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1/20. Can group B streptococci cause symptomatic vaginitis?

    BACKGROUND: Maternal cervicovaginal colonization with Lancefield group B streptococci (GBS) is an important risk factor for neonatal morbidity and mortality. About 15% of women are carriers of GBS. Usually, they are asymptomatic. CASES: We describe two patients with symptomatic vaginitis for which no apparent cause was found. Both patients were heavily colonized with GBS. After antibiotic treatment, both became asymptomatic and culture negative, but after recolonization with GBS, symptoms resumed. This phenomenon was repeatedly observed. After emergence of resistance to antibiotics, local application of chlorhexidine appeared to be the only useful treatment. CONCLUSION: We hypothesize that GBS-vaginitis may be a possible disease entity. Although at present it is not clear why some patients become symptomatic, we speculate that the immunologic response is somehow selectively hampered in such patients. ( info)

2/20. Universal prophylaxis for chlamydia trachomatis and anaerobic vaginosis in women attending for suction termination of pregnancy: an audit of short-term health gains.

    A previous study of infection and morbidity in 400 women attending for termination of pregnancy (TOP) had shown that 32 (8%) harboured cervical chlamydia trachomatis and 112 (28%) had anaerobic (bacterial) vaginosis (AV). Fifty-three per cent of the women with preoperative C. trachomatis had AV. Thirty of the 32 women with chlamydial infection were followed up and 19 (63%) of these developed post-abortion upper genital tract infection, 7 of whom needed re-admission. In view of the high morbidity in women with chlamydial infection attending for TOP, anti-bacterial prophylaxis with metronidazole suppositories and oral oxytetracycline was introduced for women attending for suction termination of pregnancy (STOP). An audit of the clinical and financial benefits and/or losses was carried out. The audit of 1951 consecutive patients attending for STOP revealed that 132 (6.8%) had chlamydial infection with equivocal results reported in a further 2 patients. One hundred and eight of the 134 women responded to recall. Full genital tract infection screening was carried out in 105 of the 108 recalled patients of whom 5 had repeat positive cervical swabs for C. trachomatis, one had trichomonas vaginalis, 24 had candidiasis and 17 had anaerobic vaginosis, none had gonorrhoea. Thirteen (12%) of the 108 women had pelvic infection as previously defined, none of whom required re-admission. At least pound sterling 20,000 has been saved each year in our trust following the introduction of pre-abortion chlamydial screening and universal antichlamydial and anti-anaerobe prophylaxis. The introduction of universal prophylaxis against C. trachomatis and AV has profoundly reduced morbidity in patients attending for TOP and has also resulted in substantial financial savings. ( info)

3/20. Recurrent bacterial vaginosis in a virgin adolescent: a new method of treatment.

    Bacterial vaginosis (BV) is a polymicrobial infection of the vagina and should not be considered an exclusively sexually transmitted disease. We describe the case of a 17-year-old female virgin adolescent with recurrent malodorous vaginal discharge for 6 months. Before referral to us she had been treated unsuccessfully with conservative treatment options. Our investigation revealed gardnerella vaginalis as the responsible factor for the vaginal infection. Because metronidazole treatment had failed as monotherapy, a new method was applied. Repeated vaginal washings with 3% H(2)O(2), 15% NaCl and 10% providone iodine were initiated. At the end of each washing, vaginal walls were thoroughly cleaned up with a small gauze. After 10 days of treatment the odor and the vaginal discharge had ceased and 12 months later no relapse had occurred. It seems to be reasonable to use this kind of treatment in recurrent BV. ( info)

4/20. An unexpected adverse drug effect.

    Adverse drug-drug interactions can occur between active and/or inactive ingredients in different formulations. The occurrence of a disulfiram reaction that developed postpartum following a 7-day course of metronidazole is presented. The case is presented, followed by a discussion of the mechanism of action and treatment. Recommendations for prevention of adverse drug effects are reviewed. ( info)

5/20. Neonatal meningococcal conjunctivitis associated with meningococcal meningitis.

    Two infants are described in whom identical strains of meningococcus were isolated from both the eyes and the cerebrospinal fluid. This suggests that the eye may be a portal of entry in at least some cases of perinatally acquired neonatal meningococcal disease and has important implications for the management of purulent conjunctivitis in the newborn. ( info)

6/20. gardnerella vaginalis-infected scalp hematoma associated with electronic fetal monitoring.

    Infections in the neonate caused by the vaginal commensal gardnerella vaginalis are rare and mostly consist of bacteremia. A 4130-g term neonate developed an infection of a scalp hematoma with G. vaginalis. The infection developed in association with electronic fetal monitoring. The only clinical sign was an increase in size of the hematoma. ( info)

7/20. Detection of Atopobium vaginae in postmenopausal women by cultivation-independent methods warrants further investigation.

    We sequenced 16S rRNA genes from the vaginal swab contents of a postmenopausal woman with asymptomatic bacterial vaginosis (BV). Sequences from Atopobium vaginae were the most commonly detected. In a survey of 35 other postmenopausal women, this organism was detected in 44% with BV but not in any subjects deemed healthy. ( info)

8/20. Case report: fatal non-menstrual toxic shock in a Chinese woman.

    A fatal case of non-menstrual toxic shock syndrome (TSS) is reported in a Chinese woman, which was associated with a vaginal staphylococcus aureus infection. Cerebral haemorrhage and vasogenic white matter oedema was shown in cranial computed tomography (CT) before the terminal event. ( info)

9/20. Treatment of recurrent bacterial vaginosis with tinidazole.

    BACKGROUND: Recurrent bacterial vaginosis is a difficult clinical condition. In women with recurrent bacterial vaginosis, relapses are common, even after prolonged courses of maintenance therapy. Because of its spectrum of activity, tinidazole was used in a patient with recurrent bacterial vaginosis. CASE: A 23-year-old woman taking oral contraceptives had a single sexual partner. She was treated for recurrent bacterial vaginosis with multiple courses of metronidazole gel 0.75%, including regimens of maintenance therapy. The patient experienced repeated recurrences shortly after stopping treatment. A single course of oral tinidazole resulted in a prolonged period where she was free of bacterial vaginosis. CONCLUSION: Treatment options for recurrent bacterial vaginosis are currently limited. tinidazole may be a useful option in women with recurrent bacterial vaginosis. ( info)

10/20. metronidazole-induced pancreatitis. A case report and review of literature.

    CONTEXT: pancreatitis is a very rare adverse effect of metronidazole with only six cases of metronidazole-induced pancreatitis reported in the English literature so far. CASE REPORT: We report a case of recurrent acute pancreatitis in a 46-year-old female associated with oral metronidazole therapy and review the literature with regards to metronidazole-induced pancreatitis. We are also highlighting the fact that the time lag between metronidazole exposure and development of pancreatitis is very variable. CONCLUSION: High degree of suspicion is warranted on the part of physicians to diagnose metronidazole induced pancreatitis in patients presenting with gastrointestinal symptoms after metronidazole exposure. If metronidazole is suspected as the causative agent then it should be discontinued and rechallenge should be avoided. ( info)
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