What is it about?
In this article, written before the Zika epidemic of 2015-2016., we presented a novel explanation about how microbes could cross the human placenta to infect the fetus to cause pregnancy complications or fetal damage. Our article contained a table that showed diverse microbes that were commonly known to cross the human placenta as well as other less familiar microbes which had only only been reported in case studies or small case series. Remarkably, all of the organisms on this list had the ability to live inside of human cells for at least a portion of their life cycle. We hypothesized, based on research with many of these organisms, that pathogens that could live inside of human cells could travel inside of white blood cells to get to the placenta where they could hack into the invasive placental layer called extravillous trophoblast. Once inside the trophoblast these organisms could spread infection to other layers in the placenta, sometimes causing miscarriage and at other times passing to the fetus to damage developing fetal tissues.. Key words: Intracellular pathogens, TORCH, placenta
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Why is it important?
This work is important because it present a model that can raise awareness among OB/GYN clinicians that any organism that can live and reproduce inside of maternal cells in early pregnancy might cause placental infections and pregnancy complications. It is timely because it explains how the Zika virus can infect the placenta and cause damage in the fetus.
Perspectives
The TORCH mnemonic I learned in medical school did not serve me well when I was taking care of a pregnant woman with typhoid fever. Unfortunately it is still being taught today despite being out-of-date and misleading. This new model for understanding blood-borne placental infection is simple to understand because it explains that any intracellular organism, whether obligate or facultative, can cross the placenta to cause harm to the fetus or the mother. All clinicians taking care of pregnant woman should understand this concept.
Marguerite Vigliani
Brown University
Read the Original
This page is a summary of: INTRACELLULAR ORGANISMS AS PLACENTAL INVADERS, Fetal and Maternal Medicine Review, November 2014, Cambridge University Press,
DOI: 10.1017/s0965539515000066.
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