drsalwa

drsalwa内容摘要：

1 Staphylococcus aureus* 7 (4 in mixed cultures) 34 SPECIFIC VULVOVAGINITIS 1 Respiratory pathogens:  Gp A βhem strep (19%)  vaginal bleeding amp。 distinctive fiery red vulvitis  H. infl (11%)  Strep pneum, pneumococcus  The history suggests URTI  Spread by oraldigital route to the genital area (autoinoculation) 35 Streptococcal vulvovaginitis in girls Pediatr Dermatol 1993 Dec。 10(4):3667 Dhar V, Roker K, Adhami Z, McKenzie S  Microbiology lab based study  Gp A βhem Strept (GAHS) 18% of swabs from girls with VV  This suggests that VV is more monly associated with GAHS than reported previously 36 Haemophilus influenzae: an underrated cause of vulvovaginitis in young girls J Clin Pathol 1997 Sep。 50(9):7658 Cox RA, Kettering General Hospital NHS Trust, Northants, UK A prospective laboratory based survey Over 19 Months A questionnaire sent to local general practitioners and hospital doctors 37 RESULTS  106—swabs  43 (%) anisms recognized as causes of .  Gp A βhaemolytic streptococcus  most mon (19)  H. infl  the second most mon (11)  Candida (9)  QUESTIONNAIRE RESPONSE rate of 52%.  41% nominated candida as the most mon cause of VV  46% were aware that β haem strept caused juvenile VV 38 RESULTS  % knew that H infl is a possible pathogen  The most popular empirical Rx of VV was topical clotrimazole cream  22% prescribed antibiotics active against both gp A β haem strept and H infl CONCLUSIONS  Most doctors managing girls with VV were unaware of the importance of H infl and may not be prescribing appropriate empirical treatment 39 SPECIFIC VULVOVAGINITIS 2GIT pathogens:  E coli  part of the normal flora (40%) Will be Rx if isolated without other bacteria in symptomatic pt  Yersinia enterocoloitica VV is rare  Shigella  spread from the GIT to the genital region (424%) Diarrhea is absent in most of the pt Mucopurulent, malodorous, bloody disch (47%) 40 SPECIFIC VULVOVAGINITIS 3Candida  Rare in prepubertal girls (04%)  Vulvar erythema amp。 edema with whitish plaques  Risk factors: DM, immunopromized, Ab use, Pt still in diapers  2ry infection in pt with other type of VV  Newborn (colonized maternal vagina) 41 SPECIFIC VULVOVAGINITIS 4 Staph aureus Part of the normal flora (27%) Should be treated when isolated in symptomatic pt without other bacteria 5 Pinworms (12%) Nocturnal pruritis Adult worm may migrate from rectum to vagina causing intense inflammation 42 Microbiological study of vulvovaginitis in premenarcheal girls Enferm Infecc Microbiol Clin 1996 May。 14(5):3113 Pena MJ, CamposHerrero MI, Ruiz MC, Rodriguez H, Lafarga A prospective study of vaginal swabs from premenarcheal girls with VV September 1991August 1994 43 RESULTS  70/262 (%) patients a pathogenic micro anism was found: Strept pyogenes 8 (3%) Candida albicans 4 (%) Neisseria gonorrhoeae 1 CASE Haemophilus influenzae (%) Enterobius vermicularis 25 (%) 44 Microbiological study of vulvovaginitis in premenarcheal girls CONCLUSIONS: The role of H infl should be considered due to the high prevalence of isolation in this group of patients Differential diagnosis with Enterobius vermicularis should be considered in all cases. 45 SPECIFIC VULVOVAGINITIS 6STD  Should alert the physician to the possibility of sexual abuse  Prepubertal pt cultures for gonorrhea amp。 chlamydia are obtained from vagina rather than cx 46 1Gonorrhea  Copious purulent greenish discharge  Sexual abuse must be assumed outside neonatal period  G found in 320% with Hx of sex abuse 2Chlamydia • Nonsexual transmission/ mother  newborn persist up to one year  co。