RESUMEN
BACKGROUND: Infection of the Fallopian tubes (FT) by Neisseria gonorrhoeae (Ngo) can lead to acute salpingitis, an inflammatory condition resulting in damage primarily to the ciliated cells, with loss of ciliary activity and sloughing of the cells from the epithelium. Recently, we have shown that Ngo infection induced apoptosis in FT epithelium cells by a TNF-alpha dependent mechanism that could contribute to the cell and tissue damage observed in gonococcal salpingitis. AIM: To investigate the apoptosis-related genes expressed during apoptosis induction in cultured FT epithelial cells infected in vitro by Ngo. MATERIALS AND METHODS: In the current study, we used cDNA macroarrays and real time PCR to identify and determine the expression levels of apoptosis related genes during the in vitro gonococci infection of FT epithelial cells. RESULTS: Significant apoptosis was induced following infection with Ngo. Macroarray analysis identified the expression of multiple genes of the TNF receptor family (TNFRSF1B, -4, -6, -10A, -10B and -10D) and the Bcl-2 family (BAK1, BAX, BLK, HRK and MCL-1) without differences between controls and infected cells. This lack of difference was confirmed by RT-PCR of BAX, Bcl-2, TNFRS1A (TNFR-I) and TNFRSF1B (TNFR-II). CONCLUSION: Several genes related to apoptosis are expressed in primary cultures of epithelial cells of the human Fallopian tube. Infection with Ngo induces apoptosis without changes in the pattern of gene expression of several apoptosis-related genes. RESULTS strongly suggest that Ngo regulates apoptosis in the FT by post-transcriptional mechanisms that need to be further addressed.
Asunto(s)
Apoptosis/genética , Células Epiteliales/microbiología , Trompas Uterinas/microbiología , Neisseria gonorrhoeae/fisiología , Salpingitis/microbiología , Células Cultivadas , Células Epiteliales/patología , Trompas Uterinas/patología , Femenino , Regulación de la Expresión Génica , Humanos , Análisis de Secuencia por Matrices de Oligonucleótidos , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Receptores del Factor de Necrosis Tumoral/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Salpingitis/patologíaRESUMEN
Background: Infection of the Fallopian tubes (FT) by Neisseria gonorrhoeae (Ngo) can lead to acute salpingitis, an inflammatory condition resulting in damage primarily to the ciliated cells, with loss of ciliary activity and sloughing of the cells from the epithelium. Recently, we have shown that Ngo infection induced apoptosis in FT epithelium cells by a TNF-alpha dependent mechanism that could contribute to the cell and tissue damage observed in gonococcal salpingitis. Aim: To investigate the apoptosis-related genes expressed during apoptosis induction in cultured FT epithelial cells infected in vitro by Ngo. Materials and Methods: In the current study, we used cDNA macroarrays and real time PCR to identify and determine the expression levels of apoptosis related genes during the in vitro gonococci infection of FT epithelial cells. Results: Significant apoptosis was induced following infection with Ngo. Macroarray analysis identified the expression of multiple genes of the TNF receptor family (TNFRSF1B, -4, -6, -10A, -10B and -10D) and the Bcl-2 family (BAK1, BAX, BLK, HRK and MCL-1) without differences between controls and infected cells. This lack of difference was confirmed by RT-PCR of BAX, Bcl-2, TNFRS1A (TNFR-I) and TNFRSF1B (TNFR-II). Conclusion: Several genes related to apoptosis are expressed in primary cultures of epithelial cells of the human Fallopian tube. Infection with Ngo induces apoptosis without changes in the pattern of gene expression of several apoptosis-related genes. Results strongly suggest that Ngo regulates apoptosis in the FT by post-transcriptional mechanisms that need to be further addressed.
Asunto(s)
Femenino , Humanos , Apoptosis/genética , Células Epiteliales/microbiología , Trompas Uterinas/microbiología , Neisseria gonorrhoeae/fisiología , Salpingitis/microbiología , Células Cultivadas , Células Epiteliales/patología , Trompas Uterinas/patología , Regulación de la Expresión Génica , Análisis de Secuencia por Matrices de Oligonucleótidos , /metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Receptores del Factor de Necrosis Tumoral/metabolismo , Salpingitis/patologíaRESUMEN
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.
Asunto(s)
Anticuerpos Antibacterianos/análisis , Anticuerpos Antibacterianos/sangre , Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/aislamiento & purificación , Técnica del Anticuerpo Fluorescente Indirecta/métodos , Infertilidad Femenina/microbiología , Adolescente , Adulto , Infecciones por Chlamydia/complicaciones , Chlamydia trachomatis/inmunología , Femenino , Humanos , Inmunoglobulina G/análisis , Inmunoglobulina G/sangre , Infertilidad Femenina/diagnóstico , Laparoscopía/estadística & datos numéricos , México , Persona de Mediana Edad , Hibridación de Ácido Nucleico/métodos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Salpingitis/diagnóstico , Salpingitis/microbiología , Sensibilidad y Especificidad , Uretra/microbiología , Salud de la MujerRESUMEN
Se analizaron 93 muestras cervicales ginecológicas del Hospital de Gineco Obstetricia No. 3, del Centro Médico La Raza, de Fomento a la Salud y de población abierta de la UMF 5. Se encontró una incidencia elevada de infección por Chlamydia trachomatis de 28.4 por ciento, en mujeres en donde se sospechó de tal infección. Se considera que se debe pensar en infección por Chlamydia trachomatis en; mujeres con cervicitis mucopurulenta, salpingitis aguda, anormalidades en el cérvix y efectuarse las pruebas específicas para su detección
Asunto(s)
Humanos , Femenino , Adolescente , Adulto , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Infertilidad Femenina/microbiología , Infertilidad Femenina/fisiopatología , Leucorrea/diagnóstico , Leucorrea/fisiopatología , Salpingitis/microbiología , Salpingitis/fisiopatologíaRESUMEN
Upper genital tract infection was investigated in 46 women admitted to hospital with clinic diagnosis of acute pelvic inflammatory disease (PID) and 62 control women accepted to hospital for laparoscopy Fallopian tubes sterilization. Diagnosis was ratified by laparoscopy in mild and moderate salpingitis; culdocentesis and ultrasonography were performed in severe salpingitis and endometrial sample was made in endometritis. Microbiological specimens were taken from the cervix and abdomen. Antecedents and complete clinical studies were obtained. Patients were treated with antibiotic association sodic G penicillin, chloramphenicol and gentamicin. Risk factors to development PID were: single female (p < 0.05), multiple sexual partner (p < 0.01), previous PID (p < 0.05), infertility (p < 0.05), mean year of IUD use in severe salpingitis (p = 0.05) and mean years of age from women with sexually transmitted bacterias (STB) vs endogenous bacterias (EB) (p < 0.05). In the control group no abdomen bacterias were isolated. In patients with PID, C. trachomatis was detected by serology in 28.3%. N. gonorrhoeae was isolated from the cervix in 23.9% and from the abdomen 17.4%. Besides it was isolated from the abdomen: M. hominis 17.3% and E. coli 15.2%. STB were isolated in 54.3% and EB in 47.8% of the patients. Bacterial association was present on the 37%. Cervix isolation of G. vaginalis and Mycoplasma were not correlated with development of PID. Cervix microbiological samples were useful to know abdomen microbic etiology. They coincide with those in the 90.9%. EB were more frequently isolated from severe salpingitis (p = 0.05) and STB from mild and moderate salpingitis (p = 0.05). Antibiotic association cured all the mild and moderate salpingitis with independence of bacterial etiology. Failure occurred in 2 diffuse peritonitis and 13/14 tubo-ovarian abscesses. Surgery used in severe salpingitis and diffuse peritonitis, principally consisted in anexectomy, peritoneal toilet and drainages. No hysterectomies were performed. Colpotomy drainage was used as a laparotomy complement or as unique drainage. Severe complications of surgery occurred in 10.5%. Failure in antibiotic treatment, surgery and complications were present with preference in PID with EB. After PID 26.5% of women had both Fallopian tubes damaged; in 39.7% tube damage was not evaluated and in 34.2% one tube rested in health. Damage did not depend of bacterial etiology. Conclusion on the necessity of adequate prevention of this disease and it should need education related to the roll of STB and standards about the IUD use.
Asunto(s)
Salpingitis/microbiología , Abdomen/microbiología , Enfermedad Aguda , Adolescente , Adulto , Bacterias/aislamiento & purificación , Cuello del Útero/microbiología , Cloranfenicol/uso terapéutico , Femenino , Gentamicinas/uso terapéutico , Humanos , Persona de Mediana Edad , Enfermedad Inflamatoria Pélvica/diagnóstico , Enfermedad Inflamatoria Pélvica/microbiología , Enfermedad Inflamatoria Pélvica/terapia , Penicilina G/uso terapéutico , Factores de Riesgo , Salpingitis/diagnóstico , Salpingitis/terapia , Enfermedades Bacterianas de Transmisión SexualRESUMEN
La infección del tracto genital superior fue investigada en 46 pacientes con el diagnóstico de enfermedad inflamatoria pélvica aguda EIP y en 62 mujeres controles ingresadas para esterilización tubaria por laparoscopia. El diagnóstico se ratificó por laparoscopia en las salpingitis leves y moderadas, por culdocentesis, ultrasonografía en las salpingitis severas y biopsia de endometrio en las endometritis. Muestras microbiológicas se tomaron del cérvix y del abdomen. Se obtuvo antecedentes y estudio clínico completo. Se usó la asociación antibiótica penicilina G sódica, cloramfenicol y gentamicina. Constituyeron factores de riesgo para adquirir EIP: mujer soltera p<0,05, pareja sexual múltiple p<0,01, EIP anterior p<0,05, infertilidad p<0,05, años promedio uso DIU en salpingitis severas p=0,05 y años de edad promedio de las mujeres con EIP por bacterias de transmisión sexual BTS versus por bacterias endógenas BE p<0,05. En el grupo control no se aislaron bacterias del abdomen. En las pacientes con EIP, c. trachomatis se detectó por serología en el 28,3 por ciento. N. gonorrhoeae seaisló del cervix en el 23,9 por ciento y del abdomen en el 17,4 por ciento. Del abdomen se aislaron además: m. hominis 8,9 por ciento, u. urealyticum 11,1 por ciento, bacteroides 23,9 por ciento, peptostreptococcus 17,3 por ciento y e. coli 15,2 por ciento. En conjunto las BTS se aislaron en el 54,3 por ciento y las BE en el 47,8 por ciento de las pacientes. La asociación bacteriana se presentó en el 37 por ciento. La g. vaginalis y los mycoplasmas urogenitales aislados del cervix no se correlacionaron con el desarrollo de la EIP. Las muestras microbiológicas del cervix fueron útiles para conocer la etiología microbiana del abdomen, coincidieron con éstas en el 90,9 por ciento. Las BE se aislaron más frecuentemente en las salpingitis severas p=0,05 y las BTS en las salpingitis leves y moderadas p=0,05. La asociación de antibióticos curó todas las salpingitis leves y moderadas independientemente de la etiología bacteriana. La falla ocurrió en 2 peritonitis difusas y en 13/14 abscesos tuboováricos. La cirugía usada en salpingitis severas y peitonitis difusa consistió principalmente en anexectomía y aseo ddrenajes. No hubo histerectomías. la colpoceliotomía se usó como complemento de la laparotomía o como drenaje único. Complicaciones severas de la cirugía ocurrieron en el 10,5 por ciento. La falla del tratamiento antibiótico, la cirugía y las complicaciones se presentaron preferentemente en EIP por BE. Post EIP el 26,5 por ciento de las mujeres tuvieron ambas trompas dañadas, en el 39,7 por ciento no se evaluó el estado de las trompas y el 34,2 por ciento quedaron con una trompa sana. El daño no dependió de la etiología bacteriana. Se concluye en la necesidad de hacer prevención adecuada de esta enfermedad que incluya educación relacionada con el rol de las BTS y normas sobre el uso del DIU
Asunto(s)
Humanos , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Enfermedad Inflamatoria Pélvica/microbiología , Salpingitis/microbiología , Enfermedades Bacterianas de Transmisión Sexual/microbiología , Quimioterapia Combinada/uso terapéutico , Dispositivos Intrauterinos/efectos adversos , Enfermedad Inflamatoria Pélvica/tratamiento farmacológico , Enfermedad Inflamatoria Pélvica/cirugía , Técnicas MicrobiológicasRESUMEN
The peritoneal fluid of two groups of patients was cultivated; the first one was of 67 patients with tuboperitoneal problem; the second of 14 patients was the control; we founded Mollicutes in 39% of the patients of the problem group and 28% of the control group. The correlation between laparoscopic aspects with the positive Mollicutes cultures suggested the infection by Mollicutes in the tubal cause of sterility.
Asunto(s)
Infertilidad Femenina/microbiología , Infecciones por Mycoplasma/complicaciones , Mycoplasma/aislamiento & purificación , Salpingitis/microbiología , Infecciones por Ureaplasma/complicaciones , Ureaplasma urealyticum/aislamiento & purificación , Femenino , Humanos , Infecciones por Mycoplasma/epidemiología , Salpingitis/complicaciones , Adherencias Tisulares/etiología , Infecciones por Ureaplasma/epidemiologíaRESUMEN
Propöe-se analisar a utilidade do exame bacterioscópico da secreçäo cervicovaginal, entre portadoras de salpingite aguda gonocócica, comparando-se com os resultados obtidos através da cultura específica. Foram estudadas 105 pacientes, com diagnóstico de salpingite aguda, no período de maio de 1983 a setembro de 1984. Neisseria gonorrhoeae foi cultivada em 43 (41,0% casos. A bacterioscopia revelou evidências da presença deste patógeno em 31 (72,1%) casos. Resultados falso-negativos foram encontrados em 12 (27,9%) e falso-positivos em apenas 3 (5,0%) casos. Conclue-se que a bacterioscopia cervicovaginal, frente à suspeita de salpingite gonocócica, pode e deve ser rotineiramente utilizada, tendo ainda como vantagens a facilidade de execuçäo, o baixo custo e a baixa incidência de resultados falso-positivos
Asunto(s)
Adolescente , Adulto , Persona de Mediana Edad , Humanos , Femenino , Moco del Cuello Uterino/metabolismo , Salpingitis/microbiología , Vagina/metabolismo , Técnicas Bacteriológicas , Neisseria gonorrhoeae/aislamiento & purificaciónRESUMEN
Acute salpingitis is an important complication of sexually transmitted disease in young women and should be considered in the differential diagnosis of abdominal pain in all young women. Many organisms, in addition to N. gonorrhoeae, have been associated with this tubal infection giving support to polymicrobial etiology. However, the exact pathophysiologic role of these organisms needs to be clearly defined. The microbiology of acute salpingitis, through direct culture from the site of infection, the fallopian tubes, needs to be clearly elucidated. Early recognition and treatment of acute salpingitis is essential in preventing the major long-term problem, involuntary infertility. Curran has estimated the reproductive outcome for a cohort of adolescent women reaching reproductive age in 1970. By the year 2000, there will have been one episode of salpingitis for every two women; 15% will be hospitalized for salpingitis with over half of these women requiring major gynecologic surgery; 10% will be rendered nonsurgically sterile; and 3% will have experienced an ectopic pregnancy. Adolescent females may be more susceptible to upper genital tract infection than older women due to possible unique biologic characteristics and sexual behaviors. Prospective microbiologically controlled studies of women with salpingitis using laparoscopy need to be developed to evaluate treatment regimens. Until such studies are undertaken, diagnosis, treatment, and fertility in women with acute salpingitis will remain unsatisfactory.