Vaginal discharge--comparison of clinical, laboratory and microbiological findings

Of 101 fertile women (15-50 years of age) consulting in general practice due to vaginal discharge and/or genital malodor, bacterial vaginosis was diagnosed in 34% and vaginal candidiasis in 23%. The presence of Chlamydia trachomatis, Trichomonas vaginalis, genital herpes virus and Neisseria gonorrhoeae was demonstrated in 15%, 9%, 7%, and 1% of cases, respectively. No specific genital tract pathogens were found in 25 patients, where the clinical diagnosis was psychological factors (n = 5), intra-uterine device-associated discharge (n = 5), cytolytic vaginosis (n = 5), urinary tract infection (n = 3), or other/unknown causes (n = 7). In most cases diagnosis of bacterial vaginosis, vaginal candidiasis or trichomoniasis was established by clinical examination and simple office tests (pH indicator paper, amine test, microscopy of wet smear, yeast culture kit). C. trachomatis and N. gonorrhoeae were diagnosed by means of culture, cervicitis being diagnosed clinically in five of 15 cases with culture-confirmed chlamydial infection, while gonorrhoea was suspected from findings in a stained cervical smear. Sexually transmitted micro-organisms were detected in 16% of women with bacterial vaginosis or candidiasis. Of 29 women with sexually transmitted agents, 14% harbored more than one such organism.

Measurement issues in research on social support and health

STUDY OBJECTIVE

The aims were: (1) to identify methodological problems that may explain the inconsistencies and contradictions in the research evidence on social support and health, and (2) to validate a frequently used measure of social support in order to determine whether or not it could be used in multivariate analyses of population data in research on social support and health.

DESIGN AND METHODS

Secondary analysis of data collected in a cross sectional survey of a multistage cluster sample of the population of the United States, designed to study relationships in behavioural, social support and health variables. Statistical models based on item response theory and graph theory were used to validate the measure of social support to be used in subsequent analyses.

PARTICIPANTS

Data on 1755 men and women aged 20 to 64 years were available for the scale validation.

RESULTS

Massive evidence of item bias was found for all items of a group membership subscale. The most serious problems were found in relationship to an item measuring membership in work related groups. Using that item in the social network scale in multivariate analyses would distort findings on the statistical effects of education, employment status, and household income. Evidence of item bias was also found for a sociability subscale. When marital status was included to create what is called an intimate contacts subscale, the confounding grew worse.

CONCLUSIONS

The composite measure of social network is not valid and would seriously distort the findings of analyses attempting to study relationships between the index and other variables. The findings show that valid measurement is a methodological issue that must be addressed in scientific research on population health.

Bacterial vaginosis and vaginal microorganisms in idiopathic premature labor and association with pregnancy outcome

The vaginal microflora of 49 women in idiopathic preterm labor was compared with that of 38 term controls to determine whether the presence of bacterial vaginosis (BV) and/or specific microorganisms would influence the rate of preterm delivery. Demographic factors, pregnancy outcome, and reproductive history were also studied. BV, as defined by the presence of clue cells in a vaginal wet mount and characteristic microbial findings in a stained vaginal smear and vaginal culture, was more common in women with preterm labor and delivery than in controls (P < 0.01). The condition, diagnosed in 41% of women who had both preterm labor and delivery (n = 22) and in 11% each of women who had preterm labor but term delivery (n = 27) and controls, was associated with a 2.1-fold risk (95% confidence intervals, 1.2 to 3.7) for preterm birth prior to 37 weeks of gestation. BV was associated with low birth weight. Of 49 women with preterm labor, 67% (8 of 12) of women with BV were delivered of low-birth-weight neonates (< 2,500 g) compared with 22% (8 of 37) of women without the condition (P < 0.0005). The presence of hydrogen peroxide-producing facultative Lactobacillus spp. was strongly negatively associated with both preterm delivery and BV. BV-associated microorganisms, i.e., Mobiluncus, Prevotella, and Peptostreptococcus species, Porphyromonas asaccharolytica, Fusobacterium nucleatum, Mycoplasma hominis, and high numbers of Gardnerella vaginalis were significantly associated with preterm delivery; all species also strongly associated with BV (P = 0.0001 for each comparison). Mobiluncus curtisii and Fusobacterium nucleatum were recovered exclusively from women with preterm delivery. Our study clearly indicates that BV and its associated organisms are correlated with idiopathic premature delivery.

Endotoxin and microorganisms in percolate derived from compostable household waste

Health related problems among Danish garbage collectors have been reported. Separated compostable household waste was analyzed for endotoxin and microorganisms in an experimental study. Aerosols and liquid (percolate) from the waste were sampled over two 14-day periods during storage in containers.

Erythromycin versus metronidazole in the treatment of bacterial vaginosis

Of 101 women, 15-50 years of age, presenting with vaginal discharge, 34 had bacterial vaginosis and were randomly assigned to a seven-day course of oral treatment with either erythromycin (0.5 g b.i.d.) or metronidazole (0.4 g b.i.d.) in a single-blind, cross-over study. Treatment failure (> or = three clinical signs of bacterial vaginosis) occurred in 13 (81%) of 16 patients given erythromycin, as compared with three (17%) of 18 women treated with metronidazole (p < 0.001). Persistence of Gardnerella vaginalis, Mobiluncus species and/or Mycoplasma hominis was found in 14 of 16 patients treated with erythromycin, and in four of 16 patients treated with metronidazole. Treatment with metronidazole was successful (< or = two clinical signs of bacterial vaginosis) in eight of 10 cases of erythromycin treatment failure. Neither of two cases of metronidazole treatment failure was cured with erythromycin. At three-month follow-up of 31 women, persistence or recurrence of bacterial vaginosis was diagnosed in 11 cases (36%).

Determination of chromium in blood and serum: evaluation of quality control procedures and estimation of reference values in Danish subjects

This paper describes analytical methods to estimate environmental and occupational exposure levels of chromium in blood and serum by Zeeman atomic absorption spectrometry. Also reported is an internal quality control procedure involving a combination of an online quality control and subsequent statistical evaluation of the quality control results to evaluate the performance of the analytical methods. The solubilization of the blood by the proteinase Subtilisin A resulted in a recovery of chromium of 106 +/- 4.5%; the uncertainty was approximately 10% at a chromium level of 1 microgram l-1. The detection limit (LOD) for chromium in serum was 0.17 micrograms l-1 and 0.20 micrograms l-1 for chromium in blood. The LODs were sufficiently low for the determination of chromium in a large fraction of reference populations not occupationally exposed. The present study indicates that reference values for chromium in blood and serum are low but within the range in recent investigations, i.e. 0.04-0.35 micrograms l-1 in serum and 0.12-0.34 micrograms l-1 in human whole blood. The fraction of reference values below LOD was between 0.45 and 0.57 for chromium in serum and blood. Consequently, the reference populations were described by distribution free one-sided tolerance intervals and the precision of the estimation of the tolerance intervals was expressed as coverage intervals. The 95% one-sided tolerance limit calculated for chromium in serum was 0.60 micrograms l-1 with the coverage interval (95 +/- 4.8) percent at a probability of 0.95. Thus, the probability was 0.975 that the tolerance interval covers at least 90.2% of the distribution. In addition, the probability was 0.025 that the tolerance interval covers more than 99.8% of the population. It was only possible to calculate the 90% tolerance interval for chromium in blood with the coverage interval at 0.90 probability. The one-sided tolerance interval for chromium in blood was 0.37 micrograms l-1 with the coverage interval (90 +/- 9.9) percent at a probability of 0.90.

Phosphorylation and activation of the arachidonate-mobilizing phospholipase A2 in macrophages in response to bacteria

The role of potential target enzymes in the protein-kinase-C-independent eicosanoid response triggered by certain bacteria in murine peritoneal macrophages [Svensson, U., Holst, E. & Sundler, R. (1991) Eur. J. Biochem. 202, 699-705] has been investigated. The eicosanoid response was found to be due to an increase in the mobilization of arachidonate rather than to inhibition of arachidonate esterification or activation of the cyclooxygenase pathway and to be accompanied by a persistent increase in the activity of the arachidonate-mobilizing phospholipase A2 (PLA2-85). Also, down-regulation of protein-kinase C by prolonged treatment with 4 beta-phorbol 12-myristate 13-acetate did not reduce the bacterial activation of PLA2-85. The increase in activity of PLA2-85, like the increase in eicosanoid formation, showed a lag period of approximately 10 min. Furthermore, exposure of 32P-labeled macrophages to either bacteria (Gardnerella vaginalis) or the protein-phosphatase inhibitor okadaic acid caused an increase in the phosphorylation of PLA2-85. Okadaic acid (0.5 microM), which itself caused arachidonate mobilization and activation of PLA2-85 after a lag period of approximately 45 min, greatly promoted the response to bacteria even at earlier time points. This study provides strong evidence that the eicosanoid response to bacteria in macrophages occurs via a protein-kinase-C-independent activation of PLA2-85 and that this activation is due to an increase in the phosphorylation of the enzyme.

Danish external quality assessment scheme: an interlaboratory comparison study on lead, cadmium and chromium in lyophilized human blood concentrate

A Danish External Quality Assessment Scheme (EQAS) was carried out by the Danish National Institute of Occupational Health during the period 1988-1992. The scheme was implemented for 29 international laboratories from 15 countries assaying lead, cadmium, and chromium in human blood to ascertain the systematic error and uncertainty of the analytical methods. In the survey the quality control material AMI B701-B705, based on lyophilized human whole-blood concentrate, were used. As an estimate of the true values the reference values used in this evaluation were (a) the computed values, i.e., sum of the basal and spiked trace element concentration, and (b) the consensus values normally used in the Danish EQAS. This international evaluation of lead, cadmium, and chromium in human blood demonstrated that the use of lyophilized human blood concentrate quality control materials combined with this scheme is valuable in estimating the systematic error and the uncertainty of the analytical methods. For evaluating analytical performance, the computed values were preferable to the consensus values for lead and cadmium in human blood. Due to analytical difficulties suitable reference values were not established for chromium in blood. The study revealed analytical difficulties for cadmium and chromium in human blood. The assessment of laboratories according to established performance indexes indicates that few laboratories can maintain these performance indexes.

Characterization and distribution of Pasteurella species recovered from infected humans

During a 3-year period, all Pasteurella strains recovered at the Clinical Microbiological Laboratory, Lund, Sweden, were studied biochemically with respect to their relationship to the recently described taxa of this genus. Of 159 strains recovered from 146 infected humans, 95 were identified as Pasteurella multocida subsp. multocida, 21 as Pasteurella multocida subsp. septica, 28 as Pasteurella canis, 10 as Pasteurella stomatis, and 5 as Pasteurella dagmatis. The homology within and between the Pasteurella species regarding cellular fatty acids and enzymatic activities was also studied. Strains of the different Pasteurella species were indistinguishable from each other regarding fatty acid composition; all strains contained major amounts of C14:0, C16:1, C16:0, and 3-OH-C14:0 acids and minor amounts of C18:2, C18:1, and C18:0 acids. Neither did the enzymatic activities distinguish between strains belonging to different species. In addition, of 56 strains examined, toxin production was demonstrated only in 1 strain each of P. multocida subsp. multocida and P. canis. Except for one severe case of necrotizing cellulitis involving P. dagmatis, P. multocida subsp. multocida or P. multocida subsp. septica was recovered in the more serious cases of infection. Except for P. canis, which in all cases was associated with dog bites, most Pasteurella strains were recovered in cases of infection associated with cat bites or scratches. Pasteurella strains occurred in four infected patients without evident connections with animals.

Severe Pasteurella multocida infections in pregnant women

We report 2 cases of severe infections due to Pasteurella multocida, both occurring during pregnancy in previously healthy women. Both women had contact with animals (dog and cat) but neither of them had been bitten. Apart from a slight decrease in IgG levels, no immunological defects could be detected. Both women had received oral phenoxymethylpenicillin in the early phase of the disease, but still fell ill with severe infections. One woman had meningitis while the other suffered from cellulitis with deep abscess formation.

Increased passage of bovine serum albumin over the respiratory tract after intratracheal instillation during septic shock in rats

Sepsis may initiate acute respiratory distress syndrome which may be accompanied by an increased pulmonary epithelial-endothelial permeability. In this study, sepsis was induced by an intraperitoneal implantation of gelatine capsules containing Escherichia coli/Bacteroides fragilis/adjuvant substance. The importance of bacteria in sepsis-related lung injury was studied in rats given an intraperitoneal injection of E. coli or in rats given the adjuvant substance alone in capsules intraperitoneally. Rats with empty capsules were used as controls. The rats were intratracheally instilled with bovine serum albumin (BSA) directly after the capsule implantation or the injection of E. coli, and the passage over the lower respiratory tract was assessed as blood plasma levels of immunoreactive BSA. The plasma BSA levels in the control rats increased continuously up to 24 h after intratracheal instillation. This increase was significantly augmented already 1 h after the septic challenge, i.e. before any clinical symptoms were observed, in both the septic rats and the rats with the E. coli injected intraperitoneally. Furthermore, the time required to obtain maximal plasma BSA levels was shorter in septic, adjuvant-exposed and in E. coli-injected rats than in the controls. The plasma levels and the total BSA passage over the lower respiratory tract was significantly higher (p less than 0.001) in the septic and in the E. coli-injected rats than in the adjuvant-exposed and the control rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Validation of a high-performance liquid chromatography/fluorescence detection method for the simultaneous quantification of fifteen polycyclic aromatic hydrocarbons

A high-performance liquid chromatography/fluorescence method using multiple wavelength shift for simultaneous quantification of different PAH compounds was developed. The new method was superior to the methods of DONG and GREENBERG [J. Liquid Chromatogr. 11, 1887-1905 (1988)] and WISE et al. [Polycyclic aromat. Hydrocarb. (in press)] with respect to sensitivity of detection of the majority of 15 PAH compounds, and in particular of naphthalene, acenaphthene, fluorene and benzo(b)fluoranthene. The method of validation analysis employed showed that the new method is in statistical balance meaning that no systematic errors, and only small unsystematic errors, could be demonstrated. Furthermore, the method had a good reproducibility and a high sensitivity.

Old persons' contact with general practitioners in relation to health: a Danish population study

The study describes health, social situation, and contact with general practitioners in a random sample of non-institutionalized persons 70-95 years old in Denmark. There was a strong correlation between health and contact with general practitioners. A small group, 3% of the respondents, had no health problems, but had been in contact with a general practitioner within the previous month. This group was characterized by a strong social network and a high degree of life satisfaction. Another small group, including 3% of the respondents, had extensive health problems, but had nevertheless not been in contact with a general practitioner within the previous year. This group was characterized by a weak social network and a low degree of life satisfaction.

Protein-kinase-C-independent activation of arachidonate release and prostaglandin E2 formation in macrophages interacting with certain bacteria

Certain bacterial species, of which we selected Fusobacterium nucleatum, Gardnerella vaginalis, Peptostreptococcus anaerobius and Propionibacterium acnes, were found to induce release of arachidonic acid in a dose- and time-dependent manner in mouse macrophages. The release of arachidonic acid showed a characteristic lag period of approximately 10 min and was accompanied by selective transformation into prostaglandin E2. Bacteria killed by various methods caused a similar response, indicating that bacterial surface structures rather than secreted products were involved. Down-regulation of protein kinase C by treatment of macrophages with 4 beta-phorbol 12-myristate 13-acetate hardly affected the response to bacteria at all, except for a partial inhibition in the case of P. acnes. Furthermore, the generation of prostaglandin E2 was synergistically enhanced when macrophages were exposed to both bacteria and phorbol ester. It is also unlikely that bacterial activation was mediated exclusively via a rise in cytosolic [Ca2+], since bacteria stimulated the release of arachidonic acid also when [Ca2+] was clamped at various levels and since the response to bacteria was enhanced in an additive to synergistic manner when combined with calcium ionophore. Changes in protein phosphorylation in macrophages exposed to F. nucleatum (Gram-negative) were virtually identical to those seen with bacterial lipopolysaccharide, while P. anaerobius (Gram-positive) induced enhanced labeling of a single detectable phosphoprotein. In both cases, the changes in protein phosphorylation showed a time lag of 4-8 min and occurred independently of protein kinase C, consistent with a possible role in signal transduction. These results demonstrate that certain bacteria cause activation of arachidonic acid release and prostaglandin E2 formation in mouse macrophages; that the response is independent of protein kinase C and that it is not wholly mediated via a rise in cytosolic [Ca2+].

Prostatectomy in Denmark. Regional variation and the diffusion of medical technology 1977-1985

In many countries prostatectomy is one of the most common surgical operations in elderly men. We used administrative data for the entire male population of Denmark to study temporal and regional variations in the use of prostatectomy from 1977 to 1985. The total annual number of prostatectomies increased by 43% during the period, when the transurethral procedure (TURP) gradually replaced traditional open surgery. TURP accounted for 56% of all operations in 1977 but increased its share to 92% in 1985. Substantial regional variations occurred with index values for prostatectomy in 72 recruitment areas ranging from 0.56 to 1.62 (SCV x 100 = 5.3). The amount of variation decreased during the process of technology diffusion, but remained at a relatively high level (as in other countries) even after the process had been completed (SCV x 100 = 5.1).

Reservoir of four organisms associated with bacterial vaginosis suggests lack of sexual transmission

This study consisted of a search for the possible reservoir and mode of spread of the four bacterial vaginosis-associated organisms Mobiluncus mulieris, Mobiluncus curtisii, Mycoplasma hominis, and Gardnerella vaginalis. Their occurrence in rectal, oral, and pharyngeal specimens from women with and without bacterial vaginosis, their male sexual consorts, four homosexual men, and children (altogether, 374 people) was studied. Genital samples were also obtained from all adults. All four organisms were isolated from the rectums of 45 to 62% of women with bacterial vaginosis and 10 to 14% of women without bacterial vaginosis. They also occurred in the rectums of males and children. M. hominis was recovered from the oropharynxes of 12 adults whose sexual consorts had genital occurrences of the organism. Mobiluncus spp. occurred only in the vaginas of women with bacterial vaginosis (97%). The organisms were only infrequently recovered from genital samples from 135 males. Organisms were recovered from the urethras and/or coronal sulci of 10 of 44 male consorts of women with bacterial vaginosis. However, after 2 weeks of condom use during sexual intercourse, only M. hominis remained in the urethra of one man. These findings suggest that the organisms associated with bacterial vaginosis are not spread sexually but colonize the vagina from an endogenous intestinal tract site. The pathophysiological mechanisms leading to bacterial vaginosis in a subpopulation of all women are still unknown.

Emergence and persistence of beta-lactamase-producing bacteria in the upper respiratory tract in children treated with beta-lactam antibiotics

PURPOSE

To assess the ecologic impact, in terms of selection of beta-lactamase-producing respiratory tract bacteria, of a single course of peroral beta-lactam antibiotics.

PATIENTS AND METHODS

One-hundred fifty consecutive children with clinical signs of bacterial respiratory tract infection were randomly assigned to a seven-day course of treatment with either penicillin V, amoxicillin, or cefaclor. Bacteriologic specimens were collected before treatment, at its termination, and at follow-up four weeks later.

RESULTS

All three drugs investigated caused a similar increase in beta-lactamase-producing bacteria, both in absolute and relative terms, an increase that persisted over a period of at least one month after completion of treatment.

CONCLUSION

Penicillin V, amoxicillin, and cefaclor all act as selective agents for beta-lactamase-producing bacteria in the upper respiratory tract. Treatment with a peroral beta-lactam antibiotic puts patients at risk of becoming persistent carriers of beta-lactamase-producing bacteria.

Treatment of bacterial vaginosis in pregnancy with a lactate gel

10 pregnant women with bacterial vaginosis were treated vaginally with a low-pH lactate gel intermittently during 6 weeks. Reappearance of a lactobacillus-dominated vaginal flora was observed after a few days treatment in all patients. All women experienced a subjective disappearance of abnormal vaginal discharge and malodour. This local treatment restores the normal vaginal acidity and facilitates recolonization with lactobacilli. It may be preferable to oral antimicrobial therapy, especially during pregnancy.

In vitro activities of cefcanel and some other cephalosporins against Pasteurella multocida

Thirty-five strains of Pasteurella multocida from humans and animals were tested for susceptibility to five cephalosporins by a broth dilution method. Cefcanel showed high activity against all isolates (MIC and MBC, less than or equal to 0.64 micrograms/ml). The corresponding figure for cefaclor and cefuroxime was 2.56 micrograms/ml. Cefadroxil and cephalexin were the least active compounds tested.

Cefadroxil as an alternative to metronidazole in the treatment of bacterial vaginosis

A randomized single-blind study was performed to compare the efficacy of cefadroxil to that of metronidazole in the treatment of bacterial vaginosis. 22 women completed the study with follow-ups after 1 and 4 weeks. After completion of treatment 2/11 women receiving metronidazole still had bacterial vaginosis compared with 1/11 women receiving cefadroxil. At follow-up after 4 weeks 3/10 women treated with cefadroxil had recurrent bacterial vaginosis while the corresponding figures for metronidazole were 2/9.

Pasteurella multocida occurs in a high frequency in the saliva of pet dogs

Pasteurella multocida is a frequent cause of infection after animal bites. In contrast to earlier reports, P. multocida appeared to be as common among dogs as among cats. We found 17 (81%) of 21 pet dogs to harbour P. multocida in their saliva. At normal contact, the risk of transmission from dogs to humans seems to be negligible. Only 1/27 dogs owners was found to harbour the organism. None of 13 cat owners or 23 persons without animal contacts harboured P. multocida.

Gas chromatographic comparison of peptone yeast glucose and gas liquid chromatography growth media for anaerobic bacteria

The growth media peptone yeast extract glucose broth and gas liquid chromatography broth were compared with respect to their suitability for anaerobic bacteria, using 63 strains belonging to 12 species. After incubation for 24 and 48 h the broth cultures were subjected to viable counts and gas chromatographic analysis of short-chain alcohols and fatty acids in head-space vapours and ether extracts. Head-space analysis was superior to the ether extraction method for detecting the rapidly eluting short-chain alcohols. The gas liquid chromatography medium provided superior growth and contained fewer compounds that interfered with the chromatographic analyses. Whereas incubation in gas liquid chromatography medium for 24 h gave characteristic chromatograms for all but one of the studied species, most species required 48 h of incubation in peptone yeast extract glucose medium. Gas liquid chromatography broth is the preferred substrate for use in gas chromatographic identification of anaerobic bacteria.

Bacterial vaginosis: microbiological and clinical findings

A prospective study was performed involving 101 women who consecutively attended a primary health care unit for complaints of genital malodour and/or abnormal vaginal discharge. Bacterial vaginosis was diagnosed in 34 women on the basis of four diagnostic criteria: vaginal pH greater than 4.7, homogeneous vaginal discharge, a positive amine test and clue cells. The sensitivity of these criteria was greater than 90% except for homogeneous discharge (82%). Their specificity was greater than 90% except for vaginal pH greater than 4.7 (46%); a specificity of 87% could have been achieved by using the criterion for vaginal pH greater than or equal to 5.0. There was a strong association between diagnosis of bacterial vaginosis and the concomitant occurrence of Gardnerella vaginalis, Mobiluncus spp. and Bacteroides spp. There was no difference between women with or without bacterial vaginosis as regards contraception methods (except for use of an intrauterine device), age at first intercourse, or earlier episodes of vaginal discharge. Sexual transmission of the predominant bacteria was not supported by data collected from the male consorts.