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The preterm prediction study: significance of vaginal infections. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

OBJECTIVE: Our purpose was to evaluate the association of bacterial vaginosis, trichomonas vaginitis, and monilial vaginitis with spontaneous preterm birth at < 35 weeks 0 days. STUDY DESIGN: A total of 2929 women at 10 centers were studied at 24 and 28 weeks' gestation by Gram stain of vaginal smear, wet mount, and 10% potassium hydroxide preparations to detect vaginal infections. RESULTS: The rates of detected infection at 24 and 28 weeks, respectively, were bacterial vaginosis 23.4% and 19.4%, trichomonas 3.3% and 2.7%, and monilia 21.1% and 19.5%. The occurrence of bacterial vaginosis at 28 weeks was associated with an increased risk of spontaneous preterm birth, odds ratio 1.84 (95% confidence interval 1.15 to 2.95, p < 0.01). Detection of Trichomonas vaginalis (by wet mount) or monilia (by potassium hydroxide preparation) had no significant associations with preterm birth. CONCLUSION: The presence of bacterial vaginosis at 28 weeks' gestation is associated with an increased risk of spontaneous preterm birth.

Adult↗

[Prognosis and treatment of bacterial endocarditis. Review of 70 cases].

The long term results of medical and surgical treatments have been reviewed in 70 cases examined during the last 8 years. In 24 of them, bacterial endocarditis developed after valvular replacement. Antibiotic treatment was administered during at least 6 weeks. Determinations of the minimum inhibitory concentration of the antibiotic and of the bactericidal power of the serum were considered as the most important laboratory controls. In the post-operative cases with prosthetic valves, numerous pathogenic organisms were found, including gram (minus) bacilli and monilia, which may partly account for the high mortality in this group. Despite surgical reinterventions, 20 of the 24 patients died. For the gram (+) cocci, prognosis is however statistically worse (at the 99% confidence limit) when prosthetic valves are present. Out of the 46 patients without prosthetic valves, 31 (68%) had a favourable bacteriological and haemodynamic evolution; in this group, gram (minus) bacilli and monilia were never found to be the pathogenic organisms. For streptococci infections, recovery was obtained in 73% of the cases (24 out of 33). Percentages of long term recovery are very similar in mitral (67%) and aortic (69%) valvular involvment, but the frequency of surgical indication was very different in either group. In cases of aortic valvular disease, valvular replacement was indicated for bacteriological or haemodynamic reasons in 19 of the 20 patients who recovered. Amongst the 9 patients who died, 6 were not operated upon. Valvular replacement is by far less frequently necessary in cases of bacterial endocarditis on the mitral valve : one prosthetic valve amongst 8 patients who recovered. Finally, the authors discuss the place of surgery in the treatment of bacterial endocarditis. According to their experience, recent improvement in the prognosis of the disease seems to depend more on the surgical approach of the problem than on the discovery of new antibiotics.

Anti-Bacterial Agents↗

Cellular immunity in adult marasmus.

Twelve patients with recent weight loss to less than 85% of standard weight-height ratio and a serum albumin level of at least 3 gm/100 ml were considered to have the adult equivalent to marasmus. Cellular immune function was assessed by delayed hypersensitivity skin testing to Monilia and streptokinase-streptodornase, peripheral lymphocyte count, proportion of T and B cells, whole blood and isolated lymphocyte transformation to phytohemagglutinin, pokeweed mitogen, concanavalin A, Monilia, and streptokinase-streptodornase. Significant impairment of skin test reactivity while in vitro responsiveness remained intact was noted in the marasmic patients. No impairment was found in 12 individuals with recent weight loss who remained at a weight greater than the 85% weight-height ratio. In four marasmic individuals in whom weight loss was arrested by nutritional repletion, skin reactivity returned without substantial change in weight. In this type of marasmus, both depleted nutritional status and weight loss must be present for impairement of skin test responsiveness. These findings confirm relative sparing of more vital functions dependent on protein metabolism in adult marasmus compared to the kwashiorkor-like syndromes of hypoalbuminemic malnutrition seen in adults.

Adult↗

Seasonal fluctuations in the cervical smear detection rates for (pre)malignant changes and for infections.

The detection of diseases can exhibit seasonal fluctuations. This can be studied in cervical smears. Over a 9-year observation span (January 1983-January 1992) a series of 504,093 cervical smears obtained from a routine cytology laboratory in The Netherlands were examined for infections (monilia, trichomonas, actinomyces, human papilloma virus [HPV], chlamydia, and herpes) as well as for mild, moderate, and severe dysplasias, carcinoma in situ, and squamous carcinoma. Statistical analysis (principal component analysis) demonstrates clear seasonal rhythms in the detection of infections as well as in precursor lesions. These findings suggest that we are dealing with "true" detection rhythms. For the detection of (pre)malignancy and HPV, yearly fluctuations in women being screened might be the explanation for our observations.

Actinomycosis↗

Delayed cutaneous hypersensitivity and peripheral lymphocyte counts in patients with advanced cancer.

One hundred eighty-three patients with advanced solid neoplasms were tested for their ability to react to four common skin test antigens (tuberculin PPD, streptokinase-streptodornase, mumps, and Monilia) and their ability to develop delayed cutaneous hypersensitivity (DCH) to 2, 4 dinitrochlorobenzene (DNCB). All patients were followed for at least 6 months or until death. Histologic tumor types studied were: melanoma (65), sarcoma (28), squamous cell carcinoma (23), and adenocarcinoma (67). The rate of progression of disease within 6 months of testing was lower in patients who had a positive response to a challenging dose of 50 mug of DNCB. Reactivity to recall antigens had no prognostic value except in patients with adenocarcinomas. Among patients with adenocarcinoma, those who reacted strongly to DNCB and one or more skin test antigens had the best prognosis, while those who were nonreactive to all had the worst prognosis (progression rate: 18% vs. 78%). Peripheral lymphocyte counts were related to the results of DCH to DNCB and skin tests. The preseence or absence of lymphocytopenia (count less than 1000/mm3) had prognostic value in patients who had positive skin test(s). In such patients, the disease progression rate was much higher in patients who were anergic to DNCB and who were lymphocytopenic (90% vs. 40%). These data suggest that DCH to DNCB, recall antigens, and peripheral lymphocyte counts are useful immunologic measurements in patients with advanced cancer. Although the prognostic value of each individual test is relatively limited, the predictive worth can be increased when multiple tests are employed. Pertinent findings reported in the literature are reviewed.

Adenocarcinoma↗

Lymphocyte cytotoxicity of patients developing multiple primary melanomas.

A study of cellular immunity was conducted, with particular attention to natural killer cell mediated in vitro cytotoxicity in 6 patients who had two or three primary melanomas (2 patients presenting synchronously with multiple primaries and additional melanomas subsequently developing in 4). All 6 patients were reactive to one or other recall skin test antigens (PPD, streptokinase streptodornase (SK-SD), monilia, mumps) and DNCB skin testing. All exhibited natural killing against melanoma and nomelanoma tumor target cells when examined in the 3H proline microcytotoxicity test with unfractionated as well as natural killer cell enriched (Fc receptor positive cells recovered as Fc receptor rosettes) lymphocyte fractions. None of the 4 patients who subsequently had additional primary tumors was found to lack in mature T or natural killer cell mediated cytotoxicity at the time of the development of additional primaries. Two melanoma cell lines were established from two separate primary tumors in 1 patient and in vitro cytotoxicity assays were performed with that patient's lymphocytes (unfractionated, T enriched, and natural killer cell enriched fractions) against these two lines. While the first melanoma cell line was consistently sensitive to lysis by all three lymphocyte fractions, the other cell line showed no sensitivity either for natural killing or for T enriched lymphocyte mediated lysis at any effector to target ratio. These results suggested that in vitro natural cytotoxicity was not translated into any substantive immunoprotective role in the development of multiple primary tumors and that the two separate melanoma cell lines from the same patient were antigenically hererogenous. Antigenic heterogeneity between different primary tumors may explain the lack of immunity against such development of multiple tumors of the same histology.

Antibody-Dependent Cell Cytotoxicity↗

An analysis of skin tests and their relationship to recurrence and survival in stage III and stage IV melanoma patients.

One-hundred-two patients with Stage III and IV malignant melanoma were analyzed to determine whether immunologic status in terms of skin testing along with sex and age played a role in recurrence and survival. Before treatment, patients had skin tests with five recall antigens (monilia, mumps, PPD, SK-SD, trichophyton) along with phytohemagglutinin (PHA). Univariate statistical analysis revealed sex as the major significant variable with respect to survival for Stage IVB patients, with female patients surviving longer than males. Patients with resected disease and greater SK-SD skin test reactivity tended to survive longer than those with impaired reactivity. Similarly, reactivity to trichophyton was associated with improved survival among patients with metastases. A multivariate analysis of the patients shows improved remission duration with mumps positivity in Stage III and Stage IVA patients. It appears that certain skin tets analyzed in this fashion have prognostic importance in these patients and should be analyzed with other variables of disease status.

Antigens↗

The use of dermal antigen testing in predicting the outcome of renal transplantation.

The responses to dermal antigen testing to a variety of antigens were measured in patients on regular dialysis. Forty-eight patients have received renal allografts and graft survival was assessed at 6 months. The antigens used were mumps, monilia, streptokinase/streptodornase, tuberculin and dinitrochlorobenzene (DNCB). The responses to these antigens were recorded using standard methodology. The response failed to correlate with graft survival in these patients when compared singly or in combination. Matching at the HLA-B locus was also correlated with graft survival. Of 31 patients with a match at this locus, 22 (71 per cent) have functioning grafts at 6 months, compared with only 4 of 13 (31 per cent) of patients with no match at the B locus (P less than 0.05). When matching at the B locus and DNCB scores were taken in combination, it became evident that those patients with no match at the B locus and low DNCB reactivity all rejected their kidneys within 4 months of transplantation.

Adolescent↗

Nature of the immunogenic moiety recognized by the human T cell proliferating in response to tetanus toxoid antigen.

This study was undertaken to investigate the nature of the immunogenic moiety recognized by the human T cell which proliferates in response to tetanus toxoid (TT) antigen. Immunosorbent-purified anti-TT IgG antibodies failed, even when added in great excess, to inhibit T cell proliferation in response to TT. Urea-denatured (UD) TT antigen containing less than 1% native TT, as assessed by its reactivity with antibodies raised against native TT, triggered proliferation in T cells to an extent equal to that seen with native TT. The proliferative response to UDTT was seen only in T cells obtained from donors immune to TT and was inhibited by antisera to DRw antigens of the cell donor. T cells responding to TT and to UDTT essentially overlapped because exposure to 5'-bromo-2-deoxyuridine and light of T cells prestimulated with TT or UDTT abolished the specific response to both forms of the TT antigen but not to phytohemagglutinin or to Monilia antigen. It is concluded that proliferating human T cells recognize determinants which differ from those that elicit an antibody response and which may arise as a result of antigen processing by macrophages. The implications of these present results on the nature of the human T cell receptor for antigen are discussed.

Animals↗

Inapparent genital herpes simplex virus infection in college women.

During a six-month period, 600 gynecological samples were collected from 585 women with typical herpes lesions, women with non-herpes symptoms (ie, vaginitis, moniliasis, trichomoniasis, etc), and normal women seen at the student health center gynecological clinic and processed for herpes simplex virus (HSV) isolation. From these specimens, 29 samples from 25 of the 585 women (4.3%) were positive for HSV. When these isolates were typed using plaque diameter in chick cells, heat stability of viral thymidine kinase (T.K.), and restriction endonuclease patterns it was found that 18 samples (15 patients or 60%) were HSV-2 and 11 samples (10 patients or 40%) were HSV-1. Inapparent HSV infections constituted 20.0% of the virologically confirmed samples (5 of 25 patients) and represented 0.9% of the total patients studied (5 of 585). The inapparent infections were about equally divided between the two HSV types (2 were HSV-2 and 3 were HSV-1), and 4 of 5 occurred in the presence of clinically diagnosed monilia.

Adolescent↗

Delayed hypersensitivity reactions vs chemotherapy and immunotherapy responses in women with ovarian adenocarcinoma.

Fifty-one previously untreated women with FIGO Stages III and IV ovarian adenocarcinoma underwent sequential monthly skin testing utilizing Keyhole Limpet Hemocyanian, Varidase, mumps, monilia, and a purified protein derivative Tuberculin (PPD) prior to each course of systemic chemotherapy (with or without Corynebacterium parvum). The purpose of the study was to evaluate the patients' ability to demonstrate a delayed cutaneous hypersensitivity reaction to these sensitizing antigens and response to therapy. There was no statistically significant correlation with response to therapy and: 1) Positive pretherapy skin test reactions vs anergy to pretherapy skin tests. 2) Negative pretherapy and positive post-therapy skin tests. 3) Anergy pre- and post-therapy vs positive skin test pre- or post-therapy. 4) Age of the patient vs skin test reactivity. 5) Skin test reactivity to any one of the five antigens tested. 6) Skin test reactivity in response to therapy in those women also receiving Corynebacterium parvum. It is concluded that the battery of skin tests utilized do not predict the patient's response to systemic chemotherapy in advanced ovarian adenocarcinoma.

Adenocarcinoma↗

Delayed cutaneous hypersensitivity, lymphocyte count, and blood tests in patients with breast carcinoma.

General immunocompetence was examined in 125 patients with various stages of breast cancer. Tests include peripheral blood lymphocyte count, serum protein electrophoresis, quantitative immunoglobulins, CEA level, and delayed cutaneous hypersensitivity (DCH) reaction to six recall antigens (PPD, Monilia, mumps, Varidase, histoplasmin, and coccidioidin). About one third of the patients responded positively to each of the first four antigens, whereas 12% reacted to histoplasmin and 4% to coccidioidin. In this study, DCH to recall antigens had no prognostic value because the distributions of skin test reactivity were similar among patients with different stages of breast carcinoma. And among patients with similar stage of disease the relapse rates were similar for those who reacted and those who were anergic. But peripheral lymphocyte count had definite prognostic value because patients with advanced stage (group III/IV) and those who were anergic had significantly lower lymphocyte counts. Among patients with relatively early stages of breast carcinoma (group I/II), those who had higher lymphocyte count (greater than or equal to 2,000/mm3) had lower chance of having relapse up to 5 years after mastectomy.

Blood Chemical Analysis↗

Medical significance of the so-called black yeasts.

Infections caused by the black yeasts (leveduras pretas) are reviewed with respect to their clinical manifestations, classification under the umbrella term, phaeohyphomycosis, and differentiation from chromoblastomycosis. Data on the prevalence of black yeasts submitted to a national reference diagnostic center are provided. Cases of phaeohyphomycosis caused by Aureobasidium pullulans, Exophiala jeanselmei, E. moniliae, E. spinifera, Phaeoannelomyces werneckii, Phaeosclera dematioides, Sarcinomyces phaeomuriformis, and Wangiella dermatitidis are described.

Humans↗

Further studies on the phylogenesis of the genus Exophiala and Hortaea.

The conidial ontogenesis of the pathogenic black yeasts is studied at an ultrastructural level and their phylogenesis is discussed. Five cultures of Exophiala dermatitidis, four of E. jeanselmei, one of E. moniliae, one of E. spinifera and six of H. werneckii were observed using a scanning electron microscope. The conidial ontogenesis of the Exophiala species is not pleomorphic but only annellidic. There are definite differences in morphology of annellated tips among the Exophiala species. The ontogenesis of Hortaea werneckii consists of a combination of sympodial and annellidic conidiogenesis. Its sympodial anamorph is unique and the annellidic anamorph is considered to be a homology of the sympodial one.

Exophiala↗

[Molds in foods of the Czechoslovak Socialistic Republik (author's transl)].

The mycoflora of 13.527 g of food powders which were normal upon sensory evaluation as well of 22.017 pieces of surface sterilized grains and nuts was examined in the Czechoslovak Socialist Republic. 147.027 colonies of 44 genera of molds were isolated and identified from samples. Colonies of Penicllium sp., Aspergillus sp., and Cladosporium sp. occured most often, less often or quite infrequently Rhizopus sp., Mucor sp., Absidia sp., Alternaria sp., Circinella sp., Trichoderma sp., Botrytis sp., Paecilomyces sp., Geotrichum sp., Syncephalastrum sp., Scopulariopsis sp., Phoma sp., Auerobasidium sp., Fusarium sp., Thamnidium sp., Cunninghamella sp., Stemphylium sp., Torula sp., Trichothecium sp., Verticillium sp., Cephalosporium sp., Mortierella sp., Neurospora sp., Ostracoderma sp., Arthrinium sp., Monodyctis sp., Papularia sp., Acremonium sp., Chaetomium sp., Chrysosporium sp., Beauveria sp., Cephaliophora sp., Daktylosporium sp., Drechslera sp., Gliomastix sp., Helminthosporium sp., Humicola sp., Monilia sp., Sepedonium sp., Ulocladium sp., and Wallemia sp.

Food Microbiology↗

Mitochondrial DNA analysis of Exophiala spinifera.

Restriction fragment length polymorphism (RFLP) of mitochondrial DNA (mtDNA) was examined in 36 isolates of Exophiala spinifera (8 isolates from Brazil, 9 from China, 15 from Columbia, 1 from the United States and 2 from Venezuela). E. spinifera isolates displayed a high degree of mtDNA diversity in RFLP patterns and were clustered into six genetically heterogeneous groups (Group 1 through Group 6). Isolates of Group 2 including the type strain seemed to have a worldwide distribution. RFLP patterns of E. spinifera were also distinct from those of other dematiaceous fungi, such as E. jeanselmei, E. moniliae, E. dermatitidis, Fonsecaea pedrosoi, Cladosporium carrionii and Phialophora verrucosa. These results indicate that E. spinifera may be a taxonomic complex and that RFLP patterns will be useful in the identification, typing and epidemiology of the E. spinifera variants.

DNA, Fungal↗

Morphogenic effects of ramihyphin A in filamentous fungi.

Ramihyphin A at subfungistatic concentrations stimulates ramification of hyphae of filamentous fungi. Stimulation of terminal ramification of hyphae that can be observed particularly in phytopathogenic fungi is most frequent. Hyphae of Microsporon canis, Trichophyton mentagrophytes, Blastomyces dermatitidis, Coccidioides immitis and Histoplasma capsulatum ramify intensively laterally. Stimulation of the lateral ramification was observed in Monilia fructigena, Penicillium marneffei and Penicillium chrysogenum. The antibiotic induces also formation of vesicular structures in phytopathogens. Due to the substantial ramification of hyphae, both terminal and lateral, the growth of colonies is interrupted. The addition of the antibiotic to a growing colony of Botrytis cinerea induces dichotomic ramification of terminal hyphae after 3 h of growth. Lateral hyphae begin to grow later and further ramify dichotomically. Dense bundles of ramified hyphae are formed after 24 h due to the unbalanced ramification and the colony no longer increases its size.

Antifungal Agents↗

Residues of dicloran in clingstone peaches after pre- and postharvest application.

Trials were carried out over a period of several years in order to test the efficacy of pre- and postharvest treatments against fungi causing postharvest rots of stored clingstone peaches destined to canning. Among the fungicides tested, dicloran (2, 6-dichloro-4-nitroaniline) was applied against Botrytis cinerea, Monilia cinerea and Rhizopus stolonifer. The purpose of this work was to determine the residues of this fungicide in fresh, washed, peeled and canned fruits. No relevant data are reported in the open literature to our knowledge. Some residue data, most of them produced by the manufacturer of the compound, were evaluated by the FAO/WHO Joint Meeting on Pesticide Residues (JMPR) and are summarized in the 1974 and 1977 monographs (FAO/WHO 1975 and 1978).

Agriculture↗