Biomedical subjects
Publications and source records attributed to G R Monif.
Neonatal septicemia/meningitis from Streptococcus pneumoniae occurred in a 36-hour-old infant. The mother had no overt evidence of infection. This case illustrates the pathogenic potential of this common bacterium in the neonate.
C-reactive protein (CRP) is an acute-phase protein synthesized by the liver during the course of a large number of diseases. During gestation and parturition, progressively increasing numbers of gravida develop elevated levels up to 32, 48 to 80 per cent, respectively). These elevations in pregnancy, the nonspecificity of the test, and the inability to function as a reliable marker of fetal and/or maternal infectious morbidity have obscured the pragmatic utility of CRP determinations in both obstetrics and gynecology. Because of its biophysical kinetics, C-reactive protein determinations are best used as a monitoring parameter after the documentation of infection rather than as a diagnostic indicator of infection. They can provide valuable end titration points for termination of parenteral antibiotic therapy.
Vulvovaginitis caused by Candida (Torulopsis) glabrata is often refractory to intravaginal imidazole therapy. Clotrimazole achieves its fungistatic activity for Candida albicans and C. glabrata by inhibiting different steps in intermediary cell metabolism. For C. glabrata, alkylation precedes dimethylation. The possibility that this altered sequence might account for the relative therapeutic nonresponsiveness was studied by determining comparative minimal inhibitory concentrations (MICs) of clotrimazole. In vitro analyses of ten strains of C. glabrata and 30 control strains of C. albicans performed using both agar and broth dilution tests revealed that four-fold lower MICs were consistently demonstrable with C. glabrata, irrespective of inoculum size. The data suggest that clinical difficulties encountered in the therapy of torulopsis vulvovaginitis probably represent the inability of intravaginal medication to eradicate urethral/urinary bladder colonization and subsequent reinfection rather than true therapeutic failures.
Using three criteria--(1) herpetic infection and altered organogenesis of inflammatory etiology that antedates dissolution of the fetal membranes, (2) documented herpetic infection present at birth and within 24 hours of rupture of the fetal membranes, and (3) evidence of viral herpetic placentitis the induction of which antedates rupture of the membranes--15 cases of congenital transplacental herpes simplex were identified in the literature. Disease occurring early in gestation produces a cluster of congenital malformations that is clinically indistinguishable from that produced by the cytomegalovirus. Disease manifesting after the shortest recognized incubation period for the induction of the disease in experimental animals does not necessarily preclude transplacental acquisition. Various factors mask the perception of congenital transplacental herpes simplex as a valid disease entity.
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Two cases of perinatal septicemia due to the Bacteroidaceae are discussed. In contrast to most cases of perinatal septicemia caused by aerobic bacteria, these cases were not associated with prolonged rupture of the fetal membranes.
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Intrauterine contraceptive devices (IUD) have been associated with the induction of chronic anaerobic endometritis as well as superimposition of exogenous sexually transmitted diseases and unilateral tubo-ovarian abscesses. We report an unusual case of spontaneous bacterial peritonitis in a patient with ascites and an IUD. Bacteriological data support the concept that the source of infection was a chronic mixed endometritis induced by prolonged use of an IUD (16 years). In the presence of ascites, a localized endometritis with its reservoir of bacteria provided the medium for systemic disease.
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A patient with cytological and clinical evidence of IUD-associated anaerobic endometritis was studied with quantitative and qualitative bacteriological techniques. With the exception of elimination of Actinomyces israelii from the deep endocervical/endometrial culture, IUD removal induced minimal qualitative changes in the bacterial flora of the endocervical/endometrial sample during the 35 days the patient was monitored. The interposition of menstruation did not significantly alter either the quantitative or qualitative interrelationship of the bacteria present.
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A case of congenital herpes simplex virus type II infection acquired in utero is reported. The issue of congenital infection due to the herpes simplex viruses is discussed.
Although candidiasis of the female genital tract is one of the most common of the vaginitides, it is a poorly understood disease entity. Vulvovaginal candidiasis is a monoetiologic disease, but the pathways by which pathogenic expression is attained are sufficiently divergent to constitute a classification schema that influences therapy. For selection of appropriate therapy, the following three broad categories are proposed: (1) primary candidiasis, (2) antibiotic-induced candidiasis, and (3) systemically induced candidiasis.
This article reviews the rationale for the therapy of acute salpingitis and the conceptual basis for the length of therapy. The key to therapy of acute salpingitis is the need to accommodate polymicrobial etiology, polymicrobial bacterial superinfection, and the potential presence of penicillinase-producing strains of Neisseria gonorrhoeae into a therapeutic equation that has been determined by the appropriate staging of disease. The anticipated therapeutic response identified for monomicrobial disease due to Neisseria gonorrhoeae constitutes the end titration point for drug administration. Duration of continued therapy beyond this point is governed by the need to complete therapy for Chlamydia trachomatis or to assure resolution of advanced disease.
A case of successful therapy with ampicillin of maternal septicemia due to Listeria monocytogenes at 26 weeks' gestation with resultant delivery at term of a normal neonate is reported. The ability to positively influence the outcome of hematogenously acquired maternal-fetal infection is stressed.
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The Gainesville staging of acute salpingitis subdivides the complexity of clinical disease into four major stages. Each stage is predicated upon distinct therapeutic goals and different therapeutic regimens for achieving the principal goal of each stage.