Aerobic Vaginitis Diagnosis Criteria Combining Gram Stain with Clinical Features: An Establishment and Prospective Validation Study

Wet-mount microscopy aerobic vaginitis (AV) diagnostic criteria need phase-contrast microscopy and keen microscopists, and the preservation of saline smears is less common in clinical practice. This research work developed new AV diagnostic criteria that combine Gram stain with clinical features. We enrolled 325 AV patients and 325 controls as a study population to develop new AV diagnostic criteria. Then, an independent group, which included 500 women, was used as a validation population. AV-related microscopic findings on Gram-stained and wet-mount smears from the same participants were compared. The accuracy of bacterial indicators from the two methods was verified by bacterial 16S rRNA V4 sequencing (n = 240). Logistic regression was used to analyse AV-related clinical features. The screened clinical features were combined with Gram-stain microscopic indicators to establish new AV diagnostic criteria. There were no significant differences in the leukocyte counts or the parabasal epitheliocytes (PBC) proportion between the Gram-stain and wet-mount methods (400×). Gram stain (1000×) satisfied the ability to identify bacteria as verified by 16S rRNA sequencing but failed to identify toxic leukocytes. The new criteria included: Lactobacillary grades (LBG) and background flora (Gram stain, 1000×), leukocytes count and PBC proportion (Gram stain, 400×), and clinical features (vaginal pH > 4.5, vagina hyperemia, and yellow discharge). These criteria satisfied the accuracy and reliability for AV diagnosis (Se = 86.79%, Sp = 95.97%, and Kendall’s W value = 0.899) in perspective validation. In summary, we proposed an alternative and valuable AV diagnostic criteria based on the Gram stain, which can make it possible to diagnose common vaginitis like AV, BV, VVC, and mixed infections on the same smear and can be available for artificial intelligence diagnosis in the future.

Chronic dermatophytosis: A clinical, epidemiological, mycological study

Background: Dermatophytes are a common cause of superficial fungal infection of the skin. The emergence of epidemic-like attacks of those chronic and recurring represents a public health problem. Materials and Methods: Two hundred patients with suspected fungal infection of the skin attending the Dermatology and Venereology Department of Al-Ramadi Teaching Hospital were examined. Fifty-nine patients with chronic dermatophytosis were selected for the study and fifty of those were subjected for culture. History taking and a physical examination were conducted for all patients. A wet mount of 10% potassium hydroxide and culture on Sabouraud dextrose agar was done for selected cases. Results: Among 59 patients with chronic infections, the main age group affected was 29 years old, with a nearly equal sex ratio. The mean duration of the illness was 1.2 years. Tinea corporis was the most common type. The Trichophyton genera were the most common (65%), and Trichophyton mentagrophyte was the most common species isolated (46%). Conclusion: Multiple factors have been associated with the appearance of epidemic-like attacks of chronic dermatophyte infections in Iraq in the last several years. Herein, we would like to shed light on these factors and the pathogens responsible.

Prevalence and Transmission of Soil Transmitted Helminths among Farmers Living Along the Metropolitan Section of River Kaduna, Nigeria

Soil-transmitted helminths (STHs) are one of the world’s most important causes of physical and intellectual growth retardation. The study was conducted to determine the prevalence and transmission of soil-transmitted helminths among farmers living along the metropolitan section of river Kaduna, Nigeria. Two billion people are infected globally and four billion at risk of infection to STH. Nigeria ranking first globally, accounts for about 156 million cases of STH. A total of 210 stool samples were randomly collected from farmers of seven (7) different farms located along the riverbank. The stool samples collected were examined for STHs using direct wet mount and formal ether sedimentation techniques. Questionnaires were administered to the farmers to assess their hygiene, sanitation, and health maintenance. The prevalence of STH based on the farmers' age and gender was also determined. Out of the total stool samples collected, 81(38.6%) were infected with at least one out of the four STH eggs. The eggs of hookworm and Ascaris lumbricoides were the only helminths eggs detected. Hookworm was found to have a prevalence of 54.3% while A. lumbricoides have a prevalence of 45.7%. Strongyloides stercoralis and Trichuris tichuira both were found to have 0% prevalence. The risk factors such as personal hygiene, sanitation and health maintenance were found to have a significant influence on the prevalence (38.6%) (P<0.05) of STH among the farmers. The age prevalence shows that group 10 – 25 have the highest prevalence of 81.3% while age 36 – 45 shows the lowest prevalence of 2.4%. The gender prevalence shows that male farmers have the highest prevalence of 41.4% out of the total infected farmers (81). The findings could be as a result of farmers’ hygiene, sanitation and health maintenance on their various farms and their use of contaminated farm tools which acts as a medium for the transmission of the parasite eggs, while the younger age group work more hours than the older age group and the male farmer spends more time in the farm than the female.

Evaluation of the Diagnostic Utility of Geohelminths from Environmental and Stool Samples in Nnewi Metropolis

Background: Geohelminths are groups of four intestinal soil transmitted parasites.They are of public health concern due to their serious morbidity they cause in children which are the major groups affected. Aim/Objective: The aim of this study is to evaluate the diagnostic performance of wet mount and concentration techniques of stool and soil samples for identification of geohelminths. Methodology: Eighty stool samples were collected from four primary schools, while forty soil samples were collected from the important sites (playground, and classroom areas) in each of the school accessed. The stool samples were examined with the wet preparation and formol-ether concentration technique, while the soil samples were examined with the formol-ether concentration technique. Ethical approval was sought from the Faculty of Health Sciences and Technology. Results: The results of geohelminths showed an overall prevalence of 6.25% (5/80) from the stool samples, and 27.5% (11/40) obtained from the soil. Recovery rates from the stool showed the presence of only two geohelminth;Hookworm (5%) and Strongyloides stercoralis (1.25%). Out of the four schools examined only three showed positive results with geohelminth infections, while the remaining school showed positive results with only Giardia.lamblia. The recovery rates from the soil also showed the same pattern of distribution as with the stool but with a higher prevalence of Hookworm (20.7%) and Strongyloides stercoralis (7.5%) with the toilet areas showing the highest prevalence (50%). The dominant specie of geohelminth observed in both stool and soil was Hookworm. The results also showed that both male (6%) and female (6.7%) are susceptible to the infection with no significant difference between their prevalances (p>0.05). Conclusion: The prevalence of Hook worm was poorly reported by wet mount technique.The diagnostic performance of concentration methods for the diagnosis of Hook worms in the samples was notably high as compared to wet mount techniques.

A demographic survey on the prevalence of gastrointestinal parasites based on socioeconomic determinants in Pakistan

Introduction: The present study was conducted to investigate prevalence of intestinal parasites and the risk factors related to socio-demographic characteristics of patients admitted in pathology ward, General Hospital, Gujranwala. Methodology: 318 stool samples were collected from patients and examined under light microscope by using wet mount technique. While socio-demographic information was collected in the form of a questionnaire. Results: The results showed seven (n = 7) species of intestinal parasites were prevalent in stool samples of patients. Among them, four (n = 4) were helminth and three (n = 3) were protozoan parasites causing single and mixed infections. Overall prevalence of intestinal parasites was 78.3% (n = 249/318) considering both male and female patients. Highest prevalence was recorded for A. lumbricoides (n = 125, 39.3%) followed by H. nana (n = 10, 3.1%), S. stercoralis and T. saginata (n = 6, 1.9%). Among protozoan parasites, higher prevalence was recorded in G. lamblia (n = 23, 7.2%) followed by E. histolytica (n = 21, 6.6%). Among single infections, the most prevalent parasite was A. lumbricoides and less prevalent parasites were S. stercoralis and T. saginata. The factors that had significant effect (p < 0.05) on prevalence of parasitic species were contaminated water, food, soil, and surrounding environment. Conclusions: The present study determined that the parasite helminth (A. lumbricoides, H. nana, S. stercoralis, T. saginata) and protozoan (G. lamblia and E. histolytica) are common that pose an important public health concern in Pakistan.

A New Therapy for Uncomplicated Vulvovaginal Candidiasis and Its Impact on Vaginal Flora

Background: An estimated 75% of women will have one episode of vulvovaginal candidiasis (VCC) during their lifetime, and 40–50% of these will experience further episodes. The high incidence of vulvovaginal candidiasis, combined with the problems of azole resistance and toxicity, highlights the necessity for new strategies for the treatment of this condition. In this context, natural compounds represent promising alternatives. Methods: We enrolled, between January 2020 and April 2021, forty women affected by uncomplicated vulvovaginal candidiasis. Women were divided into two groups. In the first group, we treated 20 women with clotrimazole daily administration for six days. In the second group, 20 women were treated with clotrimazole associated with Unilen® Microbio+, a new product containing Saccharomyces cerevisiae, melatonin, and GLA-14. Women underwent a check at days 15, 30, and 90. A clinical and cultural examination were performed to establish the effect of the treatments on vaginal flora. Results: In the group treated with Unilen® Microbio+, clinical and microbiological cure at 15 and 30 days was observed in 18 women (90%), compared with 16 women (80%) in the group treated only with clotrimazole. The efficacy of the association between clotrimazole and Unilen® Microbio+ in these uncomplicated forms was therefore not inferior to the azole treatment alone. Only four women (20%) in the Unilen® Microbio+ group presented symptomatic recurrences within the 3 months, compared with eight women (40%) in the clotrimazole-only group. Microscopic wet mount analysis at 1 and 3 months demonstrated a significant increase in lactobacillus count and a reduction in the polymorphonucleate cells in the Unilen® Microbio+ group. Conclusions: Unilen® Microbio+ supplementation was demonstrated to cure uncomplicated vulvovaginal candidiasis with clotrimazole, reducing recurrence and improving vaginal flora better than clotrimazole treatment alone.

Comparison of Molecular and Parasitological Methods for Diagnosis of Human Trichostrongylosis

Human trichostrongyliasis is a zoonotic disease that is prevalent among rural populations in some countries. This study was performed to evaluate various parasitological methods and polymerase chain reaction (PCR) for the diagnosis of human trichostrongyliasis. A total of 206 fresh stool samples were collected from residents of endemic villages of Northern Iran. All samples were examined using conventional parasitological methods, including wet mount, formalin ethyl acetate concentration (FEAC), agar plate culture (APC), Harada–Mori culture (HMC), and Willis, along with the PCR technique. Among the total of 206 individuals examined, 72 people (35%) were found infected with Trichostrongylus species using combined parasitological methods. By considering the combined results of parasitological methods as the diagnostic gold standard, the Willis technique had a sensitivity of 91.7% compared with 52.8% for the APC, 40.3% for the HMC, 37.5% for FEAC, and 5.6% for the wet mount technique. The diagnostic specificity of all the parasitological methods was 100%. Furthermore, the PCR method detected Trichostrongylus spp. DNA in 79 fecal samples (38.3%) with a sensitivity of 97.2% and a specificity of 93.3%. According to the current findings, the Willis method was more sensitive than are the other parasitological methods in the diagnosis of human trichostrongyliasis. However, the PCR assay was more sensitive and more reliable in the detection of human trichostrongyliasis in comparison with the parasitological methods.

Trichomonas Vaginalis Infection in Men with High-Risk Sexual Behaviors

Background: Trichomonas vaginalis is a protozoan pathogen of the human genitourinary tract, which is the cause of trichomoniasis. The disease is one of the most important non-viral sexually transmitted infections in the world. Many studies have been performed on the molecular identification of Trichomonas in men in different parts of the world, but in Iran, such a study has been very limited. We aimed to detect T. vaginalis in urine of men with unusual sexual behavior by wet mount microscopic observation, culturing in TYM-33 and molecular method in Tehran, Iran. Methods: Totally, 47 urine samples were collected from men with high-risk sexual behaviors referred to Health Care Centers in South of Tehran, Iran during 2017-2018. After urine centrifugation and wet mount sediment preparation, the samples were cultured in TYM-33 medium and examined microscopically. Then DNA was extracted from urine sediment samples and finally the 18srRNA gene was amplified by PCR. Results: Thirty-one (65.95%) urine samples were positive for T. vaginalis by PCR. Of these, only 6 (12.76%) were detected positive by wet mount method and 25 (53.19%) by culture and successive passages. Conclusion: The high prevalence of trichomoniasis among men with high-risk sexual behavior in Tehran indicates a potent health risk condition for families. Of course, this percentage is not the real infection rate in ordinary men in Tehran. This situation could be controlled by promoting concurrent diagnosis and treatment of T. vaginalis infection in men and women, as well as strengthening religious beliefs and health education in the individuals.

Soil-Transmitted Helminthes Infection and Nutritional Status of Elementary School Children in Sorong District, West Papua, Indonesi

It is known that soil-transmitted helminths (STHs) infection in children associates with growth and developed restriction in children, which is shown by nutritional status. However, the studies which are investigating this phenomenon is still limited in Indonesia. This recent study aimed to compare students who infected and non-infected with STH towards their nutritional status. An analytic cross-sectional research design was conducted in two elementary school students at Mayamuk sub-district, Sorong district, in January 2020. STHs infection was identifi ed by lugol stained wet mount smear from their stool under a light microscope. Children nutritional status was determined by body mass index based on age. A total of 164 children (67.5%, 164/243) were voluntary to participate by informed consent and eligible. Twenty-seven children (16.5%, 27/164) were infected with one or more STH species of Ascaris lumbricoides, Trichuris trichiura, hookworm, and Strongyloides stercoralis. T. trichiura (81.5%, 22/27) was the most common species found, either in single or mixed infection. Children nutritional status was observed as thinness, normal, overweight, and obese, that was 6.1% (10/164), 75% (123/164), 6.7% (11/164), and 12.2 % (20/164) respectively. STHs infection occurred in children with nutritional status of thinness 3.7% (1/27), normal 74.1% (20/27), overweight 3.7% (1/27), and obese 18.5% (5/27). There was no signifi cant diff erence between STHs infected children and non-infected children on their nutritional status (p=0.616, ChiSquare test). Thus, it indicated that STHs infection was not only the factor to induce the impairment of nutritional status in children at Mayamuk sub-district. It needs further investigation to clarify the factors which are leading to the thinness, overweight, and obese in Mayamuk children.

Microbiological profile of infective keratitis in a tertiary care hospital in north Karnataka

Corneal blindness is seen worldwide with 1.5 to 2 million new cases reported every year and approximately there are 6.8 million cases of corneal blindness in India. The study constituted 109 clinically diagnosed infective keratitis cases. Aseptically collected corneal scrapings are subjected to Gram stain, KOH wet mount & Culture. Further identification done by study of Colony morphology, staining & biochemical tests. Antibiotic sensitivity was found using Kirby buer’s disc diffusion method following CLSI guidelines. Males affected more common than females. Common age group being 21-40 yrs. Infective keratitis is usually Bacterial(61.4%) in origin than fungal(22%). Trauma found to be the most common predisposing factor followed by diabetes, other ocular diseases, surgery & corticosteroid therapy. Trauma with vegetative material is most common. Streptococcus pneumonia & pseudomonas are most common bacterial cause while Fusarium & Aspergillus cause most fungal cases. Infective keratitis both bacterial & fungal are more common in working males, mainly agriculturists who are exposed to vegetative trauma. Early detection and treatment with proper antibacterial & antifungals is important to prevent ocular problems and scarring of cornea.