses the placenta, has no reported adverse effects in humans [ 97 ], and is generally effective against C. glabrata . One case report showed that intravenous amphotericin B treatment resulted in pregnancy extension by 4 weeks and the delivery of live infants with no signs of inflammatory changes in the placenta or umbilical cord [ 89 ], although three other cases resulted in stillbirth [ 76 , 87 , 88 ]. Micafungin was used in one case, although its efficacy and safety in pregnant women are unclear, and whether it crosses the placenta remains unknown.…”

Section: Discussionmentioning

confidence: 99%

CandidaChorioamnionitis Leads to Preterm Birth and Adverse Fetal-Neonatal Outcome

Maki

Fujisaki

Sato

et al. 2017

Infectious Diseases in Obstetrics and Gynecology

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Candida chorioamnionitis is rare but can lead to neonatal infection, high mortality, and neurodevelopmental impairment. We aimed to investigate maternal clinical features and perinatal outcomes and discuss future management strategies. We reviewed the medical records of women with Candida chorioamnionitis at our hospital over a 10-year period (n = 9) and previous published case reports and case series. The most prevalent Candida species was C. albicans (71.3% of the all cases). The most prevalent predisposing condition was preterm premature rupture of membranes (31/123, 25.2%), followed by pregnancy with a retained intrauterine contraceptive device (26/123, 21.1%) and pregnancy after in vitro fertilization (25/123, 20.3%). Preterm labor was the most common symptom (52/123, 42.3%), and only 13% of cases involved fever. Of the infants, 27% of the singletons and 23.8% of the twins were born before 22 gestational weeks, while 60% of the singletons and 76.2% of the twins were born at 22–36 weeks. The median birth weight of the babies born after 22 weeks was 1230 g. The mortality rates of the singletons and twins born after 22 weeks of gestation in the year 2000 or later were 28.6% and 52.4%, respectively. Antenatal treatment for Candida chorioamnionitis has not been established.

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“…In developed countries, well-known risk factors for sepsis are prolonged rupture of membranes, retained placenta or conception products, preterm labour, history of pelvic or other infection, interventions like cerclage or multiple vaginal examinations, diabetes, and anaemia (50,51). Maternal age over 35 years (52) and assisted reproductive techniques (53,54) can also increase risk of sepsis-related morbidity (17). Obesity, defined as a body mass index (BMI) > 30, is as well an established risk factor for surgical-site and nosocomial infections; it seems to negatively influence pregnancy-related outcome and to have substantial effects on immune surveillance (55,56).…”

Section: Risk Factors For Maternal Sepsismentioning

confidence: 99%

Maternal sepsis: a comprehensive review from definition to treatment

et al. 2020

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Maternal mortality is a worldwide alarming concern, and sepsis is the third most frequent cause for its occurrence. Pregnancy and the postpartum period are an intrinsically vulnerable period during women's life, which may make the mothers more susceptible to develop sepsis, due to the physiological and immunological changes that regulate host capacity to counteract pathogens infection, such as bacteria, viruses, fungi, and protozoa. The physiological adaptations of pregnancy could additionally mask signs and symptoms of infection and limit the sensitivity and specificity of the available scores. On this basis, the obstetric-modified quick SOFA and the Modified Early Warning System were proposed to overcome these issues. Early recognition and treatment are vital to prevent mortality. Nevertheless, the evidence guiding the current management of maternal sepsis are derived from the general population and do not take into account the physiological changes of pregnancy. In pregnant women early fluid resuscitation should be carefully addressed, and the management of the source of infection may require expedite delivery, making the management of sepsis particularly challenging during gestation. Further studies are needed to establish pregnancy-related diagnostic criteria and therapeutic protocols for sepsis and septic shock in the obstetrical population.

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Severe systemic candidiasis following immunomodulation therapy in in vitro fertilisation-embryo transfer (IVF-ET)

Cited by 15 publications

References 23 publications

First do no harm: uterine natural killer (NK) cells in assisted reproduction

First do no harm: uterine natural killer (NK) cells in assisted reproduction

CandidaChorioamnionitis Leads to Preterm Birth and Adverse Fetal-Neonatal Outcome

Maternal sepsis: a comprehensive review from definition to treatment

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