[Chlamydia trachomatis infection of the genitals in women]. / Quelques aspects de l'infection à Chlamydia trachomatis à localisation génitale chez la femme.

Direct and by immunofluorescence examination of smears, conducted on 682 women with different diseases of the cervix uteri, allowed the detection of Chl. trachomatis in 10.5% and 11.1% of the subjects, respectively. The incidence of the infection was significantly higher among unmarried women (33.7%) than among married ones (4.2%). In a second group of 305 women, sexual partners of men with chlamydial urethritis, the incidence of infection as found by the two methods of diagnosis was 57.3% and 59.3%, respectively. Colposcopy showed that more than 90% of these women had lesions at the cervix uteri level. High frequency of cervicitis, associated frequently with ectopy of the cervical epithelium in the case of Chl. trachomatis infection, suggested the determinant implication of this pathogen in the inflammatory lesions of the cervix uteri. The ectopy of the cervix epithelium is probably a factor favoring the multiplication of the pathogen.

Investigations on the role of some viral, chlamydian, rickettsian and mycoplasmic agents in several gynecological diseases.

This work presents the results of a study on some viral, chlamydial, rickettsial and mycoplasmal agents incidence and their role on several gynecological ailments: vulvovaginitis, cervicitis, cervicovaginitis. The presence of some viral, chlamydial, rickettsial and mycoplasmal antigens in the vaginal secretion was investigated by immunofluorescence technique, isolation on selective media for Mycoplasma, and MGG staining in a group of 60 women with gynecopathies (group A) and in a control group (also 60 clinically healthy women) (group B). This study pointed out to higher incidence of chlamydial and mycoplasma antigens as well as of parainfluenza virus types I and III, adenovirus and herpes virus type II in group A. The serological screening revealed significant differences between the specific antibodies to antigens found in vaginal secretions to prove the presence of an immunological response on the same category of subjects.

Viral and rickettsial etiology of an outbreak of acute respiratory tract infection.

An outbreak of 111 cases of acute respiratory tract infection was recorded in a community of the town "T" in April-May 1984. The clinical picture was severer than usual; 28% of the cases had to be hospitalized, average absenteeism being as high as 26 days per case. Serological investigations demonstrated the previous circulation of influenza virus B/Singapore/222/79 and the simultaneous circulation during the outbreak of influenza virus A/England/333/80 (H1N1) and of Rickettsia burneti (as also ascertained by isolation in the chick embryo of the former and by visualization by immunofluorescence in exfoliated cells of the latter pathogen). The association of the two etiological agents appears to account for the severe and protracted course of the disease.

Contribution of the rapid viral diagnosis by immunofluorescence to the choice of therapy in uveitis cases.

Viral and inframicrobial antigens were detected by immunofluorescence (IF) in exfoliated conjunctival and corneal cells from 22 patients with uveitis, 2-9 different antigens being simultaneously visualized in 17 of the cases. The treatment applied on the ground of the etiological diagnosis specified by IF reactions consisted in the administration of tetracycline, Flumidin (Virustat), standard gamma-globulin or specific antiherpes immunoglobulin, the NIVGRIP inactivated influenza vaccine. This therapy led to persistent recovery (coincident with the disappearance of the antigens from conjunctival cells) in 15 cases and to clinical improvement in 7 cases. The importance of the rapid viral diagnosis by IF for the choice of an adequate therapy of uveitis is discussed.

Rapid detection by immunofluorescence of multiple viral infections in patients with keratitis.

The presence of 12 viral (herpes 1 and 2, influenza A(H1N1), A(H3N2) and B, parainfluenza 1, 2, 3, adenovirus 5) and inframicrobial (Chlamydia, mycoplasma, Rickettsia burneti) antigens was investigated by direct or indirect immunofluorescence (IF) reactions in exfoliated conjunctival cells from 110 patients with nonbacterial keratitis and keratoconjunctivitis. A rapid etiological diagnosis could be obtained in 101 (92%) of the cases, parainfluenza and herpes antigens being the most frequently detected. In most of the cases the simultaneous presence of several antigens was made evident. Encouraging results were obtained by the application of a specific treatment based on the diagnosis provided by the IF reaction.

Multiple viral and inframicrobial infections detected by immunofluorescence reaction in exfoliated cells from patients with eye or respiratory diseases.

The presence of viral (herpes 1 and 2, influenza A and B, parainfluenza 1, 2, and 3, adenovirus) and inframicrobial (Chlamydia, R. burneti and mycoplasma) antigens was investigated by indirect immunofluorescence reaction in exfoliated cells from 107 patients with chronic eye diseases and 77 patients with chronic respiratory diseases. Single or associated viral or inframicrobial antigens were detected in 80% of the former and in 60% of the latter patients. The proportion of multiple infections was of about 60% in both patient groups.

Prevalence of chlamydial infections in male patients with nongonococcal urethritis.

Direct examination of urethral smears made evident the presence of chlamydial infection in 162 (38.1%) of 425 male patients with nongonococcal urethritis. Serum antibodies to the group antigen could be detected by complement fixation and microagglutination reactions only in about 50% of the cases with chlamydial infection. The proportion of chlamydial strains isolated in chick embryos was rather low (14.8%) and the isolation rate appeared to correlate with the abundance of urethral secretion.

Investigations on the presence of viral and chlamydial antigens in cells exfoliated in the vagina of women with common and malignant gynecopathies.

A high proportion of parainfluenza, herpes, adenovirus and chlamydial antigens (10.7-36%) was detected by indirect immunofluorescence in cells exfoliated in the vagina of women with genital neoplasia and with uterine cervix ectopia and dysplasia. Much lower proportions of the same antigens were found in patients with common gynecopathies or recurrent genital herpes and in pregnant women. The possible relationships between chronic virus infections and genital neoplasia in women are discussed.

Specific prophylaxis of enzootic chlamydial ovine abortion.

A vaccine against chlamydial ovine abortion was prepared according to an original method and experimentally applied to more than 500,000 animals in large breeding units. The vaccine induced a considerable seroconversion (as demonstrated by complement fixation tests) and reduced by 3--5 times the damage due to chlamydioses. Vaccination of primiparous ewes, followed by 2--3 annual revaccinations, gave good results, conferring resistance on the vaccinated animals.

An antigen for the diagnosis of M. pneumoniae infections by passive hemagglutination.

The authors establish the optimal conditions (protein concentration, temperature) for the coupling of purified mycoplasma antigen to sheep red blood cells, in order to obtain an antigenic complex stable for at least 1 year. This comples allows specific determination by passive hemagglutination--a simple and rapid technique--of anti-mycoplasma antibodies in the sera of men or animals suspected of mycoplasma infections. Under the stated experimental conditions, antibody titers equal to or higher than 1/128 indicate an infection with M. pneumoniae.

Passive hemagglutination and complement fixation reactions in the early diagnosis of Mycoplasma pneumoniae infections.

Complement fixation (CF) and passive hemagglutination (PHA) tests (the latter with a M. pneumoniae antigen coupled by glutaraldehyde onto red blood cells) were performed in 263 patients with various infectious diseases (mostly in the 1st and 2nd week after onset) and non-infectious ones. CF reaction proved to be inappropriate for the early etiological diagnosis of mycoplasma infections, since the high titers were distributed undifferentially among the various patient groups and many sera (38%) showed anticomplementary activity. A PHA titer of at least 1/128 (preferably of 1/512) points to the presence of a M. pneumoniae infection, especially if clinical, radiological and laboratory data suggest a nonbacterial or mixed pneumonia. The diagnosis is often early enough to orientate the etiological therapy towards macrolides and tetracyclines. The PHA reaction recommended is specific, sensitive, reproducible and easy to perform.

Investigations on some antigenic relationships between different human, mammalian and avian Chlamydia strains.

Serological investigations were performed in order to establish the antigenic relationships between three Chlamydia strains: T44(subgroup A), T13 and Q18 (subgroup B). By using monospecific mouse immune sera a certain degree of antigenical relationships was made evident and the strains could be typed by microagglutination and microimmlnofluorescence reactions. Similar results were obtained by seroneutralization with hyperimmune sera prepared in the rooster. Complement fixation proved to be a group-specific reaction unable to reveal significant differences between the strains studied, not even with monospecific mouse sera. The antigenic relationships established between strains T44 (trachoma) and T13 (psittacosis) suggest the existence features common to subgroup A and B Chlamudia strains. The importance of typing Chlamudia strains with a view to specific prophylaxis is emphasized.

Preliminary investigations on the diagnostic value of passive hemagglutination and complement fixation tests in infections with Mycoplasma pneumoniae.

In order to evaluate the efficiency of passive hemagglutination (PHA) and complement fixation (CF) tests for the diagnosis of M. pneumoniae infections, 144 serum samples--out of which 81 from patients with respiratory and cutaneous infections and 63 from subjects with other diseases (controls)--were comparatively investigated by the two methods. The PHA test made evident a positivity index of 65% in the case of mixed pneumonias, as against 17% in controls, while the results obtained by CF were almost identical in the two groups investigated. The high specificity and sensitivity of the PHA reaction recommend this method for the diagnosis of acute M. pneumoniae infections.