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Acute Pelvic Inflammatory Disease


Presentation

  • All three patients presented with an acute abdomen, fever and elevated white blood cell count. Our experience suggests that PID following tubal sterilization is more common than previously described and can present a diagnostic dilemma.[ncbi.nlm.nih.gov]
  • BACKGROUND: Recurrent acute episodes of pelvic inflammatory disease (PID) often present a diagnostic dilemma.[ncbi.nlm.nih.gov]
  • Endocervical Neisseria gonorrhoeae was present in 62% of the PID group and 10% of the FPC group (P less than 0.0001). One-third of N. gonorrhoeae isolates were penicillinase-producing strains.[ncbi.nlm.nih.gov]
  • Abstract A preliminary report of 50 cases of acute pelvic inflammatory disease (PID) studied at the Kenyatta National Hospital to find out the role of chlamydia trachomatis in its aetiology is presented. Endocervical swab cultures were done.[ncbi.nlm.nih.gov]
  • The sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, are present in many cases, and microorganisms comprising the endogenous vaginal and cervical flora are frequently associated with PID.[ncbi.nlm.nih.gov]
Fever
  • Treatment with colchicine for suspected familial Mediterranean fever resulted in resolution of symptoms.[ncbi.nlm.nih.gov]
  • All three patients presented with an acute abdomen, fever and elevated white blood cell count. Our experience suggests that PID following tubal sterilization is more common than previously described and can present a diagnostic dilemma.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: A possible explanation for the association of APID with higher risk for cardiovascular CA is the high fever of APID, but this signal finding needs confirmation. Copyright 2008 Wiley-Liss, Inc.[ncbi.nlm.nih.gov]
  • The most frequent signs and symptoms were abnormal vaginal discharge (100%), adnexal tenderness (97.1%), cervical motion tenderness (94.3%) and fever 38.3 degrees C (82.9%).[ncbi.nlm.nih.gov]
  • PID IUD use Iatrogenic procedures: Endometrial biopsy, Uterine curettage, Hysterosalpingography Protective Factors: Contraceptive: OCPs and Barrier methods Menopausal, pregnant with monogamous partner Symptoms: Lower abdominal and pelvic pain (dull) Fever[medchrome.com]
Malaise
  • I had severe menstrual irregularities, fevers, bleeding between periods, bleeding after intercourse, pains, and general malaise. Several times I was treated with antibiotics, which brought only some temporary relief.[ourbodiesourselves.org]
Atrial Septal Defect
  • However, of 12 CA groups evaluated, APID was associated with a higher risk only for cardiovascular CAs (adjusted prevalence OR with 95% CI: 2.6, 1.2-5.4) and the observed number of cases with atrial septal defect, type II with maternal APID exposure exceeded[ncbi.nlm.nih.gov]
Abdominal Pain
  • An optimal set of PID indicators consisted of adnexal tenderness, lower abdominal pain of one week's duration and an elevated white blood cell count.[ncbi.nlm.nih.gov]
  • Eighty-five women presenting with the chief complaint of lower abdominal pain were entered into the study; all patients were examined by one of the principal investigators.[ncbi.nlm.nih.gov]
  • A total of 190 women of reproductive age (age range, 16-49 years; mean age, 29.3 7.6 years) with complaints of non-traumatic acute lower abdominal pain underwent subsequent abdominopelvic CT.[ncbi.nlm.nih.gov]
  • PURPOSE: To construct a decision tree based on CT findings to differentiate acute pelvic inflammatory disease (PID) from acute appendicitis (AA) in women with lower abdominal pain and inflammatory syndrome.[ncbi.nlm.nih.gov]
  • CONCLUSION: Diagnostic morphological CT findings in women with clinically proven PID and acute abdominal pain include hepatic capsular enhancement on late arterial phase and tubal thickening.[ncbi.nlm.nih.gov]
Pelvic Mass
  • mass (in the setting of a tuboovarian abscess), cervical excitation tenderness on bimanual examination All women presenting with symptoms and/or signs suggestive of PID should have a pregnancy test performed All women presenting with symptoms and/or[hse.ie]
  • Key constituents of the physical examination include an abdominal exam (with right upper quadrant palpation), vaginal speculum exam (that includes inspection of the cervix), bimanual exam (to assess cervical motion, adnexal tenderness and pelvic masses[news-medical.net]
  • For more complex cases—such as those that involve a pelvic mass, do not respond quickly to antibiotics or when the symptoms and physical exam are equivocal a laparoscopy may be necessary.[cmdrc.com]
  • An abdominopelvic CT scan showed no abdominal or pelvic masses; pelvic sonography revealed normal ovaries and no free fluid. Electrolytes, white blood cell count and liver enzymes were all within normal limits; a urinalysis was negative.[austinpublishinggroup.com]
  • If an adnexal or pelvic mass is suspected clinically or if patients do not respond to antibiotics within 48 to 72 h, ultrasonography is done as soon as possible to exclude tubo-ovarian abscess, pyosalpinx, and disorders unrelated to PID (eg, ectopic pregnancy[merckmanuals.com]
Agalactia
  • The most commonly detected baseline causative pathogens were C. trachomatis (12 strains), Prevotella bivia (10 strains), Streptococcus agalactiae (7 strains), N. gonorrhoeae and Peptostreptococcus anaerobius (6 strains each).[ncbi.nlm.nih.gov]
  • Vaginal microorganisms such as Haemophilus influenzae, Streptococcus agalactiae, and enteric gram-negative bacilli can be involved in PID, as can Ureaplasma sp.[merckmanuals.com]
Pelvic Pain
  • RESULTS: Twelve (24%) women had pelvic pain for 6 months or more after hospitalization, 22 (43%) had subsequent episode(s) of pelvic inflammatory disease, and 40% were involuntarily infertile.[ncbi.nlm.nih.gov]
  • CASE: NA young Palestinian woman presented with recurrent episodes of pelvic pain with rebound tenderness, fever, and elevated white blood cell count, erythrocyte sedimentation rate, and C-reactive protein.[ncbi.nlm.nih.gov]
  • PID can cause chronic pelvic pain, fallopian tube damage, infertility and ectopic pregnancy. Between January 2002 and December 2011, 16,817 female service members met the surveillance case definition for acute PID.[ncbi.nlm.nih.gov]
  • It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs.[ncbi.nlm.nih.gov]
  • Each year, the woman is contacted to complete a questionnaire detailing her reproductive history, presence of pelvic pain, and menstrual history, as well as other miscellaneous gynecologic history.[ncbi.nlm.nih.gov]
Vaginal Discharge
  • The most frequent signs and symptoms were abnormal vaginal discharge (100%), adnexal tenderness (97.1%), cervical motion tenderness (94.3%) and fever 38.3 degrees C (82.9%).[ncbi.nlm.nih.gov]
  • Variables that were good predictors of acute pelvic inflammatory disease were purulent vaginal discharge, erythrocyte sedimentation rate greater than or equal to 15 mm/hr, positive gonorrhea result, adnexal swelling on bimanual examination, and rectal[ncbi.nlm.nih.gov]
  • discharge Congested external urethral meatus or openings of Bartholin’s ducts Speculum examination: Congested cervix with purulent discharge Bimanual examination: Chandelier sign: Cervical motion tenderness Adnexal tenderness Thickening or definite mass[medchrome.com]
  • Most common symptom in study group was lower abdominal pain (90%), vaginal discharge (70%) and irregular bleeding (40%) and 30% patients had history of intrauterine contraceptive device (IUCD) implantation.[ijmm.org]
Dyspareunia
  • Retrospective analysis showed that 43 of the women were given outpatient treatment for acute pelvic inflammatory disease because they had low abdominal pain, deep dyspareunia, or unusual vaginal bleeding, or all of these, for less than 2 months in association[annals.org]
  • Factors: Contraceptive: OCPs and Barrier methods Menopausal, pregnant with monogamous partner Symptoms: Lower abdominal and pelvic pain (dull) Fever and chills Nausea and vomiting (indicates peritonitis) Menstrual disturbances Purulent cervical discharge Dyspareunia[medchrome.com]
  • […] unexplained and untreated abdominal pain are significantly more likely to have tubal infertility than women without such history; therefore caution should be used in dismissing mild symptoms (mild non-specific abdominal pain, vaginal discharge, bleeding or dyspareunia[pedsinreview.aappublications.org]
  • The woman usually presents with symptoms of pelvic pain, heavy and painful menstrual periods, pain with intercourse (dyspareunia) and/or infertility that triggers an evaluation that reveals extensive pelvic scar tissue.[haveababy.com]
  • Mild symptoms include – lower abdominal/pelvic pain, deep dyspareunia, a change in vaginal discharge, post coital bleeding Severe symptoms include – all of the above and in addition there may be constitutional symptoms, shoulder tip pain, right upper[hse.ie]
Cervical Motion Tenderness
  • The most frequent signs and symptoms were abnormal vaginal discharge (100%), adnexal tenderness (97.1%), cervical motion tenderness (94.3%) and fever 38.3 degrees C (82.9%).[ncbi.nlm.nih.gov]
  • motion tenderness Adnexal tenderness Thickening or definite mass Minimum clinical criteria for diagnosis Cervical motion tenderness Uterine tenderness Adnexal tenderness The presence of temperature higher than 38.3 C (101 F) and abnormal cervical or[medchrome.com]
  • More common presentations include acute pelvic pain (of variable intensity), cervical motion tenderness, vaginal discharge, fever, dyspareunia, and leukocytosis. Right upper quadrant pain from perihepatitis in Fitz-Hugh-Curtis syndrome is possible.[radiopaedia.org]
  • Fifty women in reproductive age group, who presented with atleast four of the following criteria, were included in the study: history of recurrent lower abdominal pain, presence of lower abdominal tenderness, presence of cervical motion tenderness, presence[ijmm.org]
  • Motion Tenderness Uterine Tenderness Adnexal Tenderness The following add support for the diagnosis: Fever ( 101 F / 38.3 C) Mucopurulent cervical discharge or friability Wet prep with abundant WBC We always consider: Chlamydia trachomatis Neisseria[pedemmorsels.com]
Adnexal Mass
  • Abnormal HSG was most likely to occur in women who had antichlamydial antibodies present in the serum, an adnexal mass detected on the initial bimanual examination, or had an IUD (positive associations) and least likely to occur in women who had been[ncbi.nlm.nih.gov]
  • Free exudate was associated negatively with the median duration of pain (3 versus 6 days), oral contraceptive use (4% versus 26%), and palpable adnexal mass (7% versus 25%). Analyses limited to women without a history of PID gave similar results.[ncbi.nlm.nih.gov]
  • RESULTS: A palpable adnexal mass in a woman older than 42 years and erythrocyte sedimentation rate 50 mm/h were the best predictors of TOA. There was no difference in the mean temperature or number of sick days prior to hospitalization.[ncbi.nlm.nih.gov]
  • Power Doppler was used to assess the vascularity of any adnexal mass. RESULTS: Laparoscopy confirmed the diagnosis of PID in 20 (67%) of the 30 women with clinically suspected acute PID.[ncbi.nlm.nih.gov]
  • Bilateral adnexal masses appearing either as small solid masses or as cystic masses with thick walls and possibly manifesting the cogwheel sign also seems to be a reasonably reliable sign (82 % sensitivity, 83 %specificity).[ncbi.nlm.nih.gov]

Workup

  • The patient underwent extensive workup, multiple courses of intravenous and oral antibiotics, and diagnostic laparoscopies, with continued recurrent episodes.[ncbi.nlm.nih.gov]
Ovarian Mass
  • MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging. 2016:7(1):21-41. Kouijzer IJE. Initially unrecognised group A streptococcal pelvic inflammatory disease in a postmenopausal woman. Neth J Med. 2014;72:494-6.[ijrcog.org]
  • Diagnoses such as ovarian masses, endometrial cancer, and colon cancer should be considered. Diagnosis There is no specific lab value, physical examination finding, or imaging study that is diagnostic of PID.[emdocs.net]

Treatment

  • The mean CRP levels decreased by the third day of treatment in all treatment groups, and the decrease by the sixth day of treatment was significant (P less than .05), reflecting the clinical response to therapy faster than did serial ESR determinations[ncbi.nlm.nih.gov]
  • The patients were randomly assigned to two treatment groups: 16 women received ciprofloxacin 200 mg b.i.d. iv. for two days, followed by oral administration with 750 mg b.i.d. to complete a 14-day course of treatment.[ncbi.nlm.nih.gov]
  • Pretreatment and post-treatment cervical culture specimens were obtained for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum.[ncbi.nlm.nih.gov]
  • The clinical and bacteriological responses were assessed at the end of treatment, and on Days 15 and 29.[ncbi.nlm.nih.gov]
  • There were no significant differences between antibiotic treatment groups in any response categories or in toxicity.[ncbi.nlm.nih.gov]

Prognosis

  • This study directly documents the poor fertility prognosis for women with tubal abscess and suggests that women with culture and/or serological evidence of chlamydial infection also have a poor fertility prognosis.[ncbi.nlm.nih.gov]
  • From this review, it is suggested that in future studies a randomized study design, with controls for known factors which influence prognosis, and a uniform objective scoring system for monitoring clinical response be used and long-term evaluation of[ncbi.nlm.nih.gov]
  • Besides, our study revealed that endometriosis was related to a poor prognosis of PID and patients with endometriosis had 5.7-fold higher probability of having a poor prognosis.[omicsonline.org]
  • […] become prominent due to infection draining in to lymphatics along the course of the gonadal veins MRI May show an ill-defined adnexal mass containing fluid with various signal intensities: T1 C (Gd): wall and surrounding tissues may enhance Treatment and prognosis[radiopaedia.org]

Etiology

  • In 19 (47.5%) women, the microbial etiology could not be determined (group C). In no case was Neisseria gonorrhoeae isolated.[ncbi.nlm.nih.gov]
  • There is clearly no single antimicrobial agent that is effective against all of the organisms implicated in the etiology of acute PID.[ncbi.nlm.nih.gov]
  • The grade and etiology of index PID were classified using laparoscopy, endometrial biopsy and microbiological cultures from the cervix, endometrium and tubes: 20 had mild and 19 severe PID.[ncbi.nlm.nih.gov]
  • To prevent these serious sequelae, treatment regimens must cover the major etiologic agents which are Neisseria gonorrhoeae, Chlamydia trachomatis, and mixed anaerobic-aerobic bacteria.[ncbi.nlm.nih.gov]
  • Abstract We studied 71 women with the clinical diagnosis of acute pelvic inflammatory disease (PID) by laparoscopy and comprehensive microbiology in order to define the major etiologic determinants of poor fertility prognosis after tubal infection.[ncbi.nlm.nih.gov]

Epidemiology

  • Both groups were compared in terms of laboratory, clinical, and epidemiological parameters. RESULTS: Of 73 patients admitted with the diagnosis of PID, 44 (60.3 %) were found to have TOA, and 29 (39.7 %) were not found.[ncbi.nlm.nih.gov]
  • Weström L (1986) Epidemiology of pelvic inflammatory disease. In: Ludwig H, Thomsen K (eds) Gynecology and obstetrics. Springer, New York, pp 659–661 CrossRef Google Scholar 31. Kani J, Adler MW (1992) Epidemiology of pelvic inflammatory disease.[link.springer.com]
  • […] inflammatory disease (PID) -- usually a spontaneous infection that occurs among sexually active, menstruating, nonpregnant women -- covers: pathophysiology; microbial etiology (gonorrhea, chlamydia, genital mycoplasmas, and aerobic and anerobic bacteria); epidemiology[ncbi.nlm.nih.gov]
  • Acinetobacter spp. as nosocomial pathogens: Epidemiology and resistance features. Saudi J Biologic Sci; 2016.[ijrcog.org]
Sex distribution
Age distribution

Pathophysiology

  • PIP: This discussion of acute pelvic inflammatory disease (PID) -- usually a spontaneous infection that occurs among sexually active, menstruating, nonpregnant women -- covers: pathophysiology; microbial etiology (gonorrhea, chlamydia, genital mycoplasmas[ncbi.nlm.nih.gov]
  • Acute PID increases a woman's risk for recurrent PID, chronic pelvic pain, infertility and ectopic pregnancy. [2] Our concept of etiology and pathophysiology of acute PID has changed considerably over the past few years and as might be expected, treatment[ijmm.org]
  • This review paper in Obstetrics and Gynecology is an excellent up to date source for PID pathophysiology, diagnosis, treatment, and long-term outcomes.) Eschenbach, DA, Wolner-Hanssen, P, Hawes, SE, Pavletic, A, Paavonen, J, Holmes, KK.[clinicaladvisor.com]
  • Symptoms manifesting from these responses include an oral temperature 38.3 C (101 F), elevated erythrocyte sedimentation rate or C-reactive protein, or presence of white blood cells on microscopy of vaginal secretions. 1,2,11 Pathophysiology and Diagnosis[uspharmacist.com]

Prevention

  • An intensification of educational efforts directed at IV drug-using women in San Francisco is necessary to prevent further increases in the rate of HIV infection and further spread into the heterosexual population.[ncbi.nlm.nih.gov]
  • The therapeutic goals in its treatment are to treat the symptoms, preserve fertility when desired and prevent the development of sequelae.[ncbi.nlm.nih.gov]
  • To prevent these serious sequelae, treatment regimens must cover the major etiologic agents which are Neisseria gonorrhoeae, Chlamydia trachomatis, and mixed anaerobic-aerobic bacteria.[ncbi.nlm.nih.gov]
  • Prevention of these long-term sequelae is dependent upon development of treatment strategies based on knowledge of the microbiologic etiology of acute PID. It is well accepted that acute PID is a polymicrobic infection.[ncbi.nlm.nih.gov]
  • These data strongly argue that primary prevention must be the goal for a reduction of PID morbidity and show that improved therapy for the treatment of PID in the ambulatory setting is needed.[ncbi.nlm.nih.gov]

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