MAP template controlling Crohn's disease?

Crohn's disease is stated to be an immune-mediated disease initiated by Mycobacterium avium subspecies paratuberculosis (MAP) infection within a period of host immunological vulnerability and induced by the widespread prevalence of that organism in the human food chain. For over two decades, steroids and biologics have, move often than not, been able to induce temporary remissions, but not cures. This thesis examines how the only two, very divergent, therapeutic approaches that have produced cures achieved this positive outcome.

Is ulcerative colitis a disease of a dysfunctional microbiota?

Using the gross pathology literature and the prior decoupling of Crohn's disease from inflammatory bowel disease, IDI's White Paper puts into question the current understanding of what ulcerative colitis is and how it can be therapeutically addressed. The pathology literature, when coupled with the ability of fecal enema therapy to achieve a remission rate significantly superior to those documented for biologics, puts focus on the dominant role of the gastrointestinal microbiota in both disease induction and its recovery. The concept of endogenous enterotoxogenesis is introduced.

Are the permanent sequelae of Crohn's disease a failure to treat the gastrointestinal microbiota?

Using parallel knowledge derived from gynecological infections, the thesis is advanced that late sequelae in Crohn's disease are the consequence of the failure to treat or the undertreating of the co-functioning infection by the gastrointestinal microbiota.

Understanding Therapeutic Concepts in Crohn's Disease.

For more than a decade, the therapeutic focus for Crohn's disease has remained fixed at temporary arrestment of symptomology. The Centers for Disease Control and Prevention (CDC) lists Crohn's disease as a disease entity without current cure. Biologics in combination with antibiotics can frequently achieve remissions.

The myth of autoimmunity.

Within the more than one hundred disease entities for which autoimmunity causation have been alleged, two subgroups can be identified. The first group is characterized by ability of disruption of the effector arm of the immune response to temporarily reverse the signs and symptoms of disease. The second group is characterized by the presence of antibodies directed against the target organ's cellular or subcellular components.

The Hruska postulate of Crohn's disease.

Crohn's disease is due to the loss of immunological tolerance within the gastrointestinal tract to the antigenic array of Mycobacterium avium subspecies paratuberculosis (MAP) and closely related polymorphic variants. The loss of immune tolerance results in an effector cytokine responsive upon re-exposure to MAP. For immune tolerance to MAP to be induced, infection must occur when acquired immunity is markedly underdeveloped.

Attachment of Mycobacterium avium subspecies paratuberculosis to bovine intestinal organ cultures: method development and strain differences.

Mycobacterium avium spp. paratuberculosis (MAP) causes chronic granulomatous inflammation of the intestinal tract in many species of animals, but the mechanisms of disease are poorly understood. Attachment of bacteria to epithelial cells is a critical step in pathogenesis of many mucosal diseases.

A growing concern: inability to diagnose vulvovaginal infections correctly.

The accurate diagnosis of vulvovaginitis should distinguish obstetrician-gynecologists from the vast majority of primary care physicians. Diagnostic accuracy is lost when physicians are unable to do a microscopic examination of vaginal secretions, as well as a "whiff" test and a pH determination. Structured instruction in the use of a microscope should be a required component of obstetrics and gynecology residency training.

Understanding the bacterial flora of the female genital tract.

The microbiological flora of the lower female genital tract provides a dynamic, complex example of microbial colonization, the regulation of which is not fully understood. When an exogenous bacterial species, with its array of virulence factors, is introduced into the host, disease does not always occur. Conversely, under selected conditions, commensal endogenous bacteria-for example, Gardnerella vaginalis and group B streptococci-can participate in disease processes.

Concerns regarding the Centers for Disease Control's published guidelines for pelvic inflammatory disease.

The International-Infectious Disease Society for Obstetrics and Gynecology-USA (I-IDSOG-USA) has concerns about the most recently published Centers for Disease Control and Prevention (CDC) guidelines for pelvic inflammatory disease (PID). I-IDSOG-USA advocates the following changes when the guidelines are revised. We recommend the use of the term "upper genital tract infection" (UGTI), followed by the designation of the etiologic agent, instead of the currently employed term, "pelvic inflammatory disease," or PID.

Maternal risk factors for perinatal septicemia due to the Enterobacteriaceae.

Cases of perinatal septicemia due to the Enterobactericeae, which manifest in the first 24 hr of life were analyzed for the presence or absence of the maternal risk factors defined in the CDC group B streptococcus (GBS) risk-factor protocol. Microbiological data involving blood culture isolates were reviewed for the recovery of an Enterobacteriaceae from January 1975 through June 1995. Enterobacteriaceae perinatal septicemia was defined as the recovery an Enterobacteriaceae from one or more set of blood cultures in the first 24-36 hr of life in conjuncture with clinical evidence of neonatal stress in the first 24 hr.

Trichomonas vaginalis and bacterial vaginosis. Coexistence in vaginal wet mount preparations from pregnant women.

Objective: To identify how frequently trichomoniasis and characteristics of bacterial vaginosis (BV) occur concomitantly in wet mount preparations from pregnant women.

Study Design: Diagnosis of trichomoniasis was predicted on visualization of the organism. Diagnosis of BV required a positive volatile (whiff) test, presence of "clue cells" and one of two minor criteria: (1) absence of lactobacilli, or (2) a pH > 4.

Semiquantitative bacterial observations with group B streptococcal vulvovaginitis.

Objective: Group B streptococcal (GBS) vulvovaginitis is a poorly-delineated clinical entity. The purpose of this study is to report semiquantitative data from four cases of GBS vulvovaginitis and to comment on their significance in terms of the in vitro inhibitory capabilities of GBS.

Methodology: Four patients whose clinical presentations were consistent with GBS vulvovaginitis, from whom GBS was isolated and for whom semi-quantitative as well as qualitative microbiologic data existed, were identified.

The great douching debate: to douche, or not to douche.

It has been implied douching causes chlamydial infection, acute salpingitis, ectopic pregnancy, and reduced fertility. However, the incriminating articles do not represent a vast accumulation of data from diverging sources; rather, most reflect repetitive analysis of data from a limited population base by an institutionally interrelated group of investigators. The conclusions reached were reintroduced periodically into the literature in different journals.

Female genital tract bacterial coisolates with Candida albicans in patients without clinical vaginitis.

Objective: In vitro, Candida albicans has demonstrated the ability to inhibit replication of selected bacteria. Little information exists on the impact of C. albicans on the vaginal bacterial flora in vivo.

Expanding disease spectrum associated with puerperal mastitis.

Background: Staphylococcus aureus and the beta-hemolytic streptococci are the commonest causes of puerperal mastitis which tends to be a localized disease process. This report describes 2 cases attributable to these bacteria that resulted in extramammary involvement and augmented morbidity.

Cases: Two cases of postpartum mastitis are described, one leading to necrotizing fasciitis caused by group A streptococci and the other leading to toxic shock syndrome (TSS) caused by S.

Interrelationships within the bacterial flora of the female genital tract.

Analysis of 240 consecutive vaginal swabs using the compatibility profile technique revealed that only 2 bacteria have the ability to be a sole isolate and as such a candidate to be a major aerobic regulator of the bacterial flora of the female genital tract (BFFGT). Compatibility profiles of Lactobacillus and Gardnerella vaginalis have shown that these organisms shared compatibility profiling for the majority of the normal bacterial constituents of the female genital tract. Dominance disruption appears to come from the addition of compatible co-isolates and presumed loss of numerical superiority.