Infecciones por Chlamydia trachomatis en una unidad de cuidados intensivos neonatales / Chlamydia trachomatis infections in a neonatal intensive care unit

Las infecciones por Chlamydia trachomatis han aumentado su prevalencia, especialmente en jóvenes embarazadas. Esto adquiere relevancia en pediatría por el elevado riesgo de transmisión vertical al neonato y su potencial gravedad en el lactante. Estas infecciones requieren de un alto índice de sospecha, por cuadro clínico atípico y signos radiológicos inespecíficos. Los métodos diagnósticos convencionales presentan limitaciones para su detección. Las técnicas moleculares son las recomendadas por su elevada sensibilidad, especificidad y rapidez, lo cual permite una terapéutica adecuada y oportuna. En este estudio, desarrollado en una unidad de cuidados intensivos neonatales de un hospital de alta complejidad durante 12 años, se describieron las características de la población, su presentación clínica y evolución. La detección microbiológica se realizó por métodos moleculares. Se incluyeron 29 pacientes (p) con infección por C. trachomatis (3,9% del total de muestras enviadas),13 p con infección respiratoria y 16 p con compromiso ocular. La mediana de edad fue de 19 días al momento del diagnóstico y el 65% de las gestantes tenía <25 años. Veinticuatro p (83%) eran recién nacidos a término y 23 p (79%) previamente sanos. Nueve p (31%) presentaron fiebre al momento del ingreso y 12 (41%) eosinofilia. De los 13 p con enfermedad respiratoria, 9 (69%) consultaron por tos y 11 (85%) con hipoxemia, con requerimientos de oxígeno en 8 (61%), asistencia respiratoria mecánica en 3 (23%) y uno (16%) requirió ECMO. Los hallazgos radiológicos mostraron un patrón intersticial inespecífico. Nueve p (31%) presentaron coinfección y uno falleció asociado a influenza A (AU)

The prevalence of Chlamydia trachomatis infections has increased, especially among young pregnant women. This is of particular relevance in pediatrics due to the high risk of motherto-child transmission and the potential severity of the infection in infants. A high index of suspicion is required for these infections due to the atypical clinical features and non-specific radiological signs. The usefulness of conventional diagnostic methods is limited. Molecular techniques are recommended because of their high sensitivity, specificity, and speed, allowing for adequate and timely treatment. In this 12-year study conducted in a neonatal intensive care unit of a tertiary-care hospital, patient characteristics, clinical presentation, and outcome are described. Microbiological detection was performed using molecular methods. Twenty-nine patients with C. trachomatis infection (3.9% of the total samples submitted), of whom 13 had respiratory tract infection and 16 ocular involvement, were included. The median age at diagnosis was 19 days and 65% of the mothers were <25 years old. Twenty-four p (83%) were term newborns and 23 patients (79%) were previously healthy. On admission, 9 patients (31%) had fever and 12 (41%) had eosinophilia. Of the 13 patients with respiratory tract involvement, 9 (69%) consulted for cough and 11 (85%) had hypoxemia, requiring oxygen in 8 (61%), mechanical ventilation in 3 (23%), and ECMO in 1 (16%). Radiological findings showed a nonspecific interstitial pattern. Nine patients (31%) presented with coinfection, one of whom died due to an associated influenza A infection (AU)

Actualización de la infección por Chlamydia trachomatis en mujeres / Update of Chlamydia trachomatis infection in women

La infección por Chlamydia trachomatis es la infección de transmisión sexual bacteriana más frecuente en el mundo. En este artículo se revisa la prevalencia reportada en Chile, cuadro clínico, diagnóstico, tratamiento, prevención y complicaciones a largo plazo en mujeres.

Chlamydia trachomatis infection is known to be the most common sexually transmitted bacterial infection world-wide. This article reviews the prevalence reported in the Chilean population, as well as the clinical manifestations, diagnosis, treatment, prevention and complications in women

Incidência de Chlamydia trachomatis em gestantes diagnosticadas com sífilis / Chlamydia trachomatis incidence on syphilis diagnosed pregnant women

De acordo com a Organização Mundial da Saúde, a cada ano, mais de 376 milhões de pessoas são infectadas pelas doenças sexualmente transmissíveis, das quais 127,2 milhões são por Chlamydia trachomatis. As infecções genitais não tratadas na gestação, principalmente as assintomáticas, podem acarretar complicações, tais como: endometrite puerperal e síndrome de Fitz-Hugh-Curtis. A pesquisa científica foi realizada com o objetivo de identificar a presença de Chlamydia trachomatis na secreção endocervical de gestantes sifilíticas, estabelecendo o perfil das gestantes a partir de informações dos possíveis sinais e sintomas durante a gravidez e hábitos gestacionais. Adotou-se como caminho metodológico a pesquisa quantitativa, descritiva, bibliográfica e laboratorial. Como resultados finais, 54% das gestantes foram diagnosticadas com Chlamydia trachomatis e 67% eram assintomáticas. Correlacionamos também que as altas taxas de infecção estão associadas com a falta de conhecimento sobre infecções sexualmente transmissíveis e suas formas de prevenção.(AU)

According to the World Health Organization, each year, more than 376 million people are infected with sexually transmitted diseases, of which 127.2 million are Chlamydia trachomatis, it is a asymptomatic disease, meaning there are no symptoms. Genital infections can lead to complications such as: puerperal endometritis and Fitz-Hugh- -Curtis syndrome. The scientific research was carried out to identify the presence of Chlamydia trachomatis in the endocervical secretion of syphilitic pregnant women. This research established a profile of pregnant women infected with Chlamydia trachomatis using information about possible signs and symptoms during pregnancy and gestational habits. It provides a methodological way to quantify and describe the laboratory research. The results showed, 54% of the pregnant women were diagnosed with Chlamydia trachomatis of which 67% were asymptomatic. We also correlate that high rates of Chlamydia trachomatis infection are associated with lack of knowledge about sexually transmitted infections and their forms of prevention.(AU)

Ascitis secundaria a chlamydia trachomatis tras procedimiento de reproducción asistida / Ascites secondary to chlamydia trachomatis after assisted reproduction procedure

El desarrollo de ascitis moderada o severa es infrecuente tras una enfermedad inflamatoria pélvica por Chlamydia trachomatis, una de las principales causas de infección de transmisión sexual a nivel mundial. Caso clínico: Paciente de 29 años que tras aborto diferido (gestación tras inseminación artificial) que inicia a las seis semanas con cuadro de dolor abdominal inespecífico y ascitis de predominio linfocitario. El diagnostico se realizo mediante PCR (Werfen®) tanto el liquido ascítico como en exudado endocervical. La paciente recibió tratamiento antibiótico con doxiciclina. Conclusión: Las enfermedades de transmisión sexual deben ser consideradas cuando se realiza un diagnóstico diferencial de una mujer sexualmente activa con dolor abdominal y ascitis, instaurar tratamiento antibiótico y evitar pruebas e intervenciones quirúrgicas innecesarias.

The development of moderate or severe ascites is infrequent after a pelvic inflammatory disease from Chlamydia trachomatis, one of the main causes of sexually transmitted infection worldwide. Clinical case: A 29-year-old patient who, after a delayed abortion (gestation after artificial insemination), started at six weeks with symptoms of non-specific abdominal pain and predominantly lymphocytic ascites. The diagnosis is made by PCR (Werfen®) both the ascitic fluid and the endocervical exudate. The patient received antibiotic treatment with doxycycline. Conclusion: Sexually transmitted diseases should be considered when making a differential diagnosis of a sexually activated woman with abdominal pain and ascites. Establishing antibiotic treatment, and avoiding unnecessary tests and surgical treatments.

Daños y consecuencias de Chlamydia trachomatis en mujeres infértiles / Damage and Consequences of Chlamydia Trachomatis in Infertile Women

Introducción: La infertilidad ha aumentado a nivel mundial como consecuencia del incremento de las infecciones de transmisión sexual y la enfermedad inflamatoria pélvica producidas fundamentalmente por Chlamydia trachomatis. Objetivo: Describir la relación existente entre la Chlamydia trachomatis y sus daños y consecuencias en mujeres infértiles. Métodos: Se estudiaron 552 mujeres, con diagnóstico de infertilidad y se selecciona una muestra de 175, con diagnóstico de infección por Chlamydia trachomatis. Resultados: Las mujeres en el estudio tenían una escolaridad media superior. La mayoría de las mujeres a pesar de padecer una infección por Chlamydia trachomatis no presentaron daño a órganos reproductores; y en las que sí, predominó la obstrucción tubaria bilateral. En los casos en que se diagnosticó daño al cuello uterino predominó la cervicitis. Conclusiones: La mayoría de las mujeres infértiles con infección por Chlamydia trachomatis eran adultas jóvenes con nivel escolar medio superior, con una infertilidad secundaria y sin daños estructurales en las trompas de Falopio y el cérvix uterino. Existe relación entre la Chlamydia trachomatis y la afección a las trompas de Falopio y el cérvix uterino(AU)

Introduction: Infertility has increased worldwide because of the increase in sexually transmitted infections and pelvic inflammatory disease caused mainly by Chlamydia trachomatis. Objective: To describe the relationship between Chlamydia trachomatis and its damages and consequences in infertile women. Methods: We studied 552 women with a diagnosis of infertility and we selected a sample of 175, with diagnosis of Chlamydia trachomatis infection. Results: The women in the study had high school level. Most of them did not have reproductive organ damage despite suffering from Chlamydia trachomatis infection. However, those who did not have this damage had bilateral tubal obstruction. Cervicitis predominated in those cases in which damage to the cervix was diagnosed. Conclusions: Most of the infertile women with Chlamydia trachomatis infection were young adults with a high school level, suffering secondary infertility and with no structural damage to the fallopian tubes and uterine cervix. There is a relationship between Chlamydia trachomatis and the affection to the fallopian tubes and uterine cervix(AU)

Effectiveness of syndromic management for male patients with urethral discharge symptoms in Amazonas, Brazil

Abstract: Background: Urethral discharge syndrome (UDS) is characterized by the presence of purulent or mucopurulent urethral discharge.The main etiological agents of this syndrome are Neisseria gonorrhoeae and Chlamydia trachomatis. Objectives: To evaluate the effectiveness of the syndromic management to resolve symptoms in male urethral discharge syndrome cases in Manaus, Amazonas, Brazil. Methods: Retrospective cohort of male cases of urethral discharge syndrome observed at a clinic for sexually transmitted disease (STD) in 2013. Epidemiological and clinical data, as well as the results of urethral swabs, bacterioscopy, hybrid capture for C.trachomatis, wet-mount examination, and culture for N.gonorrhoeae, were obtained through medical chart reviews. Results: Of the 800 urethral discharge syndrome cases observed at the STD clinic, 785 (98.1%) presented only urethral discharge syndrome, 633 (79.1%) returned for follow-up, 579 (91.5%) were considered clinically cured on the first visit, 41(6.5 %) were considered cured on the second visit, and 13(2.0%) did not reach clinical cure after two appointments. Regarding the etiological diagnosis, 42.7% of the patients presented a microbiological diagnosis of N.gonorrhoeae, 39.3% of non-gonococcal and non-chlamydia urethritis, 10.7% of C.trachomatis and 7.3% of co-infection with chlamydia and gonococcus. The odds of being considered cured in the first visit were greater in those who were unmarried, with greater schooling, and with an etiological diagnosis of gonorrhea. The diagnosis of non-gonococcal urethritis reduced the chance of cure in the first visit. Study limitation: A study conducted at a single center of STD treatment. Conclusion: Syndromic management of male urethral discharge syndrome performed in accordance with the Brazilian Ministry of Health STD guidelines was effective in resolving symptoms in the studied population. More studies with microbiological outcomes are needed to ensure the maintenance of the syndromic management.

Association of human papillomavirus and Chlamydia trachomatis with intraepithelial alterations in cervix samples

The influence of different infectious agents and their association with human papillomavirus (HPV) in cervical carcinogenesis have not been completely elucidated. This study describes the association between cytological changes in cervical epithelium and the detection of the most relevant aetiological agents of sexually transmitted diseases. Samples collected from 169 patients were evaluated by conventional cytology followed by molecular analysis to detect HPV DNA, Chlamydia trachomatis, herpes simplex virus 1 and 2,Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, andTreponema pallidum, besides genotyping for most common high-risk HPV. An association between cytological lesions and different behavioural habits such as smoking and sedentariness was observed. Intraepithelial lesions were also associated with HPV and C. trachomatis detection. An association was also found between both simple and multiple genotype infection and cytological changes. The investigation of HPV and C. trachomatisproved its importance and may be considered in the future for including in screening programs, since these factors are linked to the early diagnosis of patients with precursor lesions of cervical cancer.

Infecção por Chlamydia trachomatis e Neisseria gonorrhoeae: fatores associados à infertilidade em mulheres atendidas em um serviço público de reprodução humana / Chlamydia trachomatis and Neisseria gonorrhoeae infection: factors associated with infertility in women treated at a human reproduction public service

OBJETIVO: Avaliar a prevalência de infecção por Chlamydia trachomatis e Neisseria gonorrhoeae em mulheres submetidas à reprodução assistida em um serviço público de referência da região Centro-Oeste do Brasil. MÉTODOS: Estudo transversal com 340 mulheres com idade entre 20 e 47 anos, histórico de infertilidade, submetidas às técnicas de reprodução assistida. Foram analisadas as infecções por Chlamydia trachomatis e Neisseria gonorrhoeae detectadas em amostras de urina pela técnica de PCR e o perfil da infertilidade. Utilizou-se o teste do χ2 ou o teste exato de Fisher para avaliar a associação entre a infecção e as variáveis. RESULTADOS: Observou-se prevalência de 10,9% das mulheres com infecção por Chlamydia trachomatis, sendo que houve coinfecção por Neisseria gonorrhoeae em 2 casos. Mulheres infectadas por Chlamydia trachomatis apresentaram mais de 10 anos de infertilidade (54,1%; p<0,0001). O fator tubário foi a principal causa nos casos com infecção (56,8%; p=0,047). A obstrução tubária foi encontrada em 67,6% dos casos com infecção positiva (p=0,004). CONCLUSÃO: Houve associação da obstrução tubária com a infecção por Chlamydia trachomatis e Neisseria gonorrhoeae, reforçando a necessidade de estratégias efetivas para detecção precoce das doenças sexualmente transmissíveis, principalmente em mulheres assintomáticas em idade fértil. .

PURPOSE: To evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in women undergoing assisted reproduction in a public reference service in the midwestern region of Brazil. METHODS: A cross-sectional study was conducted on 340 women aged from 20 to 47 years with a history of infertility, undergoing assisted reproduction techniques. Infections with Chlamydia trachomatis and Neisseria gonorrhoeae identified in urine specimens by PCR, and the profile of infertility were analyzed. We used the χ2 test or Fisher's exact test to evaluate the association between infection and variables. RESULTS: The prevalence of Chlamydia trachomatis infection was 10.9%, and Neisseria gonorrhoeae co-infection was observed in 2 cases. Women infected with Chlamydia trachomatis had more than 10 years of infertility (54.1%; p<0.0001). The tubal factor was the main cause in infected cases (56.8%; p=0.047). Tubal occlusion was found in 67.6% of cases with positive infection (p=0.004). CONCLUSION: There was an association of tubal obstruction with infection by Chlamydia trachomatis and Neisseria gonorrhoeae, reinforcing the need for effective strategies for an early detection of sexually transmitted diseases, especially in asymptomatic women of childbearing age. .

Prevalência de infecção por Chlamydia trachomatis em mulheres candidatas à fertilização in vitro em serviço público de referência do Estado de São Paulo / Prevalence of Chlamydia trachomatis infection among women candidates for in vitro fertilization at a public institution of the State of São Paulo, Brazil

OBJETIVO: Avaliar a prevalência de infecção por Chlamydia trachomatis (CT) e Neisseria gonorrhoeae (NG) em mulheres candidatas ao tratamento tópico e de fertilização in vitro (FIV) em serviço público de referência da Região Sudeste do Brasil. MÉTODOS: Mulheres que tiveram indicação de FIV, no período de 1º de abril de 2008 a 31 de outubro de 2009, foram admitidas sequencialmente no estudo. Foi aplicado um questionário sobre antecedentes ginecológicos e obstétricos e coletada amostra de swab endocervical para pesquisa de CT e NG através de captura híbrida e PCR. As variáveis estudadas foram: faixa etária, cor, escolaridade, tempo de infertilidade, número de gestações e filhos vivos, antecedentes de aborto, gestação ectópica, número de parceiros, Doença Inflamatória Pélvica (DIP), cirurgia pélvica, manipulação de cavidade uterina, tabagismo e uso de drogas ilícitas. As mulheres foram distribuídas segundo presença ou não de infecção por clamídia e a análise foi descritiva. RESULTADOS: Entre as 176 mulheres estudadas a prevalência de infecção por CT foi de 1,1%, não houve infecção por NG. Dois terços das mulheres tinham idade >30 anos, escolaridade >8 anos, <5 anos de infertilidade e 56,2% não tinham filhos. Os principais antecedentes foram cirurgia pélvica (77,8%), manipulação de cavidade uterina (62,5%) e DIP (27,8%). O fator tubário foi o mais prevalente, em 129 mulheres (73,3%), 37,5% com e 35,8% sem laqueadura, os demais fatores tiveram prevalência <30%. CONCLUSÕES: As infecções por CT e NG tiveram baixa prevalência na amostra estudada e são necessários estudos em outros centros do país para confirmar a prevalência de infecções nesse grupo particular de mulheres inférteis.

PURPOSE: To evaluate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among women candidates to in vitro fertilization (IVF) in a reference public service in southeastern Brazil. METHODS: Women who were referred for IVF from April 1st, 2008 to December 31st, 2009 were enrolled sequentially in the study. A ginecological-obstetrical background questionnaire was applied and endocervical swab samples were obtained to search for CT and NG using hybrid capture and PCR. The variables studied were: age, color, education, duration of infertility, number of pregnancies and living children, history of miscarriage, ectopic pregnancy, number of sex partners, pelvic inflammatory disease (PID), pelvic surgery, manipulation of the uterine cavity, smoking, and illicit drug use. The women were distributed according to the presence/absence of confirmed chlamydia infection and descriptive analysis was employed. RESULTS: Among 176 women tested the prevalence of CT infection was 1.1% and there was no NG infection. Two thirds of the women were >30 years old, with schooling >8 years and <5 years of infertility, and 56.2% had no children. The main background data were pelvic surgery (77.8%), manipulation of the uterine cavity (62.5%) and PID (27.8%). The tubal factor was the most prevalent, 73.3% of women (from 129), 37.5% had been sterilized, 35.8% had not been sterilized, and other factors had a prevalence <30%. CONCLUSIONS: CT and NG infections had a low prevalence in this sample. Studies at other centers in the country are needed to confirm the prevalence of infection in this particular group of infertile women.

Infecção por Chlamydia trachomatis e anticorpos contra proteína de choque térmico 60 (HPS60) associados a fator de infertilidade tubária / Chlamydia trachomatis and antibodies against heat shock protein 60 (HPS60) associated with tubal factor infertility

Chlamydia trachomatis é uma bactéria transmitida sexualmente e uma frequente causa de doença inflamatória pélvica (DIP) que, com sua evolução, pode levar à gravidez ectópica ou a fator de infertilidade túbaria (TFI). Hipóteses sugerem que reações imunes à proteína de choque térmico 60 (HPS60) de Chlamydia trachomatis induz à DIP e à consequente infertilidade. A revisão sistemática foi conduzida utilizando artigos científicos das bases de dados MEDLINE, PubMed e Scopus, com estudos que associavam o aumento do TFI à presença de anticorpos contra HPS60 em mulheres portadoras da bactéria. Foram incluídos 12 estudos. As evidências de 11 estudos caso-controle sugerem a confirmação da associação do TFI com maior produção de anticorpos contra HPS60 de Chlamydia trachomatis. Inversamente ao resultado, foi encontrado um estudo do tipo ensaio clínico controlado randomizado em que os anticorpos contra HPS60 da Chlamydia não foram significamente associados a sequelas por doença inflamatória pélvica. Nossos achados confirmam uma associação entre TFI e anticorpos para HSP60 da Chlamydia trachomatis, mas enfatizamos a necessidade de mais estudos com ensaio clínico controlado e randomizado.

Chlamydia trachomatis is a sexually transmitted bacteria and a common cause of pelvic inflammatory disease (PID); its evolution can lead to ectopic pregnancy or tubal infertility factor (TFI). Hypotheses suggest that immune reactions to heat shock protein 60 (HPS60) of Chlamydia trachomatis induces DIP and, thus, infertility. A systematic review was conducted of scientific articles using MEDLINE, PubMed and Scopus, with studies that linked the increase in the TFI HPS60 presence of antibodies in women with the bacterium. We included 12 studies. Evidence from 11 case-control studies suggest confirmation of the TFI association with increased production of antibodies against HPS60 Chlamydia trachomatis. In contrast to the result, we found a type study randomized controlled trial in which the antibodies of Chlamydia HPS60 were not significantly associated with sequelae of pelvic inflammatory disease. Our findings confirm an association between TFI and antibodies to HSP60 of Chlamydia trachomatis, but emphasize the need for more studies with randomized controlled trial.

Chlamydia trachomatis and human papillomavirus coinfection: association with p16INK4a and Ki67 expression in biopsies of patients with pre-neoplastic and neoplastic lesions

The objective of this study was to identify the frequency of coinfection by human papillomavirus (HPV) and Chlamydia trachomatis (CT) in cervical lesions and relate it with immunohistochemical expression of p16INK4a and Ki67, both oncogenicity markers. A cross-sectional study with 86 women from primary care units in southern Brazil was conducted. Cervical swabs were collected for HPV-DNA and CT-DNA detection, through the polymerase chain reaction technique (PCR). The immunohistochemical analysis was performed on biopsy cervical tissue material to identify the expression of p16INK4a and Ki67 cell cycle markers. About 83 percent were positive for HPV-DNA and 19 percent had coinfection with CT-DNA. Among coinfected women, 56 percent expressed p16INK4a. There was a statistically significant association between the histological grade of the lesion and Ki67 expression. All high-grade lesions, 50 percent of low-grade lesions and 31 percent of negative biopsies expressed Ki67 (p = 0.004). A total of 37 percent of coinfected women expressed both markers. In conclusion, although more than half of the coinfected patients have expressed p16INK4a and more than one third have expressed both markers, these results suggest no association between those variables. However, other studies involving larger samples are necessary to corroborate such findings.

A Case of Chlamydia trachomatis Peritonitis Mimicking Tuberculous Peritonitis / 대한소화기학회지

Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination.

Estudio de Chlamydia trachomatis, Ureaplasma urealyticum y Mycoplasma hominis en pacientes infértiles y abortadoras habituales / Study on Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma homonis in infertile patients and with usual abortions

Algunos microorganismos como Chlamydia trachomatis, Ureaplasma urealyticum y Mycoplasma hominis han sido relacionados con diferentes procesos patológicos en mujeres sexualmente activas. OBJETIVO: Para conocer la frecuencia de estos agentes se realizó un estudio descriptivo observacional en el Hospital Ginecoobstétrico Ramón González Coro, en el período de noviembre de 2008 a enero de 2009. MÉTODOS: Se estudiaron 166 muestras de exudados vaginales y endocervicales tomadas a pacientes que acudieron a las consulta de infertilidad y abortadoras habituales. Se aplicaron los test diagnósticos para Chlamydia y micoplasmas genitales. RESULTADOS: De las pacientes estudiadas, 113 fueron positivas (68 por ciento), el test de Chlamydia se aplicó y 75 resultaron positivas a este microorganismo (45,2 por ciento), mientras que 57 fueron positivas a micoplasmas genitales (34,3 por ciento), de ellas 50 a Ureaplasma urealyticum, 4 a Mycoplasma hominis y en 3 muestras se aislaron Ureaplasma urealyticum más Mycoplasma hominis. Se encontró asociación de estos agentes con otros microorganismos. El 50,9 por ciento de los casos positivos a Mycoplasma tuvieron una infección moderada (29/57). El test de Mycoplasma permitió conocer la susceptibilidad de estos agentes frente a diferentes antimicrobianos; se encontró para Ureaplasma urealyticum una resistencia de 24 por ciento para la ofloxacina; 22 por ciento para la tetraciclina y 20 por ciento para la claritromicina; por su parte Mycoplasma hominis mostró el 75 por ciento de resistencia a la eritromicina y 100 por ciento a claritromicina y azitromicina; en los tres casos que coincidieron Ureaplasma urealyticum y Mycoplasma hominis se observó una resistencia elevada a la azitromicina, eritromicina y claritromicina. Hubo una alta sensibilidad frente minociclina y clindamicina. CONCLUSIONES: El microorganismo más frecuente en este estudio resultó C. trachomatis, M. hominis reportó más resistencia a los antimicrobianos que U. ure...

Some microorganisms like the Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma homonis have been related to different pathological processes in women sexually actives. OBJECTIVE: To know the frequency of these agents a observational and descriptive study was conducted in the "Ram¾n Gonzßlez Coro" Gynecology and Obstetrics Hospital from November, 2008 to January, 2009. METHODS: One hundred and sixty six samples of vaginal exudates from patients seen in infertility consulting rooms with regular abortions were studied. Diagnostic tests for Chlamydia and genital Mycoplasm tests were applied. RESULTS: From the study patients, 113 were positive (68 percent), Chlamydia test was applied and 75 were positive to this microorganism (45.2 percent), whereas 57 were positive to genital micoplasma (34.3 percent), from them 50 were positive to Uraplasma urealyticum, 4 to Mycoplasma homonis, and in three samples Ureaplasma urealyticum and Mycoplasma homonis were isolated. There was association of these agents with other microorganisms. The 50.9 percent of cases positive to Mycoplasma had a moderate infection (29/57). The Mycoplasma's test allowed to know the susceptibility of these agents to different antimicrobial agents, in the case of Ureaplasma urealyticum there was a resistance of 24 percent to Ofloxacin; 22 percent to Tetracycline, and the 20 percent to Clarithromycin; Mycoplasma hominis showed a 75 percent of resistance to erythromycin and the 100 percent to Claritromycin and to Azithromycin in the thre cases where they coindiced. Ureaplasma urealyticum and Mycoplasma hominis had a significant resistance to Azithromycin, Eritromycin and Claritromycin. There was a high level of sensitivity to minocycline and to clindamycin. CONCLUSIONS: The more frequent microorganism in present study was the C. trachomatis, and M. hominis had more resistance to antimicrobials agents than U.uralyticum, both are very sensitive to minocycline and ...

Qual deve ser o rastreamento de doenças infecciosas em casos de perda gestacional recorrente?: [revisão] / What should be the screening of infectious diseases in cases of recurrent pregnancy loss?: [review]

A perda gravídica de repetição ocorre em cerca de 1 a 2% das gestações, e em cerca de em 2% das vezes tem quadros infecciosos como agentes etiológicos. A necessidade de rastreio de causa infecciosa tem sido muito discutida na literatura. Com objetivo de avaliar o que se conhece sobre esta necessidade, foi realizada uma revisão sistemática de trabalhos em inglês, português e espanhol em bases de dados do Pubmed, Highwire, Lilacs e biblioteca Cochrane. Observou-se que, de todos os agentes, o mais estudado foi a Chlamydia trachomatis, em especial seu efeito imunológico tardio. Outros agentes têm sido associados ao aborto habitual, no entanto, as infecções bacterianas, virais e parasitárias podem interferir na evolução da gestação, mas não parece ser uma causa significante de aborto de repetição. O valor do rastreio parece ser limitado na investigação de perda gravídica de repetição fora de um episódio infeccioso agudo. No entanto, mais estudos se fazem necessários, em especial para avaliar efeitos tardios, como das infecções por Chlamydia trachomatis.

The recurrent pregnancy loss occurs in about 1-2% of pregnancies, and in about 2% the etiology would be infectious. The need for tracking infectious causes has been much discussed in the literature. In order to evaluate what is known about this need, we conducted a systematic review of papers in English, Portuguese and Spanish on this subject available in the databases of Pubmed, Highwire, Lilacs and Cochrane Library. Chlamydia trachomatis was mostly studied, especially with regard to its late immunological effect. Other agents have been associated with habitual abortion; however, bacterial infections, viral and parasitic diseases can interfere with the course of gestation, but does not seem to be a significant cause of recurrent abortion. The value of screening seems to be limited for the investigation of recurrent pregnancy loss if acute infection does not occur. However, further studies are needed, especially to evaluate late effects such as infections by Chlamydia trachomatis.

Rastreamento universal para cervicite clamidiana: uma revisão sistemática / Universal screening for chlamydial cervicitis: a systematic review

A revisão sistemática teve como objetivo avaliar a efetividade dos testes de ácido nucleico no rastreio da C. trachomatis. A maioria dos estudos foi localizada via internet, entretanto, alguns deles foram encontrados em revistas que abordavam o tema e mediante contato com especialistas. Os artigos foram selecionados após criteriosa avaliação crítica da força de evidência científica, obedecendo às regras da Associação Médica Brasileira e do Conselho Federal de Medicina, além dos critérios de Irwig, para análise qualitativa dos artigos. A revisão incluiu todos os estudos publicados a partir de 1990 que avaliavam testes de ácido nucleico em mulheres sexualmente ativas, assintomáticas e que tivessem sido submetidas à avaliação clinica e a testes moleculares. Os testes de ácido nucleico que utilizavam sondas de RNA e amplificação de DNA (PCR) foram comparados à cultura (padrão-ouro) com o intuito de determinar se seriam método de diagnóstico adequado para o rastreio da infecção. Após análise qualitativa, foram selecionados 12 estudos, mas não foi possível realizar avaliação quantitativa dos mesmos devido à heterogeneidade dos dados. A efetividade e os benefícios dos testes de ácido nucleico justificam estudos de custo-efetividade, com o intuito de avaliar o impacto do rastreio universal na redução das complicações advindas da infecção clamidiana

This systematic review aims at evaluating the effectiveness of the nucleic acid test for detection of C. trachomatis. Most of the studies were searched electronically and key journals were hand-searched. Further studies were identified in the internet and by contacting experts in the field. The articles were selected after careful critical evaluation of the strength of scientific evidence, according to the rules of the Brazilian Medical Association and the Federal Council of Medicine, besides the Irwig's criteria for qualitative analysis of article The review included all studies published from 1990 onward that evaluated nucleic acid tests in asymptomatic, young and sexually active women that have been subjected to clinical evaluation and molecular testing. The nucleic acid tests taken with the use of probes of RNA and amplification (PCR) were compared to culture (gold standard) in order to determine if a method of diagnosis would be appropriate for screening of infection. After the qualitative analysis, we selected 12 studies; it has not been possible to perform their quantitative evaluation due to the heterogeneity of data. The effectiveness and benefits of DNA testing justify the cost-effectiveness studies in order to assess the impact of universal screening in reducing the complications that arise from chlamydial infection

Infecção por Chlamydia em pacientes com e sem lesões intra-epiteliais cervicais / Chlamydia infection in patients with and without cervical intra-epithelial lesions

OBJETIVOS: Determinar a freqüência de infecção por Chlamydia trachomatis em pacientes com e sem lesões intra-epiteliais cervicais atendidas em ambulatório especializado no Recife (2007), e sua associação com variáveis biológicas, demográficas, hábitos, características reprodutivas e clínico-ginecológicas. MÉTODOS: Realizou-se um estudo do tipo corte transversal, incluindo 70 mulheres (35 com alterações citológicas e 35 normais). Realizaram-se colposcopia, biópsia quando necessário e pesquisa para Chlamydia trachomatis por Imunofluorescência Direta. As variáveis analisadas foram idade, raça, procedência, escolaridade, estado civil, menarca, idade da primeira relação sexual, paridade, número de parceiros, corrimento, realização de citologia prévia, episódios de DST, eletrocauterização, método contraceptivo, antecedente familiar de câncer uterino, consumo alcoólico, tabagismo, drogas ilícitas e imunossupressoras, resultado da citologia e infecção cervical por Chlamydia trachomatis. Para determinação da força da associação, calculou-se a Razão de Prevalência (RP) e o intervalo de confiança 95 por cento, realizando-se análise multivariada para controle das variáveis potencialmente confundidoras. RESULTADOS: A freqüência de infecção por Chlamydia trachomatis foi significativamente maior em pacientes com alterações citológicas (80 por cento vs. 14,3 por cento), com uma RP de 5,60 (IC 95 por cento = 2,44 - 12,82). Analisando os fatores associados à infecção por Chlamydia , a única variável que persistiu significativamente associada após análise multivariada foi a história pregressa de DST (OR=63,47; IC 95 por cento = 13,93 - 289,09). CONCLUSÃO: A presença da Chlamydia trachomatis está associada às alterações citológicas da cérvice uterina, e a história pregressa de DST deve ser valorizada no tratamento e seguimento clínico destas pacientes.

OBJECTIVES: To determine the frequency of Chlamydia trachomatis infection in patients with and without intraepithelial cervical lesions attended at specialized ambulatory in Recife (2007) and its association with biologic and demographic variables, habits, reproductive, clinical and gynecologic characteristics. METHODS: A cross-sectional study was conducted including 70 women (35 with cytological cervical lesions and 35 with normal smears). Colposcopy and biopsy when necessary were performed and Chlamydia infection was determined by direct immunofluorescence. Analysis variables were age, race, precedence, schooling, marital status, menarche, age at first sexual intercourse, parity, number of sexual partners, vaginal discharge, previous Pap smear, STD episodes, cervical cauterization, contraceptive methods, familial antecedents of cervical cancer, alcohol intake, use of illicit and immunosuppressive drugs, Papanicolaou result and cervical Chlamydia l infection. To determine the strength of association prevalence ratio (PR) and its 95 percent confidence interval were calculated. Multivariate analysis was performed for controlling potentially confounding variables. RESULTS: the frequency of Chlamydia l infection was significantly greater in patients with intraepithelial cervical lesions (80.0 percent vs. 14.3 percent; PR = 5.60; 95 percent CI = 2,44 - 12,82). When the factors associated with Chlamydia l infection were analyzed, the only variable that remained significantly associated after multivariate analysis was previous episode of STD (OR=63,47; 95 percent CI = 13,93 - 289,09). CONCLUSION: Chlamydia trachomatis infection is associated with intraepithelial cervical lesions and history of STD should be considered for treatment and follow-up of these patients.

Evidence for benefits from treating cervical ectopy: literature review / Evidências de benefícios no tratamento de ectopia do colo do útero: revisão de literatura

CONTEXT AND PURPOSE: Uterine cervical ectopy (cervical erosion) is today considered to be a physiological condition, but there still seems to be a strong tendency towards treating it. The purpose of this study was to review the medical literature for evidence regarding benefits from treating cervical ectopy. METHODS: The following databases were reviewed: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Cochrane Library databases. In addition, six medical textbooks were consulted. RESULTS: The review showed that: 1) there is probably an association between ectopy and higher risk of Chlamydia trachomatis, human papillomavirus and human immunodeficiency virus infection; 4) there is probably an association between ectopy and cervical intraepithelial neoplasia; 5) there is an association between ectopy and mucous discharge and nocturia; and 6) there is no evidence of an association between ectopy and cervical cancer, or of protection against cervical cancer associated with ectopy treatment. CONCLUSIONS: 1) No data were found in the medical literature to support routine treatment for ectopy; 2) Treatment could be recommended for symptom relief, but more symptoms are attributed to ectopy than could be demonstrated in a controlled study; 3) Further studies to test the hypothesis of protection against cervical cancer associated with treatment are necessary.

CONTEXTO E OBJETIVO: A ectopia do colo do útero é hoje considerada um fenômeno fisiológico, mas parece ainda haver uma forte tendência no sentido da intervenção (tratamento). Este estudo se propõe a realizar revisão da literatura buscando evidências de benefícios conseqüentes ao tratamento da ectopia. MÉTODOS: Pesquisa nas bases Medical Literature Analysis and Retrieval Sysem Online (Medline), Excerpta Medica Database (Embase), Literatura Latino-Americane e do Caribe em Ciências da Saúde (Lilacs), Biblioteca Cochrane e seis livros especializados. RESULTADOS: A revisão mostrou que: 1) existe provavelmente associação de ectopia com infecção cervical por Chlamydia trachomatis, pelo vírus HPV e maior risco de soroconversão para HIV; 2) existe provavelmente associação entre ectopia e neoplasia intra-epitelial cervical; 3) existe associação com mucorréia e nictúria; 4) não existem evidências sobre associação entre ectopia e câncer de colo do útero nem sobre proteção contra este câncer proporcionada pelo tratamento da ectopia. CONCLUSÕES: 1) Não foram encontrados na literatura dados que justifiquem o tratamento rotineiro da ectopia; 2) O tratamento pode ser utilizado para tratar sintomas associados à ectopia, porém mais sintomas são atribuídos à ectopia do que se pôde confirmar em um estudo controlado; 3) Seriam necessários novos estudos para testar a hipótese de proteção contra o câncer de colo proporcionada pelo tratamento.

Prognostic value of infection and inflammation markers for late cardiac events in an Iranian sample

We evaluated the serum levels of IgG antibodies to Helicobacter pylori, Chlamydia pneumonia and cytomegalovirus and the level of the inflammatory markers C-reactive protein and fibrinogen in 57 patients with acute coronary syndrome, 65 with unstable angina, 60 with stable angina and 44 healthy controls, and whether these markers were associated with cardiac instability 6 months after admission. There was a significant increased risk of late coronary events [cardiac death or readmission with acute coronary events] associated with seropositivity to C. pneumoniae [adjusted odds ratio 2.12; 95% confidence interval: 1.16-4.08]. Other parameters were not significantly associated with late cardiac events after adjustment for age, sex, diabetes mellitus, hypertension, hyperlipidaemia and smoking behaviour