ABSTRACT
Systemic Gardnerella infections are rare and usually associated with surgical instrumentation of the genitourinary tract. We present a case of symptomatic and transient Gardnerella bacteremia in a man with AIDS after a traumatic urinary catheter insertion.
Subject(s)
Bacteremia/diagnosis , Gardnerella/isolation & purification , Gram-Positive Bacterial Infections/diagnosis , Immunocompromised Host , Urinary Catheterization/adverse effects , Anti-Bacterial Agents/therapeutic use , Bacteremia/etiology , Gardnerella/drug effects , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/etiology , HIV Infections/complications , HIV Infections/microbiology , Humans , Male , Middle Aged , Treatment Outcome , Urinary Tract Infections/diagnosis , Urinary Tract Infections/etiology , Urinary Tract Infections/microbiologyABSTRACT
BACKGROUND: We analysed data on bacterial vaginosis (BV) contradicting the paradigm of mono-infection. METHODOLOGY: Tissues and epithelial cells of vagina, uterus, fallopian tubes and perianal region were investigated using fluorescence in situ hybridization (FISH) in women with BV and controls. RESULTS: Healthy vagina was free of biofilms. Prolific structured polymicrobial (StPM) Gardnerella-dominated biofilm characterised BV. The intact StPM-Gardnerella-biofilm enveloped desquamated vaginal/prepuce epithelial cells and was secreted with urine and sperma. The disease involved both genders and occurred in pairs. Children born to women with BV were negative. Monotherapy with metronidazole, moxifloxacin or local antiseptics suppressed but often did not eradicate StPM-Gardnerella-biofilms. There was no BV without Gardnerella, but Gardnerella was not BV. Outside of StPM-biofilm, Gardnerella was also found in a subset of children and healthy adults, but was dispersed, temporal and did not transform into StPM-Gardnerella-biofilm. CONCLUSIONS: StPM-Gardnerella-biofilm is an infectious subject. The assembly of single players to StPM-Gardnerella-biofilm is a not trivial every day process, but probably an evolutionary event with a long history of growth, propagation and selection for viability and ability to reshape the environment. The evolutionary memory is cemented in the structural differentiation of StPM-Gardnerella-biofilms and imparts them to resist previous and emerging challenges.
