Susan Alpert

Quantitative determination of antibody to capsular polysaccharide in infection with type III strains of group B Streptococcus.

The development of antibody in response to invasive infection with type III strains of group B Streptococcus was studied in sera from 31 infants and 4 adults by means of a quantitative radioactive antigen-binding assay. Low concentrations of antibody were consistently found in the acute sera of patients who developed clinical illness. Although adults with puerperal sepsis and infants with bone or joint infection uniformly demonstrated significant rises in serum antibody concentration after recovery, much lower levels of antibody were detected in convalescent sera from infants recovering from meningitis or sepsis. The median antibody concentration in sera from 43 parturients with type III strains of group B Streptococcus isolated from vaginal cultures whose neonates failed to develop symptomatic disease was significantly greater than that in sera from 29 mothers of infants with invasive, type III, group B streptococcal infection. Study of paired maternal and cord sera demonstrated a significant correlation between the antibody concentration in a mothers serum and that in her neonate.

Chorioamnionitis and Colonization of the Newborn Infant with Genital Mycoplasmas

To study the role of Mycoplasma hominis and T-mycoplasmas (Ureaplasma urealyticum) in chorioamnionitis, we obtained culture from 249 puerperal women and their babies. The placentas were examined histologically. Infants whose placentas showed inflammation (chorioamnionitis) had cultures positive for T-mycoplasmas more frequently (37.5 per cent) than those with normal placentas (19.0 per cent) (P = 0.021). Colonization with M. hominis was found in 16.0 per cent of the babies and was not significantly associated with chorioamnionitis. Material colonization with mycoplasmas was more frequent (73.4 per cent) and was not correlated with placental inflammation. We conclude that a substantial proportion of cases of chorioamnionitis may be caused by prenatal infection with T-mycoplasmas. The fact that these organisms are not highly virulent could explain the frequent finding of inflammed placentas from otherwise normal pregnacies. No adverse clinical effects of the placental lesions or of mycoplasmal colonization could be detected in this small study.

Acute pelvic inflammatory disease: characteristics of patients with gonococcal and nongonococcal infection and evaluation of their response to treatment with aqueous procaine penicillin G and spectinomycin hydrochloride.

We studied 41 women with acute gonococcal pelvic inflammatory disease and 42 women with acute nongonococcal pelvic inflammatory disease. Women with gonococcal pelvic inflammatory disease were more likely to have become ill during the first 10 days of their menstrual cycle (P < 0.05), presented themselves for treatment sooner (P < 0.05), and were more severely ill than patients with nongonococcal pelvic inflammatory disease (P < 0.05). Patients were treated with aqueous procaine penicillin G or with spectinomycin hydro-chloride for five days. Most of the patients with gonococcal disease responded to treatment. Neither drug, in the dosage employed in this study, was highly effective in the treatment of acute nongonococcal pelvic inflammatory disease. In all, 10 of 21 women with nongonococcal pelvic inflammatory disease and only one of 19 women with gonococcal pelvic inflammatory disease required retreatment for pelvic inflammatory disease within 28 days (P < 0.05). Reexamination an average of 17 months following treatment showed that women who had been treated for nongonococcal pelvic inflammatory disease were more likely to develop recurrent pelvic inflammatory disease if the episode of pelvic inflammatory disease treated in the study was not their first. Women treated for nongonococcal pelvic inflammatory disease were also less likely to become pregnant (P < 0.05). These data, which show that gonococcal and nongonococcal pelvic inflammatory disease differ in initial clinical severity, response to treatment, and long-term complications, support the concept that gonococcal pelvic inflammatory disease and nongonococcal pelvic inflammatory disease are separate clinical entities.

Hepatotoxicity of Erythromycin Estolate During Pregnancy

Women in the second half of pregnancy, who were infected with genital mycoplasmas and who gave written informed consent, were randomly assigned to receive capsules of identical appearance containing erythromycin estolate, clindamycin hydrochloride, or a placebo for 6 weeks. Levels of serum glutamic oxalacetic transaminase (SGOT) were determined before and during treatment by a fluorometric method. All pretreatment levels of SGOT were normal (<41 units). Participants who received erythromycin estolate had significantly more abnormally elevated levels of SGOT (16/161, 9.9%) than did those who received clindamycin (4/168, 2.4%, P < 0.01) or those who received placebo (3/165, 1.8%, P < 0.01). Elevated levels of SGOT ranged from 44 to 130 U. Serum bilirubin levels were normal. Gamma-glutamyl transpeptidase activity was abnormal in six of six participants who had abnormal levels of SGOT while receiving erythromycin estolate. There were few associated symptoms, and all levels of SGOT returned to normal after cessation of treatment. The treatment of pregnant women with erythromycin estolate may be inadvisable.

Anaerobic microflora of the vagina in children

Vaginal cultures from 25 healthy girls from two months to 15 years of age were examined for aerobic, facultatively anaerobic, and obligately anaerobic bacteria. An average of 8.7 species (3.7 aerobic and facultatively anaerobic species; 5.3 obligately anaerobic species) were isolated from these cultures. Staphylococcus epidermidis (21), diphtheroids (20), bacteroides (19), peptococci (19), peptostreptococci (14), and Bacteroides melaninogenicus (14) were most prevalent organisms.

Vaginal colonization with mycoplasma hominis and ureaplasma urealyticum.

Vaginal cultures obtained from unselected young women who consulted the gynecologist in a student health service were examined for Ureaplasma urealyticum and Mycoplasma hominis. Each participant completed a confidential questionnaire. Multiple logistic regression analysis was used to determine which variables, of a large number ascertained, were associated with mycoplasmal colonization. U. urealyticum was isolated from 273 (56.8%) of 481 participants. The following variables were significantly predictive of colonization with U. urealyticum: black race, absence of antibiotic use, cigarette smoking, and number of sexual partners during the last year. Lifetime number of sexual partners was significantly predictive only in women who used nonbarrier methods of contraception. M. hominis was isolated from 85 (17.7%) of the 481 participants. Independent variables that were significantly predictive of colonization with M. hominis included black race, young age, and, for users of nonbarrier methods of contraception, lifetime number of sexual partners.

Microbiological investigation of Bartholin's gland abscesses and cysts.

Percutaneous aspirates from intact Bartholins gland cysts (12) and abscesses (34) were examined for bacteria and genital mycoplasmas. Aspirates from 10 of the 12 patients with Bartholins gland cysts were sterile. Aspirates from the other two cysts contained organisms that are part of the vaginal microbial flora. Of the 34 abscesses, 24 (70.6 per cent) contained bacteria. Eight abscesses contained gram-negative rods in pure culture and four contained gonococci in pure culture. Twelve abscesses contained one or more vaginal organisms including anaerobic gram-negative rods (eight isolates), anaerobic gram-positive cocci (eight), Staphylococcus epidermidis (four), and microaerophilic streptococci (three). Although most of the patients had genital mycoplasmas isolated from vaginal cultures, Mycoplasma hominis was isolated from only one and Ureaplasma urealyticum from none of the aspirates.

Sexually transmitted conditions among women college students

We studied 500 unselected young women who consulted a gynecologist in a student health service. Most participants were symptom-free and had normal physical examinations. Few sexually transmitted infections were encountered. Neisseria gonorrhoeae was recovered from two and Trichomonas vaginalis was obtained from 14 of 500 women. Chlamydia trachomatis was recovered from 20 (4.6%) of 439 participants. Genital warts, genital herpes, and molluscum contagiosum, respectively, were noted in seven, four, and one of the 500 participants. There was no cases of syphilis, scabies, or pediculosis pubis. Mycoplasma hominis and Ureaplasma urealyticum, respectively, were recovered from 17.6 and 56.8% of the subjects. Prevalent vaginal bacteria included lactobacilli, streptococci, Staphylococcus epidermidis, and diphtheroids. Gardnerella vaginalis was isolated from the vaginal specimens of about one third of the participants.

Orogenital contact and the isolation of Neisseria gonorrhoeae, Mycoplasma hominis, and Ureaplasma urealyticum from the pharynx.

Men and women who came to clinics in Boston underwent pharyngeal examinations, and pharyngeal specimens were obtained for cultures for Neisseria gonorrhoeae, Mycoplasma hominis, and Ureaplasma urealyticum. Fifty-one (4.9%) of 1,037 participants had gonococcal pharyngeal infection. M. hominis and U. urealyticum were recovered from the pharynges of 149 (14.3%) and 154 (14.8%) of 1,044 participants, respectively. The history of ever having performed fellatio was associated with pharyngeal infection with N. gonorrhoeae (P < 0.02), M. hominis (P < 0.05), and U. urealyticum (P < 0.006). A history of fellatio was also associated with a history of a recent sore throat. There was, however, no association between pharyngeal infection with N. gonorrhoeae, M. hominis, or U. urealyticum and a recent sore throat. Cunnilingus was not associated with symptoms or signs or pharyngitis or with the isolation of gonococci or genital mycoplasmas from the pharynx. The pharyngitis associated with fellatio remains a microbiologic enigma.

Macrophage T-cell interaction in man: handling of tetanus toxoid antigen by human monocytes.

An absolute requirement for monocytes was demonstrated in the T-cell proliferative response to tetanus toxoid (TT) antigen. Antigen-pulsed monocytes were shown to be effective in triggering T-cell proliferation. Using125I-radiolabeled TT antigen, uptake by monocytes increased progressively over an 18-hr period, at which time 80–85% of the monocytes contained radiolabeled material. The ability of antigen-pulsed monocytes to trigger T-cell proliferation paralleled antigen uptake over an 18-hr period. Monocytes pulsed with antigen, then washed, lost their ability to trigger T-cell proliferation following a 24- to 48-hr culture period. Metabolic inhibitors blocked antigen uptake by monocytes and monocyte triggering of T-cell proliferation. Trypsin treatment of TT-pulsed monocytes did not affect the amount of antigen associated with monocytes or T-cell triggering by monocytes. Anti HLADR alloantibodies, which when added during antigen pulsing of monocytes inhibit the capacity of these monocytes to trigger T-cell proliferation, did not interfere with antigen uptake. These results indicate that human monocytes present antigen to T cells via an active process and in association with DR determinants, and that the immunogenic moiety of antigen does not remain indefinitely available to the T cell.