bluuebunny/crossref_metadata_2025_split huggingface dataset:
Salmonella typhi and Pregnancy: A Case Report
Authors: Gluck Brion , Ramin Kirk D. , Ramin Susan M. 
Published: March 2007

Background: Salmonella typhi may be a cause of significant morbidity and mortality in both the
mother and fetus. Febrile illness during pregnancy, especially that associated with hemolysis, is
associated with chorioamnionitis, pyelonephritis, or viral syndrome. As such, S. typhi should be
considered when a patient presents with a fever and hemolysis. We present a case of S. typhi
complicating pregnancy.Case: A primigravida at 26 weeks gestation presented with persistent spiking temperature and
severe hemolysis. Her presenting signs and symptoms included fever, vomiting, cough, earache,
jaundice, dark urine, and anemia. After 4 units of blood, her posttransfusion hematocrit was 29%.
Hemolysis was evident on a peripheral blood smear. Total bilirubin was 2.5 mg/dl and direct
bilirubin was 1.2 mg/dl. Gentamicin and clindamycin were administered empirically. Stool, blood,
and urine cultures were obtained. Blood cultures were positive for S. typhi. Antibiotic coverage was
changed to gentamicin and ceftriaxone. She defervesced on the 5th day and had no further problems.
A healthy male infant was delivered vaginally at term.Conclusion: Typhoid fever is a serious infection, and special concern arises when S. typhi complicates
pregnancy. The diagnosis of S. typhi should be considered in a gravida presenting with fever
with prompt institution of antibiotic therapy. Appropriate cultures are essential for confirming the
diagnosis.
Randomized Prospective Study Comparing Erythromycin, Amoxicillin, and Clindamycin for theTreatment of Chlamydia trachomatis in Pregnancy
Authors: Turrentine Mark A. , Troyer Lisa , Gonik Bernard 
Published: March 2007

Objective: The purpose of this study was to compare the efficacy and side effects of erythromycin,
amoxicillin, and clindamycin in eradicating Chlamydia trachomatis from the lower genital tract of
pregnant women.Methods: A total of 174 women at <36 weeks gestation with positive cervical cultures for C.
trachomatis were enrolled. Patients were assigned in a randomized prospective fashion to either
erythromycin (500 mg q.i.d, for 7 days), amoxicillin (500 mg t.i.d, for 7 days), or clindamycin (600 mg
t.i.d, for 10 days). Six women elected not to participate and 8 patients were lost to follow‐up, leaving
53 patients in the erythromycin group, 55 patients in the amoxicillin group, and 52 patients in the
clindamycin group. All sexual partners of the enrolled women were offered doxycycline (100 mg
b.i.d. for 7 days) and patients were instructed to use barrier contraception until treatment was
complete.Results: All 3 medications were effective agents for the treatment of antenatal C. trachomatis
infection with treatment efficacies of 96%, 94%, and 98% for the erythromycin, amoxicillin, and
clindamycin groups, respectively. When the antibiotic groups were compared, no statistically significant
differences were noted in intolerance. However, the differences in the incidence of gastrointestinal
symptoms between erythromycin and amoxicillin and/or clindamycin were significant
(P < 0.05).Conclusions: These findings suggest that 1) all 3 antibiotic regimens are efficacious, 2) erythromycin
has a higher incidence of side effects, and 3) amoxicillin or clindamycin are reasonable alternatives
for the treatment of C. trachomatis in pregnant patients unable to tolerate erythromycin.
Repeated Recovery of Staphylococcus saprophyticus From the Urogenital Tracts of Women:Persistence Vs. Recurrence
Authors: Rupp M. E. , Han J. , Goering R. V. 
Published: March 2007

Objective: The purpose of this study was to determine whether colonization was persistent or
recurrent in a small group of women who had repeated recovery of Staphylococcus saprophyticus from
their urogenital tracts.Methods: Paired isolates of S. saprophyticus from each of the study subjects were genotypically
typed by plasmid fingerprinting and comparison of chromosomal‐DNA restriction fragment‐length
polymorphism patterns by field‐inversion gel electrophoresis (FIGE) and contour‐clamped homogenous
electric‐field (CHEF) electrophoresis.Results: All isolates of S. saprophyticus from the study subjects were classified as genetically
unique by each of the typing methods.Conclusions: The subjects experienced recurrent colonization with different isolates of S. saprophyticus.
These findings may have broader implications regarding the pathogenesis and recurrence
of S. saprophyticus urinary‐tract infection.
Evaluation of Two Commercially Available DNA Tests for Detection of Human Papillomavirus
Authors: Halstead Diane C. , Pfleger Sharon L. H. , Dupree William 
Published: March 2007

Objective: This study was designed to compare the sensitivity, specificity, efficiency, positive and
negative predictive values, and ease of use for 2 commercially available hybridization kits for
detecting human papillomavirus (HPV) DNA: Oncor Southern blot (SB) (Oncor, Inc., Gaithersburg,
MD) and Digene ViraType dot blot (DB) (Digene Diagnostics, Inc., Silver Spring, MD).Methods: A total of 179 specimens (172 cervical and 7 penile biopsies) were assessed for acceptability
based on the presence of epithelial cells and tested for HPV by DB and SB. The results were
evaluated based on Papanicolaou‐stained cervical specimens and selected risk factors.Results: One hundred six (97.2%) of 109 results were concordant, i.e., 93 negative (85.3%) and 13
positive (11.9%). Using SB as the gold standard, we found the sensitivity, specificity, efficiency, and
positive and negative predictive values for the ViraType DB to be 100%, 96.9%, 97.3%, 81.3%, and
100%, respectively. Comparing the Papanicolaou smear to SB and DB, we found the sensitivity,
specificity, efficiency, and positive and negative predictive values to be 33.3% (SB) vs. 44.4% (DB),
89.5% vs. 87.6%, 87.3% vs. 84.2%, 11.8% vs. 23.5%, and 97.0% vs. 94.9%, respectively. The only
significant risk factor for predicting an HPV infection was the number of sexual partners.Conclusions: Although SB has been considered the standard model, DB is an acceptable method
for detecting and identifying HPV infections.
Group B Streptococcus Meningitis Following Elective Termination of Pregnancy: Two Case Reports
Authors: Walker Mark A. , McNeeley S. Gene 
Published: March 2007

Background: Although maternal group B streptococcus (GBS) infections are common, serious
infections are rare with prompt diagnosis and treatment. We present 2 cases of GBS meningitis
occurring 3 and 10 days after elective abortion. In the first patient, GBS meningitis was definitely
related to the elective termination. In the second patient, however, no evidence for a causal relationship
could be established and can only be presumed.Case: The patients presented to the emergency department with headache, altered mental status,
and fever. Their physical examinations were consistent with meningitis and confirmed by cerebrospinal
fluid (CSF) analysis. One patient recovered completely and the other developed severe
bilateral hearing loss.Conclusion: GBS meningitis is rare, occurring in men and women. When associated with pregnancy,
most cases present within 48–72 h of delivery or abortion.
In Vitro Ability of the Group B Streptococci to Inhibit Gram‐Positive and Gram‐Variable Constituents of theBacterial Flora of the Female Genital Tract
Authors: Chaisilwattana Pongsakdi , Monif Gilles R. G. 
Published: March 2007

Objective: The purpose of this study was to analyze the ability of septicemic and nonsepticemic isolates of group B streptococci (GBS) to inhibit in vitro the principal bacterial groups found in the normal bacterial flora of the female genital tract.
Methods: The target groups were composed of 1) 10 strains each of the following: viridans
streptococci, nonhemolytic streptococci (not group B or D), group A streptococci, GBS, peptostreptococci, coagulase‐negative staphylococci, Staphylococcus aureus, and Gardnerella vaginalis; 2) 9 strains of enterococci; 3) 9 strains of group C or G streptococci; 4) 7 strains of lactobacilli; and 5) 7 strains of diphtheroids. All target groups were tested for inhibition by a test panel of either a group of 10 or 41 GBS isolates. If the GBS isolates failed to inhibit a target group, that group was tested for its ability to inhibit the GBS test panel.Results: The GBS test panel did not inhibit the growth of coagulase‐negative staphylococci or S. aureus but uniformly inhibited groups A, B, C, and G streptococci, lactobacilli, and G. vaginalis. One of the 7 strains of diphtheroids was inhibited by 37 of the 41 GBS isolates; the other 6 strains of diphtheroids were uniformly inhibited. Variable inhibition by GBS was observed with viridans streptococci, nonhemolytic (not group B or D) streptococci, peptostreptococci, and enterococci; however, inhibition or noninhibition was uniform for a given target strain against the entire GBS test panel. The 23 GBS isolates obtained from septicemic neonates or adults did not differ from the 18 nonsepticemic isolates in their ability to inhibit other species of streptococci or other gram‐positive or gram‐variable constituents of the bacterial flora of the female genital tract. When converse testing was done, all 10 GBS isolates were uniformly inhibited by coagulase‐negative staphylococci and by the majority of enterococci, but were not inhibited by S. aureus.Conclusions: These studies suggest that GBS may be significant regulators of other β‐hemolytic
streptococci, diphtheroids, lactobacilli, and G. vaginalis within the bacterial flora of the female genital tract. Moreover, the absence of GBS in the vaginal flora may be the result of mediation by coagulase‐negative staphylococci and selected strains of enterococci.
Mycobacterium chelonei Breast Abscess AssociatedWith Nipple Piercing
Authors: Pearlman Mark D. 
Published: March 2007

Background: Breast abscesses are typically seen in the setting of complicated mastitis in lactating women. Abscesses resulting from foreign bodies are not commonly seen in the breast. Over the past few decades, body piercing has become increasingly common, yet the infectious morbidity resulting from it is not well recognized. A breast abscess associated with nipple piercing is described in this report.Case: A 19‐year‐old woman developed a breast abscess approximately 10 weeks after the placement of a nipple ring. Multiple drainage procedures were performed before the infection was controlled. The cultures grew Mycobacterium chelonei, an organism not commonly causing soft‐tissue infection.Conclusion: Body piercing may be associated with significant infections. The use of sterile equipment and techniques should be used to prevent these uncommon infections.
Randomized, Double‐blinded, Placebo‐controlled Trial of Amoxicillin/Clavulanic Acid to Prevent PretermDelivery in Twin Gestation
Authors: Peters Mark T. , Brown Charles E. L. , Baum Audrey , Risser Rick 
Published: March 2007

Objective: The objective of this study was to determine whether prophylactic treatment with oral broad‐spectrum antimicrobial therapy improves pregnancy outcomes in twin gestations.Methods: Patients with twin gestations between 24 and 32 weeks were randomized to receive amoxicillin/clavulanic acid or placebo. Those patients randomized before 24 weeks received a 1‐week course at 24 and at 28 weeks gestation. Those patients entered later than 24 weeks received a 1‐week course either at 28 weeks or at enrollment (up to 32 weeks). Other than antibiotic use, the management of the groups was identical and unchanged from the routine care of twin gestations.Results: Of 149 twin pregnancies enrolled, 76 were randomized to the drug group and 73 to the placebo group. There was no significant difference in mean gestational age at delivery (35.9 vs. 35.7 weeks), birth weight (2,358 vs. 2,344 g), mean neonatal nursery stay (9.9 vs. 11.7 days), or respiratory distress syndrome (6/76 vs. 4/73) in the drug vs. placebo group, respectively.Conclusions: The addition of prophylactic oral broad‐spectrum antimicrobial therapy to the standard antepartum management of twin gestations had no demonstrable effect on the gestational age at delivery, birth weight, or neonatal complications. There did not appear to be any beneficial effect of the prophylactic use of amoxicillin/clavulanic acid in this clinical setting.
Cytomegalovirus Hepatitis During Pregnancy
Authors: Chan Ying , Kean-Chong Maria , Gonzalez David , Apuzzio Joseph 
Published: March 2007

Background: Although cytomegalovirus (CMV) is an uncommon cause of viral hepatitis during pregnancy, a definitive diagnosis is important because of the potential for congenital CMV. In the case reported here, a diagnosis of hepatitis caused by CMV was made after the more common viral pathogens had been ruled out.Case: A 17‐year‐old, 12‐week pregnant patient was evaluated for fever and right upper quadrant tenderness. A serologic evaluation revealed elevated liver function levels and a positive maternal serology for CMV IgM. A diagnosis of hepatitis caused by CMV was made after the more common viral pathogens and drug‐induced hepatitis had been ruled out. She was counseled about the potential effects of CMV on her fetus.Conclusion: A step‐wise approach to the diagnosis of viral hepatitis during pregnancy is needed to determine the etiology because a potential teratogenic virus may be involved.
Erythema Nodosum Associated With Streptococcal Infection in Pregnancy
Authors: Richards W. Edward , Reedy Mark B. , Huddleston Kevin P. , Jundt Jeffrey W. 
Published: March 2007

Background: Erythema nodosum (EN) is a condition characterized by the presence of painful erythematous nodules on the pretibial aspects of the lower extremities. EN is thought to be a local inflammatory, immune‐mediated reaction to a number of systemic antigenic stimuli. This condition is noted most often in women between menarche and menopause and is associated with certain drugs, infections, and pregnancy. However, no reports in the literature describe EN as a result of streptococcal infection during pregnancy.Case: A 21‐year‐old, white woman, G3P0020, presented at 13 weeks gestation with a 2‐week history of erythematous, tender lesions on the pretibial aspects of both legs consistent with EN. The patient reported having had a “flu‐like” illness at the same time the lesions developed. The “flu” symptoms resolved within 10 days without medical intervention, but the lesions on her legs persisted. An initial antistreptolysin‐O (ASO) titer was elevated at 960 Todd units (normal values: preschool and adults <85; school‐age and young adults <170). Six days later, she presented to the emergency department with complaints consistent with a urinary‐tract infection. She was empirically treated with a 10‐day course of amoxicillin, 500 mg t.i.d. Although the patient was treated with amoxicillin for a presumed urinary‐tract infection (which was culture‐negative), the lesions resolved after her completion of the antibiotics. Twelve weeks later, a repeat ASO was within normal limits. The EN lesions did not recur.Conclusion: Although many etiologic factors are identified as causes of EN, the condition is usually self‐limiting, requiring only minimal supportive measures until it resolves. A careful history should be obtained and a physical examination performed to exclude other causes. If a recent streptococcal infection is identified or presumed, a 10‐ to 14‐day course of antibiotics is warranted.
CMV Oophoritis in an AIDS Patient
Authors: Albert Michael S. , Amstey Marvin S. 
Published: March 2007

Background: Disseminated cytomegalovirus (CMV) infection is relatively uncommon, occurring primarily in immunocompromised hosts and neonates. Patients with acquired immunodeficiency syndrome (AIDS) are the most common hosts, with symptoms secondary to lung and eye involvement. There have been no reports of symptomatic CMV infection of the pelvis in women.Case report: This case is the first described of acute symptomatic CMV infection of the genital tract in a woman with AIDS. Her presenting symptoms were the result of acute CMV oophoritis. In addition, CMV was found in the endometrium and endosalpinx (an infected structure heretofore unreported).Conclusion: The increasing prevalence and incidence of AIDS in women should make us aware of the possibility of opportunistic, symptomatic CMV pelvic infection.
Cervical Antibodies to Herpes Simplex Virus Proteins in Pregnancy and Puerperium: A Pilot Study
Authors: Watts D. Heather , Guise Jeanne-Marie , Brown Zane , Corey Lawrence , Ashley Rhoda L. 
Published: March 2007

Objective: This study was undertaken to evaluate the changes in total and anti‐herpes simplex virus
(HSV)‐specific cervical IgA and IgG antibody profiles during and after pregnancy.Methods: Serum and cervical secretions were obtained from pregnant patients before 20 weeks
gestation, at 34–36 weeks gestation, and at 6 weeks postpartum and tested for total IgA and IgG
antibody and for IgA and IgG to HSV proteins by Western blot.Results: Seven women were HSV seronegative, 14 HSV‐1 seropositive, and 14 HSV‐2 ± HSV‐1
seropositive. Minimal changes in the serum anti‐HSV profiles were seen over the 3 visits. The
total cervical IgA, IgG, and protein levels did not change between the 2 pregnancy visits but tended
to increase at the postpartum visit. No consistent change in cervical HSV‐specific IgA and IgG
was seen during pregnancy, but the levels increased markedly at the postpartum visit.Conclusions: Lower cervical anti‐HSV antibody levels may be related to the previously reported
increased frequency of a reactivation of HSV during late pregnancy. Further evaluation is necessary
to confirm and quantify the changes in genital immunity during pregnancy and to evaluate whether
the increased levels at the postpartum visit are sustained.
Preincubation of Cervical Swabs in Lim Broth Improves Performance of ICON Rapid Test for Detection of Group B Streptococci
Authors: Altaie Sousan Sayahtaheri , Bridges James , Loghmanee Darius , Lele Amol , Kahn Kenneth R. 
Published: March 2007

Objective: The purpose of this study was to determine whether an enrichment method would improve
the performance of an enzyme imunoassay test, the ICON Strep B, for detection of group B
streptococci (GBS) in vaginoperineal swabs.Methods: The study was done in 3 phases. First, in 250 maternity patients, 2 swabs per patient
were tested simultaneously by an overnight selective broth culture method (Lim broth) and the
ICON assay. Forty‐five (18%) specimens were positive for GBS by culture. The ICON assay
detected only 2 (4%) of the positives. Second, in 391 maternity patients, a single swab was cultured
as above. However, during the overnight incubation of the Lim broth, 0.5 ml aliquots were removed
and tested by ICON assay at 4, 6, 8, 10, and 12 h post‐incubation. Seventy‐two specimens (18%)
were positive by culture. The ICON assay detected 20% of the positives at 4 h, 46% at 6 h, 70%
at 8 h, 94% at 10 h, and 100% at 12 h post‐incubation. Third, 97 high‐risk patients with the diagnosis
of preterm labor (PTL)/or preterm premature rupture of the membranes (PPROM) were sampled.
Three specimens per patient were obtained: a single swab that was cultured as before and 2 double
swabs, of which 1 was tested directly using the ICON test and the other was placed directly in
Lim broth and incubated overnight. The aliquots of broth were tested by the ICON assay at 2, 4,
6, and 8 h post‐incubation. Twenty‐four specimens were positive by culture.Results: The direct ICON test detected only 4 (17%) of the positives. The ICON assay performed
on the enriched samples detected 4% of the positives at 2 h, 21% at 4 h, 58% at 6 h, and 100% at
8 h post‐incubation.Conclusions: These data indicate that the ICON assay may be used with 100% sensitivity and
specificity to detect GBS‐colonized high‐risk mothers within 8 h if the initial sample size is doubled
and the enrichment broth is used in the performance of the ICON assay.
Trichomoniasis as Seen in a Chronic Vaginitis Clinic
Authors: Dan Michael , Sobel Jack D. 
Published: March 2007

Objective: We sought to determine the clinical and laboratory features of trichomonas vaginitis (TV) in a
chronic vaginitis clinic.Methods: We studied 45 women with symptomatic TV attending a specialty chronic vaginitis clinic.
These patients were older than the usual symptomatic patients with TV. They frequently described unusual
chronicity of symptoms, half being referred because of clinical resistance and the other half referred because
of chronic vaginitis of unknown etiology.Results: In spite of the chronicity of infection, the signs and symptoms of florid inflammation were still
evident and high numbers of polymorphonuclear leukocytes and parasitic load were present.Conclusions: A longstanding infection, especially if previously untreated, invariably responded to
conventional nitroimidazole therapy. In addition, the majority of patients seen with clinical resistance
to the conventional doses of metronidazole responded to high‐dose oral metronidazole therapy. Unsuspected
TV should always be considered in low‐risk patients with chronic vulvovaginal symptoms.
Treatment of Recurrent Eczema Herpeticum in Pregnancy With Acyclovir
Authors: Latta Richard A. , Baker David A. 
Published: March 2007

Background:Eczema herpeticum is an uncommon manifestation of an infection with herpes simplex virus (HSV). The disease is primarily seen in patients with histories of atopic eczema. Eczema herpeticum may be a life-threatening illness, but the mortality is felt to be <10% with modern antiviral and antibacterial agents. The use of acyclovir for other viral infections secondary to herpesvirus in pregnancy has been well documented. The authors now present a case report of eczema herpeticum treated with acyclovir during pregnancy.Case:A patient with a history of eczema herpeticum presented in pregnancy with a recurrence. She was successfully treated with intravenous (IV) acyclovir with good maternal and fetal outcome.Conclusion:Acyclovir may be utilized in pregnancy for several manifestations of HSV including eczema herpeticum.
Significance of Genital Mycoplasmas in Pelvic Inflammatory Disease: Innocent Bystander!
Authors: Chatwani Ashwin , Harmanli Ozgur H. , Nyirjesy Paul , Reece E. Albert 
Published: March 2007

Objective: Our objective was to determine the role of Mycoplasma hominis
and Ureaplasma urealyticum in pelvic inflammatory disease (PID).Methods: The clinical and microbiologic variables in 114 patients with a clinical diagnosis of PID
were compared prospectively according to the isolation of M. hominis and U. urealyticum from their
endometrial cavities.Results: The groups were epidemiologically well matched. Clinical parameters such as temperature,
leukocyte count, erythrocyte count, and C‐reactive protein on admission and length of hospital
stay were similar in the patients, regardless of their mycoplasma status. A significant percentage of
the patients either continued or started to harbor genital mycoplasmas after the resolution of PID
without any significant clinical sequelae.Conclusions: The presence of genital mycoplasmas does not change the clinical presentation and
course of PID. Both M. hominis and U. urealyticum can persist or colonize the endometrium after
complete recovery from PID. Therefore, the genital mycoplasmas do not seem to have a dominant
pathogenic role in PID.