Transmission of Burkholderia cepacia complex: evidence for new epidemic clones infecting cystic fibrosis patients in Italy.

To analyze national prevalence, genomovar distribution, and epidemiology of the Burkholderia cepacia complex in Italy, 225 putative B. cepacia complex isolates were obtained from 225 cystic fibrosis (CF) patients attending 18 CF centers. The genomovar status of these isolates was determined by a polyphasic approach, which included whole-cell protein electrophoresis and recA restriction fragment length polymorphism (RFLP) analysis. Two approaches were used to genotype B. cepacia complex isolates: BOX-PCR fingerprinting and pulsed-field gel electrophoresis (PFGE) of genomic macrorestriction fragments. A total of 208 (92%) of 225 isolates belonged to the B. cepacia complex, with Burkholderia cenocepacia as the most prevalent species (61.1%). Clones delineated by PFGE were predominantly linked to a single center; in contrast, BOX-PCR clones were composed of isolates collected either from the same center or from different CF centers and comprised multiple PFGE clusters. Three BOX-PCR clones appeared of special interest. One clone was composed of 17 B. cenocepacia isolates belonging to recA RFLP type H. These isolates were collected from six centers and represented three PFGE clusters. The presence of insertion sequence IS 1363 in all isolates and the comparison with PHDC reference isolates identified this clone as PHDC, an epidemic clone prominent in North American CF patients. The second clone included 22 isolates from eight centers and belonged to recA RFLP type AT. The genomovar status of strains with the latter RFLP type is not known. Most of these isolates belonged to four different PFGE clusters. Finally, a third clone comprised nine B. pyrrocinia isolates belonging to recA RFLP type Se 13. They represented three PFGE clusters and were collected in three CF centers.

[Bacterial vaginosis. Prevention of recurrence]. / Vaginosi batterica. Profilassi delle ricorrenze.

Bacterial vaginosis (BV) is the main cause of vaginitis. The condition is characterised by an abundant and odorous vaginal loss, but more than half the patients with demonstrable signs of BV do not report symptoms at all. Gardnerella vaginalis (Gv) is often associated with BV, but it is not the sole factor responsible, as is shown by the fact that it can be isolated in the vagina of women withBV. In 1992 and 1993, 2630 patients, 1460 of them gynaecological and 1170 obstetric, were admitted to the Obstetrics and Gynaecology Clinic of Parma University. Amsel criteria were adopted for diagnosing BV. Cases of BV were treated with 5 mg/die 2% clindamycin vaginal cream for 7 days. In the event of recurrences, 250 mg tablets of metronidazol were added: 8 tablets in 4 administrations in a single day, treatment also being extended to the partner. Patients admitted in 1993 received a protocol of hygienic and behavioural standards, stress being laid on prophylaxisa measures even after the end of therapy. BV proved to be present in 12.3% of cases, of whom only half were symptomatic. The situation was practically stationary if the 2 years are considered separately. Recurrences of symptomatic bacterial vaginosis were 15% in the absence of protocol application and 8.3% after the protocol. Recurrences were less frequent in the asymptomatic forms. Compared to the total number od cases of BV, recurrences were significantly low (12.1% p < 0.001).

Methods of contraception and rates of genital infections.

Bacterial vaginosis, trichomoniasis and candidiasis are the most common genital infection. The aim of this study was to evaluate the various methods of contraception with regard to the prevalence of bacterial vaginosis and vulvo-vaginitis over a period of four years. We also evaluated in the same period the rates of trichomoniasis, candidiasis, bacterial vaginosis and vulvo-vaginitis between users and non users of contraceptional methods and the relationship between ages of patients and types of contraceptives. Finally we considered the change of contraceptive use with regard to age among two different periods. The IUD users showed a significant increase of B.V., T.v. and other bacteria and a decrease of the negatives compared to OC users. Barrier contraceptive users had a reduction (0.01 > p > 0.001) of B.V. and an increase (p < 0.001) of the negatives compared to IUD users. OC users had a significant (p < 0.05) increase in candidiasis, B.V. together with a reduction of the negatives compared to non users group. IUD users had a significant (p < 0.001) increase of B.V. and vulvo-vaginitis from other bacteria, and the reduction of the negatives. Teenagers use OC much more than adults, but less IUD (p < 0.001). The use of OC has increased and the use of IUD decreased among adults (p < 0.001). The barrier methods were seen to be statistically reduced.

PIP: During 1985-1986 and 1991-1992 in Italy, clinicians recruited 2387 patients attending the Centre for Sexually Transmitted Diseases (STDs) at the University of Parma with symptoms of genital infections. The study aimed to examine the various types of contraceptive methods in connection with the most common genital infections. Over the 4-year period, among patients with vulvo-vaginitis, IUD users had a higher rate than oral contraceptive (OC) users of bacterial vaginosis [BV] (24.9% vs. 15.7%; p 0.05), of trichomoniasis (1.7% vs. 1.3%), and of other infections (31.6% vs. 20%; p 0.05). They had a lower negative rate than OC users (23.9% vs. 43.4%; p 0.001). Patients using barrier methods (diaphragm and condom) had a lower rate of BV and a higher negative rate than IUD users (11.5% vs. 24.9%, p 0.01 and 49.6% vs. 23.9%, p 0.001, respectively). OC users had a higher rate of candidiasis and BV and a lower negative rate than the nonusers (19.6% vs. 14.8% and 15.7% vs. 11%; p 0.05 and 43.4% vs. 52.9%; p 0.001, respectively). IUD users had a higher rate of BV and vulvo-vaginitis from other bacteria and a lower negative rate than nonusers (24.9% vs. 11%, p 0.001; 31.6% vs. 20.4%, p 0.05; and 23.9% vs. 52.9%; p 0.001, respectively). Teenagers used OCs more often than did adults (29.3% vs. 15.6%) and were less likely to use the IUD (0.3% vs. 5.5) and no method (62.2% vs. 73.5%) (p 0.001). Between 1985-1986 and 1991-1992 among adults, OC use increased (9.9% vs. 17.9%; p 0.001) and IUD use and barrier method use decreased (8.9% vs. 4.1% and 9.3% vs. 3.9%, respectively; p 0.001).