bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology and Hospital Course of Patients With Acute Salpingitis and Coincident HIV
Authors: Ayala-Rodriguez Iris , Apuzzio Joseph
Published: March 2007

Objective: To compare the epidemiology and hospital course of
patients with acute salpingitis with and without coincident human immunodeficiency
virus (HIV) seropositivity.
Methods: Patients admitted to the UMDNJ‐University Hospital in Newark,
New Jersey from January 1, 1991, to December 31, 1991, with acute salpingitis were studied.
Results: Eight percent of all hospitalized patients with acute salpingitis
were HIV‐positive. The mean age of the HIV‐negative group was 25.4 compared with 29.6 years
in the HIV‐positive group. Gonorrhea and chlamydia were present in 49% and 22%,
respectively, in HIV‐negatives and in 40% and 20% of HIV‐positives. Two of 5 (40%)
HIV‐positive patients had tuboovarian abscesses compared with 12 of 59 (20%) HIV‐negative
patients. Three of 5 (60%) HIV‐positive patients had admission WBC counts fewer than
10,000/mm3
compared to 6 of 59 (12%) of HIV‐negatives (P = 0.024). The hospital stay was 5.4
days for HIV‐positives and 5.8 days for HIV‐negatives.
Conclusions: Eight percent of hospitalized patients with acute salpingitis
were HIV‐seropositive. Neisseria gonorrhoeae and chlamydia were commonly found
organisms in both groups. The initial WBC count was lower for HIV‐positive patients.
The hospital course of both groups was similar.
Effect of Isoflurane on Neutrophil Phagocytic Function During Pregnancy
Authors: Clark Penny , Layon A. Joseph , Duff Patrick
Published: March 2007

Objective: General anesthesia has been considered an
independent risk factor for postcesarean infection, but the mechanism for this association
has not been delineated. The purpose of this prospective investigation was to determine
if phagocytic response of neutrophils was impaired by in vitro exposure to isoflurane, a
commonly used anesthetic.

Methods: Twelve milliliter venous blood samples were withdrawn from
18 term patients during labor. Neutrophils were separated by Ficoll gradient centrifugation.
Aliquots of 2 × 106
neutrophils/ml were exposed to anesthesia using an airtight modular
incubator chamber through which a 0.5% isoflurane:50% N2O + 50% O2
mixture flowed
at a rate of 4 l/min for 90 min at 37℃. Neutrophils were assayed for phagocytosis by
incubation with Escherichia coli conjugated with fluorescein isothiocyanate for 30 min
at 37℃. Phagocytosis was assessed by flow cytometry. Neutrophils from the same
patient that were not exposed to anesthesia served as controls.

Results: The mean percentage of phagocytizing neutrophils in the
isoflurane‐treated group was 82.8 ± 24 compared to 83.5 ± 22 in the control group.
The difference between the two groups was not significant.

Conclusions: In vitro exposure to the general anesthetic isoflurane
for 90 min does not significantly alter the phagocytic capacity of neutrophils.
Treatment of Cervical Chlamydial Infection With Amoxicillin/Clavulanate Potassium
Authors: Mann Melinda S. , Faro Sebastian , Maccato Maurizio L. , Kaufman Raymond H.
Published: March 2007

Objective: To determine if amoxicillin/clavulanate potassium is effective
in the treatment of Chlamydia trachomatis endocervicitis.
Methods: Thirty‐two patients with culture‐proven endocervical infection
were treated with amoxicillin/clavulanate potassium, 500 mg orally 3 times a day for 10 days.
Post‐treatment endocervical specimens were obtained at 2, 4, and 6 weeks for culture of C. trachomatis. Male partners were treated with doxycycline, 100 mg orally twice daily for 10
days. The couples were provided condoms and asked to use them throughout the duration
of the study.
Results: All patients treated with amoxicillin/clavulanate potassium
were cured of signs of cervicitis. All were found to be free of C. trachomatis at their follow‐up
visits.
Conclusions: Amoxicillin/clavulanate potassium is effective in
eradicating C. trachomatis.
Inpatient Treatment for Uncomplicated and Complicated Acute Pelvic Inflammatory Disease: Ampicillin/Sulbactam Vs. Cefoxitin
Authors: Hemsell David L. , Wendel George D. , Hemsell Patricia G. , Heard Molly L. , Nobles Brenda J.
Published: March 2007

Objective: Ampicillin plus sulbactam, an irreversible
β‐lactamase inhibitor, was compared to cefoxitin
in the treatment of women with acute pelvic inflammatory disease (PID) with and without
inflammatory mass(es).
Methods: Participation in an open, prospective, randomized clinical trial was
offered to all women given the clinical diagnosis of acute PID who required inpatient therapy.
Neisseria gonorrhoeae and Chlamydia trachomatis were sought in cervical and endometrial
samples and aerobic and anaerobic species were sought in endometrial samples prior to
treatment initiation. Treatment was given on at least 4 days and until women were afebrile for at
least 48 h. Daily examinations were performed to assess response to therapy and safety. Only
women in whom C. trachomatis was identified were discharged from the hospital on oral
doxycycline to be taken for 10–14 days.
Results: One hundred twenty‐four women were evaluated for safety;
117 (94%) were evaluated for efficacy. Demographic characteristics were similar for women in
each treatment group. N. gonorrhoeae was recovered from 59% and C. trachomatis was
recovered from 42% of study subjects. Inflammatory masses were identified in 35/76 (46%)
women given ampicillin/sulbactam and 17/41 (41%) women given cefoxitin. Ampicillin/sulbactam
cured 75 ,of 76 women (98.7%) [95% confidence interval (CI) 92.9–100.0%] and cefoxitin cured 37
of,41,omen (90.2%) (95% CI 76.9–97.3%) in that treatment regimen.
Conclusions: Overall ampicillin/sulbactam was more effective (P = 0.05) than
cefoxitin, due to superior efficacy in infection complicated by inflammatory mass(es).35/35 vs.
12/17 cured; P = 0.007).
Management of Intrauterine Device‐Associated Actinomycosis
Authors: Chatwani Ashwin , Amin-Hanjani Soheil
Published: March 2007

Objective: To assess various methods of management of
actinomyces‐like organisms associated with intrauterine devices.

Methods: A retrospective chart review of 173 patients with intrauterine
device‐associated actinomyces‐ like organisms detected on Pap smear was performed.
The patients were managed by IUD removal with or without antibiotic therapy, antibiotic
therapy alone, or no treatment at all.

Results: The success rate as reflected in negative follow‐up smear was
100% for IUD removal combined with antibiotics, 97.4% for IUD removal alone, and 36.8% for
antibiotics therapy alone.

Conclusions: The best way to manage intrauterine device‐associated
actinomyces‐like organisms is removal of the device with or without antibiotics.
Evaluating the Concentration of a Candida albicans Suspension
Authors: Rodrigues Acácio , Vaz C. Pina , da Fonseca A. Freitas , de-Oliveira J. Martinez
Published: March 2007

Objective: The objective of this study was to develop a reproducible
method of establishing the concentration of yeast cells per milliliter of solution.
Methods: Three methods of determining the number of yeast cells in
solution were compared: Neubauer′s counting chamber, spectrophotometry, and
nephelometry.
Results: All three methods were comparable and reproducible.
The following formulas were highly effective in determining the number of yeast cells in
solution: chamber (× 103/ ml) 64.3 + 8,206 × spectrophotometry (absorbance); and chamber
(× 103
/ml) –0.2 + 64 × nephelometry (volt).
Conclusions: Utilization of spectrophotometry or nephelometry
and the appropriate formula allow for the precise determination, which is easily reproducible,
of the concentration of yeast cells in solution. This will facilitate experimentation involving
precise inocula or requirement for specific concentrations of yeast cells for various
experiments.
Candida Esophagitis in an Immunocompetent Pregnant Woman
Authors: Greenspoon Jeffrey S. , Kivnick Seth
Published: March 2007

Background: Nausea and vomiting are common during the
first half of pregnancy and usually require only supportive measures. When symptoms
are progressive and weight loss occurs, treatable causes should be sought by means of
upper gastrointestinal endoscopy. We report a case of an immunocompetent gravida with
invasive Candida albicans esophagitis.
Case: The immunocompetent primigravida developed progressive
nausea, vomiting, epigastric pain, and a 4.1 kg weight loss during the second trimester
of pregnancy. Treatment with metoclopramide and cimetidine for presumed gastroesophageal
reflux was not effective. The patient had normal T‐cell CD4 and CD8 subsets and was human
immunodeficiency virus (HIV) antibody negative. Upper gastrointestinal endoscopy
revealed C. albicans esophagitis which was treated with oral nystatin. The esophagitis had
resolved completely when reassessed postpartum. The use of histamine2 blockers is
associated with an increased risk for fungal esophagitis and may have been a
contributing cause in this case.
Conclusion: Pregnant patients with persistent nausea, vomiting,
and weight loss should be evaluated by endoscopy for fungal esophagitis.
Review of Vaginitis
Authors: Faro Sebastian
Published: March 2007

Adisruption of the dynamic equilibrium of the healthy vagina may have significant sequelae,
leading to chronic or serious conditions. Therefore, all cases of vaginitis should be
accurately diagnosed and appropriately treated.
Correlation Between the Clinical Diagnosis of Bacterial Vaginosis and the Results of a Proline Aminopeptidase Assay
Authors: Nelson George H. , Bacon Janice L.
Published: March 2007

Objective: The object of this study was to develop a simple and
inexpensive test for detection of bacterial vaginosis (BV) in pregnant patients and to test its
accuracy in a clinic population.

Methods: We developed a modified proline aminopeptidase (PAMP)
assay to detect BV and compared the results of the assay with the clinical diagnosis of BV.

Results: The results of the PAMP assay in 55 asymptomatic and 50
symptomatic subjects significantly correlated with a clinical diagnosis of BV. The prevalence
of BV in the asymptomatic population was 42% (PAMP assay) and 38% (clinical diagnosis).
In the symptomatic population, it was 50% (PAMP assay) and 54% (clinical diagnosis).
The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive
value (NPV) of the PAMP assay were 86, 85, 86, 78, and 91%, respectively, in asymptomatic
patients and 89, 96, 92, 96, and 88%, respectively, in symptomatic patients.

Conclusions: The modified PAMP assay, which we describe,
met our goals for simplicity, cost, and accuracy. We feel it could be best used as a screening
test for BV in asymptomatic pregnant patients.
Systemic vs. Topical Therapy for the Treatment of Vulvovaginal Candidiasis
Authors: Faro Sebastian
Published: March 2007

It is estimated that 75% of all women will experience at least 1 episode of vulvovaginal
candidiasis (VVC) during their lifetimes. Most patients with acute VVC can be treated with
short‐term regimens that optimize compliance. Since current topical and oral antifungals
have shown comparably high efficacy rates, other issues should be considered in
determining the most appropriate therapy. It is possible that the use of short‐duration
narrow‐spectrum agents may increase selection of more resistant organisms which will
result in an increase of recurrent VVC (RVVC). Women who are known or suspected to be
pregnant and women of childbearing age who are not using a reliable means of
contraception should receive topical therapy, as should those who are breast‐feeding or
receiving drugs that can interact with an oral azole and those who have previously experienced
adverse effects during azole therapy. Because of the potential risks associated with systemic
treatment, topical therapy with a broad‐spectrum agent should be the method of choice for
VVC, whereas systemic therapy should be reserved for either RVVC or cases where the
benefits outweigh any possible adverse reactions.
Genital Mycoplasmas in Placental Infections
Authors: Stein Andreas , Boubli Léon , Blanc Bernard , Raoult Didier
Published: March 2007

Objective: The involvement of the genital mycoplasmas Ureaplasma urealyticum
and Mycoplasma hominis in complications of pregnancy has remained
controversial especially because these microorganisms are frequent colonizers of the
lower genital tract. Recovery of bacteria from the placenta appears to be the sole technique
to represent a true infection and not vaginal contamination. Therefore, we investigated the
presence of genital mycoplasmas, aerobic and anaerobic bacteria, and fungi in human
placentas and evaluated their association with morbidity and mortality of pregnancy.

Methods: We cultured placentas from 82 women with complicated
pregnancies. One hundred placentas from women with uncomplicated pregnancies were
evaluated as controls. When possible, placentas were examined histologically for presence
of chorioamnionitis.

Results: Microorganisms were recovered from 52% of the placentas
of complicated pregnancies and U. urealyticum was the microorganism isolated most
frequently from the placenta. A significant association between positive mycoplasma
culture of the placenta and complication of pregnancy was found, and chorioamnionitis
was positively related to isolation of mycoplasmas.

Conclusions: These data suggest that genital mycoplasmas are
able to infect the human placenta where they can cause chorioamnionitis.
This infection of the placenta by genital mycoplasmas is related to preterm birth and
fatal outcome of pregnancy.
Streptococcus pneumoniae as a Cause of Salpingitis
Authors: Patterson David , Johnson Celeste M. , Monif Gilles R. G.
Published: March 2007

Background: A case of pneumococcal septicemia associated with
laparoscopically documented acute salpingitis is reported.

Case: Gram‐stained cul‐de‐sac pus revealed gram‐positive
encapsulated diplococci.

Conclusion: This case coupled with reanalysis of prior genital tract
involvement in nonpregnant individuals argues that Streptococcus pneumoniae can
mimic gonococcal diseases.
Herpes in Pregnancy
Authors: Cook Curtis R. , Gall Stanley A.
Published: March 2007

The management of genital herpesvirus infections in pregnancy has seen many
changes over the past decade as we have continued to learn more about the
epidemiology of the disease. This article reviews these changes and highlights
ongoing controversies. Clinical management schemes are proposed based upon this
most recent information.
Detection of Trichomonas vaginalis Using the Polymerase Chain Reaction in Pregnant andNon‐Pregnant Women
Authors: Jeremias J. , Draper D. , Ziegert M. , Jones W. , Inglis S. , McGregor J. A. , Witkin S. S.
Published: March 2007

Objective:Trichomonas vaginalis vaginal infections are often both asymptomatic and difficult to
detect by current methods. We evaluated the ability of a newly developed polymerase chain reaction (PCR) assay to
identify T. vaginalis in vaginal samples from pregnant and non‐pregnant women.

Methods: In the 1st study, we compared the prevalence of T. vaginalis detection by PCR and culture
using Diamond′s medium in 52 women with symptoms of vaginal infection. In the 2nd study, T. vaginalis was detected
using PCR and wet mount microscopy in 131 asymptomatic pregnant women.

Results: Among the women with symptoms of vaginitis, 7 (13.5%) were PCR‐positive for T. vaginalis.
Six of the PCR‐positive women, but none of the PCR‐negative women, were culture‐positive for this organism. All but 1 of the
women with candidal vaginitis or bacterial vaginosis were PCR‐negative for T. vaginalis. Among the asymptomatic pregnant
women, all of whom were negative for T. vaginalis by wet mount, l0 (7.6%) were PCR‐positive for T. vaginalis.

Conclusions: PCR offers a rapid and sensitive alternative to culture and microscopy for the detection
of T. vaginalis vaginal infections in both symptomatic and asymptomatic women.
Rapid Immunoassay for the Detection of Genital Herpes Infection
Authors: Alexander Samuel M. , Gebhardt Bryan M.
Published: March 2007

Objective: We evaluated a new affinity membrane strip test for the diagnosis of herpetic genital
infections. Test strip results, which are available by immunoassay in 30 min without the need for special equipment,
were compared with the results of viral culture.

Methods: Twenty‐eight female patients with vulvar lesions thought to be due to genital herpes
simplex virus (HSV) infection were tested. The affinity membrane strip was applied to the genital lesion. Dacron swabs
were then applied to the lesions and the swab contents cultured for HSV. For the immunoassay, the test strip was immersed
in peroxidase‐labeled antibodies specific for HSV type 2 (HSV‐2), incubated, washed, and developed in the substrate
tetramethylbenzidine. Positive reactions appeared as intense blue spots roughly the shape and size of the lesion. Sensitivity
and specificity of the test were determined using the results of viral cultures as the standard.

Results:The lesions of 8 patients yielded positive strips that correlated with positive cultures. The
lesions of 6 patients produced positive strips but the cultures were negative. None of the patients whose lesions yielded
negative strips had positive cultures. The lesions of 14 patients produced negative strips and negative cultures. Strips
and viral cultures from 10 control patients (no lesions) were negative. Sensitivity and specificity were 100% and
70%, respectively. Positive (PPV) and negative (NPV) predictive values were 57% and 100%, respectively.
The accuracy was 78%.

Conclusions: The affinity membrane test was extremely sensitive in detecting herpetic genital
infection compared with viral culture. The specificity was lower, resulting from false positives based on negative cultures.
However, negative cultures may occur in the presence of disease, depending in part on the type of lesion. Thus, specificity
may be higher than this preliminary study indicates, and more elaborate search for virus including serologic studies as
well as larger groups of patients may be needed to refine this evaluation. With further testing and development, this
membrane affinity test for herpes may yield a valuable adjunct to clinical diagnosis of this infection.
Diagnostic Evaluation of Pelvic Inflammatory Disease
Authors: Peipert Jeffrey F. , Soper David E.
Published: March 2007

Pelvic inflammatory disease (PID) is a serious public health and reproductive health problem in the United States.
An early and accurate diagnosis of PID is extremely important for the effective management of the acute illness and for
the prevention of long‐term sequelae. The diagnosis of PID is difficult, with considerable numbers of false‐positive and
false‐negative diagnoses. An abnormal vaginal discharge or evidence of lower genital tract infection is an important
and predictive finding that is often underemphasized and overlooked. This paper reviews the clinical diagnosis and
supportive laboratory tests for the diagnosis of PID and outlines an appropriate diagnostic plan for the clinician and
the researcher.
Animal Models of Ascending Genital‐Tract Infection in Pregnancy
Authors: McDuffie Robert S. , Gibbs Ronald S.
Published: March 2007

This article reviews animal models currently used for investigation of ascending genital‐tract infection in pregnancy.
The specific models reviewed are those in the rabbit, monkey, and mouse. These models investigate both the direct effects
of bacteria in the setting of ascending infection and the role of cytokines produced by the immune system. For each model,
experiments that delineate the pathophysiology of ascending genital‐tract infection in pregnancy are described.
Intervention experiments, including the use of antibiotics, anti‐inflammatory agents, immunotherapy, and anti‐cytokine
therapy, are described. Comparison of these models is made with respect to pathogenesis in humans, reproducibility,
anatomy, and cost.
Human Immunodeficiency Virus Infection and Pregnancy
Authors: Schwarz Richard H.
Published: March 2007

The human immunodeficiency virus (HIV) epidemic is clearly one of the most serious health‐care crises in the
professional lives of contemporary physicians. It cannot be regarded as a curiosity to be dealt with by inner‐city
infectious‐disease experts, but rather must be considered a problem for all health‐care providers and a problem
in which the obstetrician‐gynecologist has a special role to play.
Assessment of the Value of Routine Blood Cultures in the Evaluation and Treatment of Patients WithChorioamnionitis
Authors: Locksmith Gregory J. , Duff Patrick
Published: March 2007

Objective: The objective of this investigation was to determine the usefulness of blood cultures in
evaluating patients with chorioamnionitis who were treated in accordance with a specific antibiotic protocol.

Methods: We reviewed the records of 539 patients with chorioamnionitis who delivered at our
facility over a 3 year period (July 1, 1989–June 30, 1992). Patients had one set of aerobic and anaerobic blood cultures
at the time of their initial assessment. They were treated initially with ampicillin or vancomycin plus gentamicin. Those
who required cesarean delivery also received clindamycin postoperatively. Patients who had a poor initial response to
therapy were treated empirically with selected antibiotics targeted against likely resistant organisms until the results of
bacteriologic cultures were available. Bacteremic patients had repeat blood cultures while on therapy. We analyzed the
medical records to determine the frequency with which blood culture results led to meaningful changes in patient
management. We also compared the duration of febrile morbidity in bacteremic vs. nonbacteremic patients.

Results: Thirty‐nine of 538 patients (7.2%, 95% confidence interval [CI] 5.2–9.2%) had
positive blood cultures. In only one patient did the result of the blood culture definitively alter therapy. This patient had
a fever of unknown origin, and the finding of a positive blood culture ultimately led to the diagnosis of chorioamnionitis.
The mean duration of febrile morbidity was not significantly different in bacteremic vs. nonbacteremic patients (2.03 vs. 1.74 days). None of the repeat blood cultures was positive. The cost of blood cultures in the study population was
$72,759.00.

Conclusions: The routine use of blood Cultures in the assessment of patients with chorioamnionitis
rarely provides information that justifies a change in clinical management when patients are treated in accordance with
the specific antibiotic protocol outlined in this investigation.
Comparison of Culture and Rapid Enzyme Immunoassay for the Detection of Group B Streptococcus inHigh‐Risk Pregnancies
Authors: Dinsmoor Mara J. , Dalton Harry P. , Peng Thomas C. C. , Christmas James T. , Sayahtaheri-Altaie Sousan , Harvey Kevin , VanDorsten J. Peter
Published: March 2007

Objective: The purpose of this study was to evaluate the Equate Strep B® test for clinical use in
patients at high risk for complications from group B streptococcus (GBS) disease.

Methods: Vaginoperineal swabs were obtained from patients with preterm premature rupture of
the membranes and/or preterm labor and semiquantitative GBS cultures and Equate® assay were performed.

Results: From May 14, 1990, to April 30, 1992, 650 patients were enrolled; 626 had both culture
and Equate® results available, of whom 24% were colonized with GBS. The sensitivity, specificity, positive predictive value, and negative predictive value of the rapid assay were 28%, 84%, 35%, and 79%, respectively. Although the prevalence of GBS was higher in patients with ruptured membranes compared with those with intact membranes, rupture of membranes did not affect test sensitivity or specificity.

Conclusions: We conclude that the Equate® rapid assay is not a sensitive method of GBS detection in high‐risk patients.
Comparison of Short Vs. Long Half‐Life Single‐Dose Prophylactic Antibiotics for Cesarean Section
Authors: Gonik Bernard , McGregor James
Published: March 2007

Objective: Numerous studies demonstrate the efficacy of antibiotic prophylaxis for reducing postcesarean
section infectious morbidity. The duration of therapy, however, remains controversial.
Cost containment measures and the ease of single dosing have led to the introduction of “extended”
half‐life agents for cesarean‐section chemoprophylaxis. We tested the hypothesis that there was no
difference in efficacy between a single dose of a short half‐life agent (cefoxitin) and a longer half‐life
agent (cefotetan).

Methods: A prospective, double‐blind trial of 375 non‐elective cesarean‐section cases was carried
out. Study antibiotics (2 g) were administered intravenously (IV) at cord clamping only.

Results: Demographic and clinical variables between the 2 study groups were similar. No significant
differences were noted in major or minor morbidity or in infectious morbidities for patients
receiving the 2 prophylactic regimens. The occurrence of postoperative endometritis was likewise
similar for the subjects receiving cefoxitin (10%) and cefotetan (15%). When cases whose surgery
lasted >60 min were evaluated separately, no differences in outcomes between the 2 groups were
identified

Conclusions: These findings confirm our hypothesis that the half‐life difference between these 2
agents does not impact on single‐dose Prophylactic efficacy in cesarean section.
Detection of Human Papillomavirus DNA by AffiProbe HPV‐DNA Test Kit in Cervical Scrapes orBiopsies‐Histopathologic Correlates
Authors: Nieminen Pekka , Jalava Tarja , Kallio Arja , Ranki Marjut , Paavonen Jorma
Published: March 2007

Objective: The aim of this study was to evaluate and compare the efficacy of punch biopsies and
cervical scrapes in the detection of human papillomavirus (HPV) DNA from the cervix and compare the results with the
histopathologic diagnosis.

Methods: The specimens were collected simultaneously, and HPV DNA was detected using a
liquid hybridization test.

Results: Biopsies and scrapes were equally efficient, but each detected only two‐thirds of all
HPV‐DNA‐positive patients. Thus, the positivity rate increased when both tests were used. Overall, 13% of patients with normal histopathology, 38% of patients with benign atypia, and 66% of patients with squamous intraepithelial lesions (SIL) were HPV‐DNA positive. HPV‐DNA 16 was found in 54% of HPV‐DNA‐positive patients with SIL, in 20% of HPV‐DNA‐positive patients with atypia, and in none of patients with normal histopathology.

Conclusions: The liquid hybridization test used in this study detects HPV DNA equally efficiently
from both biopsies and scrapes. The test can be performed in 1 working day. However, the sensitivity of the test is low,
and it only detects a limited number of HPV types.
Occult Intraamniotic Infection at the Time of Midtrimester Genetic Amniocentesis:A Reassessment
Authors: Cherouny Peter H. , Pankuch Glenn A. , Botti John J.
Published: March 2007

Objective: The objective of this study was to reevaluate the incidence of occult early midtrimester
intraamniotic infection in asymptomatic patients at the time of genetic amniocentesis.

Methods: A total of 177 amniotic fluid (AF) specimens from patients referred for genetic amniocentesis between 15 and 20 postmenstrual weeks were evaluated for the presence of bacteria by
detailed light microscopy, after Gram and Wright stain, and by cultures for aerobic and anaerobic
baceria, Mycoplasma sp., and Ureaplasma urealyticum. Seventy‐seven AF specimens were also tested for the presence of bioactive leukoattractants by a leukotaxis bioassay.

Results: All fluids were negative for bacteria and bioactive leukoattractants [95% confidence interval (CI), 0–1.9%; 99% CI, 0–2.9%]. This is significantly less than a recently reported incidence of 5.09% (P = 0.002). Incidentally, artifacts with light microscopic morphology consistent with spermatozoa were found during the detailed light microscopic evaluation of AF Gram stains from 2 (1.1%) AF samples in otherwise uneventful pregnancies, a previously unreported finding. Scanning electron microscopy was used to confirm the light microscopic findings.

Conclusions: Occult intraamniotic infection in the second trimester is not as high as recently
reported. AF culture in all cases of second‐trimester amniocentesis is not necessary. The identification
of spermatozoa on Gram stain of second‐trimester AF specimens needs further confirmation.
Case‐control Analysis of Clostridium difficile—Associated Diarrhea on a Gynecologic Oncology Service
Authors: Waggoner Steven E. , Barter James , Delgado Gregorio , Barnes Willard
Published: March 2007

Objective: The incidence, morbidity, and risk factors associated with Clostridium difficile‐associated
diarrhea (CDAD) were studied in a group of gynecologic oncology patients.

Methods: A case‐control analysis of gynecologic oncology patients with CDAD was carried out
from August 1986 through January 1989 in a university medical center.

Results: One hundred twenty‐three stool samples were tested for C. difficile using the CDT latex
agglutination test (Marion Diagnostics, Kansas City, MO). Thirty episodes of CDAD developed in
23 patients. From August 1986 through July 1988, the incidence was stable at 1.5 episodes/100
admissions. From August 1988 through January 1989, the incidence increased to 9.9 episodes/100
admissions (P = 0.005). Compared with patients with nonspecific antibiotic‐associated diarrhea, the
study patients were hospitalized longer prior to the development of symptoms (mean 15.2 vs. 9.2
days, P = 0.006) and were admitted more frequently with diarrhea (37% vs. 11%, P = 0.015). The
rates of surgery, chemotherapy, and radiation therapy were similar. Fever (57% vs. 14%, P < 0.001),
abdominal pain (40% vs. 6%, P < 0.001), bloody stools (27% vs. 3%, P = 0.006), and leukocytosis
(64% vs. 26%, P = 0.011) were more common among the study cases. The duration, indication, and
number of antibiotics administered were similar, though once started, the mean time to symptoms
was longer in the study cases (13.7 vs. 6.1 days, P = 0.004). Seven relapses, 1 death, and 1 unplanned
colostomy occurred among women with CDAD.

Conclusions: C. difficile is a serious cause of nosocomial morbidity in gynecologic oncology
patients. Diarrhea developing after antibiotic exposure is more likely to be associated with C. difficile
in patients whose symptoms develop several days after completing antibiotics and in patients with a
history of CDAD.
Evidence for In Utero Hematogenous Transmission ofGroup B β‐hemolytic Streptococcus
Authors: Robischon Kathleen , Amstey Marvin S.
Published: March 2007

Background: The presumed ascending route of group B β‐hemolytic streptococcus (GBS) infection
from the colonized maternal genital tract is well accepted. This case report proposes a hematogenous,
selective infection of one unruptured amniotic sac over the other ruptured amniotic sac in a
twin gestation in a patient with known GBS vaginal colonization.

Case: This is a case report of GBS sepsis in twin B with intact membranes. Twin A, with 28 h of
ruptured membranes, failed to show any signs of infection. The pathology of the placenta confirmed
chorioamnionitis in twin B and the absence of infection in twin A.

Conclusion: The presence of culture‐positive GBS sepsis in the twin with the unruptured amniotic
sac, as well as the absence of GBS infection in the twin with the ruptured sac, suggests an alternative
means of infection for GBS infection, such as hematogenous transplacental transmission.
Candidal Retinitis in a Gynecologic Patient
Authors: Copas Pleas R. , Spann Cyril O. , Lim Jennifer I. , Horowitz Ira R.
Published: March 2007

Background: Candidal retinitis is a rare but potentially devastating infection in the postoperative
patient. Due to the possibility of blindness if the diagnosis and treatment are delayed, we present this
report to help educate gynecologic surgeons.

Case: A postmenopausal patient presented for the treatment of ovarian carcinoma. Her surgical
therapy required radical tumor debulking with partial bowel resection. The patient was begun on
intravenous (IV) hyperalimentation through a central venous catheter. On the 7th postoperative
day, a cephalosporin antibiotic was administered. Because of persistent fever, a septic workup was
instituted and revealed an infected central venous catheter that was culture positive for Candida
albicans. The patient complained of visual disturbances and an ophthalmological examination revealed
candidal retinitis. Amphotericin B and fluconazole were administered with resolution of her
fever and visual changes.

Conclusion: The risk factors of malignancy, abdominopelvic surgery, antibiotic therapy, and IV
catheters are discussed. In view of the common association of these iatrogenic factors in gynecologic
and obstetrical practice, we present this case to help make physicians aware of this potentially
devastating infection.
Schistosomiasis as a Cause of Chronic Lower Abdominal Pain
Authors: Yoganathan Kathir G. , McManus Tom J.
Published: March 2007

Background: Chronic intestinal schistosomiasis is rare in the United Kingdom. The symptoms are
nonspecific and may mimic several other gastrointestinal conditions. We present a case of chronic
intestinal schistosomiasis in a West Indian woman presenting to a genitourinary clinic.

Case: The patient presented with chronic lower abdominal pain and dysuria. A sexually transmitted
disease (STD) screen was negative and midstream urine cultures were sterile. A rectal biopsy
revealed a non‐necrotizing granulomatous reaction around the ova of Schistosoma. Her symptoms
resolved with anti‐schistosomiasis therapy.

Conclusion: This case illustrates that physicians should be aware of chronic schistosomiasis in the
differential diagnosis of chronic lower abdominal pain in women who have come from or visited
areas where schistosomiasis is endemic.
First‐trimester Septic Abortion Due to Salmonella enteritidis Oranienburg
Authors: Zettell LoriAnn , Jelsema Russel D. , Isada Nelson B.
Published: March 2007

Background: Septic abortion caused by transplacental salmonella infection is extremely rare; there
are no reported cases of serotype oranienburg as an etiology.

Case: We describe a patient with non‐typhoidal Salmonella enteritidis serotype oranienburg as a
cause of first‐trimester pregnancy loss. The rapid progression of this patient′s septicemia and adverse
outcome is described. The epidemiology and natural history of salmonella infections are also discussed.

Conclusion: Non‐typhoidal salmonella is still a cause of morbidity in Western countries. This
infection can result in rapid‐onset fetal demise and septic abortion.
Effect of Successive Single‐gestation Pregnancies on the Course of Maternal Human Immunodeficiency VirusDisease and Perinatal Transmission
Authors: Robinson William R. , Wiley Dan , Van Dyke Russ
Published: March 2007

Objective: This study was undertaken to examine the effect of successive pregnancies over a 3‐year
period on the course of maternal human immunodeficiency virus (HIV) infection and the rate of
perinatal transmission of HIV.

Methods: A retrospective analysis of 32 pregnancies in 14 known HIV‐infected women vs. a
matched control group of HIV‐infected women who had been pregnant only once was done.

Results: The multiple‐pregnancy group was similar to the single‐pregnancy group for age, race,
duration of known HIV infection, initial CD4 count, and date of first pregnancy. The delivery data
were similar as well. The CD4 counts in the multiple‐pregnancy group fell from 595 to 460, while
counts in the single‐pregnancy group fell comparably from 669 to 638, both over 37 months
(P = 0.1476). Five of 5 second‐born infants of known serostatus vs. 8 of 21 first‐born infants were
HIV‐infected (P < 0.05).

Conclusions: Successive pregnancies do not alter the course of HIV infection in asymptomatic
women followed up to 3 years. The infants of second pregnancies of known HIV‐infected women
may be at higher risk for perinatal transmission.
Trichomonas vaginalis Weakens Human Amniochorion in an In Vitro Model of Premature Membrane Rupture
Authors: Draper Deborah , Jones Ward , Heine R. Phillip , Beutz Michelle , French Janice I. , McGregor James A.
Published: March 2007

Objective: Trichomonas vaginalis (TV) infection is associated with preterm rupture of membranes
(PROM) and preterm birth. We evaluated the effects of TV growth and metabolism on preparations
of human amniochorion to understand and characterize how TV may impair fetal‐membrane
integrity and predispose to PROM and preterm birth.

Methods: Term fetal membranes were evaluated using an established in vitro fetal‐membrane
model. Fresh TV clinical isolates were obtained from pregnant women. The protozoa (5.0 × 105 to
1.5 × 106/ml) were incubated with fetal membranes in modified Diamond′s medium for 20 h at 37°C
in 5% CO2.The effects of fetal‐membrane strength (bursting tension, work to rupture, and elasticity)
were measured using a calibrated Wheatstone‐bridge dynamometer. Tests were also performed to
evaluate the effects of 1) inoculum size; 2) metronidazole (50 μg/ml); and 3) cell‐free filtrate.

Results: The TV‐induced membrane effects were 1) isolate variable; 2) inoculum dependent; 3)
incompletely protected by metronidazole; and 4) mediated by both live organisms as well as protozoan‐free culture filtrates. Six of 9 isolates significantly reduced the calculated work to rupture
(P ≤ 0.02); 7 of 9 reduced bursting tension; and 1 of 9 reduced elasticity. One isolate significantly
increased the work to rupture and bursting tension (P ≤ 0.002).

Conclusions: In vitro incubation of fetal membranes with TV can significantly impair the measures
of fetal‐membrane strength. This model may be used to delineate the mechanisms of TV‐induced
membrane damage. This study suggests that there are enzyme‐specific effects as well as pH effects.
Vaginal Mucositis in Measles
Authors: Chamales Ingrid A. , Napolitano Peter G. , Rosa Cesar
Published: March 2007

Background: Measles (rubeola), a common childhood exanthema, occurs infrequently in adults.
Vaginal mucositis in association with measles is not commonly described.

Case: During a recent measles epidemic, 2 female patients presented with high fever, myalgia,
exanthema, and prostration. On examination, each patient had marked inflammation and tenderness
of the vaginal mucosa, prompting the presumptive diagnosis of toxic shock syndrome. The
evolution of the illness was consistent with measles. Cervicovaginal cultures were negative for
pathogens. Acute and convalescent antibody titers for Rocky Mountain spotted fever, rubella,
leptospirosis, and Proteus Ox‐19 were not consistent with a recent infection. The sera also were
negative for anti‐toxic shock toxin‐1 and anti‐streptolysin. Measles antibody titers were consistent
with a recent infection.

Conclusion: Vaginal mucositis is an unusual manifestation of measles that may mimic toxic shock
syndrome.
Pneumonia in Pregnancy
Authors: Maccato Maurizio
Published: March 2007

Pneumonia complicating pregnancy requires a prompt diagnosis and the institution of adequate
supportive and antimicrobial therapy. In a patient with a classic presentation of pneumonia, the
most likely pathogens are Streptococcus pneumoniae and Haemophilus influenzae. In a patient with an
atypical presentation of pneumonia, Mycoplasma pneumoniae and Chlamydia pneumoniae are frequently
encountered. In a patient suffering from acquired immunodeficiency syndrome (AIDS),
Pneumocystis carinii is the most frequent pathogen. The antimicrobial therapy, therefore, has to be
tailored to the sensitivity patterns of these pathogens in the community. Hospitalization is recommended
for the pregnant patient diagnosed with pneumonia to ensure effective supportive care and
minimize the risk of preterm labor and delivery.
Meconium in the Amniotic Fluid of Pregnancies Complicated by Preterm Premature Ruptureof Membranes Is Associated With Early Onset Neonatal Sepsis
Authors: Kupferminc Michael J. , Wickstrom Elizabeth , Cho Nam H. , Garcia Patricia M.
Published: March 2007

Objective: This study was to determine the significance of meconium in the amniotic fluid of pregnancies complicated by preterm premature rupture of membranes (PPROM) without labor.

Methods: A case‐control study of 31 pregnancies complicated by PPROM at 27–36 weeks gestation with meconium present (study group) and 93 pregnancies complicated by PPROM but without meconium was performed. The patients were matched for year of delivery, gestational age, race, and parity. Pregnancy and neonatal outcome variables of the 2 groups were compared.

Results: The incidence of early onset neonatal sepsis was significantly increased in the study group (16.1% vs. 1.1%; P < 0.001). Similarly, chorioamnionitis (48.3% vs. 22.5%; P < 0.01), cesarean delivery for a nonreassuring fetal heart rate pattern (19.4% vs. 3.2%; P < 0.01), a 5‐min Apgar score < 7 (22.5% vs. 8.6%; P < 0.05), and fetal growth retardation (FGR) (12.9% vs. 2.2%; P < 0.05) were also more common in pregnancies complicated by PPROM with meconium. The mean umbilical cord arterial pH was significantly lower in these pregnancies (7.18 ± 0.07 vs. 7.28 ± 0.08;
P < 0.001). After controlling for confounding variables with multiple logistic regression analysis, we found that meconium in the amniotic fluid remained associated with early onset neonatal sepsis.

Conclusions: The presence of meconium in the amniotic fluid of pregnancies complicated by
PPROM is associated with an increased incidence of early onset neonatal group B β‐hemolytic streptococcus (GBBS) sepsis.
Antepartum Mastitis: A Case Report
Authors: Smith-Levitin Michelle , Skupski Daniel W.
Published: March 2007

Background: Acute mastitis commonly occurs in the postpartum period. It has been reported only rarely in the antepartum period.

Case: A 14‐year‐old patient presented at 29 weeks gestation with her symptoms and examination consistent with bilateral mastitis that had worsened over 2 months. She had evidence of systemic infection. She was treated with parenteral antibiotics and local skin care. She gradually improved and delivered a healthy infant at term.

Conclusion: The management of antepartum mastitis can be derived from experience with puerperal mastitis. It must include early recognition, a search for predisposing factors and causative organisms, and aggressive treatment. Such an approach can lead to successful pregnancy outcome with minimal fetal or maternal morbidity.
Intrauterine Infection and Preterm Labor
Authors: Monga Manju , Blanco Jorge D.
Published: March 2007

Preterm birth remains the leading cause of perinatal mortality and morbidity. Evidence suggests that intrauterine infection plays an important role in the pathogenesis of preterm labor. This article reviews the clinical data supporting this theory and the cellular and biochemical mechanisms by which intrauterine infection may initiate uterine contractions. The clinical and laboratory methods of diagnosing clinical chorioamnionitis and asymptomatic bacterial invasion of the intraamniotic cavity are also reviewed. Finally, the management of clinical chorioamnionitis and asymptomatic microbial invasion of the amniotic fluid and the use of adjunctive antibiotic therapy in the treatment of preterm labor are presented.
Lewis Phenotype in Women With Preterm Labor and Premature Rupture of the Membranes
Authors: O′Brien William F. , Leparc German F. , Holbrook Jodi
Published: March 2007

Objective: The purpose of this study was to evaluate the possible association between Lewis phenotype status in pregnant women and preterm labor (PTL) or preterm rupture of the membranes (PROM).

Methods: Red blood cell (RBC) Lewis phenotype was determined in 113 pregnant women admitted for PTL or PROM and in 121 controls. The results were controlled for the influence of race on Lewis phenotype.

Results: Pregnancy was associated with a higher frequency in women with the a–b– phenotype. There was no association between RBC Lewis phenotype and the occurrence of PTL or PROM.

Conclusions: A susceptibility to PTL or PROM is not due to a lack of Lewis antigen expression on
the plasma membrane of the vaginal mucosa.
Nonpuerperal Breast Infection
Authors: Casas C. Miranda , Pérez M. , Alados J. C. , Fontes J. , Orellana G. , Aguilar J. M. , Miranda J. A. , de la Rosa M.
Published: March 2007

Objective: We undertook a microbiological study of purulent specimens from women with symptomatic breast abscesses.

Methods: Fifty‐one purulent samples were collected in 2 periods (December 1991–April 1992 and January 1994–June 1994) from nonpuerperal breast abscesses in 44 patients attending our hospital.

Results: One of the most frequently isolated microorganisms was Proteus mirabilis (9 patients, 20.4%), present as a pure culture in all but 1 specimen (isolated together with Peptostreptococcus spp.). Staphylococcus aureus was isolated in 10 specimens, 6 of which were post‐tumorectomy abscesses. Polymicrobial anaerobic flora were isolated in 11 specimens (21.5%); Staphylococcus epidermidis in 4 (8%); and Streptococcus milleri,Alcaligenes sp., and mixed aerobic‐anaerobic flora in 1 specimen each. The 7 remaining samples (13.7%) were negative bacteriological cultures.

Conclusions: We draw attention to the frequent isolation of P. mirabilis in recurrent and torpid breast abscesses in 4 women in whom surgery was necessary in addition to antibiotic treatment.
Intrauterine Infection With Coxsackievirus: Is it a Cause of Congenital Cardiac Malformations?
Authors: Watson William J. , Awadallah Sami , Jaqua Mary Jo
Published: March 2007

Background: Although maternal infections with coxsackievirus during pregnancy are relatively common, fetal infections are quite rare. Coxsackievirus infection in utero has been associated with myocarditis, but has not been proven a teratogen.

Case: A patient whose fetus had structural cardiac anomalies and hydrops was found to have an intrauterine infection with Coxsackie B‐1 virus, proven by virus isolation from the amniotic fluid. This infection led to increasing intrauterine hydrops and subsequent neonatal death.

Conclusion: This interesting association of intrauterine infection with Coxsackie B virus and structural cardiac anomalies in the fetus warrants further investigation.
Chlamydia trachomatis: Management in Pregnancy
Authors: Allaire Alex , Nathan Lawrence , Martens Mark G.
Published: March 2007

Chlamydia trachomatis is a sexually transmitted disease (STD) commonly diagnosed in pregnancy. C. trachomatis has been linked to several pregnancy complications including premature rupture of membranes (PROM), preterm labor and birth, low birth weight, intrauterine growth retardation, and postpartum endometritis. Infants born to mothers through an infected birth canal are at risk for acquiring C. trachomatis pneumonitis, conjunctivitis, and nasopharyngeal infection. The standard treatment of C. trachomatis in pregnancy is erythromycin. Recently, amoxicillin and clindamycin have been added as alternative regimens for those patients intolerant of erythromycin. This paper reviews the effectiveness and tolerance of the alternative regimens compared with erythromycin and the success of antepartum treatment of chlamydia in preventing the poor pregnancy outcome and neonatal morbidity associated with C. trachomatis.