Disparate effects of methicillin-resistant Staphylococcus aureus infection on renal function in IgA-dominant infection-associated glomerulonephritis and menstrual toxic shock syndrome: a case report and literature review.

The sudden outbreak of severe acute respiratory syndrome coronavirus 2 pneumonia posed a significant challenge to medical professionals because treatment of critically ill patients requires the efforts of a multidisciplinary team. To highlight this principle, we examined acute kidney injury (AKI) in IgA-dominant infection-associated glomerulonephritis (GN) and menstrual toxic shock syndrome (mTSS). Both GN and mTSS are rare diseases caused by staphylococcal infection, and renal function is frequently impaired. The resulting AKIs are disparate pathological entities driven by distinct immune mechanisms. We begin by describing the case of a diabetic man with pyopneumothorax following methicillin-resistant Staphylococcus aureus (MRSA). He had endocapillary proliferative GN with in situ IgA-dominant immune-complex formation in the mesangium accompanied by complement C3 deposition in the glomerular capillary wall. By contrast, acute tubular necrosis was observed in a case of mTSS; the patient's immune response was stimulated differently by MRSA enterotoxin and exotoxin resulting in aberrant IgA deposition, complement activation, and insufficient antibody production. As a multidisciplinary communication covering the fields of nephrology, immunology, and pathology, this report may help clinicians to understand these distinct renal lesions and make optimal therapeutic decisions expeditiously.

Endometriosis and the microbiome: a systematic review.

BACKGROUND: The aetiology and pathogenesis of endometriosis are still under investigation. There is evidence that there is a complex bidirectional interaction between endometriosis and the microbiome. OBJECTIVE: To systematically review the available literature on the endometriosis-microbiome interaction, with the aim of guiding future inquiries in this emerging area of endometriosis research. SEARCH STRATEGY: MEDLINE, Embase, Scopus and Web of Science were searched through May 2019. A manual search of reference lists of relevant studies was also performed. SELECTION CRITERIA: Published and unpublished literature in any language describing a comparison of the microbiome state in mammalian hosts with and without endometriosis. DATA COLLECTION AND ANALYSIS: Identified studies were screened and assessed independently by two authors. Data were extracted and compiled in a qualitative synthesis of the evidence. MAIN RESULTS: Endometriosis appears to be associated with an increased presence of Proteobacteria, Enterobacteriaceae, Streptococcus spp. and Escherichia coli across various microbiome sites. The phylum Firmicutes and the genus Gardnerella also appear to have an association; however, this remains unclear. CONCLUSIONS: The complex bidirectional relationship between the microbiome and endometriosis has begun to be characterised by the studies highlighted in this systematic review. Laboratory and clinical studies demonstrate that there are indeed differences in the microbiome composition of hosts with and without endometriosis. TWEETABLE ABSTRACT: Review findings show endometriosis associated with increased Proteobacteria, Enterobacteriaceae, Streptococcus and Escherichia coli across various microbiome sites.

Female genital tuberculosis and infertility: serial cases report in Bandung, Indonesia and literature review.

BACKGROUND: Female genital tuberculosis (FGTB) is a Mycobacterium infection in the reproductive organs which often leads to infertility. FGTB is either asymptomatic or causes uncharacteristic clinical presentations, making an early diagnosis is challenging. Our aims were to evaluate the clinical presentations, the process to confirm the diagnosis and followed-up the patients who had undergone laparoscopy at our center. FGTB has been reported from many countries, but has never been reported from Indonesia. Here we present case studies to document the presence of FGTB in Indonesia. CASES PRESENTATION: There were three patients admitted to our center; two patients were admitted with irregular menstrual cycle as their chief complaint, while one patient came due to infertility. The results from laparoscopy were suggestive of FGTB; including the presence of caseating granulomas surrounded by epithelioid cells, lymphocytes, plasma cells, and Langhans giant cells. Additionally, PCR testing confirmed presence of MTB. Subsequent to diagnosis, continuous TB medications was administered with excellent clinical outcome in two patients (pregnant in 18 months after under gone laparoscopy). The infertile patient remain in one of the treated patient above. CONCLUSION: In infertile patients who live in countries where Tuberculosis is an endemic disease, such as Indonesia, a comprehensive history taking, along with ultrasonography results can be used to diagnose FGTB. Confirmation of this diagnosis can be achieved through polymerase chain reactions result. Timely diagnosis and treatment are imperative to prevent any permanent injury to patient's reproductive organs.

Comparison of diagnostic accuracy of PCR and BACTEC with Lowenstein-Jensen culture and histopathology in the diagnosis of female genital tuberculosis in three subsets of gynaecological conditions.

The prevalence of female genital tuberculosis (FGTB) in India has been estimated to be about 19%. Despite an array of diagnostic tests being available, the goal of early diagnosis and treatment remains elusive. The present study was planned to identify better diagnostic tests for early detection of FGTB and also to compare their diagnostic accuracy with the existing standard diagnostic tests in three subsets of gynaecological conditions (infertility, menstrual abnormalities and pelvic inflammatory disease). Total of 90 patients recruited in three groups of 30 each underwent endometrial sampling. The biopsied tissue was sent for histopathological examination, AFB smear examination, culture in Lowenstein-Jensen (L-J) and BACTEC 460 TB culture media and nested PCR testing. BACTEC had a sensitivity of 40% with a specificity of 90% while PCR showed a sensitivity and specificity of 62.5% and 54%, respectively, as compared to conventional methods (L-J culture or histopathology). Addition of PCR to BACTEC improved sensitivity from 40% to 52%. Hence, we conclude that combination of BACTEC and PCR had an improved detection as compared to conventional tests with an advantage of early results.

Evaluation of hormonal changes in menstrual cycle of women infected with pulmonary tuberculosis in Nnewi, south eastern Nigeria.

BACKGROUND & OBJECTIVE: The present study was designed to evaluate the hormonal changes in menstrual cycle of premenopausal women infected with pulmonary tuberculosis in Nnamdi Azikiwe University Teaching Hospital Nnewi. MATERIAL AND METHODS: A prospective study involving sixty-seven (67) female participants within the child-bearing age were randomly recruited and grouped based on their tuberculosis status as: Symptomatic TB infected females (n=20), Symptomatic TB infected females on ATT (n=20) and Control females (n=27). After due consent, a detailed medical history was obtained and routine investigations of pulmonary tuberculosis and confirmation using Ziehl Neelsen and sputum culture techniques for AFB and chest x-ray were done. Blood samples collected from the participants were used for hormonal assay using immunoenzymometric method. RESULTS: The results showed that the serum levels of FSH and LH (IU/ml) were significantly higher while progesterone and estradiol were significantly lower in Symptomatic TB females compared to Symptomatic TB females on ATT at follicular and luteal phases of menstrual cycle (P<0.05). The serum levels of FSH and LH were significantly reduced in Symptomatic TB females on ATT while progesterone and estradiol were significantly increased at follicular and luteal phases of menstrual cycle (P<0.05). FSH was significantly higher at follicular phase while estradiol was significantly higher at luteal phase of menstrual cycle in Symptomatic TB females on ATT. CONCLUSION: Tuberculosis induced hypogonadism in affected women which seemed to be reversed on treatment. Routine investigation for Tuberculosis should be done for women presenting with infertility, since early treatment can reverse the abnormality.

Chlamydia trachomatis in patients who used oral contraceptives and had intermenstrual spotting.

OBJECTIVE: To identify the incidence of positive assays for direct antigen detection of Chlamydia trachomatis in oral contraceptive (OC) users with and without intermenstrual spotting and in women seeking contraception. METHODS: We studied 65 women who had used OCs for more than 3 months and who presented with intermenstrual spotting for which no readily demonstrable cause could be identified. They were compared with 65 matched controls who were taking OCs without intermenstrual spotting and who had chlamydia testing because of one or more risk factors, and 65 matched controls seeking contraception. The incidence of positive tests for each group was compared by chi 2 test for independence using the Yates formula. The strength of the relationship was analyzed by determining the Craemer phi coefficient. RESULTS: Nineteen of the 65 women (29.2%) taking OCs for more than 3 months and experiencing bleeding had positive tests, in contrast to seven of 65 matched controls (10.7%) who were also on OCs and who had had chlamydia testing because of vaginitis or new or multiple sexual consorts, and four of 65 women (6.1%) who were screened for C trachomatis before initiation of contraception. The significance level for the chi 2 statistic was P < .01. CONCLUSION: Intermenstrual bleeding in women previously well regulated on OCs appears to be an added marker for chlamydial infection.

Acute pelvic inflammatory disease: etiology, risk factors and pathogenesis.

It was suggested that several behaviorial factors could be important in allowing mild local symptoms of infection to develop into PID. A localized gonococcal infection may produce an increased vaginal discharge or dysuria. PID results only if several other factors have been operable. Loss of the cervical mucus barrier with menstruation appears to be important in allowing bacteria to pass from the cervix in to the uterine cavity. Uterine infection may account for the abnormal uterine bleeding seen in 40% of all PID patients (18). When N. gonorrhoeae multiples beyond the capabilities of the genital tract defense mechanisms, a bilateral tubal infection ensues...

Virological studies on gynaecological patients.

Endometrial epithelial cells and blood samples taken simultaneously with the curettage (first serum) of 138 patients suffering from menstrual bleeding disorders as well as materials obtained from 16 induced abortions, were studied for the presence of virus. Fourteen adenovirus 2 strains were isolated from samples of the patients. Endometrial epithelial cells of 35 patients were examined with immunofluorescence method and 23 of them displayed specific fluorescence referring to the presence of viral antigens, with adenovirus and herpesvirus antisera. Studying withserological reactions the first and second (convalescent) sera of patients, high titers were found against type 2 herpesvirus in both sera, and titer rise against the latent adenovirus types in the second sera. Neither infective virus nor the presence of viral antigens were demonstrable in materials obtained from induced abortions.