Claudius P. Jones

Identification of yeastlike organisms isolated from the vaginal tracts of pregnant and nonpregnant women

Abstract Sixty-eight strains of yeastlike organisms have been isolated from the vaginal tracts of 52 pregnant (32 per cent) and 16 nonpregnant (14 per cent) women. These strains have been identified and compared with type species of Benham and Stovall by developing a technique which can be carried out in a routine bacteriologic laboratory and which does not require special mycologic training. The procedures necessary for identification are presented and discussed.

Anaerobic pelvic infections and developments in hyperbaric oxygen therapy

Abstract Seventy-eight patients with vulvovaginal pyogenic lesions and 104 with pelvic infection have been presented. Nonsporulating, obligate anaerobic bacteria were the organisms most commonly isolated from each of the two groups of patients. It is our belief that anaerobic bacteria, which are indigenous to the vulva and vagina, are the organisms most often responsible for acute and chronic infections of the vulva and for chronic salpingo-oophoritis. Conventional surgical therapies have been discussed. Developments in hyperbaric oxygen therapy and its potential for treatment were presented. Problems associated with highpressure oxygen therapy were reviewed, and two illustrative cases reported. Pelvic infections remain a major cause of morbidity, infertility, and mortality in women.

Vulvovaginal mycoses in pregnancy

Abstract 1.1. Cultures of yeastlike fungi from the vaginas and vulvas of 200 pregnant women were positive in 86 (or 43 per cent) of the patients. These fungi belonged to the genera Monilia, Saccharomyces, or Cryptococcus. Sixty-six (33 per cent) of the patients showed positive vaginal cultures; 20 (10 per cent) showed positive labial cultures with negative vaginal cultures. 2.2. A total of 151 strains of yeastlike fungi were classified according to the method previously described by Jones and Martin. Each strain identified as M. albicans was pathogenic for rabbits. Each strain identified as M. stellatoidea was nonpathogenic for rabbits. 3.3. In patients in whom the fungi were identified as belonging to the genera Saccharomyces or Cryptococcus, no symptoms referable to a mycotic infection were described. Symptoms in patients with positive cultures for yeastlike fungi, belonging to the genus Monilia, were found only in those in whom the 3 species, albicans, stellatoidea and (candida) tropicalis were isolated. Although the incidence of trichomonads was higher in the patients from whom M. stellatoidea was cultured, more patients complained of pruritus in the group from which M. albicans was cultured. 4.4. Intradermal skin test with antigens from the 5 species of Monilia showed no correlation between positive cultures and positive intradermal tests. The incidence of Monilia was higher in the group with negative skin tests. 5.5. The presence or absence of agglutinins in the patients serum could not be used as an index of vaginal or labial infection with Monilia. 6.6. Vaginal smear typing showed that monilia were found more frequently in patients with Type 2 smears; that trichomonads were found more frequently in patients with Type 3 smears. 7.7. Additional work must be done on the mycologic flora of the vulva and vagina in normal patients and in patients with mycotic vulvovaginitis, before we may understand the relative pathogenicity of the different genera and species of yeastlike fungi and may evaluate methods of diagnosis and treatment.

THE VAGINAL FUNGI

In the ages of ovarian function the vagina is the normal habitat for saprophytic and potentially pathogenic yeasts and yeastlike fungi.’, Because the same fungi are not found in the vagina of preadolescent and postclimacteric patients, it is probable that the incidence during menstrual life is related to the increased glycogen content of the vaginal mucosa. A higher incidence occurs during pregnancy, and attempts have been made to explain this phenomenon on the basis of higher hormone levels that tend to produce more mucosal glycogen and to increase the average vaginal acidity. Some investigators3 believe that the so-called “renal glycosuria of pregnancy” may be a contributing factor. In citro, the growth of yeasts and yeastlike fungi is stimulated by the addition of glucose. This factor appears to be the logical explanation for the occurrence of vaginal fungi in diabetics of any age group.

Disseminated granuloma inguinale and its relationship to granuloma of the cervix and pregnancy

Abstract 1. A case is presented of granuloma inguinale disseminated by the hematogenous route. 2. To our knowledge this is the first patient with this form of granuloma inguinale successfully treated with tetracycline. 3. All previous well-documented case reports were reviewed. 4. Thus far, all the patients reported have been females. 5. Seven of the 8 patients had known cervical granuloma. The remaining report makes no specific mention of cervical involvement. In only one case is it possible to be certain that pregnancy did not play a part in the hematogenous spread of the disease. 6. Severe constitutional symptoms with marked debility and cachexia are serious features of this sometimes fatal disease.

Nonspore-forming anaerobic bacteria of the vagina.

During the preadolescent and postclimacteric ages the vagina is the normal habitat for bacteria commonly referred to as the nonspore-forming anaerobic group. During menstrual life, the vaginal incidence of these same bacteria depends on the types of patients cultured, on the cultural methods used, and on the incidence of associated vaginal infections. It is also known that nonsporulating anaerobic bacteria represent a large part of the bacterial flora of the lower intestinal tract, and are frequently, if not always, present in the upper respiratory tract. The term nonspore-forming separates these bacteria from the spore-forming anaerobic Clostridia, which are more familiar to most clinicians. The anaerobic cocci are morphologically similar to aerobic cocci and are grouped by Bergeyl with the aerobic cocci in the genera Streptococcus, Micrococcus, Diplococcus, and Neisseria. An additional Gram-negative coccus, which may be of importance, is placed in the genus Veillonella. Bergey’ regards all anaerobic, nonspore-forming, Gram-negative bacilli as species of Bacteroides. Although not recognized by Bergey,’ the Gram-posi live, nonspore-forming, anaerobic bacilli from the vagina and elsewhere are usually regarded as species of Gorynebacterium (diphtheroids). Most American bacteriologists follow Bergey’s’ system of taxonomy and nomenclature, whereas, many European investigators follow a system advocated by Prevot.2 The two groupings are similar, with two major exceptions: first, Prevot recognizes a number of species of Gram-positive, nonspore-forming, anaerobic bacilli. Some of these form gas in culture and produce a fetid odor. For the lack of a better name we have regarded these organisms as anaerobic Corynebacteria. Prevot2 places them in the family Bacteriaceae Cohn emend., under the genera Eubacterium Janke 1930 emend., Catenabacterium Prevot 1938, Ramibacterium Prevot 1938, and Cillobacterium Prevot 1938. The second exception is that Prevot? on the basis of morphology, divided the Bacteroides of Bergeyl into two orders. Species not considered pleomorphic are placed in the order Bacteriales, whereas pleomorphic strains are believed to be closely related to the Actinomycetes, and are placed in the order Actinomycetales. On the basis of morphology, motility, capsule formation and other properties, a number of genera and species has been devised by Prevot. A more complete discussion of Bacteroides was published by Carter et a1.3 in 1953. From the standpoint of practical identification, neither Bergey’s nor Prevot’s groupings of the supposedly adequately studied species are of value to the bacteriologist working in obstetrics and gynecology. This deficiency is due to the fact that much of the work within this field has been done by clinicians or bacteriologists working with a single strain or with small numbers of strains. Emphasis in obstetrics and gynecology, as well as in other fields, has been on naming new species rather than in developing uniform methods applicable to the entire group. Many of the descriptions of the reported species are

Bibliography of Parts Three and Four

Bibliography of Parts Three and Four Bibliographie des 3 et 4 parties Literatur zum dritten und vierten Teil Symposium sur les urétrites non-gonococciques Monaco, 1954, vol. 1, p. 101 (Masson, Paris 1957) Symposium international sur les infestations à trichomonas Reims 1957, vol. 1, p. 381 (Masson, Paris 1958) Ackermann, A.: Derm Z. 71: 132 (1935). Allen, E.: Amer. J. Obstet. Gynec. 30: 565 (1935). – Amer. J. Surg. (1936). – Amer. J. Obstet. Gynec. 45: 246 (1943). – Amer. J. Obstet. Gynec. 51: 387 (1946). Allen, E. and Butler, S.: Amer. J. Obstet. Gynec. 51: 387 (1946). Allison, G. G.: Sth. Amer. J. Med. 36: 82-23 (1943). Appelbaum, E. and Leff, W. A.: J. amer. med. Ass. 138, 119 (1948). Archawsky, M. and Samina, M.: Urologija 13: 255 (1943). Barnes, J.: Les infestations à trichomonas, p. 352 (1957). – Bull. St. fr. Gynec. 28: 222 (1958). Barnes, J.; Boutwood, A,; Haines, E.; Lewington, W.; Lister, E. and Haram, B. J.: Brit. med. J. /; 1160-62 (1957). Barretto, M. P.; Filho, Z. M.; Oliveira, P. M. W.; Medonca, J.; Saguis, J.; Guimaraes, J. and Vila, E.: Rev. Ass. Med. brazil. 4: 126 (1958). Bauer, H.: Derm. Wschr. 115: 49 (1942). – Z. Urol. 5: 224 (1952). – Zbl. Gynäk. 7: 246 (1952). – Derm. Wschr. 136: 37 (1957). – Rapport Sté de Dermatologie, Erlangen 28 juin (1957). – Gynéc. prat. 8: 361 (1957), – Les Infestations à Trichomonas. p. 21 (1957). Baum, H. C.: Med. Clin. N. Amer. 42: 263-65 (1958). Bedoya, J. M.: Gynéc. prat. 8: 403 (1957). – Gynéc. prat. 8: 413 (1957). – Tricomonasis sexual humana. (Facta, Valencia 1959). Bedoya, J. M. and Fdez.Ortega, J. M.: Gynéc. prat. 2: 97 (1958). Bedoya, J. M. and Rios, G.: Geburtsh. Frauenheilk. 10: 989 (1958). Bedoya, J. M., Rios, G. and Rico, L. R.: Geburtsh. Frauenheilk. 8: 990, 994, 997 (1958). Bensen: Arch. Schiffsu. Tropenhyg. 12: 661 (1908). Beric, B. and Miletic, M.: Zborn. Rad. Inst. Fiziol. (Beograd). Trecieg Kongr. Ginek. Jugoslav. (1956). Bieren, S.: Med. Ann. D. C. 22: 17-22 (1953). Bland, P. B. et al: Amer. J. Obst. Gynec. 32: 835 (1936). – J. amer. med. Ass. 115: 1013 (1940). Bland, P. B. and Rakoff, A. E.: Vida nueva 37: 467 (1936). Bonestell: J. Parasit. 22: 511 (1936). Bordo: West. Vener. Dermat. 3: 54 (1957). Bourne, A.: British Obstr. and Gynec. Practice, Vol. 2. (Heinemann, London 1955). Brady, L. and Ried, R. D.: Amer. Surg. 115: 840 (1942). Breindl: cit. par Sebek in Shornik lek. 43: 1 (1941). Brewer, J. I.; Halpern, B. and Thomas, J.: Amer. J. Obstet. Gynec. 74: 834 (1957). 166 Bibliography of Parts Three and Four Bushby, S. R. M.; Catterall, R. D. and Williamson, M.: Brit. med. J. /: 78-80 (1955). Buu-Hoi‚N. P.;Xuong, N. D. and Zajdela, F.: Bull. Soc. Chim. Fr. //-/2.-1591 (1955). Buxton, L.: Obstet. Gynec, N. Y., Vol. 12, 6: (1958). Bykhowsky and Gouchansky: Ann. Mai. vénér. 30: 92 (1935). Candiani, G. B.: La Trichomoniasi vaginale. p. 172 (Salpietra, Florence 1953). – Rev.