Species of the

No abstract

Originating from observations on similarities between the rheumatoid synovial tissue and sldn lesions in delayedtype hypersensitivity reactions-similarities as to massive infiltrates of "helper" T lymphocytes close to HLA-DR-expressing macrophage/dendritic cells-a notion is formed on the importance of local macrophage-dependent helper T-cell activation in the rheumatoidjoint similar to that in a delayed-type skdn reaction.

No abstract

The development of bacterial vaginosis (BV) among women of childbearing age and the resulting quantitative and qualitative shift from normally occurring lactobacilli in the vagina to a mixture of mainly anaerobic bacteria is a microbiological and immunological enigma that so far has precluded the formulation of a unifying generally accepted theory on the aetiology and clinical course of BV. This critical review highlights some of the more important aspects of BV research that could help in formulating new basic ideas respecting the biology of BV, not least the importance of the interleukin mediators of local inflammatory responses and the bacterial shift from the normally occurring lactobacilli species: L. crispatus, L. gasseri, L. jensenii, and L. iners to a mixed flora dominated by anaerobic bacteria.

Objective To screen for bacterial vaginosis (BV) and to investigate the effect of treatment with vaginal clindamycin in order to observe the effect on late miscarriage and delivery prior to 37 completed weeks (primary outcome).Design Randomised consent design for clinical trials according to Zelen.Setting Southeast region of Sweden.Population A total of 9025 women were screened in early pregnancy.Methods A total of 819 women with a Nugent score of 6 and above were considered to have BV and treated according to Zelen allocation. The incidence of late miscarriage and spontaneous (noniatrogenic) preterm birth was assessed.Main outcome measures Late miscarriage and spontaneous preterm delivery before 37 weeks.Results Therapy with vaginal clindamycin had no significant impact on the incidence of spontaneous preterm delivery prior to 37 completed weeks; OR 0.90, 95% CI 0.40-2.02 (primary outcome variable). However, only 1 of 11 women in the treatment group versus 5 of 12 in the control group delivered prior to 33 completed weeks; OR 0.14, 95% CI 0.02-0.95. Treatment was associated with 32 days longer gestation for the 23 participants who had late miscarriage or spontaneous preterm birth (P = 0.024, Mann-Whitney U test) and significantly fewer infants had a birthweight below 2500 g (secondary outcome). A follow up of infants born preterm 4 years postnatally indicated that extending gestational age did not increase the number of sequelae.Conclusions Clindamycin vaginal cream therapy was associated with significantly prolonged gestation and reduced cost of neonatal care in women with BV. Early screening for BV and treatment with clindamycin saved approximately e27 per woman.Keywords Bacterial vaginosis, late miscarriage, preterm birth, preterm prelabour rupture of membranes, treatment.Please cite this paper as: Larsson P, Fåhraeus L, Carlsson B, Jakobsson T, Forsum U. Late miscarriage and preterm birth after treatment with clindamycin: a randomised consent design study according to Zelen. BJOG 2006; 113:629-637.

ᰔLactobacillus iners seems to be a species of lactobacilli occurring in the human vagina that deserves close scrutiny, as it was not found in earlier studies due to its peculiar culture requirements but is now discussed as one of the normal vaginal bacteria (1,4). Following up on the interesting paper by Ferris et al. on changes in vaginal flora after the treatment of bacterial vaginosis with metronidazole, and especially their finding of L. iners DNA clones posttreatment, we would like to add to the picture our findings from investigations on vaginal flora changes during estrogen treatment for the purpose of in vitro fertilization (IVF) (2).Observations in previous studies of healthy women of childbearing age using the Nugent score and Amsel criteria indicate that L. crispatus, L. iners, L. gasseri, and L. jensenii are the Lactobacillus species most likely to be part of the normal flora in a healthy vagina (4). These studies, however, were not set up to illuminate any possible changes in the flora over time, e.g., throughout a normal menstrual cycle. Earlier studies, using mostly phenotypic characteristics to type cultured vaginal lactobacilli, were not powerful enough to guide in designing experiments investigating the influence of treatment, time course, and physiological parameters such as estrogen levels on the natural flora. The interplay between physiological parameters and floral changes may be subtle, and thus, using Lactobacillus genotyping methods described in an earlier study from our group, we resorted to the study of possible Lactobacillus flora changes associated with the artificially high estrogen levels that occur during IVF in women seeking help to conceive (3).Thirty-four Swedish women, ages 23 to 39, from the normal IVF program of Linköping University Hospital, Linköping, Sweden, were enrolled in the study. According to the IVF protocol used at the time of the study, the women were treated with doxycycline and metronidazole. At intervals after the antimicrobial treatment, vaginal samples were taken for culture, vaginal fluid for Gram staining on slides and Nugent scoring was obtained from the upper third of the vagina, and samples were evaluated according to the Amsel criteria (4). Plasma estradiol levels were determined at each visit. A normal vaginal status (as defined by Nugent scores and Amsel criteria) throughout the study period was found for 22 women from whom sufficient culture data were collected. 16S rRNA DNA sequence analysis identified one or two dominant Lactobacillus species in each woman, most frequently L. iners, L. gasseri, and L. jensenii, that did not change among these women over the study period (3).Three women had abnormal vaginal floras, evident from high Nugent scores, high vaginal pHs, and the occurrence of Mobiluncus species or high numbers of gram-positive cocci, before the antibiotic treatment. Samples from two of these women yielded L. iners in cultures after metronidazole treatment, and the flora in the third woman changed to include L. iners in conjunction with ...

Whether bacterial vaginosis (BV) is acquired from an endogenous or an exogenous source is subject to controversy. Despite findings of an association between sexual behaviour and BV, some data indicate that BV is not a sexually transmitted infection in the traditional sense, while other data indicate that BV is an exogenous infection. A third aspect of BV is its tendency to go unnoticed by affected women. All of this will have a strong impact on how physicians view the risks of asymptomatic BV. This review focuses on whether or not BV should be regarded as a sexually transmitted infection (STI), its role in postoperative infections and pelvic inflammatory disease (PID), and on whether or not treatment of BV during pregnancy to reduce preterm delivery should be recommended. The reviewed studies do not lend unequivocal support to an endogenous or exogenous transmission of the bacteria present in BV. For women undergoing gynaecological surgery such as therapeutic abortion, the relative risk of postoperative infection is clearly elevated (approx. 2.3-2.8). A weaker association exists between BV and pelvic inflammatory disease. Data on treatment of BV as a way of reducing preterm delivery are inconclusive and do not support recommendations for general treatment of BV during pregnancy. The discrepant associations between BV and preterm birth found in recent studies may be explained by variations in immunological response to BV. Genetic polymorphism in the cytokine response--both regarding the TNF alleles and in interleukin production--could make women more or less susceptible to BV, causing different risks of preterm birth. Thus, studies on the vaginal inflammatory response to microbial colonization should be given priority.