Characterization of Pathogenic CD8+ T cells in Chlamydia-Infected OT1 Mice.

Chlamydia trachomatis is a leading infectious cause of infertility in women due to its induction of lasting pathology such as hydrosalpinx. Chlamydia muridarum induces mouse hydrosalpinx because C. muridarum can both invade tubal epithelia directly (as a first hit) and induce lymphocytes to promote hydrosalpinx indirectly (as a second hit). In the current study, a critical role of CD8+ T cells in chlamydial induction of hydrosalpinx was validated in both wild type C57BL/6J mice and OT1 transgenic mice. OT1 mice failed to develop hydrosalpinx partially due to the failure of their lymphocytes to recognize chlamydial antigens. CD8+ T cells from naive C57BL/6J mice rescued the ability of recipient OT1 mice to develop hydrosalpinx when naive CD8+ T cells were transferred at the time of infection with Chlamydia. However, when the transfer was delayed for 2 weeks or longer after the Chlamydia infection, naive CD8+ T cells no longer promoted hydrosalpinx. Nevertheless, CD8+ T cells from mice immunized against Chlamydia still promoted significant hydrosalpinx in the recipient OT1 mice even when the transfer was delayed for 3 weeks. Thus, CD8+ T cells must be primed within 2 weeks after Chlamydia infection to be pathogenic, but, once primed, they can promote hydrosalpinx for >3 weeks. However, Chlamydia-primed CD4+ T cells failed to promote chlamydial induction of pathology in OT1 mice. This study optimized an OT1 mouse-based model for revealing the pathogenic mechanisms of Chlamydia-specific CD8+ T cells.

Sarcoidosis of the fallopian tube: A rare case study with confirmed Propionibacterium acnes infection.

Sarcoidosis is a systemic granulomatous disease that is most commonly manifested in the pulmonary system. Though the entire etiology of sarcoidosis remains unknown, it has been reported that Propionibacterium acnes (P. acnes) has been isolated from sarcoid lesions. Herein, we report a case of salpingitis arising from sarcoidosis. A female patient aged 37 years, gravida 2 para 0, who had been diagnosed with sarcoidosis at the age of 36 years, underwent laparoscopic right salpingectomy due to obvious right hydrosalpinx with recurrent refractory right lower abdominal pain. The pathological diagnosis was granulomatous salpingitis of the right fallopian tube suspecting sarcoidosis. Immunocytochemistry using a specific monoclonal antibody against P. acnes lipoteichoic acid (PAB antibody) revealed PAB-positive reaction in sarcoid granuloma. This is the first case of sarcoidosis that the presence of P. acnes was shown in sarcoid lesions in the fallopian tube.

Pyosalpinx complicating chronic hydrosalpinx in a 50-year old virgo woman: a case report.

BACKGROUND: Pelvic inflammatory disease is an infection of the upper genital tract, including the uterus, ovaries, uterine tubes, and pelvic peritoneum. Tubo-ovarian abscess and pyosalpinx are common complications associated with pelvic inflammatory disease. They are usually encountered in sexually active women, but rare cases in Virgos have also been described. CASE PRESENTATION: Here, we report the case of a 50-year-old Virgo woman presenting with pyosalpinx secondary to previous laparotomic sigmoidectomy for acute diverticulitis. Inflammation caused by the woman's diverticulitis and laparotomic surgery could have been the origin of her left uterine tube occlusion and consequent hydrosalpinx development. The contact between the rectum and left uterine tube observed in our patient suggests that superinfection of the hydrosalpinx could have occurred secondary to bacterial translocation. The patient's condition was managed with laparoscopic left salpingectomy and antibiotic therapy, which resulted in complete resolution. CONCLUSIONS: Regardless of sexual history, pelvic inflammatory disease should be considered in all women with abdominal pain. Diagnosing pelvic inflammatory disease in Virgos could be very challenging, but its recognition and appropriate treatment are indispensable because of the potential long-term complications.

Pseudoxanthomatous salpingitis as an ex vivo model of fallopian tube serous carcinogenesis: a clinicopathologic study of 49 cases.

Iron is a well-documented carcinogen based on both animal models and observational studies in humans. There are limited published data on pseudoxanthomatous salpingitis, an uncommon condition characterized by the accumulation of histiocytes containing iron and iron-related compounds-lipofuscin and hemosiderin-in the lamina propria of the fallopian tube. The clinical and pathologic features of 49 consecutive cases were evaluated. The mean patient age was 53. A history of endometriosis was found in 20%, infertility in 17%, and tubal ligation in 7%. Thirteen (27%) had endometrial cancer and 2 patients had prior radiation therapy for cervical carcinoma. Histologic evidence of endometriosis other than tubal pigment deposition was identified in 65%, and in the fallopian tubes in 35%. Pigment deposition was unilateral in 65% and multifocal or diffuse in 80%. Plasma cells, eosinophils, and neutrophils were present in the tubal lamina propria in 57%, 18%, and 24%, respectively. Hydrosalpinx was present in 51%. An iron stain was positive in pseudoxanthoma cells lacking hemosiderin in 14 of 18 cases (78%). By immunohistochemistry, 2 of 22 cases displayed p53 signatures. The Ki67 proliferation index was elevated (>10%) in 11 of 22 cases, with a mean index of 32% in those cases. An elevated proliferation index did not correlate with inflammation. In summary, these findings characterize the clinical and pathologic features of pseudoxanthomatous salpingitis and confirm its close association with endometriosis, occasional association with radiation therapy, and the presence of iron in the histiocytes. In view of the evolving paradigm shift implicating the fallopian tubal epithelium as the site of origin of high-grade extrauterine serous carcinoma, the presence of iron and iron-related compounds in the fallopian tube provides an opportunity to study the early events in high-grade serous carcinogenesis in a setting characterized by a well-documented carcinogen in close anatomic proximity to the putative epithelium of origin.

Reduced prevalence of chronic tubal inflammation in tubal pregnancies after levonorgestrel emergency contraception failure.

PURPOSE: The aim of this study was to compare chronic fallopian tubal inflammatory disease and fibrosis between patients with general tubal pregnancy (TP) and TP with levonorgestrel (LNG) emergency contraception (EC) failure. METHODS: We retrospectively studied patients with general TP (n = 79) and TP following LNG-EC failure (n = 81) within the same conception cycle. Information on the gynecological features of each subject was collected. Pelvic inflammatory disease and associated sequelae were assessed by the serum Chlamydia trachomatis (CT) IgG test, laparoscopic evaluation of tubal damage, and histopathological observation of tube tissues. Chi-square and Student's t-tests were employed to determine the difference between the two groups. RESULTS: Compared with general TP, cases of TP following LNG-EC failure subjects were less likely to have a history of previous ectopic pregnancy (5.06% vs. 18.52%, p = 0.009) and adnexal surgery (6.33% vs. 22.22%, p = 0.010). Patients with TP following LNG-EC failure were less likely to have pelvic inflammatory disease and associated sequelae than those with general TP, as revealed by positive reaction to anti-CT IgG (18.18% vs. 35.94%, p = 0.031), assessment of tubal damage (grade I: 5.06% vs. 17.28%; grade II: 2.53% vs. 11.11%; grade III: 1.27% vs. 6.17%; p = 0.001), infiltration of chronic inflammatory cells (10.91% vs. 62.50%, p < 0.001), and positive Masson's staining (7.69% vs. 39.58%; p < 0.001). CONCLUSIONS: Compared with cases of general TP, cases of TP following LNG-EC failure exhibited reduced rates of CT infection, fallopian tubal inflammation, and/or fibrosis.

[The nature of postoperative complications in patients with peritonitis].

We studied the postoperative period in patients with peritonitis. The structure of the most important factors that slow down the healing process and lead to mortality. Among the factors that affect the healing process is the most important character of fluid, and the prevalence of peritonitis (causative factor), which causes complications on the part of the internal organs and wounds.

Clinical symptoms and diagnostic tools that are related to infertility and hydrosalpinx formation in women with advanced stage endometriosis complicated by endometrioma.

OBJECTIVES: The study included patients suffering from stage III-IV endometriosis complicated by an endometrioma (OMA). We investigated the association between age, presence of dysmenorrhea/dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility as well as the risk of intraoperative detection of hydrosalpinx that was not suspected on pre-operative assessment. MATERIALS AND METHODS: The study included patients with stage III-IV endometriosis complicated by OMA who underwent a laparoscopic or open surgery due to pre-diagnosis of infertility or adnexal mass. RESULTS: Dysmenorrhea had statistically significant association with infertility (p=0.031). There was no statistically significant relation between age, dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility (p=0.203, p=0.561, p=0.561 and p=0.668, respectively). No statistically significant relation was found between age, CA 125 level, dysmenorrhea, dyspareunia and detection of an unilateral/bilateral hydrosalpinx, that was not suspected on pre-operative assessment (p=0.179, p=0.295, p=0.895, p=0.424, respectively). There was an association between OMA size (p=0.023) and detection of unilateral/bilateral hydrosalpinx. CONCLUSIONS: Patients who desire to have children but suffer from severe dysmenorrhea must be preoperatively informed about the possibility of having stage III-IV endometriosis. Infertile patients who are about to undergo an operation, especially due to a large OMA, may turn out to have hydrosalpinx. These patients should be informed preoperatively about the possibility of having salpingectomy or the proximal tubal surgery for improving fertility.

Dienogest Use for Recurrent Pyosalpinx as a Long-Term Complication of Cloacal Exstrophy: A Case Report.

BACKGROUND: Cloacal exstrophy (CE) is a rare congenital disease that requires multiple surgeries for complex gastrointestinal and genitourinary anomalies. Long-term complications are not uncommon; however, they are poorly reported. Pyosalpinx is sometimes encountered during CE management in adolescents and young adults. CASE: A 28-year-old woman with a history of CE presented with fever, lower abdominal pain, and vomiting and was diagnosed with left pyosalpinx. Computed tomography-guided drainage and intravenous antibiotic administration were successful; however, she had 2 readmissions for recurrent pyosalpinx 1 week after discharge and again 4 months later. She was administered Dienogest, a synthetic progestin, to prevent recurrent pyosalpinx and had no recurrence for 8 months. SUMMARY AND CONCLUSION: Dienogest is a conservative treatment choice for preventing the recurrence of pyosalpinx for patients with CE.

Recurrent Bilateral Salpingitis in a Sexually Inactive Adolescent: Don't Forget about the Appendix.

BACKGROUND: Salpingitis is an acute inflammation of the fallopian tubes and is extremely uncommon in patients who are sexually inactive or premenarchal. CASE: We describe a 15-year-old sexually inactive patient with recurrent bilateral salpingitis. After the second episode, she underwent an exploratory laparoscopy and was diagnosed with chronic appendicitis. SUMMARY AND CONCLUSION: Appendicular involvement should be kept in mind in recurrent salpingitis episodes, especially if previous imaging studies do not show signs of appendicitis. Imaging studies should be repeated in experienced centers in case of recurrent episodes. Laparoscopy is the gold standard for the diagnosis of salpingitis and can confirm appendicular or other abdominal involvement. Early diagnosis can help to prevent recurrent episodes of salpingitis and thus reduce the risk of sequelae.

Adrenomedullin insufficiency alters macrophage activities in fallopian tube: a pathophysiologic explanation of tubal ectopic pregnancy.

Ectopic pregnancy is the major cause of maternal morbidity and mortality in the first trimester of pregnancy. Tubal ectopic pregnancy (TEP) accounts for nearly 98% of all ectopic pregnancies. TEP is usually associated with salpingitis but the underlying mechanism in salpingitis leading to TEP remains unclear. Adrenomedullin (ADM) is a peptide hormone abundantly expressed in the fallopian tube with potent anti-inflammatory activities. Its expression peaks at the early luteal phase when the developing embryo is being transported through the fallopian tube. In the present study, we demonstrated reduced expression of ADM in fallopian tubes of patients with salpingitis and TEP. Using macrophages isolated from the fallopian tubes of these women, our data revealed that the salpingistis-associated ADM reduction contributed to aggravated pro-inflammatory responses of the tubal macrophages resulting in production of pro-inflammatory and pro-implantation cytokines IL-6 and IL-8. These cytokines activated the expression of implantation-associated molecules and Wnt signaling pathway predisposing the tubal epithelium to an adhesive and receptive state for embryo implantation. In conclusion, this study provided evidence for the role of ADM in the pathogenesis of TEP through regulating the functions of tubal macrophages.

The Dangers of Hymenotomy for Imperforate Hymen: A Case of Iatrogenic Pelvic Inflammatory Disease with Pyosalpinx.

BACKGROUND: Complications associated with imperforate hymen include cyclical abdominal pain, acute urinary retention, endometriosis, and even iatrogenic infections. CASE: A 14-year-old young woman was diagnosed with an imperforate hymen, hematocolpos, and right hematosalpinx. A hymenotomy was performed, followed by a hymenectomy 3 days later. On postoperative day 7, she was admitted for pelvic inflammatory disease with a right pyosalpinx. The infection was refractory to intravenous gentamicin, ampicillin, and clindamycin so the patient underwent computed tomography-guided drainage of the pyosalpinx. Two days later, she was discharged home in good condition. SUMMARY AND CONCLUSION: Small incisions and punctures into imperforate hymens without immediate definitive management should be avoided because inoculation of the newly introduced bacteria can ascend the gynecologic tract and lead to serious infections.

Histopathologic Features of Postablation Tubal Sterilization Syndrome.

Postablation tubal sterilization syndrome (PATSS) is an uncommon complication of endometrial ablation in patients with antecedent tubal ligation characterized by cyclic pelvic pain. Recurrent tubal distention resulting from retrograde menstruation into occluded proximal fallopian tube segments by residual/regenerated cornual endometrial tissue is postulated to be the cause. Reports of PATSS have largely focused on the clinicoradiologic and operative findings. Detailed descriptions of the gross pathologic findings of PATSS are sparse and rarer still are examples in which the histologic manifestations are discussed. Three patients with a history of tubal ligation and subsequent endometrial ablation who underwent hysterectomy and bilateral salpingo-oophorectomy for pelvic pain were identified. A clinical suspicion of PATSS was conveyed to the pathologist at the time of initial pathologic examination in only 2 of the 3 cases. Pathologic findings in all 3 cases were similar and included hematosalpinx of the proximal fallopian tubes, intraluminal hemosiderotic material, mural hemosiderosis, and pseudoxanthomatous salpingitis featuring plical and mural lipofuscin-laden macrophages, along with inactive to attenuated endometrium with variable submucosal myometrial hyalinization/scarring compatible with postablative changes. The pathologic features, in conjunction with the appropriate clinicoradiologic findings, were interpreted as consistent with PATSS. PATSS complicates an estimated 5% to 10% of endometrial ablations, but is likely underreported due to a lack of awareness. Pathologists should consider PATSS in hysterectomy specimens that show postablative endometrial changes accompanied by hematosalpinx and pseudoxanthomatous salpingitis of the proximal segments of ligated fallopian tubes. To our knowledge, this is the first study to depict the histopathologic features of PATSS.

Bilateral recurrent pyosalpinx in a sexually inactive 12-year-old girl secondary to rare variant of Mullerian duct anomaly.

Pyosalpinx is a severe sequel of chronic pelvic inflammatory disease, whereby the fallopian tubes become filled with pus.1 2 Pyosalpinx often affects sexually active women and rarely is seen in celibate adolescent girls.3 We report a case of a 12-year-old girl with no prior sexual history who presented to our emergency department with complaints of severe right lower quadrant pain of 1-day duration. Ultrasonography and CT scan of the abdomen and pelvis revealed free fluid collections in the pelvis without visualisation of the appendix. A preoperative diagnosis of acute ruptured appendicitis was given and she was taken to the operating room. Peroperative findings included bilaterally distended, pus-filled pyosalpinges. A definitive diagnosis of bilateral pyosalpinx was then made. Two-week antibiotic therapy was successful but the patient returned with recurrent pyosalpinx and a pelvic abscess 9 weeks later.

[Escherichia coli salpingitis and peritonitis in layer chickens: an overview]. / Escherichia coli-salpingitis en -peritonitis bij leghennen: een overzicht.

Escherichia coli can induce salpingitis and/or peritonitis, a major cause of mortality in layer hens, but also other localized and systemic infections. E. coli infections have also been described in turkeys, geese, and ducks and are thought to be the cause of significant economic losses. However little is known about the real economic impact of the disease in layer chickens. The pathogenesis of E. coli salpingitis and peritonitis has not been elucidated yet. Three routes of infection have been discussed in the literature: ascending faecal contamination from the cloaca, bacterial translocation from the respiratory tract (air sac and lungs) and bacterial translocation from the intestinal lumen. Only one study has reported the occurrence of ascending faecal contamination from the cloaca to the oviduct and subsequently to the peritoneum. Regarding bacterial translocation, the only models available are for mammals, and these have not been applied to chickens so far Animal models could prove valuable to elucidate the pathogenesis of E. coli-induced salpingitis and peritonitis, and for assessing the value of preventive and curative intervention strategies. Little is known about risk factors for E. coli salpingitis and peritonitis. In contrast to colibacillosis in broilers, recent research has failed to demonstrate an association between several pathogens of the respiratory tract and the occurrence of E. coli pathology in layer chickens. The distance between poultry farms and the hen density in the cages were recently proposed as important risk factors for outbreaks ofcolibacillosis in flocks of layer hens, while in the past hormonal factors were implicated. The latter is an area of research that deserves more attention. Several methods for the molecular typing of E. coli have been described and might prove useful to study the epidemiology ofE. coli outbreaks in poultry, about which little is known. The presumptive diagnosis E. coli salpingitis and peritonitis is rather simple to establish, based on the anamnesis, clinical symptoms, and macroscopic findings at post-mortem. However; bacteriological analysis is required to establish a definite diagnosis because other pathogens can also cause salpingitis and peritonitis in layer hens. Antibiotics, chosen on the basis of sensitivity testing and their pharmacokinetic properties can be used as therapy; however residues in eggs may occur. Autovaccines are often used as prevention because in practice effective protection is only achieved against homologous E. coli serotypes.

[Pyosalpingitis after interadnexal laparoscopic hysterectomy. Two cases]. / Pyosalpinx après hystérectomie interannexielle par voie coelioscopique. A propos de deux cas.

The prolapse of a uterine tube is a rare event after hysterectomy with adnexal conservation. It is described in the literature after abdominal or vagina hysterectomy. We report two cases occurring after laparoscopic hysterectomy, and complicated by pyosalpingitis. Patients have presented with pelvic pain and vaginal discharge. Diagnosis was not easy, clinically suspected with the transvaginal ultrasonography, and confirmed by celioscopy. It may be helped by biopsy. The laparoscopic management was carried out without complications.

[Chlamydia trachomatis infection in men and its association with gynecologic alterations in their sexual partners]. / Infección por Chlamydia trachomatis en varones y su asociación con las alteraciones ginecológicas de su compañera sexual.

OBJECTIVE: To determinate the frequency of Chlamydia trachomatis infection in male partners of infertile couples who attend to the infertility clinic at Instituto Nacional de Perinatología, as well as to compare the clinical data and lifestyle between C. trachomatis-infected and uninfected men to establish a possible association with gynecological damage in their sexual female partners. METHODS: An open prospective study was performed in infertile couples, whose follow up was carried out at Instituto Nacional de Perinatología between June 2000 and April 2001. Urethral and cervical swabs were obtained from each couple and the specimens were subjected to a C. trachomatis-specific liquid-phase hybridization test (PACE-2) and routine microbiological analysis. Semen analysis were also included. A relative risk (RR) test was done to analyze variables and square chi test was used to analyze clinical and gynecological data from female partners and data from semen examination. Statistical differences were considered as significant when the p value was below 0.05. RESULTS: C. trachomatis active infection was found in 14 out of 384 urethral swabs (3.6%). No significant alterations were observed in semen samples of C. trachomatis-infected men, as compared to non-infected individuals. Microbiological analyses of semen showed a significant isolation of Mycoplasma sp (RR = 5.87, IC95% 1.4-24.7). Eight out of fourteen female partners of C. trachomatis-infected men were also infected with C. trachomatis (RR = 10.57, IC95% 5.67-19.7), Candida albicans was other pathogen isolated from 8/14 of those women (RR = 1.89, IC95% 1.17-3.05). Gynecological and obstetrical associations found among female partners of C. trachomatis-infected men were as follows: tubal adhesions in 10/14 (RR = 1.54, IC95% 1.08-2.18), salpingitis in 2/14 (RR = 2.2), history of ectopic pregnancies in 11/14 (RR = 2.94, IC95% 1.01-8.53) and abnormal pregnancy loss in 9/14 (RR = 1.5). CONCLUSION: A low prevalence of C. trachomatis infection was observed among male partners of infertile couples as compared with other reports, but this discrepancy could be attributable to the specimen collection and diagnostic assay used. Otherwise, this data suggests that a chronic pathogen's antigenic stimulation may result in an increased formation of tubal adhesions and/or in ectopic pregnancies among female partners of C. trachomatis-infected individuals. Thus, preventive and control measures must be introduced into men's healthcare services, through laboratory and clinical examination, since these subjects are the main reservoirs of C. trachomatis.

Pathogenesis of fallopian tube damage caused by Chlamydia trachomatis infections.

Chlamydia trachomatis is the leading cause of bacterial sexually transmitted disease worldwide resulting in 4-5 million new cases of Chlamydia annually and an estimated 100 million cases per annum. Infections of the lower female genital tract (FGT) frequently are asymptomatic; thus, they often remain undiagnosed or untreated. If infections are either not resolved or left untreated, chlamydia can ascend to the upper FGT and infect the fallopian tubes (FTs) causing salpingitis that may lead to functional damage of the FTs and tubal factor infertility (TFI). Clinical observations and experimental data have indicated a role for antibodies against C. trachomatis proteins such as the 60-kDa heat shock protein 60 (cHSP60) in the immunopathogenesis of TFI. When released from infected cells, cHSP60 can induce proinflammatory immune responses that may functionally impair the FTs leading to fibrosis and luminal occlusion. Chlamydial pathogenesis of irreversible and permanent tubal damage is a consequence of innate and adaptive host immune responses to ongoing or repeated infections. The extracellular matrix that is regulated by metalloproteinases may also be modified by chlamydial infections of the FGT. This review will highlight protective and pathogenic immune responses to ongoing and repeated chlamydial infections of the FGT. It will also present two recent hypotheses to explain mechanisms that may contribute to FT damage during a C. trachomatis infection. If Chlamydia immunopathology can be controlled, it might yield a method of inducing fibrosis and thus provide a means of nonsurgical permanent contraception for women.

Choice of antibiotics and length of therapy in the treatment of acute salpingitis.

This article reviews the rationale for the therapy of acute salpingitis and the conceptual basis for the length of therapy. The key to therapy of acute salpingitis is the need to accommodate polymicrobial etiology, polymicrobial bacterial superinfection, and the potential presence of penicillinase-producing strains of Neisseria gonorrhoeae into a therapeutic equation that has been determined by the appropriate staging of disease. The anticipated therapeutic response identified for monomicrobial disease due to Neisseria gonorrhoeae constitutes the end titration point for drug administration. Duration of continued therapy beyond this point is governed by the need to complete therapy for Chlamydia trachomatis or to assure resolution of advanced disease.

The next 10 years in the treatment of pelvic infections.

The future developments in the treatment of pelvic infections in women are based on recent changes. There is an expanded knowledge of the complex multibacterial nature of pelvic infections, the clinical view of salpingitis has radically changed, and there have been great modifications in antibiotic treatment strategies with particular emphasis on anaerobes and Chlamydia. In the next 10 years, the following new developments may be expected. In the diagnosis of pelvic infection, there will be new efforts to have better clinical tests and the use of nonspecific and specific laboratory tests. The rapid identification of Neisseria gonorrhea, group B beta-hemolytic Streptococcus, Chlamydia, and Bacteroides fragilis would be an important laboratory aid. The treatment of pelvic infection will not be significantly altered by the introduction of new antibiotics. There will be an emphasis on new combinations of currently available antibiotics and studies that focus on the long-term follow-up of treated patients. In the understanding of the pathophysiology of pelvic infections, the importance of the spermatozoa as a carrier of bacteria and the potent immunosuppression due to seminal fluid will be investigated in detail, along with a greater emphasis on treatment of the male.

Patient cost in the treatment of postsurgical female pelvic infection.

Soft tissue female pelvic infections, that is, postpartum endomyometritis, pelvic cellulitis, and salpingitis, are frequently polymicrobial, involving aerobic and anaerobic bacteria. The most common antibiotic regimen employed for the treatment of these patients is clindamycin and an aminoglycoside. Single-agent therapy, utilizing the newer beta-lactams, is more economical, potentially less toxic, and as effective.