RESUMO
BACKGROUND: Low vaccination rates and under-detection of pertussis infections in adolescents and young adults have an impact on the transmission of pertussis to infants. In this study, the proportion of adolescents and young adults with IgG antibodies against B. pertussis antigens, representing recent infection or vaccination, was estimated in a population-based probabilistic survey in Mexico. METHODS: Sera and data from 1,581 subjects, including 1,102 adolescents and 479 young adults (10-19 and 20-25 years old, respectively) randomly selected from Mexico's 2012 National Health and Nutrition Survey, were analyzed. IgG antibodies against pertussis toxin (PT) were measured with the CDC/FDA ELISA. A subset of 234 samples was additionally tested with Bp-IgG PT ELISA kit (EUROIMMUN AG, Lubeck, Germany). Threshold values from corresponding test kits were used to identify recent infection or vaccination. RESULTS: Overall anti-PT IgG seroprevalence was 3.9% (95% CI: 2.3-6.3); 3.1% (95% CI: 1.9-5.0) in adolescents, and 4.9% (95% CI: 2.2-11) in young adults. Seroprevalence did not significantly vary by sex, socioeconomic status, region or rural/urban location. Compared to the CDC/FDA ELISA, the EUROIMMUN test showed a 76% sensitivity and 88% specificity. The weighted estimates represent a considerable burden of recent infection in adolescents and young adults; however, most adolescents and adults were seronegative and, therefore, susceptible to pertussis infection. CONCLUSION: Since booster vaccination to B. pertussis after toddlerhood is not recommended in the Mexican national policy, anti-PT IgG seropositivity may be reasonably attributed to recent infection. Assessing pertussis seroprevalence requires careful consideration of the diagnostic test threshold interpretation and epidemiological model used.
Assuntos
Bordetella pertussis , Coqueluche , Adolescente , Humanos , Lactente , México/epidemiologia , Inquéritos Nutricionais , Estudos Soroepidemiológicos , Coqueluche/diagnóstico , Coqueluche/epidemiologia , Adulto JovemRESUMO
Methicillin-resistant Staphylococcus aureus (MRSA) isolates (n = 216), collected between January 1999 and May 2003 in a tertiary-care university hospital in Guadalajara, Mexico, were characterised by antibiotype, pulsed-field gel electrophoresis (PFGE) of SmaI macrorestriction fragments, and hybridisation of ClaI digests with mecA- and Tn554-specific DNA probes. Representatives of the single clonal type found were analysed by spa typing, multilocus sequence typing and staphylococcal chromosomal cassette mec (SCCmec) typing, and were tested for the presence of 22 virulence determinants and agr type. A single PFGE pattern was identified, with minor variations over time, with spa type 2, sequence type 5, SCCmec type II, agr type 2 and the presence of the enterotoxin genes seg and sei, the gamma-haemolysin variant gene hlg-v and the leukocidin lukE-lukD genes. In addition, the isolates showed antimicrobial resistance to beta-lactams, macrolides, chloramphenicol and imipenem, and susceptibility to gentamicin, rifampicin, trimethoprim-sulphamethoxazole and vancomycin. Following its appearance in 1997, this clone spread within the hospital, and is now present in most of the hospital units and wards.
Assuntos
Hospitais Universitários , Resistência a Meticilina , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Criança , Pré-Escolar , DNA Bacteriano/análise , Eletroforese em Gel de Campo Pulsado , Genótipo , Humanos , Lactente , México/epidemiologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fenótipo , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/patogenicidade , Virulência/genéticaRESUMO
Between 1997 and 2000 a single multidrug-susceptible methicillin-resistant Staphylococcus aureus clone, M (sequence type 30 [ST30]-staphylococcal cassette chromosome mec [SCCmec] type IV), was present in a pediatric hospital in Mexico City, Mexico. In 2001 the international multidrug-resistant New York-Japan clone (ST5-SCCmec type II) was introduced into the hospital, completely replacing clone M by 2002.
Assuntos
Resistência a Meticilina/genética , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/isolamento & purificação , Criança , Eletroforese em Gel de Campo Pulsado , Hospitais Pediátricos , Humanos , México/epidemiologia , Filogenia , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/classificação , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Virulência/genéticaRESUMO
BACKGROUND: Since 1993 the Pan American Health Organization has coordinated a surveillance network with the National Reference Laboratories of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay aimed at monitoring capsular types and antimicrobial susceptibility of Streptococcus pneumoniae causing invasive disease in children <6 years of age. METHODS: The surveillance system included children 6 years of age and younger with invasive disease caused by S. pneumoniae. The identification, capsular typing and susceptibility to penicillin of the isolates were conducted using a common protocol, based on standard methodologies. RESULTS: By June, 1999, 4,105 invasive pneumococcal isolates had been collected mainly from pneumonia (44.1%) and meningitis (41.1%) cases. Thirteen capsular types accounting for 86.1% of the isolates (14, 6A/6B, 5, 1, 23F, 19F, 18C, 19A, 9V, 7F, 3, 9N and 4) remained the most common types during the surveillance period. Diminished susceptibility to penicillin was detected in 28.6% of the isolates, 17.3% with intermediate and 11.3% with high level resistance. Resistance varied among countries and increased during this period in Argentina, Colombia and Uruguay. Serotypes 14 and 23F accounted for 66.6% of the resistance. CONCLUSION: These surveillance data clearly demonstrate the potential impact of the introduction of a conjugate vaccine on pneumococcal disease and the need for more judicious use of antibiotics to slow or reverse the development of antimicrobial resistance.
Assuntos
Resistência às Penicilinas , Penicilinas/administração & dosagem , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pneumoniae/efeitos dos fármacos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , México , Penicilinas/uso terapêutico , Vigilância da População , Garantia da Qualidade dos Cuidados de Saúde , Controle de Qualidade , Sorotipagem , América do Sul , Streptococcus pneumoniae/classificaçãoRESUMO
During a surveillance study to determine the relative prevalence of capsular types of Streptococcus pneumoniae and antimicrobial susceptibility of invasive isolates in children <5 years old in Mexico City, 220 isolates were collected. The serotype 23F was the most common found, followed by types 6A + B, 14, 19F, and 19A. Diminished susceptibility to penicillin was detected in 106 isolates (48.2%), and high penicillin resistance was found in 49 strains (22.2%), 31 belonging to type 23F. Resistance was also observed to erythromycin (13.1%), to chloramphenicol (43.1%), and to cefotaxime (10.9%). No strains were resistant to ofloxacin or vancomycin. Forty-four of the highly penicillin resistant isolates (penicillin MIC > or =2.0 microg/ml) were examined with molecular fingerprinting techniques; 29 (65.9%) of these isolates (all except two strains) were serotype 23F and shared subtype variants of PFGE type A characteristic of the internationally spread Spanish/USA clone of S. pneumoniae. These strains were also resistant to trimethoprim/sulfametoxasole (TMP/SMX), chloramphenicol, and tetracycline, and most of them were susceptible to erythromycin. Another 6 of the highly penicillin-resistant strains (serogroups 9 and 14) showed PFGE fingerprints and antimicrobial susceptibility pattern characteristic of a second internationally spread clone (French/Spanish clone) and carried resistance to penicillin and TMP/SMX. The rest of the 9 penicillin-resistant isolates were represented by 7 distinct additional PFGE types. The findings suggest that almost 80% of all highly penicillin resistant strains may have been "imported" into Mexico.
Assuntos
Resistência a Múltiplos Medicamentos/genética , Infecções Estreptocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Pré-Escolar , Resistência Microbiana a Medicamentos/genética , Eletroforese em Gel de Campo Pulsado , Humanos , México/epidemiologia , Testes de Sensibilidade Microbiana , Sorotipagem , Infecções Estreptocócicas/epidemiologia , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/genéticaRESUMO
As part of the Sistema Regional de Vacunas (SIREVA) initiative, we conducted a surveillance study to determine the relative prevalence of capsular types of Streptococcus pneumoniae and antimicrobial susceptibility of invasive isolates in children less than 5 years old. We collected 220 isolates and found 33 of the 90 known types, with type 23F as the most common followed by types 6A+B, 14, 19F, and 19A. High penicillin resistance was found in 49 strains (22.2%), 31 belonging to type 23F. Twenty-nine (13.1%) were resistant to erythromycin, 95 (43.1%) were resistant to chloramphenicol, and 24 (10.9%) were resistant to cefotaxime. No strains were resistant to vancomycin.
Assuntos
Resistência Microbiana a Medicamentos , Streptococcus pneumoniae/efeitos dos fármacos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , México/epidemiologia , Testes de Sensibilidade Microbiana , Vigilância da População , Sorotipagem , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
Due to the changes in the frequency of penicillin-resistant strains of S. pneumoniae, it is necessary to perform surveillance studies of bacterial resistance. Isolates from the upper respiratory tract of asymptomatic children have been useful. There is no information about the difference between isolates from children with and without upper respiratory tract infection (URTI). The objective of the authors in this paper is to establish the prevalence of carrier-state, serotype and antimicrobial resistance of S. pneumoniae isolates from children with and without acute upper respiratory tract infection (URTI) in a rural area in Mexico. A cross-sectional comparative study was performed in Tlaxcala, Mexico. Children from one month 5 years of age were included. Nasopharyngeal swabs were obtained. Identification was done by international microbiology standards. Serotyping was done by the capsular Quellung test. The susceptibility testing was performed by the agar dilution method. Four-hundred and fifty patients were included. S. pneumoniae was isolated in 134 children (29.7%). Frequency of carriers was greater in patients with URTI (107/323) than without URTI (27/127) (33.1% vs. 21.1% p = 0.012, OR 1.84, IC 95% 1.1-3.08). The six most frequent serotypes were: 6B (16.4%); 19F (11.9%); 19A (6.7%); 14, 23F, and 35 (5.2% each), with no difference among the groups. Only 3% of the strains had high level resistance to penicillin, and 12.6% had intermediate resistance, and for ampicillin 4%, amoxicillin 4%, amoxicillin-clavulanate 4%, ceftriaxone 3%, cefotaxime 1.5%, erythromycin 6%, miocamycin 3%, chloramphenicol 4%, and vancomycin 0%. Trimethoprim-sulfamethoxazole resistance was very high (42%). In conclusion, colonization is higher in children with URTI. Five of the most frequent serotypes identified in this study were the same as those identified in patients with S. pneumoniae invasive diseases in Mexico City. In Tlaxcala, Mexico, beta-lactams could be the drug of choice for the treatment of S. pneumoniae lower respiratory tract infections. It is necessary to perform clinical assays to evaluate the efficacy of trimethoprim-sulfamethoxazole due to the high resistance in vitro.
Assuntos
Antibacterianos/farmacologia , Nasofaringe/microbiologia , Resistência às Penicilinas , Infecções Pneumocócicas/microbiologia , Infecções Respiratórias/microbiologia , População Rural , Streptococcus pneumoniae/efeitos dos fármacos , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Pré-Escolar , Estudos Transversais , Humanos , Lactente , Testes de Sensibilidade MicrobianaRESUMO
Eight-three isolates of Streptococcus pneumoniae obtained from children hospitalized with several infections in Mexico City and Cuernavaca, and from healthy children attending a day-care center in Cuernavaca, from January to September 1992, were screened for antimicrobial resistance patterns by in vitro susceptibility testing against antimicrobial agents of potential use in the treatment of diseases caused by S. pneumoniae (39 infected patients and 44 from healthy children). 21.6% of strains were resistant to penicillin, 52% of the strains were multiresistant without a commun pattern. Children attending a day-care center had a higher rate of S. pneumoniae strains resistant to one or more antimicrobial than hospitalized children. Serotypes or serogroups 6, 23F, 14 and 19 were most prevalent. There are evidence that strain 23F has an intercontinental link, this strain is associated with disseminated diseases and multiresistance to antimicrobials. The results indicate that changes can occur in the susceptibility of S. pneumoniae and that selective susceptibility testing and epidemiologic studies in hospitalized patients and children in day-care centers are necessary.
Assuntos
Portador Sadio/microbiologia , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacos , Antibacterianos/farmacologia , Portador Sadio/epidemiologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Humanos , México/epidemiologia , Testes de Sensibilidade Microbiana/métodos , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Nasofaringe/microbiologia , Infecções Pneumocócicas/epidemiologia , Sorotipagem/estatística & dados numéricos , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
This study sought to define the prevalence rates of human papillomavirus (HPV) infection and cytologic abnormalities in 3,257 sexually active females 13 to 45 years of age, undergoing routine cervical cytologic screening in the outpatient clinic of an urban hospital. One hundred and fifty patients (4.6%) showed cytologic evidence of cervical human papillomavirus infection (abnormal Pap). We selected a control group (n = 150) with negative cervical cytologic smears. Cells collected were analysed for HPV-DNA by PCR amplification method with probes for HPV types 6.11, 16.18 and 33. The HPV-DNA was detected in 21/300 (7.0%). The prevalence of cervical HPV-DNA types among women with negative cytology was 5.3% (8/150) and 8.6% (13/150) among women with abnormal Pap. The risk of HPV infection seems to be related with age at first intercourse, younger age and number of sexual partners. We did not find relation with the use of oral contraceptives smoking and history of prior sexually transmitted disease.
Assuntos
Papillomaviridae , Infecções por Papillomavirus/patologia , Infecções Tumorais por Vírus/patologia , Esfregaço Vaginal , Adulto , Sequência de Aminoácidos , Sequência de Bases , Estudos de Casos e Controles , DNA Viral/genética , Feminino , Genótipo , Humanos , México/epidemiologia , Dados de Sequência Molecular , Papillomaviridae/genética , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/microbiologia , Prevalência , Prognóstico , Infecções Tumorais por Vírus/epidemiologia , Infecções Tumorais por Vírus/microbiologiaRESUMO
The antimicrobial activity of the colostrum serum from ten women has been evaluated. The activity against Escherichia coli, Shigella sonnei and Klebsiella pneumonia at three different bacterial populations was determined (1 x 10(4), 1 x 10(5) and 1 x 10(6) UFC/ml). Antimicrobial activity against the three strains was found. Bactericidal activity was observed to inocula of 1 x 10(4) UFC/ml in 8/10 sera against E. coli, in 6/10 sera against S. sonnei, and in 3/10 sera against K. pneumonia; in the rest of the cases, sera were bacteriostatic. With inocula of 1 x 10(5) UFC/ml there was bactericidal activity in 4/10 sera against E. coli and S. sonnei and in 1/10 against K. pneumonia. Lastly, with inocula of 1 x 10(6) UFC/ml there was bactericidal activity in 4/10 sera against E. coli, 1/10 against S. sonnei and none against K. pneumoniae. The results suggest that because of the antimicrobial properties of human milk the risk of intestinal infections by enteropathogens is less.
Assuntos
Colostro/fisiologia , Escherichia coli , Klebsiella pneumoniae , Shigella sonnei , Contagem de Colônia Microbiana , Escherichia coli/crescimento & desenvolvimento , Feminino , Humanos , Klebsiella pneumoniae/crescimento & desenvolvimento , Período Pós-Parto , Shigella sonnei/crescimento & desenvolvimentoRESUMO
In order to know the prevalence of antibodies to cytomegalovirus in healthy women, we conducted a seroimmunological survey among 1,885 women, ages 13 to 44 years old, living in a suburban area of Cuernavaca City. Overall, 91.6 per cent of women were seropositive and 8.4 per cent seronegative. The prevalence was not significantly different among women of different ages. Nine out of 10 persons already had antibodies at age 14. One out of ten 15-20 years old women represent the maximum risk of primary infection and, at the same time they represent the population with greatest possibilities of getting pregnant. We found a strong relationship of low education, low income, promiscuity, house without public services and early onset of sexual activity with the presence of antibodies to cytomegalovirus. The risk of exposure to primary infection decreases as these epidemiological markers improve.
Assuntos
Anticorpos Antivirais/sangue , Infecções por Citomegalovirus/epidemiologia , Citomegalovirus/imunologia , Adolescente , Adulto , Infecções por Citomegalovirus/prevenção & controle , Feminino , Humanos , México/epidemiologia , Prevalência , Estudos Soroepidemiológicos , Fatores Socioeconômicos , Saúde da População UrbanaRESUMO
For this prospective study, 284 women were recruited who attended a cancer detection (Papanicolaou testing) program and appeared to be healthy. The objective was to obtain cervicovaginal samples from this group and culture them on human foreskin fibroblasts to isolate and identify Herpes simplex virus by immunofluorescence with monoclonal antibodies. A total of 12 women (4.2%) were positive for the virus; upon comparison of various sociodemographic factors in positive and negative culture patients, it was possible to establish certain associations as follows: The presence of Herpes simplex virus type 2 was related to age, start of sexual life, number of sex partners, lower education and minimum income. Other markers observed in infected women were mucopurulent cervicitis, typical and non-typical confluent ulcerations and minor disruptions of the epithelium. The knowledge of this subclinical or somewhat asymptomatic Herpes prevalence should be considered to prevent further spread among couples and also to avoid the risk of reactivation in pregnant women.
Assuntos
Neoplasias dos Genitais Femininos/diagnóstico , Infecções por Herpesviridae/diagnóstico , Adulto , Instituições de Assistência Ambulatorial , Feminino , Imunofluorescência , Neoplasias dos Genitais Femininos/prevenção & controle , Infecções por Herpesviridae/epidemiologia , Humanos , Programas de Rastreamento , México/epidemiologia , Teste de Papanicolaou , Simplexvirus/isolamento & purificação , Esfregaço VaginalRESUMO
The chlamydiae are a genetically diverse group of bacteria with a unique intracellular development cycle. The spectrum of clinical manifestations of Chlamydia trachomatis infections in the female includes cervicitis, acute urethral syndrome, pelvic inflammatory disease, salpingitis and the risk of exposure of infants born through an infected birth canal who may develop inclusion conjunctivitis and/or pneumonia. In order to determine the prevalence of cervicovaginal infections caused by C. trachomatis in female population in Cuernavaca, Morelos, we studied 2,407 sexually active women from a suburban area. Genital specimens were collected from each woman and cultured in McCoy cell monolayers. Detection of the bacteria was done by staining with fluorescein-conjugated monoclonal antibodies (Syva Microtrak, Palo Alto CA). 97 of them were culture-positive for C. trachomatis, with and overall prevalence of 4.02 per cent. The most important clinical symptom observed in 47 of the infected patients was an increased or altered vaginal discharge.
Assuntos
Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Adolescente , Adulto , Chlamydia trachomatis/isolamento & purificação , Feminino , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Doenças do Colo do Útero/epidemiologia , Doenças do Colo do Útero/microbiologia , Doenças Vaginais/epidemiologia , Doenças Vaginais/microbiologiaRESUMO
Group B Streptococcus (GBS) causes maternal infections during perinatal period and serious neonatal infections. Their frequency in our country is still unknown. This study analyzed the clinical and epidemiological characteristics of 13 neonates inborn at the Instituto Nacional de Perinatología with early or late onset group B streptococcal infection. The incidence of early onset diseases (EOGBS) was 0.7 cases/1,000 live births among 20,054 inborn, and 1 case/20,000 live births of late onset diseases. EOGBS was more common in preterm newborn (median 33.2 w), low birth weight (median 2.025 g) with several maternal risk factors. Lethality rate was 38.5% (5/13). GBS is a recent important pathogen in our institute that must be investigated in another institution of our country. Group B Streptococcus; neonatal septicemia; neonatal pneumonia.
Assuntos
Doenças do Prematuro/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Feminino , Humanos , Recém-Nascido , Masculino , Meningite/microbiologia , Pneumonia Estafilocócica/microbiologia , Estudos Prospectivos , Fatores de Risco , Sepse/microbiologiaRESUMO
Listeria monocytogenes is a gram positive cocco-bacillus which causes perinatal infections and also attacks immunocompromised hosts. Little is known about it in our medium. As part of a prospective study on neonatal systemic infections, its participation at the National Institute of Perinatology was researched. During a period of 18 months, 9,283 live newborns were observed, 141 of them were diagnosed with neonatal septicemia. During this period seven neonates had systemic infections due to Listeria monocytogenes: three had septicemia (two of these with meningitis) and all seven cases had pneumonia. The gestational age of the neonates was 26.1 to 41 weeks (X + DS = 35 + 4.3), with a weight of 830 g to 2,975 g (X + DS 1,958 + 773), four out of seven weighed less than 2,000 grams. The most frequent clinical manifestation was respiratory related causing a need for a differential diagnosis with hyaline membrane disease, transitory tachypnea and meconium swallowing at birth. All of the strains isolated were found to be susceptible to ampicillin, penicillin, gentamicin and amikacin; requiring high CMI levels of cephalosporins.
Assuntos
Listeriose/complicações , Humanos , Recém-Nascido , Listeriose/microbiologia , Testes de Sensibilidade MicrobianaRESUMO
A prospective study was carried out in which quantitative clean-voided urine cultures, were obtained at the first clinic visit from 986 consecutive pregnant women, followed to delivery to assess the maternal and pediatric finding associated with maternal asymptomatic bacteriuria. Patients to be evaluated were divided in two groups: Treatment group (TG) with 42/46 patients that were treated with nitrofurantoin 100 mg a day during 10 days, and control group (CG) with 45/46 patients that were not treated. Patients who failed were given a second course of nitrofurantoin. The patients who remained infected were given further treatment (cephalexin). Primary treatment was successful in 85%, 10% more with the second course and 5% were failure treatment. There was a highly significant difference in the incidence of symptomatic bacteriuria (pyelonephritis), premature deliver, prematurity and other perinatal events in patients with persistent infection. Eradication of asymptomatic bacteriuria reduced the risk of pre-term deliveries and lower infant birth weights for gestational age.
Assuntos
Bacteriúria/microbiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções Urinárias/prevenção & controle , Doença Aguda , Adolescente , Adulto , Bactérias/isolamento & purificação , Bacteriúria/tratamento farmacológico , Bacteriúria/epidemiologia , Avaliação de Medicamentos , Feminino , Humanos , México/epidemiologia , Nitrofurantoína/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologiaRESUMO
A prospective study was carried out in 103/863 obstetric patients with cystitis characterized by urinary urgency and frequency, dysuria, pyuria and suprapubic discomfort in the absence of systemic symptoms such as fever and costovertebral angle tenderness. The association of symptomatic lower urinary tract infection with low-count bacteriuria (10(2)-10(5) UFC/mL of urine) was present in all the patients. The incidence of cystourethritis was about 12%, most of the infections occurred at the first trimester. To learn whether a multiple-dose of nitrofurantoin or ampicillin is safe and effective therapy for acute uncomplicated urinary tract infections, 103 symptomatic pregnant women were randomly grouped to receive oral nitrofurantoin (100 mg t.i.d.) or ampicillin (500 mg t.i.d.) for five days. Seventeen patient were excluded since they did not return for follow-up. Escherichia coli was isolated in 67% of infections. Overall cure varied from 87% to 89%, without any great differences between the regimens. Nine patients had asymptomatic bacteriuria in the course of pregnancy, four developed acute pyelonephritis and one of them had abnormal intravenous pyelogram.
Assuntos
Cistite/diagnóstico , Complicações na Gravidez/diagnóstico , Uretrite/diagnóstico , Doença Aguda , Ampicilina/administração & dosagem , Bacteriúria/diagnóstico , Bacteriúria/tratamento farmacológico , Bacteriúria/microbiologia , Cistite/tratamento farmacológico , Cistite/microbiologia , Feminino , Humanos , Nitrofurantoína/administração & dosagem , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/microbiologia , Estudos Prospectivos , Recidiva , Uretrite/tratamento farmacológico , Uretrite/microbiologiaRESUMO
The association of infection with Chlamydia trachomatis and cytologic changes on Papanicolaou smear was examined in 453 sexually active postmenarcal female subjects attending the cytology service for routine Papanicolaou smear. We described inflammatory and epithelial cell patterns that permit the detection of group of women with and without cervicitis at high risk for cervical chlamydial infection. We confirmed the infection by direct immunofluorescence using monoclonal antibodies. Ninety-five of 453 women had cervicitis (20.9%) chlamydial inclusions were noted by Papanicolaou in 26 patients with cervicitis and in 61 without cervicitis. Direct stain with fluorescein-conjugated monoclonal antibodies demonstrated elementary bodies of C. trachomatis in 42/453 women, 24 had cervicitis and 18 without cervicitis. One of two patients with cervical smears with chlamydial inclusions as "changes suggestive of chlamydial infection" by Papanicolaou was confirmed by inmmunofluorescence. We calculated the efficay of the Papanicolaou smear as a diagnostic technique: the sensitivity was 0.27, the specificity was 0.80, the predictive value of o positive test was 0.29. In order to compare the efficiency with immunofluorescence the sensitivity was 0.25, specificity 0.94 and the positive predictive value was 0.57. Using the epithelial changes interpreted as inflammatory, we had the highest sensitivity with both tests, 0.76 to Papanicolaou and 0.90 to immunofluorescence, specificity is near 100% for both tests, cytology tended to be more efficient in identifying women without infection than in identifying those with infection.