Journal of Perinatology (2010) 30, 359–362
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PERINATAL/NEONATAL CASE PRESENTATION
Congenital pneumonia with sepsis caused by intrauterine
infection of Ureaplasma parvum in a term newborn: a first case
report
I Morioka1, H Fujibayashi1, E Enoki2, N Yokoyama1, H Yokozaki2 and M Matsuo1
1
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan and 2Department of Pathology, Kobe University
Graduate School of Medicine, Kobe, Japan
We present an autopsy case of intrauterine pneumonia in a term newborn
in whom Ureaplasma parvum was confirmed by PCR examinations,
including a novel diagnostic tool for detecting pathogens that caused
neonatal infections using multiplex PCR. This is the first report of
U. parvum being implicated in the pathogenesis of congenital pneumonia
with sepsis in a term newborn.
Journal of Perinatology (2010) 30, 359–362; doi:10.1038/jp.2009.145
Keywords: Ureaplasma parvum; intrauterine infection; pneumonia;
sepsis; multiplex polymerase chain reaction; term newborn
Introduction
Ureaplasma parvum is a bacterium inhabitant of the
genitourinary tract in women, which was recently subclassified
from Ureaplasma urealyticum and is known to infect humans.1
Intrauterine infections of U. parvum are associated with the
development of chorioamnionitis, funisitis, preterm delivery and
chronic lung diseases of preterm newborns.1 However, little is
known about the pathogenicity of U. parvum in a human term
fetus and newborn, and there are no reports of intrauterine
infection by U. parvum causing congenital pneumonia in a
human term newborn. Here, we report a term newborn with
intrauterine pneumonia in whom U. parvum was detected by our
novel multiplex PCR method2 and a direct sequencing analysis.
Case
A 3330 g male infant was born after 40 weeks of gestation. There
was no family history of immunodeficiency. Pregnancy was
uncomplicated. Before labor, his mother had signs of fever and
premature rupture of the membranes. Laboratory investigations
showed a white blood cell count of 25 300 per ml and a serum
Correspondence: Dr I Morioka, Department of Pediatrics, Kobe University Graduate School of
Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
E-mail: ichim@med.kobe-u.ac.jp
Received 5 July 2009; accepted 18 August 2009
C-reactive protein value of 10.6 mg per 100 ml. Culture of her
vaginal mucus found Candida albicans. Owing to maternal
infectious signs and non-reassuring fetal status, a vacuum-assisted
vaginal delivery was performed. Membranes finally ruptured 101 h
before delivery. In histopathological examinations, the placenta
and umbilical cord were markedly infiltrated with inflammatory
cells, resulting in a diagnosis of chorioamnionitis and funisitis,
respectively.
The infant did not have surface anomalies and was vigorous at
birth with Apgar scores of 8 at 1 min and 9 at 5 min. Within 3.5 h
after birth, the infant developed respiratory and circulation failure
requiring endotracheal intubation and cardiopulmonary
resuscitation, and was transferred to the neonatal intensive care
unit in Kobe University Hospital.
On admission, the infant had peripheral cyanosis, poor muscle
tonus and respiratory distress despite artificial ventilation. The
white blood cell count was 45 600 per ml, platelet count was
31.8  104 per ml, serum C-reactive protein value was 0.92 mg per
100 ml, blood sugar value was 320 mg per 100 ml, IgG value was
799 mg per 100 ml and IgM value was 14 mg per 100 ml. b-D
glucan in blood was negative. Venous blood gas analysis showed
that pH was 6.780, pCO2 was 85.0 mm Hg, HCO3 was
11.9 mmol l 1 and base excess was 20.3 mmol l 1 under
intermittent mechanical ventilation with peak pressures of
18 mm Hg. A chest radiograph found slight opacifications and air
leaks from both lungs. Echocardiography revealed no congenital
heart malformations and no intracranial hemorrhage. No evidence
of persistent pulmonary hypertension was found because of the
foramen ovale or ductus arteriosus with a left-to-right blood
stream. Congenital metabolic disorder was not found by tandem
mass spectrometry-based newborn blood screening. Despite
intravenous administrations of amikacin sulfate, fosfluconazole
and g-globulin, and intensive cardiorespiratory support, severe
hypoxemia and acidosis continued. Finally, the infant died within
9 h after birth due to respiratory failure.
Autopsy revealed congestive lungs (Figure 1a). Microscopy
showed extensive pneumonitis involving the respiratory bronchioles
 Congenital pneumonia caused by Ureaplasma parvum
I Morioka et al
360

x200

Figure 1 (a) Macroscopic findings of both lungs show congestion. (b) Microscopy shows pneumonitis involving the respiratory bronchioles with infiltration of
inflammatory cells consisting of polymorphonuclear leucocytes and macrophages, and hyaline membrane formation. (c) Ureaplasma sp. was detected from blood by our
diagnostic tool using multiplex PCR. (d) U. parvum was also detected in the placenta and umbilical cord by PCR using a specific primer pair for detecting Ureaplasma
spp. (e) U. parvum was not detected in lung tissue by PCR. Extracted total DNA concentrations in blood, placenta, umbilical cord and lung tissue were 332.8, 12.7,
9.8 and 466.0 ng ml 1, respectively. HSV, herpes simplex virus; CMV, cytomegalovirus; GBS, group B Streptococcus; MRSA, methicillin-resistant Staphylococcus aureus;
PCL, positive control ladder; NC, negative control; PC, positive control.

Table 1 Clinical case reports of congenital pneumonia caused by intrauterine infection of Ureaplasma in term newborns

Author Quinn PA et al.6 Waites KB et al.7 Brus F et al.8 Our case

Published year 1985 1989 1991 2009
Gestational age 38 weeks 37 weeks 38 weeks 40 weeks
Birth weight 2750 g 2180 g 3600 g 3330 g
Onset of symptoms 22 h after birth 1 h after birth 12 h after birth 3.5 h after birth
Species U. urealyticum serovar 8 U. urealyticuma U. urealyticuma U. parvum
Sepsis + +
PPHN + +
Outcome Death Death Death Death
Abbreviations: U. urealyticum, Ureaplasma urealyticum; U. parvum, Ureaplasma parvum; PPHN, persistent pulmonary hypertension of the newborn; h, hours.
a
No information for serovar.

Journal of Perinatology

with diffuse infiltration of inflammatory cells consisting of
polymorphonuclear leucocytes and macrophages, and hyaline
membrane formation (Figure 1b). The cause of death was
determined as intrauterine pneumonia, because the bilateral lungs
already had severe infiltration of inflammatory cells soon after
birth. Bacterial and fungal cultures were negative in all specimens
including blood, pharyngeal mucus, bronchoalveolar lavage and
gastric fluid. However, an amplicon of the genomic DNA of
Ureaplasma sp. was detected from blood by a novel diagnostic tool
using multiplex PCR, which we recently established,2 and sepsis
was diagnosed (Figure 1c). U. parvum was also detected from the
placenta and umbilical cord, but not from the lung tissue, by PCR
examination using a specific primer pair for detecting Ureaplasma
spp.3,4 (Figures 1d and e). Direct sequencing analysis identified its
PCR products as U. parvum.
Discussion
Ureaplasma spp. are eubacteria, which belong to the class
Mollicutes. U. urealyticum was the only species known to infect
humans. This species was recently subdivided into two separate
species, U. urealyticum (serovars 2, 4, 5, 7–13) and U. parvum
(serovars 1, 3, 6 and 14).1,5
To our knowledge, only three cases of congenital pneumonia
caused by intrauterine infection of Ureaplasma in term newborns
have been previously reported (Table 1).6–8 The onset of symptoms
was within 1 day after birth in all of the three cases. All cases died
despite intensive care, and postmortem microscopic examinations
showed severe pneumonia as the cause of death. Some cases were
complicated with sepsis and/or persistent pulmonary hypertension
of the newborn. The species of Ureaplasma in all cases were
U. urealyticum. Therefore, our present case is the first report of
intrauterine pneumonia caused by U. parvum in a term newborn.
However, it is unclear whether two of the three previous cases were
caused by a current classification of U. urealyticum, because these
two cases were reported before U. urealyticum was subdivided into
U. urealyticum and U. parvum.
Ureaplasma can be identified by culture, PCR and serology.
Cultures for detecting Ureaplasma require specialized media and
expertise that are not widely available.1 Indeed, using common
culture, we found no growth of any pathogens in all specimens.
Serological tests for Ureaplasma have been used in the research
setting.1 However, they remain primarily as research tools and
cannot currently be recommended for routine diagnostic purposes.1
Considerable attention has been given in recent years to the
application of the PCR method. We previously established a novel
diagnostic tool for detecting pathogens that caused neonatal
infections using multiplex PCR, and a PCR method using a specific
primer pair for detecting Ureaplasma.2,3 Moreover, it is possible to
confirm either species of Ureaplasma by direct sequencing
analysis of its PCR products.
Congenital pneumonia caused by Ureaplasma parvum
I Morioka et al
361
The genomic DNA of U. parvum was not detected from this
patient’s lung tissue. Recently, in a sheep or mouse pregnant
model of intrauterine infection of U. parvum, it was found that
U. parvum could not be recovered from lung tissues 2–3 days
after birth in term pups.9,10 Therefore, in human term newborns,
U. parvum may not be able to be recovered from lung tissues.
This observation is consistent with previous studies in the sheep
model showing clearance of Ureaplasma from the nasal cavities
soon after birth11 and an inability of Ureaplasma to colonize the
respiratory tract of older lambs.12 Further observations in more
clinical cases of congenital pneumonia caused by intrauterine
infection of U. parvum will be needed to show that U. parvum
cannot be detected from lung tissues after birth in human term
newborns.
In conclusion, this is the first case report that U. parvum is
implicated in the pathogenesis of congenital pneumonia with
sepsis in a human term newborn.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgments
This work was supported by grants for scientific research from the Morinaga
Hoshi-kai Foundation and the Ministry of Education, Culture, Sports, Science and
Technology in Japan.
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