Biomedical subjects
Publications and source records attributed to W Mendling.
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The Guideline vulvovaginal candidosis, as passed by three German medical societies, is presented.
Sexual partners often harbour identical yeast strains in the vagina, in the orointestinal tract and in semen in cases of recurrent vulvovaginal candidoses. Specimen were collected from vagina, oral cavity and faeces of the patients, and from semen, oral cavity and faeces of their male partners. Mycological cultures were grown on Sabouraud glucose-agar and, if positive, specified by Candida-ID-Agar (BioMérieux), by formation of chlamydospores on rice agar, and by biochemotyping with the System Walkaway (Dade) or the API-32C system (BioMérieux). A polymerase chain reaction finger-printing technique with the T3B oligonucleotide as single primer was used for strain typing. Candida albicans was isolated from the vagina of 18 out of 21 patients, the vagina of one patient harboured a strain of Candida glabrata. The cultures obtained from vagina, oral cavity and faeces were genetically identical in 12 patients. From the partners of 15 patients C. albicans was cultured in at least one of the clinical samples. Identical strains were observed for eight of 15 couples, whereas four of these identical strains were cultured from semen. Further prospective investigations will prove whether a consequent treatment of both partners will eradicate identical yeast strains and will be able to improve the results of treatment in such women.
Sexual partners harbour often identical yeast strains in the vagina, orointestinal tract and sperm in cases of recurrent vulvovaginal candidoses. Mycologic cultures from the vagina, mouth and stool of the patient and from the mouth and sperm of her partner were cultured on Sabouraud-Glucose-Agar and, if positive, specified by Candida ID-Agar (Biomerieux), rice agar and the system Walk away (Dade). Equal species were compared by DNR-fingerprinting using PCR. The vagina of 22 women was in 21 cases infected by Candida albicans and in one case by Candida glabrata. The culture of mouth or stool of 18 women was in 11 cases identical with those of the vagina. In 13 cases of 18 sexual male partners Candida albicans was found being identical with the strain of the female partner in 8 cases. 4 of the identical strains were grown from the sperm. Future prospective investigations shall prove whether a consequent treatment of both partners to eradicate all identical yeasts is able to improve the treatment results in such women.
Yeast colonization of the vagina is found in about 30% of all pregnant women. Premature infants are severely endangered by generalized fungal infections due to their immature immune system. The objective of this study was to elucidate the relationship between vaginal yeast colonization of the mothers and Candida septicemia in their premature babies. In a prospective study, running from 12/1994 to 8/1996, 176 mothers, facing probable premature birth, were investigated, when hospitalized, for vaginal yeast colonization. 150 premature infants (birth weights ranging from 550 to 2390 g) of these mothers were culturally examined for yeasts in specimens from the mouth, ear, stool and urine immediately after birth as well as once weekly in the following weeks. The patients were divided into two groups. In group A, oral prophylaxis with nystatin was practiced only in infants with at least one positive yeast culture. In group B, all patients received nystatin prophylaxis. Candida septicemia developed one or two weeks after birth mainly in infants with birth weights below 1000 g. Primary oral prophylaxis with nystatin lowers considerably the risk of developing Candida infection.
After the detection of yeasts in 1839, German speaking mycology was first performed in obstetrics to find out the source of neonatal thrush. The authors are Berg (1846), Mayer (1862), Martin (1856), Winckel (1866), Haussmann (1870), Kehrer (1883), Epstein (1924), Rüther, Rieth and Koch (1958), Malicke (1963), Blaschke-Hellmessen (1968) and Schnell (1981) and others. In the gynecological field yeasts, vaginal mycoses and therapeutic problems had been investigated by the gynecologists Döderlein (1892), Spitzbart (1960), Lachenicht and Potel (1971), Neumann and Kaben (1971), Müller and Nold (1981) and Mendling (1987, 1995). Many gynecological papers, however, had also been written by dermatologists and microbiologists.
Due to its pathogenety Candida albicans is the most frequent yeast in cases of vaginal candidosis, probably mostly caused by local immunological weakness. In 5-30% one can expect a vaginal yeast colonisation depending on age, estrogen influence, pregnancy and dispositions by illness. Prepartal vaginal yeast colonisation should be treated to protect the newborn. The only typical symptom of acute vaginal candidosis is itching. Beside history and clinical symptoms, examination of vaginal secretion by phase contrast microscopy and the yeast culture are cornerstones of the diagnosis. Antimycotic resistance should be investigated only by specialists. Acute Candida albicans vaginitis should be treated locally by one or three day therapy. Candida glabrata vaginitis can be treated with high doses of oral fluconazole.
Fungal vaginal infections/colonisations can be divided into a symptomatic vaginal candidiasis and an asymptomatic vaginal Candida-carriage. The latter seems to be a predisposing factor for the development of a symptomatic vaginal candidiasis. The fungal organism isolated most frequently is Candida albicans, followed by Candida glabrata, which was previously also known as Torulopsis glabrata. To a lower extend, other Candida species such as Candida tropicalis and Candida krusei can be prevalent in the vulvovaginal region. Predisposing factors for vaginal candidiasis are gravidity, diabetes mellitus or a therapy with immunosuppressive agents. Also gestagenes showed to be a pre-disposing factor for vaginal candidiasis. Divergent results concerning the predisposition to vaginal candidiasis or colonisation due to oral contraception have so far been reported. Therefore we performed a study with two healthy collectives of female volunteers (n = 2 x 60) which were different concerning the taking of oral contraceptives. Overall, in 17% of the subjects (20/120) yeast could be cultured out of the vaginal secretions. There was no evidence for a higher rate of Candida-colonisation in subjects taking oral contraceptives. Further, there was no evidence for a relationship between the length of the taking of oral contraceptives and the rate of vaginal yeast-carriage. Also the type of oral contraceptive (combination or sequential contraceptive) had no influence on the frequency of Candida-carriage. Candida albicans was the most prevalent yeast (16/20), followed by Candida glabrata (4/20).
Secretory IgA of the cervico-vaginal secretions was determined for the first time using a modified ELISA method following the recommendations of Sohl Akerlund et al. (Scand. J. Immunol. 6 [1977] 1275). The results were compared with the total protein content of the cervico-vaginal secretions, which were within the normal limits reported in literature. Women in the middle of the menstrual cycle and those taking anti-ovulants, showed lower and those during pregnancy higher values. Secretory sIgA could not be detected in vaginal secretions of hysterectomised women.
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Eighteen patients with chronically recurrent vaginal candidosis showed low T-lymphocyte counts twice as frequent as a control group of 55 women. The patients were treated with azoles locally and lymphocyte stimulating pentapeptide thymopentin. The prolongation of disease-free intervals and a cure was mainly seen in the patients with low T-cell values before therapy. In vitro-proliferation assays upon stimulation with Candida albicans bore no correlation with the course of the disease. We suspect a failure in the co-operation of the immune cells, caused by differing strong responses to the Candida albicans stimulation.
After laparoscopic confirmation of adnexitis, a bacteriological examination was made of specimens taken from the small pelvis of 63 patients, with an average age of 26.4 years, at the Rheinischen Landesfrauenklinik (Gynecological Hospital) in Wuppertal. To this end, various aerobic and anaerobic optimal and selective culture media were used. The cultured germs were identified with API systems, other conventional methods, and by using gas chromatography. All bacilli were tested for their sensitivity to mezlocillin and metronidazole. In 40 cases (63.5%), it was possible to determine 1-10 bacilli from the inner genital tract. In most cases there was an aerobic/anaerobic mixed infection, with participation of streptococci, staphylococci, enteric bacteria, as well as peptococci, peptostreptococci and bacteroid types. Neisseria gonorrhoeae was only identified three times. In 23 cases (36.5%), it was not possible to determine bacilli in spite of definite inflammatory symptoms. Since, according to international literature, Chlamydia trachomatis was to be found on the inflamed tubes of roughly one third of cases of adnexitis, the presence of this bacillus is suspected even in the many bacteriologically negative cases in the author's own study. Only in one case of a monoinfection by Staphylococcus aureus did the combination of mezlocillin and metronidazole prove to be unsuitable. In 25% of the cases where the presence of bacilli was proved, metronidazole was even necessary, since bacilli of the Bacteroides fragilis and Bacteroides bivius and disiens groups were involved, all of which are capable of inactivating penicillins and cephalosporins by formation of a beta-lactamase.(ABSTRACT TRUNCATED AT 250 WORDS)
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Torulopsis glabrata, a pathogenic yeast, causes a vulvovaginal mycosis in about 10% of all cases, whereas mostly candida albicans is identified. Yeasts of the genus Torulopsis seem to occur especially on healthy women, whereas in cases of the well-known risk factors the growth of Candida albicans is advanced. Torulopsidosis of the vagina commonly takes a mild course. The diagnosis is ensured only in cooperation with special laboratories. However, microscopic traps are absence of pseudomycelia and relatively small buds which contrast with the big buds of candida albicans. Although the clinical course is usually less heavy than in cases of candidosis, a six- to ten-day treatment with local imidazole or Polyene antimycotics is necessary to avoid recurrences. The fact that yeasts of the genus Torulopsis form no pseudomycelia is perhaps an explanation for the mostly mild course of illness on the one hand and for the weak response to cellwall-synthesis blocking antimycotics on the other hand.
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The case of a 22-year-old primigravida in the 33rd week of pregnancy is presented, showing an uncommon form of EPH-gestosis which so far has been described very rarely in German literature. It is a case of pre-eclampsia with haemolytic anaemia, thrombocytopenia, increased liver values and beginning kidney failure. The key to the survival of mother and child lies in rapid delivery and an adequate substitution of erythrocytes and blood plasma. Symptomatics, differential diagnosis and therapy are discussed. Reference literature is given.
Patients with a mycologically confirmed vaginal mycosis were treated either with one 100-mg vaginal ovule of clotrimazole each for 6 days, or with one 200-mg vaginal ovule of clotrimazole each for 3 days, or with one 500-mg vaginal ovule of clotrimazole for 1 day, the ovule having been supplied in a novel, acid formulation. 24, 48 and 72 h after the last dose, samples of secretion were taken from the fornix vaginae. The intravaginal secretion levels were determined semiquantitatively on the basis of the measured inhibition zones obtained with Candida albicans growth on agar plates, and the levels obtained with the different treatment regimens were compared. The vaginal secretion levels after a single 500-mg dose of the new formulation were higher, even after 3 days, than those measured in the 6-day treatment, while administration of 200 mg clotrimazole on 3 days resulted in no increase of the secretion levels over those seen in 6-day treatment with 100 mg.