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Biomedical subjects

W M McCormack

Publications and source records attributed to W M McCormack.

At least 73 records · Page 4Linked to original sources

Relationship of vaginitis to the sex of conceptuses.

The relative viability of X-bearing and Y-bearing spermatozoa is influenced by factors in the vagina such as pH. The vaginal environment, in turn, is influenced by its flora. This study examined the relationship of the vaginal flora to the sex of conceptuses. It was found that women who carried Trichomonas vaginalis or Bacteroides sp or who had nonspecific vaginitis at first prenatal visit were significantly more likely to deliver females than women who carried none of these organisms (54 versus 37%, P less than .02).

Bacteriological Techniques↗

Nonspecific vaginitis following sexual abuse in children.

Nonspecific vaginitis, one of the most common causes of vaginitis in adults, is a polymicrobial infection in which vaginal anaerobes act synergistically with Gardnerella vaginalis. The diagnosis is made by examination of the vaginal secretions for clue cells, the development of a fishy odor after the addition of 10% KOH to vaginal secretions, and a vaginal pH greater than 4.5. To determine whether nonspecific vaginitis occurs in sexually abused children, we obtained vaginal washes from 31 abused and 23 nonabused children, 21/2 to 13 years of age. A child was considered to have definite nonspecific vaginitis if her wash contained both clue cells and odor; she was considered to have possible nonspecific vaginitis if her wash contained either clue cells or odor. We did not use vaginal pH as a diagnostic criterion because the normal range has not been standardized in prepubertal girls. Possible nonspecific vaginitis (odor only) was found in only 1/23 (4%) of nonabused children. This girl was asymptomatic and findings from her examination were normal. Only one of the 31 abused children had possible nonspecific vaginitis (odor) detected at the initial examination, less than 48 hours after the episode of abuse, whereas 4/31 (13%) developed definite, and 4/31 (13%) possible nonspecific vaginitis at the follow-up visit more than seven days after the episode of abuse or rape. Five of these eight girls developed either a new vaginal discharge or dysuria; three were treated with metronidazole with resolution of their symptoms and reversion of the vaginal wash to normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy.

Prematurity remains a major cause of perinatal mortality in the United States. Some research has indicated that infectious agents play a role in either initiating preterm labor, causing premature rupture of the membranes, or preventing tocolysis. This study attempted to determine if the presence of various vaginal pathogens in early pregnancy was associated with the subsequent development of premature rupture of membranes or preterm labor. We found that among 233 evaluable patients those with Trichomonas vaginalis were significantly more likely to have premature rupture of the membranes (p less than 0.03), and those with Bacteroides sp. were more likely to be delivered of their infants before 37 weeks (p less than 0.03) and to have infants weighing less than 2500 gm (p less than 0.05). Those with Ureaplasma urealyticum more frequently began preterm labor (p less than 0.05). Preterm premature rupture of the membranes was found significantly more often among patients with Bacteroides sp. Stepwise multiple logistic regression analysis indicated that those associations were not related to the number of previous abortions, deliveries, or preterm deliveries or to maternal age. We conclude that microbiologic screening in early pregnancy may aid in the assessment of patient risk for preterm delivery.

Adolescent↗

Effect of treatment regimens for Neisseria gonorrhoeae on simultaneous infection with Chlamydia trachomatis.

We evaluated the effect of treatment of gonorrhea on simultaneous Chlamydia trachomatis infection by randomly assigning 293 heterosexual men and 246 heterosexual women with gonorrhea to receive one of the following treatment regimens: (1) 4.8 million units of aqueous procaine penicillin plus 1 g of probenecid, (2) nine tablets of trimethoprim-sulfamethoxazole daily for three days, or (3) 500 mg of tetracycline four times a day for five days. Among the men, gonococcal infection was cured in 99 per cent given penicillin plus probenecid, 96 per cent given trimethoprim-sulfamethoxazole, and 98 per cent given tetracycline. Among the women, only 90 per cent given tetracycline were cured, in contrast to 97 per cent given penicillin plus probenecid and 99 per cent given trimethoprim-sulfamethoxazole. Chlamydial infection, present in 15 per cent of the men and 26 per cent of the women, was cured in 30 of 32 patients given trimethoprim-sulfamethoxazole and 27 of 29 given tetracycline, but in only 10 of 23 given penicillin plus probenecid. Among chlamydia-positive patients, postgonococcal urethritis in men and cervicitis in women occurred more often in patients given penicillin plus probenecid. Salpingitis developed in 6 of 20 women given penicillin plus probenecid, but in only 1 of 26 given trimethoprim-sulfamethoxazole and in none of 24 given tetracycline. We conclude that the use of penicillin plus probenecid alone for gonorrhea in heterosexual patients carries an unacceptably high risk of postgonococcal chlamydial morbidity. Trimethoprim-sulfamethoxazole and tetracycline were highly effective against both pathogens and were well tolerated in men, but both drugs caused frequent side effects in women. The failure of tetracycline to cure gonorrhea in 10 per cent of women argues against its use alone; treatment with penicillin followed by tetracycline has been recommended for further trial.

Adolescent↗

Enzyme immunoassay for diagnosis of gonorrhea.

An enzyme immunoassay (EIA; Gonozyme [Abbott Laboratories]) for gonococcal antigen was assessed for the rapid diagnosis of gonorrhea. Patients attending two sexually transmitted disease clinics were tested by EIA and culture on Thayer-Martin medium. EIA was highly effective in detecting gonococcal infection among symptomatic men, with 70 of 75 (93.3%) culture-positive men having positive tests and no false-positive reactions. The performance of the test was not as good in detecting cervical gonorrhea; the best result obtained was a sensitivity of 87% (33 of 38) for EIA compared with culture. EIA false-positives occurred at a relatively low rate for women, with the test having a specificity of ca. 97%. The test clearly is capable of detecting gonococcal antigen in cervical and urethral specimens, but its role in routine diagnosis is not clear. Its performance seems equal to that of the Gram stain for men, but it seems to be less sensitive than culture for cervical gonorrhea--a drawback in high-risk populations. The low false-positive rate could be an important issue in screening low-prevalence populations.

Antigens, Bacterial↗

Risk of acquiring gonorrhea and prevalence of abnormal adnexal findings among women recently exposed to gonorrhea.

We determined the conditions of 26 women who had recently been exposed to Neisseria gonorrhoeae. Infection was more common among women with more than one exposure (13/14) than among those with one exposure (6/12). Gonococcal infection was significantly associated with the presence of findings on physical examination suggestive of upper genital tract inflammation. Nine of 19 infected women had such findings; no uninfected women did. Among infected women, the prevalence of abnormal physical findings was 47% +/- 23% (95% confidence interval). These findings suggest that upper genital tract involvement is a common early complication of gonococcal infection.

Female↗

How sensitive is the Papanicolaou smear in the diagnosis of infections with Chlamydia trachomatis?

Fifty-three patients who presented to the sexually transmitted disease clinic at Boston City Hospital had simultaneous cervicovaginal Papanicolaou smears and cultures for Chlamydia trachomatis taken prior to the initiation of antibiotic therapy. Eleven of the chlamydial cultures had positive results. None of the Papanicolaou smears satisfied the morphologic criteria for the diagnosis of chlamydial infection. This suggests that the Papanicolaou smear is an insensitive technic for the diagnosis of chlamydial infection of the cervix.

Chlamydia Infections↗

Growth of host cells and Chlamydia trachomatis in medium containing serum from 16-week-old calves.

We compared fetal bovine serum with five batches of serum from calves of various ages. HeLa and McCoy cells grown in only one batch of calf serum (from 16-week-old calves) had morphology, growth kinetics, and cloning efficiency similar to those of cells grown in fetal bovine serum. Cells maintained in calf serum from this batch supported the growth of two laboratory strains of Chlamydia trachomatis, a genital strain (E/UW-5/Cx) in McCoy cells and a lymphogranuloma venereum strain (440L) in HeLa cells. McCoy cells maintained in calf serum also supported the growth of C. trachomatis from clinical specimens. The batch of serum from 16-week-old calves was an effective alternative to fetal bovine serum for the growth of cells and of C. trachomatis. Other laboratories may be able to use calf serum for the maintenance of cells and for the isolation of Chlamydia spp. Before use, however, each batch of calf serum will have to be carefully evaluated to ensure that it is equivalent to fetal bovine serum.

Animals↗

Association of Streptococcus bovis bacteremia with bowel disease.

We reviewed the medical records of 19 patients who had Streptococcus bovis bacteremia. Eight patients had diverticulosis, four had benign adenomatous colonic polyps, and three had adenocarcinomas of the gastrointestinal tract. Laboratory workers and clinicians should be aware of the association of S. bovis bacteremia and gastrointestinal disease.

Gastrointestinal Diseases↗

Enzyme-linked immunosorbent assay for the detection of antibody to Chlamydia trachomatis and Chlamydia psittaci.

An enzyme-linked immunosorbent assay (ELISA) was developed with use of a strain of Chlamydia trachomatis, lymphogranuloma venereum serotype 2. The ELISA reactions were monitored by absorbance at 492 nm in a spectrophotometer. A positive control method based on one serum dilution was used to assign ELISA titers to the sera. Sera that had been tested with use of complement fixation (CF) and microimmunofluorescence (MIF) tests were examined with ELISA. ELISA was more sensitive than the CF test and as sensitive as the MIF test. Serum pairs that had diagnostic titer rises in the other tests also had such rises in ELISA. ELISA is a simple, sensitive assay for detection of antibody to C. trachomatis.

Antibodies, Bacterial↗

Effect of menstrual cycle and method of contraception on recovery of Neisseria gonorrhoeae.

We examined the records of 5,287 women who were names as sexual contacts of men who had gonococcal urethritis in the National Gonorrhea Therapy Monitoring Study. Neisseria gonorrhoeae was recovered from endocervical cultures from 3,247 (61.4%) of the women. Participants who were seen during the first five days of the menstrual cycle were slightly more likely to have a positive culture (64.9%) than women who were seen on days 6 through 10 (61.3%), days 11 through 15 (60.0%), days 16 through 20 (59.8%), days 21 through 25 (60.4%), or after day 25 (61.2%). Similar data were obtained for 1,489 untreated women who presented because a recent screening culture contained N gonorrhoeae. Neisseria gonorrhoeae was isolated from pretreatment cultures from 231 (79.7%) of 290 such women who were examined during the first five days of their menstrual cycle and from 884 (73.7%) of 1,199 women who were examined later in the cycle. Method of contraception had no statistically significant influence on the recovery of N gonorrhoeae.

Anal Canal↗

Evaluation of the Phadebact Test for identification of Neisseria gonorrhoeae.

The Phadebact Gonococcus Test (Pharmacia Diagnostics, Piscataway, N.J.) is used for the identification of Neisseria gonorrhoeae. In this test, boiled organisms are examined by using a 3-min coagglutination technique. A total of 313 isolates of Neisseria confirmed by the fluorescent-antibody technique or identified to the species level by the cysteine-tryptose agar utilization technique, were tested by the coagglutination technique. Of 229 isolates of N. gonorrhoeae, 13 (5.7%) were negative by the coagglutination technique on the first testing, 4 (1.7%) of which remained negative on subsequent testing after subculture. Of the 84 isolates of Neisseria other than N. gonorrhoeae, none showed a positive coagglutination reading. The Phadebact Gonococcus Test provides rapid, accurate identification for most isolates of N. gonorrhoeae. As with any new technique, standard procedures (fluorescent-antibody or cysteine-tryptose agar analysis or both) should be performed along with the new technique until laboratory workers are comfortable with the performance and interpretation of the test. We must, however, emphasize that it is very important to follow carefully the procedures outlined on the package insert.

Agglutination Tests↗

Comparison of methods for cultivation and isolation of Chlamydia trachomatis.

McCoy cells treated with cycloheximide, iododeoxyuridine, and DEAE-dextran and untreated McCoy cells were inoculated with two stock strains of Chlamydia trachomatis and with 231 urethral specimens from men, 53 (23%) of which contained C. trachomatis. Isolation rates, number and quality of inclusions, and quality of the cell monolayers were compared. There were no significant differences between the isolation rates in the four systems, although the most isolations were made in the untreated and cycloheximide-treated cells. Cycloheximide-treated cells produced, from both the clinical specimens and the two stock strains, significantly more inclusions than any of the other systems. The monolayer of the cycloheximide-treated cells and the inclusions that grew in these cells were optimal for examination and detection of C. trachomatis.

Chlamydia trachomatis↗

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.

Adolescent↗

Human chlamydial infections.

Chlamydiae are obligate intracellular parasites, bacteria with a peculiar biology. They belong to the genus Chlamydia which includes two species: C. psittaci and C. trachomatis. A wide range of hosts, including birds, mammals and man can be infected by chlamydiae. The diseases chlamydiae can produce include psittacosis, lymphogranuloma venereum, trachoma, inclusion conjunctivitis, urethritis, cervicitis, pelvic inflammatory disease, and neonatal pneumonia. The diagnosis of chlamydial infection may be made by visualization of the organism in direct smears, isolation of the agent in cell culture, or by demonstrating a significant rise in antibody titer. Chlamydial infection may be treated with tetracycline, erythromycin, or sulfonamides.

Adult↗