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Pérez-Prieto I, Rodríguez-Santisteban A, Altmäe S. Beyond the reproductive tract: gut microbiome and its influence on gynecological health. Curr Opin Clin Nutr Metab Care 2024; 36:134-147. [PMID: 38656809 DOI: 10.1097/01.gco.0001016536.06312.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW The analysis of microbiome in association with female health is today a "hot topic" with the main focus on microbes in the female reproductive tract. Nevertheless, recent studies are providing novel information of the possible influence of the gut microbiome on gynecological health outcomes, especially as we start to understand that the gut microbiome is an extended endocrine organ influencing female hormonal levels. This review summarizes the current knowledge of the gut microbes in association with gynecological health. RECENT FINDINGS The gut microbiome has been associated with endometriosis, polycystic ovary syndrome, gynecological cancers, and infertility, although there is a lack of consistency and consensus among studies due to different study designs and protocols used, and the studies in general are underpowered. SUMMARY The interconnection between the gut microbiome and reproductive health is complex and further research is warranted. The current knowledge in the field emphasizes the link between the microbiome and gynecological health outcomes, with high potential for novel diagnostic and treatment tools via modulation of the microenvironment.
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Affiliation(s)
- Inmaculada Pérez-Prieto
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | | | - Signe Altmäe
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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2
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Fülöp V, Lakatos K, Végh G, Kalmár L, Pállinger É. [Endometriosis and microbiom]. Orv Hetil 2024; 165:3-13. [PMID: 38189832 DOI: 10.1556/650.2024.32954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 01/09/2024]
Abstract
Az endometriosis multifaktoriális betegség, melynek szűrése és kezelése komoly
kihívások elé állítja a nőgyógyászokat. Jelenleg a hormonális kezelés – például
GnRH-agonista injekciók, gesztagénimplantátumok – és az érintett szövet műtéti
eltávolítása, illetve méretének csökkentése az endometriosis leggyakoribb
kezelési módszerei. Jelenleg megbízható noninvazív módszerek hiányában az
endometriosis igazolásának legbiztosabb módszere a műtéti feltárás.
Kutatócsoportunk – részben saját eredményekre támaszkodva, részben széles körű
irodalmi adatok alapján – arra a következtetésre jutott, hogy az alsó, illetve
felső női genitalis traktus és a bél mikrobiomja kiemelkedő szerepet játszik az
endometriosis kialakulásában. Az említett területek baktériumközösségének
jelenleginél részletesebb feltérképezése fontos lépés lehet az endometriosis
patomechanizmusának megértésében, és új diagnosztikai módszereket is biztosíthat
a klinikum számára. A mikrobiom-vizsgálatok összehasonlíthatósága azonban
megköveteli, hogy a jövőbeli, prospektív vizsgálatok során szigorú és
standardizált módszertant alkalmazzanak annak érdekében, hogy tisztázni lehessen
a mikrobiom pontos szerepét a betegség patogenezisében, a klinikai kép
formálásában és a terápia monitorozásában. Orv Hetil. 2024; 165(1): 3–13.
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Affiliation(s)
- Vilmos Fülöp
- 1 Észak-pesti Centrumkórház - Honvédkórház, Szülészet-nőgyógyászati Osztály Budapest Magyarország
- 2 Miskolci Egyetem, Egészségtudományi Kar Miskolc Magyarország
| | - Kornél Lakatos
- 3 Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő, Szülészeti Nőgyógyászati Osztály Budapest, Diós Árok 1-3., 1125 Magyarország
| | - György Végh
- 3 Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelő, Szülészeti Nőgyógyászati Osztály Budapest, Diós Árok 1-3., 1125 Magyarország
| | - László Kalmár
- 1 Észak-pesti Centrumkórház - Honvédkórház, Szülészet-nőgyógyászati Osztály Budapest Magyarország
| | - Éva Pállinger
- 4 Semmlweis Egyetem, Általános Orvostudományi Kar, Genetikai, Sejt- és Immunbiológiai Intézet Budapest Magyarország
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3
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Le N, Cregger M, Brown V, Loret de Mola J, Bremer P, Nguyen L, Groesch K, Wilson T, Diaz-Sylvester P, Braundmeier-Fleming A. Association of microbial dynamics with urinary estrogens and estrogen metabolites in patients with endometriosis. PLoS One 2021; 16:e0261362. [PMID: 34914785 PMCID: PMC8675749 DOI: 10.1371/journal.pone.0261362] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/29/2021] [Indexed: 01/04/2023] Open
Abstract
Endometriosis is an estrogen dependent gynecological disease associated with altered microbial phenotypes. The association among endogenous estrogen, estrogen metabolites, and microbial dynamics on disease pathogenesis has not been fully investigated. Here, we identified estrogen metabolites as well as microbial phenotypes in non-diseased patients (n = 9) and those with pathologically confirmed endometriosis (P-EOSIS, n = 20), on day of surgery (DOS) and ~1–3 weeks post-surgical intervention (PSI). Then, we examined the effects of surgical intervention with or without hormonal therapy (OCPs) on estrogen and microbial profiles of both study groups. For estrogen metabolism analysis, liquid chromatography/tandem mass spectrometry was used to quantify urinary estrogens. The microbiome data assessment was performed with Next generation sequencing to V4 region of 16S rRNA. Surgical intervention and hormonal therapy altered gastrointestinal (GI), urogenital (UG) microbiomes, urinary estrogen and estrogen metabolite levels in P-EOSIS. At DOS, 17β-estradiol was enhanced in P-EOSIS treated with OCPs. At PSI, 16-keto-17β-estradiol was increased in P-EOSIS not receiving OCPs while 2-hydroxyestradiol and 2-hydroxyestrone were decreased in P-EOSIS receiving OCPs. GI bacterial α-diversity was greater for controls and P-EOSIS that did not receive OCPs. P-EOSIS not utilizing OCPs exhibited a decrease in UG bacterial α-diversity and differences in dominant taxa, while P-EOSIS utilizing OCPs had an increase in UG bacterial α-diversity. P-EOSIS had a strong positive correlation between the GI/UG bacteria species and the concentrations of urinary estrogen and its metabolites. These results indicate an association between microbial dysbiosis and altered urinary estrogens in P-EOSIS, which may impact disease progression.
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Affiliation(s)
- Nhung Le
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
| | - Melissa Cregger
- Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee, United States of America
- Department of Ecology and Evolutionary Biology, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Veronica Brown
- Division of Biology, University of Tennessee, Knoxville, Tennessee, United States of America
| | - Julio Loret de Mola
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
| | - Pamela Bremer
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
| | - Lyn Nguyen
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
| | - Kathleen Groesch
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
| | - Teresa Wilson
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
| | - Paula Diaz-Sylvester
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
| | - Andrea Braundmeier-Fleming
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
- * E-mail:
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Wessels JM, Domínguez MA, Leyland NA, Agarwal SK, Foster WG. Endometrial microbiota is more diverse in people with endometriosis than symptomatic controls. Sci Rep 2021; 11:18877. [PMID: 34556738 PMCID: PMC8460742 DOI: 10.1038/s41598-021-98380-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/02/2021] [Indexed: 02/08/2023] Open
Abstract
Endometriosis is a chronic, estrogen-dependent gynecological condition affecting approximately 10% of reproductive age women. The most widely accepted theory of its etiology includes retrograde menstruation. Recent reports suggest the uterus is not sterile. Thus, the refluxed menstrual effluent may carry bacteria, and contribute to inflammation, the establishment and growth of endometriotic lesions. Here, we compared and contrasted uterine bacteria (endometrial microbiota) in people with surgically confirmed presence (N = 12) or absence of endometriosis (N = 9) using next-generation 16S rRNA gene sequencing. We obtained an average of > 9000 sequence reads per endometrial biopsy, and found the endometrial microbiota of people with endometriosis was more diverse (greater Shannon Diversity Index and proportion of 'Other' taxa) than symptomatic controls (with pelvic pain, surgically confirmed absence of endometriosis; diagnosed with other benign gynecological conditions). The relative abundance of bacterial taxa enriched in the endometrial microbiota of people with endometriosis belonged to the Actinobacteria phylum (Gram-positive), Oxalobacteraceae (Gram-negative) and Streptococcaceae (Gram-positive) families, and Tepidimonas (Gram-negative) genus, while those enriched in the symptomatic controls belonged to the Burkholderiaceae (Gram-negative) family, and Ralstonia (Gram-negative) genus. Taken together, results suggest the endometrial microbiota is perturbed in people with endometriosis.
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Affiliation(s)
- Jocelyn M Wessels
- Department of Obstetrics & Gynaecology, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Miguel A Domínguez
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, 87000, Cd. Victoria, TAMPS, Mexico
| | - Nicholas A Leyland
- Department of Obstetrics & Gynaecology, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Sanjay K Agarwal
- Department of Reproductive Medicine, University of California San Diego, La Jolla, CA, 92037, USA
| | - Warren G Foster
- Department of Obstetrics & Gynaecology, McMaster University, Hamilton, ON, L8S 4K1, Canada.
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5
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Jiang I, Yong PJ, Allaire C, Bedaiwy MA. Intricate Connections between the Microbiota and Endometriosis. Int J Mol Sci 2021; 22:5644. [PMID: 34073257 PMCID: PMC8198999 DOI: 10.3390/ijms22115644] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 02/06/2023] Open
Abstract
Imbalances in gut and reproductive tract microbiota composition, known as dysbiosis, disrupt normal immune function, leading to the elevation of proinflammatory cytokines, compromised immunosurveillance and altered immune cell profiles, all of which may contribute to the pathogenesis of endometriosis. Over time, this immune dysregulation can progress into a chronic state of inflammation, creating an environment conducive to increased adhesion and angiogenesis, which may drive the vicious cycle of endometriosis onset and progression. Recent studies have demonstrated both the ability of endometriosis to induce microbiota changes, and the ability of antibiotics to treat endometriosis. Endometriotic microbiotas have been consistently associated with diminished Lactobacillus dominance, as well as the elevated abundance of bacterial vaginosis-related bacteria and other opportunistic pathogens. Possible explanations for the implications of dysbiosis in endometriosis include the Bacterial Contamination Theory and immune activation, cytokine-impaired gut function, altered estrogen metabolism and signaling, and aberrant progenitor and stem-cell homeostasis. Although preliminary, antibiotic and probiotic treatments have demonstrated efficacy in treating endometriosis, and female reproductive tract (FRT) microbiota sampling has successfully predicted disease risk and stage. Future research should aim to characterize the "core" upper FRT microbiota and elucidate mechanisms behind the relationship between the microbiota and endometriosis.
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Affiliation(s)
| | | | | | - Mohamed A. Bedaiwy
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of British Columbia, D415A-4500 Oak Street, Vancouver, BC V6H 3N1, Canada; (I.J.); (P.J.Y.); (C.A.)
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6
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Lee SR, Lee JC, Kim SH, Oh YS, Chae HD, Seo H, Kang CS, Shin TS. Altered Composition of Microbiota in Women with Ovarian Endometrioma: Microbiome Analyses of Extracellular Vesicles in the Peritoneal Fluid. Int J Mol Sci 2021; 22:ijms22094608. [PMID: 33925708 PMCID: PMC8124866 DOI: 10.3390/ijms22094608] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 12/17/2022] Open
Abstract
Human microbiota refers to living microorganisms which colonize our body and crucially contribute to the metabolism of nutrients and various physiologic functions. According to recently accumulated evidence, human microbiota dysbiosis in the genital tract or pelvic cavity could be involved in the pathogenesis and/or pathophysiology of endometriosis. We aimed to investigate whether the composition of microbiome is altered in the peritoneal fluid in women with endometriosis. We recruited 45 women with histological evidence of ovarian endometrioma and 45 surgical controls without endometriosis. Following the isolation of extracellular vesicles from peritoneal fluid samples from women with and without endometriosis, bacterial genomic DNA was sequenced using next-generation sequencing of the 16S rDNA V3–V4 regions. Diversity analysis showed significant differences in the microbial community at phylum, class, order, family, and genus levels between the two groups. The abundance of Acinetobacter, Pseudomonas, Streptococcus, and Enhydrobacter significantly increased while the abundance of Propionibacterium, Actinomyces, and Rothia significantly decreased in the endometriosis group compared with those in the control group (p < 0.05). These findings strongly suggest that microbiome composition is altered in the peritoneal environment in women with endometriosis. Further studies are necessary to verify whether dysbiosis itself can cause establishment and/or progression of endometriosis.
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Affiliation(s)
- Sa-Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.-R.L.); (J.-C.L.); (Y.-S.O.); (H.-D.C.)
| | - Jae-Chul Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.-R.L.); (J.-C.L.); (Y.-S.O.); (H.-D.C.)
| | - Sung-Hoon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.-R.L.); (J.-C.L.); (Y.-S.O.); (H.-D.C.)
- Correspondence: ; Tel.: +82-2-3010-3647; Fax: +82-2-476-7331
| | - Young-Sang Oh
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.-R.L.); (J.-C.L.); (Y.-S.O.); (H.-D.C.)
| | - Hee-Dong Chae
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.-R.L.); (J.-C.L.); (Y.-S.O.); (H.-D.C.)
| | - Hochan Seo
- MD Healthcare Inc., Seoul 121-270, Korea; (H.S.); (C.-S.K.); (T.-S.S.)
| | - Chil-Sung Kang
- MD Healthcare Inc., Seoul 121-270, Korea; (H.S.); (C.-S.K.); (T.-S.S.)
| | - Tae-Seop Shin
- MD Healthcare Inc., Seoul 121-270, Korea; (H.S.); (C.-S.K.); (T.-S.S.)
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Perrotta AR, Borrelli GM, Martins CO, Kallas EG, Sanabani SS, Griffith LG, Alm EJ, Abrao MS. The Vaginal Microbiome as a Tool to Predict rASRM Stage of Disease in Endometriosis: a Pilot Study. Reprod Sci 2020; 27:1064-1073. [PMID: 32046455 PMCID: PMC7539818 DOI: 10.1007/s43032-019-00113-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 09/09/2019] [Indexed: 12/21/2022]
Abstract
Endometriosis remains a challenge to understand and to diagnose. This is an observational cross-sectional pilot study to characterize the gut and vaginal microbiome profiles among endometriosis patients and control subjects without the disease and to explore their potential use as a less-invasive diagnostic tool for endometriosis. Overall, 59 women were included, n = 35 with endometriosis and n = 24 controls. Rectal and vaginal samples were collected in two different periods of the menstrual cycle from all subjects. Gut and vaginal microbiomes from patients with different rASRM (revised American Society for Reproductive Medicine) endometriosis stages and controls were analyzed. Illumina sequencing libraries were constructed using a two-step 16S rRNA gene PCR amplicon approach. Correlations of 16S rRNA gene amplicon data with clinical metadata were conducted using a random forest-based machine-learning classification analysis. Distribution of vaginal CSTs (community state types) significantly differed between follicular and menstrual phases of the menstrual cycle (p = 0.021, Fisher's exact test). Vaginal and rectal microbiome profiles and their association to severity of endometriosis (according to rASRM stages) were evaluated. Classification models built with machine-learning methods on the microbiota composition during follicular and menstrual phases of the cycle were built, and it was possible to accurately predict rASRM stages 1-2 verses rASRM stages 3-4 endometriosis. The feature contributing the most to this prediction was an OTU (operational taxonomic unit) from the genus Anaerococcus. Gut and vaginal microbiomes of women with endometriosis have been investigated. Our findings suggest for the first time that vaginal microbiome may predict stage of disease when endometriosis is present.
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Affiliation(s)
- Allison R Perrotta
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Giuliano M Borrelli
- Endometriosis Section, Gynecologic Division. Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Carlo O Martins
- Endometriosis Section, Gynecologic Division. Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Esper G Kallas
- Division of Clinical Immunology and Allergy. Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
| | - Sabri S Sanabani
- Laboratory of Dermatology and Immunodeficiency, Department of Dermatology, Tropical Medicine Institute of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Linda G Griffith
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Center for Gynephathology Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Eric J Alm
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute of MIT Cambridge, Cambridge, MA, USA
- Center for Microbiome Informatics and Therapeutics, MIT, Cambridge, MA, USA
| | - Mauricio S Abrao
- Endometriosis Section, Gynecologic Division. Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, São Paulo, São Paulo, Brazil
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Chadchan SB, Cheng M, Parnell LA, Yin Y, Schriefer A, Mysorekar IU, Kommagani R. Antibiotic therapy with metronidazole reduces endometriosis disease progression in mice: a potential role for gut microbiota. Hum Reprod 2019; 34:1106-1116. [PMID: 31037294 PMCID: PMC6554192 DOI: 10.1093/humrep/dez041] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/19/2019] [Accepted: 03/04/2019] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Does altering gut microbiota with antibiotic treatment have any impact on endometriosis progression? SUMMARY ANSWER Antibiotic therapy reduces endometriosis progression in mice, possibly by reducing specific gut bacteria. WHAT IS KNOWN ALREADY Endometriosis, a chronic condition causing abdominal pain and infertility, afflicts up to 10% of women between the ages of 25 and 40, ~5 million women in the USA. Current treatment strategies, including hormone therapy and surgery, have significant side effects and do not prevent recurrences. We have little understanding of why some women develop endometriosis and others do not. STUDY DESIGN, SIZE, DURATION Mice were treated with broad-spectrum antibiotics or metronidazole, subjected to surgically-induced endometriosis and assayed after 21 days. PARTICIPANTS/MATERIALS, SETTING, METHODS The volumes and weights of endometriotic lesions and histological signatures were analysed. Proliferation and inflammation in lesions were assessed by counting cells that were positive for the proliferation marker Ki-67 and the macrophage marker Iba1, respectively. Differences in faecal bacterial composition were assessed in mice with and without endometriosis, and faecal microbiota transfer studies were performed. MAIN RESULTS AND THE ROLE OF CHANCE In mice treated with broad-spectrum antibiotics (vancomycin, neomycin, metronidazole and ampicillin), endometriotic lesions were significantly smaller (~ 5-fold; P < 0.01) with fewer proliferating cells (P < 0.001) than those in mice treated with vehicle. Additionally, inflammatory responses, as measured by the macrophage marker Iba1 in lesions and IL-1β, TNF-α, IL-6 and TGF-β1 in peritoneal fluid, were significantly reduced in mice treated with broad-spectrum antibiotics (P < 0.05). In mice treated with metronidazole only, but not in those treated with neomycin, ectopic lesions were significantly (P < 0.001) smaller in volume than those from vehicle-treated mice. Finally, oral gavage of faeces from mice with endometriosis restored the endometriotic lesion growth and inflammation (P < 0.05 and P < 0.01, respectively) in metronidazole-treated mice. LARGE-SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION These findings are from a mouse model of surgically-induced endometriosis. Further studies are needed to determine the mechanism by which gut bacteria promote inflammation, identify bacterial genera or species that promote disease progression and assess the translatability of these findings to humans. WIDER IMPLICATIONS OF THE FINDINGS Our findings suggest that gut bacteria promote endometriosis progression in mice. This finding if translated to humans, could aid in the development of improved diagnostic tools and personalised treatment strategies. STUDY FUNDING AND COMPETING INTEREST(S) This work was funded, in part, by: a National Institutes of Health (NIH)/ National Institute of Child Health and Human Development (NICHD) grant (R00HD080742) to RK; Washington University School of Medicine start-up funds to RK; an Endometriosis Foundation of America Research Award to R.K.; and an NIH/NICHD grant (R01HD091218) to IUM. The authors report no conflict of interest.
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Affiliation(s)
- Sangappa B Chadchan
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis MO 63110, USA
- Center for Reproductive Health Sciences, Washington University School of Medicine, St Louis MO 63110, USA
| | - Meng Cheng
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis MO 63110, USA
- Center for Reproductive Health Sciences, Washington University School of Medicine, St Louis MO 63110, USA
| | - Lindsay A Parnell
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis MO 63110, USA
- Center for Reproductive Health Sciences, Washington University School of Medicine, St Louis MO 63110, USA
| | - Yin Yin
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis MO 63110, USA
- Center for Reproductive Health Sciences, Washington University School of Medicine, St Louis MO 63110, USA
| | - Andrew Schriefer
- Genome Technology Access Center, Washington University School of Medicine, St Louis MO 63110, USA
| | - Indira U Mysorekar
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis MO 63110, USA
- Center for Reproductive Health Sciences, Washington University School of Medicine, St Louis MO 63110, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis MO 63110, USA
| | - Ramakrishna Kommagani
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis MO 63110, USA
- Center for Reproductive Health Sciences, Washington University School of Medicine, St Louis MO 63110, USA
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Liu Y, Qiu C, Li W, Mu W, Li C, Guo M. Selenium Plays a Protective Role in Staphylococcus aureus-Induced Endometritis in the Uterine Tissue of Rats. Biol Trace Elem Res 2016; 173:345-53. [PMID: 26920733 DOI: 10.1007/s12011-016-0659-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/17/2016] [Indexed: 02/06/2023]
Abstract
The essential trace element selenium (Se) modulates the functions of many regulatory proteins in signal transduction, conferring benefits in inflammatory diseases. Endometritis is a reproductive obstacle disease both in humans and animals. Staphylococcus aureus is the major pathogen that causes endometritis. The present study analyzes the protection and mechanism of Se-methylselenocysteine (MSC) and methylseleninic acid (MSA) on S. aureus-induced endometritis. An atomic fluorescence spectrophotometry study showed that the uterine Se content increased with the addition of MSC and MSA. Histopathology observation and TUNEL detection showed that Se supplementation displayed a greater defense against uterine inflammatory damage. The quantitative PCR (qPCR) and ELISA analyses showed that the expressions of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) increased with S. aureus infection and decreased with the addition of MSC and MSA. The Toll-like receptor 2 (TLR2) expression showed the same status as the inflammatory cytokines. The Western blot results showed that the increased phosphorylation of IκBα and NF-κB p65 was also reduced by the addition of MSC and MSA. The qPCR and Western blot results also showed that the transcription expressions and the protein dissociation of caspase-9, caspase-3, caspase-7, caspase-6, and poly(ADP-ribose) polymerase (PARP), which were increased by S. aureus infection, were inhibited by Se supplementation. All of the results displayed that the protection conferred by MSC was stronger than MSA. The present study indicated the Se supplementation might be a potential prevention and control measure for S. aureus-induced endometritis.
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Affiliation(s)
- Yuzhu Liu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China
| | - Changwei Qiu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China
| | - Wenyu Li
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China
| | - Weiwei Mu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China
| | - Chengye Li
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China
| | - Mengyao Guo
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, 430070, People's Republic of China.
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Abstract
Endometriosis results from the ectopic invasion of endometrial glands and stroma in the peritoneal cavity. The exact etiology of endometriosis is still unknown. It has, however, been shown that there are higher numbers of Escherichia coli in menstrual blood, and higher endotoxin levels in menstrual fluid, as well as, in the peritoneal fluid of patients with endometriosis. In this study, we aimed to determine whether lower genital tract infections could increase the risk of endometriosis.We used the Taiwan National Health Insurance database to conduct a population-based cohort study. We included patients diagnosed with inflammatory diseases of the cervix, vagina, and vulva, and a control group comprising patients matched by age, sex, and comorbidities but without inflammatory diseases of the cervix, vagina, or vulva.A total of 79,512 patients were included in the inflammatory disease group and an equal number of control individuals were selected. The incidence of endometriosis (hazard ratio, 2.01; 95% confidence interval, 1.91-2.12; P < 0.001) was higher among patients than controls. Cox proportional hazards models showed that irrespective of comorbidities, lower genital tract infection was an independent risk factor for endometriosis.Patients with lower genital tract infections exhibit a substantially higher risk for developing endometriosis.
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Affiliation(s)
- Wu-Chou Lin
- From the Department of Obstetrics and Gynecology (W-CL, CY-YC, LW); School of Chinese Medicine (W-CL, Y-AH, LW); School of Medicine, China Medical University, Taichung (CY-YC); Institute of Molecular Medicine, National Tsing Hua University, Hsinchu (Y-AH); Management Office for Health Data, China Medical University Hospital (J-HC); Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University (J-HC) and Department of Biotechnology, Asia University (LW), Taichung, Taiwan
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Czarzasta J, Andronowska A, Jana B. Pro- and anti-inflammatory mediators change leukotriene B4 and leukotriene C4 synthesis and secretion in an inflamed porcine endometrium. Domest Anim Endocrinol 2014; 49:49-59. [PMID: 25010026 DOI: 10.1016/j.domaniend.2014.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 02/01/2023]
Abstract
We studied the effect of lipopolysaccharide (LPS), proinflammatory cytokines (tumor necrosis factor α [TNF-α] and interleukin [IL]-1β), and anti-inflammatory cytokines (IL-4 and IL-10) on leukotriene (LT) A4 hydrolase and LTC4 synthase (LTCS) protein expression in, and LTB4 and LTC4 secretion from, an inflamed porcine endometrium. On day 3 of the estrous cycle (day 0 of the study), 50 mL of either saline or Escherichia coli suspension (10(9) CFU/mL) was injected into each uterine horn of gilts (n = 12 per group). Endometrial explants, obtained 8 and 16 days later, were incubated for 24 h with LPS (10 or 100 ng/mL of medium), TNF-α, IL-1β, IL-4, and IL-10 (each cytokine: 1 or 10 ng/mL of medium). Although acute endometritis developed in all bacteria-inoculated gilts, a severe form of acute endometritis was diagnosed more often on day 8 of the study than on day 16. The amount of the LTA4 hydrolase (LTAH) protein in the inflamed endometrium on day 8 was greater after applying the lower dose of TNF-α (P < 0.001) and both doses of IL-1β (P < 0.001) and IL-4 (1 ng, P < 0.01 and 10 ng, P < 0.001) than in the saline-treated uteri. A similar situation was observed in the case of the inflamed tissue on day 16 in response to LPS (100 ng, P < 0.01), TNF-α (10 ng, P < 0.05), and IL-4 (1 ng, P < 0.001). The content of LTC4 synthase in the inflamed endometrium on day 8 was reduced by LPS (100 ng, P < 0.05), IL-1β (10 ng, P < 0.05), IL-4 (1 and 10 ng, P < 0.05), and IL-10 (1 ng, P < 0.01) but increased after the application of LPS (100 ng, P < 0.05) and TNF-α (1 and 10 ng, P < 0.001), IL-1β, and IL-4 (1 ng, P < 0.05 and 10 ng, P < 0.001) on day 16. On day 8, endometrial secretion of LTB4 from the saline-injected and E coli-injected organs was similar in response to all of the used mediators. On the other hand, the contents of LTB4 in the medium decreased after incubating the inflamed tissues from day 16 with TNF-α (1 ng, P < 0.05 and 10 ng, P < 0.01), IL-1β (1 ng, P < 0.01), and IL-10 (10 ng, P < 0.05) compared with the saline-treated ones. Secretion of LTC4 from the inflamed uteri on day 8 was elevated by the lower doses of TNF-α (P < 0.01) and IL-10 (P < 0.05), whereas on day 16, such an effect occurred in response to the higher doses of IL-4 (P < 0.01) and IL-10 (P < 0.05). The obtained results show that pro- and anti-inflammatory mediators participate in the synthesis/secretion of LTs from an inflamed porcine endometrium. Our data suggest that inflammatory mediators may indirectly affect the processes regulated by LTs by influencing LT production.
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Affiliation(s)
- J Czarzasta
- Division of Reproductive Biology, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, 10-748 Olsztyn, Poland
| | - A Andronowska
- Division of Reproductive Biology, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, 10-748 Olsztyn, Poland
| | - B Jana
- Division of Reproductive Biology, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, 10-748 Olsztyn, Poland.
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Urosevic M, Lako B, Milanov D, Urosevic I, Aurich C. Results of bacteriological and cytological examinations of the endometrium of subfertile mares in stud farms in Serbia. Berl Munch Tierarztl Wochenschr 2010; 123:365-368. [PMID: 21038807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Uterine microbiology, antimicrobial susceptibility and endometrial cytology were investigated in a total of 51 mares with fertility problems from 16 different stud farms in Serbia. Uterine cultures were performed after collection with a double guarded uterine swab, and endometrial cytology was evaluated after collection of endometrial cells with a special device (cytology brush). In 21 of 51 mares, at least one bacterial species was isolated from the uterus; the most frequent were Streptococcus equi subsp. zooepidemicus (13 isolates) and E. coli (four isolates). All isolates of Streptococcus equi subsp. zooepidemicus were susceptible to penicillin. Results from endometrial cytology were inconsistent; in 17 animals with positive bacteriological culture, cytology was not altered. It can be concluded that in Serbia, as in many other contries, Streptococcus equi subsp. zooepidemicus is the main cause for equine endometritis. It can be easily diagnosed by uterine culture but endometrial cytology does not always prove the existence of an endometrial infection with this agent.
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Chu YW, Wong CH, Chu MY, Cheung CPF, Cheung TKM, Tse C, Luk WK, Lo JYC. Varibaculum cambriense infections in Hong Kong, China, 2006. Emerg Infect Dis 2009; 15:1137-9. [PMID: 19624944 PMCID: PMC2744223 DOI: 10.3201/eid1507.081291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kodati VL, Govindan S, Movva S, Ponnala S, Hasan Q. Role of shigella infection in endometriosis: A novel hypothesis. Med Hypotheses 2008; 70:239-43. [PMID: 17888583 DOI: 10.1016/j.mehy.2007.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 06/13/2007] [Indexed: 10/22/2022]
Abstract
Endometriosis is the presence of endometrial cells and stroma at ectopic sites outside the uterine cavity. The natural history of endometriosis is uncertain, its etiology unknown, the clinical presentation inconsistent, diagnosis difficult and the treatment poorly standardized. It causes significant morbidity due to pelvic pain and infertility among 15-25% of women during their reproductive age. The benign disease causes peritoneal inflammation, fibrosis, adhesions and ovarian cysts but displays features of malignancy, like neo-vascularization, local invasion and distant metastasis. Mechanical, hormonal, immunological, environmental and genetic factors have been implicated in its etiology but provide inconclusive explanations. Present study was carried out on ectopic and eutopic endometriotic tissue specimens collected during laproscopy/laprotomy from cases of endometriosis. mRNA was isolated from the tissues and converted to cDNA by RT and subsequently subjected to differential display Polymerase Chain Reaction using seven sets of arbitrary primers. A unique band was identified only in the ectopic endometriotic tissue, which was sequenced. BLAST search results revealed sequence homology to shigella bacterial DNA leading us to hypothesize that infection may be playing a role in the etiology of endometriosis. This is the first report implicating the role of bacterial infection in the etiology of endometriosis. Shigella is known to invade the mucosa of the colon through the feco-oral route causing Shigellosis. The pathogenesis of shigellosis involves inflammation, ulceration, haemorrhage, tissue destruction and fibrosis of the colonic mucosa resulting in abdominal pain and diarrhoea/dysentery, this is similar to the pathogenesis of endometriosis which also involves inflammation, haemorrhage, tissue destruction and fibrotic adhesions of the pelvic peritoneum resulting in abdominal pain and infertility. The non-motile shigella bacteria invade the deeper mucosal layers by travelling from cell to cell of colonic epithelium, reaching the lamina propria of the colonic mucosa. We propose that, by the same mechanism, the bacteria travel across the colon wall to reach the outer peritoneal surface of the colon, which is in close proximity to the posterior uterine surface in the Pouch of Douglas, the site which incidentally happens to be the commonest site of early endometriosis. Our hypothesis therefore proposes that shigella or shigella-like organisms may be the trigger for the initiation of immunological changes in the pelvic peritoneum causing endometriosis. Once the endometrial cells are implanted at ectopic sites they are sustained by hormones and angiogenic factors. Hence "Infection hypothesis" provides a novel explanation for the etiopathogenesis of endometriosis.
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Affiliation(s)
- V L Kodati
- Vasavi Hospital, # 6-1-91 Khairtabad, Hyderabad, AP 500004, India.
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Kucharski J, Stefańczyk-Krzymowska S, Jana B. Absorption of proinflammatory cytokines from inflamed porcine uterus into the uterine venous blood--preliminary data. Pol J Vet Sci 2008; 11:9-16. [PMID: 18540202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aim of the present study was to estimate the absorption of 125I-labeled proinflammatory cytokines--interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) from inflamed porcine uterus into the uterine venous blood. Moreover, in order to test the hypothesis that the above cytokines penetrate directly into ovaries and oviduct via local destination transfer in the area of the ovarian vascular pedicle and bypassing the systemic circulation, the concentration of IL-1beta, IL-6 and TNF-alpha in ovarian and oviductal tissues was also studied. These cytokine concentrations were also estimated in the ovarian venous blood. IL-1beta, IL-6 and TNF-alpha from both control and inflamed uteri were absorbed into the uterine venous blood, but it was higher (P < 0.05-0.001) from the pathologically changed uteri. The uterine tissues, particularly the endometrium, of both control and inflamed uteri retained all studied cytokines, but to a higher degree (P < 0.001) in the inflamed uteri. Injections of IL-1beta, IL-6 and TNF-alpha into the control and inflammatory changed uteri produced the presence of these proteins in the ovary and oviduct. However, the concentrations of IL-1beta and IL-6 in the ovarian and oviductal tissues was low after injections of control and inflamed uteri with these cytokines. In turn, administration of TNF-alpha into the inflammatory changed uteri lead to an enhancement in the concentration of this cytokine in the ovarian parenchyma (P < 0.05) and oviduct (P < 0.001). All studied cytokines were found in the ovarian venous blood after their injection into both control and inflamed uteri, which indicated its local destination transfer to the ovary. However, the concentration of cytokines increased (P <0.05-0.001) in the gilts with pathologically changed uteri as compared to controls. The study showed that both control and inflamed porcine uteri absorbed IL-1beta, IL-6 and TNF-alpha into the uterine venous blood, but the values of absorbed cytokines from inflamed uteri were higher. Moreover, the quantity and the manner of the studied cytokineS absorption into the uterine venous blood differed.
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Affiliation(s)
- J Kucharski
- Division of Endocrinology and Pathophysiology, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Tuwima 10, 10-747 Olsztyn, Poland
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Cicinelli E, De Ziegler D, Nicoletti R, Colafiglio G, Saliani N, Resta L, Rizzi D, De Vito D. Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. Fertil Steril 2007; 89:677-84. [PMID: 17531993 DOI: 10.1016/j.fertnstert.2007.03.074] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 03/16/2007] [Accepted: 03/16/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the type and etiopathogenic role of infectious agents detected in endometrial cultures obtained from women with chronic endometritis (CE). DESIGN Prospective controlled study. SETTING University hospital. PATIENT(S) 2190 women undergoing hysteroscopy for different indications. INTERVENTION(S) Vaginal and endometrial samples were collected from 438 women with a CE diagnosis at hysteroscopy and 100 women with no signs of CE (controls). MAIN OUTCOME MEASURE(S) Histology and cultures for common bacteria, Neisseria gonorrhoeae and Mycoplasma, and molecular biology testing for Chlamydia were performed. RESULT(S) We compared results of vaginal and intrauterine cultures obtained from women with and without CE. Histologic results were positive in 388 of these cases (88.6%), and at least one microorganism was found in 320 endometrial samples (73.1%). In the control group, histologic results and endometrial culture were positive in only 6% and 5% of cases, respectively. The most frequent infectious agents detected at the endometrial level were common bacteria (58% of cases). Ureaplasma urealyticum was detected in 10% and Chlamydia in only 2.7% of positive endometrial cultures. In only 143 (32.6%) cases were the same infectious agent isolated in endometrial and vaginal cultures. CONCLUSION(S) More than 70% of CE cases resulted from nongonococcal, nonchlamydial infections. Common bacteria and Mycoplasma were the most frequent etiologic agents. Vaginal cultures have low concordance with endometrial cultures.
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Affiliation(s)
- Ettore Cicinelli
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Bari, Bari, Italy.
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Wang CN, Lai CH, Hsueh S, Chou HH. Ovarian endometrioma complicated by a Salmonella abscess caused by an enteroovarian fistula: a case report. J Reprod Med 2005; 50:871-3. [PMID: 16419639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Salmonella infection occurs primarily in the gastrointestinal tract but may also be found at extraintestinal locations. An ovarian abscess caused by Salmonella is one of the rare extraintestinal infections, and hematogenous spread by bacteremia to a preexisting ovarian cyst has been suggested as the cause of such infections. CASE A 43-year-old woman presented with diarrhea, fever and an ovarian tumor and was treated initially with antibiotics for Salmonella bacteremia, followed by an exploratory laparotomy due to persistent fever and progressive toxic signs. A pus-containing endometrioma with a thick wall densely adhering to an intestinal segment, with a fistula connecting the 2, was found during surgery. The patient underwent a salpingo-oophorectomy and resection of the intestinal segment, took antibiotics and recovered. Bacterial culture of the abscess showed salmonellosis, and pathology reported a fistula between the ovarian tumor and intestine, suggesting that direct spread through a fistula may be one of the causes of extraintestinal Salmonella infections. CONCLUSION Salmonella infection located in the ovary is a rare condition, often caused by bacteremia. To the best of our knowledge, this is the first report of an ovarian Salmonella abscess that occurred through a fistula.
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Affiliation(s)
- Chao-Nin Wang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
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Debattista J, Gazzard CM, Wood RN, Allan JA, Allan JM, Scarman A, Mortlock M, Timms P, Knox CL. Interaction of microbiology and pathology in women undergoing investigations for infertility. Infect Dis Obstet Gynecol 2005; 12:135-45. [PMID: 15763913 PMCID: PMC1784600 DOI: 10.1080/10647440400020703] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Cases of endometriosis with no tubal damage are associated with infertility, suggesting an immunological rather than mechanical barrier to reproduction. Laparoscopy and falloposcopy results of clinically asymptomatic women undergoing investigation of infertility were correlated with the outcomes of microbiological screening for Chlamydia trachomatis, Mycoplasma pneumoniae, Mycoplasma hominis, ureaplasma species, Neisseria gonorrhoeae, Neisseria meningitidis and Chlamydia pneumoniae. METHODS: A total of 44 women presenting to a hospital IVF service for laparoscopic or laparoscopic/falloposcopic investigation of infertility provided endocervical swabs, fallopian tube washings, and peripheral whole blood for analysis. RESULTS: Of these 44 women, 15.9% (7) showed evidence of C. trachomatis infection as detected by either PCR or EIA serology. Of these 7 women, 5 (71%) had no or mild endometriosis and 2 (29%) had moderate or severe endometriosis. Of the remaining 37 women who showed no evidence of chlamydial infection, 15 (40.5%) had no or mild endometriosis. CONCLUSION: Women with infertility, but without severe endometriosis at laparoscopy, showed a trend towards tubal damage and a higher rate of previous C. trachomatis infection. Although not statistically significant, this trend would suggest that, where moderate to severe tubal damage is found to be the primary cause of infertility, C. trachomatis infection could be a likely cause for such tubal damage.
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Affiliation(s)
- Joseph Debattista
- Sexual Health and AIDS Service, Prince Charles Hospital, Health Service District, Brisbane, Australia.
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Clayton RD, Duffy SR, Wilkinson N, Garry R, Jackson AM. Anti-Proliferative Effect of Mycobacteria, IFN-γ and TNF-α on Primary Cultures Derived from Endometrial Stroma: Possible Relevance to Endometriosis? Am J Reprod Immunol 2004; 51:63-70. [PMID: 14725567 DOI: 10.1046/j.8755-8920.2003.00114.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PROBLEM To assess the effects of mycobacteria and inflammatory cytokines on proliferation of endometrial stromal cells. An effect on endometrial stromal cell proliferation in vitro may suggest a similar effect on endometriotic cells in vivo. METHOD OF STUDY Primary cultures of endometrial stromal cells were grown from female volunteers. Proliferation of cells was assessed by cell counting and incorporation of tritiated thymidine after exposure to mycobacteria or inflammatory cytokines. RESULTS When assessed by cell counting, stromal cell growth was reduced following treatment with Connaught Bacillus of Calmette and Guérin (BCG) and Pasteur BCG: Mycobacterium smegmatis demonstrated a cytotoxic effect. Addition of the cytokines interferon (IFN)-gamma or tumour necrosis factor (TNF)-alpha at high concentrations led to a reduction in cell growth by 24 hr in two of three cell lines. A reduction in proliferation was also found when assessed by tritiated thymidine incorporation, which was statistically significant for Connaught BCG and M. smegmatis. CONCLUSIONS Endometrial stromal cells are susceptible to the anti-proliferative effects of mycobacteria. The BCG and other mycobacteria are known immunomodulators in other disease conditions. Further work is required to assess whether these in vitro effects might translate into a useful therapy for endometriosis.
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Affiliation(s)
- R D Clayton
- Applied Immunology Laboratory, Cancer Research UK Clinical Centre, St James's University Hospital, Leeds, UK.
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Abstract
OBJECTIVE Investigation of the clinical significance of Ureaplasma urealyticum and its biovars in the development of postpartum endometritis. STUDY DESIGN Cervical swabs were cultured for U. urealyticum in women presenting endometritis. The positive U. urealyticum cultures (>10(5) cfu/ml) (study group) were compared with those from women without endometritis (control group). Anti-Ureaplasma antibodies were measured and U. urealyticum biovars were determined by polymerase chain reaction. RESULTS There was no difference between the prevalence of U. urealyticum in the cervical swabs of both groups, however, the number of cfu per culture, showed a significant difference between study and control groups. Out of the culture positive endometritis patients 39% (26/67) had >10(5) cfu/ml compared to 17% of control patients (5/30) P=0.03. No significant disparity between both the groups was found in the prevalence of the parvo biovar (77% versus 71.5%, respectively). The difference in anti-Ureaplasma antibodies reached no statistical significance (30% versus 18% in study and control groups, respectively). CONCLUSIONS The significant difference in U. urealyticum culture cfu between both groups suggests that U. urealyticum may play a role in the etiology of this infection. This involvement is dependent not only on the presence or absence of U. urealyticum in the culture, but on its colonization rate in the cervix (>10(5) cfu/ml).
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Affiliation(s)
- Walter Chaim
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, PO Box 151, Beer-Sheva 84101, Israel.
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Abstract
BACKGROUND The intestinal microflora provide a strong defence against intestinal pathogens, and may be altered in inflammatory conditions that impact the gut, such as endometriosis. Therefore, intestinal bacteria shed from rhesus monkeys with endometriosis were compared with age-matched healthy controls. A second study assessed the prevalence of intestinal inflammation in female monkeys to determine whether endometriosis is associated with an increased likelihood of intestinal inflammation. METHODS Differential and selective agars were used to enumerate total and Gram-negative aerobic and facultatively anaerobic bacteria, as well as Lactobacilli, from female monkeys with or without endometriosis. In addition, the prevalence of intestinal inflammation in monkeys with or without endometriosis was determined in a retrospective analysis of necropsy reports. RESULTS Monkeys with endometriosis had a significantly different profile of shed microflora. Endometriosis was associated with lower Lactobacilli concentrations and higher Gram-negative bacteria concentrations. Moreover, there was a higher prevalence of intestinal inflammation in monkeys with endometriosis in comparison to healthy controls. CONCLUSIONS Endometriosis is associated with an altered profile of intestinal microflora in rhesus monkeys. Although the exact mechanisms linking endometriosis and the microflora are unknown, it is possible that the microflora were affected by endometriosis-associated intestinal inflammation.
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Affiliation(s)
- Michael T Bailey
- University of Wisconsin, Harlow Center for Biological Psychology, 22 N. Charter Street, Madison, WI 53715, USA.
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Abstract
OBJECTIVE To assess whether the rate of bacterial vaginosis (BV) is higher in women with tubal factor infertility compared with those with other causes of infertility. DESIGN Cross-sectional study. SETTING Assisted conception unit of a teaching hospital in Leeds. POPULATION Consecutive women undergoing in vitro fertilisation. METHODS Women undergoing in vitro fertilisation (IVF) had a vaginal smear taken at the time of their egg collection. The smear was Gram-stained and graded as normal, intermediate or BV. MAIN OUTCOME MEASURES The presence of bacterial vaginosis and the causes of infertility. RESULTS A total of 749 women were included. The vaginal smears were normal in 63.6%, intermediate in 12.1%, and BV in 24.3%. The rates of BV in women with different types of infertility were 36.4% in tubal factor, 15.6% in male factor, 33.3% in anovulation, 12.5% in endometriosis and 18.9% in unexplained infertility. After controlling for the effects of age and smoking using a multivariate logistic regression model, women with tubal infertility were significantly more likely to have BV than women with endometriosis OR 3.63 (95% CI 1.52-8.67); male factor OR 2.98 (95% CI 1.80-4.90); and unexplained infertility OR 2.20 (95% CI 1.35-3.59). The adjusted figures for the increase of BV in women with anovulation were: endometriosis OR 3.77 (95% CI 1.28-11.08); male factor OR 3.09 (95% CI 1.37-6.96); and unexplained infertility OR 2.29 (95% CI 1.02-5.12). CONCLUSIONS Women with tubal infertility were three times more likely to have BV than women with endometriosis, male factor or unexplained infertility. These findings support the association between BV, pelvic inflammatory disease (PID) and tubal damage but do not help distinguish between cause and effect. Women with anovulation were also three times more likely to have BV than women with endometriosis or male factor infertility, supporting suggestions of hormonal influence on vaginal flora.
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Aleksandrov VP, Baskakov VP, Semeniuk AA. [Diagnosis and treatment of upper urinary tract infection in women as a postoperative complication for treating genital endometriosis]. Urologiia 2002:30-1. [PMID: 12077819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
156 women operated on for genital endometriosis received treatment for infection of the upper urinary tracts diagnosed by ultrasound. The treatment was conducted only in case of normal urodynamics achieved by drainage (on demand) and comprised antibacterial therapy, efferent hemocorrection, intravascular laser irradiation of blood, hyperbaric oxigenation. A response was obtained in 98% patients.
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Szymański W, Zielińska I. [Application of IVF in women with endometriosis]. Ginekol Pol 2001; 72:273-7. [PMID: 11526756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Application of IVF at women with endometriosis after pharmacological and surgical therapy hold out hopes to possession of child. Endometriosis occurs three times more often in the patients with primary sterility than in patients with secondary sterility. The presence of a small endometriosis does not reduce the success of the IVF therapy. The women with endometriosis who undergo IVF treatment have similar prospect in compensate with women with tubal sterility. IVF improve fertility in women with mild or minimal endometriosis. But at women after IVF the presence of endometriomas is associated with increased rates of early pregnancy losses. Women with endometriosis marking often antinuclear antibodies and antiphospholipid antibodies than women without endometriosis. To evaluate the 15% of infertile women have endometriosis.
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Affiliation(s)
- W Szymański
- Katedry i Klinika Połoznictwa i Chorób Kobiecych AM w Bydgoszczy
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26
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Shaikh MA, Sadiq S, Noorani K. Adenomyosis with tuberculosis of uterus. J PAK MED ASSOC 2001; 51:47-8. [PMID: 11256000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- M A Shaikh
- Department of Pathology, B.M.S.I, Jinnah Postgraduate Medical Centre, Karachi
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Guerra-Infante FM, Flores-Medina S, López-Hurtado M, Zamora-Ruíz A, Sosa González IE, Villagrana Zesatti R, Narcio Reyes ML, Castelazo Morales E. [Determination of the tumor necrosis factor in the peritoneal fluid of gynecologic patients with intraperitoneal infections and endometriosis]. Ginecol Obstet Mex 1999; 67:221-6. [PMID: 10363425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Tumor necrosis factor (TNF-alpha) is a cytokine which can be found in peritoneal fluid (PF) of patients with endometriosis and pelvic inflammatory disease (PID) as a response of inflammatory disorder and infections diseases. The cytotoxic effect of this cytokine could be participating in the pathology of different gynecologic problem and be accountable of the high immunological response and damage on the tubal epithelium. The objective of this study was determinate the presence of TNF-alpha in PF of endometriosis patients, fallopian tube occlusion (FTO) and PID and their correlation with different isolated bacteria. Ten mililiter PF were collected and cultured in antificial medium and Mc Coy culture cells for isolation of acrobic, and anaerobic bacteria and Chlamydia trachomatis from 73 patients by laparoscopy. The TNF-alpha activity was determined by L-929 cells endometriosis, 30 PID and 4 had miomas and adherences. The 50.7% of patients were cultive positive, fom these, 31.5% were PID. Chlamydia trachomatis (16%) was the most frecuenty isolated bacteria in these patients. 59.4% of FTO patients displayed TNF-alpha activity. However, only 4% showed positive isolation, in conclusion the detection of TNF-alpha could be useful in active infectious and inflammatory diseases in patients which not present simptomatologic characteristic of these illnesses and plus being attended at for sterility clinical as a result of their incapacity to get pregnant.
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Affiliation(s)
- F M Guerra-Infante
- Departamento de Infectología, Insituto Nacional de Perinatología Mex. D.F
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28
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Liu Z, Lang J, Huang R, Li B, Zhang L. [Secondary infection of the ovarian endometriotic cysts]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 1998; 20:49-53. [PMID: 11367734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To explore the clinic manifestations, diagnostic methods and principles of management in the secondary infection of the endometriotic cysts of ovary. METHODS Thirteen cases of the infected ovarian endometriotic cysts were analysed retrospectively in our hospital from Jan. 1990 to Dec. 1996. The diagnosis was confirmed by the operation and pathologic findings. RESULTS The clinic manifestations were divided into five types, namely acute, subacute, chronic, occult and stabile types. The definitive diagnosis can be made by abdominal pain, fever and adnexal mass combined with B-scan findings and chocolate-brown purulent fluid which was punctured from the adnexal mass. Operation was the main method for treatment. CONCLUSIONS Secondary infection of the endometriotic cyst is one of the gynecologic emergency. Correct diagnosis and prompt management are of vital importance.
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Affiliation(s)
- Z Liu
- PUMC Hospital, CAMS and PUMC, Beijing 100730
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29
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Marana R, Paielli FV, Muzii L, Dell'Acqua S, Mancuso S. [The role of laparoscopy in the evaluation of chronic pelvic pain]. Minerva Ginecol 1993; 45:281-286. [PMID: 8355882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Chronic pelvic pain, defined as cyclic or acyclic pain reported for a minimum of six months, is one of the most common gynecological symptoms and one of the most important in terms of social costs. From January 1987 to December 1991, 127 patients suffering from chronic pelvic pain were submitted to diagnostic laparoscopy at the Department of Obstetrics and Gynecology of the Università Cattolica del Sacro Cuore in Rome. The mean age of the patients was 30 years, ranging from 14 to 46. All patients were submitted to bimanual pelvic examination upon hospital admission, and most of them (No. = 99, 78%) to pelvic ultrasonographic examination. In 117 patients (92%) samples for the isolation of Chlamydia trachomatis in 5-iodo-2-deoxiuridine treated McCoy cell cultures were obtained from the cervix, the endometrium and the cul-de-sac peritoneal fluid. At laparoscopy, in 25 patients (20%) the exam showed normal pelvic anatomy, whereas in 102 patients (80%) some pelvic pathology was found. The most frequent conditions observed were: pelvic adhesions in 55% (No. = 70), endometriosis in 29% of the cases (No. = 37), and other pathologies (non-endometriotic ovarian cysts, hydrosalpinges, myomas, etc.) in 25% of the cases (No. = 32). At the comparison of bimanual examination and laparoscopic findings, out of 71 patients with normal findings at bimanual examination, 75% (No. = 53) were found to have abnormal findings at laparoscopy; out of 55 patients with abnormal bimanual examination, 11% (No. = 6) were found to have normal laparoscopic findings.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Marana
- Istituto di Clinica Ostetrica e Ginecologia, Università Cattolica del Sacro Cuore, Roma
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30
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Fahmy NW, Honoré LH, Cumming DC. Subacute focal endometritis. Association with cervical colonization with ureaplasma urealyticum, pelvic pathology and endometrial maturation. J Reprod Med 1987; 32:685-7. [PMID: 3668966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Subacute focal endometritis (SFE) has been associated with cervical Ureaplasma urealyticum colonization and is considered a significant indicator of pelvic adhesions or endometriosis. A retrospective analysis was performed comparing cervical isolation rates, endometrial maturation patterns and laparoscopic findings in 64 patients with SFE and in a control group of 70 unselected patients with no histologic evidence of SFE at endometrial biopsy. The data suggest that although the prevalence of pelvic damage of various types is high, SFE cannot be used as a reliable marker for pelvic adhesions or endometriosis; that SFE does not interfere with normal endometrial maturation; and that SFE is not invariably associated with cervical U urealyticum but may represent resolving infection. It is also possible that SFE represents endometrial autoimmunity either following mycoplasma infection or arising spontaneously.
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Affiliation(s)
- N W Fahmy
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Canada
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31
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Tsunoda H, Usuki S, Iwasaki H, Miyoshi Y, Ichikawa M. [Studies on the etiology of infectious disease of female internal genitalia - bacterial flora in the female genitalia and surrounding tissues]. Nihon Sanka Fujinka Gakkai Zasshi 1983; 35:437-45. [PMID: 6343530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The present studies were carried out to clarify the indigenous bacterial flora in the female internal genitalia and surrounding tissues and the pathogenesis of parametritis. Twenty nine patients with uterine tumors which consisted of sixteen carcinomas and thirteen benign tumors underwent abdominal total hysterectomies. Each tissue aseptically collected from the uterus and adnexae was cultured for 48 hours under aerobic or anaerobic conditions and the bacterial species were isolated and identified. In benign uterine tumors, anaerobic bacteria were isolated in six patients and aerobic or anaerobic bacteria were identified In the endometrium, fallopian tube and parametrium of five of the patients. In a group of carcinoma in situ (stage 0), many bacteria were isolated in two patients after conization. In the uterine carcinomas, as the stage advanced, the rate of bacterial isolation from parametrium and lymph node became higher. The rate of anaerobic bacterial isolation, except for one from the vagina, was nine out of sixteen patients with carcinomas but three out of thirteen patients with benign tumors. The results revealed that the bacterial flora in the vagina spread to the internal genital organ and surrounding tissues via the ascending or cervical lymphatic pathway and remained there as nonpathologically indigenous bacterial flora. These results suggest that these indigenous bacterial flora in the internal genitalia and the surrounding tissue may cause an opportunistic infection.
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Abstract
Haemophilus influenzae was isolated in pure or predominant culture from genital specimens from nine females and two males. Four of the females had vaginitis, two had IUD-related endometritis, one had an incomplete septic abortion, and one had probable urethral syndrome. Two males had urethritis.
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Sahu SP, Wool S, Breese SS. Observation on the morphology of contagious equine metritis bacterial colonies isolated from infected pony mares. Am J Vet Res 1982; 43:796-800. [PMID: 7091842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In uterine or cervical specimens obtained from pony mares infected with streptomycin-resistant contagious equine metritis bacteria, several colonies of the bacteria which differed in morphologic characteristics were recognized during their primary isolation on Eugon chocolate agar and tryptose chocolate agar plates. The differences were usually not observed until plates were incubated 10 to 15 days. On Eugon chocolate agar plates, smooth colony, sandy colony with rings, and colony with blebs were recognized. On tryptose chocolate agar plates, only a round smooth convex colony was observed. By scanning electron microscopy, colonies consisted of coccal, coccobacillary, and bacillary forms. Only one type of colony was isolated from any mare.
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DiGiacomo RF, Hooks JJ, Sulima MP, Gibbs CJ, Gajdusek DC. Pelvic endometriosis and simian foamy virus infection in a pigtailed macaque. J Am Vet Med Assoc 1977; 171:859-61. [PMID: 200594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pelvic endometriosis and simian foamy virus infection occurred in a pigtailed macaque. Diffuse omental, peritoneal, and intestinal implantation of endometrium resulted in massive adhesions between adjacent abdominal and pelvic viscera, with formation of a large mass in the right caudal quadrant of the abdomen. Simian foamy virus type 1 was isolated from ectopic endometrium and from the uterine wall but was considered to be merely epiphenomenal.
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