Treatment of chlamydial and mycoplasmal genital infections.
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Anti-Bacterial Agents↗
Biomedical subjects
G L Gilbert
Publications and source records attributed to G L Gilbert.
Bacteraemia and pelvic infection in women due to Ureaplasma urealyticum and Mycoplasma hominis.
During a 22-month period, pelvic infection with bacteraemia that was due to genital mycoplasmas was diagnosed in 12 adult patients at the Royal Women's Hospital. Mycoplasma hominis was isolated from seven patients and Ureaplasma urealyticum from five patients. Infections occurred postpartum in seven patients (in three patients after a vaginal delivery and in four patients after a caesarean section) and after gynaecological procedures in five patients. All patients were moderately ill. During the same period genital mycoplasmas were isolated from the blood cultures of three newborn infants, all of whom were at risk of sepsis. Genital mycoplasmas were isolated from blood cultures with only minor modification of the previous usual blood culture procedure. During the period that was reviewed, genital mycoplasmas accounted for 35% of 34 isolates from 607 blood cultures of adult patients. Genital mycoplasmas are a common cause of febrile morbidity and pelvic infection in women after genital tract procedures or delivery.
Adult↗
Epidemiology and prevention of invasive Haemophilus influenzae type b infection.
The use of rifampicin prophylaxis is recommended in close contacts of individuals with invasive Haemophilus influenzae type b infection if they include a child less than 4 years old in whom the risk of secondary infection is relatively high. In practice, delays in administration of rifampicin, contra-indications to its use and the difficulty of identifying all contacts at risk can reduce significantly its efficacy. Only 1-2% of cases of H. influenzae type b diseases are attributable to known contact and, at best, rifampicin prophylaxis can have little impact on the incidence. In the USA, one in 200 children less than 5 years old is affected. The incidence is probably similar in Australia but there are local differences which could affect the value of preventative measures. The vaccine recently licensed in the USA is not effective in children less than 18-24 months of age in whom the incidence of invasive H. influenzae type b infection, other than epiglottitis, is highest. Nevertheless, it could prevent more than 30% of cases if given to children at the age of 24 months. Vaccines effective in younger infants should become available soon. The best chance of prevention is by the optimal use of both rifampicin prophylaxis and immunization.
Australia↗
Isolation of genital mycoplasmas from the blood of neonates and women with pelvic infection using conventional SPS-free blood culture media.
Standard blood culture media used in our laboratory were tested for their ability to support the growth of Mycoplasma hominis and Ureaplasma urealyticum. Small inocula (approximately 10 colony forming units per ml) of both organisms grew in diphasic tryptone soya medium but not in any of several media containing sodium polyanetholesulphonate (SPS) including a modified Schaedler broth (RWH anaerobic medium) and two BACTEC media (6B and 7D). Both organisms were inhibited even by very low concentrations of SPS but grew well in the Royal Women's Hospital (RWH) anaerobic medium when SPS was omitted. During a 22-month period, routine "blind" plating of the aerobic blood cultures on to mycoplasma agar resulted in isolation of M. hominis or U. urealyticum from 12 women with postpartum or postoperative pelvic infection, and from 3 neonates. Genital mycoplasmas represented 35% of significant isolates from adult blood cultures.
Adult↗
Seroepidemiology of Chlamydia trachomatis infection in infertile women in Melbourne.
A serological study was undertaken to determine the prevalence of antibody to Chlamydia trachomatis in women and to investigate any possible role of the organism in infertility and pelvic inflammatory disease. Thirty-seven per cent of pregnant women were found to have antibodies to Chl. trachomatis, as were 69% of women with pelvic inflammatory disease. Eighty-five per cent of women who were infertile due to inflammatory tubal damage and 78% who were infertile secondary to ectopic pregnancy had antibody as compared with 56% of women who were infertile for other reasons. Sperm bank donors and children showed low prevalences (16% and 3%, respectively). Exposure to Chl. trachomatis is widespread in sexually active women and appears to have a role in pelvic inflammatory disease and infertility that is due to inflammatory tubal disease.
Adolescent↗
Herpes simplex virus encephalitis in children.
Five paediatric cases of herpes simplex virus encephalitis are described. In each case the diagnosis was made with some difficulty. A high index of suspicion is required in order that appropriate diagnostic and therapeutic manoeuvres are initiated at an early stage of the illness.
Acyclovir↗
Chlamydial infections in infancy.
Non-gonococcal ophthalmia neonatorum was the first recognized manifestation of sexually transmitted chlamydial infection and for many years it was thought to be the only manifestation in infants born to infected mothers. In the 20 years since techniques for isolation of Chlamydia trachomatis in cell culture were described, many important effects of chlamydial infection, including afebrile pneumonia in infants, have been established. Prospective studies have determined the incidence of chlamydial infection in pregnant women and the risk of transmission of infection to their infants. They have shown that these are among the commonest perinatal infections. It is estimated that at least 1% of infants in this community have chlamydial conjunctivitis and up to 5/1000 will develop pneumonia. Chlamydial infections are characterized by a subacute onset and, without appropriate treatment, a prolonged course. Although they are rarely fatal, symptoms are sometimes severe and there may be long-term sequelae. The recent development of rapid and relatively inexpensive methods for direct detection of chlamydiae in clinical specimens will facilitate the diagnosis and treatment of infections in infants.
Chlamydia Infections↗
Antenatal screening for congenital infection with rubella, cytomegalovirus and toxoplasma.
The sera of 3,463 pregnant women were screened, at the first antenatal visit, for antibodies to rubella, cytomegalovirus (CMV) and Toxoplasma gondii. Rubella antibodies were detected in 97.5%, CMV antibodies in 71% and toxoplasma antibodies in 45% of women. Asymptomatic toxoplasmosis occurred during pregnancy in 3 of 609 (0.5%) and primary CMV infection in 5 of 338 (1.5%) initially seronegative women whose sera were retested at the end of their pregnancies. The observed incidence of toxoplasmosis was similar to that calculated on the basis of the age-related prevalence of antibodies found in this study. On the basis of these observations it is estimated that congenital toxoplasmosis and congenital CMV infection due to primary maternal infection each occurs in up to 2/1,000 infants in this community. Very few of these infants have obvious abnormalities at birth, but follow-up studies elsewhere have shown that many of them suffer significant long-term sequelae. Routine antenatal screening for rubella antibodies is well established and justifiable for this preventable congenital infection. However, routine antenatal screening for CMV antibodies cannot be justified at present, since neither immunization nor treatment is available. Further information is required to determine the cost-effectiveness of routine antenatal screening for toxoplasma antibodies and treatment of proven maternal infection during pregnancy.
Adolescent↗
Group A streptococci and puerperal fever. Then and now.
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Carrier State↗
Congenital and perinatal cytomegalovirus infections.
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Cytomegalovirus Infections↗
Prevention of vertical transmission of hepatitis B. The place of routine screening in antenatal care, and the case for immunization of infants at risk.
Many chronic carriers of hepatitis B virus acquire the infection from their mothers at birth; the risk is greatest if the mother either has acute hepatitis B or is a hepatitis Be antigen (HBeAg)-positive HBsAg carrier, but there is some risk also to the infants of mothers who do not carry HBeAg. At the Royal Women's Hospital, Melbourne, nearly 2% of women attending antenatal clinics are found to be carriers and, without immunization, approximately five infants per 1000 infants delivered (up to 15 infants annually) would also become carriers. Vertical transmission of hepatitis B can be prevented by a combination of passive and active immunization if infants at risk can be identified at or before birth. Routine screening for hepatitis B surface antigen in pregnant women is recommended, at least in institutions in which the patient population includes a high proportion of migrants, in whom the prevalence of hepatitis B carriage is relatively high.
Asia, Southeastern↗
Rapid diagnosis of herpes simplex virus infections by enzyme-linked immunosorbent assay.
A total of 457 clinical specimens were tested for the presence of herpes simplex virus (HSV) by isolation in cell culture and by enzyme-linked immunosorbent assay. HSV antigen was detected by enzyme-linked immunosorbent assay in 94% of the clinical specimens from which the virus was isolated. The detection rate was improved to 100% when specimens were either assayed within 24 h or stored frozen at a constant temperature (-20 degrees C) for up to 14 days. Type-specific HSV antigen was also detected in 6% of culture-negative specimens. The assay can be completed in 5 h or less, and commercially available immunoglobulins are used. Enzyme-linked immunosorbent assay is a rapid and sensitive method for the diagnosis of HSV infection and can be used to improve the management of pregnant women with a history of genital herpes and of neonates and others with serious HSV infection which may require specific antiviral therapy. It also offers an alternative to cell culture for routine diagnosis of HSV infections.
Antigens, Viral↗
Acute salpingitis. Diagnostic and therapeutic dilemmas.
Acute salpingitis is occurring with increasing frequency among sexually active young women and is associated with a significant risk of long term morbidity, especially infertility. Clinical diagnosis is difficult because symptoms and signs are nonspecific and their severity is not always commensurate with the tubal pathology. No antibiotic is ideal; the choice should depend on the most likely pathogen in each patient and the severity of her disease.
Abortion, Induced↗
Perinatal group B streptococcal infections.
Predisposing factors and clinical presentations associated with early-onset group B streptococcal (GBS) infections in 60 infants were reviewed. Over a three-year period, the incidence of these infections in The Royal Women's Hospital, Melbourne, was 2.0 per 1000 births. The clinical presentation ranged from fulminating sepsis to asymptomatic bacteraemia. In some cases, there was evidence of intrauterine fetal infection, despite intact membranes and a lack of clinical evidence of maternal infection. However, the over-all incidence of fever, before and after delivery, among the mothers of these babies was high. Early, or prophylactic, antibiotic therapy was generally associated with a favourable outcome. None of the infants who died from GBS infections had received antibiotic therapy before the onset of symptoms. The value of routine antenatal screening for vaginal carriage of group B streptococci, and the place of antibiotic prophylaxis, or immunoprophylaxis, are not yet established. However, prophylactic antibiotic therapy in mothers and babies considered to be at risk from GBS infection is recommended.
Anti-Bacterial Agents↗
Bacteriuria due to Ureaplasma urealyticum and Gardnerella vaginalis in women with preeclampsia.
Certain fastidious organisms such as U urealyticum and G vaginalis can be isolated from the aspirated bladder urine of pregnant women more frequently than conventional urinary pathogens such as Escherichia coli [1]. They can be isolated even more often from the aspirated bladder urine of patients with renal disease, but rarely from that of healthy men or nonpregnant women [2]. We investigated the incidence of bacteriuria due to these two organisms--particularly U urealyticum--in patients with preeclampsia. U urealyticum was isolated more frequently (rate, 20%), and usually in higher colony counts, from the urine of patients with preeclampsia than from that of healthy pregnant women (rate, 7%). G vaginalis was isolated with approximately the same frequency as U urealyticum from specimens of bladder urine; both organisms were isolated from the urine of 11 patients (eight healthy women and three with preeclampsia). High colony counts of G vaginalis were also found more frequently in patients with preeclampsia. In both groups other fastidious organisms were isolated in a total of only five patients, and in four of these five cases U urealyticum and/or G vaginalis were also isolated from the same specimen. Urine cultures were more frequently positive in patients with moderately severe hypertension (blood pressure, greater than 160/100 mm Hg) than in those with mild hypertension (blood pressure, 140/90-160/100 mm Hg, occurring in nine (53%) of 17 patients and in nine (26.5%) of 34 patients, respectively. This difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
Bacteriuria↗
Enzyme-linked immunosorbent assay for rubella immunoglobulin G: new method for attachment of antigens to microtiter plates.
Many of the enzyme-linked immunosorbent assay (ELISA) techniques previously described for detection of rubella-specific antibodies employ complex technology not available in routine diagnostic laboratories. The method described allows the use of commercially available rubella hemagglutination inhibition (HI) antigen. Passive adsorption of these antigens to plastic is variable, but with the use of albumin as a bridge, it is possible to attach the antigen reliably to the plastic wells. Over 1,500 sera were tested by both HI and ELISA techniques to detect the presence of rubella antibodies. These sera were selected with a bias towards those with low levels of rubella-specific antibody, since it has been demonstrated that it is in this range that discrepancies are more likely to occur between HI and ELISA techniques. In 99% of the sera tested, the results of both techniques were in agreement. On the basis of these results, the technique offers a useful alternative to the routine rubella HI test and other ELISA techniques which need sophisticated antigen preparations.
Antibodies, Viral↗
Methicillin-resistant Staphylococcus aureus in neonatal nurseries. Two years' experience in special-care nurseries in Melbourne.
Methicillin-resistant Staphylococcus aureus has become an important nosocomial pathogen in the four special-care nurseries in Melbourne during the past two years. Once introduced into a nursery, it can spread rapidly unless specific precautions are taken to prevent it. It has been responsible for a number of serious infections in susceptible infants who have required treatment with the potentially toxic antibiotic agent, vancomycin. Because of the interdependence of the four special-care nurseries, a coordinated approach to infection control is required to minimise the spread of the organism and the associated increased morbidity.
Australia↗
Midtrimester abortion associated with septicaemia caused by Campylobacter jejuni.
The clinical record of a patient who suffered a mid-trimester missed abortion during an acute febrile illness is presented. Campylobacter jejuni was isolated from her blood cultures. Complete clinical recovery followed evacuation of the uterus and antibiotic therapy. Evidence of placental infection was found on histological examination. The possible role of campylobacter and other infections in fetal and perinatal death is discussed.
Abortion, Missed↗