Bacterial vaginosis, Prevotella species, and Bacteroides species have been associated with prematurity and upper genital tract infection. Prevotella (Bacteroides) species and Bacteroidesfragilis have also been associated with preterm birth. However, the mechanism by which lower genital tract infection causes upper genital tract disease remains poorly understood. Sialidases (neuraminidases) are enzymes which enhance the ability of microorganisms to invade and destroy tissue. Elevated levels of sialidase activity were detected in 42 (84%) of 50 vaginal fluid specimens from women with bacterial vaginosis and none of 19 vaginal fluids from women without bacterial vaginosis (P < 0.001). Vaginal fluid from women with bacterial vaginosis had a median specific activity of 9.8 U compared to 2.5 U of sialidase in women without bacterial vaginosis (P < 0.001). In order to determine the probable source of sialidases in vaginal fluid, the microorganisms recovered from women with bacterial vaginosis before and after treatment were assayed. Of 28 specimens from women with bacterial vaginosis, 27 (961%) yielded sialidase-positive bacteria, at a median concentration of 106.5 CFU/ml of vaginal fluid. PrevoteUla and Bacteroides species accounted for the sialidase activity in 26 of the vaginal fluids, and GardnereUla vaginalis accounted for the sialidase activity in the remaining fluid. After treatment, sialidase was detected in the vaginal fluid of 1 (5%) of 22 women who responded to therapy and in all of 6 women for whom therapy failed. These data suggest that vaginal fluid sialidase is highly correlated with bacterial vaginosis and that the probable sources for this enzyme activity are the Bacteroides and PrevoteUla species present in the vagina.

A commercial system (Affirm VP Microbial Identification Test; MicroProbe Corp.) for detection of vaginal pathogens was evaluated with 176 consecutive women attending a sexually transmitted disease clinic for genital complaints. Vaginal swab specimens were used for culture of GardnereUa vaginalis and Trichomonas vaginalis, preparation of a vaginal smear for Gram stain interpretation, and wet mount evaluation. An additional swab was used to evaluate the 30-min nonisotopic oligonucleotide probe test. The automated probe system detected G. vaginalis in 69 (95%) of 73 women having >5 x 105 CFU of G. vaginalis per ml by culture, and 20 (43%) of 47 specimens with c5 x 10' CFU of G. vaginalis per ml. There were three false positives and four false negatives for the Affirm VP test compared with >5 x 10i CFU of G. vaginalis per ml. The probe system detected G. vaginalis in 57 (90%k) of 63 vaginal specimens from women having clue cells on wet mount examination, and in only 3 (3%) of 113 women without clue cells, suggesting that the Affirm probe for G.

Gardnerella vaginalis is the predominant vaginal microorganism in women with bacterial vaginosis. However, this organism is also frequently isolated from women without signs or symptoms of vaginitis. Earlier studies have not revealed whether certain biotypes of G. vaginalis are more often associated with bacterial vaginosis or are more common in women who acquire bacterial vaginosis. We used a typing scheme based on tests for P-galactosidase, hippurate hydrolysis, and lipase, using oleate as a substrate. Of 261 strains tested, the distribution of biotypes observed was as follows: 1, 13%; 2, 9%; 3, 5%; 4, 7%; 5, 41%; 6, 15%; and 8, 10%. Biotype 7 was not observed. The distributions of biotypes from women with and without bacterial vaginosis were found to be significantly different, with the lipase-positive biotypes (biotypes 1, 2, 3, and 4) being more predominant in women with vaginosis (41 versus 23%, P = 0.003). Of 40 women with normal vaginal flora at the index visit who remained normal at follow-up, 23 (57%) acquired a new biotype of G. vaginalis. By comparison, 90% of the 30 women who developed bacterial vaginosis acquired a new biotype of G. vaginalis (P = 0.003). Women with bacterial vaginosis at the index visit who were not treated were no more likely than normal women to have a shift in G. vaginalis biotype. However, 86% of the 30 women with bacterial vaginosis who were treated with an antibiotic at the index visit acquired a different biotype (P = 0.04 compared with the value for untreated women) regardless of treatment success. A trend toward the acquisition of a new biotype was observed among women who had contact with a new sexual partner (81 versus 65%, P = 0.15). These data demonstrate that the lipase-positive isolates of G. vaginalis are associated with bacterial vaginosis. Women who acquire bacterial vaginosis are more likely to have a shift in biotype than women who had normal fora at the follow-up, suggesting that the G. vaginalis isolates recovered from women who develop bacterial vaginosis represent newly acquired strains rather than overgrowth of previously colonizing biotypes.

Antibiotic-resistant Corynebacterium strains were isolated from 14 Harborview and one Veterans Administration Hospital patients in Seattle during the period 1987-90. These clindamycin-erythromycin resistant strains were shown to hybridize with the ermCd gene, which was cloned from a Corynebacterium diphtheriae plasmid and encodes for a rRNA methylase. Thirteen of these strains also hybridized with the tetM gene probes, and were tetracycline resistant. The ermCd gene could be transferred, by conjugation, while the tetM gene was not transferable.

The Rapid CORYNE system for identification of aerobic, nonsporeforming, gram-positive rods was evaluated according to the manufacturer's instructions with 177 organisms. After inoculation with a heavy suspension of growth, strips containing 20 cupules were incubated for 24 h, reagents were added, and the results of 21 biochemical reactions were recorded as numerical profiles. The strains consisted of pathogenic species of the genus Corynebacterium, primarily C. diphtheriae (n = 29), opportunistic species of Corynebacterium including C. jeikeium (n = 75), recognized species of non-corynebacteria such as Gardnerella and Arcanobacterium (n = 51), and Centers for Disease Control (CDC) coryneform groups (n = 22). Results from single tests read after 24 h yielded correct identifications to species level with no additional tests for 26 (89.7%) of the pathogenic species; 64 (85.3%) of the opportunistic organisms; 51 (100%) of the non-corynebacteria, and 8 (36.4%) of the CDC coryneform groups. Supplemental tests produced the correct identification for three additional pathogenic isolates (100% total) and four additional isolates from the opportunistic species (90.6% total). Twelve of the 15 isolates not identified by the system were in the CDC coryneform groups. Four of the six misidentified and one of the unidentified isolates were C. matruchotii, which was not included in the data base. The system is an excellent rapid alternative to conventional biochemical tests.Identification of Corynebacterium jeikeium and Corynebacterium CDC group D2 with the API 20 strep system. Eur. J. Microbiol. Infect. Dis. 7:675-678.