Mycoplasma, bacterial vaginosis-associated bacteria BVAB3, race, and risk of preterm birth in a high-risk cohort

OBJECTIVE

Genital tract infection accounts for approximately 25-40% of all preterm births. We sought to assess the relationship between preterm birth and selected vaginal bacterial taxa associated with preterm birth either directly or through their association with bacterial vaginosis (BV).

STUDY DESIGN

Vaginal fluid for Gram stain was collected between 17 and 22 weeks' gestation as part of a randomized trial of ultrasound-indicated cerclage for preterm birth prevention in women at high risk for recurrent spontaneous preterm birth. Bacterial deoxyribonucleic acid was extracted from the Gram stain slides and analyzed using quantitative polymerase chain reaction.

RESULTS

Among the 499 participants, Mycoplasma was positively correlated with increased risk of preterm (risk ratio [RR], 1.83; 95% confidence interval [CI], 1.52-2.22) as was Mobiluncus (RR, 1.36; 95% CI, 1.07-1.73) and Atopobium (RR, 1.44; 95% CI, 1.1-1.87). However, there were strong interactions between the race/ethnic group and the presence of these and other individual taxa on risk of preterm birth. By contrast, bacterial vaginosis-associated bacteria (BVAB)-3 was consistently associated with a reduction in the risk of preterm birth for all racial/ethnic groups (0.55; 95% CI, 0.39-0.78).

CONCLUSION

BV is characterized by a reduction of Lactobacillus, and lactic acid-producing bacteria and the presence of Mobiluncus; we found these factors and the presence of Mycoplasma to be associated with an increased risk of preterm birth. By contrast, the presence of a recently identified organism sufficient to cause BV, BVAB3, decreased the risk of preterm birth. These findings give insight into why treating BV has mixed impact on risk of preterm birth.

A multi-omic systems-based approach reveals metabolic markers of bacterial vaginosis and insight into the disease

BACKGROUND

Bacterial vaginosis (BV) is the most common vaginal disorder of reproductive-age women. Yet the cause of BV has not been established. To uncover key determinants of BV, we employed a multi-omic, systems-biology approach, including both deep 16S rRNA gene-based sequencing and metabolomics of lavage samples from 36 women. These women varied demographically, behaviorally, and in terms of health status and symptoms.

PRINCIPAL FINDINGS

16S rRNA gene-based community composition profiles reflected Nugent scores, but not Amsel criteria. In contrast, metabolomic profiles were markedly more concordant with Amsel criteria. Metabolomic profiles revealed two distinct symptomatic BV types (SBVI and SBVII) with similar characteristics that indicated disruption of epithelial integrity, but each type was correlated to the presence of different microbial taxa and metabolites, as well as to different host behaviors. The characteristic odor associated with BV was linked to increases in putrescine and cadaverine, which were both linked to Dialister spp. Additional correlations were seen with the presence of discharge, 2-methyl-2-hydroxybutanoic acid, and Mobiluncus spp., and with pain, diethylene glycol and Gardnerella spp.

CONCLUSIONS

The results not only provide useful diagnostic biomarkers, but also may ultimately provide much needed insight into the determinants of BV.

Gram stains: a resource for retrospective analysis of bacterial pathogens in clinical studies

We demonstrate the feasibility of using qPCR on DNA extracted from vaginal Gram stain slides to estimate the presence and relative abundance of specific bacterial pathogens. We first tested Gram stained slides spiked with a mix of 10(8) cfu/ml of Escherichia coli and 10(5) cfu/ml of Lactobacillus acidophilus. Primers were designed for amplification of total and species-specific bacterial DNA based on 16S ribosomal gene regions. Sample DNA was pre-amplified with nearly full length 16S rDNA ribosomal gene fragment, followed by quantitative PCR with genera and species-specific 16S rDNA primers. Pre-amplification PCR increased the bacterial amounts; relative proportions of Escherichia coli and Lactobacillus recovered from spiked slides remained unchanged. We applied this method to forty two archived Gram stained slides available from a clinical trial of cerclage in pregnant women at high risk of preterm birth. We found a high correlation between Nugent scores based on bacterial morphology of Lactobacillus, Gardenerella and Mobiluncus and amounts of quantitative PCR estimated genus specific DNA (rrn copies) from Gram stained slides. Testing of a convenience sample of eight paired vaginal swabs and Gram stains freshly collected from healthy women found similar qPCR generated estimates of Lactobacillus proportions from Gram stained slides and vaginal swabs. Archived Gram stained slides collected from large scale epidemiologic and clinical studies represent a valuable, untapped resource for research on the composition of bacterial communities that colonize human mucosal surfaces.

Candida albicans and bacterial vaginosis can coexist on Pap smears

OBJECTIVE

The aim of our study was to study the relationship of blastospores and pseudohyphae in Papanicolaou (Pap) smears and Nugent scores for bacterial vaginosis (BV).

STUDY DESIGN

A total of 471 Pap smears with Candida albicans were reviewed. The presence of blastospores and pseudohyphae was established. The Pap smears were restained with the Gram stain method to evaluate the bacterial flora according to the Nugent scoring system.

RESULTS

Of the 471 Pap smears, blastospores and pseudohyphae were observed in 62.8% (296/471) and 37.2% (175/471) of the smears, and displayed symptoms in 4.4% (13/296) and 43.4% (76/175), respectively. A significant difference was found between these 2 groups (p < 0.0001). A positive BV Nugent score (≥ 7) was found in 22.1% (104/471) of the C. albicans cases. Blastospores and pseudohyphae with BV were 14.2% (42/296) and 35.4% (62/175), respectively. These high Nugent scores indicate statistically significant differences (p < 0.0001).

CONCLUSION

C. albicans and BV can coexist. The presence of blastospores in these C. albicans cases was negatively related to symptoms.

[Evaluation of efficacy of ketoconazole 800 mg-clindamycin 100 mg tablets vaginal against ketoconazole 800 mg- clindamycin 100 mg vaginal capsules in candida vaginitis and vaginosis]

BACKGROUND

pharmaceutical forms (presentations) influence treatment compliance and therefore the effectiveness. Here we present the results in the relief of vaginitis and vaginosis with two different dosage forms.

OBJECTIVE

To compare the efficacy and safety of a combination of ketoconazole 800 mg + clindamycin in soft vaginal gel capsules 100 mg (vaginal capsules) against ketoconazole 800 mg + 100 mg clindamycin vaginal tablets (TV) in the management of vaginitis by C. albicans and/or vaginosis.

MATERIAL AND METHOD

In a randomized, multicenter, comparative open label study, patients between 18 and 60 years with a diagnosis of vaginitis by C. albicans and/or vaginosis were included. Patients were evaluated clinically and direct exam of genital discharge and culture were performed. Patients were randomized to one of two treatments vaginal tablets or vaginal capsules, for 3 days.

RESULTS

one hundred an sitxty nine patients were included, 85 in TV Group and 84 in vaginal capsules group. We found significant statistical difference in clinical response for tablet group at day three for burning p = 0.032 and itching p = 0.043. Microbiological cure was observed in patients with vaginitis by C. albicans, 92.5% in Group TV vs. 90.47% vaginal capsules group, all patients with G. vaginalis at baseline were negative for the organism at the end of the study, cure in patients with mixed infections were 78.94% for TV group vs. 78.26% vaginal capsules; group no adverse events were reported during treatment.

CONCLUSIONS

Treatment of vaginitis/vaginosis with vaginal tablets is clinically better than vaginal soft gelatin capsules both treatments were well tolerated.

Characteristics and Pregnancy Outcomes of Pregnant Women Asymptomatic for Bacterial Vaginosis

STUDY DESIGN

To determine the clinical, behavioral or demographic factors associated with asymptomatic bacterial vaginosis (BV) and to examine if women with asymptomatic BV had a higher risk of a variety of pregnancy outcomes compared to symptomatic BV positive women. For this study, 1916 pregnant women who were 12 weeks' gestation or less were enrolled. Interviewers facilitated vaginal swab collection for BV assessment, and completed the baseline questionnaire. BV was identified by Gram stain.

RESULTS

Forty percent of pregnant women screened positive for BV and a substantial proportion of BV positive pregnant women were asymptomatic (67%). Asymptomatic BV positive women reported lower stress scores (RR = 0.78, 95% CI: 0.67-0.89), slightly more prior STD's (RR = 1.03, 95% CI: 1.01-1.07), and a higher quantity of Mobiluncus (RR = 1.04 95% CI: 1.01-1.07) compared to symptomatic BV positive women. We did not find an increase in adverse pregnancy outcomes related to BV symptomatology.

CONCLUSION

Among first trimester pregnant women, only stress, STD history, and quantity of Mobiluncus were associated with symptom reports among BV positive pregnant women. We also found that women with asymptomatic BV did not have an increased risk of a variety of adverse pregnancy outcomes compared to symptomatic BV positive women.

The International Infections in Pregnancy (IIP) study: variations in the prevalence of bacterial vaginosis and distribution of morphotypes in vaginal smears among pregnant women

OBJECTIVE

The objective of the study was to determine the prevalence of bacterial vaginosis and the distribution of associated morphotypes among asymptomatic pregnant women in different countries.

STUDY DESIGN

In 8 institutions participating in the Global Network for Perinatal and Reproductive Health (www.gnprh.org) from July 1999 to September 2001, 1466 women were enrolled. Vaginal smears were Gram stained and scored with Nugent's method at a reference laboratory. The prevalence of bacterial vaginosis and bacterial morphotype distributions were compared.

RESULTS

Overall, 12.3% of women had bacterial vaginosis according to Nugent's criteria. Zimbabwe had the highest prevalence (24.4%) when compared with all other sites, except Myanmar (P < .05). Among bacterial vaginosis cases, 98.9% of vaginal smears had more than 30 Gardnerella/Bacteroides morphotypes present per oil immersion field. Individual centers showed significant differences in the number of Mobiluncus and lactobacillus morphotypes (P < .01).

CONCLUSION

The prevalence of bacterial vaginosis and distribution of bacterial morphotypes in vaginal smears among asymptomatic pregnant women vary significantly in populations from different countries.

Variation in microbiologic profiles among pregnant women with bacterial vaginosis

OBJECTIVE

The purpose of this study was to determine if clinical findings and sociodemographic variables among bacterial vaginosis (BV)-positive pregnant women are associated with different microbiologic profiles.

STUDY DESIGN

Pregnant women were assessed for BV by Nugent criteria. BV+ women were separated into 6 mutually exclusive microbiologic groups. In unadjusted analyses, we compared (1) sociodemographic and behavioral characteristics, and (2) 3 clinical characteristics among BV+ women with and without Mobiluncus (M+ vs M-). Unadjusted data were analyzed using the chi-square test. Multiple logistic regression was used to assess the likelihood of having clinical signs of BV in women with and without Mobiluncus spp while controlling for confounders.

RESULTS

A total of 1756 BV+ pregnant women were followed. The M+ group (n=702) was significantly more likely than the M- group (n=1054) to be non-Hispanic black (80.9% vs 66.2%; P < .0001), older than 21 years (61.7% vs 48.7%; P < .0001), and to have had more than 3 lifetime sexual partners (66.4% vs 54.9%; P < .0001). The M+ group was also more likely to have clue cells on wet mount (63.9% vs 47.2%; P < .0001) and a positive amine odor after addition of KOH (57.2% vs 45.0%; P=.001). There was no difference in other demographic variables or physician diagnosis of abnormal vaginal discharge. In the adjusted analyses for each clinical outcome, all findings were consistent with the unadjusted analyses.

CONCLUSION

BV+ pregnant women with Mobiluncus spp are more likely to have clue cells present on wet mount, a positive amine odor after KOH preparation, and to be older, non-Hispanic black, and have had more lifetime sexual partners compared to BV+ women without any Mobiluncus species.

Mobiluncus species in gynaecological and obstetric infections: antimicrobial resistance and prevalence in a Turkish population

The purpose of this study was to determine the prevalence and antimicrobial resistance of Mobiluncus species isolated from specimens collected from Turkish women with gynaecological infections. Mobiluncus species were isolated on enriched Schaedler agar and RLK agar plates under anaerobic conditions. The MICs of various antibiotics were evaluated using an agar dilution procedure. The prevalence of Mobiluncus species isolated from vulvo-vaginal abscesses, endometrial smears, salpingitis and bacterial vaginosis was 2%, 4.7%, 3.8% and 49%, respectively. Mobiluncus isolates were only resistant to metronidazole (81% resistance). The isolation rate of M. curtisii was higher than M. mulieris in Turkish women with bacterial vaginosis, vulvo-vaginal abscesses, endometritis or salpingitis.

[Detection of Mobiluncus species by special primer amplification and 16S DNA sequence analysis]

Bacterial Vaginosis (BV), a microecological disease leaded by overgrowth of the vaginal bacteria, is one of the Polymicrobial Diseases. The close relationship between BV and Mobiluncus ssp. was recognized gradually. But it is difficult to get the pure culture of this anaerobic bacterium because of its rigorous requirement for growth conditions. The vaginal discharge came from the BV animal model--Rhesus monkey was cultured in anaerobic environment. The 16S rRNA gene was amplified and sequenced using mobiluncus-specific primers. Mobiluncus ssp, closely related to Mobiluncus mulieris, were detected, by comparing with the 16S rRNA genes in the GenBank.

Reliability of interpretation of gram-stained vaginal smears by nugent's scoring system for diagnosis of bacterial vaginosis

This study was designed to assess reliability of interpretation of Gram-stained vaginal smears by using Nugent's scoring system for diagnosis of bacterial vaginosis (BV) across three different centers in Turkey: two in Ankara and one in Trabzon. The vaginal smears were collected from clients attending a family planning clinic in Trabzon, Turkey during October-December 1997. One slide taken from each client was prepared according to the standard methods and enumerated. One evaluator from each center examined the slides independently for the presence of BV and none of them had access to the evaluation of the others. Out of 372 slides, 301 (81%) were found to be satisfactory for scoring by all three evaluators and included in the analysis. Nugent's scores from 1-10 reported from each evaluator were compared by Spearman correlation coefficients and Kappa statistics. The difference in the proportions of BV diagnosis in three centers was evaluated by chi2 test. There was good agreement for the interpretation of Gram-stained vaginal smears by Nugent's scoring system for diagnosis of BV. These results indicate that it is a reliable method in diagnosis of BV at different settings.

Can known risk factors explain racial differences in the occurrence of bacterial vaginosis?

BACKGROUND

Black women are more likely to have bacterial vaginosis (BV) than are non-Hispanic white women. We examined whether this disparity can be explained by racial differences in known BV risk factors.

METHODS

Nine hundred black and 235 white women were enrolled from five US sites. At baseline, structured interviews were conducted and vaginal swabs self-collected for Gram-stain and culture.

RESULTS

Black women were more likely than white women to have BV/intermediate vaginal flora. They also were more likely to be older, have lower educational attainment and family incomes, have a history of a sexually transmitted disease, and douche. After adjustment for demographic and lifestyle factors, blacks remained at elevated risk for BV/intermediate flora (OR 2.2, 95% CI 1.5-3.1). Blacks also were more likely to have specific BV-related vaginal microflora, as well as gonococcal or chlamydial cervicitis (OR 2.2, 95% CI 1.2-3.8) after adjustment for known BV risk factors.

CONCLUSION

Risk factor differences did not explain the observed racial disparity in the occurrence of BV, BV-related microflora, or gonococcal or chlamydial cervicitis. These findings highlight our limited understanding of the factors accounting for the occurrence of bacterial vaginosis and cervicitis among black and white women.

A multiplex polymerase chain reaction-based diagnostic method for bacterial vaginosis

OBJECTIVE

To develop a polymerase chain reaction (PCR)-based diagnostic method for bacterial vaginosis using bacterial vaginosis-associated anaerobes.

METHODS

A multiple PCR assay was developed using primers specific to 16S ribosomal deoxyribonucleic acid (DNA) (Mobiluncus mulieris and Mobiluncus curtisii), nanH (Bacteroides fragilis), and an internal spacer region of ribosomal DNA (Gardnerella vaginalis). The vaginal swabs from pregnant and nonpregnant women were examined by Gram stain-based Nugent scoring system. One hundred seventy-two samples of 853 Gram stain-interpretable samples were randomly selected and subjected to multiplex PCR assay.

RESULTS

The sensitivity of the PCR assay ranged from 10 to 10 colony-forming units per vaginal swab. The prevalence of the bacterial vaginosis, intermediate, and normal categories was found by Nugent scoring system to be 21.6% (184/853), 26.0% (222/853), and 52.4% (447/853), respectively. By the multiplex PCR-based diagnostic method, 20.3% (35/172) of the samples were identified as bacterial vaginosis. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of multiplex PCR in comparison with Gram stain examination were 78.4% (95% confidence interval [CI] 65.1%, 91.6%), 95.6% (95% CI 92.1%, 99.0%), 82.9% (95% CI 70.4%, 95.4%), and 94.2% (95% CI 90.3%, 98.1%), respectively.

CONCLUSION

This multiplex PCR can be used as a diagnostic or screening test for bacterial vaginosis.

Evaluation of liquid culture media to support growth of Mobiluncus species

Mobiluncus curtisii and M. mulieris are anaerobic, gram-negative, motile curved rods isolated commonly from the vagina of women with bacterial vaginosis. Hitherto, there has been difficulty in isolating and growing these bacteria and little attention has been paid to growth in liquid media. Reasons for establishing the means of attaining optimal growth in such media include production of antigens for diagnostic and immunological studies and production of the soluble cytotoxin. In this study the efficacy of 12 liquid culture media in supporting growth was examined. M. mulieris (strain A198) multiplied > or =10-fold in only five media - Schaedler broth, Columbia blood broth (CBB), peptone-starch-dextrose (PSD) broth, brain-heart infusion plus arginine and spent tissue-culture medium. Similarly, M. curtisii (strain A98) multiplied > or =10-fold in only three media -Schaedler broth, CBB and PSD. Some strains of both bacterial species grew very poorly or not at all, in all the media tested. With an inoculum of > or =10(5)/ml, CBB, or PSD plus 10% horse serum, supported the growth of some strains of both bacterial species to 10(9) organisms/ml within 48 h, and viable bacteria persisted longer in some media (e.g., CBB) than in others. While variation in growth of Mobiluncus spp. may occur between one laboratory and another, these observations provide the basis for optimisation of a universal liquid culture medium that should facilitate production of antigens and cytotoxin.

Prevalence of Mobiluncus spp among women with and without bacterial vaginosis as detected by polymerase chain reaction

BACKGROUND

Mobiluncus spp are highly associated with bacterial vaginosis, but their role in its pathogenesis is unknown. The authors used polymerase chain reaction (PCR) to compare the prevalence of Mobiluncus in women with and without bacterial vaginosis.

GOAL

To compare the prevalence of Mobiluncus spp among women with and without bacterial vaginosis and to compare the sensitivities of PCR and Gram stain for detection.

STUDY DESIGN

Vaginal specimens from 74 women were analyzed by PCR and Gram stain for the presence of Mobiluncus spp. Comparisons were made between the prevalence of this organism between the two cohorts and between the Gram stain and PCR detection methods.

RESULTS

Mobiluncus was detected by PCR in 84.5% of women with bacterial vaginosis and in 38% of women without infection. M curtisii was rarely detected in the latter group, though it was found in 65.3% of women with bacterial vaginosis. The sensitivity and specificity of Gram stain compared with PCR were 46.9% and 100%, respectively.

CONCLUSIONS

Mobiluncus is more common in healthy women than previously suspected, with M mulieris as the predominant species. The significant difference in the prevalence of M curtisii between women with bacterial vaginosis and uninfected women suggests that this species could be involved in the pathogenesis of bacterial vaginosis.

The diagnosis of bacterial vaginosis and vaginal flora changes

In a population of 956 women, attending for contraceptive advice, 131 (13.7%) were found to have BV acording to Amsel's criteria. Clue cells were detected in 200 (20.9%) women, a positive amine ('sniff') test in 191 (20.0%), a vaginal pH > or = 4.7 in 243 (25.4%) and a "characteristic" vaginal discharge in 104 (10.9%) women. Sensitivity, specificity, positive and negative predictive values in relation to BV were calculated for each of these four criteria. The detection of clue cells, an increased pH and a positive sniff test showed excellent sensitivity (86-100%) values, but had a less satisfactory positive predictive value (52-68%). Vaginal discharge was found to be a poor predictor of BV. The vaginal flora in women with clue cells, increased vaginal pH or a positive sniff test was very similar to that of the women with BV, every after excluding concomitant cases of BV and the three respective criteria. Thus, a positive amine test, which is easily performed, strongly suggests BV and a vaginal flora predominated by Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus species and anaerobic species on one hand, and lack of lactobacilli on the other. When there is a clinical suspicion of BV, the sniff test is positive and differential diagnoses are excluded, one can safely treat a woman for bacterial vaginosis.

Bacterial vaginosis among a group of married Jordanian women: occurrence and laboratory diagnosis

A total of 310 vaginal swabs collected from a group of married Jordanian women complaining of vaginal discharge were examined for bacterial vaginosis. The scoring system of Nugent for the interpretation of Gram staining was employed. This system revealed the presence of the condition in 29.7% of patients. Results obtained using the scoring system correlated significantly with the detection of clue cells and the scarcity of white blood cells in the vaginal discharge. An inverse relationship was found between bacterial vaginosis and Lactobacillus morphotypes determined by Gram staining. No definite relationship was detected between bacterial vaginosis and the recovery of Gardnerella vaginalis by culture as this organism was isolated from swabs which according to the Nugent criterion were negative for bacterial vaginosis. Bacterial vaginosis among the women investigated was more prevalent than vaginitis caused by Trichomonas vaginalis or yeasts.

Isolation of Mobiluncus species from the human vagina

We report the results of a study concerning the characteristics of 52 strains of Mobiluncus spp. isolated from 982 vaginal secretions from patients with suspected bacterial vaginosis. 158 of these women presented the features of this bacterial infection. Of the strains isolated, 39 belonged to the species Mobiluncus curtisii, (25 of these which to M. curtisii subsp. curtisii and 14, to M. curtisii subsp. holmesii), and 13, to Mobiluncus mulieris. The vaginal isolates of Mobiluncus spp. were identified by comparing their biochemical profiles with those of the type strains M. curtisii subsp. holmesii (ATCC 35,242), M. curtisii subsp. curtisii (ATCC 35,241) and M. mulieris (ATCC 35,243). All strains of M. mulieris proved to be sensitive to the antimicrobial agents assayed, while strains of M. curtisii were seen to be resistant only to metronidazole.

[Clinical, epidemiological and microbiological aspects of Mobiluncus sp. in bacterial vaginosis]

BACKGROUND

In this paper, our goal was to determine the optimal isolation conditions, biochemical characterization, and preservation of species of the genus Mobiluncus, associated with bacterial vaginosis in patients attending the family planning clinic. Also, we tried to relate its presence with demographic variables and criteria used in the clinical diagnosis of bacterial diagnosis.

METHODS

The specimen from the posterior fornix were collected and transported to the laboratory in a Stuart medium, one at room temperature and the other at 4 degrees C. These samples were inoculated in anaerobic culture media.

RESULTS

Of a total of 92 patients studied, 61 (66.3%) were normal, 28 (30.4%) bacterial vaginosis, and 3 (3.3%) had intermediate vaginosis. There was statistically significant relationship only with intrauterine device use (p = 0.00499). The presence of curved rod, using Gram's method, was significantly related with pH (p = 0.00000) positive amines test (p = 0.00000), and the presence of clue cells (p = 0.00000). Mobiluncus was observed in 23 samples (82%), and the majority (15) using RLK agar (cold enrichment technique). With conventional techniques, we identified 12 strains as Mobiluncus curtisii and 3 strains as Mobiluncus mulieris. The strains of Mobiluncus sp. grew better from litmus milk conserved at -30 degrees C.

CONCLUSION

Isolating Mobiluncus sp. is fairly easy, if the right media and the techniques are used.

Bacterial vaginosis a "broad overview"

Bacterial vaginosis (BV) was first reported in 1995 by Gardner and Dukes, who described the unique clinical signs and symptoms and the distinctive nature of the vaginal discharge associated with it. They also described a "new" causative organism, which they named "Haemophilus vaginalis", subsequently renamed Gardnerella vaginalis. BV is currently the most prevalent cause of infectious vaginitis among women attending for genitourinary diseases. BV has a complex microbiology. Lactobacillus populations, which are usually dominant in healthy women, are replaced by a polymicrobial group of organisms that includes G. vaginalis, anaerobic Gram-negative rods such as Prevotella species, Peptostreptococcus species, Mycoplasma hominis, Ureaplasma urealyticum, and often Mobiluncus species. Anaerobic bacteria produce enzymes, aminopeptidases, that degrade protein and decarboxylases that convert amino acids and other compounds to amines. Those amines contribute to the signs and symptoms associated with the syndrome, raising the vaginal pH and producing a discharge odor. The excessive amounts of bacteria characteristic of the syndrome attach to epithelial cell surfaces, resulting in "clue cell". Nearly half the patients report no noticeable symptoms, but many develop a characteristic copious, malodorous discharge if untreated. Results from epidemiologic studies have associated BV with serious upper genital tract infections and adverse pregnancy outcome. In particular, the presence of BV in pregnant women increases the risk of preterm delivery, and evidence is now compelling that BV is a cause of preterm delivery. The interest in potential invasiveness of G. vaginalis has increased. However, virulence determinants have not been studied enough. The most important therapy includes clindamycin and metronidazole.

Severe sepsis caused by Mobiluncus curtisii subsp. curtisii in a previously healthy female: case report and review

We present the case of a 54-year-old female with life-threatening septicaemia due to Mobiluncus curtisii subsp. curtisii. Her admission was complicated by septic shock, renal failure, disseminated intravascular coagulation, the adult respiratory distress syndrome and spontaneous splenic rupture. The patient survived with full intensive care support and intravenous ceftriaxone. Extra-genital infection with Mobiluncus species is rarely diagnosed and has been confined to breast abscesses and non-life-threatening bacteraemia. A review of extra-genital infections with Mobiluncus species is presented.

[Laboratory diagnosis of bacterial vaginosis]

Microbiological analysis of discharge from the genitals in passenger car conductors (5787 women and 1496 men aged 20 to 40) showed Gardnerella vaginalis to be the most frequent agent of urogenital infection. It was isolated in 26% cases, whereas Trichomonas were isolated in 2.5%, fungi in 1.5%, and gonococci in 0.27% cases. The diagnosis of gardnerellosis is reliable if the key cells are found. Monoinfection with G. vaginalis was diagnosed in 80% patients, the overwhelming majority (74%) of carriers of this bacterium had no inflammatory symptoms, and in only 26% the carrier state was associated with the presence of leukocytes and histiocytes, more often in the cervix. In men the carrier state was detected in 0.4% cases. The clinical picture of Gardnerella infection is similar to that of infection with Mobiluncus, which is little known. This infection occurred 10 times less frequently (2.5%) than gardnerellosis, but in 92% cases it was a component of mixed infection, most frequently in association with G. vaginalis. A little known fungus Leptothrix was found in the genital discharge of 4% examinees, mostly women, but sometimes in men as well; it is represented by 3 types of ramifying threads. The practitioners are to know these infections causing specific diseases, such as bacterial vaginosis, which are often responsible for serious complications in gynecology and obstetrics.

Bacterial vaginosis: prevalence in an Italian population of asymptomatic pregnant women and diagnostic aspects

The present study has been carried out with the main objective of determining the prevalence rate of bacterial vaginosis (BV) in a population of asymptomatic pregnant women (8th to 9th month of pregnancy). Out of a total 1,441 patients examined BV was found to be present in 70 (4.9%). The diagnosis was made when an analysis of the vaginal discharge revealed the simultaneous presence of at least three out of four of the following laboratory indices: (1) direct Gram stain positive (bacterial flora mixed with Gram-negative coccobacilli and variable-gram predominant over the lactobacillus flora); (2) pH > 4.5; (3) positive odour test with KOH 10%; (4) presence of clue cells. After a discussion of the principal laboratory and clinical signs presently used for the diagnosis of BV, the authors suggest the exclusion of the evaluation of the appearance of the vaginal discharge from the standard diagnostic criteria. Further, three diagnostic methods are hypothesized for use in different settings.

[Clinical analysis of bacterial vaginosis in 76 cases]

OBJECTIVE

To study the clinical manifestation and treatment of bacterial vaginosis (BV).

METHODS

The criteria used for diagnosis were the presence of clue cells by wet mount slide or gram stain, plus at least 2 of the following 3 signs and symptoms: (1) vaginal discharge with pH > 4.5; (2) an increased thin homogeneous vaginal discharge; (3) positive amine test. From 1994, 1 to 1995, 3, a total of 76 cases with BV who had good follow up were diagnosed and treated by Kejunning (a combination of chinese traditional herb medicine), Shuangzuotai (combined metronidazole vaginal suppository), metronidazole, etc.

RESULTS

For BV, the presence of clue cells is a prerequisite for diagnosis. Vaginal discharge with pH > 4.5 and positive amine test were present in all the cases. Increased white thin homogeneous vaginal fluid were found in 96.1% (73/76) of the cases. 79.0% of the patients complained of fishy odor vaginal discharge. Treatment with antibiotics or Shuangzuotai were effective. Kejunning had a cure rate of 70.0% one month after treatment.

CONCLUSIONS

The detection of clue cell is an important diagnostic criterion. Besides metronidazole, Kejunning had a good result for the treatment of BV as well.

Extragenital infection due to Mobiluncus mulieris. Case report and review

Mobiluncus species are uncommonly isolated from nongenital sites. We report a case of abdominal abscess with associated Mobiluncus mulieris bacteremia and review the literature on extragenital infections due to Mobiluncus species.

[Value of the score for Gram strains in the diagnosis of bacterial vaginosis]

The interpretation of Gram-stained slides of vaginal swab specimens is evaluated for the diagnosis of bacterial vaginosis and correlated with the isolation bacteria and clinical signs: thin homogeneous vaginal discharge, pH > or = 4.7, amine odor and presence of clue cells. Gram stained smears were scored following a morphotype classification: (a)-Lactobacillus morphotypes (scored 4 to 0), (b)-small Gram negative (G. vaginalis, scored 0 to 4), (c)-curved Gram variable rods (Mobiluncus morphotypes, scored 0 to 2). The scoring system (0 to 10) was a weighted combination of these morphotypes: a+b+c. The criterion for bacterial vaginosis was a score > or = 7, a score of 0 to 6 was considered as no bacterial vaginosis. Samples of 709 women, aged 18 to 84 (mean age = 39.7) were examined. The prevalence of G. vaginalis culture was 12.5%, and Mobiluncus infection occurred in 1.5%. The frequency of M. hominis was diagnosed in 2.8% of women. A score of 7 to 10 on Gram stain was observed in 9.7% in the population. Compared to G. vaginalis culture, Gram stained smear was more sensitive (0.71) than clinical signs of bacterial vaginosis (0.46). The specificity was similar with the two methods. The assessment of G. vaginalis morphotypes was highly correlated with the G. vaginalis culture (p < 0.001, OR = 248). The infection of T. vaginalis or Candida sp. was never associated with a score > or = 7. The Gram-stained smear is a cheap, fast and easy method. It provides good results for diagnosis of bacterial vaginosis.