1887

Abstract

We present three cases of pre-term low-weight infants with suspected necrotizing enterocolitis (NEC) [one eventually recognized as a connatal cytomegalovirus (CMV) infection], microbiologically monitored using a molecular assay detecting bacterial and fungal DNA in blood. The detection of DNA from enteric pathogens in blood was interpreted as a sign of ongoing perforation, and represented a useful complement in the management of the presented cases. Moreover, these cases suggest the opportunity for larger future studies to assess the possible role of a molecular approach in the close monitoring of infants with suspected NEC or with other conditions at-risk for intestinal perforation.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.043067-0
2012-10-01
2020-01-21
Loading full text...

Full text loading...

/deliver/fulltext/jmm/61/10/1465.html?itemId=/content/journal/jmm/10.1099/jmm.0.043067-0&mimeType=html&fmt=ahah

References

  1. Brook I.. ( 2008;). Microbiology and management of neonatal necrotizing enterocolitis. . Am J Perinatol 25:, 111–118. [CrossRef][PubMed]
    [Google Scholar]
  2. Cheu H. W., Brown D. R., Rowe M. I.. ( 1989;). Breath hydrogen excretion as a screening test for the early diagnosis of necrotizing enterocolitis. . Am J Dis Child 143:, 156–159.[PubMed]
    [Google Scholar]
  3. Claud E. C., Walker W. A.. ( 2008;). Bacterial colonization, probiotics, and necrotizing enterocolitis. . J Clin Gastroenterol 42: (Suppl. 2), S46–S52. [CrossRef][PubMed]
    [Google Scholar]
  4. Cotten C. M., Taylor S., Stoll B., Goldberg R. N., Hansen N. I., Sánchez P. J., Ambalavanan N., Benjamin D. K. Jr.NICHD Neonatal Research Network ( 2009;). Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. . Pediatrics 123:, 58–66. [CrossRef][PubMed]
    [Google Scholar]
  5. De Marco D., Perotti M., Ossi C. M., Burioni R., Clementi M., Mancini N.. ( 2007;). Development and validation of a molecular method for the diagnosis of medically important fungal infections. . New Microbiol 30:, 308–312.[PubMed]
    [Google Scholar]
  6. Epelman M., Daneman A., Navarro O. M., Morag I., Moore A. M., Kim J. H., Faingold R., Taylor G., Gerstle J. T.. ( 2007;). Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. . Radiographics 27:, 285–305. [CrossRef][PubMed]
    [Google Scholar]
  7. Fitzgibbons S. C., Ching Y., Yu D., Carpenter J., Kenny M., Weldon C., Lillehei C., Valim C., Horbar J. D., Jaksic T.. ( 2009;). Mortality of necrotizing enterocolitis expressed by birth weight categories. . J Pediatr Surg 44:, 1072–1076. [CrossRef][PubMed]
    [Google Scholar]
  8. Gessler P., Bischoff G. A., Wiegand D., Essers B., Bossart W.. ( 2004;). Cytomegalovirus-associated necrotizing enterocolitis in a preterm twin after breastfeeding. . J Perinatol 24:, 124–126. [CrossRef][PubMed]
    [Google Scholar]
  9. Grave G. D., Nelson S. A., Walker W. A., Moss R. L., Dvorak B., Hamilton F. A., Higgins R., Raju T. N.. ( 2007;). New therapies and preventive approaches for necrotizing enterocolitis: report of a research planning workshop. . Pediatr Res 62:, 510–514. [CrossRef][PubMed]
    [Google Scholar]
  10. Guner Y. S., Chokshi N., Petrosyan M., Upperman J. S., Ford H. R., Grikscheit T. C.. ( 2008;). Necrotizing enterocolitis–bench to bedside: novel and emerging strategies. . Semin Pediatr Surg 17:, 255–265. [CrossRef][PubMed]
    [Google Scholar]
  11. Henry M. C., Moss R. L.. ( 2009;). Necrotizing enterocolitis. . Annu Rev Med 60:, 111–124. [CrossRef][PubMed]
    [Google Scholar]
  12. Horbar J. D., Badger G. J., Carpenter J. H., Fanaroff A. A., Kilpatrick S., LaCorte M., Phibbs R., Soll R. F..Members of the Vermont Oxford Network ( 2002;). Trends in mortality and morbidity for very low birth weight infants, 1991–1999. . Pediatrics 110:, 143–151. [CrossRef][PubMed]
    [Google Scholar]
  13. Hsueh W., Caplan M. S., Qu X. W., Tan X. D., De Plaen I. G., Gonzalez-Crussi F.. ( 2003;). Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts. . Pediatr Dev Pathol 6:, 6–23. [CrossRef][PubMed]
    [Google Scholar]
  14. Krediet T. G., van Lelyveld N., Vijlbrief D. C., Brouwers H. A. A., Kramer W. L. M., Fleer A., Gerards L. J.. ( 2003;). Microbiological factors associated with neonatal necrotizing enterocolitis: protective effect of early antibiotic treatment. . Acta Paediatr 92:, 1180–1182. [CrossRef][PubMed]
    [Google Scholar]
  15. Lehmann L. E., Hunfeld K. P., Emrich T., Haberhausen G., Wissing H., Hoeft A., Stüber F.. ( 2008;). A multiplex real-time PCR assay for rapid detection and differentiation of 25 bacterial and fungal pathogens from whole blood samples. . Med Microbiol Immunol (Berl) 197:, 313–324. [CrossRef][PubMed]
    [Google Scholar]
  16. Lucignano B., Ranno S., Liesenfeld O., Pizzorno B., Putignani L., Bernaschi P., Menichella D.. ( 2011;). Multiplex PCR allows rapid and accurate diagnosis of bloodstream infections in newborns and children with suspected sepsis. . J Clin Microbiol 49:, 2252–2258. [CrossRef][PubMed]
    [Google Scholar]
  17. Mancini N., Ossi C. M., Perotti M., Carletti S., Gianni C., Paganoni G., Matusuka S., Guglielminetti M., Cavallero A.. & other authors ( 2005a;). Direct sequencing of Scedosporium apiospermum DNA in the diagnosis of a case of keratitis. . J Med Microbiol 54:, 897–900. [CrossRef][PubMed]
    [Google Scholar]
  18. Mancini N., Ossi C. M., Perotti M., Clementi M., DiGiulio D. B., Schaenman J. M., Montoya J. G., McClenny N. B., Berry G. J.. & other authors ( 2005b;). Molecular mycological diagnosis and correct antimycotic treatments. . J Clin Microbiol 43:, 3584–, author reply 3584–3585. [CrossRef][PubMed]
    [Google Scholar]
  19. Mancini N., Perotti M., Ossi C. M., Cavallero A., Matuska S., Paganoni G., Burioni R., Rama P., Clementi M.. ( 2006;). Rapid molecular identification of fungal pathogens in corneal samples from suspected keratomycosis cases. . J Med Microbiol 55:, 1505–1509. [CrossRef][PubMed]
    [Google Scholar]
  20. Mancini N., Clerici D., Diotti R., Perotti M., Ghidoli N., De Marco D., Pizzorno B., Emrich T., Burioni R.. & other authors ( 2008;). Molecular diagnosis of sepsis in neutropenic patients with haematological malignancies. . J Med Microbiol 57:, 601–604. [CrossRef][PubMed]
    [Google Scholar]
  21. Mancini N., Carletti S., Ghidoli N., Cichero P., Ossi C. M., Ieri R., Poli E., Burioni R., Clementi M.. ( 2009;). Molecular diagnosis of polymicrobial sepsis. . J Clin Microbiol 47:, 1274–1275. [CrossRef][PubMed]
    [Google Scholar]
  22. Mancini N., Carletti S., Ghidoli N., Cichero P., Burioni R., Clementi M.. ( 2010;). The era of molecular and other non-culture-based methods in diagnosis of sepsis. . Clin Microbiol Rev 23:, 235–251. [CrossRef][PubMed]
    [Google Scholar]
  23. Mussap M., Molinari M. P., Senno E., Gritti P., Soro B., Mannelli S., Fabris C.. ( 2007;). New diagnostic tools for neonatal sepsis: the role of a real-time polymerase chain reaction for the early detection and identification of bacterial and fungal species in blood samples. . J Chemother 19: (Suppl. 2), 31–34.[PubMed]
    [Google Scholar]
  24. Neu J., Walker W. A.. ( 2011;). Necrotizing enterocolitis. . N Engl J Med 364:, 255–264. [CrossRef][PubMed]
    [Google Scholar]
  25. Obladen M.. ( 2009;). Necrotizing enterocolitis–150 years of fruitless search for the cause. . Neonatology 96:, 203–210. [CrossRef][PubMed]
    [Google Scholar]
  26. Paolucci M., Capretti M. G., Dal Monte P., Corvaglia L., Landini M. P., Varani S., Pession A., Faldella G., Sambri V.. ( 2009;). Laboratory diagnosis of late-onset sepsis in newborns by multiplex real-time PCR. . J Med Microbiol 58:, 533–534. [CrossRef][PubMed]
    [Google Scholar]
  27. Patel S., Dammann O., Martin C. R., Allred E. N., Leviton A..ELGAN Study Investigators ( 2011;). Presumed and definite bacteremia in extremely low gestational age newborns. . Acta Paediatr 100:, 36–41. [CrossRef][PubMed]
    [Google Scholar]
  28. Pierro A., Hall N.. ( 2003;). Surgical treatments of infants with necrotizing enterocolitis. . Semin Neonatol 8:, 223–232. [CrossRef][PubMed]
    [Google Scholar]
  29. Pryce T. M., Palladino S., Kay I. D., Coombs G. W.. ( 2003;). Rapid identification of fungi by sequencing the ITS1 and ITS2 regions using an automated capillary electrophoresis system. . Med Mycol 41:, 369–381. [CrossRef][PubMed]
    [Google Scholar]
  30. Sharma R., Tepas J. J. III, Hudak M. L., Mollitt D. L., Wludyka P. S., Teng R. J., Premachandra B. R.. ( 2007;). Neonatal gut barrier and multiple organ failure: role of endotoxin and proinflammatory cytokines in sepsis and necrotizing enterocolitis. . J Pediatr Surg 42:, 454–461. [CrossRef][PubMed]
    [Google Scholar]
  31. Smith B., Bodé S., Petersen B. L., Jensen T. K., Pipper C., Kloppenborg J., Boyé M., Krogfelt K. A., Mølbak L.. ( 2011;). Community analysis of bacteria colonizing intestinal tissue of neonates with necrotizing enterocolitis. . BMC Microbiol 11:, 73. [CrossRef][PubMed]
    [Google Scholar]
  32. Thuijls G., Derikx J. P., van Wijck K., Zimmermann L. J., Degraeuwe P. L., Mulder T. L., Van der Zee D. C., Brouwers H. A., Verhoeven B. H.. & other authors ( 2010;). Non-invasive markers for early diagnosis and determination of the severity of necrotizing enterocolitis. . Ann Surg 251:, 1174–1180. [CrossRef][PubMed]
    [Google Scholar]
  33. Walsh M. C., Kliegman R. M.. ( 1986;). Necrotizing enterocolitis: treatment based on staging criteria. . Pediatr Clin North Am 33:, 179–201.[PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.043067-0
Loading
/content/journal/jmm/10.1099/jmm.0.043067-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error