Assuntos
Abscesso Abdominal/etiologia , Actinomyces , Actinomicose/diagnóstico por imagem , Dispositivos Intrauterinos/microbiologia , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/microbiologia , Dor Abdominal/etiologia , Actinomyces/isolamento & purificação , Actinomicose/complicações , Feminino , Febre/etiologia , Humanos , Dispositivos Intrauterinos/efeitos adversos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Útero/diagnóstico por imagemRESUMO
Resumen Introducción: La actinomicosis, es una infección crónica rara producida por bacterias del género Actinomyces sp. La afectación pélvica es una de sus formas más infrecuentes y en gran parte de los casos se relaciona al uso de un dispositivo intrauterino de larga data o a una cirugía previa. Como otras enfermedades raras, la infección es conocida como "la gran imitadora" por su variada forma de presentación y particular comportamiento pudiendo simular una neoplasia. El tratamiento es fundamentalmente médico y de buenos resultados. Caso Clínico: Damos a conocer el caso de una paciente que se presentó con un cuadro compatible con un tumor de recto, pero que resultó ser actinomicosis. El diagnóstico se realizó en base a la tinción de Gram, el cuadro clínico y el antecedente de un dispositivo intrauterino abandonado por más de 25 años. Fue corroborado posteriormente mediante anatomía patológica y tratada en forma exitosa con antibióticos por un periodo extendido. Conclusión: Si bien la actinomicosis es una patología infrecuente, debe ser considerada en el diagnóstico diferencial de los pacientes que se presentan con tumores de la pelvis. Un alto índice de sospecha y una actitud diagnóstica activa son fundamentales para un tratamiento oportuno, seguro y eficaz de esta enfermedad.
Introduction: Actinomycosis is a rare chronic infection caused by bacterias of the genus Actinomyces sp. Pelvic involvement is one of its most infrequent forms and in many cases it is related to the use of a longstanding intrauterine device or a previous surgery. Like other rare diseases, the infection is known as "the great imitator" because of its varied form of presentation and its particular behavior, which can simulate a neoplasm. The treatment is fundamentally medical with good results. Case Report: We present the case of a patient who presented with a rectal tumor but that turned out to be Actinomycosis. The diagnosis was made based on the Gram stain, the clinical presentation and the history of an intrauterine device left for more than 25 years. It was subsequently corroborated by pathological anatomy and successfully treated with antibiotics for an extended period. Conclusion: Although actinomycosis is an infrequent pathology, it should be considered in the differential diagnosis of patients who present with tumors of the pelvis. An active diagnostic attitude and a high index of suspicion are fundamental for the timely, safe and effective treatment of this disease.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Actinomyces/isolamento & purificação , Actinomicose/etiologia , Neoplasias Ovarianas/diagnóstico , Actinomicose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Colonoscopia , Diagnóstico Diferencial , Dispositivos Intrauterinos/efeitos adversos , Dispositivos Intrauterinos/microbiologiaRESUMO
A fit and healthy 26-year-old woman presented to the general surgical team with epigastric pain and weight loss of 2 stones over 6 months. She has also a positive family history of ulcerative colitis. As her oesophagogastroduodenoscopy and colonoscopy were normal, a contrasted CT was requested, and it detected an inflammatory mass with fat streaking around her transverse colon. An intrauterine contraceptive device (IUCD) was noted. In light of the CT findings, she underwent a diagnostic laparoscopy. As the inflammatory mass was not separable from the transverse colon, a segmental transverse colectomy was proceeded. The histology revealed multiple actinomycosis abscesses in the mesentery. Subsequently, we learnt that her IUCD had been in situ for the last 7 years, and the source of actinomycosis abscesses is likely from her IUCD. The patient was recommended to have the coil removed and commenced on a 6 months course of amoxicillin.
Assuntos
Actinomicose/diagnóstico , Colo/cirurgia , Doenças do Colo/microbiologia , Dispositivos Intrauterinos/microbiologia , Dor Abdominal/etiologia , Actinomicose/complicações , Actinomicose/cirurgia , Adulto , Colectomia , Colo/diagnóstico por imagem , Doenças do Colo/complicações , Doenças do Colo/cirurgia , Feminino , Humanos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The role of antibiotic prophylaxis for prevention of infective endocarditis is unknown. Endocarditis prophylaxis is recommended for certain high-risk individuals prior to dental procedures. To our knowledge, this is the first case reported in the literature of a patient with complex congenital heart disease developing endocarditis in the period immediately following otherwise uncomplicated intrauterine device insertion.
Assuntos
Endocardite Bacteriana/diagnóstico , Próteses Valvulares Cardíacas/microbiologia , Dispositivos Intrauterinos/microbiologia , Infecções Relacionadas à Prótese/diagnóstico , Tetralogia de Fallot/tratamento farmacológico , Adulto , Antibioticoprofilaxia , Procedimentos Cirúrgicos Cardiovasculares , Assistência Odontológica , Assistência Odontológica para Doentes Crônicos/normas , Endocardite Bacteriana/terapia , Feminino , Humanos , Dispositivos Intrauterinos/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Fatores de Risco , Tetralogia de Fallot/complicações , Resultado do TratamentoRESUMO
Amoebic trophozoites were identified in the cervicovaginal smear of a U.S. patient without travel history at the time of intrauterine device (IUD) removal. Subsequent morphologic analysis and DNA sequencing identified a mixed cervicovaginal colonization of the female genital tract with both Entamoeba gingivalis and Entamoeba polecki in association with Actinomyces species bacteria. This highlights to the potential for colonization of the genital tract with E. gingivalis, particularly in association with IUD placement, and represents the first report of E. polecki in this context.
Assuntos
Actinomyces/genética , Actinomicose/diagnóstico , Entamoeba/genética , Entamebíase/diagnóstico , Dispositivos Intrauterinos , Actinomyces/classificação , Actinomyces/isolamento & purificação , Actinomicose/parasitologia , Colo do Útero/microbiologia , Colo do Útero/parasitologia , Coinfecção , Entamoeba/classificação , Entamoeba/isolamento & purificação , Entamebíase/parasitologia , Feminino , Humanos , Dispositivos Intrauterinos/microbiologia , Dispositivos Intrauterinos/parasitologia , Teste de Papanicolaou , Vagina/microbiologia , Vagina/parasitologia , Adulto JovemAssuntos
Abdome Agudo/etiologia , Actinomyces/isolamento & purificação , Actinomicose/complicações , Dispositivos Intrauterinos/microbiologia , Abdome Agudo/microbiologia , Abdome Agudo/cirurgia , Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Actinomicose/microbiologia , Adulto , Amoxicilina/uso terapêutico , Doenças do Ceco/diagnóstico , Doenças do Ceco/etiologia , Doenças do Ceco/cirurgia , Colo/cirurgia , Colonoscopia , Colostomia , Terapia Combinada , Diagnóstico Diferencial , Contaminação de Equipamentos , Feminino , Humanos , Íleo/cirurgia , Neoplasias Intestinais/diagnóstico , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Dispositivos Intrauterinos/efeitos adversos , Peritonite/tratamento farmacológico , Peritonite/etiologia , Peritonite/cirurgiaRESUMO
AIMS: The study aimed to compare the clinical course and disease severity between culture positive and culture negative patients with intra-uterine devices (IUD)-associated pelvic inflammatory disease (PID). METHODS: A retrospective study of all IUD-associated PID patients admitted to tertiary medical center between 2010 and 2015. All patients received standard empiric antibiotic therapy upon admission. The study cohort was divided into 2: patients with culture positive IUDs and patients with negative cultures. Electronic medical records and culture results were analyzed from the time of admission. RESULTS: During the study period, 480 hospitalized patients were diagnosed with PID. Of these, 94 patients had IUD-associated PID, 59 with positive cultures and 35 with negative cultures. While fever was more common in the latter (p = 0.01), no significant differences were found in disease severity in patient outcomes (i.e., length of stay, rates of invasive treatment, and total abdominal hysterectomies). In a sub-analysis of patients with IUD cultures of established PID pathogens only, there were no differences in disease severity and outcome in patients with antibiotic susceptible or resistant strains. CONCLUSIONS: IUD removal for culture in PID patients is probably unnecessary. Alteration of treatment according to the culture results may have little impact on disease course and outcome.
Assuntos
Dispositivos Intrauterinos/efeitos adversos , Dispositivos Intrauterinos/microbiologia , Doença Inflamatória Pélvica/etiologia , Adulto , Antibacterianos/uso terapêutico , Feminino , Febre/etiologia , Humanos , Histerectomia , Tempo de Internação , Pessoa de Meia-Idade , Doença Inflamatória Pélvica/terapia , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: The long-term use of intrauterine devices (IUDs) may lead to biofilm formation on the surface. The aim of this study was to perform the culture- and PCR-based detection of bacteria/fungi from the biofilm of the removed IUDs with different time periods in place. METHODS: For a 2-year period, 100 IUD users were involved in the study. In the majority of the cases, IUDs were removed because of the patients' complaints. Beside the aerobic and anaerobic culture, species-specific PCR was carried out to detect Chlamydia trachomatis Neisseria gonorrhoeae and the "signalling" bacteria of bacterial vaginosis (BV) in the biofilm removed by vortexing. RESULTS: Sixty-eight percent of IUDs were used for more than 5 years, 32% were removed after 10 years in place. In 28% of the IUDs ≥ 3 different anaerobic species typically found in BV with or without other aerobic bacteria were found by culture method. Streptococcus agalactiae (14%) and Actinomyces spp. (18%) were also isolated frequently. The PCR detection of Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp. and Ureaplasma urealyticum were 62%, 32%, 23% and 16%, respectively. Seventy-six percent of the IUDs were PCR positive at least for one "signalling" bacterium of BV. C. trachomatis was detected by PCR only in one IUD together with other aerobic and anaerobic bacteria, while the presence of N. gonorrhoeae could not be confirmed from the biofilm of these removed devices. CONCLUSION: Sexually transmitted infections (STI)-related bacteria-except for one patient-were not detected on the IUDs removed due to different reasons including clinical symptoms of infection. Presence of any BV "signaling" anaerobic bacteria were detected in a much higher number in the biofilm of the removed IUDs by PCR-based method compared to use culture method (76 versus 28 samples). Different aerobic and anaerobic bacteria colonized an equal number of IUDs, independent of the time-period in place, which may be relevant, if the IUD is removed due to planned pregnancy or due to a fear from upper genital tract infection caused by anaerobic bacteria including Actinomyces spp.
Assuntos
Biofilmes/crescimento & desenvolvimento , Dispositivos Intrauterinos/efeitos adversos , Dispositivos Intrauterinos/microbiologia , Infecções do Sistema Genital/tratamento farmacológico , Infecções do Sistema Genital/etiologia , Vaginose Bacteriana/tratamento farmacológico , Vaginose Bacteriana/etiologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Infecções do Sistema Genital/diagnóstico , Infecções do Sistema Genital/microbiologia , Fatores de Tempo , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/microbiologia , Adulto JovemRESUMO
PURPOSE: Candida biofilm infections are frequently linked to the use of biomaterials and are of clinical significance because they are commonly resistant to antifungals. Clioquinol is an antiseptic drug and is effective against multidrug-resistant Candida. We investigated the effect of clioquinol and two other 8-hydroxyquinoline derivatives on Candida biofilm. METHODOLOGY: The ability to inhibit biofilm formation, inhibit preformed biofilm and remove established biofilms was evaluated using in vitro assays on microtitre plates. The action of clioquinol on biofilm in intrauterine devices (IUDs) was also investigated, describing the first protocol to quantify the inhibitory action of compounds on biofilms formed on IUDs. RESULTS: Clioquinol was found to be the most effective 8-hydroxyquinoline derivative among those tested. It prevented more than 90â% of biofilm formation, which can be attributed to blockade of hyphal development. Clioquinol also reduced the metabolic activity of sessile Candida but the susceptibility was lower compared to planktonic cells (0.031-0.5 µg ml-1 required to inhibit 50â% planktonic cells and 4-16 µg ml-1 to inhibit 50â% preformed biofilms). On the other hand, almost complete removal of biofilms was not achieved for the majority of the isolates. Candida spp. also showed the ability to form biofilm on copper IUD; clioquinol eradicated 80-100â% of these biofilms. CONCLUSION: Our results indicate a potential application in terms of biomaterials for 8-hydroxyquinoline derivatives. Clioquinol could be used as a coating to prevent morphological switching and thus prevent biofilm formation. Furthermore, clioquinol may have future applications in the treatment of Candida infections linked to the use of IUDs.
Assuntos
Antifúngicos/farmacologia , Biofilmes/efeitos dos fármacos , Candida/efeitos dos fármacos , Candidíase/prevenção & controle , Clioquinol/farmacologia , Oxiquinolina/farmacologia , Antifúngicos/química , Antifúngicos/uso terapêutico , Candida/fisiologia , Candidíase/tratamento farmacológico , Candidíase/etiologia , Candidíase/microbiologia , Clioquinol/análogos & derivados , Clioquinol/química , Clioquinol/uso terapêutico , Cobre , Feminino , Humanos , Dispositivos Intrauterinos/efeitos adversos , Dispositivos Intrauterinos/microbiologia , Testes de Sensibilidade Microbiana , Oxiquinolina/análogos & derivados , Oxiquinolina/químicaRESUMO
OBJECTIVE: To summarize knowledge about the mana-gement in women with proven actinomyces in uterine cervix and inserted intrauterine device (IUD). DESIGN: An overall review. RESULTS: Actinomycosis is an uncommon but important subacute or chronic infection caused by anaerobic or microaerophilic bacteria, mainly within the Actinomyces genus. Actinomycosis can affect various organs and tissues in the human body, often manifesting draining sinuses, abscess formation and fibrosis. The pelvic form in women is the most common in the developed countries. Long-duration treatment with antibiotics can be completely effective even in cases of heavy disease. Although pelvic actinomycosis is predominantly associated with the longstanding use of intrauterine device, the risk of future symptomatic infection is extremly low even in women with a cervical Pap smear positive for actinomyces-like organisms (ALO). Therefore the identification of actinomycetes by cytology after cervical Pap smears is not diagnostic nor predictive of any disease because the actinomycetes normally reside in the female genital tract. In the absence of symptoms, patients with ALO on a Pap test do not need antimicrobial treatment or IUD removal. Nevertheless, women choosing an IUD for contraception should know that there is very low risk of developing the infection in later years after insertion. CONCLUSION: The sources of literature conclude that removal of the intrauterine device in a patients with a positive ALO in the uterine cervix is not necessary and antibiotics treatment is not required. However, IUD must be changed at least every five years in order to limit the risk of the development of pelvic actinomycosis.
Assuntos
Actinomyces/patogenicidade , Actinomicose/microbiologia , Dispositivos Intrauterinos/microbiologia , Actinomyces/isolamento & purificação , Portador Sadio/microbiologia , Colo do Útero/microbiologia , Feminino , Humanos , Esfregaço VaginalRESUMO
A bacterial biofilm is a structured community of bacteria in a self-produced extracellular matrix, adherent to an inert surface or biological tissue. The involvement of biofilm in a bacterial infection implies that the infection is difficult to treat and that the patient will probably experience relapses of the condition. In bacterial vaginosis (BV), the lactobacilli concentration decreases, while the bacterial load of other (facultative) anaerobic bacteria increases. A hallmark of BV is the presence of clue cells, now known as the result of a polymicrobial biofilm formed in vaginal epithelial cells. Current knowledge of the individual roles of bacterial species involved in polymicrobial BV biofilms or interactions between these species are not fully known. In addition, knowledge of the composition matrix and triggers of biofilm formation is still lacking. Bacteria are able to attach to the surface of indwelling medical devices and cover these surfaces with biofilm. Vaginally inserted devices, such as tampons, intra-uterine devices and vaginal rings, can also be colonized by bacteria and be subjected to biofilm formation. This might hamper release of active product in case of drug-releasing devices such as vaginal rings, or promote the presence of unfavorable bacteria in the vagina. This paper reviews current knowledge of biofilms in the vaginal environment.
Assuntos
Aderência Bacteriana/fisiologia , Biofilmes/crescimento & desenvolvimento , Mucosa/microbiologia , Vagina/microbiologia , Vaginose Bacteriana/microbiologia , Antibacterianos/uso terapêutico , Feminino , Humanos , Dispositivos Intrauterinos/microbiologia , Lactobacillus/isolamento & purificação , Produtos de Higiene Menstrual/microbiologia , Vaginose Bacteriana/tratamento farmacológicoAssuntos
Bacteriemia/etiologia , Dispositivos Intrauterinos/efeitos adversos , Infecções Estafilocócicas/etiologia , Staphylococcus lugdunensis/isolamento & purificação , Bacteriemia/diagnóstico , Feminino , Humanos , Dispositivos Intrauterinos/microbiologia , Pessoa de Meia-Idade , Infecções Estafilocócicas/diagnósticoRESUMO
We report on a typical clinical course of pelvic actinomycosis: initial uncharacteristic discomfort develops into a systemic illness associated with a pelvic mass, which progresses so fast that along with the systemic infection further symptoms can be reduced to its growth rate--tiredness, abdominal pain, micturition deficiency, and leg pain. Distinction between malignancy and pelvic actinomycosis could be made only intraoperative. After hysterectomy and with antibiotics the patient recovered quickly.
Assuntos
Abscesso/complicações , Abscesso/diagnóstico , Actinomicose/complicações , Actinomicose/diagnóstico , Dispositivos Intrauterinos/efeitos adversos , Perna (Membro)/inervação , Síndromes de Compressão Nervosa/diagnóstico , Dor/etiologia , Parametrite/complicações , Parametrite/diagnóstico , Nervos Espinhais/patologia , Abscesso/patologia , Abscesso/cirurgia , Actinomicose/patologia , Actinomicose/cirurgia , Diagnóstico Diferencial , Tubas Uterinas/patologia , Feminino , Humanos , Dispositivos Intrauterinos/microbiologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Miométrio/patologia , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/cirurgia , Parametrite/patologia , Parametrite/cirurgiaRESUMO
Eustachian valve endocarditis caused by Actinomyces species is extremely rare. A literature review revealed only one reported case-caused by Actinomyces israelii in an intravenous drug abuser. Our patient, a 30-year-old woman who at first appeared to be in good health, presented with fever, a large mobile mass on the eustachian valve, and extensive intra-abdominal and pelvic masses that looked malignant. Histopathologic examination of tissue found in association with an intrauterine contraceptive device revealed filamentous, branching microorganisms consistent with Actinomyces turicensis. This patient was treated successfully with antibiotic agents. In addition to presenting a new case of a rare condition, we discuss cardiac actinomycotic infections in general and eustachian valve endocarditis in particular: its predisposing factors, clinical course, sequelae, and our approaches to its management.
Assuntos
Actinomicose/microbiologia , Endocardite Bacteriana/microbiologia , Valvas Cardíacas/microbiologia , Dispositivos Intrauterinos/microbiologia , Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Biópsia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Valvas Cardíacas/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
Biofilms are colonies of microbial cells encased in a self-produced organic polymeric matrix and represent a common mode of microbial growth. Microbes growing as biofilm are highly resistant to commonly used antimicrobial drugs. We aimed to screen and characterize biofilm formation by different isolates of Candida on removed intrauterine devices (IUDs), to perform experimental biofilm formation with isolated strains, and to examine biofilm by the crystal violet and XTT reduction assays and scanning electron microscopy (SEM). A total of 56 IUDs were examined for biofilm formation using Sabouraud's dextrose chloramphenicol agar. Suspected colonies were identified by different methods. Antifungal susceptibility testing with fluconazole (FLU) and amphotericin B for the isolated strains and in vitro experimental biofilm formation was carried out. The biofilm was quantified by crystal violet, XTT reduction assay and SEM. Among the 56 IUDs investigated, 26 were Candida positive (46.4â%). Candida albicans was recovered from 15 isolates. The biofilm MIC of FLU was increased 64 to 1000 times compared to the MIC for planktonic cells. The XTT method results were dependent on the Candida species; biofilm formation was highest in Candida krusei and Candida glabrata strains, followed by C. albicans and Candida tropicalis. SEM of Candida biofilm revealed a heterogeneous thick biofilm with a mixture of micro-organisms. The main conclusion from this study was non-albicans Candida represents more than a half of the Candida biofilm. Better understanding of Candida biofilms may lead to the development of novel therapeutic approaches for the treatment of fungal infections, especially resistant ones among IUD users.
Assuntos
Biofilmes/crescimento & desenvolvimento , Candida/isolamento & purificação , Candida/fisiologia , Dispositivos Intrauterinos/microbiologia , Anfotericina B/farmacologia , Candida/classificação , Estudos Transversais , Meios de Cultura/química , Feminino , Fluconazol/farmacologia , Humanos , Testes de Sensibilidade Microbiana , Técnicas Microbiológicas , Microscopia Eletrônica de Varredura , Coloração e RotulagemRESUMO
The presence of intrauterine contraceptive devices (IUDs) provides a solid surface for attachment of microorganisms and an ideal niche for the biofilm to form and flourish. Vaginal candidiasis is often associated with the use of IUDs. Treatment of vaginal candidiasis that develops in connection with IUD use requires their immediate removal. Here, we present in vitro evidence to support the use of combination therapy to inhibit Candida biofilm. Twenty-three clinical Candida isolates (10 C. krusei and 13 C. tropicalis) recovered from endocervical swabs obtained from IUD and non-IUD users were assessed for biofilm-formation ability. The rate of isolation of Candida did not differ significantly among IUD and non-IUD users (P = 0.183), but the biofilm-formation ability of isolates differed significantly (P = 0.02). An in vitro biofilm model with the obtained isolates was subjected to treatment with amphotericin B, tyrosol, and a combination of amphotericin B and tyrosol. Inhibition of biofilm by amphotericin B or tyrosol was found to be concentration dependent, with 50% reduction (P < 0.05) at 4 mg/l and 80 µM, respectively. Hence, a combination effect of tyrosol and amphotericin B was studied. Interestingly, approximately 90% reduction in biofilm was observed with use of 80 µM tyrosol combined with 4 mg/l amphotericin B (P < 0.001). This represents a first step in establishing an appropriate antibiofilm therapy when yeasts are present.
Assuntos
Anfotericina B/farmacologia , Antifúngicos/farmacologia , Biofilmes/efeitos dos fármacos , Candida/efeitos dos fármacos , Dispositivos Intrauterinos/microbiologia , Álcool Feniletílico/análogos & derivados , Adulto , Candida/isolamento & purificação , Candida tropicalis/efeitos dos fármacos , Candida tropicalis/isolamento & purificação , Sinergismo Farmacológico , Feminino , Humanos , Testes de Sensibilidade Microbiana , Álcool Feniletílico/farmacologia , Adulto JovemRESUMO
AIM: The aim of this study was to investigate the presence of biofilm formation around intrauterine contraceptive devices (IUCD) and to correlate the microbiological profile of the IUCD-associated genital infections to the microbiological profile of specimens retrieved from vaginal discharge. MATERIAL AND METHODS: Samples of the vaginal discharge in the posterior fornix were collected from 50 women attending the Family Planning Clinic in Ain Shams University Hospital using two high vaginal swabs. Swabs were immediately sent for Gram staining as well as microbiological culture. The IUCD was then removed. A 0.5-cm piece of the removed IUCD was cut and sent for culture. Growing colonies were tested for their abilities to form a biofilm (colorimetric method). Another 0.5-cm piece of the removed IUCD was examined by electron microscopy (EM) for detection of biofilm formation. RESULTS: Among the included 50 women, 24 (48%) women showed biofilm formation (via colorimetric methods). EM scanning was able to detect biofilm formation in the prepared pieces of the removed IUCD of 48 (96%) women. There was no significant agreement between the isolated microorganisms on the removed IUCD and the vaginal swab (proportion of agreement was 14 [11.4%]; κ = -0.089, P = 0.892). CONCLUSION: Scanning EM is a useful tool in detection of biofilm formation on removed IUCD.
Assuntos
Biofilmes , Doenças dos Genitais Femininos/microbiologia , Dispositivos Intrauterinos/microbiologia , Vagina/microbiologia , Adulto , Remoção de Dispositivo , Egito , Feminino , Humanos , Dispositivos Intrauterinos/efeitos adversos , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Adulto JovemRESUMO
INTRODUCTION: Pelvic inflammatory disease (PID) is frequent in adolescents and younger women. Diagnosis is usually based on the clinical findings, and the threshold for empiric antibiotic therapy should be low. However, at least in cases of resistance toward therapy or deterioration of symptoms, laparoscopic evaluation can be helpful. METHODS: We searched the hospital charts for in-house patients who were treated for PID or tubo-ovarian abscess between 2007 and 2010. In cases with both vaginal and intra-abdominal bacterial cultures, results of those were compared. RESULTS: 73 patients with suspected PID or tubo-ovarian abscess were included. Median patients' age was 40 years (18-88), 18 of 73 (24.7 %) patients had an IUD at the time of consultation. 58 patients underwent laparoscopy or laparotomy. In 41 patients (70.7 %) tubo-ovarian abscess could be confirmed, four patients had differential gynecologic diagnoses, and two patients appendicitis. In vaginal swabs, most frequent bacteria were Streptococcus sp. (28.5 %), Escherichia coli (22.2 %), Enterococcus faecalis (15.9 %), and Staphylococcus sp. (9.5 %). In eight patients (11 %) Chlamydia trachomatis could be found, there was no case of Neisseria gonorrhea. In 33 patients both vaginal and abdominal cultures were available. In nine cases (27.3 %), identical bacteria could be found, however, 11 cases (33.3 %) showed different results. CONCLUSION: In severe cases of PID, laparoscopic evaluation and taking an intra-abdominal bacterial culture are helpful for the confirmation of diagnosis, accurate microbiologic testing and specific therapy.
Assuntos
Abdome/microbiologia , Doença Inflamatória Pélvica/diagnóstico , Doença Inflamatória Pélvica/microbiologia , Vagina/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Proteína C-Reativa/análise , Quimioterapia Combinada , Feminino , Humanos , Período Intraoperatório , Dispositivos Intrauterinos/microbiologia , Laparoscopia , Laparotomia , Tempo de Internação/estatística & dados numéricos , Leucocitose/etiologia , Pessoa de Meia-Idade , Doença Inflamatória Pélvica/terapia , Estudos Retrospectivos , Adulto JovemRESUMO
Haemophilus influenzae rarely causes acute endometritis and the few published cases have always been associated with intrauterine devices (IUD). A 48-year-old female presented to the emergency department with a 3-day history of lower abdominal pain and fever. On physical examination she was tachycardic, hypotensive and had fundic tenderness to palpation. Imaging showed uterine leiomyomas and no IUD. Blood cultures grew a non-typable H. influenzae. Endometrial biopsy demonstrated acute endometritis. Tissue Gram stains and cervico-vaginal cultures were negative; however, polymerase chain reaction (PCR) determined presence of H. influenzae on the formalin-fixed, paraffin-embedded tissue biopsy. Evidence of H. influenzae in the endometrium demonstrates that the uterus can be the nidus for sepsis when invasive H. influenzae is found with no distinct usual primary focus. This case underscores the importance pathologic diagnosis and molecular testing.
Assuntos
Bacteriemia/microbiologia , Endometrite/microbiologia , Haemophilus influenzae/isolamento & purificação , Doença Aguda , Bacteriemia/patologia , DNA Bacteriano/isolamento & purificação , Endometrite/patologia , Endométrio/microbiologia , Endométrio/patologia , Feminino , Haemophilus influenzae/crescimento & desenvolvimento , Humanos , Dispositivos Intrauterinos/efeitos adversos , Dispositivos Intrauterinos/microbiologia , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Sepse/microbiologia , Sepse/patologiaRESUMO
Intrauterine devices (IUD) used for contraception can be the source of local infections or can migrate, which justifies regular checking recommendations and limitations around the implantation period. To our knowledge, bone and joint infections related to an infected IUD have not been described in the scientific literature. This paper reports on a case of the repeated infection of a total hip prosthesis related to an infected IUD that had been forgotten after being implanted 34years previously. The arthroplasty infection revealed itself through dislocation of a dual mobility cup. Commensal bacteria that colonize the female genital tract (Streptococcus agalactiae) were identified at the site of hip arthroplasty. This led to the discovery of the IUD that was infected by the same bacterium. Despite lavage of the non-loosened arthroplasty, removal of the IUD and 2months of antibiotic treatment, the dislocation recurred and the prosthesis was again infected with the same microorganism 4months later. This recurrence of the infection, with persistence of a uterine abscess containing the same bacterium, was treated with repeated lavage of the joint, total hysterectomy and antibiotics treatment. The infection had resolved when followed-up 3years later. The occurrence of a bone and joint infection with this type of bacterium should trigger the evaluation of a possible IUD infection.