Gynecological and obstetrical aspects of Enterobius vermicularis infection.

Enterobiasis is an easily recognizable and treatable disease with higher incidence among children. Based on these facts, its clinical importance is usually underestimated. This infection also occurs during adulthood and without treatment, it can cause severe complications in some rare cases. Unnoticed subclinical infection in women can lead to infertility and even to life-threatening conditions. It is also emphasized in this paper that the treatment of identified enterobiasis during pregnancy needs caution. After reviewing the current scientific literature, two gynecological cases are presented here.

[One case report of ectopic schistosomiasis in fallopian tube in Jingmen City].

One cases of ectopic schistosomiasis in fallopian tube was found by the histopathological examination in Jingmen City. After surgery and anthelmintic treatment with praziquantel, the curative effect was satisfactory. This case suggests that in schistosomiasis endemic area, the imaging technology and tissue pathological examination should be used sufficiently for the differential diagnosis of ectopic schistosomiasis, so as to reduce misdiagnosis.

Prevalence of 7 sexually transmitted organisms by multiplex real-time PCR in Fallopian tube specimens collected from Saudi women with and without ectopic pregnancy.

BACKGROUND: Ectopic pregnancy (EP) is associated with maternal morbidity and occasionally mortality during the first trimester. A history of sexually transmitted infection (STI) and pelvic inflammatory disease have been implicated as major risk factors for EP. Our aim was to measure the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Mycoplasma genitalium (MG), Ureaplasma parvum/urealyticum, Gardnerella vaginalis, Trichomonas vaginalis and herpes simplex virus (HSV)-1&2 in Fallopian tubes collected from EP and the results were compared with those obtained from total abdominal hysterectomy (TAH) and tubal ligation. METHODS: This was a prospective case-control study and tubal samples were collected from 135 Saudi women recruited from 3 centres in the Western region as follow: 84 EPs, 20 TAH and 31 tubal ligations. Multiplex TaqMan PCR was performed using an IVD CE kit for the simultaneous detection of candidate pathogens following DNA extraction. RESULTS: Infections were detected in 31.8 % of the 135 participants either as single (11.1 %) or co-infections (20.7 %) and the frequencies were significantly higher in EP (42.85 %) compared with control (13.72 %). The rates of CT (27.4 %; P = 0.001); MG (20.2 %; P = 0.009) and HSV-1/2 (21.4 %; P = 0.01) were significantly higher in EP. No significant difference between the study groups was observed for the other pathogens (P > 0.05). Binary logistic regression also showed that infection with ≥ 2 pathogens (OR 4.9; 95 % CI: 2.2 - 11.6; P = 0.006), CT (OR 3.07; 95 % CI: 1.3 - 12.3; P = 0.002), MG (OR 2.3; 95 % CI: 1.1 - 8.6; P = 0.03) and HSV-1/2 (OR 1.7; 95 % CI: 0.75 - 5.7; P = 0.004) were associated with a significantly higher risk of developing EP. CONCLUSIONS: STIs are frequent in the upper genital tract of Saudi women during the reproductive age and, CT, MG and HSV-1/2 were more prevalent in EP. The observed high rates of co-infection advocate the necessity of establishing national guidelines and/or screening program utilising multiplex PCR approach for the detection of common STIs among high risk groups in the kingdom. Further studies are needed to measure the adverse reproductive outcomes associated with STIs in Saudi Arabia.

Extraintestinal oxyuriasis - report of three cases and review of literature.

Extraintestinal oxyuriasis, in our experience with three affected women of fertile age, presented itself as a solitary fibrotic nodular lesion, with a varying location. The sites of location were: parietal peritoneum, serous surface of the uterus and wall of the uterine tube. The size of the nodules was 5 to 10 mm. Histologically, the lesions were hypocellular fibrotic nodules with a variable amount of neutrophils and amorphous eosinophilic material in the center, harbouring eggs of the parasite and remnants of pinworm cuticle. All three lesions were asymptomatic, only being discovered incidentally during the operations for unrelated conditions. Their peroperative recovery by a surgeon did not alter the course of surgery. These findings document the ability of pinworms to migrate into the abdominal cavity via the female genital tract.

Enterobius vermicularis salpingitis seen in the setting of ectopic pregnancy in a Malaysian patient.

We report a rare and unusual case of invasive Enterobius vermicularis infection in a fallopian tube. The patient was a 23-year-old Malaysian woman who presented with suprapubic pain and vaginal bleeding. A clinical diagnosis of ruptured right ovarian ectopic pregnancy was made. She underwent a laparotomy with a right salpingo-oophorectomy. Histopathological examination of the right fallopian tube showed eggs and adult remnants of E. vermicularis, and the results were confirmed using PCR and DNA sequencing.

Enterobius vermicularis infection with tuboovarian abscess and peritonitis occurring during pregnancy.

BACKGROUND: Extraintestinal Enterobius vermicularis infections are rare but may occasionally affect the female genital tract. Although mostly asymptomatic or causing minor clinical problems, they may lead to severe infectious complications. METHODS: Case report and review of the pertinent English language literature. RESULTS: A 31-year-old, 30-week-pregnant female was admitted with a clinical suspicion of appendicitis. At surgery, the appendix appeared normal, but generalized peritonitis of unclear origin was present. Eggs of Enterobius vermicularis were found upon microbiological and pathological examination. Because of persisting infectious disease, the patient underwent an elective caesarean section, and at that time the diagnosis of a right tuboovarian abscess was made, and salpingo-oophorectomy was performed. The pathology report confirmed the diagnosis of an E. vermicularis salpingo-oophoritis. CONCLUSION: This case was extraordinary because of a combination of tuboovarian abscess and generalized peritonitis with E. vermicularis infection occurring during late pregnancy. Ectopic enterobiasis should be considered in the differential diagnosis of pelvic infections of gynecological origin.

Disseminated hydatid disease.

Echinococcus infestation is endemic in certain parts of the world. Extrahepatic dissemination of the disease is rare. Successful management of these patients and possible routes for abdominopelvic dissemination of the disease are discussed.

Trichomonas vaginalis: in vitro survival in swimming pool water samples.

In this work it is shown that Trichomonas vaginalis remains viable and infective in swimming pool water samples for several hours. After survival, trichomonad cytotoxicity was tested on primary cultures of epithelial cells. It demonstrates that the some trichomonad strains are able to survive in water pools and survival time is dependent on the degree of strain infectivity and also if it is a long term cultured or fresh isolate.

Tubal gestation and schistosomiasis: a case report.

BACKGROUND: Schistosomal infections of the female reproductive tract are common in countries where the parasite is endemic. Serious complications, such as ectopic pregnancy and infertility, may arise in patients with gynecologic schistosomiasis. CASE: A primiparous, African woman presented with vaginal bleeding and was found to have an ectopic pregnancy. Laparoscopy revealed distorted pelvic anatomy due to dense adhesions. Pathologic examination confirmed an ectopic pregnancy and identified Schistosoma haematobium ova in the patient's fallopian tube. Urine examination was confirmatory, and the patient was treated and referred for fertility counseling. CONCLUSION: Clinicians should consider schistosomiasis as a possible etiology for gynecologic complaints, including serious complications such as ectopic pregnancy and infertility, in patients from endemic regions.

Interaction of Tritrichomonas foetus and the bovine oviduct in an organ culture model.

Tritrichomonas foetus is an extracellular parasite of the reproductive tract in cattle. The mechanism by which T. foetus causes abortion in cattle is largely unknown. There are no studies of infection in the cow oviducts, almost all published papers are related to vagina infection and few articles focusing on the uterus. The aim of the present study was to establish a working model of bovine oviduct epithelial cells and submit these cells to Tritrichomonas foetus interaction. Twenty bovine oviducts were obtained from cows at a commercial abattoir and T. foetus was injected through the isthmus into the oviduct lumen. The whole oviduct was analyzed by scanning and transmission electron microscopy. The results reported here demonstrate that: (1) fresh whole oviducts can be used as a good model to study parasite-host cell interaction; (2) cow oviduct epithelium has been shown to consist of two cell types: ciliated and nonciliated secretory cells, and T. foetus displayed great specificity for the nonciliated cells localized in the deeper oviduct folds; (3) T. foetus adheres as single separate cells, and maintains the flagella externalized; (4) differently from T. vaginalis, T. foetus does not change its shape during the adhesion process; and (5) oviduct cells exhibited morphological characteristics of apoptosis after trichomonadal interaction.

Ruptured tubal gestation: an unusual presentation of Schistosoma haematobium infection of the fallopian tube.

An unusual mode of presentation of schistosomiasis in the form of a ruptured tubal pregnancy in a previously asymptomatic 23-year-old woman is described. Histological examination of the salpingectomy specimens demonstrated Schistosoma haematobium ova.

Salpingitis due to Entamoeba histolytica.

We describe the pathology of a unique case of Fallopian tube amebiasis, associated with hydrosalpinx, in a 21-year-old woman. She complained of lower abdominal pain, had a foul-smelling green vaginal discharge and fever during one week. There was a discrete increase in body temperature and a painful abdominal palpation at the lower right side, with signs of local peritoneal irritation. Pathological examination showed a marked dilatation of the fallopian tube and hydrosalpinx. Microscopic examination showed a poorly formed granuloma composed of large macrophages with many Entamoeba histolytica trophozoites inside the fallopian tube. Even though it is a rare disease the correct diagnosis of female genital tract amebiasis is of great importance for the indication of proper therapy.

[Improvement of amplification method for Cryptosporidium parvum oocysts from mice].

OBJECTIVE: To establish a simplified amplification method for obtaining a large number of purified Cryptosporidium parvum oocysts from infected C57BL/6N mice. METHODS: All mice in the experimental groups were immunosuppressed by given different concentrations of dexamethasone phosphate added in drinking water throughout the experiment. The recovery and purity of the oocysts obtained using different purification methods was compared. The infectivity of the oocysts obtained from the same origin but different animals and different purification methods in a bovine fallopian tube epithelial cell culture system was studied. RESULTS: 4.16 x 10(9) oocysts were obtained in 30 mice in the 3rd group with dexamethasone of 20 micrograms/ml in drinking water. No significant difference in the oocyst recovery, purity and infectivity was found between methods using saturated saline floatation and sucrose density gradient centrifugation. The infectivity of the oocysts obtained from the same origin but different animals was similar. CONCLUSION: A simplified amplification method for obtaining a large number of purified Cryptosporidium parvum oocysts from the infected mice was established.

Oxyuriasis pélvica / Pelvic oxyuriasis

El enterobius vermicularis, es un parásito que comúnmente infesta el lumen intestinal, en raras ocasiones es posible encontrarlo en otras localizaciones. Se presenta caso clínico, en el que se encontraron granulomas por enterobius vermicularis en serosa de trompa uterina, que se habrían instalado allí por fístula rectal secundaria a perforación por un dispositivo intrauterino. Se describen las lesiones histopatológicas, sus implicancias clínicas y revisión de la literatura

Synergistic anticryptosporidial potential of the combination alpha-1-antitrypsin and paromomycin.

The combined effect of the serine protease inhibitor alpha-1-antitrypsin (AAT) and the aminoglycoside paromomycin on Cryptosporidium parvum infection in vitro was investigated. AAT and paromomycin were mixed with C. parvum oocysts as either single or combined treatments and used to inoculate epithelial cell cultures. Single- and combined-treatment groups had significantly lower (P < 0.01) parasite numbers than untreated controls. The mean fractional inhibitory concentration indices suggested significant synergistic activity.

Efficacy of serine protease inhibitors against Cryptosporidium parvum infection in a bovine fallopian tube epithelial cell culture system.

The anticryptosporidial potential of the protease inhibitors alpha-1-antitrypsin (AAT), antipain, aprotinin, leupeptin, methoxysuccinyl-ala-ala-pro-valine chloromethylketone (MAAPVCK), soybean trypsin inhibitor (SBTI), and phenylmethylsulfonyl fluoride (PMSF) was evaluated in a bovine fallopian tube epithelial (BFTE) cell culture system. Protease inhibitor concentrations of 5, 10, 50, 100, and 500 micrograms/ ml (PMSF at 1, 2, and 3 mM) in RPMI medium were mixed with Cryptosporidium parvum oocysts and used to inoculate BFTE cell monolayers. At 24 hr postinoculation (candlejar/37 C), cells were rinsed with RPMI medium, fixed in methanol, and stained with Giemsa. Parasites were enumerated in cell monolayers by brightfield microscopy. The mean number of parasites counted in each protease inhibitor treatment group was expressed as a percentage of the mean number of parasites counted in an infection control group. Leupeptin and SBTI reduced parasite numbers to 40-50% of the control mean at 500 micrograms/ml: AAT, antipain, and aprotinin reduced parasite numbers to 10-15% at the same concentration. PMSF reduced parasite numbers to 40% of the control mean at 3 mM. MAAPVCK did not significantly inhibit cryptosporidial infection. These findings suggest that a protease component of C. parvum may be essential for host cell infection.

Complete development of Cryptosporidium parvum in bovine fallopian tube epithelial cells.

Cryptosporidium parvum is a coccidian parasite responsible for causing protracted and life-threatening diarrheal illness in immunocompromised humans, especially patients with AIDS. The lack of medications effective in treating people suffering from cryptosporidiosis has prompted the development of in vivo and in vitro models for this disease. This study is the first to demonstrate that C. parvum can complete its entire life cycle (from sporozoite to infective oocyst) in a primary culture of bovine fallopian tube epithelial (BFTE) cells. Scanning and transmission electron photomicrographs were used to detail the ultrastructure of individual parasitic stages. Successful infections were produced by inoculating cell cultures with either oocysts or purified sporozoites. Infection of BFTE cells with C. parvum close paralleled in vivo infections with regard to host cell location and chronology of parasite development. Infecting BFTE cells with sporulated oocysts provided a reproducible and quantitative cultivation system with significantly (P < or = 0.001) higher infection rates than in Madin-Darby canine kidney cells. Oocysts produced in BFTE cells were infective for immunosuppressed adult C57BL/6N mice. Cultivation of C. parvum in BFTE cells will facilitate the study of interactions between parasites and host cells as well as provide a reliable system for evaluating anticryptosporidial compound efficacy.

Schistosomiasis: an unusual cause of tubal infertility.

A case report of a Nigerian woman having an unusual cause of tubal infertility is presented. On histological examination of the Fallopian tube, ova of Schistosoma haematobium enclosing living miracidia were found in the smooth muscle layer of the Fallopian tube and its mesosalpinx. Mechanisms of tubal involvement are analysed. The case indicates the need to consider schistosomiasis as a possible aetiological factor in patients with tubal infertility coming from areas where the disease is endemic.