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Sexton436presentation

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Sexton436presentation

  1. 1. Life is a garden With Gardnerella vaginalis By: Edison Sexton
  2. 2. Case  Q.C. Is a 28 year old woman.  Went to doctor complaining about fishy smelling vaginal discharge.  Denied soreness or itching  Stated several sexual partners including other women  Gram stain revealed clue cells, PMNs and a score of 8 on the nugent scale.  Vaginal pH of 6
  3. 3. Case continued  “Whiff” test was positive  Affirm VPIII was positive for Gardnerella vaginalis.  Culture revealed gamma hemolysis on SBA agar and Beta on HBT agar
  4. 4. Organisms associated with BV  Lactobacillus sp. are normal flora  Mobiluncus spp.  Gardnerella vaginalis  Mycoplasma hominis  Prevotella spp.  Peptostreptococcus spp.  Porphyromonas spp.  Atopobium vaginae  Usually polymicrobial
  5. 5. BV tests  Vaginal discharge  >4.5 pH  Affirm VPII – Detect Gardnerella vaginalis, Candida albicans and Trichomonas vaginalis.  “Whiff” test – Add two drops of 10% KOH – Wait for fishy odor  Microscopic - Clue cells - PMNs
  6. 6. More BV tests  Nugent Scoring System – Preliminary identification microscopically – Gives insight to vaginal microbiota prior to culture – Quantitate Lactobacillus morphology – Compare to Gardnerella morphology – More accurate than cultures
  7. 7. Gardnerella vaginalis  Gram-positive coccobacillus (gram variable)  Normal flora in 40% of women (in small amounts)  Also possible in urine  Rarely in blood or wounds
  8. 8. Growing in lab  5-7% CO2  37°Celsius  SBA - pinpoint, gamma hemolysis  Human blood bilayer tween agar (HBT) - Beta hemolytic, small, gray, opaque - Similar to V agar  Culture rarely done, normally presumptive diagnosis
  9. 9. Biochemical results  Catalase, Oxidase negative  Motility negative  Esculin hydrolysis negative  Acid produced from glucose and maltose
  10. 10. Biochemical continued -Gamma hemolysis (Beta on HBT) -Positive urease -Rapid antigen testing -Affirm VPIII (DNA hybridization) -16S rRNA gene sequencing
  11. 11. Treatment  Oral or topical  Metronidazole or tinidazole  Twice daily for seven days  Pregnant women at high risk  Probiotics
  12. 12. Sources  Amatnieks, Yuri. Fun with microbiology. N.p., 14 Nov. 2010. Web. 27 Apr. 2014.  Connie, Mahon, Lehman Donald, and Manuselis George. Textbook of Diagnostic Microbiology. 4th ed. Maryland Heights: Saunders Elsevier, 2011. Print.
  13. 13. Questions?

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