Evaluation of an indirect immunofluorescence assay for detecting Chlamydia trachomatis as a method for diagnosing tubal factor infertility in Mexican women.

UNLABELLED: To evaluate the clinical impact of the use of an indirect immunofluorescence assay (IFA) against Chlamydia as a method to identify patients with tubal factor infertility (TFI) in a population of infertile Mexican women. METHODS: This was a retrospective analysis made on 100 patients attending the infertility clinic who underwent laparoscopy. Blood and cervical samples were collected during the clinical examination. The presence of anti-Chlamydia trachomatis IgG antibodies was documented using the IFA test, and the presence of active chlamydial infection was evaluated using the nucleic acid hybridization assay. RESULTS: The sensitivity and specificity values of the IFA test to identify patients with periadnexal adhesions were 45% and 82%, respectively; and the positive predictive and negative predictive values were 42% and 84%, and the positive and negative likelihood ratios were 2.5 and 0.7, respectively. CONCLUSION: The IFA test was not usable for the identification of patients with periadnexal adhesions as a cause of infertility in this population. However, it could be useful as a screening test to decide which patients might receive laparoscopic treatment. Furthermore, it could be useful for identifying patients with active chlamydial infections in the upper genital tract, but a study with a larger sample needs to be done.

[Risk factors and reproductive sequelae associated with Chlamydia trachomatis infection in infertile women]. / Factores de riesgo y secuelas reproductivas asociados a la infección por Chlamydia trachomatis en mujeres infértiles.

OBJECTIVE: To assess the clinical and sexual lifestyle characteristics associated with Chlamydia trachomatis infection among women diagnosed with infertility. MATERIAL AND METHODS: Study subjects were women with an infertility diagnosis attending the infertility clinic at the National Institute of Perinatology. Endocervical specimens from 309 women were examined for Chlamydia trachomatis using the direct immunofluorescence method. Vaginal culture samples were taken before initiating treatment. The presence of other sexually-transmitted infections was also assessed. Demographic, sexual behavioral, historical, and clinical data were collected for each subject. RESULTS: Seventy-seven women (24.9%) were infected with C trachomatis. Of these women, 70 (90.9%) had only one sexual partner, 58 (75.3%) were married, and 19 (24.7%) were single or had a common-law sex partner. Intrauterine device (IUD) was the main contraceptive method used in 15 women (19.5%). A coinfection with other sexually-transmitted microorganisms was detected in 41 of these patients (53.2%). Nineteen (24.7%) women had undergone tubal ligation. Among women with C trachomatis infection, reproductive sequelae were found: 24 (31.2%) women had had abortions and 50 (64.9%) had had a miscarriage. In 26 women cervical abnormalities were detected (33.8%); 50 (64.9%) had purulent vaginal discharge and 14 (18.1%) had pelvic pain. Bivariate analysis revealed that the risk factors for C trachomatis infection in women with infertility were: having a sex partner (OR = 2.96, 95% CI 1.22-7.5, p = 0.008), common-law union (OR = 3.68, p = 0.03), and IUD use (OR = 2.42, p = 0.01). CONCLUSIONS: A consistent relationship between C trachomatis infection and infertility was found. Infection with C trachomatis in women with infertility was associated with having one single sexual partner, marital status, and IUD use. The presence of ectropion and friability of the cervix may signal C trachomatis infection. Identification and presumptive therapy should be evaluated as measures to prevent and control C trachomatis infection in patients at risk. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Factores de riesgo y secuelas reproductivas asociados a la infección por Chlamydia trachomatis en mujeres infértiles / Risk factors and reproductive sequelae associated with Chlamydia trachomatis infection in infertile women

OBJETIVO: Comparar la información clínica y el estilo de vida sexual en dos grupos de mujeres con y sin infección por Chlamydia trachomatis que asisten a la clínica de infertilidad del Instituto Nacional de Perinatología, de la Ciudad de México. MATERIAL Y MÉTODOS: De febrero a noviembre de 1998, se realizó un estudio prospectivo en pacientes con diagnóstico de infertilidad. En el estudio se incluyó a pacientes con diagnóstico de infertilidad, tratados en el Instituto Nacional de Perinatologia, de la Ciudad de México, durante 1988. Las muestras endocervicales de 309 mujeres, que incluyeron a 77 con infección y a 232 sin infección, fueron examinadas para Chlamydia trachomatis, usando inmunofluorescencia directa. Los cultivos vaginales fueron obtenidos antes de iniciar el tratamiento. También se investigó la presencia de otros agentes infecciosos de transmisión sexual y la información demográfica, de conducta sexual, histórica y clínica fue recopilada de cada paciente. Los datos clínicos y ginecológicos de ambos grupos fueron comparados por ji2. La magnitud de las asociaciones fueron establecidas por razón de momios en análisis bivariados. Se realizó un análisis de regresión logística para establecer los efectos confusores en relación con los factores analizados. Las diferencias fueron consideradas estadísticamente significativas si p<0.05. RESULTADOS: Para el estudio 309 mujeres fueron elegibles, 77 (24.9 por ciento) cursaron con infección por C trachomatis, de éstas, 70 (90.9 por ciento) mencionaron tener un compañero sexual, 58 (75.3 por ciento) estaban casadas, 19 (24.7 por ciento) eran solteras o vivían en concubinato, 15 (19.5 por ciento) utilizaron el dispositivo intrauterino para el control de la natalidad, 41 (53.2 por ciento) presentaron coinfección con otros agentes infecciosos de transmisión sexual, y 19 (24.7 por ciento) cursaron con infertilidad por obstrucción tubárica. Las secuelas reproductivas observadas en las pacientes con infección por C trachomatis mostraron que 24 (31.2 por ciento) tuvieron abortos, 50 (64.9 por ciento), gestaciones previas, 26 (33.8 por ciento) anormalidades en el cérvix y 50 (64.9 por ciento) secreciones vaginales purulentas, con dolor (18.1 por ciento). El análisis bivariado mostró que los factores de riesgo asociados significativamente con la infección por C trachomatis fueron la presencia de un compañero sexual (OR= 2.96, IC 95 por ciento 1.22-7.5, p=0.008), concubinato (RM=3.68, p=0.03) y uso de...

Induction of tumor necrosis factor-alpha by cefodizime in U-937 cells

La cefodizima presenta efectos moduladores sobre la liberación de diversas citocinas. En esta investigación se determinó la actividad moduladora de este antibiótico sobre la producción del factor de necrosis tumoral (TNF) en una línea de células monocitica humana U-937. La medición de TNF se realizó mediante las pruebas de ELISA y bioensayo de citotoxicidad empleando células L-929. Los resultados mostraron que la cefodizima por si sola indujo la producción de TNF sobre las células U-937, sin embargo, la adición de LPS condujo a una disminución en la liberación de esta citocina (p<0.05). Por otro lado la combinación cefodizima-PMA tuvo un efecto sinérgico (p<0.05), sin embargo, la adición de LPS a esta combinación causó una disminución de la producción de TNF (p<0.05). Con estos resultados observamos que la cefodizima regula la producción de TNF en las células U-937, produciendo una menor concentración de TNF con la adición de LPS.

Tumor necrosis factor in peritoneal fluid from asymptomatic infertile women

Background. Tumor necrosis factor-Ó (TNF-Ó) is a cytokine that can be found in the peritoneal fluid (PF) of patients with endometriosis and pelvic inflammatory disease (PID) as a response to inflammatory disorders and infections. The cytotoxic effect of this cytokine could be a factor participating in the pathology of various gynecological diseases, and could also be accountable for the high immunological response and demage to the tubal epithelium. The objective of this study was ato establish the presence of TNF-Ó in asymptomatic infertility and its association with various isolated bacteria. Methods. Ten milliliters of PF were collected from each of 73 patients by means of laparoscopy and cultured in synthetic medium and McCoy cells for the isolation of aerobic and anaerobic bacteria, as well as for Chlamydia trachomatis. The activity of TNF-Ó was determined by means of a bioassay using L-929 cells. Results. Forty-three parcent of the PFs showed positive TNF-Ó activity, while the laparoscopic evaluation showed that 32 patients had Fallopian tube occlusion (FTO), 7 had endometriosis, 30 had PID. and 4 had myomas and adhesions. TNF-Ó activity was found to be high in FTO patients (P<0.05). Positive cultures were found in 50.7 percent of patients; of these, 31.5 percent had PID (p< 0.05), and only 20.5 percent of positive cultures were TNF-Ó positive. Chlamydia trachomatis (16 percent) was the most frequently isolated bacteria in these patients. Conclusions. The detection of TNF-Ó could be useful in the diagnosis of active infectious and inflammatory diseases in asymptomatic infertile patients