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PubMed1986

Molecular mechanisms of pathogenicity of gonococcal salpingitis.

Despite the availability of effective antimicrobial agents and aggressive public health programmes, gonococcal infections, including salpingitis, remain a major worldwide problem resulting in significant rates of morbidity and infertility. Using an experimental model of gonococcal-infected human fallopian tubes in organ culture which are examined by light microscopy and scanning and transmission electron microscopy, basic pathogenic interactions between the gonococcus and the fallopian tube have been elucidated. The major steps in the pathogenic process include attachment, damage and invasion. Attachment appears to result from interaction of gonococcal pili with the tips of microvilli of non-ciliated cells of the fallopian tube mucosa. After gonococcal attachment occurs, fallopian tube damage is evident with loss of ciliary activity and sloughing of ciliated cells. The 2 compounds most likely to be mediators of this damage appear to be gonococcal lipopolysaccharide, which is released from the surface of the organism in the form of outer membrane blebs, as well as monomeric units of peptidoglycan, which are elaborated by the organism. Gonococcal attachment and perhaps elaboration of some molecule appear to initiate phagocytosis by non-ciliated epithelial cells. Gonococci are transported to the base of the non-ciliated cells and are released into the subepithelial space. This may lead to local disease (salpingitis) or disseminated disease (dermatitis-arthritis). Understanding the molecular mechanisms by which gonococci attach to, damage or invade the fallopian tube mucosa may result in identification of ways of preventing gonococcal infections and their sequelae.

Adhesiveness↗
PubMed1982

Antibiotic treatment of acute salpingitis. A study of plasma concentrations of two tetracyclines (doxycycline and lymecycline).

A group of 782 patients with a diagnosis of acute salpingitis (a few of the patients because of other infection in the pelvis) were treated with the recommended oral dose of doxycycline (200 mg the first day and 100 mg once daily for at least the following 9-12 days) in combination with 1 g benzyl penicillin and 0.6 g procaine penicillin twice daily intramuscularly for 5-7 days. The plasma concentrations of doxycycline were determined on the third day of treatment before the next dose was given. In 26.5% of the patients the concentrations were below 1 microgram/ml plasma, considered as the minimum therapeutic level. The dose of doxycycline was increased to 200 mg a day in these patients and the plasma concentrations increased accordingly. In another group of 80 patients, 40 were treated with the standard doxycycline dose, and the other 40 patients with the standard lymecycline dose (300 mg twice a day). The plasma concentrations, determined before the dose on the third day, were below 1 microgram/ml in 35% of the patients treated with doxycycline, and in 5% of those treated with lymecycline. Since acute salpingitis in most cases is a serious complication to a lower genital tract infection, often a sexually transmitted disease caused by tetracycline-sensitive organisms, the importance of achieving and determining the therapeutic plasma concentrations of tetracyclines is stressed.

Acute Disease↗
PubMed1983

Sacro-iliitis in women--a sequela to acute salpingitis. A follow-up study.

Follow-up information is presented on 37 women with SI and a history of severe acute salpingitis. It was found that 18 (49%) had clinical symptoms of intermittent or persistent back pain and stiffness indicating SI; 8 of them had serious and persistent discomfort. The rate of development varied greatly. The long-term prognosis appears to be good. Radiographic progression in the sacro-iliac joint was observed in 3 of the 11 patients who were re-examined. The findings indicate that salpingitis is a pathogenetic factor in SI in both HLA-B27 positive and negative women, but that the etiology and prognosis may differ between these two groups. The frequency of symptomatic SI tends to be higher among women carrying the HLA-B27 compared with those not having this antigen. In the latter group the course of disease was milder; the majority of the women had periodical symptoms or were asymptomatic.

Adult↗
PubMed1982

Autoantibodies in patients with acute salpingitis caused by Chlamydia trachomatis.

Autoantibodies were investigated by the indirect immunofluorescence method in 10 women with salpingitis caused by Chlamydia trachomatis and in 22 controls. Smooth-muscle antibodies (SMA) of the IgG and IgM class and IgM-antinuclear antibodies (ANA) were found more frequently in patients with salpingitis than in controls (p = 0.024, p = 0.001 and p = 0.015, respectively), but the titres were low (10-80) in both groups. Other antibodies (IgG-ANA, glomerular antibodies, parietal cell antibodies and reticulin antibodies) were uncommon in both patients and in controls. An in virus and mycoplasma infections IgM-SMA occurred most often in the beginning of the disease.

Acute Disease↗
PubMed2001

Xanthogranulomatous salpingitis and oophoritis: a case report and review of the literature.

A case of xanthogranulomatous salpingitis and oophoritis in a 47-year-old woman is presented. Xanthogranulomatous inflammation is an uncommon form of chronic inflammation that is destructive to affected organs; it is characterized by the presence of lipid-filled macrophages with admixed lymphocytes, plasma cells, and neutrophils. Only a few cases of xanthogranulomatous salpingitis and oophoritis have been reported to date. The case presented here is associated with Escherichia coli infection, endometriosis, and an intrauterine device.

Endometriosis↗
PubMed1976

Salpingitis: a frequent response to intrauterine contraception.

Nonbacterial, chronic salpingitis was found in less than 1% of non-IUD users undergoing elective tubal sterilization, Nonbacterial, chronic salpingitis was found in 47% of IUD users undergoing elective sterilization. Speculation about the influence of this finding on inflammatory morbidity is presented.

Adult↗
PubMed2003

Xanthogranulomatous oophoritis and salpingitis: late sequelae of inadequately treated staphylococcal PID.

We describe the case of a 42-year-old woman who was a follow-up case of incompletely treated pelvic inflammatory disease, and presented with menorrhagia and bilateral ovarian masses. Subtotal hysterectomy with bilateral salpingo-oophorectomy was performed. Purulent material was obtained from the cystic masses, which grew Staphylococcus aureus. Histological examination of right-sided cystic mass revealed a simple cyst of the ovary. Left sided tuboovarian mass revealed the presence of lipid filled macrophages with lymphocytes, plasma cells and neutrophils; this established the diagnosis of xanthogranulomatous salpingitis and oophoritis. The case is of interest in view of the rarity of this condition; five cases of xanthogranulomatous salpingitis and oophoritis have been reported in the world literature till date.

Adult↗
PubMed1991

[Salpingitis].

The etiology of salpingitis is polymicrobial, however, the particular pathogen is difficult to identify, even in laparoscopically obtained specimens. Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobes and facultative anaerobic bacteria have to be covered by antimicrobial therapy. This article reviews the current aspects of etiology, diagnosis, therapy, prevention and complications of salpingitis.

Anti-Bacterial Agents↗
PubMed1991

[Salpingitis and bacteriology].

Salpingitis remains a public health problem due to their direct cost (hospitalization) and indirect cost (sequelae) and they also confront the clinician with questions concerning the bacteriological diagnosis. It is necessary to multiply the samples taken in order to obtain a series of arguments to attribute the origin of the salpingitis to an organism, if a single organism is involved. The reliability of these examinations depends on the site and the care with which they are carried out as well as on the quality of the transportation and culture media. The convergence of these data leads to the prescription of appropriate antibiotics.

Adolescent↗
PubMed1990

[Rectal stenosis. A rare complication of chronic salpingitis caused by an intrauterine device].

The authors describe one case of rectal stenosis complicating chronic salpingitis in a patient carrying an intrauterine device. This observation is peculiar in that the inflammatory fibrous reaction is very intense, spreading all over the pelvis and forming a pseudotumoral mass sheathing the rectum. The clinical signs were mainly digestive, including a rectal syndrome: cramplike pelvic pain before defecation, tenesmus, constipation, abdominal pain and induration of the anterior aspect of the rectum observed during the clinical examination. Radiological examinations (barium enema, ultrasound, CT) show a tissue mass within the pelvis, with considerable thickening of the rectal wall. Ultrasound-guided biopsy in the pelvis yielded only nonspecific inflammatory signs with dominant fibrosis. The diagnosis of rectal stenosis caused by chronic salpingitis complicating the presence of an IUD was made only during surgery.

Adult↗
PubMed1988

[Assessment of the inflammatory evolution of the sequelae of salpingitis].

Fifty-four patients who had consulted because of their sterility had a laparoscopy carried out with bacteriological, cytological and biochemical studies of the peritoneal fluid as well as a histological assessment of the peritoneal adhesions. The purpose of this prospective study was to show the usefulness of laparoscopy in pre-operative assessment of tubal sterility and to look for objective criteria of the progress of inflammation. To do the study, two groups of women in different clinical stages (29 patients with no pelvic infection and 25 patients who had salpingitis) were divided into three sub-groups: 25 free of disease, 4 subsiding salpingitis patients and 25 with tubo-peritoneal sequellae. Different samples taken with the laparoscope made it possible to decide whether the inflammatory process was carrying on or not in these 25 cases. Using swabs for bacteriological examinations we had to employ transport medium and this showed bacteria in 7 cases. We found a significant correlation between the serum and peritoneal levels of anti chlamydia antibodies and the levels of AC antibodies when there was a tubal lesion. There was little value in carrying out cytology on the peritoneal fluid except when the histology showed that this was necessary. The level of serum and peritoneal orosomucoid was found to be different in the two groups of patients. This study shows that it is necessary to assess several different parameters to exclude pelvic inflammatory disease before resorting to reparative tubal surgery.

Adult↗
PubMed1988

[Laparoscopic control in the treatment of salpingitis. Apropos of 40 cases].

In studying 40 cases of salpingitis diagnosed by laparoscopy, the course of which was controlled with a second laparoscopy, the authors try to evaluate the overall effectiveness of the treatment, the effectiveness according to the type of salpingitis, and finally the effectiveness according to the nature of the antibiotic treatment.

Ampicillin↗
PubMed1988

Second look laparoscopy after treatment of acute salpingitis with doxycycline/benzylpenicillin procaine or trimethoprim-sulfamethoxazole.

To have their diagnosis verified, etiology determined and treatment evaluated, 64 patients with a suspected acute salpingitis underwent laparoscopy during which isolates were taken. The patients were then randomized to one of two groups for treatment; doxycycline/benzylpenicillin procaine (DC + BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated three to six months later by second look laparoscopy when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 37 (58%) patients and for Neisseria gonorrhoeae (NG) in 15 (23%). Isolates from the oviducts were positive in 17 (27%) patients of whom 12 had CT and two had NG. Mild salpingitis (Grade I) was found in 16 patients, moderate (Grade II) in 26 and severe (Grade III) in 22 patients. At second look laparoscopy, two patients had totally occluded oviducts, 31 had adhesions but tubal passage on at least one side while 31 patients had healed without any signs of residue. Results at second look laparoscopy showed no statistical difference between the two treatment groups.

Acute Disease↗
PubMed1987

[Chronic salpingitis and extra-uterine pregnancy. Results of the histologic study of 215 tubal pregnancies].

215 women who had tubal pregnancy were treated by total salpingectomy at the University Hospital Port-Royal between the 1st January 1977 and the 30th January 1986. All of these had histological examination of the tube in which the pregnancy occurred. Our series of histological examinations confirms that tubal pregnancy occurs in the great majority of cases in a tube that is already pathological. The responsibility for tubal abnormalities in the occurrence of tubal pregnancy has been suggested by a comparative study of a control series where chronic lesions of the tube were statistically far less frequent (p less than 0.001). Ampullary pregnancy, of which there were 200 cases, was associated in 89.5% of the cases with a pathological condition of the ampulla. Isthmic pregnancy, of which there were 15 cases, would seem to be secondary to a pathology in the isthmus in all cases except one, and is nearly always associated with lesions in the ampulla. Chronic salpingitis was the main histological lesion that was observed. It represented 95.5% of the abnormalities of the ampulla in ampullary pregnancies. In isthmic pregnancies it was found in two-thirds of cases attacking the isthmus, the ampulla or the whole tube. Isthmic salpingitis nodosa was the second lesion that was observed in 40% of isthmic pregnancies. As far as endometriosis is concerned, it is very rare and occurred in only one case. Prevention of tubal pregnancy, therefore, necessarily must lie in preventing tubal infections and sexually transmitted diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Disease↗
PubMed1987

[Treatment of acute salpingitis with a combination of augmentin and synthetic tetracycline or augmentin alone].

UNLABELLED: 41 cases of acute salpingitis were treated: either with the combination Augmentin + Tetracycline (A + T) including 21 severe cases treated intravenously for 4 days, then per os and 10 moderate cases treated per os from the beginning-or by Augmentin alone (A) per os for 10 other moderate cases. An accurate bacteriological diagnosis was made before treatment and, in case of failure, most often by celioscopy. A Chlamydia serology was performed. Patients were seen again after 8 days (41 cases), one month (39 cases) and several months (32 cases). RESULTS: A Chlamydia infection was found responsible, by culture or serology, in one out of 2 cases; only one germ was found in 14 cases, 2 germs in 21 cases and none in 7 cases. The association A + T was effective in all moderate cases at 8 and 30 days; in severe forms, there was a failure at 8 days and 4 others at 30 days or 17%. Augmentin alone per os caused 5 failures out of 10 cases at 8 days. No new failure was observed after several months in cases cured at 30 days. The association A + T may be recommended as very effective in moderate forms of acute salpingitis.

Acute Disease↗
PubMedDate not supplied

Inflammatory etiology of salpingitis isthmica nodosa: a clinical, histological and ultrastructural study.

Fifteen patients with obstructive salpingitis isthmica nodosa were studied. Histologically the tubal lumen was narrowed in all cases and in five patients the central tubal lumen could not be detected at all. In all cases an at least slight inflammatory response was found, consisting of lymphocytes and slight fibrosis. Seven of the patients had high serum chlamydial antibody titers (greater than 128). Ultrastructurally the epithelium lining the gland-like structure was similar to normal tubal epithelium. Inflammation may be a chronic irritant, leading to tubal spasm, muscular hypertrophy and eventually to salpingitis isthmica nodosa.

Epithelium↗
PubMed1986

Evaluation of doxycycline in the treatment of chlamydial salpingitis.

Acute salpingitis caused by Chlamydia trachomatis and other associated pathogens was diagnosed in 55 patients by means of laparoscopy and serological tests. All patients were treated with intravenous injections of doxycycline (200 mg/day) for four days followed by the same dosage orally for 20 days. Other antibiotics were given concomitantly for the associated infections. Treatment efficacy was evaluated on day 7 and day 30. Clinical symptoms had disappeared in 45 (82%) of the patients, and improvement was seen in another four (11%). Failure to improve in six cases was attributed to concurrent infection with microorganisms other than C trachomatis. After 30 days of treatment, two infections attributed to C trachomatis had not been cured with the doxycycline treatment; one of the patients was believed to have been reinfected and the other did not follow the prescribed treatment. The finding of clinical failure due to associated infection, sometimes discovered after two or three weeks of treatment, necessitates treatment of chlamydial salpingitis with multiple antibiotics, subsequent follow-up procedures (laparoscopic and serological), and appropriate changes in antibiotic therapy after C trachomatis has been eradicated but other pathogens remain.

Adult↗
PubMed1985

[Salpingitis in children before puberty. Apropos of 2 cases].

Salpingitis is exceptional in pre-pubertal girls. The authors compare a case of histologically and bacteriologically well documented salpingitis in a 3 year old girl to another case in a pre-pubertal 14 year old girl and review the literature on the subject. Six other cases have been reported. The clinical presentation is very variable and, in the absence of ultrasonography or laparoscopy, laparotomy is required for both the diagnosis and the treatment.

Adolescent↗