Pseudocholinesterase deficiency: a dangerous, unrecognized complication of the ovarian hyperstimulation syndrome.
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Encephalitozoon cuniculi is a microsporidial parasite, which has rarely been reported to cause placentitis in animals. A late-term aborted fetus and placenta from a Quarterhorse were presented to the Livestock Disease Diagnostic Center, University of Kentucky, for diagnostic examination. There was a necrotizing placentitis, with distension of many chorionic epithelial cells by intracytoplasmic vacuoles containing 1-2-microm-diameter, elongated, gram-positive organisms. The organisms were identified as E. cuniculi by electron microscopy and by polymerase chain reaction using primers to microsporidial ribosomal DNA. Joints of the fetus were swollen, with gross and microscopic lesions of synovitis; however, E. cuniculi DNA was not detected.
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Neospora caninum and Toxoplasma gondii are related parasites. The former is a common cause of abortion in dairy cattle. The latter has not been conclusively demonstrated in bovine fetuses. During the course of attempts to isolate N. caninum from aborted fetuses, T. gondii was isolated from 2 aborted fetuses, 1 from Portugal and 1 from the United States. Both isolates were made by bioassay of fetal brains in mice. The fetus from Portugal was about 5 mo in gestational age, and the fetus from the United States was a full-term stillborn.
We aimed to assess the efficacy of a screen and treat policy for sexually transmitted infections in women requesting termination of pregnancy, with particular reference to Chlamydia trachomatis. A retrospective review of 100 consecutive cases of Chlamydia-positive women between December 1995 and February 1998, was performed. The referral rate to genitourinary medicine (GUM), the subsequent management, contact tracing and treatment of partners were assessed. Ninety-nine women were referred to the GUM department, of whom 72 (71.4%) attended. Eighteen (25%) required further treatment. Seventy-five women identified 89 potentially infected men, of whom 62 (69%) attended for treatment. Identification of positive cases with referral to GUM enabled tests of cure to be carried out, treatment of those reinfected and re-enforcement of behaviour modification, in addition to successful contact tracing. This policy may confer greater benefit for the patient herself and make a significant impact on the reservoir of infection in the community when compared to a policy of blanket prophylactic antibiotic treatment at the time of termination. The implications for future service provision are discussed.
In 1977, a large rubella outbreak occurred in Hawaii. Because attack rates were high among women of childbearing age, we conducted extensive surveillance efforts to detect both pregnancies complicated by rubella and cases of congenital rubella syndrome (CRS). Initial surveillance included a survey of physicians and hospitals, review of fetal death and birth certificates, and cord blood screening for rubella-specific IgM of infants born following the epidemic. Two years after the outbreak, the medical community was again surveyed to identify affected children who were missed initially. No case of CRS was identified either shortly after the outbreak or in the ensuing two years. In addition, none of the 5,605 cord serum samples obtained was found to contain rubella-specific IgM antibody. Through active surveillance, we received 12 reports of rubella in pregnant women, of whom 11 elected to terminate their pregnancies. The extensive use of therapeutic abortion by exposed women may have prevented the birth of infants with CRS. Surveillance for rubella-related abortions is an important component in assessing the health impact of rubella in a community.
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The role of U. urealyticum in spontaneous and recurrent spontaneous abortion was studied in 633 women. Cervical colonization with U. urealyticum was found in 42.6% of 310 normal pregnant women, in 41.6% of 84 patients who underwent induced abortion, in 41.5% of 41 normal fertile patients, in 53.3% of 122 patients with spontaneous abortion and in 64.5% of 76 patients with recurrent spontaneous abortion. The cervical isolation rate was significantly higher in patients with spontaneous abortion (p less than 0.05) and recurrent spontaneous abortion (p less than 0.005) than in normal pregnant women. Endometrial colonization was more frequent in patients with recurrent spontaneous abortion (27.6%) than in normal fertile women (9.7%) (p less than 0.05). Moreover, in 6 patients with intact membranes and uncontrollable preterm labor resulting in fetal loss (all between the 20th and 28th week of gestation) U. urealyticum was isolated in 5 of them from the cervix, in 4 patients from the placenta and in 2 out of 4 from the amniotic fluid. Histological examination of the placenta showed signs of chorioamnionitis in 5 patients. From this study we conclude that although U. urealyticum is a common inhabitant of the lower genital tract, it may play a role in the etiology of spontaneous abortion and uncontrollable preterm labor.
On a farm housing cattle and goats an abortion storm occurred affecting 50% of the goats during the lambing season 2000/2001. In one of three investigated caprine abortions Chlamydophila abortus could be identified as aetiology. During this time a pregnant woman (pregnancy week 19/20) had contact with aborting goats. She developed a severe generalized infection and aborted. The placenta contained Chlamydophila abortus shown by immunohistochemistry and PCR. The aim of the present case report is to alert medical doctors about the potential zoonotic risk of ovine/caprine abortions.
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From December 1998 through February 1999, a study was conducted in a Brucella-infected bison herd to evaluate the safety of booster vaccination of adult bison (Bison bison) with 6 x 10(9) colony forming units (CFU) of Brucella abortus strain RB51 (SRB51) that had previously been vaccinated as yearlings with 1 x 10(10) CFU of SRB51. Abortions or other adverse effects were not observed after SRB51 booster vaccination. At 10 wk after adult vaccination, pregnant and nonpregnant bison (n = 65) were randomly selected for bacteriologic sampling of targeted maternal tissues during abattoir processing. Fetal tissues were also sampled in pregnant bison. The SR351 recovered from tissue samples of eight of 48 pregnant bison and none of 17 nonpregnant bison. In three of the eight culture-positive bison, SRB51 was recovered from fetal tissues. In three additional bison, one pregnant and two nonpregnant, B. abortus biovar 1 field strain was recovered from internal iliac or supramammary lymphatic tissues. Results of this study suggest the possibility that the SRB51 vaccine can be safely used to booster vaccinate pregnant bison in a Brucella-infected bison herd. Our data also reaffirms the potential for B. abortus field strains to persist in bison until attainment of reproductive age, despite extensive use of vaccination and serologic testing.
Nine (four female, five male) captive adult Rocky Mountain bighorn sheep (Ovis canadensis) contracted brucellosis caused by Brucella abortus biovar 4 as a result of natural exposure to an aborted elk (Cervus elaphus) fetus. Clinical signs of infection were orchitis and epididymitis in males and lymphadenitis and placentitis with abortion in females. Gross pathologic findings included enlargement of the testes or epididymides, or both, and yellow caseous abscesses and pyogranulomas of the same. Brucella abortus biovar 4 was cultured in all bighorn sheep from a variety of tissues, including testes/epididymides, mammary gland, and lymph nodes. All bighorn sheep tested were positive on a variety of standard Brucella serologic tests. This is the first report of brucellosis caused by B. abortus in Rocky Mountain bighorn sheep. It also provides evidence that bighorn sheep develop many of the manifestations ascribed to this disease and that infection can occur from natural exposure to an aborted fetus from another species. Wildlife managers responsible for bighorn sheep populations sympatric with Brucella-infected elk or bison (Bison bison) should be cognizant of the possibility of this disease in bighorn sheep.
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National morbidity figures show a decline in reported rubella and congenital rubella syndrome since 1969, concurrent with widespread use of rubella vaccine. In addition, no nationwide outbreak, such as the 1963-1964 epidemic, has occurred, though on the basis of long-term secular trends, one would be expected between 1970 and 1974. Recent rubella outbreaks have occurred in unimmunized students in high schools and universities, and there appears to have been a slight upward shift in the age-specific incidence of rubella in the United States since the beginning of widespread immunization. Currently available vaccines have provided durable protection to date, and, although reinfection is known to occur following vaccination, it has not proven a risk to the pregnant woman. There is a small but significant incidence of adverse reactions and a potential risk to the woman who is vaccinated during pregnancy. These data indicate that rubella vaccines are safe and effective. They also imply that rubella vaccines, as they are currently applied, have been successful in reducing the morbidity of congenital rubella syndrome, although continued surveillance will be necessary to confirm this trend.
OBJECTIVE: To investigate Hepatitis B Virus (HBV) infection status in placentas of Hepatitis B Surface Antigen (HBsAg) positive pregnant women during middle and late period of pregnancy. METHODS: One hundred and sixty-seven placentas from HBsAg positive pregnant women were collected, including 158 term placentas and 9 aborted second-trimester placentas. HBsAg and hepatitis B core antibody (HBcAg) in placental cytotypes were detected by immunohistochemistry. RESULTS: Of the 158 term placentas, HBV infection rates in decidual cells (DC), trophoblastic cells (TC), villous mesenchymal cells (VMC) and villous capillary endothelial cells (VCEC) were 66.46% (105/158), 58.23% (92/158), 27.22% (43/158) and 12.66% (20/158), respectively. The HBV infection rates gradually decreased from maternal side to fetal side of placentas. Both HBsAg and HBcAg were mainly located in the cytoplasm of infected cells. The positive cells were mostly in focal distribution. One out of 9 aborted second-trimester placentas was infected. CONCLUSIONS: HBV infection was found in different cells of term placentas. The positive rates for HBsAg and HBcAg in placentas were gradually decreased from maternal side to fetal side. The positive rate was low in aborted second-trimester placentas.
The aim of the study was to examine whether, and in what extend bacterial vaginosis (BV) might be the cause of threatening premature labor. Vaginal ecosystem was examined in the group of 225 pregnant women with the symptoms of threatening premature labor. The control group consisted of women with physiologically proceeding pregnancies. Bacterial vaginosis was confirmed in 14.2% of pregnant women with the symptoms of premature labor, whereas BV was found in 10.2% of women in the control group. The examination of BV seems to be useful in all pregnant women, especially in those with threatening premature labor.
The study included 125 patients in the first trimester of pregnancy, who were divided into group A (50 control subjects with normal intrauterine pregnancy), Group B (50 patients with spontaneous abortion), group C (25 patients with ectopic pregnancy). All the patients were investigated including routine blood and urine tests and special tests related to the cause of pregnancy loss. The patients were tested for IgG antibodies to Chlamydia trachomatis by ELISA technique and conjunctival smear were tested for presence of inclusion bodies to C. trachomatis. It was concluded that C. trachomatis is one of the important cause of spontaneous abortion and ectopic pregnancy. It is highly prevalent in our population, the prevalence being 10% in group A, 26% in group B, 28% in group C. Conjunctival smear showed presence of inclusion bodies in 0.8% patients. With abortions then risk of lower genital tract chlamydia infection spreading to upper genital tract increases. ELISA for C. trachomatis should be done when women are being investigated for the cause of spontaneous abortion and ectopic pregnancy.