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PubMed1980

Ectopic pregnancy: a five-year experience.

In the five-year period 1974 to 1978, there were 23,256 deliveries and 204 ectopic pregnancies at Fairfax Hospital. Forty-six patients (22.5%) had had previous pelvic surgery, including 14 salpingectomies for previous ectopic pregnancies. Only 27 patients (13.2%) had a history of salpingitis, but chronic salpingitis was evident in 91 patients (44.6%). Twenty-one patients (10.3%) had an IUD in situ at the time of diagnosis. Presenting symptoms included abdominal pain (95.1%), amenorrhea (73.7%), and abnormal uterine bleeding (63.7%). Abdominal pain (91.2%) and adnexal tenderness (94.6%) were the common pelvic findings. The correct diagnosis was made on admission in 77.5% of cases. Culdocenteses and pregnancy tests were positive in 82.4% and 81.2% of patients, respectively. Unilateral salpingectomy was the primary operative procedure in 78% of patients. Postoperative morbidity was limited almost exclusively to nonspecific fever (41.2%) and urinary tract infection (9.3%).

Adolescent↗
PubMed1991

Chlamydia trachomatis major outer membrane protein epitopes expressed as fusions with LamB in an attenuated aro A strain of Salmonella typhimurium; their application as potential immunogens.

The major outer-membrane protein (MOMP) of Chlamydia trachomatis is the focus of attention for chlamydial vaccine design, particularly those serovar- and subspecies-specific epitopes which provoke neutralizing immune responses. Selected surface-exposed B-cell epitopes of MOMP, incorporating B-subspecies specificities, were expressed as fusions with LamB, an inducible outer-membrane transport protein of Escherichia coli. These recombinant chlamydial-LamB proteins were correctly transported to the outer membrane of both E. coli and an aro A mutant of Salmonella typhimurium. The immunogenicity of the constructs was investigated in a mouse model of chlamydial salpingitis. After oral immunization, recombinant S. typhimurium were recovered from the livers of mice for up to two weeks, and a serum IgG response was induced both to the Salmonella and to the inserted chlamydial epitopes. By contrast, intravenous inoculation was ineffective. Although these LamB fusions proved only weakly immunogenic, this approach should be useful for investigating the ability of attenuated S. typhimurium vaccines incorporating chlamydial epitopes to stimulate protective mucosal immunity in the mouse model of chlamydial salpingitis.

Administration, Oral↗
PubMed1986

Oral contraceptive use modifies the manifestations of pelvic inflammatory disease.

A case-control study was performed on 94 women with acute salpingitis and 12 women with salpingitis and perihepatitis; all patients included in the study were infected with Chlamydia trachomatis, and all had been subjected to diagnostic laparoscopy. None of the 12 patients with, but 38 (40%) of the 94 patients without, perihepatitis used oral contraceptives (P = 0.002). The geometric mean titre of serum IgG antibodies to C. trachomatis was higher among patients with (1:1021) than among patients without (1:69) perihepatitis (P = 0.0001). Oral contraceptive users had lower geometric mean titre of antibodies to the organism (1:25) than non-users (1:109, P = 0.001). The study suggests that oral contraceptive use may modify the clinical manifestations of chlamydial pelvic inflammatory disease.

Acute Disease↗
PubMed2006

Infection of human fallopian tube epithelial cells with Neisseria gonorrhoeae protects cells from tumor necrosis factor alpha-induced apoptosis.

Following infection with Neisseria gonorrhoeae, bacteria may ascend into the Fallopian tubes (FT) and induce salpingitis, a major cause of infertility. In the FT, interactions between mucosal epithelial cells and gonococci are pivotal events in the pathogen's infection cycle and the inflammatory response. In the current study, primary FT epithelial cells were infected in vitro with different multiplicities of infection (MOI) of Pil+ Opa+ gonococci. Bacteria showed a dose-dependent association with cells and induced the secretion of tumor necrosis factor alpha (TNF-alpha). A significant finding was that gonococcal infection (MOI = 1) induced apoptosis in approximately 30% of cells, whereas increasing numbers of bacteria (MOI = 10 to 100) did not induce apoptosis. Apoptosis was observed in only 11% of cells with associated bacteria, whereas >84% of cells with no adherent bacteria were apoptotic. TNF-alpha was a key contributor to apoptosis, since (i) culture supernatants from cells infected with gonococci (MOI = 1) induced apoptosis in naïve cultures, suggesting that a soluble factor was responsible; (ii) gonococcal infection-induced apoptosis was inhibited with anti-TNF-alpha antibodies; and (iii) the addition of exogenous TNF-alpha induced apoptosis, which was inhibited by the presence of increasing numbers of bacteria (MOI = 10 to 100). These data suggest that TNF-alpha-mediated apoptosis of FT epithelial cells is likely a primary host defense mechanism to prevent pathogen colonization. However, epithelial cell-associated gonococci have evolved a mechanism to protect the cells from undergoing TNF-alpha-mediated apoptosis, and this modulation of the host innate response may contribute to establishment of infection. Understanding the antiapoptotic mechanisms used by Neisseria gonorrhoeae will inform the pathogenesis of salpingitis and could suggest new intervention strategies for prevention and treatment of the disease.

Apoptosis↗
PubMed1978

Experimental infection of the genital tract of female grivet monkeys by Mycoplasma hominis.

Mycoplasma hominis, a common inhabitant of the mucosae of the genitourinary tract of human and nonhuman primates, was inoculated directly into the uterine tubes of five laparotomized grivet monkeys. A self-limiting acute salpingitis and parametritis developed within a few days in all animals. Although there were no clinical signs of overt disease, the gross pathology was characterized by pronounced oedematous swelling and hyperaemia of the tubes and parametria. Microscopically, cellular infiltrations of lymphocytes and some polymorphonuclear leukocytes were found in the acute phase in the subserosa and muscularis of the tubes and in the parametria. Granulation tissue and fat necrosis appeared at a later stage in the parametria. The infection was associated with a marked antibody response and a moderate rise of the erythrocyte sedimentation rate and leukocyte counts. The capability of M. hominis to produce salpingitis and parametritis in a nonhuman primate would seem to add rather significantly to the available evidence suggesting an etiological role of this organism in inflammatory diseases of the internal female genitals of humans.

Acute Disease↗
PubMed1983

Lesions of contagious equine metritis in mares.

Twenty-three mares were infected with contagious equine metritis organism by intrauterine inoculation, and necropsied after intervals of two to 116 days. Severe diffuse subacute salpingitis was seen in one mare, and mild multifocal subacute salpingitis was common. Severe diffuse endometritis and cervicitis initially were acute and became more severe, subacute and predominantly plasmacytic by 14 days, then declined but persisted as mild diffuse or multifocal inflammation for the rest of the experimental period. Vaginitis arose in parallel but resolved after 70 days. There were no lesions in the clitoral fossa or clitoral sinus.

Animals↗
PubMed1989

Pyosalpinx subsequent to tubal ligation.

A case of salpingitis with pyosalpinx subsequent to tubal ligation is described. The procedure was performed at the time of cesarean section 7 years earlier. The pyosalpinx included the distal portion of the ligated tube, with no evidence of infection in the proximal segment. Although pelvic peritonitis, salpingitis and tubo-ovarian abscess are rare following tubal ligation, they should be suspected in any patient presenting with lower abdominal pain.

Adult↗
PubMed1988

Chlamydia trachomatis: is it possible to reduce the number of infections after abortions?

In a study at the University Hospital in Trondheim during 1983, the frequency of Chlamydia trachomatis among women terminating their pregnancies was 8.2%. Younger women were infected by C. trachomatis at a more frequent rate than older women (p less than 0.001). Treatment of chlamydia-positive women was initiated within the first two weeks after the abortion. However, among women readmitted to the hospital, chlamydia-positive women showed a higher frequency of salpingitis than chlamydia-negative women (p less than 0.08). Preabortion examination for C. trachomatis and treatment of chlamydia-positive women by practitioners before the abortion is carried out, may reduce the postabortal frequency of salpingitis.

Abortion, Induced↗
PubMed2003

Xanthelasma or xanthoma of the fallopian tube.

We report a case of a 24-year-old woman who presented with abdominal pain, a tense abdomen, and rebound tenderness. A vague, ill-defined mass was palpated, and an ultrasound examination revealed a cystic lesion in the left adnexal region. At laparotomy, a slightly dilated fallopian tube was seen and excised. Light microscopy showed intact fallopian tube mucosa, with a diffuse infiltrate of foam cells in the lamina propria. There were no associated inflammatory cells. The foam cells were positive for CD68 and negative for AE1/AE3. Discontinuous areas of the epithelium also showed epithelial cells with "foamy cytoplasm." These cells were negative for CD68 but positive for AE1/AE3. To our knowledge, this represents the first case of a fallopian tube xanthelasma that shows a resemblance to lesions encountered in the stomach. Fallopian tube xanthelasma must be distinguished from xanthogranulomatous salpingitis, which is associated with an inflammatory cell infiltrate, often including giant cells. However, this lesion may share pathogenetic similarities with xanthogranulomatous salpingitis, since both processes are mediated by inflammation.

Adult↗
PubMed1976

Actinobacilli in domestic fowl.

Reports on haemolytic rods from salpingitis in hens and from organs of died chicks may be found since the year 1950 (Kjos-Hanssen). Correct systematic classification on these microorganisms is still lacked because not all relations to the nearest pasteurellae were known as well as the clear differences in the Pasteurella-Actinobacillus group. The authors have isolated 34 suspected strains from 14 localities; 25 strains were from salpingitis or internal organs of died fowl inclusively chicks, and 9 strains from choanas of pullets clinically healthy. Bacteriological, serological, chemical and biological tests gave the results as follows: 1) All strains exhibit fundamental properties of Pasteurella-Actinobacillus group, and moreover, they show ability to grow on MacConkey agar with crystal violet (BioQuest) being a significant feature of the genus Actinobaccillus (Mráz, 1975). 2) From the nearest species Actinobacillus haemolyticus (Newsom and Cross, 1932) Mráz, 1969, they differ with expressive haemolysis on agar with sheep blood, single haemolytic zone on agar with lamb blood according to Smith (1962), structure of somatic antigen, with natural hosts (gallinaceous birds) and pathogenicity for 5-day-old chicks. The GC content in DNA was determined in the range 39,6-42,9% (mean value 41,5%). 3) The first who presumed an independent state of these microorganisms, was Kohlert (1968), from the work of which the epithet for correct name, i.e. Actinobacillus salpingitidis (Kohlert, 1968) comb. nov., was accepted.

Actinobacillus↗
PubMed2002

[Peri-hepatitis abscess secondary to pelvic peritonitis].

OBJECTIVE: To report the case of a 42-year-old patient referred for exploration of a tumor of the right flank and evidence of inflammation. MATERIAL: and methods. Ultrasonography and computed tomography showed a liver mass associated with a heterogeneous adnexal mass. Serum CA-125 was elevated and ovarian cancer with liver metastasis was suspected. An alternative diagnosis was salpingitis complicated by Fitz-Hugh-Curtis syndrome in this patient wearing an intra-uterine contraceptive device. RESULTS: Exploratory laparoscopy was performed and confirmed the diagnosis of salpingitis complicated by an ovarian abscess and Fitz-Hugh-Curtis syndrome with rare abscess formation. Outcome was favorable after adapted antibiotic treatment. CONCLUSION: Fitz-Hugh-Curtis syndrome can take on an atypical aspect and should be entertained as a possible diagnosis in young women presenting pain of the right flank and fever.

Acute Disease↗
PubMed1991

[A method of indirect immunofluorescence for diagnosing chlamydia infections].

The diagnostic value of indirect immunofluorescence in the detection of antichlamydial IgG antibodies in patients with chronic chlamydial salpingitis is insufficient. The condition may be diagnosed if antichlamydial IgG antibodies are detectable in the serum diluted at least 1:128. Examinations of paired sera are of no value in chronic chlamydial salpingitis.

Chlamydia Infections↗
PubMed1990

[Chlamydia trachomatis perihepatitis (Fitz Hugh-Curtis syndrome). Apropos of 20 cases].

We report a retrospective series of 20 cases of peri-hepatitis diagnosed using the laparoscope. They were all young women who were nulliparous or primiparous. In eight cases, the dominant clinical picture was of acute cholecystitis. In the other cases, asymptomatic peri-hepatitis was discovered when the laparoscope had been used to try to diagnose acute salpingitis. Chlamydia trachomatis is the principal aetiological agent (in 18 cases) and it has overtaken the gonococcus which was the common one in early publications but here was responsible for only one case. Treatment with tetracyclines or quinolones always brings about a cure. Whenever a young woman complains of pain in the right hypochondrium, one has to think of this infection as well as diagnosing and treating the associated salpingitis early.

Adolescent↗
PubMed1990

C-reactive protein in assessing antimicrobial treatment of acute pelvic inflammatory disease.

Serial serum C-reactive protein (CRP) determinations were used in the evaluation of antimicrobial treatment of acute pelvic inflammatory disease (PID) as proven by laparoscopy and endometrial biopsy or microbiologic findings in the upper genital tract in 36 women. Sixteen patients were treated with ciprofloxacin and 20 with doxycycline plus metronidazole. The mean CRP levels did not differ significantly in patients with severe and moderate salpingitis in comparison with mild salpingitis on admission or during treatment, nor was there any significant difference between the mean CRP levels in patients with acute chlamydial/gonococcal and nonchlamydial/nongonococcal PID. The mean CRP levels decreased by the third day of treatment in all treatment groups, and the decrease by the sixth day of treatment was significant (P less than .05), reflecting the clinical response to therapy faster than did serial ESR determinations. After the documentation of acute PID, serial serum CRP determinations were a useful predictor of the short-term response to antimicrobial therapy.

Adolescent↗
PubMed1990

The effects of Chlamydia trachomatis on the female reproductive tract of the Macaca nemestrina after a single tubal challenge following repeated cervical inoculations.

The effects of repeated cervical infections followed by a single direct tubal inoculation with Chlamydia trachomatis, serovars D and F, were examined in 11 pig-tailed macaques to test the hypothesis that tubal inoculation after cervical priming causes a more severe disease than primary tubal inoculation alone. Animals were cervically inoculated between two and five times. Fallopian tubes were inoculated with serovar D or F 1 week after the last cervical challenge. Three control monkeys received only one direct tubal inoculation without previous cervical inoculation. Infection was confirmed by isolating the microorganism from the endocervix in 13 of 14 monkeys and from the endosalpinx in four only after the tubal inoculation. Antibody was detected in post-infection sera of all 14. Tubal edema occurred in seven of 11 animals after the first cervical inoculation, and uterine erythema occurred in 11 of 11 after the second cervical inoculation. Peritubal adhesions were induced before the tubal inoculation in zero of seven given three or fewer cervical inoculations and four of four given five cervical inoculations (P less than .01). After direct tubal inoculation, peritubal adhesions became more prominent, and the 11 hysterectomy specimens showed plasma cell endometritis in nine and salpingitis in nine. Two control monkeys developed minor adhesions, the other none. One tube in two of three controls showed mild plasma cell infiltrates, whereas no evidence of endometritis was observed in controls. Histopathology in these monkeys was characteristic of chlamydial endometritis and salpingitis. However, the pathogenesis of these changes is uncertain because C trachomatis was not isolated from the endosalpinx after cervical inoculations alone.

Animals↗
PubMed1990

[Chlamydia infection in gynecology].

The frequency of chlamydial infections was investigated by means of the McCoy culture technique and a serological procedure using the microimmunofluorescence test in female outpatients showing suspect symptoms; in patients suffering from acute salpingitis, and in women with involuntary infertility. In 18.6% of 290 subjects of the first group, chlamydiae were isolated from cultures. Of 26 patients with acute salpingitis, Chlamydia trachomatis could be detected in 10. The high frequency of positive serological tests suggests chlamydial infection to constitute an important etiological factor in female infertility and extrauterine pregnancies.

Adolescent↗
PubMed1989

[Chlamydia trachomatis and ectopic pregnancy. A causal relationship].

In a case-control study, chlamydial antibody (IgG) was examined in sera from 58 women with ectopic pregnancy and 58 birth-giving controls matched for age (+/- 3 years) and parity. More patients than controls stated that they had previously been treated for salpingitis (p less than 0.05). In the index pregnancy, two cases and four controls were positive for C trachomatis in specimen from the cervix uteri. Chlamydial antibody was detected among 69% of the cases and 33% of the controls (p less than 0.01). These results were consistent with age, parity and information on previous treatment for salpingitis. The occurrence of a previous chlamydial infection, proven by IgG-antibodies, increases risk of an ectopic pregnancy by a factor of 4.6 (odds ratio 4.6, 95% CI 2.1-10.3).

Adolescent↗
PubMed1979

The humoral antibody response to Bacteroides fragilis infections in humans.

The humoral antibody response to Bacteroides fragilis infections in humans, with particular reference to ss. fragilis, was studied using an enzyme immunosorbent assay (EIA). Phenol-water extracted polysaccharide fractions (PS) from B. fragilis ss. fragilis, ss. ovatus, ss. distasonis and ss. vulgatus were used as antigens. Antibody titer determinations were done on sera collected from 57 patients where B. fragilis had been cultured and from 50 controls. In patients with septicemia caused by B. fragilis ss. fragilis a significant titer increase (greater than or equal to doubling) against PS from strain 9343 was seen during the course of the illness. In sera from patients with appendicitis, and where B. fragilis was isolated from the appendix, a titer increase against B. fragilis ss. fragilis 9343 was observed for 6 of 17 patients. However, in sera from 9 of the 17 patients a titer increase against B. fragilis ss. ovatus was also seen. No titer increase was observed in sera from most of the patients with salpingitis where B. fragilis had been isolated. In sera from 10 patients with Crohn's disease the median antibody titer against all four B. fragilis antigens was slightly higher than in sera from the controls. The median antibody titer against B. fragilis ss. ovatus was, however, significantly higher. Our experience is that a humoral antibody response against B. fragilis ss. fragilis can be expected in patients where the organism is isolated from blood. In diseases like appendicitis and salpingitis titer increases are less common. When they occur they are not necessarily directed against ss. fragilis only but are as frequent against ss. ovatus. Titer increases against ss. vulgatus and ss. distasonis are also seen. This raises the question if the observed titer increases are a consequence of a specific pathogenic role of B. fragilis in these infections, or if they merely represent the result of an antigenic stimulus as a result of an increased permeability of the mucosal barriers caused by inflammation and/or surgical manipulation.

Antibodies, Bacterial↗