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Biomedical subjects

P Piot

Publications and source records attributed to P Piot.

At least 307 records · Page 17Linked to original sources

Comparison of growth inhibition and immunofluorescence tests in serotyping clinical isolates of Ureaplasma urealyticum.

Typestrains of the eight serotypes of Ureaplasma urealyticum and 39 genital isolates were typed by the growth inhibition (GI) and indirect immunofluorescence (IF) tests. The GI test proved to be very specific and simple, demanding large volumes of serum. It was less sensitive than the IF test, which produced more cross-reactions, was economical in serum, and able to detect mixed infections. Of the 39 isolates, 27 were serotyped by GI and 34 by IF. Mixed cultures occurred in as many as 36% of the isolates.

Bacteriological Techniques↗

[Sensitivity of "Haemophilus influenzae" to 5 antibiotics and rapid detection of its resistance to ampicilin (author's transl)].

Sensitivity of Haemophilus influenzae to 5 antibiotics has been determined by the agar dilution method. Two strains out of 165 are resistant to ampicillin and 5% to tetracycline. All strains were sensitive to chloramphenicol, cotrimoxazole and cefuroxime. A simple test for rapid detection of beta-lactamase with a chromogenic cephalosporin and sensitivity testing by an agar diffusion method were evaluated for Haemophilus.

Ampicillin↗

Distribution of eight serotypes of Ureaplasma urealyticum in cases of non-gonococcal urethritis and of gonorrhoea, and in healthy persons.

The isolation rate of Ureaplasma urealyticum was 57 per cent. from 47 patients with non-gonococcal urethritis, 40 per cent. from forty patients with gonorrhoea, 47 per cent from healthy sailors, and 53 per cent. from healthy students and laboratory technicians. No difference in distribution of eight serotypes among 45 isolates from these groups was demonstrated and no particular serotype could be correlated with disease symptoms.

Adult↗

Activity in vitro of ten antimicrobial agents against Neisseria gonorrhoeae. A study of the correlation between the sensitivities.

105 Belgian strains of Neisseria gonorrhoeae were tested for their sensitivity to penicillin, ampicillin, rifampicin, erythromycin, tetracycline, streptomycin, spectinomycin, sulphamethoxazole, trimethroprim, and a combination of sulphamethoxazole and trimethroprim in a 5:1 ratio. Distribution and median values of minimum inhibitory concentrations (MICs) are given and discussed. 42 per cent. of strains were relatively resistant to penicillin (MIC greater than or equal to 0-04 mug/ml.), but only 2 per cent. showed high-level resistance (MIC greater than or equal to 0-38 mug/ml.), which is comparable with the prevalence of decreased sensitivity found in other European countries. A significant positive correlation (P less than or equal to 0-01, rank correlation coefficient) is found between the sensitivities to penicillin, ampicillin, erythromycin, tetracycline, and streptomycin, except for the ampicillin-erythromycin and ampicillin-tetracycline pairs. Rifampicin is correlated with tetracycline. No correlation is found between the sensitivities to spectinomycin and any of the other drugs. The combination of sulphamethoxazole and trimethoprim in a 5:1 ratio also shows a significant positive correlation with penicillin and ampicillin and with sulphamethoxazole and trimethoprim separately.

Ampicillin↗

Evaluation of three techniques for carbohydrate fermentation of Neisseriae.

Three different techniques to study carbohydrate fermentation by Neisseriae were compared using 226 strains: growth in semi-solid cystine trypticase agar, the rapid test in phosphate buffered solutions of carbohydrates and growth on slants of solid cystine trypticase agar. The latter method was found to be the easiest to perform and is more suited for smaller laboratories, since the media used may be stored for at least 2 months.

Carbohydrate Metabolism↗

Etiology of genital ulcerations in Swaziland.

The etiology of genital ulcer disease was determined among 155 consecutive new cases in Mbabane, Swaziland. In contrast to genital ulcerations in industrialized countries, chancroid was the most common diagnosis (44% of cases), as established on clinical grounds and by exclusion of other etiologies. Primary syphilis and genital herpes accounted for only 17% and 12% of the cases, respectively. Lymphogranuloma venereum was found in 13% of the patients, and in 15% of cases no diagnosis was made.

Chancroid↗

Comparison of media for the primary isolation of Haemophilus ducreyi.

The rates of isolation of Haemophilus ducreyi from patients with presumed chancroid has been low, and improved cultural techniques are required. We determined the isolation rates of H. ducreyi from 38 patients with clinical chancroid and compared gonococcal agar supplemented with bovine hemoglobin to Mueller-Hinton agar supplemented with chocolated horse blood, each with and without 5% fetal calf serum. The rate of isolation and the qualitative and quantitative growth of strains was best on gonococcal agar with added fetal calf serum (GC-HgS). However, three strains were isolated only on Mueller-Hinton base (MH-base). GC-HgS was compared with MH-HB for the isolation of H. ducreyi from 201 patients with clinical chancroid. Seventy-one percent of cultures were positive on GC-HgS, and 61% were positive on MH-HB (P less than .005); however, 10% of cultures were positive only on MH-HB. The use of the two media together increased the yield of positive cultures to 81%. Thus maximal rates of isolation of H. ducreyi from clinical specimens requires the use of two media, GC-HgS and MH-HB.

Chancroid↗

The clinical diagnosis of genital ulcer disease in men in the tropics.

Since the clinical diagnosis of genital ulcers without laboratory confirmation is not reliable in developed countries, we postulated that clinical diagnosis alone would be no more reliable in developing countries. A presumptive clinical diagnosis of chancroid, genital herpes, syphilis, or lymphogranuloma venereum was made for 100 male patients at the Special Treatment Clinic in Nairobi, Kenya. This diagnosis was then compared to the final diagnosis determined by laboratory identification of the pathogen, by culture, or by serologic response. In 64 patients, a final diagnosis of either chancroid, syphilis, or genital herpes was established. The diagnostic accuracy varied from 75% for chancroid to 42% for syphilis and 43% for herpes. The overall diagnostic accuracy was 66%. The predictive values of positive clinical diagnoses were 84% for chancroid, 60% for syphilis, and 75% for herpes. Thus, clinical diagnosis of genital ulcer disease was not sufficiently reliable in this study.

Chancre↗

Treatment of gonorrhea with single-dose thiamphenicol in Kenya.

The efficacy of a single 2.5-g dose of thiamphenicol against infection with penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) or non-penicillinase-producing strains (non-PPNG) was studied in a two-phase clinical trial in Nairobi. The first phase included men who had had a urethral discharge for less than seven days, were infected with either PPNG or non-PPNG, and had not received previous treatment. The second phase included men with PPNG infections that had not responded to treatment with penicillin. The overall cure rate (determined by follow-up examinations and cultures three and ten days after treatment) was 90.6% in the first phase of the study and 92.1% in the second phase. A second 2.5-g dose of thiamphenicol was administered to four of the six patients in the second phase whose cultures yielded gonococci after the initial dose; the infections of all four patients were cured. The results of disk diffusion tests of gonococcal isolates did not correlate well with the outcome of treatment.

Adult↗

Prostitutes are a major reservoir of sexually transmitted diseases in Nairobi, Kenya.

Prostitutes are a major reservoir of sexually transmitted diseases in many developing nations. In Nairobi we found that 16%, 28%, and 46%, respectively, of upper-, middle-, and lower-social strata prostitutes were infected with Neisseria gonorrhoeae. Genital ulcers and infections with Haemophilus ducreyi were more prevalent among prostitutes of the middle and lower social strata. A group of 97 prostitutes of the lower social strata were followed longitudinally to determine the rate of reinfection with N. gonorrhoeae. The mean time to acquisition of a new infection was 12.0 +/- 9.2 days. These results show that in Nairobi prostitutes are a readily identifiable group of high-frequency transmitters of gonococcal infection. Strategies based on intervention in the prostitute reservoir could prove to be an effective means of control of gonococcal infections in developing nations.

Chancroid↗

Parents of infants with ophthalmia neonatorum: a high-risk group for sexually transmitted diseases.

One hundred forty-nine mothers and 74 fathers of infants who presented at the Special Treatment Clinic (Nairobi) with ophthalmia neonatorum were evaluated. Neisseria gonorrhoeae was isolated from 60 (40%) of 149 mothers and Chlamydia trachomatis was isolated from 31 (21%). Twenty-six mothers (17.5%) had clinical evidence of endometritis or pelvic inflammatory disease. Mothers with endometritis and/or pelvic inflammatory disease were more often infected with N. gonorrhoeae (65%) than were mothers without these conditions (24%) (P less than or equal to .001). N. gonorrhoeae was isolated from ten (14%) and C. trachomatis from three (9%) of 32 fathers, and nongonococcal urethritis was diagnosed in an additional 21 fathers (28%). Seven of ten men with gonococcal urethritis and 18 of 21 with nongonococcal urethritis had no symptoms. These data confirm that the presence of ophthalmia neonatorum in a neonate should be considered as a strong indicator of sexually transmitted disease in the parents. Although most infections in fathers were asymptomatic, the mothers were at high risk for complications.

Adult↗

Clinical and microbiologic studies of genital ulcers in Kenyan women.

The etiology of genital ulcers in women in tropical regions is poorly understood. Eighty-nine women, presenting to a sexually transmitted disease clinic in Nairobi (Kenya) with a primary complaint of genital ulcers, were evaluated prospectively in a clinical and laboratory study. A final etiologic diagnosis was possible for 60 (67%) of the women. Culture for Haemophilus ducreyi was positive for 43 women, eight had secondary syphilis with ulcerated condyloma latum, three had primary syphilis, one had both chancroid and syphilis, two had moniliasis, two had herpetic ulceration, and one had a traumatic ulcer. The clinical characteristics that best distinguished chancroid from secondary syphilis were ulcer excavation and a rough ulcer base. No etiologic diagnosis was established for 29 patients. However, the clinical and epidemiologic features of these patients suggested that they were similar if not identical to the patients with H. ducreyi culture-positive chancroid. Further studies are necessary to determine the etiology of ulcers in females in whom no pathogen was identified.

Chancroid↗

Single-dose ceftriaxone therapy of gonococcal ophthalmia neonatorum.

Ceftriaxone (125 mg) given as a single intramuscular dose without topical therapy was evaluated in seven infants with smear-positive gonococcal ophthalmia neonatorum. Neisseria gonorrhoeae was isolated from the eyes of six infants, and four of these isolates were penicillinase-producing N. gonorrhoeae. Two infants had concomitant ocular infection with Chlamydia trachomatis. All seven infants, when seen at follow-up, showed marked clinical improvement. Conjunctivitis resolved completely in four infants. One infant was lost to subsequent follow-up, while two infants had persistent ophthalmia due to C. trachomatis. Follow-up eye cultures for N. gonorrhoeae were all negative.

Ceftriaxone↗

Advances in the diagnosis and management of chancroid.

Improved technologies for the cultural diagnosis of chancroid have resulted in increased interest in the management and control of genital ulcer disease. New treatment regimens have been identified, and new control strategies have evolved. These strategies now permit localized introductions of chancroid into developed countries to be contained rapidly. However, additional work is still necessary in developing countries.

Anti-Bacterial Agents↗

A comparison of single-dose spectinomycin with five days of trimethoprim-sulfamethoxazole for the treatment of chancroid.

In a controlled trial 32 patients with ulcers culture-positive for Haemophilus ducreyi were treated with a single 2-g dose of spectinomycin, and 20 patients were treated with a five-day course of trimethoprim-sulfamethoxazole (TMP-SMZ; 160/800 mg) twice daily. Both regimens rapidly eradicated H. ducreyi from ulcers, with subsequent healing of ulcers and buboes. The cure rates 14 days after initiation of therapy were 94% for spectinomycin and 95% for TMP-SMZ. Patients with H. ducreyi-negative ulcers who were treated with the same regimens also healed and did not show a significantly different efficacy for either regimen. Thus we found that the one-day regimen of spectinomycin was as effective for the treatment of chancroid as was TMP-SMZ given for five days. Further studies on a larger number of patients are needed to confirm our findings.

Adult↗