Cases reported "Endometritis"

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1/11. Postpartum herpes simplex endometritis. A case report.

    BACKGROUND: herpes simplex virus (HSV) can cause postpartum endometritis. The clinical diagnosis of HSV endometritis has been reported previously. The disease is responsive to acyclovir intravenously. CASE: A 22-year-old woman, gravida 2, para 1, status post primary cesarean section for a double footling breech presentation, developed a persistent postpartum fever. Simulating the febrile course of septic pelvic thrombophlebitis, the patient's condition was unresponsive to broad-spectrum antimicrobials and heparin therapy. Active herpetic lesions and a positive cervical culture for herpes simplex prompted the use of intravenous acyclovir. Rapid resolution of the fever and the similarity to previous case reports suggested the clinical diagnosis of herpes simplex endometritis. CONCLUSION: The diagnosis of postpartum herpes simplex endometritis should be considered when managing a persistent postpartum fever unresponsive to aggressive antimicrobial and heparin therapy. Immediate resolution of the fever should occur with the use of acyclovir.
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2/11. cytomegalovirus endometritis: report of a case associated with spontaneous abortion.

    Maternal cytomegalovirus infection is a relatively common, yet very often silent complication of pregnancy. The association between early gestational wastage and cytomegalovirus endometritis has been documented in recent tissue culture studies without the morphologic demonstration of the virus. This case study presents the clinical and pathologic findings of a young, secundigravida female with cytomegalovirus endometritis and spontaneous abortion. The intranuclear inclusions were restricted to the endometrial glands; Involvement of the endocervix by cytomegalovirus has been the only site in the female reproductive tract, excluding fetal tissues, affected by this virus which has been demonstrated histologically. The data are still incomplete regarding the etiologic role, if any, of cytomegalovirus and the occurrence of spontaneous abortion.
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3/11. Uterine herpes virus infection with multifocal necrotizing endometritis.

    A case of herpes simplex virus (HSV) infection was diagnosed by biopsy of the cervix and endometrium in a 28-year-old woman with abnormal uterine bleeding. The cervical biopsy demonstrated surface ulceration and underlying patchy necrosis of endocervical clefts and stroma. The endometrium was late secretory, with striking patchy necrosis of gland epithelium and stromal cells. Both sites contained occasional epithelial and stromal cells with nuclear inclusions consistent with HSV infection. Viral culture further confirmed the presence of HSV. immunohistochemistry demonstrated the presence of HSV antigens in the tissue, and ultrastructural study of the endometrium revealed viral particles within epithelial and stromal cells. The results suggest endometrial involvement via an ascending infection from the cervix. Recognition of this unusual pattern of endometrial inflammation may facilitate diagnosis of additional cases.
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4/11. Isolation of gardnerella vaginalis in pure culture from the uterine cavity of patients with irregular bleedings.

    hysterectomy was performed in three patients because of persistent irregular vaginal bleeding. Before the operation samples were taken from the cervical os for cultivation of gardnerella vaginalis, yeasts, viruses, chlamydia trachomatis, and aerobic and anaerobic bacteria. Immediately after the operation, the uterus was opened under sterile conditions and samples obtained from the isthmus and fundus of the uterine cavity were examined microbiologically. In all three patients G. vaginalis was grown in pure culture from the fundus. serum antibody titres against G. vaginalis were significantly raised in all three patients, and histology revealed mononuclear cells in the endometrium. The isolation of G. vaginalis from the endometrium of patients with clinical and histological signs of inflammation and with antibodies to G. vaginalis in serum indicates that the organism may play a causative role in endometritis.
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5/11. coccidioidomycosis of the female genital tract.

    female genital tract involvement is a rare manifestation of disseminated coccidioidomycosis; to our knowledge, only ten patients have previously been described in the English literature. We describe a patient who seems to be unique in that she developed female genital tract coccidioidomycosis and coccidioidal peritonitis after chemotherapy for Hodgkin's disease. coccidioidomycosis of the female genital tract is usually manifest as granulomatous endometritis and/or granulomatous tubo-ovarian disease with peritonitis. The diagnosis of coccidioidomycosis was unsuspected clinically in all 11 reported cases (including our patient); initial diagnosis was made by biopsy or culture in all 11 patients. In eight of the reported cases of female genital tract coccidioidomycosis (including our patient), clinical improvement occurred after treatment with surgery or antifungal chemotherapy; three patients died of disseminated coccidioidomycosis.
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6/11. Short-term failure of IUD removal to alter bacterial flora in a patient with chronic anaerobic endometritis.

    A patient with cytological and clinical evidence of IUD-associated anaerobic endometritis was studied with quantitative and qualitative bacteriological techniques. With the exception of elimination of actinomyces israelii from the deep endocervical/endometrial culture, IUD removal induced minimal qualitative changes in the bacterial flora of the endocervical/endometrial sample during the 35 days the patient was monitored. The interposition of menstruation did not significantly alter either the quantitative or qualitative interrelationship of the bacteria present.
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7/11. Maternal sepsis, uterine rupture and coagulopathy complicating cervical cerclage.

    A previously healthy woman with a Shirodkar cerclage for cervical incompetence had a spontaneous rupture of the membranes at the 37th week of pregnancy. Three days later after a short period of weak labor pains, she developed a severe sepsis, uterine rupture and coagulopathy leading to renal failure, beta-hemolytic streptococcus group B and peptostreptococcous could be cultured from the amniotic fluid immediately after rupture of the membranes and from the uterus and placenta.
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8/11. Severe pelvic infection from chlamydia trachomatis after cesarean section.

    A severe pelvic infection developed in a 17-year-old primigravida after a cesarean section. Multiple antibiotics were administered for presumed mixed aerobic and anaerobic infections, without improvement. Subsequently, total hysterectomy and bilateral salpingo-oophorectomy were performed. Despite negative standard cultures, her condition continued to deteriorate and she required two more exploratory laparotomies for suspected intra-abdominal abscesses. Chlamydia trachomatis and, subsequently, candida albicans were recovered from cultures of peritoneal fluid obtained after the third operation. Serological tests confirmed the presence of acute chlamydial infection. Marked clinical improvement occurred after doxycycline hyclate administration. Although genitourinary and acute pelvic inflammatory diseases due to chlamydiae have been reported previously, no case of severe pelvic infection due to this agent after cesarean section had been described, to our knowledge. Specimens should be studied specifically for chlamydiae when standard cultures demonstrate no pathogens in women suffering from documented pelvic infection.
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9/11. endometritis caused by chlamydia trachomatis.

    chlamydia trachomatis was found to be the aetiological agent of endometritis in three women with concomitant signs of salpingitis. All patients developed a significant antibody response to the organism. Chlamydia were recovered from aspirated uterine contents of two patients and darkfield examination of histological sections showed chlamydial inclusions in endometrial cells in one patient. Thus, C trachomatis can be recovered from the endometrium of patients in whom the cervical culture result is negative. In one patient curettage showed endometritis with a characteristic plasma-cell infiltration. The occurrence of chlamydial endometritis may explain why irregular bleeding is a common finding in patients with salpingitis. It also suggests a canalicular spread of chlamydia from the cervix to the fallopian tubes.
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10/11. endometritis related to chlamydia trachomatis infection.

    A 23-year-old woman had endometritis due to chlamydia trachomatis infection. chlamydia trachomatis was cultured from endometrial tissue obtained by biopsy, and elevated levels of serum antibodies, including IgM antibodies, to C. trachomatis were found. Cervical secretions were also positive for antibody. After treatment with tetracycline, endometrial cultures for C. trachomatis were negative and endometrial inflammation disappeared. chlamydia trachomatis has been implicated in salpingitis, cervicitis, urethritis, and peritonitis, This case shows that endometritis may also result from C. trachomatis infection and in such instances may be a contributing factor in infertility.
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