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Alikhani M, Akhoundi M, Sereno D, Abdi J, Naserifar R, Mahmoudi MR, Mirzaei A. Molecular characterization of Trichomonas infections in women of Ilam City, southwestern Iran. Parasitol Res 2022; 121:1631-1638. [PMID: 35332380 DOI: 10.1007/s00436-022-07492-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/11/2022] [Indexed: 11/25/2022]
Abstract
Trichomoniasis is a sexually transmitted infection (STI) caused by the flagellated protozoan Trichomonas vaginalis. Little information is available on the epidemiology and genetic diversity of T. vaginalis in Ilam City, southwestern Iran. A descriptive cross-sectional investigation was carried out between July 2017 and December 2018 on the suspected women patients referred to eight gynecology clinics of Ilam City for probable Trichomonas infection. They were undergone a set of clinical, parasitological, and molecular examinations. During clinical consultation, posterior vaginal fornix secretions and urine samples were gathered from the participants. For the reasons such as physical conditions and cultural and religious constraints, most of participating women, especially young girls due to their virginity, preferred to give urine samples instead of vaginal discharge. The presence of Trichomonas was diagnosed by microscopic examination and molecular detection using conventional PCR targeting ITS1-rDNA. A total of 1765 suspected individuals were examined clinically via vaginal secretions (495 specimens) and urine samples (1270 specimens). Of them, 21 (1.18%) cases, including 13 vaginal secretions and 8 urine samples, were positive for Trichomonas infection by microscopy. Slightly more than half of the patients (11/21, 52.4%) complained of vulvar itching, burning, and frequent urination. Cervical lesions, patchy erythema, and vaginal discharge were recorded in 28.6%, 23.8%, and 19% of the patients respectively. All patients with positive microscopic identification were confirmed by amplification of 450-bp fragment of ITS1-rDNA. Phylogenetic analysis revealed a high rate of genetic homogeneity in which all our isolates together with homologous sequences from China, Philippines, Austria, and USA were clustered within the same clade. A statistically significant relationship was recorded between the patients positive for trichomoniasis and the presence of chronic disease (e.g., diabetes, immune system deficiency).
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Affiliation(s)
- Maryam Alikhani
- Parasitology Department, Paramedical School, Ilam University of Medical Sciences, Ilam, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Akhoundi
- Parasitology-Mycology Department, Avicenne Hospital, AP-HP, Bobigny, France.
| | - Denis Sereno
- Institut de Recherche pour le Développement, Montpellier University, MIVEGEC, 34032, Montpellier, France
- Institut de Recherche pour le Développement, Montpellier University, InterTryp, 34032, Montpellier, France
| | - Jahangir Abdi
- Parasitology Department, Paramedical School, Ilam University of Medical Sciences, Ilam, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Razi Naserifar
- Parasitology Department, Paramedical School, Ilam University of Medical Sciences, Ilam, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Reza Mahmoudi
- Department of Parasitology and Mycology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Cellular and Molecular Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Asad Mirzaei
- Parasitology Department, Paramedical School, Ilam University of Medical Sciences, Ilam, Iran.
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran.
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Fang N, Tang D, Zhang H, Zeng J. Smooth muscle actin immunostain is useful for the diagnosis of Trichomonas vaginalis in vaginal smears. Diagn Cytopathol 2021; 49:1052-1055. [PMID: 34291890 DOI: 10.1002/dc.24822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The parasite Trichomonas vaginalis (T. vaginalis) causes one of the most common non-viral sexually transmitted infections in humans. T. vaginalis is notorious for its inconspicuous appearance in vaginal smears. It can be missed under the microscope. METHOD In the present study, we investigate the immunoreactivity of T. vaginalis to smooth muscle actin (SMA) in the vaginal smear. RESULT T. vaginalis trophozoite and pseduocyst are immunoreactive for SMA in all of the study group cases (n = 21) and in none of the control group cases (n = 21). Thus, SMA immunostain is a sensitive method for the demonstration of T. vaginalis. Moreover, the protozoan attains a conspicuous and unique appearance. By SMA immunohistochemical stain, the apperance of T. vaginalis floated freely or located in the cytoplasm of the epithelial cells is easily identified. CONCLUSION We recommend performing SMA immunostain in every vaginal smear with clinical or pathologic suspicion of trichomoniasis.
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Affiliation(s)
- Ni Fang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Deng Tang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hanjie Zhang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Zeng
- Department of Medical Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Nikas I, Hapfelmeier A, Mollenhauer M, Angermeier D, Bettstetter M, Götz R, Schmidmayr M, Seifert-Klauss V, Muckenhuber A, Schenck U, Weirich G. Integrated morphologic and molecular analysis of Trichomonas vaginalis, Mycoplasma hominis, and human papillomavirus using cytologic smear preparations. Parasitol Res 2018; 117:1443-1451. [PMID: 29549429 DOI: 10.1007/s00436-018-5829-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 03/06/2018] [Indexed: 01/03/2023]
Abstract
Pathogenic microbes may colonize the female genital tract via sexual transmission and cause health issues like inflammation or malignancy, summarized as sexually transmitted disease (STD). A major representative of such pathogens is Trichomonas vaginalis (T.v.), whose role in the etiology of cervical cancer remains elusive. Traditional morphologic screening of cervical smears is able to detect T.v., although its identification may be complicated by look-alikes such as degenerated granulocytes and basal cells. In addition, the parasite's endosymbiont Mycoplasma hominis (M.h.) cannot be detected in the Pap test. This investigation was aimed at designing a PCR-based method to detect specific pathogenic germs by using cervical cytology slides to overcome morphologic uncertainty and increase diagnostic accuracy. To test our molecular screening method on T.v., M.h., and HPV in archival smears, we elaborated a multiplex PCR approach based on microdissection. This assay was applied to a minute quantity of starting material which harbored or was suspected to harbor T.v.; the resulting isolated DNA was used for subsequent molecular analyses of T.v., M.h., and HPV. We clarified the diagnosis of genital T.v. infection in 88 and 1.8% of morphologically suspicious and T.v.-negative cases, respectively. We also revealed a tendency of M.h. co-infection in high-risk HPV cases. In conclusion, a microdissection-based approach to detect pathogenic microbes such as T.v., HPV, and M.h. is a molecular tool easy to implement and may help to better understand the interactivity of these germs with respect to pathogenesis.
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Affiliation(s)
- I Nikas
- Institute of Pathology, Technische Universität München, Trogerstraße 18, 81675, Munich, Germany.,School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - A Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - M Mollenhauer
- Institute of Pathology, Technische Universität München, Trogerstraße 18, 81675, Munich, Germany
| | - D Angermeier
- Institute of Pathology, Technische Universität München, Trogerstraße 18, 81675, Munich, Germany
| | | | - R Götz
- Institute of Pathology, Technische Universität München, Trogerstraße 18, 81675, Munich, Germany
| | - M Schmidmayr
- Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany
| | - V Seifert-Klauss
- Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany
| | - A Muckenhuber
- Institute of Pathology, Technische Universität München, Trogerstraße 18, 81675, Munich, Germany
| | - U Schenck
- Institute of Pathology, Technische Universität München, Trogerstraße 18, 81675, Munich, Germany.,MVZ Gynäkologie & Pathologie, Munich, Germany
| | - Gregor Weirich
- Institute of Pathology, Technische Universität München, Trogerstraße 18, 81675, Munich, Germany.
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Doxtader EE, Elsheikh TM. Diagnosis of trichomoniasis in men by urine cytology. Cancer Cytopathol 2016; 125:55-59. [PMID: 27636204 DOI: 10.1002/cncy.21778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/26/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Trichomonas vaginalis is a rare finding in urine cytology specimens, especially those from men; only 2 case reports have been described in the literature. The authors of the current report sought to determine the incidence and clinical significance of this finding in urine cytology in males. METHODS The authors' cytopathology archives were queried for urine cytology specimens that contained Trichomonas over a 30-year period. Clinical information from men with Trichomonas-positive urines was reviewed retrospectively. Slides were reviewed, and the morphologic characteristics of the organisms were recorded. RESULTS Trichomonas was detected in 73 of 60,000 urine cytology specimens (0.1%). The patients included 45 women and 28 men. Men with Trichomonas in their urine ranged in age from 28 to 87 years (mean age, 67 years; median, 71 years). Trichomonas organisms were round to oval, with eccentric nuclei and cytoplasmic granules. Acute inflammation was observed in 6 of 7 cases. Clinical history was available in 13 of 28 men. Lower urinary tract symptoms were reported in 10 of 13 men, most commonly hematuria; and urethral strictures were identified by cystoscopy in 3 of 13 men. Clinical follow-up was available for 10 of 13 patients; of these, 8 (80%) had received treatment with metronidazole based on urine cytology results. CONCLUSIONS This study is the largest series of Trichomonas infection in men diagnosed by urine cytology in the literature. Most men had no prior diagnosis of trichomoniasis and received specific antibiotic therapy based on their urine cytology results. Urine cytology may represent the initial diagnostic test for Trichomonas in men, and accurate cytologic diagnosis may prevent undesired adverse outcomes for them and their partners. Cancer Cytopathol 2017;125:55-59. © 2016 American Cancer Society.
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Hoda RS, Loukeris K, Abdul-Karim FW. Gynecologic cytology on conventional and liquid-based preparations: a comprehensive review of similarities and differences. Diagn Cytopathol 2012; 41:257-78. [PMID: 22508662 DOI: 10.1002/dc.22842] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/10/2012] [Indexed: 02/06/2023]
Abstract
Liquid-based preparations (LBPs) have largely replaced conventional Papanicolaou smears (CPS) for cervical samples in the United States and in many other industrialized countries. The two FDA-approved LBP currently in use include ThinPrep (TP), (Hologic Inc., Bedford, MA) and SurePath (SP), (BD Diagnostic, Burlington, NC). Split-sample and direct-to-vial studies have shown that LBPs show an overall improvement in sample collection and processing, reduce artifacts that interfere in diagnosis, are more sensitive, can be utilized for ancillary tests and are a cost-effective replacement for CPS. Comparative analyses of diagnostic accuracy indicate that LBPs perform at least as well as CPS. However, the added advantages of standardized, automated preparations and screening, reduced unsatisfactory rate, improved specimen adequacy and ability to perform human papillomavirus (HPV) test, are enough to continue use of LBP. The cytologic features in LBP are similar to CPS with subtle differences, particularly in background information. There are also subtle differences between the two LBPs, SP and TP, which are reflective of different sampling devices, collection media, and processing techniques. Architecturally, LBP shows smaller cell clusters and sheets and more dyscohesion. Cytologically, enhanced nuclear features and smaller cell size are more prominent. Advances in liquid-based Papanicolaou's (Pap) test have lead to well-defined patient management guidelines by the American Society for Colposcopy and Cervical Pathology. Herein, we review these aspects of Pap test including, morphology, automation, ancillary tests (HPV and immunochemistry), pertinent QA/QC monitors, patient management guidelines, and review of pertinent literature.
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Affiliation(s)
- Rana S Hoda
- Department of Pathology & Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10065, USA.
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Aslan DL, Pambuccian SE, Prekker FL, Schacker TW, Southern P, Savik K, McKeon D, Gulbahce HE. Accuracy of herpes simplex virus detection in liquid-based (SurePath) Papanicolaou tests: a comparison with polymerase chain reaction. Diagn Cytopathol 2008; 36:94-103. [PMID: 18181191 DOI: 10.1002/dc.20732] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A review of our institution's Papanicolaou test records over an 11-yr period showed that liquid-based Papanicolaou tests (LBPTs) had a significantly higher frequency of diagnoses of Herpes simplex virus (HSV)-related cellular changes compared to conventional Papanicolaou smears (77/302,841, 0.026% vs. 56/376,173, 0.015%, P = 0.002). To investigate the accuracy of the diagnosis of HSV by LBPT, we performed conventional polymerase chain reaction (PCR) on the residual samples from 258 prospectively collected LBPT and real-time PCR using a different primer set on a subset of 40 LBPT. Conventional PCR was positive in 22 of 22 cases diagnosed of HSV, 1 of 2 cases diagnosed as suspicious for HSV, and none of 234 LBPT without a cytologic HSV diagnosis. Real-time PCR was positive in 8 of 8 cases diagnosed as HSV and none of the 32 controls. We conclude that LBPT allows an increased detection of HSV that is highly accurate.
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Affiliation(s)
- Deniz L Aslan
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Fairview University Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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Abstract
A variety of cytological changes suggestive of genital tract infection may be noted during microscopy of a Papanicolaou-stained cervical smear. The dilemma faced by cytopathologists is whether or not to report suspicious changes to the clinician responsible for the woman's care. This review examines the effectiveness of Papanicolaou-smear microscopy in the diagnosis of the more common sexually transmitted infections, and aims to encourage debate on the reporting of suggestive cytological changes.
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Affiliation(s)
- A McMillan
- Department of Genitourinary Medicine, Edinburgh Royal Infirmary, NHS Lothian, University Hospitals Division, Edinburgh, UK.
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Pantanowitz L, Cao QJ, Goulart RA, Otis CN. Diagnostic utility of p16 immunocytochemistry for Trichomonas in urine cytology. Cytojournal 2005; 2:11. [PMID: 15985185 PMCID: PMC1183263 DOI: 10.1186/1742-6413-2-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2005] [Accepted: 06/29/2005] [Indexed: 11/15/2022] Open
Abstract
We present a case in which p16 immunocytochemistry helped establish the diagnosis of Trichomonas in urine from a male patient. Based on this finding, we recommend p16 immunocytochemistry as a diagnostic tool for unexpected patients or specimen types in which potential trichomonads are identified following routine cytologic evaluation.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, USA
| | - Q Jackie Cao
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, USA
| | - Robert A Goulart
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, USA
| | - Christopher N Otis
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, USA
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