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1.
Z Geburtshilfe Neonatol ; 223(6): 373-394, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801169

RESUMO

AIMS: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups. METHODS: The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus). RECOMMENDATIONS: Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.


Assuntos
Ruptura Prematura de Membranas Fetais , Trabalho de Parto Prematuro/prevenção & controle , Guias de Prática Clínica como Assunto , Nascimento Prematuro , Sociedades Médicas , Prevenção Terciária , Incompetência do Colo do Útero , Áustria , Feminino , Ruptura Prematura de Membranas Fetais/prevenção & controle , Ruptura Prematura de Membranas Fetais/terapia , Humanos , Recém-Nascido , Obstetrícia , Gravidez , Nascimento Prematuro/prevenção & controle , Nascimento Prematuro/terapia , Sistema de Registros
2.
Z Geburtshilfe Neonatol ; 223(5): 304-316, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31623006

RESUMO

AIMS: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups. METHODS: Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus). RECOMMENDATIONS: Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.


Assuntos
Guias de Prática Clínica como Assunto , Nascimento Prematuro , Áustria , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Prevenção Primária , Sistema de Registros , Prevenção Secundária , Sociedades Médicas
3.
Geburtshilfe Frauenheilkd ; 79(8): 800-812, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31423016

RESUMO

Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups. Methods Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus). Recommendations Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.

4.
Geburtshilfe Frauenheilkd ; 79(8): 813-833, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31423017

RESUMO

Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups. Methods The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus). Recommendations Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.

5.
Arch Gynecol Obstet ; 300(1): 1-6, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30953190

RESUMO

INTRODUCTION: Bacterial vaginosis (BV) is the most common vaginal disorder in reproductive-age women. The condition is characterised by the replacement of a healthy, lactobacilli-dominated vaginal microbiota by anaerobic and facultative anaerobic bacteria. BV increases the risk of acquisition of STIs and is associated with pregnancy complications. Although the composition of the bacteria in BV varies between individuals, there are some species such as Gardnerella, Atopobium, Mycoplasma, Snethia, Megasphera, Dialister, etc., that are found most frequently. MATERIAL AND METHODS: Literature research to the importance of Atopobium vaginae in BV and treatment options. RESULTS: Atopobium (A.) vaginae is an important component of the complex abnormal vaginal flora in BV; even though A. vaginae, like Gardnerella vaginalis, has also been detected in the normal flora, it is much more common in BV patients. A. vaginae has been shown to play an important role in the pathophysiology of BV and is thought to be at least a partial cause of the known negative sequelae. The presence of A. vaginae in the BV-associated biofilms and its resistance to some antimicrobial substances has been described - this seems to have a major impact on treatment outcome. CONCLUSION: Current scientific data demonstrate that dequalinium chloride (Fluomycin®) is one of the valid therapeutic options for BV treatment, since it displays a broad antimicrobial spectrum against relevant vaginal pathogens, especially against G. vaginalis and A. vaginae, without having safety concerns.

6.
Int J STD AIDS ; 29(13): 1258-1272, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30049258

RESUMO

Four common pathological conditions are associated with vaginal discharge: bacterial vaginosis, aerobic vaginitis, candidosis, and the sexually transmitted infection, trichomoniasis. Chlamydial or gonococcal cervical infection may result in vaginal discharge. Vaginal discharge may be caused by a range of other physiological and pathological conditions including atrophic vaginitis, desquamative inflammatory vaginitis, cervicitis, and mucoid ectopy. Psychosexual problems may present with recurrent episodes of vaginal discharge and vulval burning. These need to be considered if tests for specific infections are negative. Many of the symptoms and signs are non-specific and a number of women may have other conditions such as vulval dermatoses or allergic and irritant reactions.


Assuntos
Guias como Assunto , Doenças Sexualmente Transmissíveis , Tricomoníase/diagnóstico , Descarga Vaginal/etiologia , Vaginite/etiologia , Vaginose Bacteriana/microbiologia , Europa (Continente) , Feminino , Humanos , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Tricomoníase/tratamento farmacológico , Descarga Vaginal/diagnóstico , Descarga Vaginal/tratamento farmacológico , Vaginite/diagnóstico , Vaginite/tratamento farmacológico , Vaginose Bacteriana/tratamento farmacológico , Organização Mundial da Saúde
7.
Microbiome ; 5(1): 119, 2017 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-28903767

RESUMO

BACKGROUND: Bacterial vaginosis (BV) is the most common vaginal syndrome among women in their reproductive years. It is associated with an increased risk of acquiring sexually transmitted infections and complications like preterm labor. BV is characterized by a high recurrence rate for which biofilms frequently found on vaginal epithelial cells may be a reason. RESULTS: Here, we report a controlled randomized clinical trial that tested the safety and effectiveness of a newly developed pessary containing an amphoteric tenside (WO3191) to disrupt biofilms after metronidazole treatment of BV. Pessaries containing lactic acid were provided to the control group, and microbial community composition was determined via Illumina sequencing of the V1-V2 region of the 16S rRNA gene. The most common community state type (CST) in healthy women was characterized by Lactobacillus crispatus. In BV, diversity was high with communities dominated by either Lactobacillus iners, Prevotella bivia, Sneathia amnii, or Prevotella amnii. Women with BV and proven biofilms had an increased abundance of Sneathia sanguinegens and a decreased abundance of Gardnerella vaginalis. Following metronidazole treatment, clinical symptoms cleared, Nugent score shifted to Lactobacillus dominance, biofilms disappeared, and diversity (Shannon index) was reduced in most women. Most of the patients responding to therapy exhibited a L. iners CST. Treatment with WO 3191 reduced biofilms but did not prevent recurrence. Women with high diversity after antibiotic treatment were more likely to develop recurrence. CONCLUSIONS: Stabilizing the low diversity healthy flora by promoting growth of health-associated Lactobacillus sp. such as L. crispatus may be beneficial for long-term female health. TRIAL REGISTRATION: ClinicalTrials.gov NCT02687789.


Assuntos
Antibacterianos/administração & dosagem , Biofilmes/efeitos dos fármacos , Microbiota/efeitos dos fármacos , Tensoativos/administração & dosagem , Vagina/microbiologia , Vaginose Bacteriana/tratamento farmacológico , Adulto , Feminino , Gardnerella vaginalis/efeitos dos fármacos , Gardnerella vaginalis/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Lactobacillus/efeitos dos fármacos , Lactobacillus/genética , Lactobacillus crispatus/efeitos dos fármacos , Lactobacillus crispatus/genética , Lactobacillus crispatus/isolamento & purificação , Metronidazol/uso terapêutico , Microbiota/genética , Pessoa de Meia-Idade , Pessários , Prevotella/efeitos dos fármacos , Prevotella/genética , RNA Ribossômico 16S/genética , Vagina/efeitos dos fármacos , Vaginose Bacteriana/microbiologia , Adulto Jovem
8.
Adv Exp Med Biol ; 902: 83-93, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27161352

RESUMO

The knowledge about the normal and abnormal vaginal microbiome has changed over the last years. Culturing techniques are not suitable any more for determination of a normal or abnormal vaginal microbiota. Non culture-based modern technologies revealed a complex and dynamic system mainly dominated by lactobacilli.The normal and the abnormal vaginal microbiota are complex ecosystems of more than 200 bacterial species influenced by genes, ethnic background and environmental and behavioral factors. Several species of lactobacilli per individuum dominate the healthy vagina. They support a defense system together with antibacterial substances, cytokines, defensins and others against dysbiosis, infections and care for an normal pregnancy without preterm birth.The numbers of Lactobacillus (L.) iners increase in the case of dysbiosis.Bacterial vaginosis (BV) - associated bacteria (BVAB), Atopobium vaginae and Clostridiales and one or two of four Gardnerella vaginalis - strains develop in different mixtures and numbers polymicrobial biofilms on the vaginal epithelium, which are not dissolved by antibiotic therapies according to guidelines and, thus, provoke recurrences.Aerobic vaginitis seems to be an immunological disorder of the vagina with influence on the microbiota, which is here dominated by aerobic bacteria (Streptococcus agalactiae, Escherichia coli). Their role in AV is unknown.Vaginal or oral application of lactobacilli is obviously able to improve therapeutic results of BV and dysbiosis.


Assuntos
Disbiose/terapia , Lactobacillus/fisiologia , Microbiota/fisiologia , Probióticos/uso terapêutico , Vagina/microbiologia , Vaginose Bacteriana/terapia , Biofilmes/crescimento & desenvolvimento , Clostridiales/patogenicidade , Clostridiales/fisiologia , Disbiose/microbiologia , Disbiose/patologia , Escherichia coli/patogenicidade , Escherichia coli/fisiologia , Feminino , Gardnerella vaginalis/patogenicidade , Gardnerella vaginalis/fisiologia , Humanos , Gravidez , Nascimento Prematuro/prevenção & controle , Streptococcus agalactiae/patogenicidade , Streptococcus agalactiae/fisiologia , Vaginose Bacteriana/microbiologia , Vaginose Bacteriana/patologia
9.
Arch Gynecol Obstet ; 293(3): 469-84, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26506926

RESUMO

BACKGROUND: Vaginal infections are responsible for a large proportion of gynaecological outpatient visits. Those are bacterial vaginosis (BV), vulvovaginal candidosis (VVC), aerobic vaginitis (AV) associated with aerobic bacteria, and mixed infections. Usual treatments show similar acceptable short-term efficacy, but frequent recurrences and increasing microbial resistance are unsolved issues. Furthermore, vaginal infections are associated with a variety of serious adverse outcomes in pregnancy and generally have a major impact on quality of life. Identifying the correct therapy can be challenging for the clinician, particularly in mixed infections. FINDINGS: Dequalinium chloride (DQC) is an anti-microbial antiseptic agent with a broad bactericidal and fungicidal activity. Systemic absorption after vaginal application of DQC is very low and systemic effects negligible. Vaginal DQC (Fluomizin vaginal tablets) has been shown to have equal clinical efficacy as clindamycin in the treatment of BV. Its broad antimicrobial activity makes it appropriate for the treatment of mixed vaginal infections and in case of uncertain diagnosis. Moreover, resistance of pathogens is unlikely due to its multiple mode of action, and vaginal DQC provides also a reduced risk for post-treatment vaginal infections. CONCLUSIONS: Vaginal DQC (10 mg) as 6-day therapy offers a safe and effective option for empiric therapy of different vaginal infections in daily practice. This review summarizes the available and relevant pharmacological and clinical data for the therapy of vaginal infections with vaginal DQC and provides the rationale for its use in daily gynaecologic practice.


Assuntos
Antibacterianos/uso terapêutico , Anti-Infecciosos Locais/farmacologia , Bactérias/efeitos dos fármacos , Dequalínio/farmacologia , Cremes, Espumas e Géis Vaginais/uso terapêutico , Doenças Vaginais/microbiologia , Anti-Infecciosos Locais/uso terapêutico , Antifúngicos/farmacologia , Bactérias Aeróbias , Candidíase Vulvovaginal/diagnóstico , Feminino , Humanos , Gravidez , Qualidade de Vida , Doenças Vaginais/tratamento farmacológico , Vaginose Bacteriana/microbiologia
10.
Mycoses ; 58 Suppl 5: 22-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26449503

RESUMO

In the late 1980's, the incidence of invasive fungal diseases (IFDs) in Germany was estimated with 36.000 IFDs per year. The current number of fungal infections (FI) occurring each year in Germany is still not known. In the actual analysis, data on incidence of fungal infections in various patients groups at risk for FI were calculated and mostly estimated from various (mostly national) resources. According to the very heterogenous data resources robust data or statistics could not be obtained but preliminary estimations could be made and compared with data from other areas in the world using a deterministic model that has consistently been applied in many countries by the LIFE program ( www.LIFE-worldwide.org). In 2012, of the 80.52 million population (adults 64.47 million; 41.14 million female, 39.38 million male), 20% are children (0-14 years) and 16% of population are ≥65 years old. Using local data and literature estimates of the incidence or prevalence of fungal infections, about 9.6 million (12%) people in Germany suffer from a fungal infection each year. These figures are dominated (95%) by fungal skin disease and recurrent vulvo-vaginal candidosis. In general, considerable uncertainty surrounds the total numbers because IFDs do not belong to the list of reportable infectious diseases in Germany and most patients were not hospitalised because of the IFD but a distinct underlying disease.


Assuntos
Micoses/epidemiologia , Adolescente , Adulto , Candidíase Vulvovaginal/epidemiologia , Candidíase Vulvovaginal/microbiologia , Criança , Pré-Escolar , Dermatomicoses/epidemiologia , Dermatomicoses/microbiologia , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Prevalência , Adulto Jovem
11.
Mycoses ; 58 Suppl 1: 1-15, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25711406

RESUMO

The oestrogenised vagina is colonised by Candida species in at least 20% of women; in late pregnancy and in immunosuppressed patients, this increases to at least 30%. In most cases, Candida albicans is involved. Host factors, particularly local defence mechanisms, gene polymorphisms, allergies, serum glucose levels, antibiotics, psycho-social stress and oestrogens influence the risk of candidal vulvovaginitis. Non-albicans species, particularly Candida glabrata, and in rare cases also Saccharomyces cerevisiae, cause less than 10% of all cases of vulvovaginitis with some regional variation; these are generally associated with milder signs and symptoms than normally seen with a C. albicans-associated vaginitis. Typical symptoms include premenstrual itching, burning, redness and odourless discharge. Although itching and redness of the introitus and vagina are typical symptoms, only 35-40% of women reporting genital itching in fact suffer from vulvovaginal candidosis. Medical history, clinical examination and microscopic examination of vaginal content using 400× optical magnification, or preferably phase contrast microscopy, are essential for diagnosis. In clinically and microscopically unclear cases and in chronically recurring cases, a fungal culture for pathogen determination should be performed. In the event of non-C. albicans species, the minimum inhibitory concentration (MIC) should also be determined. Chronic mucocutaneous candidosis, a rarer disorder which can occur in both sexes, has other causes and requires different diagnostic and treatment measures. Treatment with all antimycotic agents on the market (polyenes such as nystatin; imidazoles such as clotrimazole; and many others including ciclopirox olamine) is easy to administer in acute cases and is successful in more than 80% of cases. All vaginal preparations of polyenes, imidazoles and ciclopirox olamine and oral triazoles (fluconazole, itraconazole) are equally effective (Table ); however, oral triazoles should not be administered during pregnancy according to the manufacturers. C. glabrata is not sufficiently sensitive to the usual dosages of antimycotic agents approved for gynaecological use. In other countries, vaginal suppositories of boric acid (600 mg, 1-2 times daily for 14 days) or flucytosine are recommended. Boric acid treatment is not allowed in Germany and flucytosine is not available. Eight hundred-milligram oral fluconazole per day for 2-3 weeks is therefore recommended in Germany. Due to the clinical persistence of C. glabrata despite treatment with high-dose fluconazole, oral posaconazole and, more recently, echinocandins such as micafungin are under discussion; echinocandins are very expensive, are not approved for this indication and are not supported by clinical evidence of their efficacy. In cases of vulvovaginal candidosis, resistance to C. albicans does not play a significant role in the use of polyenes or azoles. Candida krusei is resistant to the triazoles, fluconazole and itraconazole. For this reason, local imidazole, ciclopirox olamine or nystatin should be used. There are no studies to support this recommendation, however. Side effects, toxicity, embryotoxicity and allergies are not clinically significant. Vaginal treatment with clotrimazole in the first trimester of a pregnancy reduces the rate of premature births. Although it is not necessary to treat a vaginal colonisation of Candida in healthy women, vaginal administration of antimycotics is often recommended in the third trimester of pregnancy in Germany to reduce the rate of oral thrush and napkin dermatitis in healthy full-term newborns. Chronic recurrent vulvovaginal candidosis continues to be treated in intervals using suppressive therapy as long as immunological treatments are not available. The relapse rate associated with weekly or monthly oral fluconazole treatment over 6 months is approximately 50% after the conclusion of suppressive therapy according to current studies. Good results have been achieved with a fluconazole regimen using an initial 200 mg fluconazole per day on 3 days in the first week and a dosage-reduced maintenance therapy with 200 mg once a month for 1 year when the patient is free of symptoms and fungal infection (Table ). Future studies should include Candida autovaccination, antibodies to Candida virulence factors and other immunological experiments. Probiotics with appropriate lactobacillus strains should also be examined in future studies on the basis of encouraging initial results. Because of the high rate of false indications, OTC treatment (self-treatment by the patient) should be discouraged.


Assuntos
Antifúngicos/administração & dosagem , Candida albicans/efeitos dos fármacos , Candidíase Vulvovaginal/tratamento farmacológico , Complicações Infecciosas na Gravidez/diagnóstico , Antifúngicos/uso terapêutico , Candida glabrata/efeitos dos fármacos , Candidíase Vulvovaginal/diagnóstico , Candidíase Vulvovaginal/microbiologia , Feminino , Alemanha , Humanos , Recém-Nascido , Testes de Sensibilidade Microbiana , Microscopia de Contraste de Fase , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/microbiologia , Descarga Vaginal
12.
Histol Histopathol ; 29(5): 567-87, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24327088

RESUMO

BACKGROUND: We analysed data on bacterial vaginosis (BV) contradicting the paradigm of mono-infection. METHODOLOGY: Tissues and epithelial cells of vagina, uterus, fallopian tubes and perianal region were investigated using fluorescence in situ hybridization (FISH) in women with BV and controls. RESULTS: Healthy vagina was free of biofilms. Prolific structured polymicrobial (StPM) Gardnerella-dominated biofilm characterised BV. The intact StPM-Gardnerella-biofilm enveloped desquamated vaginal/prepuce epithelial cells and was secreted with urine and sperma. The disease involved both genders and occurred in pairs. Children born to women with BV were negative. Monotherapy with metronidazole, moxifloxacin or local antiseptics suppressed but often did not eradicate StPM-Gardnerella-biofilms. There was no BV without Gardnerella, but Gardnerella was not BV. Outside of StPM-biofilm, Gardnerella was also found in a subset of children and healthy adults, but was dispersed, temporal and did not transform into StPM-Gardnerella-biofilm. CONCLUSIONS: StPM-Gardnerella-biofilm is an infectious subject. The assembly of single players to StPM-Gardnerella-biofilm is a not trivial every day process, but probably an evolutionary event with a long history of growth, propagation and selection for viability and ability to reshape the environment. The evolutionary memory is cemented in the structural differentiation of StPM-Gardnerella-biofilms and imparts them to resist previous and emerging challenges.


Assuntos
Biofilmes/crescimento & desenvolvimento , Gardnerella/patogenicidade , Infecções por Bactérias Gram-Positivas/microbiologia , Vaginose Bacteriana/microbiologia , Biofilmes/efeitos dos fármacos , Candidíase Vulvovaginal/microbiologia , Estudos de Casos e Controles , Feminino , Gardnerella/efeitos dos fármacos , Gardnerella/genética , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Hibridização in Situ Fluorescente , Masculino , Gravidez , Vagina/microbiologia , Vaginose Bacteriana/tratamento farmacológico
13.
PLoS One ; 8(1): e53997, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23320114

RESUMO

OBJECTIVE: To assess whether the bacterial vaginosis biofilm extends into the upper female genital tract. STUDY DESIGN: Endometrial samples obtained during curettage and fallopian tube samples obtained during salpingectomy were collected. Endometrial and fallopian tube samples were analyzed for the presence of bacteria with fluorescence-in-situ-hybridisation (FISH) analysis with probes targeting bacterial vaginosis-associated and other bacteria. RESULTS: A structured polymicrobial Gardnerella vaginalis biofilm could be detected in part of the endometrial and fallopian tube specimens. Women with bacterial vaginosis had a 50.0% (95% CI 24.0-76.0) risk of presenting with an endometrial Gardnerella vaginalis biofilm. Pregnancy (AOR  = 41.5, 95% CI 5.0-341.9, p<0.001) and the presence of bacterial vaginosis (AOR  = 23.2, 95% CI 2.6-205.9, p<0.001) were highly predictive of the presence of uterine or fallopian bacterial colonisation when compared to non-pregnant women without bacterial vaginosis. CONCLUSION: Bacterial vaginosis is frequently associated with the presence of a structured polymicrobial Gardnerella vaginalis biofilm attached to the endometrium. This may have major implications for our understanding of the pathogenesis of adverse pregnancy outcome in association with bacterial vaginosis.


Assuntos
Biofilmes , Endométrio/microbiologia , Gardnerella vaginalis/fisiologia , Vaginose Bacteriana/microbiologia , Tubas Uterinas/microbiologia , Feminino , Gardnerella vaginalis/genética , Gardnerella vaginalis/isolamento & purificação , Humanos , Hibridização in Situ Fluorescente , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Resultado da Gravidez , Vagina/microbiologia , Vaginose Bacteriana/complicações , Vaginose Bacteriana/urina
14.
J Perinat Med ; 40(4): 433-8, 2012 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-22752776

RESUMO

OBJECTIVE: The objective of the study was to assess the efficacy and safety of subcutaneously (SC) and intramuscularly (IM) administered BT088 (Fovepta) human hepatitis B immunoglobulin in neonates of hepatitis B surface antigen (HBs/HBsAg)-positive mothers in the prevention of hepatitis B infection. METHODS: This was an open, prospective, multicenter trial, in which infants were randomized to receive a single SC or IM dose of BT088 (200 IU, 0.4 mL) within 12 h of birth simultaneously with active vaccination against hepatitis B. The primary efficacy variable was the response rate, defined as the proportion of infants whose anti-HBs concentration was negative at predose and ≥100 IU/L 48 to 72 h postdose. RESULTS: The full analysis set included 31 neonates (17 SC and 14 IM). Response was experienced by 30 (96.8%) of 31 infants who received BT088 by either route of administration. The median postdose anti-HBs concentration was 261.2 IU/L. One neonate had a postdose anti-HBs level lower than 100 IU/L (81.0 IU/L). No infant experienced seroconversion during the 7- to 15-month follow-up. BT088 was well tolerated, with no allergic-like, or injection-site reactions observed. CONCLUSION: SC and IM administration of 200 IU (0.4 mL) BT088 resulted in protective serum anti-HBs titers within 72 h of administration in newborn infants and was well tolerated and effective.


Assuntos
Hepatite B/prevenção & controle , Imunoglobulinas/administração & dosagem , Portador Sadio , Feminino , Hepatite B/imunologia , Hepatite B/transmissão , Anticorpos Anti-Hepatite B/sangue , Vacinas contra Hepatite B/administração & dosagem , Humanos , Imunoglobulinas/efeitos adversos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Injeções Intramusculares , Injeções Subcutâneas , Masculino , Gravidez , Complicações Infecciosas na Gravidez/virologia , Estudos Prospectivos , Vacinação
15.
Arch Gynecol Obstet ; 285(6): 1619-25, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22218825

RESUMO

OBJECTIVE: We tested the effect of vaginally applied lactic acid gel on symptoms and bacteriuria in acutely exacerbated recurrent Eschericia coli cystitis. METHODS: Carnoy fixed samples of the morning urine from 20 women with a history of recurrent E.coli cystitis were prospectively investigated for bacteriuria using fluorescence in situ hybridization (FISH). RESULTS: In 11/20 women with acute cystitis, the symptoms and bacteriuria were regressive with lactic acid gel treatment, without the need for antibiotic treatment. The complete regression of symptoms took between 1 week (7 women) and 4 weeks (4 women). In parallel with this regression, the microscopic shape of E.coli bacteria in these women changed from short rods to long curly filaments starting within the first days of therapy. The filamentous transformation affected 100% of the E.coli population in six women and at least 50% of E.coli population in five women and was not observed in urine samples from untreated women or in women without clinical response to lactic acid gel. This could not happen if the bladder was the origin of the infection. CONCLUSIONS: A number of recurrent and probably acute cystitis is a local vagino-urethritis caused by an adhesive invasive E.coli biofilm of the vaginal surface.


Assuntos
Antibacterianos/uso terapêutico , Cistite/tratamento farmacológico , Infecções por Escherichia coli/tratamento farmacológico , Géis/uso terapêutico , Ácido Láctico/uso terapêutico , Doenças Vaginais/tratamento farmacológico , Administração Intravaginal , Adulto , Idoso , Cistite/microbiologia , Disuria/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Prevenção Secundária , Doenças Vaginais/microbiologia
16.
World J Urol ; 30(1): 51-7, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21590469

RESUMO

PURPOSE: Biofilm infections have a major role in implants or devices placed in the human body. As part of the endourological development, a great variety of foreign bodies have been designed, and with the increasing number of biomaterial devices used in urology, biofilm formation and device infection is an issue of growing importance. METHODS: A literature search was performed in the Medline database regarding biofilm formation and the role of biofilms in urogenital infections using the following items in different combinations: "biofilm," "urinary tract infection," "bacteriuria," "catheter," "stent," and "encrustation." The studies were graded using the Oxford Centre for Evidence-based Medicine classification. RESULTS: The authors present an update on the mechanism of biofilm formation in the urinary tract with special emphasis on the role of biofilms in lower and upper urinary tract infections, as well as on biofilm formation on foreign bodies, such as catheters, ureteral stents, stones, implants, and artificial urinary sphincters. The authors also summarize the different methods developed to prevent biofilm formation on urinary foreign bodies. CONCLUSIONS: Several different approaches are being investigated for preventing biofilm formation, and some promising results have been obtained. However, an ideal method has not been developed. Future researches have to aim at identifying effective mechanisms for controlling biofilm formation and to develop antimicrobial agents effective against bacteria in biofilms.


Assuntos
Biofilmes , Corpos Estranhos/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Stents/microbiologia , Infecções Urinárias/microbiologia , Cateteres de Demora/microbiologia , Feminino , Humanos , Masculino , Infecções Relacionadas à Prótese/prevenção & controle , Uretra/microbiologia , Infecções Urinárias/prevenção & controle
17.
Antimicrob Agents Chemother ; 55(5): 2490-2, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21321147

RESUMO

Bacterial vaginosis is characterized by a shift of the physiological flora to a diverse spectrum of bacteria, where Gardnerella vaginalis and Atopobium vaginae are the most important markers. In this study, the antimicrobial activity of nifuratel against G. vaginalis, A. vaginae, and lactobacilli was compared with that of the two currently used antibiotics metronidazole and clindamycin. Results suggest that nifuratel has a better spectrum of activity, being highly active against G. vaginalis and A. vaginae without affecting lactobacilli.


Assuntos
Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Nifuratel/farmacologia , Nifuratel/uso terapêutico , Vagina/microbiologia , Vaginose Bacteriana/tratamento farmacológico , Clindamicina/farmacologia , Clindamicina/uso terapêutico , Feminino , Humanos , Metronidazol/farmacologia , Metronidazol/uso terapêutico , Testes de Sensibilidade Microbiana
18.
FEMS Immunol Med Microbiol ; 61(1): 41-6, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20955467

RESUMO

Polymicrobial communities are often recalcitrant to antibiotics. We tested whether the polymicrobial Gardnerella vaginalis biofilm can be eradicated with moxifloxacin. Twenty women with bacterial vaginosis were treated with 400 mg moxifloxacin for 5 days. The changes in the occurrence and proportions of Gardnerella, Atopobium and Lactobacillus spp. were assessed using FISH. The bacterial biofilm was investigated using desquamated epithelial cells of spontaneously voided urine and sections of vaginal biopsies. Fifteen of 20 women showed a significant and sustained clinical response to moxifloxacin according to Amsel and Nugent criteria. The concentrations of adherent bacteria decreased significantly. The incidence and proportion of Atopobium declined sustainably. The proportions of Lactobacillus in the biofilm mass increased following therapy. Initially, Gardnerella was the main component of the polymicrobial biofilm. Following treatment, Gardnerella was not accessible to FISH in the urine and vaginal samples of 75% of all women. Ten to 12 weeks after the end of therapy, Gardnerella biofilm was cumulatively present in 40%. This was not due to newly acquired disease, but due to reactivation of the persisting, but biochemically inactive biofilm. Despite clear clinical efficacy, and initially definite suppression of the biofilm, moxifloxacin was, similar to metronidazole, not able to eradicate the Gardnerella vaginalis biofilm in all patients.


Assuntos
Antibacterianos/administração & dosagem , Compostos Aza/administração & dosagem , Biofilmes/efeitos dos fármacos , Gardnerella vaginalis/efeitos dos fármacos , Gardnerella vaginalis/crescimento & desenvolvimento , Quinolinas/administração & dosagem , Vaginose Bacteriana/tratamento farmacológico , Adulto , Feminino , Fluoroquinolonas , Humanos , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Moxifloxacina , Fatores de Tempo , Resultado do Tratamento , Urina/microbiologia , Vagina/microbiologia , Vagina/cirurgia , Vaginose Bacteriana/microbiologia , Adulto Jovem
19.
Gynecol Obstet Invest ; 70(4): 256-63, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21051845

RESUMO

OBJECTIVE: To study the incidence and distribution of adherent Gardnerella vaginalis. METHODS: Bacteria adherent to desquamated epithelial cells in the urine were detected using fluorescence in situ hybridization (FISH). Urine from patients with bacterial vaginosis (BV, n = 20), their partners (n = 10) and different control populations (n = 344) including pregnant women and their partners, randomly selected populations of hospitalized man, women and children as also healthy controls was investigated. RESULTS: Gardnerella was found in two different forms: cohesive and dispersed. In the cohesive form, Gardnerella were attached to the epithelial cells in groups of highly concentrated bacteria. In the dispersed form, solitary Gardnerella were intermixed with other bacterial groups. Cohesive Gardnerella was present in all patients with proven BV and their partners, in 7% of men and 13% of women hospitalized for reasons other than BV, in 16% of pregnant women and 12% of their male partners, and in none of the healthy laboratory staff or children. In sexual partners, occurrence of cohesive Gardnerella was clearly linked. Dispersed Gardnerella were found in 10-18% of randomly selected females, 3-4% of males and 10% of children and not sexually linked. In daily longitudinal investigations over 4 weeks no transition between cohesive and dispersed Gardnerella and vice versa was observed. Transmission of a cohesive Gardnerella strain could be followed retrospectively over 15 years using molecular genetic methods. CONCLUSIONS: Cohesive Gardnerella biofilm is a distinct, clearly definable entity which involves both genders and is sexually transmitted. The correct name distinguishing it from symptom-defined conditions like BV should be gardnerellosis and for the bacterium Gardnerella genitalis.


Assuntos
Biofilmes , Gardnerella vaginalis/isolamento & purificação , Doenças Bacterianas Sexualmente Transmissíveis/microbiologia , Adulto , Aderência Bacteriana , Bacteriúria/microbiologia , Criança , Pré-Escolar , Células Epiteliais/microbiologia , Feminino , Gardnerella vaginalis/genética , Genótipo , Hospitalização , Humanos , Hibridização in Situ Fluorescente , Masculino , Gravidez , Técnica de Amplificação ao Acaso de DNA Polimórfico , Estudos Retrospectivos , Parceiros Sexuais , Doenças Bacterianas Sexualmente Transmissíveis/transmissão , Urina/citologia , Urina/microbiologia , Vaginose Bacteriana/microbiologia , Vaginose Bacteriana/transmissão , Vaginose Bacteriana/urina
20.
Gynecol Obstet Invest ; 70(4): 306-21, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21051852

RESUMO

For sporadic acute Candida vaginitis, any oral or local antifungal therapy can be used. For women with recurrent vulvo-vaginal candidosis (RVC), on the other hand, such simple approaches are insufficient, regardless of the product chosen. Instead, RVC should be managed as any other chronic disease and requires long-term, prophylactic, suppressive antifungal treatment. A regimen using individualized, decreasing doses of oral fluconazole (the ReCiDiF regimen) was proven to be highly efficient and offered great comfort to the patients. During this regimen, it is crucial that patients are carefully examined by anamnestic, clinical, microscopic and culture-proven absence of Candida. If a relapse occurs, the medication is adjusted and efforts are taken to find a possible triggering factor for the reactivation of the infection. Care has to be taken not to accumulate 'don't do's', unless the efficiency of a measure has been proven, by trying to eliminate one risk factor at a time for 2 months. Known possible triggers to be kept in mind are (1) antibiotic use, (2) use of specific contraceptives, especially combined contraceptive pills, (3) disturbed glucose metabolism, (4) the use of personal hygienic products, and (5) tight clothing or plastic panty liners. In therapy-resistant cases, non-albicans infection must be ruled out, and alternative therapies should be tried. Boric acid is proven to be efficient in most of these resistant cases, but other non-azoles like amphotericin B, flucytosine, gentian violet, and even caspofungin may have to be tried. As a final remark it has to be said that many patients feel poorly understood and inefficiently managed by many care-givers, increasing their feelings of guilt and sexual inferiority. Therefore, attention has to be given to take the disease seriously, follow strict treatment regimens, and advise precisely and based on individual evidence concerning any possible risk factors for recurrence. In case of therapy-resistant vulvo-vaginitis, reconsider your diagnosis and/or consider referral to specialized therapists.


Assuntos
Candidíase Vulvovaginal/tratamento farmacológico , Candidíase Vulvovaginal/prevenção & controle , Antifúngicos/uso terapêutico , Candida/genética , Candida/isolamento & purificação , Candida albicans/genética , Candida albicans/isolamento & purificação , Candidíase Vulvovaginal/diagnóstico , Doença Crônica , Vestuário , Anticoncepcionais Femininos/efeitos adversos , Diagnóstico Diferencial , Carboidratos da Dieta/efeitos adversos , Farmacorresistência Fúngica , Feminino , Produtos de Higiene Feminina/efeitos adversos , Predisposição Genética para Doença , Genótipo , Humanos , Concentração de Íons de Hidrogênio , Imunidade , Masculino , Recidiva , Saliva/microbiologia , Comportamento Sexual , Doenças Sexualmente Transmissíveis , Vagina/química , Vagina/microbiologia , Vulva/microbiologia
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