RU2351931C1 - Method of differential diagnosing bacterial vaginosis and non-specific vaginitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: digital images of crystallograms of vaginal fluid facies, obtained in standard conditions, are analysed evaluating evidence of crystallisation zones, in case fern-like crystals are found, bacterial vaginosis is diagnosed, if there is no clear zonality and diffusedly distributed sphere-like crystals with concentration in central zone are present, non-specific vaginitis is determined.

EFFECT: revealing infectious process at early stage, possibility to differentiate bacterial vaginosis and non-specific vaginitis.

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Description

The invention relates to the field of medicine, gynecology, and in particular to the diagnosis of nonspecific infectious diseases of the vagina.

A known method for the differential diagnosis of bacterial vaginosis and nonspecific vaginitis, based on the study of clinical and laboratory data (Saidova R.A. Bacterial vaginitis or bacterial vaginosis? // Rus.med.zhurn. - 2001. -v.9, No. 19. - C .843-847).

The disadvantages of the prototype: is descriptive, subjective, time-consuming.

Technical result: objectification of the accounting of results due to registration of objects through microphotography, reduction of time.

These tasks are achieved by obtaining a crystallogram and analyzing the image of the facies of the vaginal fluid, taking into account the severity of crystallization zones: central, intermediate and peripheral, as well as the types of crystals formed. The shapes of the resulting crystalline structures are determined by the gradient between the crystal-forming elements and the environment. With various pathologies, a change in the quality and quantity of organic and inorganic molecules occurs, which leads to the formation of specific types of crystals.

The method is depicted in the figures, where Figs. 1, 4 show an image of the facies of the vaginal fluid during normocenosis; figure 2, 5 is an image of the facies of the vaginal fluid with bacterial vaginosis; figure 3, 6 is an image of the facies of the vaginal fluid with bacterial vaginitis.

The method is as follows: the material (vaginal contents) is taken atraumatically with a spatula (non-invasive procedure) into an Eppindorf-type tube, centrifuged at a speed of 8000 rpm for 15 minutes, then the supernatant is taken with an automatic dispenser and applied in a volume of 0.004 ml to a preliminary fat-free mixture Nikiforov's glass slide. Facies of the vaginal fluid (VF) are obtained by the method of wedge-shaped dehydration (Shabalin V.N., Shatokhina S.N. // Methodical recommendations of the Ministry of Health of the Russian Federation No. 96/165 “Formation of the crystal structures of biological fluids with various types of pathology”, 1998) at room temperature, relative humidity of 70% and the time of its formation 24 hours. The resulting sample is photographed using a binocular nozzle adapted for digital photography and connected to a personal computer. When analyzing the images obtained, the separation of the facies of the vaginal fluid into the central, intermediate and peripheral zones, their width, uniformity, location and shape of the crystals are evaluated.

The image of the facies of the vaginal fluid in conditionally healthy patients (figure 1) has a clearly defined differentiation into zones. The peripheral zone is narrow, contains arched structures. The intermediate zone is transparent, does not contain crystals. The structure of the central zone is granular, spherical clumps of crystals are found that have the highest concentration in the central part.

In bacterial vaginosis, a change in the qualitative and quantitative composition of the vaginal microflora leads to changes in the biochemical composition of the vaginal fluid, due to which the peripheral zone increases in the biofluid facies, there are no arch-like elements, the entire central part is filled with fern-shaped crystals, the intermediate zone is pronounced, heterogeneous, also contains crystals (figure 2).

With nonspecific vaginitis, the structure of the facies of the vaginal fluid is different (figure 3). The division into zones is not clear, spherical crystals are diffusely distributed throughout the facies, with maximum accumulation in the central zone. The intermediate and peripheral zones are not expressed, arcade structures are absent.

A total of 47 patients were examined: 8 patients with normocenosis, 20 with bacterial vaginosis, 19 with non-specific vulvovaginitis.

Examples of practical application.

Example 1

Patient N., 36 years old, contacted the City Consultative and Diagnostic Center of the MUZ MSCh No. 9 on January 17, 2008 for a routine examination; she did not make any complaints. Gynecological examination data. The external genitalia are formed correctly, the hair is of a female type. On the mirrors: the vaginal mucosa is pink, milky milky secretions are scarce. The result of a bacterioscopic examination of a smear of the vaginal discharge, stained by Gram - leukocytes 2-4-6 in the field of view, the flora is polymorphic with a predominance of bacillary, moderate (corresponds to the normocenosis). The crystallogram is presented in figure 4.

Example 2

Patient P., 25 years old, complained of discharge from the genital tract with an unpleasant odor. Gynecological examination data. The external genitalia are formed correctly, the hair is of a female type. On the mirrors: the vaginal mucosa is not changed, the discharge is abundant white homogeneous, with an unpleasant fish smell. The result of a bacterioscopic examination of a smear of the vaginal discharge, stained by Gram - leukocytes 2-6-12 in the field of view, the flora is polymorphic, abundant, Mobiluncus, "key" cells in large numbers. The diagnosis is bacterial vaginosis. The crystallogram is presented in figure 5.

Example 3

Patient L., 37 years old, complained of copious discharge from the genital tract. Gynecological examination data. The external genitalia are formed correctly, the hair is of a female type. On the mirrors: the vaginal mucosa is hyperiminated, the discharge is abundant yellow pus with an admixture of mucus. The result of a bacterioscopic examination of a smear of the vaginal discharge, stained by Gram - white blood cells 40-60-80 in the field of view, the flora is polymorphic, plentiful, with a predominance of coccal. Bacteriological examination of the vaginal contents revealed excessive growth (2.9 × 10 ⁷ CFU / ml) of Staphylococcus aureus. The diagnosis is nonspecific vaginitis. The crystallogram is shown in Fig.6.

The positive effect of the proposed method is as follows:

the method is informative at low cost and labor, allows you to identify the infectious process in the early stages, to differentiate non-specific vaginitis and bacterial vaginosis, and also provides objectivity in evaluating the results.

Claims (1)

A method for differential diagnosis of bacterial vaginosis and nonspecific vaginitis by examining the vaginal fluid, characterized in that the contents of the vagina are taken into a test tube, centrifuged at a speed of 8000 rpm for 15 minutes, then the supernatant in an amount of 0.004 ml is applied to a glass slide, crystallograms are obtained under standard conditions, they are photographed using a binocular nozzle adapted for digital photography and connected to a personal computer; images of facies of the vaginal sheath are analyzed bacteria, evaluating the severity of crystallization zones: central, intermediate and peripheral, as well as the type of crystals, and with the expansion of the peripheral zone, the detection of fern-like crystals, bacterial vaginosis is diagnosed, and in the absence of clear zonality, the presence of diffusely distributed spherulite crystals with a concentration in the central zone, nonspecific vaginitis is determined .

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