RESUMO
OBJECTIVE: Neutrophil gelatinase-associated lipocalin (NGAL) is a component of innate immunity that prevents iron uptake by microorganisms. We evaluated whether NGAL was present in vaginal fluid and whether concentrations were altered in women with bacterial vaginosis (BV) or vulvovaginal candidiasis (VVC). METHODS: Vaginal secretions from 52 women with VVC, 43 with BV, and 77 healthy controls were assayed by enzyme-linked immunosorbent assay for NGAL and for concentrations of L-lactic acid. RESULTS: The median concentration of NGAL in vaginal fluid was significantly higher in control women (561 pg/mL) than in women with BV (402 pg/mL; P = .0116) and lower in women with VVC (741 pg/mL; P = .0017). Median lactic acid levels were similar in controls (0.11 mmol/L) and women with VVC (0.13 mmol/L) and were lower in women with BV (0.02 mmol/L; P < .0001). The NGAL and lactic acid concentrations were highly correlated (P < .0001). CONCLUSION: A decrease in Lactobacilli and/or lactic acid plus the absence of leukocytes results in lower vaginal NGAL levels that might facilitate the growth of bacteria associated with BV.
Assuntos
Proteínas de Fase Aguda/análise , Líquidos Corporais/química , Candidíase Vulvovaginal/metabolismo , Lipocalinas/análise , Proteínas Proto-Oncogênicas/análise , Vagina/metabolismo , Vaginose Bacteriana/metabolismo , Adulto , Biomarcadores/análise , Líquidos Corporais/metabolismo , Líquidos Corporais/microbiologia , Candidíase Vulvovaginal/diagnóstico , Candidíase Vulvovaginal/imunologia , Candidíase Vulvovaginal/microbiologia , Estudos de Casos e Controles , Regulação para Baixo , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunidade Inata , Ácido Láctico/análise , Lipocalina-2 , Vagina/imunologia , Vagina/microbiologia , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/imunologia , Vaginose Bacteriana/microbiologia , Adulto JovemRESUMO
OBJECTIVE: To evaluate levels of proinflammatory cytokines and sialidase activity in aerobic vaginitis (AV) in relation to normal vaginal flora and bacterial vaginosis (BV). STUDY DESIGN: In this cross-sectional study, a total of 682 consecutive non-pregnant women attending the gynecology service were assessed and 408 women were included. Vaginal rinsing samples were collected from 223 women with microscopic finding of BV (n=98), aerobic vaginitis (n=25) and normal flora (n=100). Samples were tested for interleukin (IL)-1ß, IL-6, IL-8, tumor necrosis factor (TNF)-α, and sialidase activity. RESULTS: Compared to women with normal flora, vaginal levels of IL-1ß were highly increased in both BV and AV (p<0.0001). Significantly higher vaginal IL-6 was detected in AV (p<0.0001) but not in BV, in relation to normal flora. Women with AV also presented increased IL-8 levels (p<0.001), while those with BV presented levels similar to normal flora. Sialidase was increased in BV and AV compared with the normal group (p<0.0001) but no difference in sialidase activity was observed between BV and AV. CONCLUSION: A more intense inflammatory host response occurs for AV than for BV when compared with normal flora. Furthermore, the increased sialidase activity in AV and BV indicates that both abnormal vaginal flora types can be harmful to the maintenance of a healthy vaginal environment.
Assuntos
Proteínas de Bactérias/metabolismo , Mucosa/metabolismo , Neuraminidase/metabolismo , Regulação para Cima , Vagina/metabolismo , Vaginose Bacteriana/metabolismo , Adolescente , Adulto , Bactérias Aeróbias/classificação , Bactérias Aeróbias/enzimologia , Bactérias Aeróbias/isolamento & purificação , Proteínas de Bactérias/isolamento & purificação , Brasil , Estudos Transversais , Feminino , Humanos , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Interleucina-8/metabolismo , Pessoa de Meia-Idade , Tipagem Molecular , Mucosa/imunologia , Mucosa/microbiologia , Neuraminidase/isolamento & purificação , Vagina/imunologia , Vagina/microbiologia , Esfregaço Vaginal , Vaginose Bacteriana/imunologia , Vaginose Bacteriana/microbiologia , Adulto JovemRESUMO
OBJECTIVES: To investigate if the participation of Atopobium vaginae, Megasphaera sp. and Leptotrichia sp. in the bacterial community of bacterial vaginosis (BV) is associated with distinct patterns of this condition. METHODS: In this cross-sectional controlled study, 205 women with BV and 205 women with normal flora were included. Vaginal rinsing samples were obtained for measuring the levels of pro-inflammatory cytokines and bacterial sialidases. Real-time PCR was used to quantify the BV-associated bacteria and to estimate the total bacterial load using the 16S rRNA. Principal component analysis (PCA) using the measured parameters was performed to compare the BV samples with lower and higher loads of the species of interest. RESULTS: Higher bacterial load (p<0.001), levels of interleukin 1-ß (p<0.001) and sialidase activity (p<0.001) were associated with BV. Women with BV and higher relative loads of A vaginae, Megasphaera sp. and Leptotrichia sp. presented increased sialidase activity, but unchanged cytokine levels. PCA analysis did not indicate a different pattern of BV according to the loads of A vaginae, Megasphaera sp. and Leptotrichia sp. CONCLUSIONS: Greater participation of A vaginae, Megasphaera sp. and Leptotrichia sp. in vaginal bacterial community did not indicate a less severe form of BV; moreover, it was associated with increased sialidase activity.
Assuntos
Actinobacteria/imunologia , Imunidade Inata , Leptotrichia/imunologia , Megasphaera/imunologia , Neuraminidase/metabolismo , Vaginose Bacteriana/imunologia , Adolescente , Adulto , Carga Bacteriana , Biota , Estudos Transversais , Citocinas/análise , Citocinas/imunologia , Feminino , Humanos , Pessoa de Meia-Idade , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Reação em Cadeia da Polimerase em Tempo Real , Ducha Vaginal , Adulto JovemRESUMO
OBJECTIVE: Reduced CD16 expression is associated with neutrophil apoptosis. This study aimed to compare CD16 expression on neutrophils in the vagina from women with normal bacterial flora and with vaginitis. STUDY DESIGN: Vaginal lavages were sampled from volunteers diagnosed with bacterial vaginosis (BV, n=34), vulvovaginal candidiasis (VC, n=43), BV plus VC (BV+VC, n=14), and normal flora (NF, n=51). Neutrophils were identified by expression of CD15, CD16 and CD24 surface markers as assessed by flow cytometry. RESULTS: CD16 expression was elevated in neutrophils from women with vaginitis (BV p<0.0001; VC p=0.01; BV+VC p=0.0027) as compared to women with NF. CONCLUSION: The reduction in CD16 down-regulation is consistent with prolonged neutrophil viability and activity in the vagina of women with vaginitis. This may contribute to greater microbial clearance and, conversely, with inflammation-associated pathology.
Assuntos
Candidíase Vulvovaginal/imunologia , Neutrófilos/metabolismo , Receptores de IgG/metabolismo , Vagina/imunologia , Vaginose Bacteriana/imunologia , Antígenos de Superfície/metabolismo , Estudos Transversais , Feminino , Citometria de Fluxo , Humanos , Contagem de LeucócitosRESUMO
PROBLEM: The extent of the vaginal immune response is not fully determined. The purpose of this study was to evaluate the vaginal immune cells from women with vulvovaginitis (VV). METHOD OF STUDY: A total of 142 volunteers diagnosed with bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and BV associated with VC or normal microflora were sampled to evaluate the immune cells by flow cytometry. The immune cells were obtained by vaginal lavage and labeled with fluorochrome-conjugated monoclonal antibodies to identify neutrophil granulocytes, macrophages, CD4(+) and CD8(+) T lymphocytes, B lymphocytes, and NK lymphocytes. RESULTS: Neutrophil granulocytes were present in 84.6% of samples among the leukocyte populations. Considering samples in which neutrophils were present, the mean percentage of neutrophil granulocytes was significantly higher in women with VC than BV and normal microflora and was significantly lower in women with BV than normal microflora. Macrophages and lymphocytes were present in a lower percentage of samples. The mean percentage of CD4(+) T lymphocytes in vaginal lavages was significantly higher in VC and BV compared with women with normal microflora. CONCLUSIONS: Neutrophils were the predominant leukocytes and were associated with VC and inversely with BV. CD4(+) T lymphocytes were associated with both VC and BV.
Assuntos
Candidíase Vulvovaginal/imunologia , Vagina/imunologia , Vaginose Bacteriana/imunologia , Adulto , Candidíase Vulvovaginal/patologia , Feminino , Citometria de Fluxo , Humanos , Ducha Vaginal , Vaginose Bacteriana/patologiaRESUMO
OBJECTIVE: To evaluate the local immune response in patients with bacterial vaginosis (BV) and cervical intraepithelial neoplasia (CIN), as assessed by cytokine and nitric oxide (NO) concentrations. STUDY DESIGN: Patients attending for routine gynaecological examination were prospectively enrolled in groups: BV (n=25) diagnosed by clinical criteria, CIN graded I to III (n=35, 6 CIN I, 8 CIN II and 21 CIN III) by histological analysis, and controls (n=15) without clinical and cytological findings. Randomly selected patients within CIN group at grades II or III (n=15) were re-evaluated at 60 days after surgical treatment. Endocervical (EC) and vaginal secretion samples were collected by cytobrush and the levels of cytokines (ELISA) and NO metabolite (Griess reaction) were assayed. RESULTS: NO was assessed in all subjects, and cytokines in all controls, 15 BV and 30 CIN patients. Interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and nitrite levels were higher in EC than in vaginal secretions in BV and CIN groups. In CIN group, IL-8, IL-10 and nitrite concentrations were greater in EC and/or vaginal secretions than in BV or controls. Surgical treatment reduced IL-8 levels in EC and vaginal secretions. CONCLUSION: A similar local immune profile was found in BV and CIN groups. The increased local production of IL-8, IL-10 and NO in CIN suggests a role for these mediators in the immune response against tumour or tumour development.
Assuntos
Citocinas/análise , Óxido Nítrico/análise , Displasia do Colo do Útero/imunologia , Neoplasias do Colo do Útero/imunologia , Vaginose Bacteriana/imunologia , Adolescente , Adulto , Secreções Corporais/química , Colo do Útero , Citocinas/imunologia , Feminino , Humanos , Interleucina-10/análise , Interleucina-6/análise , Interleucina-8/análise , Pessoa de Meia-Idade , Óxido Nítrico/imunologia , Estudos Prospectivos , Neoplasias do Colo do Útero/cirurgia , Vagina , Displasia do Colo do Útero/cirurgiaRESUMO
OBJECTIVE: To evaluate associations between polymorphisms in the gene coding for mannose-binding lectin (MBL) and the diagnosis of acute or recurrent vulvovaginal candidiasis and bacterial vaginosis METHODS: Women at two outpatient clinics in Brazil filled out a questionnaire and were examined for the presence of vulvovaginal candidiasis or bacterial vaginosis. A buccal swab was blindly tested for codons 54 and 57 MBL2 gene polymorphisms by polymerase chain reaction and endonuclease digestion. RESULTS: A total of 177 women were enrolled. Vulvovaginal candidiasis was identified in 78 (44.1%) women, 33 (18.6%) had bacterial vaginosis, and 66 (37.3%) were normal controls. Recurrent vulvovaginal candidiasis was present in 50 (64.1%) of the women with vulvovaginal candidiasis; 20 (60.6%) of the bacterial vaginosis patients had recurrent disease. Vulvovaginal candidiasis was associated with white race (P=.007), bacterial vaginosis was associated with nonwhite race (P=.05), and both were associated with a history of allergy (P< or =.02) and having sexual intercourse at least three times a week (P<.001). Carriage of the variant MBL2 codon 54 allele B was more frequent in women with recurrent vulvovaginal candidiasis (25.0%) than in the women with acute vulvovaginal candidiasis (17.9%) or controls (10.6%) (P=.004). Allele B was also more prevalent in women with recurrent bacterial vaginosis (22.5%) than in those with acute bacterial vaginosis (0%) (P=.009). The MBL2 codon 57 polymorphism was infrequent and not associated with vulvovaginal candidiasis or bacterial vaginosis. CONCLUSION: The incidence of vulvovaginal candidiasis and bacterial vaginosis differs by ethnicity in Brazilian women. The MBL2 codon 54 gene polymorphism is associated with both recurrent vulvovaginal candidiasis and recurrent bacterial vaginosis.
Assuntos
Candidíase Vulvovaginal/genética , Lectina de Ligação a Manose/genética , Polimorfismo de Nucleotídeo Único/genética , Vaginose Bacteriana/genética , Doença Aguda , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Candidíase Vulvovaginal/etnologia , Candidíase Vulvovaginal/imunologia , Estudos Transversais , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Lectina de Ligação a Manose/sangue , Pessoa de Meia-Idade , Vaginose Bacteriana/etnologia , Vaginose Bacteriana/imunologiaAssuntos
Humanos , Pré-Escolar , Adolescente , Adulto , Feminino , Recém-Nascido , Lactente , Criança , Vulvovaginite/imunologia , Genitália Feminina/imunologia , Candidíase Vulvovaginal/imunologia , Vaginose Bacteriana/imunologia , Vulvovaginite/fisiopatologia , Recidiva , Genitália Feminina/microbiologia , Vagina/microbiologia , Vagina/imunologia , Candidíase Vulvovaginal/fisiopatologia , Proteínas de Choque Térmico , Vaginose Bacteriana/microbiologia , Vulva/microbiologia , Vulva/imunologia , Colo do Útero/microbiologia , Colo do Útero/imunologiaRESUMO
OBJECTIVE: Predisposing factors influencing recurrences of bacterial vaginosis (BV) or vaginitis from Candida remain unidentified for most women. As a component of studies to determine host susceptibility factors to genital tract infections in women, we measured expression of the 60-kDa and 70-kDa heat shock proteins (hsp60 and hsp70, respectively) in the circulation of women with or without a history of recurrent BV or candidal vaginitis and with or without a current lower genital tract infection. Heat shock protein expression is associated with a down-regulation of pro-inflammatory immune responses that would inhibit microbial infection. METHOD: The investigators measured hsp60 and hsp70, antibodies to these proteins, the pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-alpha), and the anti-inflammatory cytokine interleukin-10 (IL-10) in sera by ELISA. The study population consisted of 100 women who attended a gynecology clinic in Campinas, Brazil. Of those, 55 had a history of recurrent vulvovaginitis (RV), while 45 were controls with no such history. Only women who were asymptomatic for at least 1 month were studied. RESULTS: Although all were asymptomatic, clinical and microbiological examination revealed that five of the women with a history of RV and two controls had a current candidal vaginal infection; 16 RV patients and 12 controls had BV; and six RV patients had both BV and candidiasis. Twenty-eight RV patients and 31 controls had no clinical or microbiological detectable vaginal infection. Among the RV patients, hsp60 and hsp70 were more prevalent in those with current BV (40.9% and 50.0%, respectively) or a candidal infection (45.5% and 54.5%) than in women with no current infection (21.4% and 17.9%). In the women with no history of RV, BV was not associated with a high prevalence of hsp60 (8.3%) or hsp70 (8.3%). Interleukin-10 and TNF were not more prevalent in vaginitis patients or controls with a current candidal infection or BV than in uninfected subjects. CONCLUSION: The high prevalence of circulating hsp60 and hsp70 in women with a history of RV and current BV or vaginal candidiasis, but not in women with no history of RV, suggests that differences in heat shock protein induction may be related to susceptibility to recurrent vaginal infections.