The role of leptotrichia in the clinical course of seborrheic dermatitis and principles of treatment

Leptotrichosis is a disease of the oropharynx caused by the bacterium Leptothrix buccalis. This is a conditionally pathogenic microflora, since leptotrichia constantly live in the human oral cavity. In order for the disease to develop, some provoking factor is necessary. Children are very often susceptible to this disease. The bacteria multiply quickly, usually affecting the back of the tongue, but can also develop on other surfaces of the oral cavity.

Causes

The provoking factors causing leptotrichosis are:

• Diseases of the immune system, incl. AIDS.
• Fungal infections, candidiasis.
• Diabetes.
• Diseases of the gastrointestinal tract.
• Diseases of the oral cavity leading to degeneration of the epithelium of the mucous membrane.
• Metabolic disorders, carbohydrate-protein metabolism.
• Lack of vitamins C and B.
• Taking certain medications (corticosteroids, antibiotics).

Insufficient oral hygiene can also provoke the development of the disease. It is especially often the cause of leptotrichosis in children.

Treatment of dermatitis

Based on the results of microscopic examinations and studies of the immune status, the clinical picture of patients with seborrheic, oral dermatitis and leptotrichosis, it is necessary to use complex therapy .

To treat mucous membranes, bacteriophages (staphylococcal, complex) and antiseptic solutions (Betadine and Miramistin) are used by application to the tongue or for rinsing the mouth, as well as antimycotic (Orungal, Lamisil) and antiparasitic (Trichopol, Dekaris) therapy orally.

To treat skin inflammation, antibacterial (Metrogyl) and antifungal (Nizoral, Triderm, Akriderm GK, etc.) drugs are used in combination.

Source

Symptoms

Leptotrichosis has pronounced symptoms:

• White deposits form on the surface of the mucous membrane. As a rule, they are localized on the root of the tongue, tonsils, and dorsum of the tongue.
• Dense plaques develop under the plaque, which are clearly visible if the deposits are removed.
• The patient feels a burning sensation and pain in the oral cavity. Sometimes these symptoms are so severe that it becomes difficult for the patient to speak or eat.
• There are small “tweezers” on the surface of the plaques, which cause a sore throat and a feeling of a foreign body.

Leptothrix in a smear during pregnancy: diagnosis and consequences

It is worth noting a bacterium from the same family - Leptotrichia amnionii. French scientists managed to isolate it from the amniotic fluid of women who gave birth prematurely. The bacterium caused chorioamnionitis - inflammation of the membranes. The result of this was premature rupture of amniotic fluid and termination of pregnancy.

But the negative impact on the fetus did not stop there. In addition to prematurity and all the problems associated with it, bacteremia was recorded in infants, the presence of the same infectious pathogens in the blood as in the amniotic fluid (water).

Apparently, the bacterium has this effect due to a physiologically determined decrease in the mother’s immunity during pregnancy.

Only the attending physician, a gynecologist who is managing the pregnancy, can confirm or refute the diagnosis. Expectant mothers undergo flora smears at least twice during pregnancy. And if the analysis turns out to have a lot of leukocytes, a competent doctor will prescribe another, additional test - vaginal culture . It is also called cultural research. It takes about a week to complete. Task: to identify which specific microorganisms caused the inflammatory process and which antibiotics they are sensitive to, that is, to prescribe the most effective drug.

It is in the culture that Leptothrix is ​​detected. It must be treated necessarily in the presence of symptoms and (or) in case of confirmation of its subtype - amnionii, even a small amount of which can lead to fetal death.

The PCR test, which is also taken by expectant mothers, helps to identify hidden sexually transmitted infections. They often occur in parallel with leptotrichosis and are dangerous for the fetus.

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Diagnosis and treatment

Despite the pronounced symptoms, visual examination alone is not enough to make an accurate diagnosis. The doctor will definitely prescribe an additional examination of a smear taken from the oral mucosa. The diagnosis is made when leptothrix bacteria are detected in the smear.

In rare cases, leptotrichosis resolves spontaneously. Most often, treatment is required, and the effectiveness of medications varies greatly between patients. As a rule, leptotrichosis is persistent, and complete recovery requires a long time, the patient’s patience and strict adherence to the doctor’s prescriptions. Leptotrichosis can be treated using different methods and their combinations:

• Drug treatment. As a rule, the doctor prescribes a course of anibiotics and, in addition to it, washing the affected areas with antiseptic solutions. Drug treatment is long-term, taking several months.
• Cryotherapy. One of the modern methods, in which the affected areas are frozen. The procedure is performed under local anesthesia. Cryotherapy is most often used as an additional treatment method.
• Physiotherapy. The oral cavity is treated with laser and ultraviolet radiation. As an independent method, physiotherapy is effective only if all plaques are in the irradiation zone. Plaques not irradiated during the session are preserved. Physiotherapy is successfully combined with drug treatment and vitamin therapy.

Combined treatment programs achieve the greatest success. At the first stage, treatment with antibiotics and rinsing the throat and mouth with antiseptic solutions are prescribed. At the same time, treatment of diseases that provoked the development of leptotrichosis is carried out. The course of treatment is long, usually 3-4 months, but in most cases the combined effect gives a good effect.

Bacterial vaginosis: new perspectives in treatment

A.A. KHRYANIN

, Doctor of Medical Sciences, Professor,
Novosibirsk State Medical University of the Ministry of Health of Russia; Vice-President of the ROO "Association of Obstetricians-Gynecologists and Dermatovenerologists", Novosibirsk, O.V.
RESHETNIKOV , MD, Senior Researcher,
Research Institute of Therapy and Preventive Medicine, Novosibirsk
Bacterial vaginosis is an infectious non-inflammatory syndrome characterized by the replacement of normal microflora (mainly lactobacilli) with polymicrobial associations of anaerobes and Gardnerella vaginalis. In recent years, the use of molecular biology techniques has shown that there is a much greater diversity of microorganisms associated with bacterial vaginosis than previously thought. Clindamycin has established itself as an effective and safe drug in the treatment of bacterial vaginosis in modern conditions.

The vaginal flora is a multicomponent microecological system that provides protection to all reproductive organs of women both under normal conditions and in pathology. The main representatives of the vaginal microflora are normally lactobacilli of various species (Lactobacillus spp.) and, to a lesser extent, bifidobacteria and corynebacteria, as well as anaerobic gram-negative bacilli of the genus Fusobacterium

and gram-negative cocci of the genus
Veillonella
. In healthy women of reproductive age, the leading place in the vaginal microcenosis is occupied by lactobacilli (anaerobic and aerobic origin), united under the general name “Dederlein's rods,” which make up more than 95% of the total vaginal microflora. Bifidobacteria, like lactobacilli, protect the vaginal mucosa from the effects of not only pathogenic, but also opportunistic microorganisms and their toxins, prevent the breakdown of secretory IgA, stimulate the formation of interferon and the production of lysozyme. In healthy women, anaerobic microflora prevails over aerobic microflora in a ratio of 10: 1 [1, 2].

Lactobacilli convert glycogen, which is contained in large quantities in the vaginal epithelial cells of women of reproductive age, into lactic acid, increasing the acidity of the vagina. In addition, lactobacilli produce hydrogen peroxide. As a result, the acidic environment of the vagina and hydrogen peroxide inhibit the growth of opportunistic microbes (staphylococci, streptococci, E. coli, anaerobic bacteria, Gardnerella vaginalis, Mobiluncus spp.

), which are found in small quantities in the vagina of the vast majority of women. If the proportion of lactobacilli decreases, their place in the ecosystem is taken by opportunistic microbes (primarily Gardnerella vaginalis). Thus, the acidic environment of vaginal contents, lactobacilli and the protective factors they produce form a powerful natural barrier to the penetration of pathogenic bacteria, protecting the upper parts of the woman’s reproductive tract.

A feature of the vaginal microflora is its variability under the influence of both exogenous (use of tampons, frequent vaginal showers and douching, change of sexual partner) and endogenous factors (neuroendocrine diseases, diabetes, hypothyroidism). Microcenosis is influenced by physiological and hormonal changes (puberty, pregnancy, menopause), phases of the menstrual cycle, and various disorders of menstrual function [3]. The use of certain medications (antibiotics, hormones) and surgical interventions also plays a role.

Bacterial vaginosis (BV) (formerly known as vaginal dysbiosis) is a general infectious non-inflammatory syndrome associated with vaginal dysbiosis and accompanied by an excessively high concentration of obligate and facultative anaerobic opportunistic microorganisms in combination with a sharp decrease in the number or absence of lactic acid bacteria in the vaginal discharge ( table 1

).

With bacterial vaginosis, elimination of lactobacilli occurs, accompanied by colonization of the vagina by anaerobes: Fusobacterium, Mobiluncus, Peptostreptococcus, Gardnerella vaginalis

. Despite the fact that BV is characterized by its polymicrobial nature, the main microorganism that triggers the process is Gardnerella vaginalis, a facultative anaerobic gram-negative rod; It is this that determines the main symptoms of BV.

The fact is that G. vaginalis

has the unique ability to form a so-called biofilm on the surface of the urogenital mucosa.
Biofilm a
conglomerate of microorganisms located on any surface, the cells of which are attached to each other. Typically, cells are immersed in an extracellular polymeric substance (extracellular matrix) they secrete - mucus. It is believed that 95-99% of all microorganisms in the natural environment exist in the form of biofilm. Microorganisms form a biofilm under the influence of a number of factors, including cellular recognition of sites of attachment to the surface and the presence of nutrients or aggressive substances, oxygen, etc. In the biofilm formation mode, the cell changes its behavior, which is determined by the regulation of gene expression.

It is this biofilm, like cement or glue, that attracts other microorganisms to itself, forming a conglomerate of bacteria, most of which have a pathogenic, or at least dangerous, effect for humans. Biofilms have been found to consist primarily of Gardnerella vaginalis

, while
Atopobium vaginae
was present in 80% of cases and constituted 40% of the biofilm mass.
Other bacteria are much less common, including bacteria belonging to the genera Bacteroides, Corynebacterium, Lactobacillus, Veillonella, Ruminococcus and Streptococcus
[4].

Factors contributing to the development of BV include:

— Immunodeficiency states of the body (chronic stress, diseases, massive treatment with antibiotics and cytostatics, radiation therapy, diabetes, vitamin deficiency). — Hormonal dysfunction of the ovaries, including age-related hormonal changes, hormone therapy. — Inhibition of local immunity factors and lactobacilli (vaginal douching, foreign bodies, intrauterine contraceptives, use of spermicides, contraceptive suppositories and creams containing 9-nonoxynol (Patentex Oval, Nonoxynol) — Massive infection of the vagina, promiscuous relationships.

Prevalence of BV

It is not possible to determine the true incidence of BV due to the fact that in 1/3 of women this disease is asymptomatic. The few studies have found the prevalence of BV to range from 3.14% in asymptomatic women aged 18 to 72 years (screened in the Netherlands) to 49% in women aged 13 to 65 years in a colposcopy office in the United States. The wide variation in reported prevalence rates may be due to the inclusion of different patient groups, demographic variations, and different diagnostic criteria. Overall, based on the results of 21 studies, the overall prevalence of BV was 27.1%, with no significant difference between developed (28.0%) and developing (23.5%) countries [5].

During the Human Microbiome Project, molecular biology techniques revealed that there is a much greater diversity of microorganisms associated with BV than was apparent using culture methods. As an example, here is a list of microorganisms previously unknown in BV: Atopobium vaginae, BV-associated bacteria (BVAB-1, BVAB-2 and BVAB-3) from the order Clostridiales, Megasphaera spp, Leptotrichia spp, Dialister spp, Chloroflexi spp, Olsenella spp, Streptobacillus spp, Shuttleworthia spp, Porphyromonas asaccharolytica

[6].

These diverse organisms accumulate to form distinct communities or profiles, which suggest that BV is not a single entity but a syndrome of variable composition, causing a variety of symptoms, different phenotypic outcomes, and resulting in variable responses to different antibiotic regimens. Some organisms or combinations of organisms are highly specific for BV, so in the future the use of molecular quantitative assays will allow better diagnosis of each BV subtype and individualized therapy. A woman's race and geographic region, as well as different racial groups within the same geographic region, have significant differences in which microorganism is dominant in the vaginal environment. In most populations, L. crispatus is the dominant isolate, and in white women, L. crispatus and/or L. jensenii are more common than any other Lactobacillus

[6].

Among African American women in the United States, the prevalence of gram-negative bacteria BVAB1, which was previously mistakenly perceived as Mobiluncus spp,

. [7].

A recent meta-analysis involving more than 10,000 women demonstrated an association between BV and precancerous conditions, namely cervical intraepithelial neoplasia/dysplasia [5]. Since only a minority of patients infected with HPV develop cervical dysplasia, studies of cervical carcinogenesis should include the presence of an additional contributing factor. This factor is BV. Biochemical changes in the vaginal secretions of women with BV include the formation of metabolic products such as propionate and butyrate, which can damage epithelial cells. In addition, BV-associated anaerobes release volatile amines (especially putrescine, trimethylamine and cadaverine), which appear in the vaginal environment after the conversion of amino acids derived from the abundance of anaerobes, and form, in combination with nitrites (derived from bacterial nitrates), nitrosamines. These carcinogenic compounds are capable of forming DNA adducts and therefore mutagenic events. Local accumulation of nitrosamines during episodes of BV may promote cellular transformation in the cervical epithelium in combination with other oncogenic agents such as HPV infection. In addition, patients with BV and dysplasia showed an altered profile of local cervical immunity, namely nitric oxide (NO) and cytokine concentrations (IL-6, IL-8 and IL-10). Finally, another important additional cofactor in cervical carcinogenesis may be the relative absence of hydrogen peroxide (H2O2), normally produced by lactobacilli. This prevents the selective induction of apoptosis, which is a key element of lactobacilli-stimulated antitumor defense [5].

In non-pregnant women, the presence of BV is associated with an increased risk of infection of the upper genital tract with non-sexual infections and STIs, as well as HIV infection. During pregnancy, BV increases the risk of post-abortion sepsis, early miscarriage, recurrent miscarriage, late miscarriage, premature rupture of membranes, spontaneous preterm contractions and preterm birth, histological chorioamnionitis and postpartum endometritis. As a result, abnormal vaginal flora may predispose to increased colonization of the genital tract, infiltration of membranes, microbial invasion of the amniotic cavity, and fetal damage [6].

Careful observation of 49 women (vaginal samples taken weekly during pregnancy and monthly after childbirth) showed that a relatively greater diversity of microorganisms present in the birth canal was associated with the risk of preterm birth, and the highest risk was found in women whose vaginal secretions contained few lactobacilli , as well as microorganisms of the species Gardnerella spp

and
Ureaplasma spp.
Most women have postpartum disturbances in the vaginal microbiota with a decrease in
Lactobacillus spp
and an increase in various anaerobes, such as
Peptoniphilus, Prevotella and Anaerococcus
species. This impairment was not associated with gestational age at delivery and persisted for up to 1 year postpartum. The findings have important implications for predicting preterm birth and for understanding the potential impact of persistent changes in the postpartum microbiota on maternal health, including outcomes in subsequent short-term pregnancies [8].

Laboratory diagnosis of BV

BV can be diagnosed clinically or using a set of clinical criteria, microscopic, enzymological, chromatographic methods, as well as using qualitative or semi-quantitative cultural methods [6].

In world medical practice, clinical and laboratory criteria proposed by Amsel R. (1983) are used, listed in Table 2 [9]. The diagnosis of bacterial vaginosis is considered confirmed if three or four of the following criteria are present:

The presence of at least 3 positive signs out of 4 is considered diagnostically significant:
1. Clinical manifestations. 2. Increased pH of vaginal discharge > 4.5. 3. Positive amine test (increased smell of rotten fish when reacting with 10% KOH). 4. Gram smear microscopy criteria: desquamated epithelium in large quantities, “key cells” make up 20% of all epithelial cells, leukocytes are rare.

The culture method has the highest sensitivity and specificity in the diagnosis of bacterial vaginosis.
Its high information content is due to qualitative and quantitative indicators of the composition of the vaginal microbiocenosis. Accordingly, with bacterial vaginosis, there is a decrease in the number of lactobacilli and an increase in the content of opportunistic flora. Disadvantages of the method: relative high cost and duration of implementation. The study of Gardnerella DNA in scrapings from lesion sites using PCR is an important additional criterion for BV. Expanded criteria for diagnosing BV
1. Predominance of epithelial cells over leukocytes (no more than 30 per field of view). 2. No visual signs of inflammation. 3. The presence of at least 20% key cells. 4. Detection of less than 5 lactobacilli per field of view by immersion microscopy. 5. Polymicrobial picture of the smear (abundant polymicrobial coccal and rod G-/G+ flora. 6. Increased bacterial contamination in the cytological preparation.

Nugent criteria

The low sensitivity of the Amsel criteria and the presence of asymptomatic forms of bacterial vaginosis forced us to look for other methods and criteria for confirming the diagnosis. At the end of the 80s. Spiegel proposed using a scoring system for diagnosing bacterial vaginosis, taking into account the ratio of morphotypes of lactobacilli and vaginal gardnerella during microscopy of a Gram-stained vaginal smear. However, the system did not take root, and only in 1991 Nugent RP et al. proposed their laboratory criteria for diagnosing bacterial vaginosis (Nugent's Diagnostic Criteria for Bacterial Vaginosis), which are still widely used in world medicine [10]. It is based on a system of points (points) from 0 to 7 and their combination for diagnosing and assessing the degree of bacterial vaginosis by assessing three bacterial morphotypes of the vagina ( Table 3

):

A - Lactobacilli - large gram-positive rods ( Lactobacillus acidophilus: large gram-positive rods)

B - Gardnerella vaginalis and Bacteroides species:small gram-variable or
gram-negative
C -
Mobiluncus species:curved gram-variable
rods

A recent study compared the Amsel and Nugent criteria; as a result, it turned out that the Amsel criteria are somewhat less informative, but can be used in the absence of a specialized laboratory [11].

In recent years, the global scientific community has developed criteria for the differential clinical and laboratory diagnosis of BV and other similar or associated conditions (diseases). There are nonspecific manifestations that can be recorded by a gynecologist, followed by more accurate laboratory analysis (Table 4) [12].

Treatment
Recognition of the importance of BV and its association with STIs and poor reproductive prognosis has led to the search for better and more comprehensive treatment options. There is a wide range of differential diagnosis for vaginal discharge, and the success of treatment often depends on the correct diagnosis, however, a large percentage of patients are treated without additional specific tests.

The presence of a wide range of therapeutic options diagnosing the main causes of vaginitis, and the lack of a clear diagnosis in 30% of patients, even after additional expensive examination, explains why many gynecologists use these drugs. Misdiagnosis or failure to diagnose other infections, associated mainly in cases of BV and T. vaginalis

, can lead to inadequate treatment, a new exacerbation and re-infection.

In non-pregnant women, treatment will not only eliminate vaginal discharge, but will also reduce the likelihood of infectious complications after an abortion and/or hysterectomy is possible for each woman. In addition, treatment of BV by restoring the acidic pH in the vagina reduces the risk of infection with the immunodeficiency virus and other sexually transmitted diseases.

In pregnant women, treatment with BV, along with the above-mentioned effects, helps reduce the risk of developing pregnancy complications, namely premature rupture of amniotic fluid, the onset of labor (contractions) and childbirth itself, as well as postpartum inflammation of the inner surface of the uterus (endometritis). Pregnant women with asymptomatic BV should also be treated, especially if there is a threat of premature birth.

The drug of choice for the treatment of BV is clindamycin.

This is an antibiotic of the lincosamide group for topical use in gynecology. The mechanism of action of the drug is associated with a disruption of intracellular protein synthesis in the microbial cell at the level of the 50S ribosomal subunit. It has a bacteriostatic effect, and in higher concentrations it has a bactericidal effect against some microorganisms. Has a wide spectrum of action. Active against microorganisms that cause bacterial vaginosis:

•
Gardnerella vaginalis. • Mobiluncus spp. • Bacteroides spp. • Mycoplasma hominis. • Peptostreptococcus spp.
Clindamycin (Dalacin)

.
Release form: vaginal cream and vaginal suppositories
. 5 g of cream (1 dose) vaginal 2% and one vaginal suppository contain: clindamycin phosphate 100 mg.

Pharmacokinetics.

After a single intravaginal administration of 100 mg of clindamycin, an average of 4% of the administered dose is systemically absorbed. Cmax in blood plasma averages 20 ng/ml.

Clinical studies on the use of clindamycin in women in the first trimester of pregnancy have not been conducted, therefore the use of Clindacin in the first trimester of pregnancy is possible only when the expected benefit to the mother outweighs the risk to the fetus. Use in the second and third trimesters of pregnancy is possible if the expected effect of therapy outweighs the potential risk to the fetus (adequate and strictly controlled studies have not been conducted in pregnant women; clindamycin passes through the placenta and can concentrate in the fetal liver, but no complications have been reported in humans). Studies have not determined whether treating bacterial vaginosis reduces the risk of adverse pregnancy outcomes such as premature rupture of membranes, preterm labor, or preterm delivery. FDA category of effect on the fetus is B.

A study conducted in Switzerland examined 5,377 pregnant women with symptoms of potential obstetric complications at 25–37 weeks' gestation. pregnancy. Symptomatic women were tested by culture for Mycoplasma hominis and Ureaplasma spp. and treated with clindamycin if positive. As a result of treatment, the percentage of premature births and respiratory complications in newborns significantly decreased [13].

Our colleagues from Belgium searched the PubMed and Web of Science databases to find new approaches in the prevention, treatment and prevention of relapses of BV. As a result, it turned out that clindamycin and metronidazole remain the main drugs in the treatment of BV. Other medications such as tinidazole, rifaximin, nitrofuran, decalinum chloride, ascorbic acid (vitamin C) and lactic acid are being intensively studied. It is believed that the use of a combination regimen, alternating and long-term administration to prevent relapses is promising. The benefits of parallel administration of probiotics are also undoubted [14].

A multicenter, randomized, double-blind study conducted in Germany, Austria, and Switzerland compared the effectiveness and tolerability of 2% vaginal clindamycin cream (5 g at night for 7 days) and oral metronidazole (500 mg orally for 7 days) in the management of BV. Patients were observed 5-10 days and 25-39 days after completion of treatment. As a result, cure or improvement was noted after 1 month in 83% of patients in the clindamycin group versus 73% in the metronidazole group, side effects were noted with equal frequency (12%) in both groups [15].

Recently, the concept of aerobic vaginitis has appeared in the world literature. Aerobic vaginitis is an inflammatory disease of the vagina caused by aerobic microflora with a sharp decrease or absence of normal vaginal lactoflora. Previously, the term “aerobic vaginitis” meant bacterial vaginitis. The basis of aerobic vaginitis, as with bacterial vaginosis, is the reduction or absence of normal vaginal lactoflora and its replacement with aerobic bacteria. The exact causes and mechanism of development of aerobic vaginitis are still unknown. It is also unknown why in some cases there is a proliferation of anaerobic microflora and the development of bacterial vaginosis, and in others the colonization of the vagina by aerobic microorganisms and the development of aerobic vaginitis. The most common etiological agents of aerobic vaginitis ( Escherichia coli, Enterococcus sp.

, group A beta-hemolytic streptococcus, Staphylococcus aureus).
In resolving this controversy, it turned out that vaginal suppositories containing kanamycin or clindamycin showed high effectiveness in relieving aerobic vaginitis in non-pregnant women. Additionally, clindamycin (vaginal suppositories) in combination with probiotics was found to be a better choice for pregnant women with aerobic vaginitis than metronidazole [16]. Conclusion
Bacterial vaginosis is a long-known pathological condition of the female genital area with well-developed clinical diagnostic criteria (Amsela and Nugenta).
New molecular diagnostic capabilities are constantly expanding our understanding of the various types of native and foreign microflora, indicating the diversity of the vaginal microbiota in each individual woman. In this case, the choice of the optimal drug provides clinical effectiveness against most pathogenic microorganisms. Such a drug can be clindamycin, the significance of which in the treatment of bacterial vaginosis is beyond doubt in recent scientific publications. References
1. Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA 2004, 291:11:1368–1379. 2. Mitchell H. Vaginal discharge – causes, diagnosis, and treatment. BMJ 2004, 328:7451:1306–1308. 3. Khryanin A.A., Reshetnikov O.V. Bacterial vaginosis: new ideas about the microbial biosocium and treatment possibilities. Medical Council, 2014, 17: 128-133. 4. Verstraelen H, Swidsinski A. The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment. Curr Opin Infect Dis 2013, 26: 86–89. 5. Gillet E, Meys JFA, Verstraelen H et al. Association between bacterial vaginosis and cervical intraepithelial neoplasia: Systematic review and meta-analysis. Plos One, 2012, 7, Issue 10 e45201. 6. Lamont RF, Sobel JD, Akins RA et al. The vaginal microbiome: New information about genital tract flora using molecular based techniques BJOG, 2011, 118(5): 533–549. 7. Muzny CA, Sunesara IR, Griswold ME et al. Association between BVAB1 and high Nugent scores among women with bacterial vaginosis. Diagn Microbiol Infect Dis., 2014 December, 80(4): 321–323. 8. Di Giulio DB, Callahan BJ, McMurdie PJ et al. Temporal and spatial variation of the human microbiota during pregnancy Proceedings of the National Academy of Sciences 2015/ www.pnas.org/cgi/doi/10.1073/pnas.1502875112. 9. Amsel R, Totten PA, Spiegel CA, et al. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 1983, 74(1): 14–22. 10. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol, 1991, 29(2): 297–301. 11. Mohammadzadeh F, Dolatian M, Jorjani M, Alavi Majd H. Diagnostic value of Amsel's clinical criteria for diagnosis of bacterial vaginosis. Glob J Health Sci., 2014 Oct 29, 7(3): 8-14. 12. Workowski K.A. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recommend Rep 2010; 59:61–63. 13. Vouga M, Greub G, Prodhom G, et al. Treatment of genital mycoplasma in colonized pregnant women in late pregnancy is associated with a lower rate of premature labor and neonatal complications. Clin Microbiol Infect, 2014 Oct, 20(10): 1074-9. 14. Donders GG, Zodzika J, Rezeberga D. Treatment of bacterial vaginosis: what we have and what we miss. Expert Opin Pharmacother, 2014 Apr, 15(5): 645-57. 15. Fischbach F, Petersen EE, Weissenbacher ER, et al. Efficacy of clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis. Obstet Gynecol, 1993 Sep, 82(3): 405-10. 16. Han C, Wu W, Fan A, Wang Y, Zhang H, Chu Z, Wang C, Xue F. Diagnostic and therapeutic advancements for aerobic vaginitis. Arch Gynecol Obstet, 2015 Feb, 291(2): 251-7.

Diagnostic methods

In gynecology, the first stage of diagnosis is a speculum examination and bimanual examination. During the examination, the doctor will not notice any changes in the vagina or cervix.

Two-handed examination in the absence of inflammation in the appendages and uterus is painless. The acidity of the vaginal environment is within normal limits.

• Leptothrix is ​​detected in a simple smear on the flora. Its characteristic feature is its arrangement in the form of long thin chains according to the dot-dash principle.
• A modern diagnostic method is the Femoflor analysis. It is distinguished by the speed of obtaining results, as well as the ability to detect different representatives of normal flora and count their number.

The normal value is 104. If this indicator is exceeded, dysbiosis or nonspecific vaginitis is diagnosed.

Differential diagnosis is carried out with vaginal candidiasis and bacterial vaginosis. Each of these pathologies has characteristic symptoms that make it easy to distinguish them from each other.

Treatment of infection

Treatment of leptothrix in a smear is carried out in each case according to an individual scheme, which is drawn up by a gynecologist, urologist or therapist. Patients are prescribed medications, taking into account the state of the body, the degree of development of pathological processes and individual characteristics.

The woman is additionally prescribed drugs to restore normal vaginal microflora (Acilact). For pregnant women, a standard treatment regimen is selected, but the most gentle drugs are used.

In representatives of the stronger sex, the infection is rarely diagnosed due to the anatomical structure of their reproductive system. But therapy is carried out using all standard medications. Antibacterial drugs internally and externally, immunostimulants, probiotics and anti-inflammatory drugs.

What symptoms may be observed?

Lactobacilli begin to predominate in the vaginal microflora after puberty. But why Leptothrix infection occurs is not known exactly.

There is an opinion that bacteria often appear after self-diagnosis and improper treatment of candidiasis. Anti-thrush medications are readily available, and women often skip gynecological appointments.

Leptothrix is ​​often combined with the following pathogens:

1. 1Trichomonas.
2. 2Gardnerellas.
3. 3 Candida.
4. 4Chlamydia.

Manifestations of infection are nonspecific; in Western literature it is sometimes called the term “lactobacillosis.” It is not sexually transmitted and does not cause any symptoms in men.

The most common symptoms women experience are:

1. 1 Copious, white or clear vaginal discharge without an unpleasant odor or lumps, sometimes resembling water.
2. 2Itching and burning in the vagina and vulva area.
3. 3The acidity of the vaginal environment remains normal.
4. 4Sometimes a woman complains of discomfort and burning when urinating.
5. 5During examination, the doctor, as a rule, does not see redness of the vaginal walls and swelling - obvious signs of inflammation.

Complaints often appear in the second phase of the cycle, when menstruation approaches. There is evidence that high concentrations of hydrogen peroxide and lactic acid in the vagina lead to damage to epithelial cells and nerve endings, which can cause the development of vulvodynia.

During pregnancy, the detection of leptothrix is ​​also accompanied by copious liquid discharge, which constantly wets the underwear.

Leptotrichosis, that is, an infection caused by leptotrichia , is characterized by slightly different symptoms:

1. 1Increase in the amount of vaginal discharge, change in color (gray, white-gray).
2. 2The appearance of an unpleasant odor, typical of bakvaginosis.
3. 3Shift of acidity to the alkaline side.
4. 4Pain during sexual intercourse (dyspareunia).
5. 5Itching and burning in the vagina.

One of the types of leptotrichia - Leptothrix amnionii - can cause the following complications:

1. 1Premature termination of pregnancy.
2. 2Choriamnionitis.
3. 3Low fetal weight at birth.
4. 4Postpartum sepsis in immunosuppressed women in labor.
5. 5Infection of a newborn.

Identification of this pathogen is extremely rare.

Clinical picture: symptoms and signs

Affecting the mucous membranes of the vagina and cervix, the pathology manifests itself as a gray coating on the walls, and vaginal discharge also becomes gray. And in addition, redness, itching and burning, which intensify during sex. The female body does not show any other reactions. At least in the “non-pregnant” state and with normal immunity.

If a woman has concomitant inflammatory diseases of the pelvic organs, for example, endometritis, parametritis, salpingitis, then broader symptoms are possible. This is an increase in temperature to 39-40 degrees, headache and muscle pain, dehydration. General intoxication of the body occurs. Such symptoms appear mainly in expectant mothers when leptothrix enters their blood. The same bacterium provokes severe abdominal pain in them. The amniotic membranes are also affected. A child becomes infected with the bacteria in utero .

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Consequences and possible complications of leptotrichosis

Without timely and properly selected therapy, a person will face serious consequences:

For a pregnant woman, leptotrichosis is dangerous due to abnormal development of the fetus, its infection and premature birth, as well as postpartum sepsis. There is a high risk of spontaneous miscarriage. After birth, the baby's oral mucosa becomes inflamed.

In some situations, there remains a high probability of relapse of the disease. This is explained by the fact that secondary infection of the human body can occur. Relapse of leptotrichosis is also a consequence of an incomplete course of treatment.

Opportunistic flora is present in every organism, and it is not dangerous. But under the influence of certain factors, there is an increase in pathogenic bacteria, which provoke an inflammatory process. These bacteria include Leptothrix. The pathogen can be determined as accurately as possible using a smear. The doctor prescribes treatment after a complete diagnosis, referring to the data obtained.

Features of the pathogen

The causative agent of leptotrichosis is a gram-negative bacillus (fusobacterium family). It is able to develop and reproduce under anaerobic conditions. They also live in the normal microflora of the human body.

Under certain conditions, bacteria are activated and provoke the development of the inflammatory process. This may be a decrease in immunity or another concomitant disease, under the influence of which the body’s defenses deteriorate.

What is leptothrix

Leptothrix (Leptothrix from Leptos thin + thrix hairs) or in modern terminology leptotrichia (Leptotrichia) is an anaerobic gram-negative bacterium belonging to the family Fusobacteriaceae, forming thin threads or “chains” (trichiae) with segmented ends and a thickening in the center with a diameter of 0.2 - 0.4 microns, which do not branch or bud. Leptorix is ​​characterized by a microscopic sign - “dot-dash”. Optimal growth of the microorganism occurs in the presence of an increased concentration of CO2

Leptotrichosis is not a sexually transmitted disease and vaginal leptotrichosis is not transmitted to men. But why then, you ask, are issues related to leptothrix discussed on the site about sexually transmitted infections?

Firstly, leptothrix is ​​often found in mixed sexual infections - trichomoniasis, chlamydia, candidiasis and bacterial vaginosis - i.e. its detection (and it is easily diagnosed by microscopy) should alert the doctor and provide for further more in-depth examination (PCR, bacteriological culture). Secondly, leptotrichosis of the oropharynx is classified as an HIV-associated disease (it is also often found in patients with a significant decrease in immunity, cancer patients, and people with blood diseases).

Third, recent studies have established the role of leptothrix (in modern terminology - leptotrichia) in the development of choriamnionitis, spontaneous abortion, postpartum sepsis, bacteremia in newborns and septic arthritis.

Dosage form and composition of the drug Terzhinan

Terzhinan is a combined broad-spectrum antimicrobial drug. It is produced in the form of tablets for local and intravaginal use. These are suppositories similar to suppositories, but have a flatter shape and differ in structure. They do not contain wax.

The packaging of the drug contains 6 or 10 yellowish tablets, packaged in plastic or metallized blisters with individual cells. One dose of the medicine contains 4 active ingredients:

• 200 mg. tenidazole: an antibiotic effective against anaerobic bacteria;
• 100 mg. neomycin: an aminoglycoside that destroys proteins of aerobic microbes;
• 100,000 IU nystatin: antifungal agent;
• 4.7 mg. prednisolone derivative: glucocorticoid hormone with anti-inflammatory effect.

Auxiliary compounds of the drug: starch, lactose, silicon dioxide, magnesium stearate and others.

The mechanism of action of Terzhinan tablets

The instructions for the drug inform that Terzhinan has a pronounced antimicrobial and antiseptic effect, eliminates fungal infections, inflammatory processes, and helps restore the balance of internal microflora. The combination of active substances in it allows you to successfully treat advanced infectious diseases, including those of a combined nature, caused by several pathogens:

• gram-positive and gram-negative bacteria;
• pathogenic fungi;
• Trichomonas.

Terzhinan helps maintain the integrity of the epithelial covers of the mucous membranes, prevents exudative infiltration, the development of erosive and other lesions during inflammatory reactions, normalizes the pH level, alleviates the symptoms of the acute phase of diseases, helps to quickly get rid of itching, burning, tissue swelling and pathological discharge.

The high concentration of components ensures the rapid destruction of all pathogens sensitive to them before they have time to develop resistance to Terzhinan. It is likely that the active substances in the drug enhance the effectiveness and duration of action of each other.

Antibiotics and prednisolone in the medication are active only in the area of ​​placement. They are not absorbed through the mucous membranes into the systemic circulation. The concentrations of active substances penetrating into the body are negligible.