Zeliha HAYTOĞLU, Özlem ÖZGÜR GUNDESLIOĞLU, Filiz KİBAR, Nurdan EVLİYAOĞLU

Prepubertal Kız Çocuklarında Vulvovajinitin Klinik ve Mikrobiyolojik Açıdan Değerlendirilmesi

Prepubertal kızlarda en sık görülen jinekolojik problem vulvovajinal enfeksiyonlardır. Bu retrospektif çalışmada üniversite hastanemizin çocuk polikliniğinde Ocak 2014-Ocak 2019 tarihleri arasında prepubertal vulvovajinit tanısı alan hastaların kayıtları incelendi. 46 hasta çalışmaya dahil edildi. Çocukların yaş ortalaması 82±37.6 ay idi. 9 hastada (%19.6) üreme gözlenmedi. Cilt ve vajinal flora üyesi olan mikroorganizmalar 6 hastada (34.8%) pozitif bulundu. Bunlar; 11 hastada (%23.9) koagülaz negative stafilokok, 5 hastada (%10.9) difteroidleridi. E.Coli 11 hastada (%23.9), Streptokokus pyogenes 4 hastada (%8.7), Gardnerella vajinalis 3 hastada (%6.5), Kandid aalbikans 2 hastada (%4.3) ve en az sıklıkla Enterobakter 1 hastada (%2.2) saptandı. Tüm hastalarımız semptomları başladığında değerlendirilmiş, tedavileri ilk başvuru merkezleri tarafından verilmişti. Prepubertal kızlarda kandida vulvovajinit çok nadir görülmekle birlikte tüm hastalarımıza antifungal krem yazılmıştı. Bu yaş grubunda vajinal kültür çoğunlukla negatiftir. Prepubertal yaş grubunda hijyen önlemleriyle tedavi edilen spesifik olmayan vulvovajinitakıldatutulmalıdır. En sık izole edilen patojenler ise bağırsak florası üyeleri ve solunum patojenleridir.

Anahtar Kelimeler:

bakteriyal vajinit, mikrobial ajan, prebubertal, vulvovajinal kandidiyazis

Evaluation of Clinical and Microbiological Features of Vulvovaginitis in Prepubertal Girls

The most common gynecological problem in prepubertal girls is vulvovaginal infections. In this retrospective study, the records of patients who were diagnosed with prepubertal vulvovaginitis between January 2014 and January 2019 in the pediatric outpatient clinic of our university hospital were retrieved. 46 patients were included in the study. The mean age of the children was 82±37.6 months. No growth in culture was observed in 9 patients (19.6%). Microorganisms that are members of the skin and vaginal flora were positive in 16 patients (34.8%). Coagulase negative staphylococcus was positive in 11patients (23.9%), diphtheroids in 5 patients (10.9%), E.coli in 11 patients (23.9%), Streptococcus pyogenes in 4 patients (8.7%), Gardnerella vaginalis in 3 patients (6.5%), Candida albicans in 2 patients (4.3%), least frequently Enterobacter in 1 patient (2.2%). All of our patients were evaluated when their symptoms started and their treatments were given by the first application centers. Candida vulvovaginitis is very rare in prepubertal girls, but antifungal cream was prescribed to all our patients. In this age group, vaginal culture is mostly negative. Nonspecific vulvovaginitis, which is treated with hygiene measures in the prepubertal age group, should be kept in mind. The most frequently isolated pathogens are intestinal flora and respiratory pathogens.

Keywords:

Bacterial vaginitis, microbial agents, prepubertal, vulvovaginal candidiasis,

PDF

___

1. Jaquiery A, Stylianopoulos A, Hogg G, Grover S. Vulvovaginitis:clinical features, aetiology, and microbiology of the genital tract. Arch Dis Child 1999;81:64-67.
2. Loveless M, Myint O. Vulvovaginitis- presentation of more common problems in pediatric and adolescent gynecology. Best Pract Res Clin Obstet Gynaecol 2018;48:14-27
3. Garden AS. Vulvovaginitis and other common childhood gynaecological conditions. Arch Dis Child Educ Pract Ed 2011; 96:73-78.
4. Stricker T, Navratil F, Sennhauser FH. Vulvovaginitis in prepubertal girls. Arch Dis Child 2003;88:324–326.
5. Joishy M, Ashtekar CS, Jain A, Gonsalves R. Do we need to treat vulvovaginitis in prepubertalgirls?. BMJ.2005;330(7484):186‐188. doi:10.1136/bmj.330.7484.186
6. Neyazi SM. Prepubertal Vulvovaginitis. J Nat Sci Med 2019;2:14-22.
7. Zuckerman A, Romano M. Clinical Recommendation Vulvovaginitis. J Pediatr Adolesc Gynecol 2016; 29: 673-679.
8. Randelovic G, Mladenovic V, Ristic L, Otasevic S, Branković S, Mladenović-Antić S, et al. Microbiological aspects of vulvovaginitis in prepubertal girls. Eur J Pediatr 2012;171: 1203-1208.
9. McGreal S, Wood P. Recurrent vaginal discharge in children. J PediatrAdolescGynecol2013;26:205-208.
10. Sharma B, Preston J, Greenwood P. Management of vulvovaginitis and vaginal discharge in prepubertal girls. Reviews in Gynaecological Practice 2004;4:1111-1120.
11. Jasper JM. Vulvovaginitis in the prepubertal child. Clin Pediatr Emerg Med 2009;101:10-13.
12. Tartaglia E, Giugliano B, Ucciferri C, Giannattasio A, Giuliano P, Iannaccone VL, et al. Vulvo-vaginitis in prepubertal girls: new ways of administering old drugs. J Pediatr Adolesc Gynecol. 2013;26(5):277‐280.
13. Banerjee K, Curtis E, de San Lazaro C, Graham JC. Low prevalence of genital candidiasis in children. Eur J Clin Microbiol Infect Dis 2004;23:696-8.
14. Petrova Ch, Shentov B, Tanchev S, Mikhaĭlov V, Sredkova M, Popova V. Genital infections in girls with type 1 diabetes. Akush Ginekol (Sofiia) 2004;43(4):21–25.
15. Hansen MT, Sanchez VT, Eyster K, Hansen KA. Streptococcus pyogenes pharyngeal colonization resulting in recurrent, prepubertal vulvovaginitis. J Pediatr Adolesc Gynecol 2007;20:315–317.
16. Mogielnicki NP, Schwartzman JD, Elliott JA. Perineal group a streptococcal disease in a pediatric practice. Pediatrics 2000;106:276–281