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D Taylor-Robinson

Publications and source records attributed to D Taylor-Robinson.

At least 109 records · Page 6Linked to original sources

Association of bacterial vaginosis with a history of second trimester miscarriage.

The aim of this study was to determine whether bacterial vaginosis (BV) is associated with a history of recurrent pregnancy loss. A total of 500 consecutive patients attending the Recurrent Miscarriage Clinic were screened for the presence of BV. In women who had had at least one late miscarriage BV was found twice as commonly (27/130; 21%) as in women who had had only early losses (31/370; 8%) (P < 0.001). The difference was even larger (26 versus 8%) if women who had had term pregnancies were excluded. Moreover, BV was found three times more commonly in Afro-Caribbean women [17 (29%) of 58] than in Caucasian women [36 (9%) of 379] and, in both groups of women, BV was diagnosed at least twice as frequently in those with a history of at least one late miscarriage than in those who had experienced first trimester pregnancy losses only (P < 0. 001). The condition occurred twice as often among smokers than non-smokers and, in both groups, it was at least twice as common in women with a history of at least one late miscarriage as in those who had had early pregnancy losses only (P < 0.001). However, the relationship between BV and smoking was independent of ethnic origin. Women who douched with chloroxylenol were mostly Afro-Caribbean and had BV more than twice as often as women who did not douche.

Abortion, Habitual↗

Bacterial vaginosis in pregnancy: distribution of bacterial species in different gram-stain categories of the vaginal flora.

Vaginal swabs for microbiological culture were taken from 174 pregnant women whose vaginal flora had been evaluated by Gram's stain; 50 had grade III flora (bacterial vaginosis, BV), 50 grade II (intermediate), 41 had vaginal flora graded as abnormal which then reverted to grade I (revertants) and 33 had normal flora (controls). The aim was to determine whether bacterial species isolated from women with grade II flora differed from those with grade III flora. Isolation of Lactobacillus spp. decreased from grade I to grade III and that of other aerobic and anaerobic bacterial species increased. There was little difference in the species isolated from women with grade II and grade III flora, but there was a distinct order in which organisms in different species increased in numbers. The vaginal flora of revertants was intermediate between that of healthy controls and those with grade II flora. Coagulase-negative Staphylococcus spp. were isolated from a greater number of revertants than grade I controls but the incidence did not increase in grade II or grade III. Bifidobacterium spp. were isolated from a greater number of revertants than grade I controls and increased further in grade II and grade III. However, Gardnerella vaginalis and Mycoplasma hominis were isolated from a much larger number of women with grade III flora than the other groups. The conclusion is that grade II is a transitional phase between grade I and grade III and that some organisms such as G. vaginalis and M. hominis only reach large numbers in the late stage. The sequence of appearance of the various bacterial species may be a result of the pathophysiological alteration of the vaginal ecosystem associated with BV.

Bacteria↗

Comparison of Gram-stained smears prepared from blind vaginal swabs with those obtained at speculum examination for the assessment of vaginal flora.

OBJECTIVE: To determine whether Gram-stained smears obtained from blind vaginal swabs could be used reliably for the assessment of the vaginal flora. DESIGN: A prospective, blind comparative study. SETTING: The antenatal clinic of a district general hospital. PARTICIPANTS: Eighty-eight women examined and screened for the presence of bacterial vaginosis during their first antenatal clinic visit. Two smears were obtained for each woman, the first prepared from a vaginal swab taken blindly and the second at speculum examination. The smears were Gram-stained and classified according to the Nugent score: Grade 1 (normal), Grade 2 (intermediate), Grade 3 (bacterial vaginosis). RESULTS: Eight of the 88 pregnant women were identified as having bacterial vaginosis on the basis of the smear taken at speculum examination, and these were correctly identified as having bacterial vaginosis by smears prepared from the blindly taken swab. This gives the blind vaginal swab technique for detecting bacterial vaginosis a sensitivity and specificity of 100% when compared with swabbing at speculum examination. The flora of two women were graded as intermediate, and of 75 as normal by both techniques. Only in three cases was there a disparity between the two techniques, a difference that was not statistically significant (kappa = 0.8546, 95% CI 0.6945 to 1.0). CONCLUSIONS: Vaginal smears prepared from correctly taken blind vaginal swabs can be used to assess the vaginal flora and screen for bacterial vaginosis. This method could be used in epidemiological studies of bacterial vaginosis in the general population and for screening antenatal populations for abnormal vaginal flora.

Double-Blind Method↗

Mycoplasma fermentans, but not M penetrans, detected by PCR assays in synovium from patients with rheumatoid arthritis and other rheumatic disorders.

AIM/BACKGROUND: Mycoplasmas, especially Mycoplasma fermentans, were suggested more than 20 years ago as a possible cause of rheumatoid arthritis but this hypothesis was never substantiated. In view of the superior sensitivity of the polymerase chain reaction (PCR) assay over culture, the aim was to use this method to seek M fermentans and M penetrans in synovial samples from patients with various arthritides. METHODS: Synovial fluid samples (n = 154) and synovial biopsy specimens (n = 20) from 133 patients with various rheumatic disorders were stored at -80 degrees C for between one and 40 months. Aliquots (500 microliters) of the synovial fluid samples were centrifuged and the deposit, and also the synovial biopsy specimens (approximately 1 g) were placed in lysis buffer with proteinase K for DNA extraction. The DNA was tested by using a semi-nested PCR assay for M fermentans and a single-round PCR for M penetrans. RESULTS: M fermentans was detected in the joints of eight (21%) of 38 patients with rheumatoid arthritis, two (20%) of 10 patients with spondyloarthropathy with peripheral arthritis, one (20%) of five patients with psoriatic arthritis, and four (13%) of 31 patients with unclassified arthritis. M fermentans was not found in the joints of the seven patients with reactive arthritis, the 29 with osteoarthritis or post-traumatic hydrarthrosis, the nine with gouty arthritis, nor the four with chronic juvenile arthritis. M penetrans was not detected in any sample. CONCLUSIONS: These findings show that the presence of M fermentans in the joint is associated with inflammatory rheumatic disorders of unknown cause, including rheumatoid arthritis. However, whether this organism triggers or perpetuates disease of behaves as a passenger remains conjectural.

Adolescent↗

Detection and widespread distribution of Chlamydia pneumoniae in the vascular system and its possible implications.

AIMS: To attempt to detect Chlamydia pneumoniae DNA in atheromatous vascular tissue. METHODS: A modification of an existing polymerase chain reaction (PCR) assay and immunofluorescence staining with a monoclonal antibody directed against C pneumoniae were used to detect C pneumoniae. Specimens from 32 patients undergoing abdominal aortic aneurysm repair were examined. Vascular tissue, ostensibly normal, from six liver transplant donors was also examined for comparison. Altogether, 43 vessels from these 38 subjects (age range 36-85 years) were examined. RESULTS: C pneumoniae was detected in 11 (44%) of 25 aortas, five (55%) of nine iliac arteries, two (40%) of five femoral arteries, and one of two iliac veins. Immunofluorescence staining supported positive PCR results in three of 12 cases in which it was used. Overall, C pneumoniae was detected in the arteries of 14 (44%) of the patients undergoing vascular surgery and three (50%) of the donors. CONCLUSIONS: This study is the first in the UK in which C pneumoniae organisms have been found in atherosclerotic vessels and the tendency for the organisms to be present most often in such vessels exhibiting chronic inflammatory changes suggests that a search for them in various forms of arteritis may also be rewarding.

Adult↗

Antigen capture ELISA for the heat shock protein (hsp60) of Chlamydia trachomatis.

AIMS: To develop an indirect ELISA using the heat shock protein (hsp60) of Chlamydia trachomatis as antigen. METHODS: The hsp60 gene was amplified by PCR, expressed in the vector pDEV-107 and transformed into Escherichia coli. The recombinant protein, expressed as a beta-galactosidase fusion product, was captured onto a solid phase using a monoclonal antibody directed against beta-galactosidase. Following incubation with goat anti-human antibody conjugated to peroxidase and colour development on addition of peroxidase substrate, antibody recognition of antigen was quantified by optical density at 492 nm. RESULTS: A sensitive and relatively specific ELISA to detect hsp60 has been produced, which can be exploited to determine the antibody response to C trachomatis hsp60. CONCLUSIONS: This assay will permit the future investigation of the immunopathogenesis of persistent inflammation following C trachomatis infection.

Blotting, Western↗

Defining bacterial vaginosis: to BV or not to BV, that is the question.

The history of bacterial vaginosis (BV), now extending over more than 40 years, has been remarkable not only in terms of repeatedly changing the name of the bacterium that we now know as Gardnerella vaginalis but also in relation to what is thought to constitute the condition, what it should be called and how the diagnosis can best be made. The composite clinical criteria are often confusing for the nonspecialist, provide room for inter-observer error, and misinterpretation of just one criterion can lead to considerable over or under diagnosis. There is no doubt that diagnosis should be through a Gram-stained vaginal smear, allowing detection not only of 'full blown' BV but also patterns of vaginal flora that while not in this category are nevertheless abnormal. Accurate diagnosis is important in view of the ever-growing list of other important conditions that may occur as a consequence of the abnormal flora. In addition to this, we raise the question of whether the name and abbreviation BV is the best either scientifically or from the point of view of the lay public. While recognizing that it now may be too ingrained for further change, is it possible to have a better term, at least for lay use?

Bacteriological Techniques↗

Evaluation of a commercial polymerase chain reaction assay for Chlamydia trachomatis and suggestions for improving sensitivity.

A commercial polymerase chain reaction (PCR) assay (Amplicor, Roche) for Chlamydia trachomatis was compared with a direct fluorescent antibody (DFA) test using urethral and cervical samples, many of which on the basis of prior testing by DFA contained small rather than large numbers of elementary bodies. Urine samples were collected from patients in a sequential unselected manner. Of 244 clinical specimens (138 male urethral and cervical; 106 male and female urine), 66 were positive by both DFA and PCR and 141 were negative by both tests. Nine samples were DFA negative and PCR positive, and 28 samples were DFA positive and PCR negative. However, 24 (86%) of the latter samples contained fewer than ten elementary bodies. When serial dilutions of laboratory stock strains (serovars E and H) were tested, the DFA test detected Chlamydia trachomatis at a dilution tenfold greater than the PCR. Furthermore, of five DFA-positive clinical samples, three that were PCR negative when tested according to the manufacturer's instructions were positive when they were diluted less. A modification of the PCR assay along these lines might improve sensitivity.

Chlamydia Infections↗

Infrequent detection of Chlamydia trachomatis in a longitudinal study of women with treated cervical infection.

OBJECTIVE: To determine how often Chlamydia trachomatis cervical infections are detected in women following completion of a currently recommended treatment regimen and the reason for recurrence. METHODS: A longitudinal follow-up study of 43 initially C trachomatis-positive women for periods of up to two years. RESULTS: C trachomatis was detected in three women, 19, 16 and about four months, respectively after completion of treatment. All specimens from the other 40 women which were taken during visits two to seven, that is periods of three to 700 days after treatment, were chlamydia-negative. CONCLUSION: Although C trachomatis is usually eradicated from the genital tract by conventional treatment, occasionally it may be found again. It is difficult to determine whether detection after treatment is due to persistence or reinfection and further studies are required.

Adult↗

Site of localization of Mycoplasma pulmonis and Mycoplasma hominis in the genital tract of female mice demonstrated by culture and scanning and immuno-electron microscopy.

Thirty young adult mice, of strain BALB/c, treated previously with progesterone, were inoculated intravaginally (10 mice) or directly into the uterus (10 mice) with Mycoplasma pulmonis and 10 mice remained uninoculated. Ten mice not treated with the hormone were also inoculated intrauterinely with M. pulmonis. The same numbers of mice treated with oestradiol were inoculated in the same ways with M. hominis. Vaginal swab specimens were obtained from all mice 7, 14 and 28 days after inoculation and samples of genital tract tissue were collected from pairs of mice at the same time intervals. Large numbers of M. pulmonis and M. hominis organisms were isolated from the vagina throughout the course of the experiments and they were cultured also from the cervix and uterine horns. Mycoplasma-like bodies were demonstrated by scanning electron microscopy in the cervix and in the uterus, but neither mycoplasmal species was found attached to vaginal epithelium. The results of silver-enhanced immunogold labelling in conjunction with scanning microscopy provided assurance that the mycoplasma-like bodies were, in fact, mycoplasmas. The importance of hormone treatment was indicated by the diminished susceptibility of untreated mice to M. pulmonis and the almost complete insusceptibility to M. hominis, shown by culture and scanning electron microscopy.

Animals↗

Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage.

OBJECTIVE: To find out whether women with bacterial vaginosis detected early in pregnancy are at increased risk of preterm delivery. DESIGN: Prospective description cohort study. SETTING: Antenatal clinic in a district general hospital. SUBJECTS: 783 women examined during their first antenatal clinic visit and screened for recognised risk factors for preterm delivery and the presence of bacterial vaginosis or intermediate abnormal flora detected by examination of a vaginal smear stained by Gram's method. MAIN OUTCOME MEASURES: Gestational age at delivery classified as late miscarriage (16-24 weeks' gestation), preterm delivery (24-37 weeks' gestation), term delivery (> or = 37 weeks' gestation). RESULTS: Multiple logistic analysis showed that there was an increased incidence of preterm delivery in women with a previous preterm delivery (9/24; odds ratio 25; 95% confidence interval 9 to 70; P < 0.001) and bacterial vaginosis (9/115; 2.8; 1.1 to 7.4; P = 0.04). A further logistic analysis of data from women recruited before 16 weeks' gestation showed that preterm deliveries or late miscarriages occurred more often in women with bacterial vaginosis (12/77; 5.5; 2.3 to 13.3; P < 0.001). CONCLUSIONS: Late miscarriage and preterm delivery are associated with the presence of bacterial vaginosis in early pregnancy. This is independent of recognised risk factors such as previous preterm delivery.

Abortion, Spontaneous↗

Limited value of two widely used enzyme immunoassays for detection of Chlamydia trachomatis in women.

Enzyme immunoassays (EIAs) are widely used to diagnose chlamydial infections in patients attending genitourinary medicine clinics. They are relatively easy to perform and are suitable for testing large numbers of samples. The objective of this study was to determine what proportion of women with chlamydial infection, defined as the presence of Chlamydia trachomatis in a cervical smear or deposit and/or in the urinary tract, detected by means of a sensitive direct fluorescent antibody test could also be identified by using two commercially available EIAs to test cervical samples. On hundred fifty-one women attending the genitourinary medicine clinic at St. Mary's Hospital, London, were enrolled. The use of the Chlamydiazyme (Abbott Diagnostics, UK) and MicroTrak (Syva, UK) EIAs resulted in the identification of only 56% and 63%, respectively, of women with chlamydial infection detected by direct fluorescent antibody staining. Thus, the EIAs available for detection of chlamydiae in cervical samples are inadequate for identifying all infected women. Improvement might be achieved by testing multiple samples or by resorting to tests of greater sensitivity.

Chlamydia Infections↗