Genetic and infectious determinants of puerperal fever: a study of viral and bacterial coinfections in postpartum women

Abstract Background Puerperal fever is a major cause of maternal morbidity, traditionally associated with bacterial infections. However, the role of viral pathogens and genetic factors remains inadequately studied, particularly in low- and middle-income countries (LMICs). Objective This study aimed to investigate the prevalence of viral infections, bacterial pathogens, and genetic variants in postpartum women diagnosed with puerperal fever at Edo State University Teaching Hospital, Auchi, Nigeria. Methods A cross-sectional study involving 300 postpartum women (200 with puerperal fever and 100 controls) was conducted from April 2021 to May 2022. Blood samples were analyzed for antibodies and viral DNA/RNA using Bio-Rad ELISA kits and polymerase chain reaction (PCR). PCR–RFLP and real-time PCR with TaqMan probes were used for genotyping. Bacterial pathogens were identified through culture techniques. Genetic polymorphisms in immune-regulatory genes (IL-6, TNF-α, TLR4, HLA Class I and II) were analyzed using PCR-based methods. Statistical analysis employed SPSS version 25, with Chi-square tests, multivariate logistic regression, and corrections for multiple comparisons. Results The puerperal fever group showed significantly higher rates of viral antibodies for Cytomegalovirus (CMV) (40% vs. 10%, p < 0.001), Herpes Simplex Virus (HSV-1: 35% vs. 15%, p = 0.002; HSV-2: 28% vs. 14%, p = 0.01), and Epstein-Barr Virus (EBV) (30% vs. 12%, p = 0.005). PCR confirmed the presence of viral DNA/RNA in the puerperal fever group: CMV (30%), HSV-1 (25%), HSV-2 (20%), and EBV (22%), compared to controls (5%, 8%, 6%, and 4%, respectively). Bacterial infections were more prevalent in the puerperal fever group, with Streptococcus pyogenes (32% vs. 10%, p < 0.001) and Escherichia coli (25% vs. 8%, p = 0.002) being notable contributors. Additionally, genetic variants in IL-6 (rs1800795) and TNF-α (rs1800629) were significantly associated with an increased risk of puerperal fever ( p < 0.05). The study controlled for confounding variables such as socioeconomic and health status. Conclusion This study highlights the dual role of viral and bacterial infections, as well as genetic factors, in puerperal fever. The findings underscore the need for integrated diagnostic approaches, including viral screening and genetic testing, to enhance maternal health outcomes in LMICs.