Assuntos
Vírus da Hepatite E/genética , Hepatite E/diagnóstico , Hepatite E/virologia , Transplantados , África Austral/epidemiologia , Feminino , Genótipo , Anticorpos Anti-Hepatite/sangue , Anticorpos Anti-Hepatite/imunologia , Hepatite E/epidemiologia , Vírus da Hepatite E/classificação , Vírus da Hepatite E/imunologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Transplante de Rim , Pessoa de Meia-Idade , Filogenia , RNA Viral/genética , Carga ViralRESUMO
OBJECTIVE: To report an extremely rare case of endotoxic shock due to Enterobacter cloacae that occurred after laparoscopy for gamete intrafallopian transfer (GIFT) in a nulligravid woman. DESIGN: Private fertility center in Cape Town, South Africa. SETTING: Case report. PATIENT(S): A 34-year-old woman with primary infertility. INTERVENTION(S): Routine preparation for GIFT procedure, sonar aspiration to obtain oocytes, followed by GIFT. Endotoxic shock developed within hours after the procedure, followed by admission to the intensive care unit, intravenous antibiotic therapy, mechanical ventilation, and abdominal hysterectomy. MAIN OUTCOME MEASURE(S): Preventing patient mortality and morbidity. RESULT(S): Discharge from the intensive care unit occurred on day 11 after GIFT, which was day 8 after surgery. A MEDLINE search (1980 to 2003) found no previous literature on endotoxic shock associated with assisted reproduction. CONCLUSION(S): Gram-negative infection with subsequent endotoxic shock after assisted reproductive techniques is extremely rare. As this case report shows, early diagnosis and active management of these cases are mandatory to prevent serious complications and mortality.
