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1.
World J Urol ; 42(1): 68, 2024 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-38308683

RESUMEN

BACKGROUND: Urinary Tract Infections (UTIs) and Genital Tract Infections (GTIs) are common yet serious health concerns. Precise diagnosis is crucial due to the potential severe consequences of misdiagnosis. This study aims to distinguish between UTIs and GTIs, highlighting the importance of accurate differentiation. MATERIALS AND METHODS: The study encompassed 294 patients, categorized into 4 groups: Group GNI (no infection, N = 57), Group GUI (urinary infection, N = 52), Group GGI (genital infection, N = 139), and Group GGUI (both infections, N = 46). Methods included patient interviews, clinical examinations, and laboratory tests such as urine and vaginal swab cultures. RESULTS: The investigation revealed no significant differences in age, BMI, residency, or nationality across groups. However, socioeconomic status varied, with Group GNI having the lowest proportion of low socioeconomic status. In obstetrical characteristics, non-pregnancy rates were higher in Groups GUI and GGUI, with GGUI showing a notably higher abortion rate. Symptom analysis indicated lower symptom prevalence in Group GNI, with pain, itching, pruritus, and vaginal discharge being less frequent, suggesting a link between infection presence and symptom severity. Treatment patterns showed higher usage of ciprofloxacin, antifungals, and vaginal tablets in Groups GUI and GGUI. Laboratory findings highlighted significant Leucocyte Esterase presence and variations in WBC and RBC counts, particularly in Group GGUI. CONCLUSION: The study emphasizes the need for advanced diagnostic techniques, especially those focusing on individual microbial patterns, to enhance UGTI diagnosis. Variations in symptom presentation and treatment across groups underline the necessity for personalized diagnostic and treatment strategies.


Asunto(s)
Infecciones del Sistema Genital , Infecciones Urinarias , Femenino , Humanos , Infecciones del Sistema Genital/diagnóstico , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones del Sistema Genital/epidemiología , Líbano/epidemiología , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Errores Diagnósticos
2.
Vet Res Commun ; 48(3): 1497-1510, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38347266

RESUMEN

Multidrug-resistant bacteria have become the predominant etiology in bovine female reproductive tract infections and thus require effective treatment approaches. The main goal of this study was the molecular detection of mecA, blaZ, tetK, and aacA-aphD genes in Staphylococcus aureus (S. aureus) responsible for methicillin, beta-lactam, tetracycline, and aminoglycoside resistance respectively. Phylogenetic analysis was conducted to check the homology of staphylococcal genes with NCBI sequences. The in-vitro efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) in combination therapies against MDR S. aureus was evaluated using well diffusion assay and checkerboard method. Vaginal swab samples (n = 384) collected from bovines suffering from endometritis, pyometra, and retained placenta were tested for S. aureus. Results showed a 17.96% overall prevalence. Both phenotypic and genotypic resistance was observed among S. aureus isolates with 50.72% and 37.68% isolates being confirmed as methicillin-resistant (MRSA), 36.23% and 18.84% isolates exhibiting beta-lactam, 40.58%, and 27.54% isolates showing tetracycline, and 33.33% and 36.23% isolates showing aminoglycosides resistance based on disc diffusion and gene confirmation, respectively. Phylogenetic analysis indicated homology with previously reported Pakistani isolates suggesting the possibility of MDR S. aureus transmission within and between animals. Synergy testing indicated that combinations of ceftriaxone-ketoprofen (153.77%), ceftriaxone-meloxicam (149.55%), amoxiclav-flunixin meglumine (106.06%), and oxytetracycline-flunixin meglumine (104.47%) showed synergy on well diffusion assay. Based on the fractional inhibitory concentration index by checkerboard method, oxytetracycline-meloxicam and gentamicin-ketoprofen combinations exhibited synergistic interaction. In conclusion, MDR S. aureus resistance was mitigated in-vitro through the combination of antibiotics (oxytetracycline, gentamicin) with NSAIDs (meloxicam, ketoprofen) that could be used to create therapeutic strategies for bovine reproductive issues.


Asunto(s)
Antibacterianos , Antiinflamatorios no Esteroideos , Enfermedades de los Bovinos , Farmacorresistencia Bacteriana Múltiple , Infecciones Estafilocócicas , Staphylococcus aureus , Animales , Bovinos , Antiinflamatorios no Esteroideos/farmacología , Antiinflamatorios no Esteroideos/uso terapéutico , Infecciones Estafilocócicas/veterinaria , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Femenino , Staphylococcus aureus/efectos de los fármacos , Enfermedades de los Bovinos/microbiología , Enfermedades de los Bovinos/tratamiento farmacológico , Antibacterianos/farmacología , Quimioterapia Combinada/veterinaria , Pruebas de Sensibilidad Microbiana/veterinaria , Infecciones del Sistema Genital/veterinaria , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones del Sistema Genital/microbiología , Filogenia
3.
BMC Infect Dis ; 23(1): 547, 2023 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-37608250

RESUMEN

BACKGROUND: Genital tract infections pose a public health concern. In many low-middle-income countries, symptom-based algorithms guide treatment decisions. Advantages notwithstanding, this strategy has important limitations. We aimed to determine the infections causing lower genital tract symptoms in women, evaluated the Kenyan syndromic treatment algorithm for vaginal discharge, and proposed an improved algorithm. METHODS: This cross-sectional study included symptomatic non-pregnant adult women presenting with lower genital tract symptoms at seven outpatient health facilities in Nairobi. Clinical, socio-demographic information and vaginal swabs microbiological tests were obtained. Multivariate logistic regression analyses were performed to find predictive factors for the genital infections and used to develop an alternative vaginal discharge treatment algorithm (using 60% of the dataset). The other 40% of data was used to assess the performance of each algorithm compared to laboratory diagnosis. RESULTS: Of 813 women, 66% had an infection (vulvovaginal candidiasis 40%, bacterial vaginosis 17%, Neisseria gonorrhoea 14%, multiple infections 23%); 56% of women reported ≥ 3 lower genital tract symptoms episodes in the preceding 12 months. Vulvovaginal itch predicted vulvovaginal candidiasis (odds ratio (OR) 2.20, 95% CI 1.40-3.46); foul-smelling vaginal discharge predicted bacterial vaginosis (OR 3.63, 95% CI 2.17-6.07), and sexually transmitted infection (Neisseria gonorrhoea, Trichomonas vaginalis, Chlamydia trachomatis, Mycoplasma genitalium) (OR 1.64, 95% CI 1.06-2.55). Additionally, lower abdominal pain (OR 1.73, 95% CI 1.07-2.79) predicted sexually transmitted infection. Inappropriate treatment was 117% and 75% by the current and alternative algorithms respectively. Treatment specificity for bacterial vaginosis/Trichomonas vaginalis was 27% and 82% by the current and alternative algorithms, respectively. Performance by other parameters was poor to moderate and comparable between the two algorithms. CONCLUSION: Single and multiple genital infections are common among women presenting with lower genital tract symptoms at outpatient clinics in Nairobi. The conventional vaginal discharge treatment algorithm performed poorly, while the alternative algorithm achieved only modest improvement. For optimal care of vaginal discharge syndrome, we recommend the inclusion of point-of-care diagnostics in the flowcharts.


Asunto(s)
Candidiasis Vulvovaginal , Enfermedades Transmisibles , Enfermedades de los Genitales Femeninos , Gonorrea , Infecciones del Sistema Genital , Vaginosis Bacteriana , Adulto , Femenino , Humanos , Kenia/epidemiología , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/tratamiento farmacológico , Vaginosis Bacteriana/epidemiología , Infecciones del Sistema Genital/diagnóstico , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones del Sistema Genital/epidemiología , Estudios Transversales
4.
Curr Opin Urol ; 33(3): 180-186, 2023 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-36861760

RESUMEN

PURPOSE OF REVIEW: Male infertility may be secondary to male genital tract infection (MGTI) in an estimated 15% of cases. In the absence of overt clinical signs, evaluation for MGTI beyond semen analysis is not well established. Therefore, we review the literature on the evaluation and management of MGTI in the setting of male infertility. RECENT FINDINGS: A set of international guidelines recommends semen culture and PCR testing, but the significance of positive results remains unclear. Clinical trials evaluating anti-inflammatory or antibiotic treatment report improvements in sperm parameters and leukocytospermia, but data on the effect on conception rates are lacking. Human papillomavirus (HPV) and the novel coronavirus (SARS-CoV-2) have been associated with poor semen parameters and decreased conception rates. SUMMARY: The finding of leukocytospermia on semen analysis prompts further evaluation for MGTI, including focused physical examination. The role of routine semen culture is controversial. Treatment options include anti-inflammatories; frequent ejaculation; and antibiotics, which should not be used in the absence of symptoms or microbiological infection. SARS-CoV-2 represents a subacute threat to fertility that should be screened for in the reproductive history along with HPV and other viruses.


Asunto(s)
COVID-19 , Enfermedades de los Genitales Masculinos , Infertilidad Masculina , Infecciones por Papillomavirus , Infecciones del Sistema Genital , Femenino , Masculino , Humanos , Infecciones del Sistema Genital/diagnóstico , Infecciones del Sistema Genital/tratamiento farmacológico , Semen/microbiología , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/terapia , COVID-19/complicaciones , SARS-CoV-2 , Infertilidad Masculina/diagnóstico , Infertilidad Masculina/etiología , Infertilidad Masculina/terapia , Enfermedades de los Genitales Masculinos/diagnóstico , Enfermedades de los Genitales Masculinos/tratamiento farmacológico , Espermatozoides
5.
Clin Lab ; 68(6)2022 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-35704729

RESUMEN

BACKGROUND: The aim of this study was to investigate the infection and antimicrobial resistance of Ureaplasma urealyticum (U. urealyticum) and Mycoplasma hominis (M. hominis) in patients with genital tract diseases in Jiangsu, China. METHODS: A total of 3,321 patients suspected with genital tract infectious diseases were enrolled in this study from September 2017 to September 2020. The Mycoplasma detection and antimicrobial susceptibility were tested using the commercially available Mycoplasma kit. RESULTS: Among the 3,321 specimens tested, 1,503 (45.3%) were positive for Mycoplasmas, and the proportion of mono-infection of U. urealyticum is highest (79.5%). The overall infection rate has been increasing in the past 3 years. The positive rate in females (68.7%) was higher than in males (25.0%), and the main infection age group was 20 - 39 (81.2%). Besides, U. urealyticum and M. hominis displayed relative lower resistance rates to gatifloxacin, josamycin, minocycline, and doxycycline (6.0%, 6.5%, 3.1%, and 3.2%, respectively). However, the antimicrobial resistance rates to azithromycin, clindamycin, roxithromycin, sparfloxacin, and ofloxacin were relatively high (45.4%, 42.1%, 34.9, 36.0, and 65.5%, respectively). Antimicrobial resistance of U. urealyticum and M. hominis to these 14 drugs have been changing in the past 3 years. CONCLUSIONS: In total, these preliminary data showed the prevalence and antimicrobial resistance status of U. urealyticum and M. hominis in patients suspected with genital tract infectious diseases, which has use for reference on both prevention and treatment of diseases caused by them.


Asunto(s)
Enfermedades Transmisibles , Infecciones por Mycoplasma , Mycoplasma , Infecciones del Sistema Genital , Infecciones por Ureaplasma , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/epidemiología , Mycoplasma hominis , Prevalencia , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones del Sistema Genital/epidemiología , Infecciones por Ureaplasma/diagnóstico , Infecciones por Ureaplasma/tratamiento farmacológico , Infecciones por Ureaplasma/epidemiología , Ureaplasma urealyticum
6.
PLoS One ; 17(4): e0266764, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35446884

RESUMEN

Neisseria gonorrhoeae has been classified by the U.S. Centers for Disease Control and Prevention as an urgent threat due to the rapid development of antibiotic resistance to currently available antibiotics. Therefore, there is an urgent need to find new antibiotics to treat gonococcal infections. In our previous study, the gold-containing drug auranofin demonstrated potent in vitro activity against clinical isolates of N. gonorrhoeae, including multidrug-resistant strains. Therefore, the aim of this study was to investigate the in vivo activity of auranofin against N. gonorrhoeae using a murine model of vaginal infection. A significant reduction in N. gonorrhoeae recovered from the vagina was observed for infected mice treated with auranofin compared to the vehicle over the course of treatment. Relative to the vehicle, after three and five days of treatment with auranofin, a 1.04 (91%) and 1.40 (96%) average log10-reduction of recovered N. gonorrhoeae was observed. In conclusion, auranofin has the potential to be further investigated as a novel, safe anti-gonococcal agent to help meet the urgent need for new antimicrobial agents for N. gonorrhoeae infection.


Asunto(s)
Gonorrea , Infecciones del Sistema Genital , Animales , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Auranofina/farmacología , Auranofina/uso terapéutico , Modelos Animales de Enfermedad , Femenino , Oro/uso terapéutico , Gonorrea/tratamiento farmacológico , Gonorrea/microbiología , Humanos , Masculino , Ratones , Pruebas de Sensibilidad Microbiana , Neisseria gonorrhoeae , Infecciones del Sistema Genital/tratamiento farmacológico
7.
Am J Trop Med Hyg ; 105(6): 1684-1689, 2021 10 04.
Artículo en Inglés | MEDLINE | ID: mdl-34607308

RESUMEN

Streptococcus agalactiae serotype distribution and its antibiotic susceptibility affect disease prevention strategies, but the serotype distribution varies among patient groups. The objectives of this study were to establish the group B Streptococcus (GBS) serotype distribution in patients from Egypt and to assess antibiotic sensitivity of invasive GBS isolates. A total of 490 patients participated in this multicenter study; 160 had urinary tract infection, 115 complained of diabetic foot ulcers, 125 men had genital tract infections, and 30 women females had genital tract infections. Others had bronchopneumonia, otitis media, synovitis, or meningitis. Serotyping of the isolated GBS was performed at the CDC in the United States. Antibiotic sensitivity patterns were determined using the disk diffusion method. In men, the most common serotypes were II, III, and V, whereas types Ia, II, III, and V were isolated from women. Macrolides (erythromycin) resistance occurred in 4.1% of the isolates; 10.2% were resistant to both clindamycin and inducible resistance of macrolides, lincomycin, and streptogramin; 17.3% were resistant to quinolones; and 95.9% were resistant to tetracyclines. GBS primarily infected the urinary tract, skin, soft tissue, and genital tract in both genders. Isolates were sensitive to beta-lactam drugs, vancomycin, and linezolid; 14.0% were resistant to macrolides with or without clindamycin. Only 6.0% of the strains were sensitive to tetracyclines. Although GBS causes invasive infections in Egyptian adults, it rarely causes neonatal meningitis or sepsis. Future studies should determine whether GBS isolates are transmitted sexually, by performing a follow-up study of the partner of the infected patient.


Asunto(s)
Diabetes Mellitus/epidemiología , Infecciones Estreptocócicas/microbiología , Streptococcus agalactiae/genética , Adulto , Antibacterianos/uso terapéutico , Pie Diabético/tratamiento farmacológico , Pie Diabético/epidemiología , Pie Diabético/microbiología , Farmacorresistencia Bacteriana , Egipto/epidemiología , Femenino , Humanos , Masculino , Meningitis Bacterianas/tratamiento farmacológico , Meningitis Bacterianas/epidemiología , Meningitis Bacterianas/microbiología , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Epidemiología Molecular , Otitis Media/tratamiento farmacológico , Otitis Media/epidemiología , Otitis Media/microbiología , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/epidemiología , Neumonía Bacteriana/microbiología , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones del Sistema Genital/epidemiología , Infecciones del Sistema Genital/microbiología , Serogrupo , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/epidemiología , Streptococcus agalactiae/fisiología , Sinovitis/tratamiento farmacológico , Sinovitis/epidemiología , Sinovitis/microbiología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiología , Adulto Joven
8.
Carbohydr Polym ; 261: 117919, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33766328

RESUMEN

Vaginal administration is a promising route for the local treatment of infectious vaginal diseases since it can bypass the first-pass metabolism, drug interactions, and adverse effects. However, the commercial products currently available for topical vulvovaginal treatment have low acceptability and do not adequately explore this route. Mucoadhesive systems can optimize the efficacy of drugs administered by this route to increase the retention time of the drug in the vaginal environment. Several polymers are used to develop mucoadhesive systems, among them chitosan, a natural polymer that is highly biocompatible and technologically versatile. Thus, the present review aimed to analyze the studies that used chitosan to develop mucoadhesive systems for the treatment of local vaginal infections. These studies demonstrated that chitosan as a component of mucoadhesive drug delivery systems (DDS) is a promising device for the treatment of vaginal infectious diseases, due to the intrinsic antimicrobial activity of this biopolymer and because it does not interfere with the effectiveness of the drugs used for the treatment.


Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Quitosano/química , Portadores de Fármacos , Infecciones del Sistema Genital/tratamiento farmacológico , Enfermedades Vaginales/tratamiento farmacológico , Administración Intravaginal , Antiinfecciosos Locales/farmacocinética , Materiales Biocompatibles/síntesis química , Materiales Biocompatibles/química , Materiales Biocompatibles/farmacocinética , Quitosano/síntesis química , Quitosano/farmacocinética , Portadores de Fármacos/síntesis química , Portadores de Fármacos/química , Portadores de Fármacos/farmacocinética , Sistemas de Liberación de Medicamentos , Femenino , Humanos , Ensayo de Materiales , Infecciones del Sistema Genital/metabolismo , Enfermedades Vaginales/metabolismo
9.
Sex Transm Infect ; 97(8): 555-565, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-33608480

RESUMEN

OBJECTIVES: STIs cause inflammation that is detrimental for both HIV risk and reproductive health. We assessed the impact of point-of-care (POC) STI testing, immediate treatment and expedited partner therapy (EPT) on genital tract cytokines among a cohort of young South African women. METHODS: HIV-negative women underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) by Xpert CT/NG and OSOM TV, and for bacterial vaginosis (BV) by microscopy. Women with STIs and/or BV received immediate treatment, EPT for STIs and retested after 6 and 12 weeks. Concentrations of 48 cytokines were measured in cervicovaginal fluid at each visit using multiplex ELISA technology. The impact of STI treatment on cytokine concentrations was assessed by multivariable linear mixed models and principal component analysis. RESULTS: The study enrolled 251 women with median age of 23 years (IQR 21-27). The prevalence of CT, NG and TV were 14.3%, 4.4% and 4.0%, and 34.3% had BV. Women with STIs or BV at baseline (n=94) had significantly higher concentrations of pro-inflammatory cytokines (interleukin (IL)-1α, IL-1ß, IL-6, tumour necrosis factor (TNF)-α, TNF-ß, IL-18 and macrophage inflammatory factor (MIF)) and chemokines (IL-8, IL-16, macrophage inflammatory protein (MIP)-1α, IFN-α2, monokine induced by gamma interferon (MIG), monocyte chemoattractant protein (MCP)-3, regulated on activation normal T cell expressed and secreted and eotaxin) compared with women without (n=157). STI treatment was strongly associated with reduced concentrations of pro-inflammatory cytokines IL-6 (p=0.004), IL-1ß (p=0.013), TNF-α (p=0.018) and chemokines MIG (p=0.008) and growth-related oncogene (GRO)-α (p=0.025). A lower Nugent score was associated with a reduction in pro-inflammatory cytokines IL-1α (p=0.003), TNF-related apoptosis-inducing ligand (p=0.004), MIF (p=0.010) and IL-18 (p<0.001), but an increase in chemokines MIG (p=0.020), GRO-α (p<0.001), IP-10 (p<0.001), MIP-1ß (p=0.008) and MCP-1 (p=0.005). Principal component analysis showed differences in STI and BV-related inflammatory profiles, but that resolution restored a profile consistent with vaginal health. CONCLUSIONS: A comprehensive STI intervention effectively reduced genital inflammation among young women, thereby improving vaginal health and potentially reducing HIV risk.


Asunto(s)
Citocinas/inmunología , Inflamación/inmunología , Pruebas en el Punto de Atención/normas , Infecciones del Sistema Genital/inmunología , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/tratamiento farmacológico , Adolescente , Adulto , Antibacterianos/uso terapéutico , Estudios de Cohortes , Citocinas/análisis , Femenino , Humanos , Inflamación/tratamiento farmacológico , Estudios Prospectivos , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones del Sistema Genital/microbiología , Enfermedades de Transmisión Sexual/microbiología , Vagina/efectos de los fármacos , Vagina/microbiología , Adulto Joven
10.
Microbiologyopen ; 9(11): e1121, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32985133

RESUMEN

Candida tropicalis is a common human pathogenic yeast, and its molecular typing is important for studying the population structure and epidemiology of this opportunistic yeast, such as epidemic genotype, population dynamics, nosocomial infection, and drug resistance surveillance. In this study, the antifungal susceptibility test and multilocus sequence typing (MLST) analysis were carried out on C. tropicalis from central China. Among 64 urogenital isolates, 45 diploid sequence types (DST) were found, of which 20 DSTs (44.4%) were new to the central database. The goeBURST analysis showed that CC1 (clonal complex) was the only azole-resistant (100%, 10/10) cluster in Wuhan, which was composed of DST546, DST225, DST376, and DST506, and most of the strains (90%, 9/10) were isolated from the urinary tract. Potential nosocomial infections were mainly caused by CC1 strains. The azole resistance rate of urinary isolates (50.0%, 21/42) was higher than that of vaginal isolates (27.3%, 6/22). The genotype diversity and novelty of vaginal isolates were higher than those of urinary isolates. C. tropicalis population in Wuhan was genetically diverse and divergent from that seen in other countries. In this study, there were significant differences in genotype and azole susceptibility between urine and vaginal strains. The azole-resistant cluster (CC1) found in urine is of great significance for the clinical treatment and prevention of nosocomial infection. The newly discovered DSTs will contribute to further study the similarity, genetic relationship, and molecular epidemiology of C. tropicalis worldwide.


Asunto(s)
Azoles/uso terapéutico , Candida tropicalis/aislamiento & purificación , Candidiasis/epidemiología , Farmacorresistencia Fúngica/genética , Infecciones del Sistema Genital/epidemiología , Infecciones Urinarias/epidemiología , Antifúngicos/uso terapéutico , Candida tropicalis/efectos de los fármacos , Candida tropicalis/genética , Candidiasis/tratamiento farmacológico , Candidiasis/microbiología , China/epidemiología , Infección Hospitalaria/microbiología , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Tipificación de Secuencias Multilocus , Técnicas de Tipificación Micológica , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones del Sistema Genital/microbiología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología
11.
Rev Med Interne ; 41(7): 493-495, 2020 Jul.
Artículo en Francés | MEDLINE | ID: mdl-32371121

RESUMEN

INTRODUCTION: Lemierre's syndrome is defined as an oropharyngeal infection due to Fusobacterium necrophorum, associated with septic thrombophlebitis of the internal jugular vein. The uncommon pelvic variant of the syndrome is a rare condition, poorly described in literature. CASE REPORT: We report a case of gynecological Lemierre's syndrome in a 19-year-old woman after a first sexual intercourse, who presented acute respiratory failure, left internal iliac vein thrombosis with pulmonary embolism, in the setting of salpingitis and F. necrophorum bacteriemia. CONCLUSION: Gynecological Lemierre's syndrome is a rare and unrecognized condition, which could be lethal. Early recognition of the disorder enables initiation of appropriate antibiotic therapy for 4 to 6 weeks, and discussion of anticoagulant therapy which indications are not yet well defined.


Asunto(s)
Infecciones por Fusobacterium/diagnóstico , Síndrome de Lemierre/diagnóstico , Infecciones del Sistema Genital/diagnóstico , Antibacterianos/uso terapéutico , Femenino , Infecciones por Fusobacterium/tratamiento farmacológico , Infecciones por Fusobacterium/microbiología , Fusobacterium necrophorum/aislamiento & purificación , Humanos , Vena Ilíaca/microbiología , Vena Ilíaca/patología , Síndrome de Lemierre/tratamiento farmacológico , Síndrome de Lemierre/microbiología , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones del Sistema Genital/microbiología , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/tratamiento farmacológico , Síndrome de Dificultad Respiratoria/microbiología , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/microbiología , Tromboflebitis/diagnóstico , Tromboflebitis/tratamiento farmacológico , Tromboflebitis/microbiología , Adulto Joven
12.
Eur J Clin Microbiol Infect Dis ; 39(2): 229-234, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31522281

RESUMEN

Mycoplasma genitalium was first isolated from the urethral swabs of two symptomatic men with urethritis in 1980. It is a sexually transmitted bacterium associated with a number of urogenital conditions in women like cervicitis, endometritis, pelvic inflammatory disease, infertility, and susceptibility to human immunodeficiency virus (HIV). However, M. genitalium may also act like a stealth pathogen at female reproductive tract, giving no symptoms. Its prevalence varies between different groups, with the average being 0.5-10% in the general population and 20-40% in women with sexually transmitted infections. The recommended treatment of this infection is azithromycin as a single 1-g dose. However, in recent years, macrolide resistance has increased which is significantly lowering the cure rate, being less than 50% in some studies. New treatment regimens need to be investigated due to increasing drug resistance. The discussion and suggestion of an algorithm for management of this infection is the highlight of this paper.


Asunto(s)
Farmacorresistencia Bacteriana , Infecciones por Mycoplasma/diagnóstico , Mycoplasma genitalium/patogenicidad , Infecciones del Sistema Genital/microbiología , Enfermedades de Transmisión Sexual/microbiología , Antibacterianos/uso terapéutico , Infecciones Asintomáticas , Azitromicina/uso terapéutico , Femenino , Humanos , Macrólidos/uso terapéutico , Infecciones por Mycoplasma/tratamiento farmacológico , Mycoplasma genitalium/aislamiento & purificación , Enfermedad Inflamatoria Pélvica/microbiología , Prevalencia , Infecciones del Sistema Genital/tratamiento farmacológico , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Uretritis/microbiología
13.
Artículo en Inglés | MEDLINE | ID: mdl-31740561

RESUMEN

Maraviroc-based regimens have been explored as preexposure prophylaxis (PrEP) against human immunodeficiency virus (HIV). In this study, we utilized mucosal tissue drug exposure data, combined with target concentrations generated in vitro, in a pharmacokinetic-pharmacodynamic analysis to predict the effects of drug combinations and adherence on PrEP efficacy. Mucosal tissue concentrations of maraviroc were measured in 24 healthy women. The 90% effective concentrations (EC90) of maraviroc (alone and combined with tenofovir and emtricitabine) for protection against HIV were identified in CD4+ T cells. Monte Carlo simulations were performed to identify dosing strategies to protect colorectal and female genital tract (FGT) tissues from HIV infection. Colorectal maraviroc concentrations were 350-fold higher than in the FGT. Under steady-state conditions, our model predicted that one 300-mg dose/week was sufficient to protect colorectal tissue from HIV in 99% of the population, while 300 mg daily would protect the FGT in only 63% of the population. FGT protection increased to >90% when maraviroc was used in combination with tenofovir (5 doses/week) or emtricitabine (3 doses/week). Poor adherence resulted in a drastic decrease in efficacy in the FGT but not colorectal tissue. However, greater forgiveness was seen when maraviroc was combined with tenofovir or emtricitabine, suggesting that maraviroc should not be used alone as PrEP.


Asunto(s)
Fármacos Anti-VIH/farmacocinética , Emtricitabina/farmacocinética , Infecciones por VIH/prevención & control , Maraviroc/farmacocinética , Profilaxis Pre-Exposición , Infecciones del Sistema Genital/tratamiento farmacológico , Tenofovir/farmacología , Fármacos Anti-VIH/administración & dosificación , Linfocitos T CD4-Positivos , Estudios de Cohortes , Simulación por Computador , Demografía , Quimioterapia Combinada , Emtricitabina/administración & dosificación , Femenino , Infecciones por VIH/virología , Humanos , Maraviroc/administración & dosificación , Infecciones del Sistema Genital/virología , Tenofovir/administración & dosificación , Resultado del Tratamiento
14.
Acta Vet Scand ; 61(1): 25, 2019 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-31146786

RESUMEN

BACKGROUND: Although artificial insemination (AI) was developed as a means of controlling disease transmission, pathogens can still be transmitted to females in semen used for AI. In addition, bacteria can cause deterioration in sperm quality during storage. Semen becomes contaminated by the male's normal bacterial flora as it passes out of the reproductive tract but potential pathogens may also contaminate the semen. Therefore, semen samples from stallions to be used for AI are tested before the breeding season to minimize transmission of pathogens to inseminated mares. In Sweden, semen samples are tested at the National Veterinary Institute, Uppsala (SVA). For the present study, a retrospective analysis was made of potentially pathogenic bacteria isolated from samples submitted to the SVA from 2007 to 2017. RESULTS: In our study, Taylorella equigenitalis was found infrequently (53 out of 25,512 samples), representing 11 out of 2308 stallions. If T. equigenitalis was detected, the stallions were treated with antibiotics and re-tested later in the same year. Klebsiella pneumoniae and beta haemolytic streptococci were the most commonly found potential pathogens, whereas Pseudomonas aeruginosa was also isolated occasionally. There were considerable differences in the number of species isolated each year. CONCLUSIONS: Potential pathogens were identified in relatively few of the samples submitted to SVA during this period, with T. equigenitalis not being identified since 2015. Of the other potential pathogens, K. pneumoniae and beta haemolytic streptococci were the most common. The information is relevant for determining guidelines on the testing and treatment of stallions before breeding.


Asunto(s)
Infecciones Bacterianas/veterinaria , Fenómenos Fisiológicos Bacterianos , Líquidos Corporales/microbiología , Genitales Masculinos/microbiología , Enfermedades de los Caballos/microbiología , Infecciones del Sistema Genital/veterinaria , Semen/microbiología , Animales , Antibacterianos/uso terapéutico , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Enfermedades de los Caballos/diagnóstico , Enfermedades de los Caballos/tratamiento farmacológico , Caballos , Inseminación Artificial , Masculino , Infecciones del Sistema Genital/diagnóstico , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones del Sistema Genital/microbiología , Suecia
15.
Sex Health ; 16(4): 332-339, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31122336

RESUMEN

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT). METHODS: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake. RESULTS: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners. CONCLUSIONS: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice.


Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Infecciones por Chlamydia/tratamiento farmacológico , Atención a la Salud , Política de Salud , Infecciones del Sistema Genital/tratamiento farmacológico , Parejas Sexuales , Instituciones de Atención Ambulatoria , Infecciones por Chlamydia/transmisión , Chlamydia trachomatis , Trazado de Contacto , Heterosexualidad , Humanos , Ciencia de la Implementación , Legislación de Medicamentos , Nueva Gales del Sur , Proyectos Piloto , Infecciones del Sistema Genital/transmisión
16.
Biomed Microdevices ; 21(2): 36, 2019 03 29.
Artículo en Inglés | MEDLINE | ID: mdl-30923927

RESUMEN

Infections of the female reproductive tract are a major cause of morbidity and mortality in humans, requiring significant investment to sustain treatment and representing a major challenge to health. The increasing prevalence of bacterial resistance, and an almost complete absence of new antibiotic therapies for the past five decades, mean there is a desperate need for novel approaches to the treatment of bacterial infections. Within the present study, we demonstrate the effective ex vivo treatment of bacterial infection of the female reproductive tract using a controlled-release, liquid crystal-based platform. Liquid crystal encapsulation of ciprofloxacin significantly enhanced its bactericidal efficacy and reduced cell toxicity. Liquid crystal structures are low-cost, simple to manufacture and provide a sustained-release profile of encapsulated ciprofloxacin. Treatment of Escherichia coli infected reproductive tract epithelial cells and whole organ cultures with liquid crystal encapsulated ciprofloxacin proved to be an effective strategy for reducing bacterial load and reproductive tract inflammatory responses to infection. These data suggest that such an approach could provide an efficacious treatment modality for enhancing the effectiveness of current antibiotic therapies.


Asunto(s)
Antibacterianos/química , Antibacterianos/farmacología , Ciprofloxacina/química , Ciprofloxacina/farmacología , Portadores de Fármacos/química , Cristales Líquidos/química , Infecciones del Sistema Genital/tratamiento farmacológico , Antibacterianos/uso terapéutico , Supervivencia Celular/efectos de los fármacos , Ciprofloxacina/uso terapéutico , Portadores de Fármacos/toxicidad , Células Epiteliales/citología , Células Epiteliales/efectos de los fármacos , Escherichia coli/efectos de los fármacos , Escherichia coli/fisiología , Femenino , Células HeLa , Humanos , Cristales Líquidos/toxicidad , Pruebas de Sensibilidad Microbiana
17.
PLoS One ; 14(3): e0213062, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30822331

RESUMEN

BACKGROUND: Persistence of high-risk human papillomavirus (hr-HPV) infections is the most critical risk factor for cervical intraepithelial neoplasia (CIN) and cervical cancer (CC). Treatment of persistent oncogenic HPV-positive women after 12-24 months follow-up is still controversy. Detoxification therapy of Chinese medicine (DTCM) has been conducted recently. However, the conclusions are still unclear. We planned to conduct a systematic review and meta-analysis to explore DTCM in the treatment of persistent hr-HPV infections. METHODS: Nine electronic databases were systematically searched from their inception to 30 September 2018. Randomized controlled trials comparing DTCM with follow-up or placebo were included. Risk of bias was assessed by the Cochrane 'Risk of Bias' tool. Review Manager 5.3 was used for statistical analyses. Relative ratios (RR) and 95% confidence intervals were used for dichotomous data, and the mean difference (MD) was used for continuous data. We assessed the quality of trials by the GRADE. RESULTS: Seventeen RCTs from 2011 to 2018 with 1906 participants were included. The evidence showed that DTCM had a pooled efficacy difference in favor of increasing the HPV clearance rate compared to placebo groups (RR = 2.62, 95% CI 1.28 to 5.33, very low quality) and follow-up groups (RR = 1.88, 95% CI 1.60 to 2.22, low quality). The median HPV persistence tended to decline from 50% within six months to 41.5% at 12 months, and 31.5% at 24 months. A significantly increased regression rate of CIN was found in the DTCM compared with placebo groups (RR = 3.61, 95% CI 1.21 to 10.83, very low quality) and follow-up groups (RR = 1.79, 95% CI 1.31 to 2.45, very low quality). Additionally, we found DTCM have an impact on TNF-α (MD = 2.99, 95% CI 1.90 to 4.07; very low quality), IFN-α (MD = 3.47, 95% CI 2.42 to 4.52; very low quality), CD4+/CD8+ cells (MD = 0.21, 95% CI 0.05 to 0.37; very low quality) compared with follow up groups in some trials with small sample sizes. The major adverse events were genital mucosal irritation symptoms (10%, 5/50). CONCLUSIONS: DTCM have favorable outcomes on improving the HPV clearance rate, increasing the regression rate of CIN, and impacting the proportion of some immune cells and cytokine levels. However, most of the evidence was of low quality. Any future high-quality trials and a more extended follow-up period of 24 months or more should be performed.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Medicina Tradicional China/métodos , Infecciones por Papillomavirus/tratamiento farmacológico , Infecciones del Sistema Genital/tratamiento farmacológico , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/efectos adversos , Femenino , Humanos , Medicina Tradicional China/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto
18.
Eur J Pharm Biopharm ; 138: 37-47, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30195726

RESUMEN

The secreted mucus layer in the vaginal epithelium presents a formidable barrier to the transport of active agents for the prevention and treatment of female reproductive tract (FRT) infections. Nanoparticle-mediated drug delivery has been proposed to help facilitate the transport and release of active agents through the cervicovaginal mucus (CVM) and underlying mucosa. However, both nanoparticles (NPs) and free active agents face a variety of challenges, often requiring the administration of high localized doses to circumvent leakage and poor penetration to targeted intravaginal tissue compartments. To address these challenges, "stealth" NP modifications have been investigated, due to their favorable mucus-penetrating properties, resulting in improved intravaginal active agent retention and transport. A number of other NP characteristics including size, surface modification type, ligand density, and co-modification, as well as the complexity of the FRT tissue are involved in obtaining adequate tissue penetration and, if needed, cell internalization. Studies that systematically investigate variations of these characteristics have yet to be conducted, with the goal to obtain a better understanding of what properties most impact prophylactic and therapeutic benefit. To complement the progress made with experimental evaluation of active agent transport in in vitro and in vivo, mathematical modeling has recently been applied to analyze the transport performance of agents and delivery vehicles in the FRT. Here, we build upon this work to simulate NP transport through mucus gel, epithelial, and stromal compartments, with the goal to provide a platform that can systematically evaluate transport based on NP and tissue characteristics. Model parameters such as PEG density and NP release (decay) rate from mucus gel into the epithelium, are set from previous in vitro and in vivo experimental work that assessed the transport of poly(lactic-co-glycolic acid (PLGA) NPs. The modeling results show that while unmodified and 2% PEG-modified NPs were retained in mucus for ∼1-4 h, dependent upon decay constant values, and traverse to the epithelium, no NP penetration was observed in the stroma. In contrast, NPs modified with 3% PEG, exhibited prolonged retention in each compartment, remaining for ∼4-6 h. Moreover, a significant concentration of NPs is observed in the stroma, indicating a transition in transport behavior. For NPs modified with 5, 8, or 25% PEG, steady retention profiles were noted, which gradually decline over 24 h. To supplement this modeling study and to develop a more representative experimental system that may be useful in future work, we report on the feasibility of constructing single and multicellular layered (MCL) culture systems to represent the epithelial and stromal tissue of the FRT. We anticipate that a combined mathematical/experimental approach may longer term enable prediction and customization of patient tissue-specific approaches to attain effective NP-mediated drug delivery and release for the treatment of infectious disease.


Asunto(s)
Enfermedades Transmisibles/tratamiento farmacológico , Genitales Femeninos/efectos de los fármacos , Nanopartículas/administración & dosificación , Infecciones del Sistema Genital/tratamiento farmacológico , Transporte Biológico/efectos de los fármacos , Línea Celular Tumoral , Portadores de Fármacos/química , Sistemas de Liberación de Medicamentos/métodos , Células Epiteliales/efectos de los fármacos , Femenino , Humanos , Moco/efectos de los fármacos , Nanopartículas/química , Copolímero de Ácido Poliláctico-Ácido Poliglicólico/química
19.
Exp Clin Transplant ; 17(4): 470-477, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30381050

RESUMEN

OBJECTIVES: Long-term outcomes of kidney transplant recipients with postoperative genitourinary tract infections are not well characterized. In this single center retrospective study, we aimed to investigate the long-term effects of early posttransplant genitourinary infections under a protocol that included 1 month of antibiotic prophylaxis on graft failure and patient outcomes. MATERIALS AND METHODS: Electronic medical records of 1752 recipients of kidney-alone transplant between January 2000 and December 2008 were reviewed. Of these, 344 patients had postoperative genitourinary tract infections within 6 months of transplant. Infections included urinary tract infections, recurrent urinary tract infections, and pyelonephritis. All patients received 1-month of treatment with antibiotic prophylaxis for genitourinary infections after graft placement. Kaplan-Meier survival curves and multivariable regression modeling were performed to determine survival outcomes. RESULTS: In the 344 patients with postoperative infections, the most common cause was Escherichia coli (34.9%). Kaplan-Meier graft survival results showed no significant differences (P = .08) among those with and those without postoperative urinary tract infections; however, patient survival (P = .01) was significantly different. Multivariate analysis demonstrated no significant trend regarding graft failure (hazard ratio: 1.28; 95% confidence interval, 0.95-1.71; P = .09) or patient death (hazard ratio: 1.33; 95% confidence interval, 0.98-1.79; P = .06) in patients with and without genitourinary infections. The major cause of graft failure was infection in the infection cohort (17.4%). CONCLUSIONS: Kidney transplant recipients who develop urinary tract infections within 6 months of transplant may be at increased risk of graft failure or patient death; however, further studies are needed to elucidate the relationship between posttransplant infections and long-term outcomes.


Asunto(s)
Antibacterianos/uso terapéutico , Trasplante de Riñón/efectos adversos , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológico , Adulto , Registros Electrónicos de Salud , Femenino , Supervivencia de Injerto , Humanos , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Infecciones del Sistema Genital/diagnóstico , Infecciones del Sistema Genital/microbiología , Infecciones del Sistema Genital/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/microbiología , Infecciones Urinarias/mortalidad , Adulto Joven
20.
Ann Clin Microbiol Antimicrob ; 17(1): 40, 2018 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-30466466

RESUMEN

OBJECTIVES: The long-term use of intrauterine devices (IUDs) may lead to biofilm formation on the surface. The aim of this study was to perform the culture- and PCR-based detection of bacteria/fungi from the biofilm of the removed IUDs with different time periods in place. METHODS: For a 2-year period, 100 IUD users were involved in the study. In the majority of the cases, IUDs were removed because of the patients' complaints. Beside the aerobic and anaerobic culture, species-specific PCR was carried out to detect Chlamydia trachomatis Neisseria gonorrhoeae and the "signalling" bacteria of bacterial vaginosis (BV) in the biofilm removed by vortexing. RESULTS: Sixty-eight percent of IUDs were used for more than 5 years, 32% were removed after 10 years in place. In 28% of the IUDs ≥ 3 different anaerobic species typically found in BV with or without other aerobic bacteria were found by culture method. Streptococcus agalactiae (14%) and Actinomyces spp. (18%) were also isolated frequently. The PCR detection of Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp. and Ureaplasma urealyticum were 62%, 32%, 23% and 16%, respectively. Seventy-six percent of the IUDs were PCR positive at least for one "signalling" bacterium of BV. C. trachomatis was detected by PCR only in one IUD together with other aerobic and anaerobic bacteria, while the presence of N. gonorrhoeae could not be confirmed from the biofilm of these removed devices. CONCLUSION: Sexually transmitted infections (STI)-related bacteria-except for one patient-were not detected on the IUDs removed due to different reasons including clinical symptoms of infection. Presence of any BV "signaling" anaerobic bacteria were detected in a much higher number in the biofilm of the removed IUDs by PCR-based method compared to use culture method (76 versus 28 samples). Different aerobic and anaerobic bacteria colonized an equal number of IUDs, independent of the time-period in place, which may be relevant, if the IUD is removed due to planned pregnancy or due to a fear from upper genital tract infection caused by anaerobic bacteria including Actinomyces spp.


Asunto(s)
Biopelículas/crecimiento & desarrollo , Dispositivos Intrauterinos/efectos adversos , Dispositivos Intrauterinos/microbiología , Infecciones del Sistema Genital/tratamiento farmacológico , Infecciones del Sistema Genital/etiología , Vaginosis Bacteriana/tratamiento farmacológico , Vaginosis Bacteriana/etiología , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Infecciones del Sistema Genital/diagnóstico , Infecciones del Sistema Genital/microbiología , Factores de Tiempo , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/microbiología , Adulto Joven
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