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Biomedical subjects

R C Brunham

Publications and source records attributed to R C Brunham.

At least 109 records · Page 6Linked to original sources
PubMed1988

Screening for Chlamydia trachomatis infection in a pregnancy counseling clinic.

Five hundred twenty asymptomatic women attending a pregnancy counseling clinic were interviewed and screened for cervical Chlamydia trachomatis infection before therapeutic abortion. Overall, 56 (10.8%) women were culture positive for C. trachomatis. Restricting testing to women with risk factors for infection or who had cervical leukocytosis on Gram staining of cervical mucus, or who were seropositive for C. trachomatis antibodies proved impractical because of insensitivity or nonspecificity. We evaluated three chlamydia diagnostic tests to determine which test had the best performance characteristics. In comparison with culture, the direct fluorescent antigen test had a sensitivity of 89% and a positive predictive value of 78%, whereas the enzyme immunoassay had 96% and 69%, respectively. When analysis was redone with any two positive laboratory tests to define true infection status, the performance parameters of enzyme immunoassay were sensitivity 98%, specificity 98%, and positive predictive value 87%. We conclude that all women undergoing therapeutic abortion require testing for C. trachomatis infection and that enzyme immunoassay is the most effective and practical test in this group of women.

Abortion Applicants↗
PubMed1988

Etiology and outcome of acute pelvic inflammatory disease.

We studied 71 women with the clinical diagnosis of acute pelvic inflammatory disease (PID) by laparoscopy and comprehensive microbiology in order to define the major etiologic determinants of poor fertility prognosis after tubal infection. Fifty women were found to have acute PID. Of the 50 women, 23 were pregnancy seeking and had a subsequent evaluation to determine fertility outcome. Seven of 13 women with non-gonococcal infection had an adverse reproductive outcome, compared with none of 10 women with gonococcal infection (P = .007). Two groups of causes for adverse reproductive outcome were found. Of the seven infertile women, four had initial tubal abscess, and three had evidence of Chlamydia trachomatis infection. This study directly documents the poor fertility prognosis for women with tubal abscess and suggests that women with culture and/or serological evidence of chlamydial infection also have a poor fertility prognosis.

Abscess↗
PubMed1988

Infection and disease after perinatal exposure to Chlamydia trachomatis in Nairobi, Kenya.

A cohort of 49 infants exposed to maternal chlamydial infection and 40 nonexposed infants was studied after birth for a mean of 3.3 +/- 1.5 and 3 +/- 1.7 mo, respectively. Eighteen (37%) exposed infants had at least one positive culture for Chlamydia trachomatis, whereas C. trachomatis was not isolated from any of the nonexposed infants. Eighteen (37%) exposed infants developed ophthalmia neonatorum (n = 12) or infant conjunctivitis (n = 7), compared with six (15%) of the nonexposed infants (P = .04). Six (12%) exposed infants developed pneumonia, compared with none of the 40 nonexposed infants (P = .05). One infant in the exposed group died during follow-up. These results suggest that appreciable infant morbidity in Kenya may be associated with the high prevalence of maternal chlamydial infection.

Chlamydia Infections↗
PubMed1988

Microbial aetiology and diagnostic criteria of postpartum endometritis in Nairobi, Kenya.

Using a protected triple lumen device, Neisseria gonorrhoeae or Chlamydia trachomatis, or both, were isolated from the endometriums of five out of 35 women with clinical postpartum endometritis compared with none of a control group of 30 puerperal women without endometritis (p less than 0.05) in Nairobi, Kenya. These sexually transmitted agents were also found in 12 cervical specimens from women with and three without postpartum endometritis (p = 0.04). Mycoplasma hominis and Ureaplasma urealyticum were equally isolated from the endometrium in both groups. Histology showed plasma cell infiltration in 6/25 patients compared with 1/22 controls (p = 0.06). A history of foul lochia (p less than 0.01) and abdominal pain (p = 0.02) were associated with postpartum endometritis. Sexually transmitted agents appear to be major causes of puerperal upper genital tract infections in Nairobi.

Adult↗
PubMed1988

Characterization of Chlamydia trachomatis antigens with monoclonal and polyclonal antibodies.

We used monoclonal antibodies (MAbs) to examine the antigenic specificity and biologic function of several Chlamydia trachomatis antigens. Thirteen distinct MAbs to eight C. trachomatis antigens were produced. Six MAbs reacted with unique epitopes on the major outer membrane protein (MOMP) and two of these had neutralizing activity. MAbs were produced to each of the chlamydial antigens with molecular masses of 10, 29, 32, 57, 60, 70, and 75 kilodaltons (kDa). These MAbs showed species and genus specificity in an immunoblot assay. None of the MAbs had neutralizing activity. The epitopes recognized on MOMP, 29-, and 10-kDa (presumably lipopolysaccharide) antigens were surface exposed. MAbs to the 75-kDa, 57-kDa, and MOMP antigens were used for immunoaffinity purification of these antigens to produce monospecific antisera in mice. With polyclonal sera, we found that the 75-kDa antigen was also immunoaccessible and that antibody to MOMP and 75-kDa antigens neutralized C. trachomatis infectivity. We conclude that, in addition to MOMP and lipopolysaccharide, antigens with molecular masses of 75 and 29 kDa are surface exposed. Antibodies to MOMP and 75-kDa antigens can neutralize the organism in vitro.

Animals↗
PubMed1987

Enhanced susceptibility of trypsinized HeLa cells to Chlamydia trachomatis infection.

An improved cell culture method for the recovery of Chlamydia trachomatis from clinical samples was evaluated. Freshly trypsinized HeLa 229 cells were infected in suspension culture and compared to a standard monolayer culture method. Among 1085 specimens evaluated, 84 were positive by both methods, 978 were negative by both methods, 2 were positive by the monolayer method only, and 21 were positive by the suspension method only. Inclusion counts were two-fold higher in the suspension culture method than in the monolayer method (p less than .001). It is concluded that freshly trypsinized HeLa 229 cells infected in suspension culture are more susceptible to infection with Chlamydia trachomatis than standard monolayer cells.

Bacteriological Techniques↗
PubMed1987

Postabortal Chlamydia trachomatis salpingitis: correlating risk with antigen-specific serological responses and with neutralization.

Serum antibodies to Chlamydia trachomatis were studied by microimmunofluorescence (micro-IF) testing and by immunoblotting among 52 women with C. trachomatis cervical infection. All women underwent therapeutic abortion, and 10 (19.2%) subsequently developed laparoscopically confirmed salpingitis. Women who developed salpingitis had lower geometric mean titers of micro-IF antibody before abortion (14.9 x/divided by 2.3) than did women who did not develop salpingitis (41.6 x/divided by 4.9, P less than .01). Women who developed salpingitis significantly less often had serum IgA antibodies to a 60-kilodalton (kDa) chlamydial antigen (P = .02) and IgG antibodies to antigens of 75-kDa (P = .008), 60-kDa (P = .03), and 57-kDa (P = .0003). Serum antibodies to 100-kDa, 32-kDa, and 29-kDa antigens occurred only in women who did not develop salpingitis. Differences in antibody prevalence to specific chlamydial antigens were not due to differences in serum antibody titers between the two groups. No correlation between neutralizing sera and the risk of postabortal salpingitis was detected.

Abortion, Therapeutic↗
PubMed1987

Postpartum upper genital tract infections in Nairobi, Kenya: epidemiology, etiology, and risk factors.

We investigated the frequency of clinically defined upper genital tract infection (UGTI) and its relation to sexually transmitted diseases and other risk factors among 1,013 women initially studied while in labor at a Nairobi, Kenya maternity hospital. Women were enrolled during labor and followed up at seven days and one month postpartum. Cultures for Neisseria gonorrhoeae and Chlamydia trachomatis were done at enrollment and at day 7. The prevalence of gonococcal and chlamydial infections was 6.7% and 20.8%, respectively. The overall prevalence of UGTI was 20.3%. The development of UGTI was significantly correlated with gonococcal infection (odds ratio, 4.4; P less than .0001), chlamydial infection (odds ratio, 1.7; P less than .02), presence of ophthalmia neonatorum (odds ratio, 2.6; P less than .0001), labor greater than 12 hr (odds ratio, 1.8; P less than .01), and area of residence (odds ratio, 1.5; P less than .05). Postpartum UGTI, an enormous public health problem in Nairobi, would be partially susceptible to antenatal intervention programs focusing on sexually transmitted diseases.

Chlamydia Infections↗
PubMed1987

Epidemiology of an outbreak of infectious syphilis in Manitoba.

An outbreak of 82 cases of infectious syphilis (primary, secondary, and early latent) which occurred in 1984 in the province of Manitoba was analyzed by age, sex, geographic distribution, and stage of disease. In the preceding four years, from 1980-1983, there were 19, 24, 13, and 32 cases, respectively, of infectious syphilis, of which 89% involved males. Compared with 1983, the overall crude incidence rate in 1984 increased by 259%, from 2.9 to 7.5/100,000 population, with a peak incidence in the 25- to 29-year age group of 25.8/100,000 population. This increase was predominantly due to a striking increase in incidence in females which rose 6.3-fold, from 0.4 to 2.5/100,000 females, compared with a 2.3-fold increase in males. This increase was accompanied by a decline in the male-to-female ratio, from 15.0 to 4.9. Of the 68 males, 45 named women as their sexual contacts. Females were 2.4 times more likely to present with early latent disease, whereas males were 7.0 times more likely to present with primary disease (p less than 0.01). There was clustering in suburban locations with regard to clinical presentation (60% primary disease) and overall incidence (46% of all cases). These data suggest the occurrence of a major change in the epidemiology of syphilis in the province of Manitoba, with a shift from homosexual to heterosexual transmission.

Adolescent↗
PubMed1987

In vitro activity of ceftriaxone, cefetamet (Ro 15-8074), ceftetrame (Ro 19-5247; T-2588), and fleroxacin (Ro 23-6240; AM-833) versus Neisseria gonorrhoeae and Haemophilus ducreyi.

We examined 300 strains of Neisseria gonorrhoeae and 100 strains of Haemophilus ducreyi to determine their in vitro susceptibility to two new cephalosporins, cefetamet (Ro 15-8074) and ceftetrame (Ro 19-5247; T-2588), and a new fluroquinolone, fleroxacin (Ro 23-6240; AM-833). Their activity was compared with that of ceftriaxone, penicillin, spectinomycin, tetracycline, and erythromycin. Cefetamet, ceftetrame, and fleroxacin had excellent in vitro activity against both groups of microorganisms. beta-Lactamase production did not significantly affect the MICs of these agents. The Mtr phenotype of N. gonorrhoeae raised the MICs two- to fourfold, but the MICs remained within the range of achievable levels in serum. These newer compounds have a distinct advantage over existing therapeutic agents in that they can be administered orally. Clinical trials are warranted to assess their usefulness in the therapy of gonorrhea and chancroid.

Cefmenoxime↗
PubMed1986

Single-dose therapy of gonococcal ophthalmia neonatorum with ceftriaxone.

We conducted a randomized clinical trial comparing a single intramuscular dose of 125 mg of ceftriaxone with a single intramuscular dose of 75 mg of kanamycin followed by topical gentamicin for seven days, and with a single intramuscular dose of 75 mg of kanamycin followed by topical tetracycline for seven days, in the treatment of gonococcal ophthalmia neonatorum in Nairobi, Kenya. Of 122 newborns with culture-proved gonococcal ophthalmia neonatorum, 105 returned for follow-up. Sixty-one infants (54 percent) received ceftriaxone, 32 received kanamycin plus topical gentamicin, and 29 received kanamycin plus topical tetracycline. Sixty-six (54 percent) of the Neisseria gonorrhoeae isolates were penicillinase producing. All 55 newborns who received ceftriaxone and returned for follow-up were clinically and microbiologically cured. One of 26 returning newborns who received kanamycin plus tetracycline and 2 of 24 returning newborns who received kanamycin plus gentamicin had persistent or recurrent gonococcal conjunctivitis. Ceftriaxone also eradicated oropharyngeal gonococcal infection in 18 newborns, whereas oropharyngeal infection persisted in 2 of 8 newborns who had received kanamycin (P not significant). We conclude that 125 mg of ceftriaxone as a single intramuscular dose is very effective therapy for gonococcal ophthalmia neonatorum, with marked efficacy against extraocular infection and without the need for concomitant topical antimicrobial therapy.

Ceftriaxone↗
PubMed1986

Epidemiology of ophthalmia neonatorum in Kenya.

In a Nairobi hospital where ocular prophylaxis against ophthalmia neonatorum has been discontinued, 1,019 women were screened for Neisseria gonorrhoeae and Chlamydia trachomatis during labour and 7 and 28 days postpartum. The prevalence of gonococcal infection was 7% and that of chlamydial was 29%. 52.4% of gonococcal isolates produced penicillinase. The incidence of ophthalmia neonatorum was 23.2 per 100 live births, and incidences of gonococcal and chlamydial ophthalmia were 3.6 and 8.1 per 100 live births, respectively. Of 181 cases of neonatal conjunctivitis, 31% were caused by C trachomatis, 12% by N gonorrhoeae, and 3% by both. In 67 babies exposed to maternal gonococcal infection and 201 exposed to maternal chlamydial infection, rates of transmission to the eye were 42% and 31%, respectively, and to the throat were 7% and 2%. Gonococcal transmission rate was higher in mothers with concomitant chlamydial infection (68%; p = 0.01). Postpartum endometritis was associated with ophthalmia neonatorum (p less than 0.001). Ocular prophylaxis at birth for gonococcal ophthalmia should be reintroduced.

Adult↗
PubMed1986

Fallopian tube obstruction as a sequela to Chlamydia trachomatis infection.

The association of tubal infertility and ectopic pregnancy with Chlamydia trachomatis infection was investigated using a case-control study design. Although culture methods failed to document active chlamydial infection in the majority of cases, serology revealed a significant association of Chlamydia trachomatis antibody with tubal infertility and ectopic pregnancy. Thirteen of 18 (72%) women with tubal factor infertility and 18 of 32 (56%) women with ectopic pregnancy had antibodies to Chlamydia trachomatis as compared to 11 of 49 (22%) normal pregnant controls. Interestingly, only 7 of 18 (39%) infertile women and 5 of 36 (14%) women with ectopic pregnancy recalled a history of pelvic inflammatory disease. These results suggest that chlamydia-associated salpingitis, whether clinically evident or subclinical, is a major contributor to diseases of tubal dysfunction.

Antibodies, Bacterial↗