Ascitis secundaria a chlamydia trachomatis tras procedimiento de reproducción asistida / Ascites secondary to chlamydia trachomatis after assisted reproduction procedure

El desarrollo de ascitis moderada o severa es infrecuente tras una enfermedad inflamatoria pélvica por Chlamydia trachomatis, una de las principales causas de infección de transmisión sexual a nivel mundial. Caso clínico: Paciente de 29 años que tras aborto diferido (gestación tras inseminación artificial) que inicia a las seis semanas con cuadro de dolor abdominal inespecífico y ascitis de predominio linfocitario. El diagnostico se realizo mediante PCR (Werfen®) tanto el liquido ascítico como en exudado endocervical. La paciente recibió tratamiento antibiótico con doxiciclina. Conclusión: Las enfermedades de transmisión sexual deben ser consideradas cuando se realiza un diagnóstico diferencial de una mujer sexualmente activa con dolor abdominal y ascitis, instaurar tratamiento antibiótico y evitar pruebas e intervenciones quirúrgicas innecesarias.

The development of moderate or severe ascites is infrequent after a pelvic inflammatory disease from Chlamydia trachomatis, one of the main causes of sexually transmitted infection worldwide. Clinical case: A 29-year-old patient who, after a delayed abortion (gestation after artificial insemination), started at six weeks with symptoms of non-specific abdominal pain and predominantly lymphocytic ascites. The diagnosis is made by PCR (Werfen®) both the ascitic fluid and the endocervical exudate. The patient received antibiotic treatment with doxycycline. Conclusion: Sexually transmitted diseases should be considered when making a differential diagnosis of a sexually activated woman with abdominal pain and ascites. Establishing antibiotic treatment, and avoiding unnecessary tests and surgical treatments.

Enfermedad inflamatoria pélvica: un reto en el diagnóstico y tratamiento precoz / Pelvic inflammatory disease: a challenge in the early diagnosis and treatment

Actualizar los datos disponibles en referencia a la enfermedad inflamatoria pélvica para poder unificar criterios diagnósticos y terapéuticos y así minimizar las complicaciones que a corto y/o largo plazo puedan derivar. Método: Revisión de la literatura en Pubmed atendiendo sobre todo a las guías clínicas más actualizadas y ensayos clínicos aleatorizados. Resultados: La enfermedad inflamatoria pélvica es un cuadro infeccioso común entre las mujeres en edad fértil. Su mecanismo de transmisión más frecuente es la vía sexual y comparte factores de riesgo con otras enfermedades de transmisión sexual. Su diagnóstico, que es clínico, puede ser complejo y las formas subclínicas pueden pasar en ocasiones inadvertidas. Generalmente se puede comenzar con un tratamiento médico ambulatorio siguiendo las pautas recomendadas, y si la paciente no mejora o presenta un cuadro grave de inicio se indicará ingreso hospitalario y tratamiento médico endovenoso, reservando la cirugía para aquellos casos rebeldes en que fracasen los pasos anteriores. Conclusión: Es imprescindible reconocer esta entidad e instaurar el tratamiento antibiótico precoz, un retraso en el tratamiento adecuado, puede incrementar las secuelas inflamatorias a corto y largo plazo.

Update the pelvic inflammatory disease to standardize diagnostic and therapeutic criteria and to minimize its complications in the short and/or long term. Method: Search in Pubmed with especial attention to clinical guidelines and randomized clinical trials. Results: Pelvic inflammatory disease is a common infectious condition among women of fertile age. Its mechanism is the most common sexually transmitted shared risk factors and other sexually transmitted disease. Its clinical diagnosis can be complex and subclinical forms can sometimes go unnoticed. Usually it's indicated to start with medical treatment following the recommended guidelines, and if the patient does not improve or has a severe case, hospitalization and intravenous medical treatment is indicated, reserving surgery for those cases in which fail the above steps. Conclusion: It is essential to recognize this entity and establish early antibiotic treatment, so that a delay in appropriate antibiotic treatment, can lead to an increase in inflammatory short and long term sequelae.

Revisión de infección pelviana por actinomices: presentación de un caso clínico / Pelvic actinomycosis review: presentation of a clinical case

La infección por actinomices ha sido llamada "la gran imitadora" en la práctica clínica. La actinomicosis es una infección crónica supurativa debido a gérmenes gram positivos, anaerobios, no esporulados. Habita normalmente en las mucosa oral, gastrointestinal, genitales. Las infecciones oportunistas ocurren cuando se rompen las barreras mucosas, ocasionando la formación de abscesos, fístulas o masas. La actinomicosis tiene tres grandes presentaciones clínicas: cervicofacial, torácica y abdomino-pélvica. Se presenta un caso de actinomices abdomino-pélvica.

Role of non-H2O2 producing lactobacilli and anaerobes in normal and complicated pregnancy.

Lactobacilli (Doederlein's bacilli) are the most important predominant protective agents of the vaginal microbial ecosystem and alteration in vaginal pH directly speculates the concentration of lactobacilli. Currently, recognition of anaerobic lactobacilli (non-H2O2 producing lactobacilli) had further raised its significance. Therefore, the present study was aimed to explore the role of non-H2O2 lactobacilli and its association with other anaerobes in 100 cases of complicated pregnancy, 75 cases of normal pregnancy and 35 cases in non-pregnant women. Vaginal and cervical swabs were obtained and were inoculated in special and suitable media. Anaerobic lactobacilli (non-H2O2 producing) were more common genital microbes in women of complicated pregnancy (56.0%) than in normal pregnancy (34.7%) and in control group (14.2%). Rate of recovery of non-H2O2 producing lactobacilli increased when pathogenic bacteria especially anaerobes dominate the genital microflora. Anaerobic lactobacilli were seen in higher numbers when they were associated with bacteroides sp and other anaerobes. They were significantly reduced when aerobes predominated in flora; the correlation have been discussed.

A study of bacterial pathogens in acute pelvic inflammatory disease.

The study was carried out on two groups--the study group consisting of 50 women with acute pelvic inflammatory disease and the control group consisting of 20 women admitted for tubal ligation. Pouch of Douglas aspirates were collected under all aseptic precautions with 18 gauge medicut needle. The samples were transferred to thioglycollate broth. A direct Gram staining was done followed by plating on media for aerobic and anaerobic incubation. All cultures were sterile in the control group. There were both monomicrobial (56.7%) and polymicrobial (43.2%) isolates in the study group. The predominant aerobic isolates were coagulase negative Staphylococci, E. coli and Staphylococcus aureus. Amongst anaerobic isolates gram negative bacilli were the most common at 46.6% followed by gram positive cocci at 40%.

Chlamydia and fertility

Chlamydia trachomatis infection is the most common sexually transmitted disease all around the world. For a long time, Chlamydia trachomatis has been recognized as the common cause of urethritis, cervicitis, and other complications such as pelvic inflammatory disease [PID], ectopic pregnancy, etc. However, today there is more concern on its role in male and female fertility and infertility and many studies have concentrated on this issue all over the world. There is good evidence based on seroepidemiologic studies on relationship between serum Chlamydial antibodies and infertility due to tubal factor in women with or without PID. However, there are many questions about Chlamydia trachomatis and its influence on IVF outcome and the exsisting information is controversial. The impact of Chlamydia trachomatis on male infetility is under investigation and it seems able to cause destruction of different parts of male genital tract in addition to high rate of transmission to women. With regard to these data, it seems that prevention, early diagnosis and treatment of Chlamydial infections are importart and cost effective

Screening for chlamydial infections in women with pelvic inflammatory diseases.

One hundred female patients clinically diagnosed as pelvic inflammatory disease (PID) were studied for the presence of chlamydial infection by cytology and antigen detection. Cervical smears stained by Giemsa revealed inclusion bodies, only in 3 percent of cases. While using Immunocomb Enzyme Immunoassay (EIA) test, antigen was detected in 13% of cases, thereby showing that antigen detection is a better method than cell cytology. A significant correlation with the low socioeconomic status and younger age group was seen in patients showing presence of Chlamydia trachomatis antigen.

Etiología microbiana de la enfermedad inflamatoria pélvica leve y moderada (EIP) / Microbial ethiology of mild and moderate pelvic inflammatory disease

La Enfermedad Inflamatoria Pélvica (EIP) es una de las complicaciones más severas de las Enfermedades de Transmisión Sexual (ETS) se puede deber entre otros eventos al ascenso de la microflora genital femenina o a la infección de gérmenes implicados en ETS como la Chlamydia trachomatis o Neisseria gonorrhoeae. Esto trae como consecuencia serias repercusiones desde el punto de vista gineco-obstétrico. Una de las principales limitaciones a la que se enfrenta el médico es el conocer su etiología. De tal manera que con el presente trabajo, se pretende establecer el tipo de microorganismos involucrados en esta patología a fin de que al identificarlos, mediante el cultivo de endocérvix, endometrio y líquido peritoneal; se otorgue a la paciente el tratamiento adecuado, oportuno y certero, logrando así una mayor eficacia terapéutica

Espectro clínico de las infecciones por chlamydia trachomatis en mujeres / Clinical spectrum of chlamydia trachomatis infection in women

Hoy en día es incierto el rol que tiene C. trachomatis como causa de efectos adversos durante el embarazo. Pero si está claramente establecido que es causa de EIP en mujer, uretritis y epididimitis en el hombre y conjuntivitis y neumonitis en los niños. La EIP aguda por C. trachomatis tiene un impacto enorme en la reproducción de la mujer: es causa de embarazo tubario e infertilidad por obstrucción tubaria. Por sus consecuencias y porque habitualmente la salpingitis por C. trachomatis es asintomática, es necesario desarrollar estrategias precisas para su control. Se recomienda la pesquisa regular de esta bacteria en la mujer menor de 35 años con factores de riesgo. Es necesario mantener registro de estas infecciones y tratar a la pareja y los contactos. De este modo se pueden prevenir las complicaciones más importantes secundarias a esta infección

Epidemiología serológica de chlamydia trachomatis en mujeres que asisten a un servicio de planificación familiar / Serologic epidemiology of chlamydia trachomatis infection among fertile women attending a birth control facility

C. trachomatis is an important cause of sexually transmitted diseases, being mainly associated to cervicitis or urethritis among female and male patients, respectively. This study was designed to evaluate the frecuency of C. trachomatis infection among female patients attending a bith control facility using chlamydia IgG and IgM antibody detection, and to correlate this findings with the presence of C. trachomatis at the endocervix. Two hundred fertile women attending a hostital associated birth control facitity were evaluated by indirect microimmunofluorescence (IMIF) to detect circulating antibodies and with direct microimmunofluorescence (DMIF) to detect C. trachomatis in endocervix. C. trachomatis was present in 24 percent (44/200) of endocervical samples. IgG antibodies were equally prevalent in both DMIF positive group had higher antibody titers than the negative group (54,1 vs 32,9 percent, p < 0,05). Moreover, the DMIF positive group was associated with a higher frecuency of chlamydia IgM antibodies than the DMIF negative group. (97,5 vs 4,6 percent, p < 0,0001). These results indicate that C. trachomatis is a frequent agent of infection among women asking to be included in a birth control programm and also suggest that epidemiological surveillance studies are needed

Chlamydia in pelvic inflammatory disease

Pelvic inflammatory disease is one of the major public health problems in the world, both in the developing as well as developed countries. Genitourinary tract infections caused by Chlamydia trachomatis are most common sexually transmitted diseases. Fifty to seventy per cent of women suffering from chlamydial infection of the genital are symptom free and 25-30% of chlamydial urethritis is silent. Clinical presentation is varied. Laparoscopy is the gold standard in the diagnosis of Chlamydia associated pelvic infections. Treatment depends on the severity of the disease. Early diagnosis, prompt, accurate, aggressive and appropriate chemotherapy is essential to prevent its sequelae

Anaerobic and aerobic microflora of pouch of Douglas aspirate v/s high vaginal swab in cases of pelvic inflammatory disease.

The anaerobic and aerobic bacterial flora in pouch of Douglas (POD) aspirate and high vaginal swabs (HVS) was studied in 43 cases of pelvic inflammatory disease (PID) using standard techniques. High vaginal swabs from 20 healthy women were included as controls. Anaerobic and aerobic bacteria were isolated from 37 (86%) HVS and 31 (72%) POD aspirates from these 43 women. A total of 100 aerobic and 10 anaerobic bacterial strains were recovered from both the sites. Coagulase negative staphylococci (28), Escherichia coli (23) and Streptococcus faecalis (14) were predominant aerobic bacteria. Of the anaerobes, peptostreptococci species and Bacteroides species were more common, polymicrobial flora (more than one type of organism) was present in a total of 27 specimens. However mixture of anaerobic and aerobic bacteria were seen in only 5 specimens. Of the 20 control specimens, ten were positive for organisms. Ten aerobic and 3 anaerobic bacterial strains were recovered.

Rol de la laparoscopía en el diagnóstico de los procesos inflamatorios pélvicos / Role of the laparoscopy in the diagnosis of pelvic inflammatory process

Se presentan los resultados de laparoscopías diagnósticas realizadas en 278 pacientes que ingresaron al Servicio de Ginecología y Obstetricia del Hospital Regional de Temuco, durante el período comprendido entre enero de 1993 y marzo de 1994. Se realiza laparoscopia diagnóstica y se certifica el diagnóstico de procesos inflamatorio pelviano utilizando los criterios de Hager. Se confirma el diagnóstico de proceso inflamatorio sólo en el 74 por ciento de los casos. Los hallazgos son concordantes con lo señalado en varias publicaciones en cuanto a otorgar un rol significativo a la laparoscopia diagnostica en los procesos inflamatorios pélvicos, con lo cual se logra un mejor diagnóstico diferencial. Se analizan las propiedades de sensibilidad y especificidad para los diferentes elementos clínicos y de laboratorio considerados en el diagnóstico de PIP. El test de inmunofluorescencia para Clamidias fue positivo en el 40,7 por ciento de las pacientes. Los gérmenes aerobios más frecuentemente encontrados corresponden a E. coli

Incidência de Chlamydia trachomatis e Neisseria gonorrhoeae em mulheres assintomáticas näo promíscuas e com doença inflamatória pélvica aguda / Incidence of Chlamydia trachomatis and Neisseria gonorrhoeae in asynptomatic non-promiscuous women and with acute inflammatory pelvic disease

Levando-se em conta a importância epidemiológica da Chlamydia trachomatis e Neisseria gonorrhoeae e das possíveis complicaçoes provenientes destes patógenos, os autores investigaram l86 mulheres que visitaram o Serviço de Orientaçao e Planejamento Familiar e a Emergência do Hospital de Clínicas de Porto Alegre, no período de fevereiro de 1987 a fevereiro de 1988. As pacientes foram divididas em dois grupos: o primeiro era composto por mulheres assintomáticas nao promíscuas e o segundo por pacientes com doença inflamatória pélvica aguda. Foi coletado material do canal endocervical para cultura de gonococo e para pesquisa de clamidia. O grupo de mulheres assintomáticas mostrou a incidência de 4 por cento para Chlamydia trachomatis e 2 por cento para Neisseria gonorrhoeae, já o grupo de pacientes com doença inflamatória pélvica aguda apresentou clamídia em 27,94 por cento das amostras e gonococo em 21,32 por cento. Os autores concluíram que Chlamydia trachomatis e Neisseria gonorrhoeae podem ser isoladas de mulheres assintomáticas nao promíscuas e estao associadas significativamente com doença inflamatória pélvica aguda.

Evaluación de la sensibilidad y especificidad de tres reactivos de inmunofluorescencia directa para el diagnóstico de Chlamydia trachomatis / Evaluation of sensitivity and specificity of three reagents of direct immunofluorescence for the diagnosis of chlamydia trachomatis

Se evaluó la sebsibilidad, especificidad, valor predictivo positivo y negativo y porcentaje de falsas positivas y negativas de tres reactivos de inmunofluorescencia directa para el diagnóstico de infecciones por Chlamydia trachomatis. Se estudiaron 150 muestras de raspados cervicovaginales y 50 muestras de líquido peritoneal de pacientes con enfermedad pélvica inflamatoria. Los reactivos en contra de la proteína principal de membrana externa presentaron mayor sensibilidad pero menor especifidad que el reactivo de inmunofluorescencia contra el lipopolisacárido de Chlamydia trachomatis

Mycoplasma hominis in pelvic inflammatory disease.

Fifty one cases of Pelvic Inflammatory disease (PID) and sixty one control subjects were screened for the genital mycoplasmas. Cervical swabs, urine & blood were collected from the patients and the control subjects and were processed by standard techniques for isolation and identification of bacteria, fungi and mycoplasmas. The rate of isolation of M. hominis from the PID and controls were 54.90% and 16.39% respectively, and this difference was statistically significant (p. < 0.001). Metabolic inhibition test revealed a titer of > 1:2 in 92% of the acute sera of PID against the homologous strain and there was a rise or fall in four fold titer in 45% of the convalescent sera tested for.

Actinomyces species associated with intrauterine contraceptive devices and pelvic inflammatory disease.

Swabs from 112 removed intrauterine contraceptive devices (IUCD), endocervical swabs from these women and from 65 women with pelvic inflammatory disease (PID) were studied for actinomyces, using direct fluorescent antibody test and culture. Endocervical swabs from 50 control subjects were also studied. Actinomyces species could be detected in 23 (20.5 percent) of IUCD wearers and 8 (12.3 percent) of patients with PID. In control cases, no actinomyces were detected. The isolation rate using a selective medium (Actino Blood Agar) was 71.4 percent. Actinomyces israelii, Actinomyces naeslundii and Actinomyces viscosus were isolated.