Successful laparoscopic resection of ovarian abscess caused by Staphylococcus aureus in a 13-year-old girl: a case report and review of literature.

BACKGROUND: Ovarian abscesses, which occur mostly in sexually active women via recurrent salpingitis, occur rarely in virginal adolescent girls. Here, we present a case of an ovarian abscess in a virginal adolescent girl who was diagnosed and treated by laparoscopy. CASE PRESENTATION: A 13-year-old healthy girl presented with fever lasting for a month without abdominal pain. Computed tomography scan and magnetic resonance imaging indicated a right ovarian abscess. Laparoscopic surgery revealed a right ovarian abscess with intact uterus and fallopian tubes. The abscess was caused by Staphylococcus aureus. The patient recovered completely after excision of the abscess, followed by antibiotic treatment. CONCLUSIONS: Ovarian abscess may occur in virginal adolescent girls; Staphylococcus aureus, an uncommon species causing ovarian abscess, may cause the infection.

Fitz-Hugh-Curtis syndrome associated with tuberculous salpingitis and peritonitis: a case presentation and review of literature.

BACKGROUND: Fitz-Hugh-Curtis syndrome or acute perihepatitis is considered a rare complication of pelvic inflammatory disease, mostly associated with chlamydial or gonococcal salpingitis. Peritoneal tuberculosis is a rare site of extra-pulmonary infection caused by Mycobacterium tuberculosis. Infection usually occurs after reactivation of latent tuberculous foci in the peritoneum and more seldom after contiguous spread from tuberculous salpingitis. CASE PRESENTATION: We describe a case of a 21-year old female of Somalian origin diagnosed with Fitz-Hugh Curtis syndrome associated with tuberculous salpingitis and peritonitis, presenting with new onset ascites. Acid fast stained smear and polymerase chain reaction for Mycobacterium tuberculosis on ascitic fluid, endocervical culture and tuberculin skin test were all negative. Eventually, the diagnosis was made laparoscopically, showing multiple peritoneal white nodules and perihepatic "violin string" fibrinous strands. CONCLUSIONS: To our knowledge, this is the first case where Fitz-Hugh-Curtis syndrome is associated with both peritoneal and genital tuberculosis and where ascites was the primary clinical finding. Female genital tuberculosis has only rarely been associated with Fitz-Hugh-Curtis syndrome and all cases presented with chronic abdominal pain and/or infertility. Ascites and peritoneal involvement was not present in any case. Moreover, most patients with Fitz-Hugh-Curtis syndrome show no evidence of generalized intra-abdominal infection and only occasionally have concomitant ascites.

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.

Streptococcus pyogenes: an unusual cause of salpingitis. Case report and review of the literature.

BACKGROUND: Streptococcus pyogenes can colonize genitourinary tract, but it is a rare cause of salpingitis. CASE REPORT: We report a case of bilateral salpingitis due to Streptococcus pyogenes in a 34-year-old woman using an intra-uterine device and which occurred following a family history of recurrent S. pyogenes infections. We review 12 other cases reported in the literature, and discuss the pathophysiological mechanisms of this potentially life-threatening disease. CONCLUSION: It is important to take into account consider Streptococcus pyogenes as a cause of acute salpingitis in the context of recent intra-familial Streptococcus pyogenes infections.

Tubo-Ovarian Abscess Caused by Candida Albicans in an Obese Patient.

BACKGROUND: Tubo-ovarian abscess (TOA) arises in most cases from pelvic infection. Appropriate treatment includes use of antimicrobials and, especially in patients with increased BMI, drainage of the contents. CASE: A 44-year-old morbidly obese woman (BMI 72) had a persistent TOA despite receiving antibiotic treatment for four months. She had no history of diabetes, and denied being sexually active. Imaging demonstrated a pelvic abscess of 14.9 × 8.9 × 11.1 cm. Successful percutaneous drainage was performed yielding purulent material which grew Candida albicans. The patient recovered after drainage of the abscess and the addition of fluconazole to her antimicrobials. She had no apparent risk factor for acquiring such an opportunistic infection, other than her morbid obesity. CONCLUSION: Because morbid obesity may confer a relative immunodeficiency, morbidly obese patients may develop unusual infections such as opportunistic fungal abscesses.

Contexte : Les abcès ovario-tubaires (AOT) sont, dans la plupart des cas, attribuables à une infection pelvienne. Parmi les moyens de prise en charge adéquats, on trouve le recours à des agents antimicrobiens et, particulièrement chez les patientes qui présentent un IMC accru, le drainage des abcès en question. Cas : Une femme obèse morbide de 44 ans (IMC 72) présentait un AOT persistant malgré l'administration d'une antibiothérapie pendant quatre mois. Elle ne présentait pas d'antécédents de diabète et affirmait ne pas être sexuellement active. L'imagerie a révélé la présence d'un abcès pelvien de 14,9 cm sur 8,9 cm sur 11,1 cm. Un drainage percutané a été mené avec succès; la présence de Candida albicans a été identifiée dans le matériel purulent drainé. La patiente a récupéré à la suite du drainage de l'abcès et de l'ajout de fluconazole à ses agents antimicrobiens. À part son obésité morbide, elle ne présentait aucun facteur de risque apparent de contracter une telle infection opportuniste. Conclusion : Puisque l'obésité morbide pourrait conférer une immunodéficience relative, les patientes obèses morbides pourraient contracter des infections inhabituelles, telles que des abcès fongiques opportunistes.

Acute Salpingitis in a Nonsexually Active Adolescent.

Acute salpingitis is an uncommon cause of an acute surgical abdomen, especially in an adolescent who is not sexually active. The following is a case of a 12-year-old girl who denied sexual activity, had a remote history of an appendectomy, and a recent diagnosis of a large, right-sided ovarian cyst, who presented with acute abdominal pain, urinary symptoms, and fever. The patient was ill-appearing and progressed to uncompensated septic shock in the emergency department despite aggressive fluid resuscitation and empiric antibiotics. She ultimately underwent an exploratory laparotomy and was diagnosed with acute bilateral salpingitis. This case highlights the diagnostic dilemmas facing those caring for an adolescent girl with abdominal pain and presents an extremely rare etiology for abdominal pain in a nonsexually active adolescent.

Chrono- and Immunocorrection of Inflammatory Disorders of Internal Reproductive Organs in Women of Reproductive Age.

We compared the effectiveness of immunomodulators used in the treatment of patients with chronic salpingitis and oophoritis with or without changes in succinate dehydrogenase (SDH) activity in blood lymphocytes at incubation with the drug. Diurnal variations in individual reaction of SDH in blood lymphocytes to thymalin or ridostin were revealed. In the groups of women receiving ridostin or thymalin during the reaction of lymphocyte SDH to it, improvement of clinical laboratory and immunological parameters was observed in the majority of the patients and no effect was found in a lesser group of patients than in the groups treated with drugs during the absence of lymphocyte SDH reaction thereto. The timing of the presence of SDH reaction to drugs in the immunocompetent cells makes it possible to set the optimal daily regime of their application and to select a drug that would be most effective in each particular case.

[Role and place of antibacterial therapy in prophylaxis of disturbances in reproductive function of women].

One-stage retrospective analysis of 350 primary medical documents of the female patients treated under hospital conditions for salpingo-oophoritis in 2010-2011 was performed. The results were compared with those of the investigation of the present etiological pattern of pelvic inflammatory diseases (PID) by the data of the microbiological examination of 117 patients with PID and susceptibility of the isolates to the antibacterials. The frequency and efficiency of the use of antibacterials alone or in combinations were analysed in the treatment of various clinical forms of PID. The ovarian reserve was estimated in 87 patients after recovery from salpingo-oophoritis. 52 of them had an episode of the chronic process exacerbation and 35 had the first episode of acute PID. The ovarian reserve was estimated by determination of the anti-Mullerian hormone (AMH), basal FSH level, ovarian volume and antral follicle count. A statistically significant decrease of the ovarian reserve in the patients with chronic salpingo-oophoritis confirmed the necessity of rational treatment of the acute inflammatory process.

Modified Gexiazhuyu decoction alleviates chronic salpingitis p38 signaling pathway.

OBJECTIVE: To investigate pharmacodynamic effects of modified Gexiazhuyu decoction (MGXZYD) and explore the underlying mechanism in the treatment of chronic salpingitis METHODS: Chronic salpingitis model rats were firstly constructed and the blood was collected to detect the whole blood viscosity and plasma viscosity. Rat oviduct were collected to evaluate the macroscopic damage and the pathological injury and fibrosis of oviduct by hematoxylin-eosin (HE) and Masson staining. Elisa assay was to detect the production interleukin-1 ß (IL-1ß) in serum and collagen I (COL-1), matrix metalloprotein 9 (MMP-9), tissue inhibitor of metalloproteinases 1 (TIMP-1) in oviduct tissue. And immunohistochemical staining with MMP-9 and TIMP-1 in oviduct tissue were examined. Western blot was used to detect the expressions of p38 mitogen-activated protein kinases (p38MAPK), phospho-p38MPAK (p-p38MPAK), transforming growth factor-ß1 (TGF-ß1) in oviduct. The expression of α-smooth muscle actin (α-SMA), p-p38MPAK, in oviduct tissue were detected by immunofluorescence method. The mRNA of p-p38MAPK, α -SMA, COL-1, MMP-9, TIMP-1 was measured by reverse transcription-polymerase chain reaction. RESULTS: Rats administrated with MGXZYD demonstrated decreased the whole blood viscosity and plasma viscosity. MGXZYD obviously improved the tubal wall thickening, swelling and pelvic adhesion. And HE and Masson staining showed MGXZYD improved the pathological injury and fibrosis of oviduct. The results of MTT assay and flow cytometry indicated that MGXZYD could decreased the NIN-3T3 cells viability and improved the apoptosis. Besides, MGXZYD inhibited the protein and / or mRNA of TGF-ß1, IL-1ß, COL-1, α-SMA, p-p38MAPK expressions and increased the production of MMP-9/TIMP-1. CONCLUSION: MGXZYD could prevent the progression of chronic salpingitis by inhibited the fibrocyte and inflammation which inhibited the p38 MAPK signaling pathway.

Idiopathic pyometra and tubo-ovarian abscess in a postmenopausal patient treated conservatively.

Background: Pyometra is a rare gynecological condition and is characterized by pus accumulation in the uterine cavity. It occurs more frequently in postmenopausal women than tubo-ovarian abscesses, which constitute a more common gynecological complication among premenopausal women. Objective: A 72-year-old woman was admitted to our emergency department with lower abdominal pain, diarrhea and fever for the last three days. The laboratory results were indicative to sepsis. The clinical examination revealed sensitivity by palpation of the lower abdomen without any signs of acute abdomen. The gynecological assessment showed pus outflow through the cervix and a pus culture was done. The ultrasound examination found an enlarged uterus, full of hypoechoic fluid, unclear borders between endometrium-myometrium, a mixed echogenicity adnexal mass and no free fluid in the pouch of Douglas. A computed tomography (CT) of the abdomen showed the presence of pyometra and a tubo-ovarian abscess of the right adnexa. Method: The patient was treated with intravenous antibiotic therapy. When the patient was hemodynamically stable and afebrile, she underwent ultrasound-guided dilatation and curettage of the cervical canal and the endometrium in order to exclude an underlying malignancy, under general anesthesia. Results: The patient responded promptly to the intravenous antibiotic therapy which was adapted to the pus culture result. The laboratory results withdrew to normal values and the patient was discharged after fifteen days of hospitalization in an afebrile and hemodynamically stable condition. Conclusion: Pyometra and tubo-ovarian abscess in postmenopausal women could be a lethal complication of pelvic inflammatory disease. The key in treatment is the dilatation of the cervix and drainage of the pyometra. The administration of intravenous antibiotics and drainage through the cervix could be a suitable method of treatment for pyometra in older patients or those with poor performance status if only the histological examination is negative for malignancy.

Moxifloxacin: new indication. Do not use in gynaecological infections or other conditions.

In pelvic inflammatory disease, fluoroquinolones are not first-line drugs and moxifloxacin is the worst of these drugs.

A diagnosis of pneumococcal peritonitis secondary to pyo-salpinx in a young healthy female by culturing peritoneal pus.

Pneumococcal intra-abdominal infections of female genital tract origin are rare. A 33-year-old woman with peritonitis due to Streptococcus pneumoniae serotype 3 was reported. The patient did not have any of the known predisposing conditions for intra-abdominal pneumococcal infection. The clinical presentation included signs of multiorgan failure. Peritoneal toilette, bilateral salpingectomy and antibiotic treatment were promptly administered. The patient remained febrile, developed respiratory failure and required a repeated laparotomy and a prolonged antimicrobial treatment. Penicillin susceptible S. pneumoniae was isolated from the pus collected at surgery. Thus, culturing of intra-operative specimens should never be neglected to establish the correct microbiologic diagnosis.

[Low-intensity laser irradiation in the combined treatment of depressive disoreders in patients with chronic salpingo-oophoritis].

This study was designed to evaluate the possibility to use low-intensity laser radiation in combined therapy of somatogenic depressions in patients having gynecological problems, such as inflammatory disease of uterine appendages. It was shown that the combined treatment including administration ofantidepressants significantly accelerated the development of beneficial changes and stabilized depressive manifestations. Inclusion of low-intensity laser irradiation in the combined therapy further improved its positive effect. Nevertheless, the complete recovery could not be achieved in the absence of specific antidepressant treatment despite the alleviation of depressive symptoms.

A rare case of large pyosalpinx in an elderly patient with well-controlled type 2 diabetes mellitus: a case report.

BACKGROUND: Pyosalpinx, which is one of the pelvic inflammatory diseases, is usually observed in young women; it is rarely found in older women. Possible causative agents are thought to be Chlamydia trachomatis and Neisseria gonorrhea in addition to some Enterobacteriaceae. On the other hand, type 2 diabetes is a disease with a lot of complications such as hyperglycemia, inflammation, and immune disorders. Therefore, patients with type 2 diabetes mellitus have an increased susceptibility to infection especially when glycemic control is poor. CASE PRESENTATION: We experienced a rare case of large pyosalpinx in an elderly patient with well-controlled type 2 diabetes mellitus. A 72-year-old Japanese woman with a 10-year history of type 2 diabetes mellitus had symptoms of diarrhea and persistent pain in left lower abdomen. She had mild tenderness to palpation in her abdomen. Inflammation markers were markedly elevated. Her abdominal computed tomography and magnetic resonance imaging on admission revealed a tumor in left side of intrapelvis and we diagnosed her as having pyosalpinx. Pathogenic bacteria were not detected. On admission, her glycemic control was relatively good; in addition, her glycated hemoglobin levels were around 6% for over 1 year. Although pathogenic bacteria were not detected, we started antibiotics therapy. Fourteen days after starting the antibiotics her laboratory data were improved. Three months later, the tumor was markedly smaller compared to that on admission. CONCLUSIONS: We should keep in mind that older patients with type 2 diabetes mellitus are immunocompromised hosts and thereby they could have rare pelvic inflammatory disease such as pyosalpinx even when good glycemic control is obtained for a long period of time.

[Effects of Salvia miltiorrhiza on Chlamydia trachomatis mice of salpingitis].

OBJECTIVE: To study the effects of Salvia miltiorrhiza on treatment of Chlamydia trachomatis salpingitis (CTS) and fibrosis. METHOD: A mouse model for CTS was estahlished in C3H/He by intravaginal inoculation. after 3 weeks mice were randomly divided into 3 groups. Only Azithromyxin was given orally, Azithromyxin and early S. miltiorrhiza given, or Azithromyxin and later S. miltiorrhiza given. After 10 weeks, observe the change of oviduct of mice, observe the histopathologic change and analysis collagen histochemical index. RESULT: 3 Treatment groups induce tubal occlusion and hydrosalpinx decreased and the collagen histochemical index decreased significantly than those of no treatment given (P < 0.05). Early S. miltiorrhiza given group induce tubal occlusion and hydrosalpinx decreased and the collagen histochemical index decreased significantly than only Azithromyxin group or later S. miltiorrhiza given group (P <0.05). CONCLUSION: When we treat CTS genital infection with Azithromyxin, if we can give S. miltiorrhiza treatment as early as possible, it may decrease tubal occlusion and hydrosalpinx. significantly inhibit fibrosis maybe one of its pharmacologic mechanismin.

Effect of human immunodeficiency virus-1 infection on treatment outcome of acute salpingitis.

OBJECTIVE: To examine the effect of human immunodeficiency virus (HIV)-1 infection on treatment outcome of laparoscopically verified acute salpingitis. METHODS: Women aged 18-40 years with laparoscopically verified acute salpingitis received antibiotic therapy that included cefotetan 2 g intravenously and doxycycline 100 mg orally every 12 hours and laparoscopically guided drainage of tuboovarian abscesses of 4 cm or more. Clinical investigators blinded to HIV-1 serostatus used predetermined clinical criteria, including calculation of a clinical severity score and a standard treatment protocol to assess response to therapy. RESULTS: Of the 140 women with laparoscopically confirmed acute salpingitis, 61 (44%) women had mild, 38 (27%) had moderate, and 41 (29%) had severe disease (ie, pyosalpinx, tuboovarian abscesses, or both). Fifty-three (38%) were HIV-1-infected. Severe disease was more common in HIV-1-infected in comparison with HIV-1-uninfected women (20 [38%] compared with 21 [24%], P = .02). Defined as time of hospital discharge or 75% or more reduction in baseline clinical severity score, HIV-1-infected women with severe (6 days [4-16] compared with 5 days [3-9], P = .09) but not those with either mild (4 days [2-6] compared with 4 days [2-6] P = .4) or moderate salpingitis (4 days [3-7] compared with 4 days [3-6] P = .32) tended to take longer to meet criteria for clinical improvement. The need for intravenous clindamycin or additional surgery was not different in HIV-1-infected and uninfected cases (15 [28%] compared with 18 [21%], P = .3). CONCLUSION: Although HIV-1 infection may prolong hospitalization in women with severe salpingitis, all women hospitalized with acute salpingitis responded promptly to antibiotic therapy and surgical drainage regardless of HIV-1 infection status. LEVEL OF EVIDENCE: II-2.

Comparison of parenteral ciprofloxacin with clindamycin-gentamicin in the treatment of pelvic infection.

A prospective, randomized study of intravenous followed by oral ciprofloxacin compared with the combination of intravenous clindamycin and gentamicin was conducted in 122 women hospitalized with pelvic infections. Clinical diagnoses included endometritis (97 patients) and uncomplicated pelvic inflammatory disease (25 patients). Treatment successes for endometritis included 42 of 50 (84 percent) patients treated with ciprofloxacin compared with 35 of 47 (75 percent) treated with the clindamycin-gentamicin combination. Treatment successes for acute salpingitis included 10 of 10 (100 percent) treated with ciprofloxacin and 13 of 15 (87 percent) treated with clindamycin-gentamicin. Ciprofloxacin successfully eradicated Chlamydia trachomatis in 11 of 12 patients as did clindamycin-gentamicin in six of seven patients. In this study of pelvic infection, ciprofloxacin demonstrated efficacy comparable with the combination of clindamycin and gentamicin, and is effective against C. trachomatis.

Aminoglycosides in gynecologic infections.

Aminoglycosides have always had a major role in the treatment of gynecologic infections. This therapeutic emphasis has been based upon the bactericidal activity of the aminoglycosides against gram-negative aerobes. This group of organisms is important to the gynecologist because of their frequent isolation from soft tissue, urinary sites, and the bloodstream in women with nosocomial or community-acquired pelvic infections. In the past decade, there has been increasing clinical awareness of the multi-bacterial nature of these soft tissue pelvic infections. A major therapeutic change directed against gram-negative anaerobes has been the substitution of more effective agents like clindamycin or metronidazole for the penicillin arm of the older penicillin-aminoglycoside combination. The majority of intra-abdominal and pelvic infections treated by gynecologists occur in patients who are younger and usually healthier than those with similar infections who are treated by general surgeons. Consequently, in many instances, single drug therapy with a cephalosporin (usually cefoxitin) is adequate, if combined with surgical drainage when indicated. However, there is an increasingly larger group of patients who are significantly older and who may also have pelvic malignancies. In addition, they may be immunocompromised. Infections in this group mandate the use of the most effective antimicrobial agents that will cover the broadest spectrum. When anaerobic bacteria are involved, either clindamycin or metronidazole are acceptable choices; for aerobic gram-negative organisms, an aminoglycoside should be used. Recent studies suggest that amikacin may be the best choice, since it is associated with a low level of bacterial resistance and has been shown to reduce levels of resistance to other aminoglycosides. Amikacin has become the "gold standard" for comparisons with any new cephalosporins or penicillins. New developments will modify the use of aminoglycosides in the future. The expansion of oncology care with immune-system-modifying chemotherapy and radiation will expose patients to the dangers of gram-negative sepsis. Aminoglycosides are a logical part of the initial therapeutic regimen for these septic patients. On the other hand, the majority of gynecologic patients with pelvic infections are young and healthy. Recent studies have demonstrated that as many as 40 percent of these women will be underdosed by standard treatment regimens based upon ideal body weight. This means that patients receiving aminoglycosides will require monitoring of peak and trough levels to insure therapeutic drug levels.(ABSTRACT TRUNCATED AT 400 WORDS)

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.