Ari Miettinen

Prevalence and manifestations of endometritis among women with cervicitis.

Thirty-five women referred from a clinic treating sexually transmitted diseases, because of suspected cervicitis, were studied for the presence of endometritis by transcervical endometrial biopsies and cervical and endometrial cultures. Fourteen (40%) of the patients had histologic evidence of endometritis. Findings that significantly correlated with endometritis included a history of intermenstrual vaginal bleeding, the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, or Streptococcus agalactiae in the cervix, and the presence of serum antibodies to C. trachomatis or to Mycoplasma hominis.

Serologic evidence for the role of Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis in the etiology of tubal factor infertility and ectopic pregnancy

&NA; The authors used anzyme immunoassay to determine the prevalence of serum antibodies to the sexually transmitted disease (STD) organisms Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis among 104 infertile women undergoing in vitro fertilization. Altogether, 55 (72%) out of 76 women with tubal abnormalities tested positive for one or more STD organisms, compared with only 6 (21%) out of 28 infertile women with normal tubes (P < .001). The authors obtained positive test results for C. trachomatis, N. gonorrhoeae, and M. hominis in 40%, 14%, and 37% of the patients with tubal abnormalities, respectively; of women without tubal abnormalities, the test results were 7%, 0%, and 14%, respectively. Out of 20 patients with a history of ectopic pregnancy, the authors obtained positive findings for C. trachomatis, N. Gonorrhoeae, and M. hominis in 8 (40%), 1 (5%), and 7 (35%), respectively. These results indicate an independent role for all three STD organisms in the etiology of tubal factor infertility and ectopic pregnancy following both symptomatic and asymptomatic pelvic inflammatory disease (PID). The correlation between positive mycoplasmal serology and secondary infertility and tubal abnormalities may suggest a link between M. hominis infections during pregnancy and delivery complications and consequent development of tubal factor infertility.

Test performance of erythrocyte sedimentation rate and C-reactive protein in assessing the severity of acute pelvic inflammatory disease*

OBJECTIVE The objective of the study was to evaluate the test performance of erythrocyte sedimentation rate and serum C-reactive protein in assessing the severity of acute pelvic inflammatory disease and to determine clinically useful cutoff levels to discriminate mild from severe pelvic inflammatory disease. STUDY DESIGN The study population consisted of 72 women with acute pelvic inflammatory disease verified by laparoscopy and endometrial histopathologic studies; 37 patients had mild and 35 had severe pelvic inflammatory disease. Cutoff levels for erythrocyte sedimentation rate and C-reactive protein were determined to reach best sensitivity and specificity to discriminate between severe and mild disease. Clinical and microbiologic data were analyzed by chi 2, or t test. Logistic regression analysis was used to analyze risk factors for severe pelvic inflammatory disease. RESULTS Patients with severe pelvic inflammatory disease had higher erythrocyte sedimentation rates and C-reactive protein levels than did those with mild disease. In detecting severe disease an erythrocyte sedimentation rate > or = 40 mm/hr and C-reactive protein levels > or = 60 mg/L had a sensitivity of 97%, a specificity of 61%, a negative predictive value of 96%, and a positive predictive value of 70%. All patients with tuboovarian abscess or perihepatitis and six of seven patients who had anaerobic bacteria isolated from the fallopian tubes tested positive with these cutoff levels. CONCLUSION Combined use of erythrocyte sedimentation rate and C-reactive protein levels is useful in assessing the severity of acute pelvic inflammatory disease and augments the clinical decision making regarding treatment.

Comparison of Procalcitonin with CRP and Differential White Blood Cell Count for Diagnosis of Culture-proven Neonatal Sepsis

We analysed the utility of procalcitonin (PCT) assay, either alone or in combination with 2 simple blood assays, for the diagnosis of culture-proven neonatal septicaemia. Tests for serum PCT concentration, serum CRP concentration and blood immature to total neutrophil leucocyte ratio all had reasonable (58-77%) sensitivity, reasonable (62-84%) specificity, good (94-97%) negative predictive value and poor (16-24%) positive predictive value for the diagnosis of sepsis. Algorithms combining various tests produced slight improvements in sensitivity or specificity. Although the PCT test appeared to be useful for the diagnosis of neonatal sepsis in this small study, it did not offer any significant advantages over traditional tests for the diagnosis of infection.

Laparoscopic study on the microbiology and severity of acute pelvic inflammatory disease

OBJECTIVE To study the microbiologic findings in relation to the severity of acute pelvic inflammatory disease (PID). STUDY DESIGN Of 72 women with acute PID verified and graded by laparoscopy and endometrial histopathology, 37 had mild PID and 35 had severe PID. Cervical, endometrial and tubal cultures were obtained for Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas, facultative and anaerobic bacteria and herpes simplex virus. RESULTS C. trachomatis was the primary pathogenic agent in 44% of patients with acute PID. C. trachomatis and N. gonorrhoea were as common in both severity groups, although C. trachomatis was isolated significantly more frequently from the fallopian tubes among cases with severe PID. Where aerobic or facultative bacteria other than C. trachomatis or N. gonorrhoeae were concerned, Escherichia coli and Haemophilus influenzae were the most important aerobic bacteria isolated from the fallopian tubes. Anaerobic bacteria were recovered from the fallopian tubes significantly more frequently in cases with severe PID than in those with mild PID, whereas their presence in the endometrium was not related to the severity of PID. CONCLUSIONS The role of C. trachomatis as the leading cause of PID was confirmed in both laparoscopically mild and severe PID. Severe PID with abscess is invariably a polymicrobial infection with anaerobic bacteria involved, whereas their role in affecting the outcome of mild PID as well as the need of antianaerobic antimicrobial therapy in mild PID remains questionable.

Serum C-reactive protein determination in acute pelvic inflammatory disease.

We have studied the role of serum C-reactive protein determination in the diagnosis of acute pelvic inflammatory disease. Acute-phase serum C-reactive protein concentration reflected the extent and the severity of pelvic inflammatory disease more closely than erythrocyte sedimentation rate or white blood cell count determinations. We recommend that both C-reactive protein concentration and erythrocyte sedimentation rate should be routinely used to augment the clinical diagnosis of pelvic inflammatory disease.

Epidemiologic and clinical characteristics of pelvic inflammatory disease associated with Mycoplasma hominis, Chlamydia trachomatis, and Neisseria gonorrhoeae.

We studied selected epidemiologic, clinical, serologic, and microbiologic findings and their interrelationships among 57 women with acute pelvic inflammatory disease (PID). Cervical cultures positive for Neisseria gonorrhoeae alone and for both N. gonorrhoeae and Chlamydia trachomatis were associated with young age, nulliparity, and use of birth-control pills. Positive serologic findings for C. trachomatis were associated with the isolation of C. trachomatis and/or N. gonorrhoeae from the cervix and predicted the presence of a pelvic mass. High levels of antibody to Mycoplasma hominis were associated with increasing age and parity, and predicted a low concentration of C-reactive protein (CRP), a long hospital stay, and a high convalescent-phase erythrocyte sedimentation rate (ESR). Women with recurrent PID had higher titers of antibody to C. trachomatis than those with primary PID. The use of an intrauterine contraceptive device predicted high CRP, high acute-phase ESR, long hospital stay, and was frequently associated with positive serologic tests for M. hominis. These results demonstrate that the clinical picture of PID depends not only on the microorganisms involved but also on many epidemiologic factors such as age, contraceptive method, and parity.

Haemophilus influenzae causes purulent salpingitis

We describe two patients with laparoscopically diagnosed, severe acute salpingitis who had nontypable Haemophilus influenzae isolated directly from the fallopian tubes. Nontypable H. influenzae should be recognized as an important genital pathogen.

Microbiology of Bartholin's Duct Abscess

Objective: The aim of the study was to determine the currently most frequent microbial findings in Bartholins duct abscess. Methods: Computerized records of microbial findings of 249 cases of Bartholins duct abscess were retrospectively studied. Results: In 129 cases, only 1 microbe and, in 117 cases, >1 microbe were recovered. In 3 cases, the flora was recorded as normal for the lower genital tract. Of all bacteria isolated, 252 were aerobic or facultative and 108 were anaerobic or microaerophilic. Aerobic or facultative bacteria alone caused 142 (57%) of the 249 cases, Escherichia coli being the most frequent isolate in this group. Anaerobic or microaerophilic bacteria alone caused 33 cases (13%), Bacteroides species and Prevotella species being most frequently identified. Both aerobic or facultative and anaerobic or microaerophilic bacteria were isolated in 70 cases (28%). Candida albicans alone caused 1 case of Bartholins duct abscess. The sexually transmitted pathogens Neisseria gonorrhoeae and Chlamydia trachomatis were both involved in only 2 cases. Conclusions: Bartholins duct abscess was mainly caused by opportunistic bacteria, and sexually transmitted pathogens were only rarely involved in its pathogenesis. Since potentially pathogenic bacterial species were also frequently isolated, the use of antibiotics to complement the surgical treatment of Bartholins duct abscess seems advisable, especially in patients with systemic symptoms.