Binding of Elementary Bodies by the Opportunistic Fungal Pathogen Candida albicansor Soluble β-Glucan, Laminarin, Inhibits Chlamydia Trachomatisinfectivity

Microbial interactions represent an understudied facet of human health and disease. In this study, the interactions that occur between Chlamydia trachomatis and the opportunistic fungal pathogen, Candida albicans were investigated. Candida albicans is a common component of the oral and vaginal microbiota responsible for thrush and vaginal yeast infections. Normally, Candida exist in the body as yeast. However, disruptions to the microbiota create conditions that allow expanded growth of Candida, conversion to the hyphal form, and tissue invasion. Previous studies have shown that a myriad of outcomes can occur when Candida albicans interacts with pathogenic bacteria. To determine if C. trachomatis physically interacts with C. albicans, we incubated chlamydial elementary bodies (EB) in medium alone or with C. albicans yeast or hyphal forms for 1 h. Following incubation, the samples were formaldehyde-fixed and processed for immunofluorescence assays using anti-chlamydial MOMP or anti- chlamydial LPS antibodies. Replicate samples were replenished with culture medium and incubated at 35°C for 0-120 h prior to fixation for immunofluorescence analysis or collection for EB infectivity assays. Data from this study indicates that both C. trachomatis serovar E and C. muridarum EB bind to C. albicans yeast and hyphal forms. This interaction was not blocked by pre-incubation of EB with the Candida cell wall components, mannan or β-glucans, suggesting that EB interact with a Candida cell wall protein or other structure. Bound EB remained attached to C. albicans for a minimum of 5 days (120 h). Infectivity assays demonstrated that EB bound to C. albicans are infectious immediately following binding (0h). However, once bound to C. albicans, EB infectivity decreased at a faster rate than EB in medium alone. At 6h post binding, 40% of EB incubated in medium alone remained infectious compared to only 16% of EB bound to C. albicans. Likewise, pre-incubation of EB with laminarin, a soluble preparation of β-glucan, alone or in combination with other fungal cell wall components significantly decreases chlamydial infectivity in HeLa cells. These data indicate that interactions between EB and C. albicans inhibit chlamydial infectivity, possibly by physically blocking EB interactions with host cell receptors

Binding of Elementary Bodies by the Opportunistic Fungal Pathogen Candida albicans or Soluble β-Glucan, Laminarin, Inhibits Chlamydia trachomatis Infectivity

Microbial interactions represent an understudied facet of human health and disease. In this study, the interactions that occur between Chlamydia trachomatis and the opportunistic fungal pathogen, Candida albicans were investigated. Candida albicans is a common component of the oral and vaginal microbiota responsible for thrush and vaginal yeast infections. Normally, Candida exist in the body as yeast. However, disruptions to the microbiota create conditions that allow expanded growth of Candida, conversion to the hyphal form, and tissue invasion. Previous studies have shown that a myriad of outcomes can occur when Candida albicans interacts with pathogenic bacteria. To determine if C. trachomatis physically interacts with C. albicans, we incubated chlamydial elementary bodies (EB) in medium alone or with C. albicans yeast or hyphal forms for 1 h. Following incubation, the samples were formaldehyde-fixed and processed for immunofluorescence assays using anti-chlamydial MOMP or anti- chlamydial LPS antibodies. Replicate samples were replenished with culture medium and incubated at 35°C for 0–120 h prior to fixation for immunofluorescence analysis or collection for EB infectivity assays. Data from this study indicates that both C. trachomatis serovar E and C. muridarum EB bind to C. albicans yeast and hyphal forms. This interaction was not blocked by pre-incubation of EB with the Candida cell wall components, mannan or β-glucans, suggesting that EB interact with a Candida cell wall protein or other structure. Bound EB remained attached to C. albicans for a minimum of 5 days (120 h). Infectivity assays demonstrated that EB bound to C. albicans are infectious immediately following binding (0h). However, once bound to C. albicans, EB infectivity decreased at a faster rate than EB in medium alone. At 6h post binding, 40% of EB incubated in medium alone remained infectious compared to only 16% of EB bound to C. albicans. Likewise, pre-incubation of EB with laminarin, a soluble preparation of β-glucan, alone or in combination with other fungal cell wall components significantly decreases chlamydial infectivity in HeLa cells. These data indicate that interactions between EB and C. albicans inhibit chlamydial infectivity, possibly by physically blocking EB interactions with host cell receptors

Contraceptive Counseling Among Family Medicine Residents

Unintended pregnancy rates remain a world wide public health concern. Healthy People 2030 has designated unintended pregnancies a key initiative, stating that increasing the use of contraception and decreasing unintended pregnancy is an important public health goal. According to the American Academy of Family Physicians, approximately one-half of the 6.6 million pregnancies each year in the United States are unintended. Family medicine physicians have an ideal position to provide contraception counseling in our communities. Unfortunately when surveyed, although 95% of medicine faculty and residents responded that contraceptive counseling is important, only one-quarter of providers reported providing contraceptive counseling “routinely” (defined as ≥ 80% of the time) to reproductive aged women during prevention-focused visits. Several studies have attempted to understand why primary care physicians are not routinely providing preconception and contraception counseling with multiple factors identified including inadequate knowledge of contraception methods (especially in regards to long-acting reversible contraceptives or LARCs), lack of time, lack of routine sexually history taking, and provider misconception regarding contraception. This study was completed as a quality improvement project among ETSU Health Family Medicine Kingsport residents. The aim of the quality improvement project was to determine if increasing awareness of gaps in contraception counseling and providing contraception counseling education would increase the rates of contraception counseling during yearly visits (well child checks, annual physicals, and annual wellness visits) for women of reproductive age (defined as ages 14-45). Clinic charts were reviewed in a 3 month time period pre and post an educational intervention. The educational intervention included a 1 hour lecture on current contraception methods and recommendations. A survey was also collected pre and post educational intervention to identify self-reported rates of contraception counseling and other perceived barriers to contraception counseling in our clinic. The rates of contraception were determined by either the presence or absence of the billing ICD-10 code Z30.09 (Encounter for contraceptive management). Pre-intervention chart review revealed a documented contraceptive counseling rate of 13% at annual preventative visits. Despite these low rates, 71% of residents surveyed pre-intervention strongly agreed that contraceptive counseling was important at annual exams for women of reproductive age. Post-intervention chart review revealed a contraceptive counseling rate of 31% at annual preventative visits, an 18% increase in contraceptive counseling. The results showed that while residents did not self-identify inadequate knowledge of contraceptive methods as a barrier to providing counseling, raising awareness of the importance of contraception counseling and providing an educational intervention did increase rates of contraception counseling. The major barrier identified by providers was a perceived lack of time. One limitation of this study was measuring contraceptive counseling rates by the use of the billing ICD-10 code of Z30.09. By only using this ICD code, visits that documented sexually activity, current contraceptive use, and/or history of prior hysterectomy but did not properly bill for Z30.09 were not included