Management of patients with herpes-associated recurrent vulvovaginal candidiasis

Objective. To develop a diagnostic algorithm, a rational method of treatment, and principles of preconception care in women with herpes-associated recurrent vulvovaginal candidiasis (RVVC).Materials and methods. We examined 68 patients with herpes-associated RVVC and 20 gynecologically healthy women.Results. It has been found that in RVVC it is necessary to study vaginal swab culture with the determination of the microorganism and its biofilm-forming ability in combination with viral DNA detection by the polymerase chain reaction (PCR) in vaginal secretion, determination of the IgG titer to the herpes simplex virus (HSV), the avidity index to HSV I and II. In the presence of laboratory-confirmed RVVC and HSV infection, it is necessary to assume the presence of an atypical course of HSV infection followed by complex antiviral and antimycotic therapy.Conclusion. The use of the developed algorithm of diagnostic and treatment interventions as preconception care makes it possible to address symptoms, reduce relapse rates and extend a non-relapse interval, prepare women with the mixed-infection for favorable pregnancy outcomes.

False-positive detection of Group B Streptococcus (GBS) in chromogenic media due to presence of Enterococcus faecalis in High Vaginal Swabs

Background Group B Streptococcus (GBS) is a gram-positive bacterium and its vaginal colonization is associated with preterm births and neonatal sepsis. Thus, routine screening of GBS in prenatal care before the onset of labour is recommended. Recently chromogenic media have been develop and are found to be useful in rapid and sensitive screening for GBS in vaginal swabs. In the present study we evaluated the performance of chromogenic media for the detection of GBS in vaginal swabs of pregnant Indian women near term. Methodology In this study 201 vaginal swab samples were collected from pregnant women. Swabs were inoculated in chromogenic media (carrot broth).The positive and negative cultures were inoculated on Blood agar and Crome agar plates. The colonies were subjected to 16S rRNA sequencing and gene-specific PCR for confirmation. CAMP and BEA were used for biochemical confirmation. PCR was done on genomic DNA isolated from uncultured vaginal swabs. Result 20/201(9.9%) vaginal swab samples were positive in the carrot broth. 17/20 (85%) and 19/20 (95%) of these samples yielded colonies on Blood agar and Crome agar respectively. Of the 181 carrot broth negative samples 1(0.5%) and 38 (20.9%) yielded colonies on Blood agar and crome agar plates respectively. However 16s rRNA sequencing revealed that none of the 20 carrot broth positive cultures were that of GBS and had sequence similarities to the Enterococcus faecalis. This was also confirmed by using gene specific PCR and BEA positivity. Furthermore, Enterococcus faecalis was detected by PCR in DNA isolated from 57 uncultured vaginal swabs samples, GBS could be detected by PCR only in 4 samples. Conclusion Carrot Broth-based culture can lead to false-positive detection due to the presence of Enterococcus faecalis. Keywords: Streptococcus agalactiae, Infection, PCR, pregnant women, Carrot Broth, Blood agar, Crome agar, Preterm birth, Sepsis

Early neonatal respiratory distress revealing meningitis caused by Streptococcus pneumoniae serotype 17F: a case report

Background: Streptococcus pneumoniae (S. pneumoniae) is the first leading cause of invasive diseases such as meningitis, bacteremia and pneumoniae in children. In this case we report an early neonatal respiratory distress revealing meningitis caused byS. pneumoniae Serotype 17F through vertical transmission, in the newborn of 3 hours of live. Case description: A male late preterm newborn was born by vaginal delivery at a gestational age of 34 weeks. At 3 hours of life, he was admitted for early moderate neonatal respiratory distress in the Neonatal Medicine and Resuscitation Service.Cerebrospinal fluid culture yielded S. pneumoniae belonging to serotype 17F while the blood culture was negative. The same pneumococcal serotype was recovered from the high vaginal swab of the mother. Both isolates were found susceptible to all tested antibiotics except tetracycline and chloramphenicol to which the strain was resistant. Antibiotherapy management of the child included ceftriaxone at 150mg/kg/day for 21 days, in combination with gentamycin at 5 mg/kg/day for 5 days. ciprofloxacin was added at 40mg/kg/day in two doses for a period of three weeks as the baby presented a hydrocephalus. Conclusion: This finding shows that clinical manifestations of neonatal pneumococcal meningitis may be atypical and/or misleading. Keywords: Streptococcus pneumoniae; neonatal meningitis; respiratory distress.

Puerperal Group A Streptococcal sepsis: a case report

Group A Streptococcal (GAS) sepsis in puerperium is one of the recognised causes of maternal mortality. Though the onset is often insidious, it can progress rapidly to a life-threatening invasive infection, toxin-mediated shock, and end-organ failure, even before clinical signs become apparent. We report a case of puerperal GAS sepsis that was successfully managed. 24-years-old para 1 was readmitted to the intensive care unit requiring non-invasive ventilation on postnatal day 6 with clinical and biochemical features of sepsis. Blood culture, episiotomy wound swab, and high vaginal swab grew GAS. Broad-spectrum antibiotics initiated. She developed ascites that progressively increased and needed therapeutic paracentesis. She was discharged after four weeks of hospitalization. Early identification and prompt treatment are the keys to prevent severe morbidity and maternal mortality.

The Diagnostic accuracy of procalcitonin in maternal plasma to detect early intra-amniotic infection in preterm premature rupture of the membranes with respect of highvaginal swab as gold standard

Objective: To determine the diagnostic accuracy of procalcitonin in maternal plasma to detect early intra-amniotic infection in Preterm premature rupture of the membranes (PPROM) with respect of high vaginal swab as gold standard Methods: A cross-sectional study was conducted at Liaquat National Hospital, Karachi, from February to August 2017. The blood sample of women with PPROM were collected to measure procalcitonin level. PCT1 and PCT2 were run along with the sample for the accuracy of the results. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of procalcitonin were calculated taking HVS C/S as gold standard. Results: Out of total 150 women, mean age was 28.78±4.79 years. Mean gestational age was 30.79±3.07 weeks. Mean procalcitonin level was 0.13±0.24 ng/ml. Intra-amniotic infection was diagnosed in 48.7% cases through procalcitonin levels and 51.3% through HVS culture and sensitivity. Sensitivity, Specificity, PPV (Positive predictive value), NPV (Negative predictive value) and accuracy were 87%, 91.8%, 91.78%, 87%, and 89.3% respectively. For females with gestational age ≤32 weeks, sensitivity, specificity, and diagnostic accuracy were 83.9%, 90.4%, and 87.03% respectively. For females with gestational age >32 weeks, sensitivity, specificity, and diagnostic accuracy were 95.2%, 92.5%, and 95.23% respectively. Conclusion: Diagnostic accuracy of maternal blood procalcitonin levels were found satisfactory in detection of early intra-amniotic infection in PPROM. doi: https://doi.org/10.12669/pjms.38.1.4436 How to cite this:Farooqui R, Siddiqui QA. Diagnostic accuracy of procalcitonin in maternal plasma to detect early intra-amniotic infection in preterm premature rupture of the membranes with respect of high vaginal swab as gold standard. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4436 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Parity and gestational age are associated with vaginal microbiota composition in term and late term pregnancies

Vaginal microbiota and its potential contribution to preterm birth has been under intense research in recent years. However, only few studies have studied vaginal microbiota in later stages of pregnancy or at the onset of labor. We analyzed vaginal swab samples collected between 37- and 42-weeks of gestation from 324 Finnish women before elective cesarean section, at the onset of spontaneous labor, and in pregnancies continuing beyond 41 weeks of gestation. Vaginal microbiota composition associated strongly with parity, i.e. previous deliveries, and advancing gestational age. Absence of previous deliveries was a strong predictor of L. crispatus dominated vaginal microbiota, and the relative abundance of L. crispatus was higher in late term pregnancies, especially among nulliparous women. The results underscore the importance of the vaginal microbiota for improving the currently limited understanding on how the duration of gestation and timing of birth is regulated, with potentially vast clinical utilities.

Prevalence of Candida infection in Covid-19 pandemic: A study from a tertiary care center in Central India

Background: Corona virus disease 2019 (COVID-19) infections may be associated with a wide range of bacterial and fungal co-infections. Candida and mucor are the common fungus encountered during this pandemic. Candida is one of the commonly encountered opportunistic fungi that cause superficial mucosal infections usually, but can invade tissue and produce life threatening infections. Candida species recognized as one of the major agent of hospital Acquired (nosocomial) fungal infections. Keeping this in background the current study was conducted. Aims and Objective: To estimate the prevalence of candida infection in tertiary care hospital of Indore. Materials and Methods: The present study was done in the period of one and half year. During this period all received clinical specimens like urine, sputum; high vaginal swab and pus suspected for fungal infection from Covid as well as non-Covid patients were processed according to standard protocol. The specimen was subjected to preliminary tests like wet mount, Gram’s stain, culture on sabourads dextrose agar (SDA) and Hichrome agar, germ tube test, sugar assimilation test and culture on Cornmeal agar (dalmau technique) for candida species were done. For statistical analysis Chi-square test was performed and p ≤ 0.05 was considered statistically significant. Results: The prevalence of Candidiasis was 0.86%. Non-albicans candida (65.9%) isolates was more than Candida albicans (34.07%). Among non-albicans species, C. tropicalis was 27.4% followed by C. glabrata 16.29%, C. krusei 15.55%,C. parapsilosis 5.92% and C. lusitenia 0.74% were the major isolates. Males were affected more than the females. In both the genders maximum patients were from the age group of >60 years. Maximum number of Candida isolates was from blood followed by urine, pus, sputum, vaginal swab and aural swab. Most common risk factors for candidiasis noted in this study was diabetes mellitus in both Covid as well as non-Covid patients. Conclusion: Non albicans candida are gradually increasing in India. Speciation of candida play an important role in preliminary treatment because different species is intrinsically resistant to different antifungal drugs and have different antifungal susceptibility pattern.

Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is not detected in the vagina: A prospective study

Objective To determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present in the vagina of women diagnosed with coronavirus disease-19 (COVID-19) pneumonia. Study design The study was conducted prospectively in a university affiliated hospital. Forty-one women of reproductive age whose nasopharyngeal PCR test were positive for SARS-CoV-2 and clinically diagnosed with pneumonia were included in the study. Vaginal swabs were obtained for SARS-CoV-2 PCR tests when the patients were admitted to the inpatient service before pneumonia treatment was initiated. Results Vaginal swab samples of 38 patients were analysed with SARS-CoV-2 PCR tests. None of the vaginal swabs were positive for SARS-CoV-2. Conclusions SARS-CoV-2 does not infect the vagina of women diagnosed with SARS-CoV-2 pneumonia.

Serological Specificity in the Detection of Syphilis among Pregnant Women Attending Antenatal in Some Hospitals in Mubi Metropolis, Adamawa State, Nigeria

Syphilis is a sexually transmitted infection (STI) caused by the Treponema pallidum (spirochetes). Syphilis remains a major cause of reproductive morbidity and poor pregnant outcomes in developing countries. This Research work seeks to determine the specificity of serological VDRL test for syphilis against the use of High Vaginal Swab in molecular detection of syphilis among pregnant women attending antenatal in some selected hospitals and clinics in Mubi North and South L.G.A. Adamawa State, Nigeria to subvert the challenges, hence finding lasting solution to the Reproductive and mental health challenges posed by secondary Syphillis. A total of 120 blood samples were collected from 120 consented pregnant women in batches from General hospital, Mubi, Sabon layi clinic, Lokuwa PHC, Lamurde maternity, Kwaja PHC and Alheri Nursing hospital all in Mubi North and South Local Government, during their Antenatal days. In all, 30(25.0 %) of the samples were seropositive, with the highest prevalence recorded as 11(9.17 %) of the 20 samples collected from Kwajah PHC in Mubi South L.G.A. The HVS of pregnant with positive serological test results were subjected to molecular nPCR test to amplify the tpp47 gene of Treponema pallidum. The only amplified fragment which arouse from the positive as the only positive amplification products was analyzed for specificity in an agarose gel developed 0.01 % ethidum bromide for ease of visualization of the band of fragment weight 260 bp tpp47 gene of Treponema pallidum under U.V since all HVS samples showed no bands of amplification, no further sequencing was technically necessary.

Application and utility of alternative methods in isolation of pure cells from forensic biological mixtures in modern-day: a review

Development of genetic profiles from the biological mixtures has remained challenging, although modern-day technologies may help forensic scientists to attain a reliable genetic profile in the identification of the accused. In the case of rape, vaginal swab exhibits usually contain epithelial cells of victims and sperm cells of accused, such samples are more challenging when there is more than one contributor. In such cases, separation of distinct cells from a mixture that includes blood cells, epithelial cells and sperm cells for their single genetic profile is important. In the last ten decades several new techniques were developed and invented for the separation of single cell from the biological mixture that includes differential lysis, laser micro-dissection, cell sorting (FACS), sieve-based filtration, (vi) micro-fluidic devices or immunomagnetic beads cell separation of fresh samples, and the magnetic activated cell sorting (MACS). Out of them, some techniques have been commonly applied for cell separation in forensic biology. Each technique has its own limitation. Some recent studies showed, magnetic activated cell sorting (MACS), laser capture microdissection (LCM), DEPArray technology and fluorescence activated cell sorting (FACS) has proved to be effective in separation of single cell from cell mixtures. Therefore, in this review we have evaluated these four alternative methods and their potential application in the modern-day over the others for the separation of a single cell from the mixture. In this review we also discuss the advantage of these methods and their modern–day applicability and acceptance in the forensic world.