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Ruiz Del Pino M, Rosales-Castillo A, Navarro-Marí JM, Gutiérrez-Fernández J. Clinical significance of isolation of Haemophilus no ducreyi in genital samples. Systematic review. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:468-484. [PMID: 36443187 DOI: 10.1016/j.eimce.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION AND OBJECTIVES Currently, the microbiological diagnosis of genital infections is carried out with molecular methods, which allow the detection of less frequent etiological agents but with potential pathogenic importance, such as Haemophilus spp. The objective of this review is to analyse and highlight the clinical importance of the isolation of Haemophilus spp. in genital and rectal infections, excluding Haemophilus ducreyi. MATERIAL AND METHODS A systematic review was carried out based on an exhaustive search of the publications included in the MEDLINE database up to August 5, 2021, on the presence of Haemophilus spp. in genital and rectal infections, excluding H. ducreyi. RESULTS After reviewing what was described in the literature, Haemophilus spp. (excluding H. ducreyi: HSNOD) was detected in 2397 episodes of genital infection, the most frequently isolated species being H. influenzae and H. parainfluenzae. Most of the episodes (87,6%) are constituted by single isolation. There is a slight predominance in women (48,3%) where it can cause vaginitis, salpingitis, endometritis or complications during pregnancy. In men, the clinical picture usually corresponds to urethritis. Most of the samples correspond to vaginal and urethral exudates, with a minority representation at the rectal level (2.3%). CONCLUSION HSNOD plays a relevant pathogenic role in episodes of genital infection, so microbiological diagnostic protocols must include methods that allow their detection, as well as include them in the etiological spectrum of this type of clinical picture.
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Affiliation(s)
- Marta Ruiz Del Pino
- Departamento de Microbiología, Facultad de Medicina, Universidad de Granada-ibs, Granada, Spain
| | - Antonio Rosales-Castillo
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves-ibs, Granada, Spain; Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain.
| | - José María Navarro-Marí
- Departamento de Microbiología, Hospital Universitario Virgen de las Nieves-ibs, Granada, Spain; Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain
| | - José Gutiérrez-Fernández
- Departamento de Microbiología, Facultad de Medicina, Universidad de Granada-ibs, Granada, Spain; Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain
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Gao H, Zhang Y, Pan Y, Zhao M, Qi Y, Zhou M, Chan SSC, Huang S, Song P, Tang K, Sun L, Yuan C. Patterns of pediatric and adolescent female genital inflammation in China: an eight-year retrospective study of 49,175 patients in China. Front Public Health 2023; 11:1073886. [PMID: 37727603 PMCID: PMC10506404 DOI: 10.3389/fpubh.2023.1073886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/22/2023] [Indexed: 09/21/2023] Open
Abstract
Background Genital inflammation is one of the most frequent clinical complaints among girls, which was easily overlooked by the general public. This study aimed to investigate the patterns and epidemiological characteristics of pediatric and adolescent female genital inflammation in China. Methods A retrospective observational study (2011 to 2018) was conducted among all female patients under the age of 0-18 years at the Department of Pediatric and Adolescent Gynecology of The Children's Hospital, Zhejiang University School of Medicine. Data were collected from the electronic medical records. The abnormal vaginal discharge of patient was collected for microbiological investigation by bacterial and fungal culture. Descriptive analysis was conducted to evaluate the genital inflammation pattern and epidemiological characteristics, including age, season, and type of infected pathogens. Results A total of 49,175 patients met the eligibility criteria of genital inflammation and 16,320 patients later came to the hospital for follow-up over the study period. The number of first-visit increased gradually from 3,769 in 2011 to 10,155 in 2018. The peak age of the first visit was 0-6 years old. Non-specific vulvovaginitis, lichen sclerosis, and labial adhesion were the top three genital inflammation. Among the top five potential common pathogens of vaginal infection, the prevalence of Haemophilus influenzae cases was the highest (31.42%, 203/646), followed by Streptococcus pyogenes (27.74%, 176/646), Candida albicans (14.09%, 91/646), Escherichia coli (8.51%, 55/646), and Staphylococcus aureus (6.35%, 41/636). The specific disease categories and pathogens of genital inflammation vary by age groups and season. Conclusion Our study summarizes the pattern of pediatric and adolescent female genital inflammation over an 8-year period in China, emphasizing the need for more public awareness, healthcare services and research in this field.
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Affiliation(s)
- Huihui Gao
- Department of Pediatrics and Adolescent Gynecology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yuchen Zhang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanzheng Pan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengjia Zhao
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Ye Qi
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Mingming Zhou
- Department of Clinical Laboratory, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Symphorosa S. C. Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, China
| | - Siyi Huang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Peige Song
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Liying Sun
- Department of Pediatrics and Adolescent Gynecology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Changzheng Yuan
- Department of Pediatrics and Adolescent Gynecology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
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Clinical Symptoms and Microbiological Findings in Prepubescent Girls with Vulvovaginitis. J Pediatr Adolesc Gynecol 2022; 35:629-633. [PMID: 35820605 DOI: 10.1016/j.jpag.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 06/17/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The diagnosis and treatment of vulvovaginitis in children is poorly managed because it is difficult to determine whether the agent causing vulvovaginal inflammation is a single bacterial species. STUDY OBJECTIVE This study retrospectively evaluated genital microbiological findings in prepubescent girls with vulvovaginitis and then compared the findings to healthy controls without discharge. METHODS This was a retrospective case-control study of 483 prepubescent girls aged 2-10 years with vulvovaginitis and 50 age-matched healthy asymptomatic controls. Data were collected at the Pediatric General Outpatient Unit of the Hospital of the Bezmialem Vakıf University from December 2015 to March 2021. RESULTS Of the 483 positive vaginal cultures in the study group, 248 (51.3%) exhibited potential causative agents. Conversely, 8 of 50 (16%) of the vaginal cultures in the control group (P < .001) exhibited potential causative agents. Streptococcus pyogenes was the most frequently detected causative agent of vulvovaginitis in the study group. S. pyogenes was present in specimens from 74 girls (15.8%) with symptoms of vulvovaginitis vs 1 (4.1%) specimen in the control group. Other specific organisms identified in the study group were Escherichia coli (12%), Haemophilus influenzae (5%), Staphylococcus aureus (4.3%), Candida albicans (4.3%), and Streptococcus agalactia (3.3%). CONCLUSIONS Among prepubescent girls with vulvovaginitis, 51.3% of vaginal cultures exhibited potential causative agents in the study group. Our microbiological data indicated that the most common pathogens were S. pyogenes and E. coli.
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Ruiz del Pino M, Rosales-Castillo A, Navarro-Marí JM, Gutiérrez-Fernández J. Importancia clínica del aislamiento de Haemophilus spp. (excluyendo H. ducreyi) en muestras genitales. Revisión sistemática. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Microbiological findings in prepubertal and pubertal girls with vulvovaginitis. Eur J Pediatr 2022; 181:4149-4155. [PMID: 36163515 PMCID: PMC9649474 DOI: 10.1007/s00431-022-04631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/01/2022] [Accepted: 09/19/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED Vulvovaginitis is a common and challenging gynaecological problem in prepubertal and pubertal girls. Such an infection, owing to a wide range of aetiologies, if not responding to hygienic measures, needs further investigation through vaginal cultures, since treatment should be tailored accordingly. This study aimed to investigate the pathogens isolated in prepubertal and pubertal girls with signs and symptoms of vulvovaginitis. A total of 2314 symptomatic girls, 1094 prepubertal and 1220 pubertal, aged 2 to 16 years, were included. Vaginal samples were inoculated on specific culture plates followed by incubation in aerobic, anaerobic or CO2 atmosphere at 37 °C for 24 or 48 h, as appropriate. The identification of the isolated pathogens was carried out using Gram stain, conventional methods and the automated system VITEK 2 (BioMerieux, Marcy l'Etoile, France). Positive cultures were obtained from 587 (53.7%) of prepubertal girls and 926 (75.9%) of pubertal girls. A total of 613 and 984 pathogens were detected in prepubertal and pubertal subjects, respectively. Isolated bacteria included 40.1% and 22.8% Gram-positive cocci, 35.6% and 24.8% Gram-negative rods in the prepubertal and pubertal groups, respectively, with faecal pathogens being the most prevalent. Bacterial vaginosis was diagnosed in 22.8% of prepubertal and 37.9% of pubertal girls. Candida species were isolated mostly in the pubertal girls (14.5%). CONCLUSION Culture results should be evaluated with caution in children with vulvovaginitis. In the prepubertal girls, the most common isolated pathogens were opportunistic bacteria of faecal origin while girls in late puberty were more susceptible to bacterial vaginosis and vulvovaginal candidiasis. WHAT IS KNOWN • Vulvovaginitis is the most frequent and challenging reason for referral to paediatric and adolescent gynaecology services. • Microbiological examination can prove to be a significant tool to help diagnosis although results should be evaluated with caution in children. WHAT IS NEW • Significantly more positive vaginal cultures and pathogens were recorded in symptomatic pubertal girls compared to prepubertal children. • The prevalence of bacterial vaginosis was increased in both prepubertal and pubertal girls with vulvovaginitis although significantly more in girls at puberty.
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Yu D, Liang Y, Lu Q, Meng Q, Wang W, Huang L, Bao Y, Zhao R, Chen Y, Zheng Y, Yang Y. Molecular Characteristics of Streptococcus pyogenes Isolated From Chinese Children With Different Diseases. Front Microbiol 2021; 12:722225. [PMID: 34956108 PMCID: PMC8696671 DOI: 10.3389/fmicb.2021.722225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Streptococcus pyogenes is a bacterial pathogen that causes a wide spectrum of clinical diseases exclusively in humans. The distribution of emm type, antibiotic resistance and virulence gene expression for S. pyogenes varies temporally and geographically, resulting in distinct disease spectra. In this study, we analyzed antibiotic resistance and resistance gene expression patterns among S. pyogenes isolates from pediatric patients in China and investigated the relationship between virulence gene expression, emm type, and disease categories. Forty-two representative emm1.0 and emm12.0 strains (n = 20 and n = 22, respectively) isolated from patients with scarlet fever or obstructive sleep apnea-hypopnea syndrome were subjected to whole-genome sequencing and phylogenetic analysis. These strains were further analyzed for susceptibility to vancomycin. We found a high rate and degree of resistance to macrolides and tetracycline in these strains, which mainly expressed ermB and tetM. The disease category correlated with emm type but not superantigens. The distribution of vanuG and virulence genes were associated with emm type. Previously reported important prophages, such as φHKU16.vir, φHKU488.vir, Φ5005.1, Φ5005.2, and Φ5005.3 encoding streptococcal toxin, and integrative conjugative elements (ICEs) such as ICE-emm12 and ICE-HKU397 encoding macrolide and tetracycline resistance were found present amongst emm1 or emm12 clones from Shenzhen, China.
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Affiliation(s)
- Dingle Yu
- Microbiology Laboratory, National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Shenzhen Children's Hospital, Shenzhen, China
| | - Yunmei Liang
- Beijing Chaoyang Hospital Affiliated to the Capital Medical University, Beijing, China
| | - Qinghua Lu
- Microbiology Laboratory, National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Shenzhen Children's Hospital, Shenzhen, China
| | - Qing Meng
- Shenzhen Children's Hospital, Shenzhen, China
| | | | - Lu Huang
- Shenzhen Children's Hospital, Shenzhen, China
| | - Yanmin Bao
- Shenzhen Children's Hospital, Shenzhen, China
| | | | | | | | - Yonghong Yang
- Microbiology Laboratory, National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Shenzhen Children's Hospital, Shenzhen, China
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