Clinical Microbiological Tests Research Articles

Association of cervicovaginal infections with increased vaginal fluid phospholipase A2 activity

OBJECTIVE: The purpose of this study was to determine if phospholipase A2 was detectable within vaginal fluid and to correlate its presence with the presence of common lower genital tract infection or microbial conditions.STUDY DESIGN: Pregnant women were examined at the first prenatal visit with standard clinical evaluations and microbiologic cultures or tests. Vaginal fluid samples were evaluated for phospholipase A2 activity by means of a standardized enzyme fluorometric assay. Data were stratified to control for coexisting infections.RESULTS: Phospholipase A2 activity was detected among 29.8% of women and was independently associated with the presence of bacterial vaginosis (p < 0.001), Trichomonas. vaginalis (p < 0.04), and Chlamydia trachomatis (p < 0.02). The percentage of women with phospholipase A2 activity and the level of activity was increased in the presence of more than one infection.CONCLUSIONS: Elevated reproductive tract phospholipase A2 concentrations among pregnant women may play roles in the pathogenesis of preterm labor and birth. Identification of pregnant women with increased concentrations in vaginal fluid may allow for development of effective intervention strategies to reduce the risk of preterm birth. (AM J OBSTET GYNECOL 1992;167:1588-94.)

Current and Experimental Methods of Rapid Microbial Identification

Current techniques in the clinical microbiology laboratory, such as radioimmuno-assays (RIA) and enzyme linked immunosorbent assays (ELISA), are examined critically. A conceptually different, still experimental technique, which we believe may alter clinical microbiology testing substantially, is discussed.

Early Clinical Differentiation Between Legionnaires' Disease and Other Sporadic Pneumonias

Early diagnosis of Legionnaires' disease is difficult because other pathogens cause a similar clinical picture and microbiologic tests are usually only of retrospective value. Since May 1977, 17 patients with sporadic cases of Legionnaires' disease have been admitted, all previously well, the diagnosis being made with standard serologic or bacteriologic criteria. From the clinical, laboratory, and radiologic findings, we propose criteria that may enable the clinician to make a diagnosis earlier in many cases, differentiating them from other pneumonias. Within 24 hours of admission, any three of the following four features are strongly suggestive of Legionnaires' disease: [1] prodromal "viral" illness, [2] dry cough or confusion or diarrhoea, [3] lymphopenia without marked neutrophilia, [4] hyponatremia. Two thirds of cases had at least three of these features, and no false-positive diagnoses would have been made in other pneumonias that were serologically negative for Legionnaires' disease if these proposed criteria had been applied diagnostically. In the next few days the diagnosis is very likely if microbiologic tests are negative and if there is radiologic extension, abnormal liver function test results, or hypoalbuminemia.

Origins of penile ulcerations.

Genital ulcerations have diverse origins; therefore the definitive diagnosis requires a combination of clinical skill and appropriate microbiologic and serologic tests. A small percentage of penile ulcers are due to fixed drug reactions, aphthous ulcers, malignancies, scabies, candidiasis, and primary cutaneous gonococcal infections. An estimated 10%-15% of penile ulcers are of traumatic origin and at least one-half of these are complicated by infection with pyogenic bacteria. Most penile ulcerations are produced by recognized genital pathogens. The prevalence of specific pathogens varies by population and geographic location, but evidence suggests that in many areas herpes simplex virus accounts for over one-half of all penile ulcers. Treponema pallidum is a frequent cause of penile ulcers in certain populations and chancroid is a common clinical diagnosis, particularly in the Far East. However, the failure to confirm the presence of Haemophilus ducreyi by culture and the failure to exclude other pathoge...