Shigellosis complicating preterm premature rupture of membranes resulting in congenital infection and preterm delivery

BACKGROUND: The association of chorioamnionitis with preterm birth is well established. Intra-amniotic infection complicates 13-60% of preterm premature rupture of membranes (PROM) with enteric gram-negative pathogens accounting for 20-40% of recoverable organisms. However, the source of enteric pathogens leading to premature birth has been poorly characterized. CASE: A 36-year-old multiparous woman presented at 2567 weeks with preterm PROM. She reported a 5-day history of bloody, mucous diarrhea. A fourth cesarean delivery was performed secondary to the onset of labor. Fetal blood, placental membrane, and vaginal pool cultures revealed the presence of Shigella sonnei. With appropriate antibiotic therapy, the patient was discharged home on postoperative day 5. Neonatal stool cultures revealed evidence of in utero fetal transmission. CONCLUSION: It is prudent to treat pregnant patients with clinical symptoms suggestive of shigellosis because this pathogen can result in preterm PROM and preterm delivery. Neonatal testing is indicated if maternal disease is suspected before delivery.