Characteristics of motile curved rods in vaginal secretions

Motile curved rods seen in vaginal secretions have been isolated on Columbia agar supplemented with 5% human blood and vitamin K. Growth occurred anaerobically and in 5% oxygen but not in more aerobic conditions. There were two distinct groups of these organisms, distinguishable by morphology, biochemical activity and susceptibility to metronidazole. All isolates were sensitive to a wide range of antimicrobial agents, with the exception of nalidixic acid and polymyxin, but one group was resistant to metronidazole. There was little difference between the results of tests of susceptibility to aminoglycosides or to metronidazole performed in anaerobic and microaerophilic conditions. Motile curved rods were isolated from 18 of 80 patients with a clinical diagnosis of non-specific vaginitis, but from only two of 39 without the disease.     

Characterisation of anaerobic curved rods (Mobiluncus spp.) isolated from the urogenital tract

Thirty-two strains of anaerobic curved rods isolated from vaginal secretions and one isolated from seminal fluid were examined. Growth of all strains on solid media was superior to growth in liquid media, and at 37 degrees C they grew both anaerobically and in O2 5% in N2; they also grew anaerobically at 33 degrees C but not at 42 degrees C. No growth factors were identified, but strains grew more profusely at pH values above 5 X 0. The strains were screened in 80 biochemical tests, and for their susceptibility to 30 different antimicrobial agents. Most of the tests did not differentiate between the strains, but they were divided into four groups on the basis of cell morphology, metronidazole susceptibility, beta-galactosidase activity and arginine and hippurate hydrolysis. Group 1 consisted of 19 strains conforming to the species M. curtisi; group 2 consisted of five strains conforming to the species M. mulieris; group 3 consisted of five strains that resembled M. curtisi morphologically, and group 4 consisted of four strains that resembled M. mulieris morphologically, but the strains in the latter two groups reacted differently in at least one of the three major differential biochemical tests. Of three strains of M. curtisi and three of M. mulieris chosen at random, one of M. mulieris had a SDS-PAGE and fast-protein liquid chromatography protein profile indistinguishable from that of M. curtisi. We conclude that further efforts are required to clarify the taxonomic status of the genus Mobiluncus.     

Mobiluncus species and other anaerobic bacteria in non-puerperal breast abscesses

Samples of 109 breast masses were cultured aerobically and anaerobically forMobiluncus spp. using selective and non-selective media. Two of the 103 evaluable samples were sterile and 57 (55%) yielded facultative bacteria only. The remaining 44 (43%) contained anaerobic growth alone or mixed infections. Seven (16%) of the 44 samples with anaerobes, six from women and one from a man, yieldedMobiluncus spp. Six were identified asMobiluncus curtisii and one asMobiluncus mulieris. There were two types of breast abscesses: one withStaphylococcus aureus predominating and one with anaerobes predominating. Most of the anaerobes belonged to the normal vaginal flora, but some were members of the normal oral flora. These results support the hypothesis that breast infections with these anaerobes result from sexual activities.     

Mobiluncus species in bacterial vaginosis: aspects of pathogenesis

Mobiluncus is an anaerobic motile rod associated with bacterial vaginosis. In this work, luminol-enhanced chemiluminescence was used to study the ability of Mobiluncus spp. from the vaginas of women with bacterial vaginosis to induce, in the presence of normal adult serum, oxidative metabolism of polymorphonuclear leukocytes, which is an indirect measure of phagocytic activity. M. curtisii induced a significantly (p less than 0.05) lower response than M. mulieris, which indicates that M. curtisii escapes phagocytosis more easily. Indirect immunofluorescence assays showed IgG antibodies to M. curtisii at significantly (p less than 0.01) higher titres than to M. mulieris in women with bacterial vaginosis. The titres were higher in patients with bacterial vaginosis than in women without vaginosis and healthy men. No antibodies to Mobiluncus spp. of secretory IgA type were found in vaginal washings. These results indicate that M. curtisii is a more virulent species than M. mulieris, and agree with reports of M. curtisii found in postoperative and extragenital infections.     

Identification of oxidase-positive, glucose-negative, motile species of nonfermentative bacilli.

Motile and glucose-negative nonfermentative bacilli are difficult to identify by commonly used procedures. We found eight features (reduction of nitrate and nitrite, acidification of fructose, and alkalinization of acetamide, arginine, histidine, saccharate, and urea) that identified 83% of 143 strains. These, along with additional biochemical tests, effected identification of 93% of the strains. Hence, only a minority of these strains required examination by microscopy (for type of flagellation and presence of inclusion bodies) for complete identification.     

Incidence of vaginal Weeksella virosa (formerly group IIf).

The antimicrobial susceptibilities, biochemical properties, and cultural characteristics of six strains of Weeksella virosa (formerly group IIf) were determined. The main characteristics of this non-fermentative organism were production of cytochrome oxidase, gelatinase, and indole, but a lack of saccharolytic activity. A study was then made of the isolation rates of Weeksella virosa from high vaginal swabs from 300 women: a healthy control group (n = 100), a general group with symptoms of vaginal infection (n = 100), and 100 women from a remand centre, where likelihood of exposure to sexually transmitted disease might be expected to be higher. The incidence of Weeksella virosa was found to be 2% in the first two groups. This suggests that, irrespective of the presence of pathogens, the incidence of the species in the general female population is around 2%. A much higher incidence (15%) was found in the third group, suggesting sexual transmission of the organism.     

Incidence of anaerobic bacteria in respiratory tract infections

Anaerobic bacteria are predominant components of normal oral cavity, upper respiratory tract, gastrointestinal, genital and skin flora. They are involved in infections such as pneumonia, aspiration pneumonia, lung abscess and empyema. Laboratory diagnosis of anaerobic infections is based on recovering the etiological agents from clinical materials. Appropriatte specimens include: pus, purulent fluid, biopsy specimen of lung, transtracheal aspirates and bronchoalveolar lavage (BAL). Lower respiratory infections are usually either polymicrobial or mixed anaerobic-aerobic infections. Peptostreptococcus, Fusobacterium, Prevotella and Bacteroides are the most common anaerobes. Anaerobic bacteria are susceptible to metronidazole, tinidazole (exception of Gram-positive rods), amoxicillin/clavulanate, ampicillin/sulbactam, piperacillin/tazobactam, imipenem and clindamycin. Treatment includes an antibiotics regimen with an agent active against anaerobic and aerobic bacteria (therapy with 2 or 3 antimicrobial drugs).     

Evaluation of semen detection in vaginal secretions: comparison of four methods

Problem To determine the best method to detect semen in human vaginal secretions. Method of study Vaginal secretions from 302 pregnant women at mean 11.8 weeks' gestation were analyzed. Semen detection was assessed with: (i) measurement of total prostate-specific antigen (PSA), (ii) acid phosphatase activity, (iii) microscopic measurement of spermatozoa on Gram stain, and (iv) self-reported sexual intercourse in the past 2 days. Sensitivity and specificity were calculated for each technique in comparison with PSA levels. Results A total of 119 (39.4%) women had a detectable PSA. Compared with measurable PSA, the sensitivity and specificity for other methods were: acid phosphatase (26.9%, 98.4%), Gram stain (36.1%, 98.4%), and self-report of intercourse in the past 48 hr (41.9%, 88.8%). Conclusion Compared with PSA levels, commonly used assays for recent semen exposure are inaccurate. This inaccuracy may affect the results of studies, which measure vaginal immune factors like cytokines or retrieve DNA from vaginal specimens.     

Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery

BACKGROUND. Preterm delivery is the leading cause of neonatal mortality in the United States, but efforts to address the problem are hampered by the inability to predict accurately which pregnancies are at risk. We postulated that damage to the fetal membranes may release fetal fibronectin into the cervix and vagina, giving rise to a biochemical marker for preterm delivery. METHODS. We measured fetal-fibronectin concentrations in cervical and vaginal secretions, amniotic fluid, and maternal plasma with a sensitive immunoassay using the monoclonal antibody FDC-6. Immunohistochemical studies were used to determine the distribution of fetal fibronectin in the placenta and amniochorionic membranes and to ascertain its cell of origin. RESULTS. Women with uncomplicated pregnancies (n = 163) who delivered at term rarely had cervicovaginal fetal-fibronectin concentrations above 0.05 micrograms per milliliter between 21 and 37 weeks of gestation (11 of 267 cervical samples [4 percent] and 9 of 267 vaginal samples [3 percent]. High levels of fetal fibronectin were detected in amniotic fluid and in the cervical or vaginal secretions of 93.8 percent of the women with preterm rupture of membranes (n = 65). Cervical or vaginal fetal fibronectin was also present in 50.4 percent of the women with preterm uterine contractions and intact membranes (n = 117), and its presence identified the women who delivered before term (n = 60) with a sensitivity of 81.7 percent and a specificity of 82.5 percent. In the placenta and membranes, fetal fibronectin was found at points of contact with the uterine wall. CONCLUSIONS. The presence of cervicovaginal fetal fibronectin in the second and third trimesters of pregnancy identifies a subgroup of women who are at high risk for preterm delivery. This phenomenon may reflect the separation of the chorion from the decidual layer of the uterus, with the release of intact or degraded chorionic components of the extracellular matrix into the cervical and vaginal secretions.     

Prevalence,species distribution and antifungal sensitivity of vaginal yeasts in infertile women

A total of 326 high vaginal swabs from infertile women attending the Institute of Reproductive Medicine were cultured from June 1999 to May 2000. Candida species was isolated from 42(12.88%) patients. Candida albicans (40.47%) followed by Candida glabrata (38.09%) were the most common isolates. Other species included Candida tropicalis (14.28%) and Candida krusei (7.14%). All isolates were tested for sensitivity by disc diffusion method on Yeast Nitrogen Agar base towards four antifungals. Seven (16.7%) candida strains showed resistance to Fluconazole and 19(45.23%) of the strains showed resistance to Itraconazole, and 4(9.5%) strains showed resistance to Nystatin. There was no resistance to Amphotericin B. Of the 7 strains resistant to Fluconazole, 3 were Candida krusei, 3 were Candida glabrata and 1 was Candida tropicalis.     

Effect of uterine immunization and oestradiol on specific IgA and IgG antibodies in uterine, vaginal and salivary secretions.

Levels of IgA and IgG antibodies were measured in uterine and vaginal secretions to examine the effect of uterine immunization on the genital tract humoral immune system. When ovariectomized animals were immunized on Day 0 and boosted 13 days later by placing sheep erythrocytes (SRBC) directly in the uterine lumen (UT/UT) immunization), a pronounced IgA and IgG antibody response was detected in uterine secretions measured on Day 26. This response was 20-30-fold greater than that measured following Peyer's patch immunization and boosting (PP/PP) and Peyer's patch immunization followed by uterine boosting (PP/UT). In contrast to uterine antibody responses that were oestradiol-dependent following PP/PP and PP/UT immunization, UT/UT immunization resulted in IgA and IgG antibody responses that were hormonally independent. To determine whether immunological information is distributed beyond the immediate site of immunization, ovariectomized rats were immunized and boosted by injection of SRBC into one uterine horn. When uterine secretions from the contralateral (non-immune) horns were analysed, IgA and IgG antibodies were found in uterine secretions after oestradiol stimulation. IgA and IgG antibodies were also present in vaginal secretions following UT/UT immunization and ligation of uteri at the utero-cervical junction. This response was hormonally dependent in that vaginal antibody levels were lowered by oestradiol treatment. IgG but not IgA antibodies were also found in saliva of UT/UT immunized animals. Oestradiol had no effect on salivary IgG levels in contrast to those of the genital tract. In summary, these experiments indicate that immunization of uteri can elicit pronounced IgA and IgG antibody responses in uterine secretions and this response is not altered by oestradiol. Moreover, immunization at one site in the genital tract results in the appearance of antibodies at other uterine sites (the contralateral-non-immunized horn), in vaginal secretions, in serum and at other mucosal sites, such as the salivary glands.     

A new species of Cacatuocotyle (Monogenea,Dactylogyridae) parasitizing two species of Astyanax (Ostariophysi,Characidae) in southern Brazil

A new species of Cacatuocotyle is described from the external surface of Astyanax aff. fasciatus and Astyanax jacuhiensis from Lake Guaíba, State of Rio Grande do Sul, Brazil. It differs from the other three species of the genus, recorded from Mexico and the State of Paraná, Brazil, by possessing an accessory piece with a long proximal portion, a U-shaped bar with irregular posterior margin in its midportion, and a haptor containing two circular thickenings with muscular anterior margins. Only one monogenean species, Urocleidoides astyanacis (= Characithecium costaricensis) was recorded for the host Astyanax aff. fasciatus, whereas none were known for A. jacuhiensis. This paper records a new host (A. jacuhiensis) for monogeneans in southern Brazil and extends southward with the geographical distribution of the genus Cacatuocotyle to the State of Rio Grande do Sul, Brazil.     

Comparison of the oral, rectal, and vaginal immunization routes for induction of antibodies in rectal and genital tract secretions of women.

To determine which mucosal immunization routes may be optimal for induction of antibodies in the rectum and female genital tract, groups of women were immunized a total of three times either orally, rectally, or vaginally with a cholera vaccine containing killed Vibrio cholerae cells and the recombinant cholera toxin B (CTB) subunit. Systemic and mucosal antibody responses were assessed at 2-week intervals by quantitation of CTB-specific antibodies in serum and in secretions collected directly from mucosal surfaces of the oral cavity, rectum, cervix, and vagina with absorbent wicks. The three immunization routes increased levels of specific immunoglobulin G (IgG) in serum and specific IgA in saliva to similar extents. Rectal immunization was superior to other routes for inducing high levels of specific IgA and IgG in rectal secretions but was least effective for generating antibodies in female genital tract secretions. Only vaginal immunization significantly increased both specific IgA and specific IgG in both the cervix and the vagina. In addition, local production of CTB-specific IgG in the genital tract could be demonstrated only in vaginally immunized women. Vaginal immunization did not generate antibodies in the rectum, however. Thus, generation of optimal immune responses to sexually transmitted organisms in both the rectal and the genital mucosae of women may require local immunization at both of these sites.     

Strength and strength retention vitro,of absorbable,self-reinforced polyglycolide (PGA) rods for fracture fixation

The initial shear strength and changes in flexural strength of self-reinforced, absorbable polyglycolide (PGA) composite rods, submerged in distilled water (at 37°C) for a period of 6 wk, were investigated. The recently developed self-reinforced absorbable material consists of an absorbable polymeric matrix reinforced with fibres of the same polymer.The initial shear strength of self-reinforced cylindrical PGA rods with a diameter of 3.2 mm was 250 MPa and the initial flexural strength of the rods was 370 MPa. During the first week of immersion the level of flexural strength decreased very little i.e. to 320 MPa. The loss of flexural strength increased after 1 wk immersion. However, after 3 wk it was 90 MPa. After 5 wk the flexural strength decreased to the level of strength of cancellous bone i.e. 10–20 MPa.The γ-irradiation of the PGA rods (total dosage 2.5 Mrad) decreased the initial bending strength to 300 MPa but the hydrolytic behaviour of the rods was not changed.The in vitro strength and the strength retention of self-reinforced PGA rods are clearly better than the corresponding values for self-reinforced glycolide/lactide copolymer rods which we developed recently. Self-reinforced PGA rods are now used routinely in Helsinki University Central Hospital in the treatment of certain types of cancellous bone fracture.