Human lactobacilli as supplementation of clindamycin to patients with bacterial vaginosis reduce the recurrence rate; a 6-month, double-blind, randomized, placebo-controlled study

<p>Abstract</p> <p>Background</p> <p>The primary objective of this study was to investigate if supplementary lactobacilli treatment could improve the initial cure rate after vaginal clindamycin therapy, and secondly, if lactobacilli as repeated adjunct treatment during 3 menstrual cycles could lengthen the time to relapse after initial cure.</p> <p>Methods</p> <p>Women (n = 100) with bacterial vaginosis diagnosed by Amsel criteria were after informed consent offered vaginal clindamycin therapy followed by vaginal gelatine capsules containing either 10⁹freeze-dried lactobacilli or identical placebo capsules for 10 days during 3 menstrual cycles in a double-blind, randomized, placebo-controlled trial.</p> <p>Results</p> <p>The initial intent to treat (ITT) analysis for the one-month cure rate was 64% in the lactobacilli group and 78% in the placebo group (p > 0.05). However, any patient with missing or unclassified smears at the initial visit who continued the study and whose next smear indicated a cure was included in the cured group; the study also excluded two of the patients in the lactobacilli group who reported that they did not take any vaginal capsules. With consideration to these population changes, the initial cure rate would be 77% in the lactobacilli group. The 76 cured women were followed for 6 menstrual cycles or until relapse within that time span. At the end of the study, 64.9% (24/37) of the lactobacilli treated women were still BV-free compared to 46.2% (18/39) of the placebo treated women. Comparison of the two groups regarding "Time from cure to relapse" was statistically significant (p = 0.027) in favour of the lactobacilli treatment. Adjuvant therapy with lactobacilli contributed significantly to avoidance of relapse with a proportional Hazard Risk ratio (HR) of 0.73 (0.54–0.98) (p < 0.05)</p> <p>Conclusion</p> <p>The study shows that supplementary treatment combining two different strains of probiotic lactobacilli does not improve the efficacy of BV therapy during the first month of treatment, but for women initially cured, adjunct treatment of lactobacilli during 3 menstrual cycles lengthens the time to relapse significantly in that more women remained BV free at the end of the 6-month follow up.</p> <p>Trial registration number</p> <p>ISRCTN62879834</p

Diagnosis of Bacterial Vaginosis (BV) Using Nugent Criteria and a New Point-of-Care Chromogenic BV Blue Test for Detecting Elevated Vaginal Fluid Sialidase Enzyme

Bacterial vaginosis (BV) is a condition that predisposes women to increased susceptibility to sexually transmitted diseases, including human immunodeficiency virus (HIV) infections and obstetric complications. The etiology of BV is diverse and the diagnostic methods currently adopted include Amsel criteria, and Nugent score (improved Gram stain) that requires microscopy and expert interpretation. We evaluated vaginal swabs from 56 premenopausal women with clinical signs suggestive of BV, using the Nugent criteria and a new BV Blue test for the detection of elevated vaginal fluid sialidase enzyme. For the Nugent criteria, slides were Gram stained and a score of 0-10 was assigned, considering the relative proportions of large Gram positive rods (lactobacilli), small Gram-negative or Gram variable rods and curved Gram-variable rods. The BVBlue test detected the presence of elevated vaginal sialidase enzyme in samples from 49(87.5%)women, compared with Nugent score of 7-10 interpreted as BV occurrence in 36 (64.2%) subjects. The BVBlue test is yet to be introduced in Nigeria as a routine screening BV test, and it is simple, rapid, and objective for the diagnosis of BV. It has the potential to facilitate prompt diagnosis and appropriate treatment of BV in the absence of microscopy. Keywords: Bacterial Vaginosis, Sialidase, Nugent Score Journal of Medical Laboratory Sciences Vol. 14 (1) 2005: pp. 37-4

Genome Sequence of Lactobacillus pentosus KCA1: Vaginal Isolate from a Healthy Premenopausal Woman

Contains fulltext : 119285.pdf (publisher's version ) (Open Access)The vaginal microbiota, in particular Lactobacillus species, play an important role in female health through modulation of immunity, countering pathogens and maintaining a pH below 4.7. We report the isolation and genome sequence of Lactobacillus pentosus strain KCA1 (formally known as L. plantarum) from the vagina of a healthy Nigerian woman. The genome was sequenced using Illumina GA II technology. The resulting 16,920,226 paired-end reads were assembled with the Velvet tool. Contigs were annotated using the RAST server, and manually curated. A comparative analysis with the available genomes of L. pentosus IG1 and L. plantarum WCFS1 showed that over 15% of the predicted functional activities are found only in this strain. The strain has a chromosome sequence of 3,418,159 bp with a G+C content of 46.4%, and is devoid of plasmids. Novel gene clusters or variants of known genes relative to the reference genomes were found. In particular, the strain has loci encoding additional putative mannose phosphotransferase systems. Clusters of genes include those for utilization of hydantoin, isopropylmalate, malonate, rhamnosides, and genes for assimilation of polyglycans, suggesting the metabolic versatility of L. pentosus KCA1. Loci encoding putative phage defense systems were also found including clustered regularly interspaced short palindromic repeats (CRISPRs), abortive infection (Abi) systems and toxin-antitoxin systems (TA). A putative cluster of genes for biosynthesis of a cyclic bacteriocin precursor, here designated as pentocin KCA1 (penA) were identified. These findings add crucial information for understanding the genomic and geographic diversity of vaginal lactobacilli

Probiotics for the developing world

Every minute of every day more and more children die of diarrheal diseases and women, and girls become infected by HIV An estimated 7,000 women become infected each day. While many valiant efforts are being made to address these issues, until now they have proved to be markedly ineffective. The notion that lactic acid bacteria, formulated into food or dietary supplements, could have a role to play in slowing the morbidity and mortality associated with HIV/AIDS and gastroenteritis, is built upon sound clinical findings and scientific investigations, yet no international efforts have been placed in this approach, to date. We hereby summarize the reasons why such efforts should be made, provide an example of one model being set up in sub-Saharan Africa, and challenge the international community to consider the potential benefits of probiotics, especially for communities not reached by governmental and nongovernmental agencies

Contamination of Laboratory Bench-tops, Incubators and the Effects of a Spray-Disinfectant - A Quarterly Ammonium Compound

We surveyed the prevalence of contaminants associated with bench-tops and incubators during a routine working day in our clinical microbiology laboratories in Benin City. A total of 93 swabs, 50 from bench-tops and 43 from inside incubators were randomly collected. One ml of sterile phosphate buffered saline was added into the swab and incubated aerobically at 37oC for 48 hours. Isolated organisms were characterized biochemically. Spray disinfectant, was applied on the bench top and cultured accordingly. Swabs were collected from the incubators every day for 10 consecutive days. Results indicate, that both bench-tops and incubators are contaminated with organisms of clinical importance. Thirty-six (72%) of the swabs yielded growth, with Bacillus subtilis (24%) being the predominant organism, followed by coagulase negative Staphylococcus (CNS) (12%), Staphylococcus aureus (10%), Proteus spp. and Escherichia coli (8%) each, Pseudomonas aeruginosa (4%), moulds (2%) and Candida albicans (2%). Eighteen (41%) swabs from incubators yielded growth, with B. subtilis (13.8%) dominating, followed by Proteus spp. (9.3%), Staphylococcus aureus (6.9%), CNS (4.5%) and moulds (2.2%). Three hours after the spray disinfection, only 5 (10%) of the bench-top swabs yielded growth of B. subtilis, while the swabs from incubators, even after 10 days yielded no growth. This study recommends that spray disinfectant, mostly quaternary ammonium compounds, free of aldehydes can minimize contamination of bench-tops and microbiology incubators during routine working hours. Keywords: Laboratory, contaminants, incubators, bench-tops, spray-disinfectants. Journal of Medical Laboratory Science Vol. 13 (2) 2004: pp. 33-3

Lactobacillus reuteri-produced cyclic dipeptides quench agr-mediated expression of toxic shock syndrome toxin-1 in staphylococci

The production of the staphylococcal exotoxin toxic shock syndrome toxin-1 (TSST-1) by Staphylococcus aureus has been associated with essentially all cases of menstruation-associated toxic shock syndrome (TSS). In this work, we show that the human vaginal isolate Lactobacillus reuteri RC-14 produces small signaling molecules that are able to interfere with the staphylococcal quorum-sensing system agr, a key regulator of virulence genes, and repress the expression of TSST-1 in S. aureus MN8, a prototype of menstrual TSS S. aureus strains. Quantitative real-time PCR data showed that transcription from the Ptst promoter, as well as the P2 and P3 promoters of the agr system from all four agr subgroups of S. aureus, was strongly inhibited in response to growth with L. reuteri RC-14 cultural supernatant. Alterations in the transcriptional levels of two other virulence-associated regulators sarA and saeRS were also observed, indicating a potential overall influence of L. reuteri RC-14 signals on the production of virulence factors in S. aureus. S. aureus promoter-lux reporter strains were used to screen biochemically fractionated L. reuteri RC-14 supernatant, and the cyclic dipeptides cyclo(l-Phe-l-Pro) and cyclo(l-Tyr-l-Pro) were identified as the signaling molecules. The results from this work contribute to a better understanding of interspecies cell-to-cell communication between Lactobacillus and Staphylococcus, and provide a unique mechanism by which endogenous or probiotic strains may attenuate virulence factor production by bacterial pathogens