Microbiological aspects of vulvovaginitis in prepubertal girls

This study aimed to establish the vaginal introitus microbial flora in girls with and without symptoms of vulvovaginitis, and to present the distribution of isolated microorganisms by age groups in girls with vulvovaginitis. We enrolled 500 girls with vulvovaginitis symptoms, aged 2-12 years, referred by their pediatricians for microbiological examination of the vaginal introitus swabs, and 30 age-matched asymptomatic girls. Similar microbial flora was isolated in both groups, but the symptomatic girls had significantly more common positive microbiological findings compared to controls (p?相似文献   

The aetiology of paediatric inflammatory vulvovaginitis

Vulvovaginitis is the most common gynaecological problem in prepubertal girls and clear-cut data on the microbial aetiology of moderate to severe infections are lacking. Many microorganisms have been reported in several studies, but frequently the paediatrician does not know the pathogenic significance of an isolate reported in vaginal specimens of girls with vulvovaginitis. A multicentre study was performed, selecting 74 girls aged 2 to 12 years old with a clinical picture of vulvovaginitis and inflammatory cells on Gram stain. All the specimens were cultured following standard microbiological techniques and the paediatricians completed a questionnaire to highlight risk factors after interviewing the parents or tutors. The data were compared with those obtained in a control group of 11 girls without vulvovaginitis attending a clinic. Streptococcus pyogenes and Haemophilus spp.were isolated in 47 and 12 cases, respectively. Upper respiratory infection in the previous month ( P <0.001) and vulvovaginitis in the previous year ( P <0.05) were identified as significant risk factors. Foreign bodies, sexual abuse, poor hygiene and bad socioeconomic situation were not identified as risk factors for the infection. Conclusion: Paediatric inflammatory vulvovaginitis is mainly caused by pathogens of the upper respiratory tract and the most common risk factor for this infection is to have suffered an upper respiratory tract infection in the previous month.Abbreviations HI Haemophilus influenzae - PIV paediatric inflammatory vulvovaginitis - SP Streptococcus pyogenes On behalf of the Spanish Study Group for Primary Care Infection     

Vulvovaginitis: clinical features, aetiology, and microbiology of the genital tract.

AIM: To clarify the contribution of clinical and environmental factors and infection to the aetiology of vulvovaginitis in premenarchal girls, and to determine clinical indicators of an infectious cause. DESIGN: It was necessary first to define normal vaginal flora. Cases were 50 premenarchal girls > 2 years old with symptoms of vulvovaginitis; 50 controls were recruited from girls in the same age group undergoing minor or elective surgery. RESULTS: Interview questionnaire showed no difference between cases and controls in regards to hygiene practices, exposure to specific irritants, or history of possible sexual abuse. Normal vaginal flora was similar to that described in previous studies, with the exception of organisms likely to be associated with sexual activity. 80% of cases had no evidence of an infectious cause. In the 10 cases in whom an infectious cause was found, there was significantly more visible discharge and distinct redness of the genital area on examination compared with other cases. CONCLUSIONS: The findings suggest that vulvovaginitis in this age group is not usually infectious or necessarily related to poor hygiene, specific irritants or sexual abuse, although any of these can present with genital irritation. The possibility of sexual abuse should always be considered when a child presents with genital symptoms, but our data indicate it is not a common contributing factor. Infection is generally associated with vaginal discharge and moderate or severe inflammation.     

Vulvovaginitis

The evaluation of vulvovaginitis, which is common in pediatric practice, depends on the pubertal development of the patient, keeping the possibility of sexual abuse in mind. Prepubescent girls are especially susceptible to vulvovaginitis because of anatomic and hormonal factors and because of their tendency to have poor local hygiene. If symptoms persist despite hygienic measures vaginal secretions should be investigated microbiologically and specific antimicrobial treatment prescribed accordingly. When the major complaint is of perineal pruritus, especially at night, empirical treatment with Mebendazole can be considered. In adolescents, who usually present with vaginal discharge, pruritus or dysuria, the pH of vaginal secretions should be tested and the secretions should be examined under the light microscope and sent for microbiological investigations. Physiologic leukorrhea is a common cause of vaginal discharge in adolescents. In the sexually active adolescent a complete pelvic examination with speculum should be performed including evaluation of endocervical specimen for sexually transmitted pathogens. Treatment is then directed at the specific cause. The diagnosis of one sexually transmitted disease necessitates investigation for others and treatment of the partner.     

Transhymenal cultures for sexually transmissible organisms.

Vaginal swabs were examined for sexually transmissible organisms in 238 girls seen over a 36 month period from July 1989 to June 1992 inclusive. Three groups were seen (age range 1.5-16.1 years), 165 in group 1 in whom there had been a disclosure of sexual abuse, 35 in group 2 where there was a strong suspicion of sexual abuse, and 38 with vulvovaginitis who formed group 3. The isolation of recognised sexually transmitted organisms was low; however, of group 1 19% were colonised with Gardnerella vaginalis compared with 3% of group 2 and 3% of group 3. These figures show significant differences in the proportion of children in each group isolating only from children over the age of 8 years and in five of the six girls with Candida spp there was concern about sexual abuse. Vulvovaginitis in young children was not associated with vaginal candidiasis. The relation of findings to age is discussed and recommendations are made for testing procedures.     

Transhymenal cultures for sexually transmissible organisms

Vaginal swabs were examined for sexually transmissible organisms in 238 girls seen over a 36 month period from July 1989 to June 1992 inclusive. Three groups were seen (age range 1.5-16.1 years), 165 in group 1 in whom there had been a disclosure of sexual abuse, 35 in group 2 where there was a strong suspicion of sexual abuse, and 38 with vulvovaginitis who formed group 3. The isolation of recognised sexually transmitted organisms was low; however, of group 1 19% were colonised with Gardnerella vaginalis compared with 3% of group 2 and 3% of group 3. These figures show significant differences in the proportion of children in each group isolating only from children over the age of 8 years and in five of the six girls with Candida spp there was concern about sexual abuse. Vulvovaginitis in young children was not associated with vaginal candidiasis. The relation of findings to age is discussed and recommendations are made for testing procedures.     

The role of cystovaginoscopy and hygienic advice in girls referred for symptoms of vulvovaginitis

Vulvovaginitis is a common presenting symptom referred to a paediatric urology clinic. Some of these patients undergo diagnostic cystovaginoscopy to determine whether there is any underlying anatomical cause for the persistent infection. However, in the majority of the patients, no underlying abnormality is found and they are given hygienic advice and prescribed bio yoghurt postoperatively. This study examines the outcome in these patients after hygienic advice is given: determining whether cystovaginoscopy was really necessary and whether it changed the management of vulvovaginitis.     

Vulvovaginitis: clinical features,aetiology, and microbiology of the genital tract

AIM—To clarify the contribution of clinical and environmental factors and infection to the aetiology of vulvovaginitis in premenarchal girls, and to determine clinical indicators of an infectious cause.DESIGN—It was necessary first to define normal vaginal flora. Cases were 50 premenarchal girls > 2 years old with symptoms of vulvovaginitis; 50 controls were recruited from girls in the same age group undergoing minor or elective surgery.RESULTS—Interview questionnaire showed no difference between cases and controls in regards to hygiene practices, exposure to specific irritants, or history of possible sexual abuse. Normal vaginal flora was similar to that described in previous studies, with the exception of organisms likely to be associated with sexual activity. 80% of cases had no evidence of an infectious cause. In the 10 cases in whom an infectious cause was found, there was significantly more visible discharge and distinct redness of the genital area on examination compared with other cases.CONCLUSIONS— The findings suggest that vulvovaginitis in this age group is not usually infectious or necessarily related to poor hygiene, specific irritants or sexual abuse, although any of these can present with genital irritation. The possibility of sexual abuse should always be considered when a child presents with genital symptoms, but our data indicate it is not a common contributing factor. Infection is generally associated with vaginal discharge and moderate or severe inflammation.     

Treatment of purulent leukorrhea in young girls

The case of a prepuberal girl complaining of a more or less purulent genital discharge, eventually associated with bleeding, evokes a vulvovaginitis. Vulvovaginitis is much less frequent than vulvitis. When a vulvovaginitis is resistant to medical treatment or is recurrent, an endoscopic examination is required in order to eliminate the presence of a vaginal foreign body. Treatment includes local cleaning, local antibiotics and sometimes a short course of oestrogen therapy. Oral antibiotics are indicated only in specific germ infections.     

Vaginal bleeding in the pre-pubertal child

Vaginal bleeding is a rare presenting complaint in pre-pubertal girls which can cause a lot of anxiety in parents and carers. The differential diagnoses range from relatively simple conditions such as vulvovaginitis to more sinister conditions including malignant vulval tumours or child sex abuse. A detailed clinical review is required in making a diagnosis and planning treatment. This review article will provide an overview of the most likely differential diagnosis and suggests an approach to assessment and management for the general paediatrician.     

Vulvovaginitis in the preadolescent girl

Vaginal discharges in prepubertal girls can be categorized under two broad headings--those with specific microbiological causes and, in the absence of such, those that are nonspecific in origin. For specific vulvovaginitis, treatment should be tailored to the findings on cultures, wet mounts, KOH, or other slide preparations. For the sexually transmissible organisms resulting in a vaginal discharge, thorough social service investigation should be undertaken in addition to appropriate antibiotic therapy. When a microbiological cause cannot be found and a foreign body has been ruled out, one is left with a diagnosis of nonspecific vulvovaginitis; treatment goals should be aimed at reassuring and re-educating the patient and parents in good hygienic practices as well as the elimination of potential irritants.     

Lack of specificity of Chlamydiazyme for detection of vaginal chlamydial infection in prepubertal girls

A 1-year prospective study was undertaken of 65 prepubertal girls referred for evaluation of sexual abuse or vulvovaginitis to compare Chlamydiazyme, an enzyme immunoassay (EIA), with culture for the detection of Chlamydia trachomatis i in vaginal specimens. Five (8%) of 65 patients were initially EIA-positive. On repeat sampling without intervening antibiotic treatment, 4 girls who were initially positive became negative and 1 remained persistently positive. Chlamydial cultures were negative in all patients. The patient with the persistently positive EIA also had Group A streptococcal vaginitis. We were able to demonstrate that some strains of Group A Streptococcus can cause a positive reaction with the EIA. Cross-reactions with other bacterial species are also known to occur. We therefore conclude that Chlamydiazyme is not specific for the detection of chlamydial infection in the vagina of prepubertal girls and, for medicolegal reasons, should not be used for evaluation of sexual abuse.     

Precocious puberty in Turner syndrome

Turner syndrome (TS) affects approximately 1 in 2000 liveborn girls. It is a common cause of short stature and is often, but not universally, associated with characteristic dysmorphic features and ovarian dysgenesis. Genotype/phenotype correlation in TS is generally poor and girls with TS may occasionally have normal functioning ovarian tissue, with approximately 30-40% entering puberty, 4% achieving menarche and 1% being fertile. In this report, we describe a girl with mosaic TS who unusually experienced spontaneous precocious puberty with associated accelerated longitudinal growth during mid childhood. This case acts as a useful clinical vignette with which to highlight important aspects of diagnosis and treatment in children with TS, particularly in relation to future growth potential and issues relating to fertility.     

儿童脑卒中诊断治疗进展

儿童脑卒中危险因素不同于成人脑卒中的危险因素,如高血压、糖尿病等,其发作通常是由于多种危险因素同时存在,这需要综合评估。但目前关于儿童脑卒中仍存在一些挑战。因父母或照看者对儿童脑卒中发作认识的延迟,所以提高对脑卒中的认识与教育更为重要。儿童脑卒中有多种神经系统表现,确诊需要MRI。然而最具有挑战性的是小儿脑卒中治疗方面的临床研究,以便能作出高级别循证医学依据的治疗方案。现介绍儿童动脉缺血性脑卒中及出血性脑卒中的诊断与治疗方面的新发现和新观点。     

A practical approach to growth hormone deficiency

Short stature is one of the most frequent reasons for referral to the paediatric endocrinologist. Familial short stature is the commonest cause; however, a child who is unexpectedly small for their family requires careful evaluation. Short stature in itself is not a disease, but growth failure can be a sensitive sign of underlying health issues in children and adolescents. Differentiating short stature due to a non-endocrine cause from an endocrine cause is critical. Of the endocrine causes, growth hormone deficiency (GHD) is rare with a prevalence of approximately 1:4,000 to 1:10,000 but is an important condition warranting careful evaluation and management. In children with GHD, replacement growth hormone (GH) treatment can be highly effective in normalizing height during childhood and in achieving an adult height within the genetic target range. Whilst GHD, once diagnosed, is relatively easy to treat, the diagnosis still remains a challenge. There is no consensus with respect to a gold standard diagnostic test for GHD, and this is usually based upon a combination of clinical, biochemical and radiological data. This article provides a stepwise guide to diagnosing GHD in children.     

Zakażenia narządów płciowych u dziewcząt – profilaktyka i leczenie

Genital infections are a frequent diagnosis in pediatric and adolescent gynecology out-patient clinics, 2/5 of which relate to girls aged 0–14 years. The course of disease ranging from symptoms and ending on the treatment depends on many factors, foremost of the infection pathogen, but also on the child's age, coexisting diseases and sexual activity. Genital infections in girls can be caused by bacteria, viruses, fungi, parasites or factors of non-communicable. The most common symptoms of vulvovaginitis in girls are vaginal discharges with different color, texture and smell, occurring in 60–90% of the cases. Diagnosis of genital infections should begin with an anamnesis. During gynecological examination of external sexual organs, the vestibule of the vagina, urethra and area around the anus should be revealed for the presence of skin lesions and absences of the defects of interior genital. In sexually active girls cervix and vaginal walls should be also revealed. Personal hygiene and supportive treatment (sitz baths, vaginal irrigation, topical soothing agents, corticosteroids, antihistamines, loose cotton underwear, preparations of lactic acid) play a huge role in the prevention of vulvovaginitis in girls. Treatment of infections should be based on the result of bacteriological testing and antibiogram, in dose adjusted to age and body weight of girl.     

Vulvovaginitis: causes and management.

Over a period of 33 months in a paediatric accident and emergency department, the clinical pattern and possible causes of vulvovaginitis were studied prospectively in 200 girls presenting with genital discharge, irritation, pain, or redness. The major causes were poor hygiene and threadworms. The suspicion of sexual abuse arose in a few girls but no organisms of sexually transmitted disease were found. Urinary symptoms were common but only 20 patients had a significant bacteriuria and 40 had sterile pyuria. Specific skin problems occurred in 28 cases. Simple measures to improve hygiene and treatment of threadworms gave effective relief. Genital irritation caused urinary symptoms with no clinical evidence of infection, and it is advised that antibiotic treatment should await urine culture. Specific skin problems require help from a dermatologist. The possibility of sexual abuse must be considered especially if the vulvovaginitis is persistent or recurrent after adequate treatment.     

The prevalence of abnormal genital findings,vulvovaginitis, enuresis and encopresis in children who present with allegations of sexual abuse

ObjectiveTo assess the prevalence of vulvovaginitis, enuresis and encopresis in children who were referred for allegations of sexual abuse.SubjectsA retrospective chart review of 1280 children presenting for non-acute examination after allegations of sexual abuse during a 15-year time span. Interview documentation, physical examination documentation, urinalysis, urine and vaginal cultures were reviewed.ResultsOf the 1280 children, 73.3% were female and 26.7% male. The ages of the children ranged from 6 months to 18 years (median age was 6 years). Interviews revealed that fondling contact was the most common allegation, followed by oral, vaginal, and anal penetration. Interviews also disclosed lower urinary tract symptoms, UTI, constipation, encopresis and enuresis. Physical examination revealed no abnormal genital findings in 44.7% of cases. Examinations of the vagina noted: erythema (18.1%); hymenal notching (posterior 16.8%, anterior 4.4%); vuvlovaginitis (14.0%); laceration or transection (0.6%); and bruising (0.4%). Examination of the anus noted: anal fissure/tear (14.9%); loss of anal tone (10.6%); reflex anal dilatation (9.2%); venous congestion (3.8%); and proctitis (0.9%). Vulvovaginitis was noted in 14% (131/936) and encopresis in 2.3% (21/936). Enuresis according to age was reported in 13% of 5–9 year olds, 14.7% of 10–16 year olds and 18.2% of 17–18 year olds suspected of being abused.ConclusionPrevalence of vulvovaginitis and enuresis were increased, and encopresis was decreased in children with allegations of sexual abuse when compared to the general pediatric population. Physicians should continue to be aware of the possibility of the presence of these conditions in children who have been sexually abused, and offer appropriate treatment.     

Non-Traumatic Coma and Altered Mental Status

Non traumatic coma in childhood is an important emergency. It can result from wide range of etiologies. CNS infections are the most common cause of non traumatic coma in children. However, multiple interrelated factors may be present in one patient. Management of a comatose child goes hand in hand with clinical evaluation. It is an emergency that requires simultaneous institution of immediate life support, identification of the cause and institution of definite therapy. The primary goal is to establish airway, breathing and circulation and to identify and treat raised intracranial pressure and seizures.     

Group A beta-hemolytic streptococcal vulvovaginitis: a recurring problem

Differential diagnosis of purulent vulvovaginitis in prepubertal girls should include infection caused by group A beta-hemolytic streptococci. Cultures should be obtained not only for N. gonorrhoeae but also for respiratory and skin pathogens such as streptococci. While a specific diagnosis of group A streptococcal vulvovaginitis does not exclude child abuse or a vaginal foreign body, the child's symptoms and parental anxiety and concern can usually be rapidly alleviated with oral antibiotics effective against streptococci. Further investigation beyond culturing and treatment with antibiotics can be reserved for cases where history, physical findings, and response to therapy indicate such a need.