Serogroup distribution of urogenital Chlamydia trachomatis in urban ethnic groups in The Netherlands.

The prevalence of Chlamydia trachomatis varies between ethnic groups in The Netherlands. It is, however, unknown whether this is associated with specific serogroups. The objective of this study was to determine whether serogroup distribution is associated with ethnic origin in the region of The Hague, The Netherlands. Serogroups of 370 microbiologically confirmed C. trachomatis-positive samples were analysed. The samples were obtained from 247 women and 123 men between January and October 2008, of self-reported Dutch Caucasian, Dutch Antillean, Surinamese, N. African/Turkish or other descent. We observed a difference in serogroup distribution comparing Dutch Caucasian women to Dutch Antillean women (χ2 for distribution P = 0·035). Serogroup C was more common in Dutch Antillean women, whereas serogroup B was less common (P = 0·03). This difference was not observed for Dutch Antillean men. The observed difference in distribution of C. trachomatis serogroups between ethnic groups is relevant for further transmission studies.

Analyses of multiple-site and concurrent Chlamydia trachomatis serovar infections, and serovar tissue tropism for urogenital versus rectal specimens in male and female patients.

OBJECTIVES: The aims of this study were: to determine the incidence of concurrent infections on a serovar level; to determine the incidence of multiple anatomical infected sites on a detection and genotyping level and analyse site-specific serovar distribution; to identify tissue tropism in urogenital versus rectal specimens. METHODS: Chlamydia trachomatis-infected patients in two populations were analysed: 75 visiting the outpatient department of obstetrics and gynaecology of the MC Haaglanden, and 358 visiting the outpatient sexually transmitted disease clinic, The Hague, The Netherlands. The PACE 2 assay (Gen-Probe) was used to detect C trachomatis from urethral, cervical, vaginal, oropharyngeal and anorectal swabs. C trachomatis genotyping was performed on all C trachomatis positive samples, using the CT-DT genotyping assay. RESULTS: Samples from 433 patients (256 female and 177 male) with confirmed C trachomatis infection were analysed. In 11 patients (2.6%), concurrent serovars in one anatomical sample site were present. In 62 (34.1%) female and four (9.3%) male patients, multiple sample site infections were found. A substantial percentage of women tested at the cervical/vaginal and rectal site were found to be positive at both sites (36.1%, 22/61). In men, D/Da and G/Ga serovars were more prevalent in rectal than urogenital specimens (p=0.0081 and p=0.0033, respectively), while serovar E was more prevalent in urogenital specimens (p=0.0012). CONCLUSIONS: The prevalence of multiple serovar infections is relatively low. Significant differences in serovar distribution are found in rectal specimens from men, with serovar G/Ga being the most prominent, suggesting tissue tropism.

Significantly higher serologic responses of Chlamydia trachomatis B group serovars versus C and I serogroups.

Chlamydia trachomatis serovars are divided into three serogroups, namely serogroup B, serogroup I (Intermediate) and serogroup C, and subsequently into 19 different serovars. Worldwide, serogroup B is the most prevalent followed by serogroup I. Clear differences have been observed in the duration of infection and growth kinetics between serovars from different serogroups in murine and cell culture models. Reasons for these observed differences are bacterial and host related, and are not well understood. The aim of this study was to determine the differences in immunoglobulin (Ig) G responses between the three serogroups in a group of patients infected with different serovars. Serovars were assessed from 235 C. trachomatispositive patients and quantitative IgG responses were determined. Analyses of variance were used to compare the IgG responses between the three serogroups. Of the serovars, 46% were B group (with serovar E the most prevalent: 35.3%), 39.6% were I group and 14.3% were C group. A highly significant difference in serologic response was shown when comparing the mean IgG concentrations (AU/mL) of patients having serovars in the most prevalent serogroup compared to the other serogroups: B = 135, C = 46 and I = 60 (B vs. C and B vs. I, P < 0.001). In conclusion, the most prevalent serovars generate the highest serologic responses.

Comparison of serological assays for detection of Chlamydia trachomatis antibodies in different groups of obstetrical and gynecological patients.

New serological enzyme immunoassays (EIAs) were compared with microimmunofluorescence (MIF) as a "gold standard" to detect Chlamydia trachomatis antibodies in different groups of obstetrical, gynecological, and subfertile patients. There were no significant differences in seroprevalence rates, except for the group of C. trachomatis-positive patients (P < 0.01). Test characteristics were calculated for Chlamydia-EIA (Biologische Analysensystem GmbH, Lich, Germany) and pELISA (Medac, Wedel, Germany). pELISA seems to be a good alternative to MIF. It has high specificity and is easier to perform.

Clinical characteristics of Chlamydia trachomatis infections in a general outpatient department of obstetrics and gynaecology in the Netherlands.

OBJECTIVE: Evaluation of prevalence and risk factors of Chlamydia trachomatis infections in an outpatient obstetric and gynaecological population. METHODS: A prospective, observational study was performed at an inner city hospital in The Hague, Netherlands. 1368 women attending the outpatient department of obstetrics and gynaecology participated in the study. For detection of C trachomatis infections we used amplification of CT rRNA in urine samples (Gen Probe/AMPLIFIED-CT) and DNA probe for detection of CT rRNA from a urethral, endocervical and anal swab (Gen Probe/PACE 2). RESULTS: The overall prevalence of C trachomatis infections in our general obstetric and gynaecological population was 4.5%. The prevalence in women under 30 years of age was 8. 1%. We found age and postcoital bleeding to be significant risk factors. We did not find significant differences between women from different ethnic origin or between women using different kinds of contraceptives. 12 (19.4%) patients with C trachomatis infections were found positive by urine test only, and 15 (24.2%) only by DNA probe. CONCLUSIONS: Age is the most important risk factor in our population (overall prevalence 4.5%, prevalence in women under 20 years of age 15.8%). Analyses of urine and of endocervical specimens are complementary for the determination of the prevalence of C trachomatis infections in women. Cost effectiveness analysis is needed to determine to what extent age based screening and/or antibiotic prophylaxis before intrauterine manipulations is indicated.

[Echographic recognition of tuberculous peritonitis]. / Peritonitis tuberculosa echografisch te herkennen.

OBJECTIVE: To assess the role of ultrasonography (US) and US-guided puncture in the diagnostic procedure of tuberculous peritonitis. DESIGN: Retrospective study. SETTING: An inner-city hospital: Westeinde Ziekenhuis, The Hague, the Netherlands. METHODS: Of 12 patients with bacteriologically confirmed tuberculous peritonitis diagnosed between 1987 and 1995, the results of ultrasonography and the bacteriological and cytological results of US-guided puncture were studied. RESULTS: The ultrasonographic appearance of wet tuberculous peritonitis was recognized by the radiologist in all 11 cases. There was loculated ascites with fine septations as well as thickening of peritoneum, mesentery and omentum. Ultrasonography was of no merit in the one case of peritonitis sicca in this study. US-guided puncture of ascites and omentum yielded a bacteriological diagnosis in eight patients, six of whom had a positive Ziehl-Neelsen or auramine test. In two other patients cytological examination showed a granulomatous inflammation. On average, the ultrasonographic diagnosis of wet tuberculous peritonitis was suggested 3 days after admission and bacteriologically confirmed 10 days later. Eleven of the 12 patients were immigrants from countries where tuberculosis is endemic. The mean duration of residency in the Netherlands was 7 years. CONCLUSION: Ultrasonography is valuable in the diagnostic procedure of tuberculous peritonitis in that it considerably reduces diagnostic delay and unnecessary surgical procedures are avoided.

Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella: clinical, radiological and US findings.

Yersinia, Campylobacter, and Salmonella are pathological microorganisms which incidentally may specifically infect the ileocecal area (infectious ileocecitis). In such cases pain in the right lower quadrant is the predominant symptom, and diarrhea is absent or only mild. This symptomatology can lead to an unnecessary laparotomy for suspected appendicitis. At surgery a normal appendix is removed, while there is edematous thickening of ileum and cecum, and enlarged mesenteric lymph nodes. These ileocecal abnormalities give rise to a fairly characteristic US image, enabling the radiologist to rapidly differentiate infectious ileocecitis from appendicitis, thus preventing an unnecessary laparotomy. Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella is a common mimicker of appendicitis, and its incidence at this moment is grossly underestimated. Ultrasound is presently the only means to prevent an unnecessary operation for this condition which is principally self-limiting and innocuous.

Value of a DNA probe assay (Gen-Probe) compared with that of culture for diagnosis of gonococcal infection.

The Gen-Probe PACE 2 system for Neisseria gonorrhoeae (GP), which uses a chemiluminescently labeled DNA probe, was compared with conventional culture as the method of reference. A total of 1,750 specimens were collected from 496 females and 623 males visiting the outpatient clinic of the Sexually Transmitted Diseases Department of the Westeinde Hospital, The Hague, The Netherlands, during the year 1991. The prevalences of gonorrhea culture-positive men and women were 14.9 and 7.7%, respectively. The overall positive rate was 8.7%. Sensitivity, specificity, and positive and negative predictive values of GP were 97.1, 99.1, 90.6, and 99.8%, respectively. A total of 12 of 13 patients with positive GP results and negative cultures may have had a gonococcal infection, a conclusion based on clinical symptoms, positive methylene blue smears, and high relative light unit ratios. The DNA probe test can be useful as a suitable screening and diagnostic test for gonorrheal infection in men and women. An advantage of using this DNA probe technique is that simultaneous testing for Chlamydia trachomatis of the same specimen is possible. We also examined whether (all) rRNA had disappeared after adequate treatment for gonococcal and/or chlamydial infection in 30 patients. None of those positive patients showed a positive result in the DNA probe assay after treatment.