Vaginal microbiota evaluation and prevalence of key pathogens in ecuadorian women: an epidemiologic analysis.

Vaginal infection is a gynecological problem in women of reproductive age with multiple health outcomes. The most common forms of infection include bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and aerobic vaginitis (AV). Our main goals were to evaluate different types of vaginal infections in Ecuadorian women in a large urban area (Quito) and to characterize the vaginal microbiota colonization by opportunistic species. We collected vaginal swabs and epidemiological surveys from 414 women from June 2016 to July of 2017. We analyzed vaginal samples for the presence of any vaginal infection. The microbiological examination was done through Gram-stain, wet mount smears, and polymerase chain reaction (PCR) assays using primers for target genes, such as 16S rRNA (Atopobium vaginae, Mobiluncus mulieris, and Gardnerella species), ddl (Enterococcus faecalis), adk (Escherichia coli) and KER1 (Candida albicans) genes. Most women showed a healthy vaginal microbiota (66.7%). Nearly one-tenth (10.4%) of the participants had intermediate microbiota, and the remaining women (22.9%) had a single vaginal infection (BV, AV, or VC) or coinfections. From the 95 participants that had an infection, AV was the main diagnosed vaginal infection (51.6%), followed by BV (24.2%) and finally VC (7.4%). The remaining women (16.8%) showed coinfections, being BV and AV the most common coinfection. Using univariable logistic regression analyses we found an increased odds of healthy microbiota in women with a sexual partner (P = 0.02, OR = 1.64). Also, women in a free union relationship (P = 0.000, OR = 16.65) had an increased odds of having coinfections. On the other hand, the use of birth control (condom OR = 0.388 or other contraceptive method OR = 0.363) was associated with significantly lower odds of intermediate microbiota (P ≤ 0.05). We found no statistically significant differences between women with infection and a particular group age. Using multivariate logistic regression analyses we initially found an increased odds of having BV in women with M. mulieris (P = 0.020, OR = 4.98) and Gardnerella species (P = 0.010, OR = 4.16). Women with E. coli showed an increased odds of having AV (P = 0.009, OR = 2.81). The presence of C. albicans in women showed an increased odds of having VC (P = 0.007, OR = 17.94). Finally, women with M. mulieris showed a reverse odds of having healthy microbiota (P = 0.008, OR = 0.06). We found no statistically significant differences between women with symptomatic and asymptomatic infections or the presence of Enterococcus faecalis. We found using logistic regression analyses that M. mulieris was the most prevalent opportunistic pathogen among women with vaginal infection. Further studies should evaluate the possibility to use M. mulieris as a potential key predictor for vaginal infections.

Antifungal, anti-inflammatory and antioxidant activity of bi-herbal mixtures with medicinal plants from Argentinean highlands.

ETHNOPHARMACOLOGICAL RELEVANCE: Argentinean medicinal plants such as Larrea divaricata Cav., Larrea cuneifolia Cav., Larrea nitida Cav., Zuccagnia punctata Cav. and Tetraglochin andina Ciald. are used alone and in combination in traditional medicine by inhabitants from northwestern Argentina to solve mycosis, vaginal infections, gastrointestinal, respiratory, and inflammatory processes. AIM OF THE STUDY: To assess the effect of interactions between hydroalcoholic extracts of these five species of medicinal plants against yeast strains isolated from vaginal infections, select the most active mixtures and evaluate anti-inflammatory and antioxidant activities. MATERIAL AND METHODS: Synergy between the plant extracts was studied by using a broth microdilution assay by means of the checkerboard method against Saccharomyces cerevisiae, Candida albicans, and non albicans strains. The inhibitory effect on lipoxygenase and the antioxidant capacity in cell-free and cell systems were studied. The chemical profile was evaluated by qualitative and quantitative screening, whereas chemical markers were quantified by HPLC-DAD. RESULTS: A synergistic antifungal effect was observed in some binary combinations. Z. punctata/L. divaricata, Z. punctata/L. cuneifolia, and Z. punctata/L. nitida were the most active mixtures. Nordihydroguaiaretic acid and 2',4'-dihydroxychalcone, two antifungal compounds, present in these extracts, were identified and quantified by HPLC-DAD. Both single extracts and bi-herbal mixtures showed antioxidant activity (in cellular and in cell-free systems) and were active on pro-inflammatory enzymes (LOX). CONCLUSIONS: Our results indicated that the most active combinations of these species extracts could be useful in the treatment of vaginal infectious diseases caused by Saccharomyces cerevisiae and Candida spp. strains and in associated oxidative and inflammatory processes, supporting its traditional use. In addition, the results highlighted the phyto-therapeutic potential of total phytochemical compounds present in these medicinal plants.

Infectious disease symptoms and microbial carriage among French medical students travelling abroad: A prospective study.

BACKGROUND: In France, no previous studies have focused specifically on health problems among medical students during internships abroad including the clinical symptoms suggestive of infectious diseases and the acquisition of pathogen carriage. METHODS: Clinical follow up and qPCR based respiratory, gastrointestinal and vaginal pathogen carriage before and after travel were prospectively assessed in a cohort of medical students departing from Marseille, France. RESULTS: 134 students were included. 73.9%, 38.8% and 5.0% of students reported gastrointestinal, respiratory and vaginal symptoms, respectively. The acquisition rate of Enteroaggregative Escherichia coli (EAEC) and Enteropathogenic E. coli (EPEC) was 53% and 41%, respectively. The acquisition of respiratory viruses was low but associated with persisting symptoms, while bacterial acquisition ranged from 3.3% for Streptococcus pyogenes to 15.0% for Haemophilus influenzae. Gardnerella vaginalis and Atopobium vaginae acquisition rates were 7.7% and 14.3% respectively. Five students (5.1%) had molecular quantification criteria for bacterial vaginosis on return. CONCLUSION: This preliminary study demonstrates that besides the known risk of gastrointestinal and respiratory infections and associated changes in intestinal and respiratory microbiota, medical students abroad may also experience changes in vaginal microbiota leading, in some cases, to clinical symptoms or the acquisition of bacterial vaginosis, which may be asymptomatic.

[Prevalence and phylogenetic analysis of Chlamydia trachomatis in a population of women in Posadas, Misiones]. / Prevalencia y análisis filogenético de Chlamydia trachomatis en una población de mujeres de Posadas, Misiones.

OBJECTIVE: Chlamydia trachomatis is the most prevalent bacteria causing sexually transmitted infections. In women, this infection can cause cervicitis and urethritis, although it's usually asymptomatic. The aim of this study was to investigate the prevalence of C. trachomatis in women attending the lab Instituto de Previsión Social and detect the genotypes. METHODS: Endocervical samples from 505 symptomatic and asymptomatic women were assayed. It was determined the presence of C. trachomatis by PCR through amplification of a fragment of the cryptic plasmid. Positive samples were genotyped by the partial amplification of the ompA gene and analyzed phylogenetically. RESULTS: Forty-three positive samples were detected to infection with C. trachomatis, obtaining a prevalence of 8.5% (IC 95%: 6.4-11.3%). The prevalence of C. trachomatis was higher in women with vaginal symptoms [11.3% (30/265) vs. 5.4% (13/240)] (p = 0.018), as well as in women under 26 year-old [11.5% (28/244) vs. 6.2% (15/246)] (p = 0.021). Based on phylogenetic analysis, it was observed that 62% of the samples were genotype E, 15% genotype J, 15% genotype D, and 8% genotype F. CONCLUSIONS: This work is the first contribution on the molecular epidemiology of C. trachomatis in the Misiones province, Argentina, which shows the rate of prevalence of this bacterium and offers information on circulating genotypes.

Prevalence and genetic diversity of Trichomonas vaginalis in the general population of Granada and co-infections with Gardnerella vaginalis and Candida species.

PURPOSE: Purulent or exudative genitourinary infections are a frequent cause of consultation in primary and specialized healthcare. The objectives of this study were: to determine the prevalence of Trichomonas vaginalis and co-infections with Candida spp. and Gardnerella vaginalis in vaginal secretion; and to use multilocus sequence typing (MLST) to analyse the genetic diversity of T. vaginalis strains. METHODOLOGY: The samples were submitted for analysis (n=5230) to a third-level hospital in Granada (Southern Spain) between 2011 and 2014; eight T. vaginalis strains isolated during 2015 were randomly selected for MLST analysis. Culture and nucleic acid hybridization techniques were used to detect microorganisms in the samples. RESULTS: The prevalence of T. vaginalis was 2.4 % between 2011 and 2014, being higher during the first few months of both 2011 and 2012. Among samples positive for T. vaginalis, co-infection with G. vaginalis was detected in 29 samples and co-infection with Candida spp. in 6, while co-infection with all three pathogens was observed in 3 samples. The only statistically significant between-year difference in co-infection rates was observed for T. vaginalis with G. vaginalis due to an elevated rate in 2011. MLST analysis results demonstrated a high genetic variability among strains circulating in our setting. CONCLUSION: These findings emphasize the need for the routine application of diagnostic procedures to avoid the spread of this sexually transmitted infection.

Genital Mycoplasma infection among Mexican women with systemic lupus erythematosus.

OBJECTIVE: To assess the prevalence of genital Mycoplasma spp. among women with systemic lupus erythematosus (SLE) and to identify factors associated with such infection. METHODS: A cross-sectional study was conducted among patients with SLE and healthy women who attended a hospital in Puebla, Mexico, between July 29, 2014, and January 4, 2015. All participants were aged 18 years or older and sexually active. A structured interview assessed sociodemographic, obstetric, gynecologic, and clinical characteristics. Disease activity was evaluated using the Mexican SLE Disease Activity Index. Polymerase chain reaction was used to detect the presence of Mycoplasma spp. in genital samples. RESULTS: Ureaplasma urealyticum was the only genital mycoplasma detected; it was present in 32 (24.6%) of 130 patients with SLE and 12 (12.8%) of 94 healthy women. Patients with SLE had increased odds of infection (odds ratio 2.120, 95% confidence interval 1.046-4.296). Among patients with SLE, multiparity was more common in those with U. urealyticum infection (P=0.043). CONCLUSION: One-quarter of women with SLE had genital infection with U. urealyticum. An association was found between infection and multiparity among women with SLE.

[Pilot tests using molecular diagnostic assay cervicovaginal infection during pregnancy]. / Ensayo piloto del uso de pruebas moleculares para el diagnóstico de infecciones cervicovaginales en pacientes embarazadas.

Background: The prevalence of cervicovaginal infections during pregnancy has been associated with adverse perinatal outcomes however, the actual approach used for diagnosis is not effective. The aim of this study was to compare the diagnosis of vaginal infections in pregnant women using clinical, molecular diagnostic and traditional microbiological culture in a pilot study, to determine the prevalence and association with the development of preterm labor. Materials and methods: We performed a nested cross-sectional study composed by 54 women in a cohort of pregnant women in Mexico City. Cervicovaginal infections were evaluated by clinical methods, microbiology culture and a commercially available molecular biology test. Results: Prevalence of cervicovaginal infections during pregnancy was estimated between 28% and 50% according to methodologies. Considering the clinical diagnosis of preterm labor as the gold standard, all diagnostic tests were poor as predictors of preterm labor. Conclusion: Traditional approaches to establish the significance of cervicovaginal infection in pregnancy are exhausted, so be sought new ways to understand this complex relationship. Meanwhile it is recommended to continue to use traditional methods to identify infections during pregnancy in both knowledge of new methods aimed at understanding these relationships are sophisticated.

Preventive effect of Lactobacillus reuteri CRL1324 on Group B Streptococcus vaginal colonization in an experimental mouse model.

AIMS: To assess the preventive effect of different intravaginal (i.va.) doses of Lactobacillus reuteri CRL1324 against vaginal colonization by Group B Streptococcus (GBS) in a murine experimental model. METHODS AND RESULTS: The major virulence factors of four vaginal GBS clinical isolates were determined to select the most virulent strain and set up a murine model of streptococcal vaginal colonization. Later, the effect of four and seven doses of 10(8) viable cells of Lact. reuteri CRL1324 i.va. administered, prior to the GBS challenge was studied. Seven doses of lactobacilli were able to significantly reduce the number of viable GBS cells, while four doses showed no preventive effect. Both doses reduced the leucocyte influx induced by GBS. Seven doses caused a slight increase in the Lact. reuteri CRL1324 vaginal colonization compared with four doses and reduced murine vaginal pH compared to control mice. CONCLUSIONS: Lactobacillus reuteri CRL1324 evidenced a preventive effect on GBS vaginal colonization in an experimental mouse model. SIGNIFICANCE AND IMPACTS OF THE STUDY: Maternal GBS colonization is one of the most important risk factors for developing disease in newborns. Lactobacillus reuteri CRL1324 could be considered as a new biological agent to reduce infections caused by this micro-organism.

[Clinical efficacy of fluconazole, tinidazole and clindamycin vs fluconazole, tinidazole and azithromycin in the treatment of mixed cervical-vaginal infections, included those caused by Mycoplasma and Chlamydia trachomatis]. / Eficacia clínica de fluconazol, tinidazol y clindamicina vs fluconazol, tinidazol y azitromicina en el tratamiento de infecciones cérvico- vaginales mixtas, incluidas las causadas por Mycoplasma y Chlamydia trachomatis.

BACKGROUND: In the United States 19 million people acquire a sexually transmitted disease every year. Sexually transmitted diseases impact in gynecological terms because they may cause sterility, infertility and ectopic pregnancy. OBJECTIVE: To compare the effectiveness of two combinations of three oral antimicrobial drugs in the treatment of mixed cervical-vaginal infections, included those caused by Mycoplasma and Chlamydia trachomatis. MATERIAL AND METHOD: Aclinical, random, comparative, double-blind study included 50 patients assisting to infectology consult with diagnosis of mixed cervical-vaginal infection. Patients were divided into two groups: Group A (n = 25): fluconazole 37.5 mg, tinidazole 500 mg and azithromycin 250 mg; group B (n = 25): fluconazole 37.5 mg, tinidazole 500 mg and clindamycin 312.5 mg. Patients of both groups received two tablets twice p.o. for one day. Cultures were performed to corroborate the diagnosis and then to demonstrate effectiveness of the schemes studied. For the analysis of the data we used measures of central tendency, dispersion and inferential statistics for comparison of proportions by c2 and Fisher's exact tests with a significance level of p < 0.05. RESULTS: All patient got clinical cure; however, regarding the microbiologic eradication a positive case was identified in group A, requiring rescue treatment. The compliance in both groups was of 100%. In both groups, statistical analysis did not show significant differences. Three patients in group A had mild adverse effects. Patients mean age was 33.4 +/- 5.3 years. CONCLUSIONS: Both treatments showed similar effectiveness against mixed cervical-vaginal infections. Microbiological efficacy was of 96% and 100% in group A and B, respectively, besides, scheme of group B was better tolerated.

Pyocolpos in a Pinscher bitch: a case report

Diseases related to the urogenital system in both males and females, are common in clinical routine of smallanimal and represents important causes of morbidity and mortality in dogs and cats. Pyocolpos is a cysticdilatation of the vagina due to the accumulation of pus resulting from the genital tract obstruction. The maincause of obstruction is imperforate hymen, transverse vaginal membrane, or vaginal atresia.We present a caseof a three-year-old female Pinscher with a history of constipation for four days, even after administration oflaxatives and enema, and estrus for ten days without a report of cover. Physical examinations were performed,which revealed increased abdominal size. Ultrasound confirmed the presence of large amounts of vaginal fluid.Exploratory laparotomy was performed, which confirmed the diagnosis of pyocolpos. Although pyocolposis a rare congenital malformation in female domestic animals, this report of its existence underscores theimportance of more accurate clinical research when increased abdominal size is noted by veterinarians.

Infecciones del tracto genital y urinario como factores de riesgo para parto pretérmino en adolescentes / Genitourinary infections as risk factors for preterm delivery in teenagers

Objetivo: Determinar las infecciones genitourinarias como factores de riesgo para parto pretérmino en adolescentes. Método: Estudio de casos y controles en las Unidades de Medicina Familiar del IMSS Querétaro, periodo octubre 2010 a octubre 2011. Se incluyeron 35 adolescentes con parto pretérmino y 148 con parto a término, mediante muestreo no aleatorio por cuota; se excluyeron aquellas con preeclampsia, eclampsia u otras enfermedades. Los datos se recolectaron del expediente clínico electrónico. Se estudiaron variables sociodemográficas; antecedentes gineco-obstétricos; tipo de parto (pretérmino y término); e infecciones urinarias y vaginales. La infección de vías urinarias fue diagnosticada mediante urocultivo y/o examen general de orina, con >105 UFC y >10 leucocitos por campo, respectivamente. La infección vaginal se diagnosticó por exudado vaginal con reporte de patógenos y/o por clínica. El análisis se realizó con porcentajes, promedios, chi2, razón de momios (Odds Ratio), prueba de t e intervalo de confianza. Resultados: De las adolescentes con parto pretérmino el 54,3 por ciento presentaron infección de vías urinarias, mientras que solo 33,8 por ciento de estas presentaron parto a término (p=0,02). El 57,1 por ciento de las adolescentes con parto pretérmino presentaron infección vaginal en comparación con 35,1 por ciento de las de parto a término (p=0,01). Conclusión: Las infecciones vaginales y urinarias incrementan dos veces el riesgo de presentar parto pretérmino en adolescentes.

Objective: To determine genitourinary infections as risk factors for preterm delivery in teenagers. Method: Case-control study in the Family Medicine Unit IMSS Querétaro, from October 2010 to October 2011. We included 35 teenagers with preterm delivery and 148 who delivered at term, using non-random sampling, we excluded those with preeclampsia, eclampsia or other diseases. Data were collected from electronic medical record. We studied socio-demographic variables, gyneco-obstetrics antecedents, mode of delivery (preterm and term), and genitourinary infections. Urinary tract infection was diagnosed by urine culture or urinalysis, with > 105 CFU and >10 leukocytes per field, respectively. Vaginal infection was diagnosed by vaginal culture with report of pathogens and / or by clinic. The analysis was performed using percentages, averages, chi-squared test, odds ratio, t-test and confidence intervals. Results: The 54.3 percentof the teenagers with preterm delivery had urinary tract infection, while only 33.8 percent of those with term delivery presented it (p = 0.02). Also 57.1 percent of adolescents with vaginal infection had preterm delivery compared with 35.1 percent of those giving birth at term (p=0.01). Conclusion: Vaginal and urinary infections increase twice the risk of preterm delivery in teenagers.

Phenotypic characterization and genomic DNA polymorphisms of Escherichia coli strains isolated as the sole micro-organism from vaginal infections.

Vaginal infections such as vulvovaginal candiadiasis, trichomoniasis and bacterial vaginosis are common worldwide. Accurate diagnosis and prescription of appropriate treatments are important since these infections are linked to adverse outcomes for women during pregnancy and for newborns. Several aetiological agents are responsible for these infectious diseases; however, the presence of Escherichia coli in these infections is controversial. Thus, it is important to identify some phenotypic and genotypic properties of E. coli strains isolated from vaginal infections. Forty-six E. coli strains isolated from vaginal fluid as the sole micro-organism, and 20 other E. coli strains isolated from other samples (urinary tract infections, otitis and septicaemia) were analysed by several phenotypic tests. In addition, genotypic features were studied by RAPD-PCR techniques. Biochemical tests showed that the E. coli strains isolated from vaginal fluid could be grouped into a single cluster which is subdivided into two phenogroups. Analysis of the dendrogram based on fragment length polymorphisms of genomic DNA indicated that E. coli isolates from vaginal infections form a single cluster with two subdivisions. Further studies are needed to analyse the molecular structure and virulence characteristics of these E. coli strains in order to determine their potential role in vaginal infections.

Prevalencia y determinantes de las infecciones vaginales en las mujeres recluidas en una cárcel Colombiana / Prevalence and determinants of vaginal infections in women incarcerated in a Colombian prison

OBJETIVO: Determinar la prevalencia y los factores determinantes de las infecciones vaginales en mujeres recluidas en una cárcel de Bucaramanga, Colombia. MÉTODO: Estudio de corte transversal. Se recolectaron factores sociodemográficos y clínicos, antecedentes de tabaquismo, síntomas previos y comportamiento sexual. Se tomaron muestras de flujo vaginal para determinar microscópicamente el agente causante de infección. Se utilizó regresión log-binomial para calcular razones de prevalencia (RP), intervalos de confianza (IC95%) y valores p. El ajuste global del modelo final se evaluó con la razón de probabilidad (likelihood ratio). RESULTADOS: La prevalencia global de las infecciones evaluadas fue del 28,2%. Los factores asociados con una mayor probabilidad de tener una infección vaginal al momento del estudio fueron: tabaquismo (RP: 1,71; IC95%: 1,08-2,71); edad mayor a 35 años (RP: 1,41; IC95%: 1,01-1,97); el antecedente de flujo vaginal maloliente (RP: 2,22; IC95%: 1,42-3,47) y duchas vaginales (RP: 1,71; IC95%: 1,08-2,71). CONCLUSIONES: Las mujeres que se encuentran en centros de reclusión podrían tener una mayor frecuencia de factores de riesgo para infecciones vaginales y de enfermedades sexualmente transmitidas. En este grupo es recomendable la realización de un programa de educación y de detección temprana de estas entidades como actividad regular de prevención.

OBJECTIVE.lo determine the prevalence and the determining factors of vaginal infections in women imprisoned in a prison in Bucaramanga, Colombia. METHOD: Cross-sectional study. Socio-demographic and clinical factors were collected, as well as smoking antecedents, previous symptoms and sexual behaviour. Specimens of discharge vaginal were collected by trained personal to microscopically determine the infection agent. Log-binomial regression was used to calculate prevalence ratios (PR), 95% confidence intervals (CI95%), and p-values. The likelihood ratio test was used to assess the overall significance of the model. RESULTS.lhe global prevalence of vaginal infections was 28.2%. The factors associated with a higher risk of vaginal infection at the time of the study were: a. smoking (PR: 1.71; 95%CI: 1.08-2.71); b. age over 35 (PR: 1.41; 95%CI: 1.01-1.97); c. the antecedent symptom of bad-smelling vaginal discharge (PR: 2.22; 95%CI: 1.42-3.47) and d. vaginal douches (PR: 1.71; 95%CI: 1.08-2.71). CONCLUSION:Those women imprisoned in penitentiaries may have a higher frequency of risk factors of vaginal infections. In this group, it is recommendable to create an awareness and early-detection program for these entities as a regular prevention activity.

Nosocomial candiduria in women undergoing urinary catheterization. Clonal relationship between strains isolated from vaginal tract and urine.

We determined the incidence of nosocomial candiduria associated with indwelling urinary catheters in 42 women with and without Candida spp. vaginal colonization being treated in the intensive care unit (ICU). We established a relationship between strains initially isolated from the vaginal tract and those subsequently recovered from urine samples through the use of random amplified polymorphic DNA (RAPD). The overall incidence of nosocomial candiduria in these patients was 21.4%. Vaginal colonization by Candida spp. was detected in 11 patients (26.2%) of whom 6 (54.5%) developed candiduria. In comparison, only 3 (9.7%) cases of candiduria were found in women who were not colonized by the yeast (RR: 4.4, 95% CI 1.61-86.8, P=0.005). The dendrogram obtained by RAPD using 14 primers showed that the strains isolated from vagina and urine samples in five women had high similarity values (SAB >0.9) forming independent clusters. Our study suggests that women vaginally colonized by Candida spp. in an ICU setting have a high risk of acquiring nosocomial candiduria and that strains isolated from both sites in a single patient may be genetically related.

Aislamiento de cepas de Escherichia coli desde casos clínicos de infección vaginal: asociación con otros microorganismos y susceptibilidad antibacteriana / Presence of E. coli in vaginal fluids of women with vaginal infection and its antimicrobial susceptibility

Objetivo: Determinar la presencia de Escheríchia coli en fluidos vaginales de mujeres con infección vaginal y analizar la susceptibilidad antimicrobiana. Método: Se estudiaron 425 muestras de mujeres con diagnóstico clínico de infección vaginal (casos) y 100 mujeres sanas (controles). Las muestras vaginales fueron estudiadas mediante los criterios de Amsel y Nugent. Se utilizaron diferentes metodologías para identificar: Trichomonas vaginalis, Candida albicans, Gardnerella vaginalis, Chlamydia trachomatis, Myco-plasma hominis, Urea plasma urealyticum, Neisseria gonorrhoeae, Mobiluncus sp., Streptococcus agalactiae, Enterococcus faecalis, enterobacterias, bacilos Gram negativo anaerobios estrictos, Lactobacillus sp. y Staphylococcus coagulasa negativo. Resultados: Se observaron 160 casos de vaginitis y 265 de vaginosis. En los primeros predominó C. albicans y T. vaginalis, aislándose 27 cepas de E. coli en los casos de vaginosis, G. vaginalis y E.E. coli fueron los más comunes. La mayor asociación se observó entre G. vaginalis y E. coli . En 47 casos se aisló únicamente E. coli , y en los controles se observaron 6 cepas de E. coli . El estudio caso-control demostró un OR: 4,7 (95 por ciento IC: 1,91-12,27). Sobre el 90 por ciento de las cepas aisladas de E. coli demostró sensibilidad a cefotaxima, ciprofloxacino y amikacina. Conclusión: E. coli de aislados monomicrobianos podría tener un rol potencial en la patogenia de la infección vaginal.

Objective: To determine the presence of Escheríchia E. coli vaginal fluids of women with vaginal infection and to study its antimicrobial susceptibility. Methods: 425 samples of women with clinical diagnosis of vaginal infection (cases) and 100 healthy women were studied (controls). The vaginal samples were studied by means of the criteria of Amsel and Nugent. Different methodologies were used to identify: Trichomonas vaginalis, Candida albicans, Gardnerella vaginalis, Chlamydia trachomatis, Mycoplasma hominis, Ureaplas-ma urealyticum, Neisseria gonorrhoeae, Mobiluncus sp., Streptococcus agalactiae, Enterococcus faecalis, enterobacterias, strict anaerobic Gram negative bacilli, Lactobacillus sp. and coagulase negative Staphylococcus. Results: 160 cases of vaginitis and 265 of vaginosis were observed. In vaginitis predominated C. albicans and T vaginalis, and were isolated 27 E.E. coli strains. In the bacterial vaginosis, G. vaginalis and E. coli were the most common. The greater association was observed between G. vaginalis and E. coli . In 47 cases singleE. coli was isolated. In the controls 6E. coli strains were observed. The study of case-control demonstrated a OR: 4.7 (95 percent Cl: 1.91-12.27). Isolated E. coli demonstrated sensitivity over 90 percent to cefotaxime, ciprofloxacin and amikacin. Conclusion: SingleE. coli isolated could have a potential role in the pathogenia of the vaginal infection.

Marginal validity of syndromic management for reproductive tract infections among pregnant women in Jamaica.

We assessed the validity of a syndromic case management approach for reproductive tract infections (RTIs) among 371 pregnant women attending antenatal care facilities in Kingston, Jamaica, using an algorithm previously validated in high-risk Jamaican women. For our antenatal attenders, the algorithm had low sensitivities for all RTIs (66.7% for cervicitis, 35.4% for trichomoniasis, 11.1% for bacterial vaginosis (BV) and 24% for candidiasis). Specificities for BV (88.9%) and candidiasis (81.1%) were higher than for cervicitis (62.8%) and trichomoniasis (68.5%). The positive predictive values were lower than 36% for all diagnoses, especially BV (6.9%). Syndromic management of RTIs in pregnant women was problematic using a clinical algorithm that had worked well for high-risk women. Syndromic management for RTIs in Jamaican antenatal clinics is only a temporary solution until more simple and affordable diagnostic tests for RTIs are developed and/or until laboratory support and clinical care can be upgraded at antenatal clinics.

[Cervicovaginal infection as a risk factor for premature labor]. / Infección cervicovaginal como factor de riesgo para parto pretérmino.

OBJECTIVE: To identify the possible association between cervicovaginal infections (CVI) and preterm delivery. DESIGN: Cohorts. REFERENCE FRAME: Instituto Nacional de Perinatología, Hospital Central Militar and Hospital General Regional No. 1, IMSS, Culiacán, Sinaloa, México. PATIENTS: Four hundred and sixty eight patients attending prenatal control and delivery care. INTERVENTIONS: Fresh smears, Gram stain, and cervicovaginal sample culture from samples obtained during the following gestational stages: First sample at 16-24 weeks, second sample at 25-32 weeks, and third sample at 33-42 weeks. The following microorganisms were studied: Candida albicans, Gardnerella vaginalis, Ureaplasma urealyticum, Streptococcus agalactiae, Mycoplasma hominis, Neisseria gonorrhoeae, Listeria monocytogenes, and Chlamydia trachomatis. In case of a positive culture, the specific treatment was indicated. MEASUREMENTS: Positive or negative culture for each of the studied pathogens, and the presence or absence of a preterm delivery for each of the patients included in the study. RESULTS: Three hundred and ninety eight were still present at the end of the study, of which 156 had a CVI and 242 had no CVI. No differences between both groups were observed concerning preterm delivery. Significant relative risks were: In the first stage, Ureaplasma urealyticum and Mycoplasma hominis with RR = 9.0 (6.81, 11.8); in the second stage, Ureaplasma urealyticum with RR = 6.2 (3.30, 11.7) and Escherichia coli with RR = 3.4 (1.33, 8.6); in the third stage, Ureaplasma urealyticum with RR = 9.19 (6.93, 12.1). The logistic regression analysis identified Ureaplasma urealyticum during the second stage with OR = 16.6 (2.9, 93.7), statistically significant with p = 0.001. The survival analysis showed differences between the two groups concerning pregnancy duration (p < 0.001). CONCLUSIONS: There is a difference in the duration in pregnancy in patients with CVI and without CVI. Ureaplasma urealyticum is consistently associated with preterm delivery.