女性生殖道沙眼衣原体感染时局部免疫因子变化的研究

目的:研究沙眼衣原体(CT)对女性生殖道感染患者局部生殖道上皮免疫状态的影响。方法:(1)选取2006年4月至8月被诊断为生殖道沙眼衣原体感染患者及无生殖道感染的生育年龄女性,每组各60例,取其阴道灌洗液,用ELISA方法比较IL-8,TNF-α,HD-5水平;(2)采用与沙眼衣原体类似来源的脂多糖(LPS),刺激体外培养的正常宫颈上皮细胞,检测LPS刺激后不同时间点TNF-α,HD-5水平。结果:沙眼衣原体组与正常组相比,阴道灌洗液IL-8,TNF-α,HD-5均升高,有明显差异。体外实验结果表明,LPS刺激体外培养的宫颈上皮细胞,0、24、48h细胞培养液中TNF-α,HD-5水平均增加,且呈现时间依赖性。结论:沙眼衣原体感染可影响女性生殖道局部免疫状态,体外实验证实宫颈上皮细胞可能参与了上述过程。     

Epidemiology of female genital Chlamydia trachomatis infections

The World Health Organization (WHO) has estimated that 92 million new cases of C. trachomatis (Chlamydia trachomatis) infection occur each year. This chapter focuses on the epidemiology of C. trachomatis infection, including the prevalence of infection in high- and low-risk groups, the incidence of infection, and data on secular trends. The evidence on the transmission of infection is reviewed. Risk factors for C. trachomatis infection in women are discussed. The adverse sequelae associated with C. trachomatis infection are described. Areas requiring further research are highlighted.     

Anaerobic infections of the female genital tract.

Anaerobic bacterial organisms are a frequent cause of female genital tract infections. There has been a lack of appreciation of the significant role anaerobes play in obstetric and gynecologic infections. Utilization of newer appropriate anaerobic culture techniques has shown the importance of these organisms as pathogens in serious infections of the genital tract. Many species of anaerobic bacteria appear to be part of the normal microflora of the lower genital tract in female subjects. Similar organisms are frequently isolated from pelvic infections. Bacteroides, anaerobic cocci, and Clostridia are the most commonly isolated anaerobes associated with clinical infections. The clinician must recognize the presence of anaerobic infections, utilize proper anaerobic culture methods, and institute appropriate antibiotic and/or surgical therapy.     

Localized asymptomatic giant cell arteritis of the female genital tract

Three postmenopausal patients with giant cell arteritis involving the female genital tract are presented. None of these patients had a prior history of vasculitis. The giant cell arteritis was confined to the myometrium in one patient, involved the cervix and myometrium in another, and involved all the internal genital organs in the third patient. Based on follow-up of our patients and analysis of similar cases in the literature, we conclude that asymptomatic patients may best be managed by close follow-up and monitoring of erythrocyte sedimentation rate levels, but that treatment may be unnecessary.     

Immunopathogenesis of chlamydia trachomatis infections in women

OBJECTIVE: To develop a model of pathogenesis by which Chlamydia trachomatis progresses from acute to chronic infection, and finally serious disease (salpingitis, tubal occlusion). DESIGN: Review of current literature located through web-based Medline searches using key words: Chlamydia trachomatis, immunology, cytokines, heat shock protein, infertility. RESULT(S): Cell-mediated immune mechanisms appear to be critical in determining whether acute infection is resolved or progresses into chronicity with pathological outcome. What determines the particular immune pathway depends on a range of determinants-HLA subtype and human genetics, cytokine profile, infectious load, route of infection, and endocrinology. A clearer picture of the natural history of chlamydial pathology may assist in providing better predictors of those women who may go on to develop significant sequelae after infection. CONCLUSION(S): Predicting those who may develop serious disease, including infertility, may contribute to improved management of such persons during earlier stages of infection and assist in prevention.     

Immunological aspects of genital chlamydia infections

Chlamydia trachomatis ascends from the cervix to the Fallopian tubes where it forms a persistent infection. The immune response to this infection results in tubal occlusion and infertility. In its persistent formC. trachomatis produces high levels of a 60-kDa heat shock protein (c-hsp60). There is a human hsp60 (h-hsp60) which shares a 50% amino acid sequence homology with the c-hsp60. Therefore, a chlamydial Fallopian tube infection can induce the development of autoantibodies to h-hsp60. H-hsp60 is one of the first proteins synthesized following fertilization. It is also expressed by epithelial cells in the decidua. Therefore, expression of h-hsp60 in early pregnancy can reactivate the c-hsp60-sensitized lymphocytes, leading to immune rejection of the embryo. The role of C. trachomatis in male infertility requires clarification. Because most C. trachomatis infections occur without defined symptoms, only the screening of sexually active women will reveal whether a woman is infected with this organism. Detection and treatment of a recently acquired infection can prevent development of h-hsp60 autoantibodies and tubal occlusion, preserve fertility, and prevent complications such as ectopic pregnancy.     

Mycoplasma, chlamydia and viruses in the female genital tract and infertility: clinical experience

In the University of Padua during the last ten years the chlamydia trachomatis, mycoplasma and viruses were studied in human infertility. The results show the influence on chlamydia and ureaplasma urealyticum, in some cases with different pathogenetic mechanisms. The results are discussed.     

Survey of the treatment of Chlamydia trachomatis infection of the female genital tract.

A questionnaire was sent to every tenth (n = 302) general practitioner in Norway. The physicians were to indicate their choice of antibiotic regimen for the treatment of genital chlamydial infections in women. Sixty-nine percent of the practitioners responded. The choice of treatment varied widely between the respondents. Forty-two different regimens were used for chlamydial cervicitis, 34 for cervicitis in pregnancy and 63 for probable pelvic infection. Of the prescribed treatments for these three diagnoses 14%, 5% and 46%, respectively, were compatible with the advice of the World Health Organization or the Centers for Disease Control. For the three previously mentioned diagnoses 49%, 79% and 43%, respectively, of the practioners would prescribe an antibiotic in either smaller doses, fewer daily doses or shorter duration than recommended. There is an urgent need to improve and standardize Norwegian general practitioners' treatment of chlamydial infection in women.     

Microbiology and management of polymicrobial female genital tract infections in adolescents

This review describes the microbiology and management of female genital tract infections in adolescents. These infections include vulvovaginitis, vulvovaginal pyogenic infections (abscesses of Bartholin's and Skene's glands, infected labial inclusion cysts, labial abscesses, furunculosis, and hidradenitis), endometritis, pyometritis, salpingitis, pelvic inflammatory disease, and tubo-ovarian and pelvic abscess. Anaerobes can be cultured in 50% to 90% of females with a variety of genital infections and are the exclusive isolates in 20% to 50%. Obligate anaerobes are particularly common in closed-space infections, such as tubo-ovarian and vulvovaginal abscesses. The most common anaerobes found in these infections are gram-negative bacilli (especially P. bivia and P. disiens) and anaerobic cocci. Anaerobes generally are not the only pathogens found, but are usually mixed with aerobes. The most common aerobic pathogens are members of the Enterobacteriaceae family, especially E. coli, and aerobic or microaerophilic streptococci. Sexually acquired infections include Neisseria gonorrhoeae, Gardnerella vaginalis, Trichomonas vaginalis, Chlamydia trachomatis, herpes simplex, and Condyloma accuminata. Treatment regimens must provide antimicrobial coverage for N gonorrhoeae, C trachomatis, anaerobes, streptococci, and gram-negative facultative bacteria.     

Beta interferon therapy of HPV infections of the female genital tract]

The aim of the study was to evaluate the incidence of cervical and vaginal lesions due to Papilloma virus before and after beta-interferon therapy. Clinical symptoms and the therapeutic approach are described, whereas drug efficacy was assessed on a long-term basis. The study of 19 cases, brought to the Author's attention over an eight-year period (1984-91) confirms previously published reports: the use of interferon shows a good level of tolerability without complications and undeniable efficacy following surgical treatment.     

Anaerobic infections of the female genital tract: bacteriologic and therapeutic aspects

33 women with severe infection of the genital tract were studied using fastidious anaerobic techniques. The women, admitted to the Department of Obstetrics and Gynecology at Cook County Hospital were referred to the Infectious Disease Service for the following: pelvic abscesses (13), tubo-ovarian abscesses (3), endometritis following dilatation and currettage (2), sepsis associated with incomplete abortion (7), puerperal sepsis (5), vaginal abscess (1), vulval abscess (1), and Bartholin's gland abscess (1). Anaerobic bacteria was cultivated from all 33 patients. Aerobic bacteria was associated with anaerobes in 21 patients, the most frequent isolate being E. coli, followed by facultative streptococci of the viridans group. 12 patients had only anaerobes present but no patients had aerobes in the absence of anaerobic forms. 12 patients also has positive blood cultures for the same anaerobes isolated from soft tissues. The 3 groups of anaerobes isolated with greatest frequency were bacteroides, peptostreptococci and clostridia. Bacteroides fragilis was the major species recovered in 26 specimens. 6 patients who had failed on conventional antibiotics were treated with clindamycin, a new antibiotic with high activity against anerobes. All patients responded satisfactorily. These bacteriologic and clinical observations suggest that anaerobes play an important and often decisive role in serious pelvic infections.