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Oophoritis

Oophoritides

Oophoritis is a term describing inflammation of the ovaries, and it is primarily considered as one of the variants of pelvic inflammatory disease, an infection of the upper genital tract in women. However, xanthomatous and autoimmune forms of infection and inflammation, respectively, have been recognized. Oophoritis can be life-threatening if progression to peritonitis or sepsis occurs, which is why an early diagnosis is vital.


Presentation

Oophoritis is rarely used in literature as a distinct term for infection or inflammation of the ovaries. In most cases, it is described as a component of pelvic inflammatory disease (PID), an infection of the female upper genital tract that has spread from the cervix (cervicitis), endometrium (endometritis) and the fallopian tubes (salpingitis) [1] [2] [3] [4]. In such instances, symptoms are high fever (> 38.5°C), abdominal and/or back pain, cervical discharge, dyspareunia, bleeding, vomiting and lower urinary tract infection (UTI) like signs - dysuria, polyuria, and an unpleasant odor [2] [3] [4]. Women msy be asymptomatic in the initial stages which may be a significant challenge for the diagnosis for the physician. Notable pathogens that can cause oophoritis are mumps (in approximately 5% of cases, with similar symptoms to PID), mycobacterium tuberculosis in its extrapulmonary forms (characterized by chronic pelvic pain, sterility or the development of ectopic pregnancy), whereas the term xanthomatous oophoritis is used to describe a chronic and destructive infection caused by escherichia coli, actinomycosis, proteus spp. or staphylococcus aureus [1] [5] [6]. Xanthomatous oophoritis, like other forms of infectious oophoritis, occurs as a complication of PID [3]. Endometriosis, inappropriate antimicrobial therapy, radiotherapy, the presence of an intrauterine device (IUD) and inborn errors of lipid metabolism are considered as risk factors [3]. Apart from infections, an autoimmune form of oophoritis is recognized in the literature, most commonly seen in premature ovarian failure (POF) that presents with amenorrhea and hypoestrogenism in women of child-bearing age (usually younger than 40 years) [7] [8].

Fever of Unknown Origin
  • A 39-year-old woman with fever of unknown origin was admitted to our hospital. Whole body scintigrams with 67Ga-citrate showed an abnormal accumulation of radioactivity in the pelvic cavity.[ncbi.nlm.nih.gov]
Abdominal Pain
  • We report a 16-year-old girl with abdominal pain, ovarian cysts, and biopsy-proven eosinophilic oophoritis, which resulted in right oophorectomy.[ncbi.nlm.nih.gov]
  • Case: We report a 16-year-old girl with abdominal pain, ovarian cysts, and biopsy-proven eosinophilic oophoritis, which resulted in right oophorectomy.[mayoclinic.pure.elsevier.com]
  • The patient was a 43-year-old multiparous woman who presented with vaginal bleeding and lower abdominal pain which she had had for one month. Grossly, the ovaries were enlarged and multicystic. The cysts measured up to 3.0 cm.[ncbi.nlm.nih.gov]
  • Acute oophoritis symptoms Severe lower abdominal pain High fever and chills Vomiting Chronic oophoritis symptoms Fever Abdominal pain Lower back pain Malaise Oophoritis treatment Speedy treatment for oophoritis is essential, as the infection is often[baby-pedia.com]
  • The signs include: Lower abdominal pain The pain associated with Oophoritis occurs around the lower abdominal region on both sides, it is usually severe and can be confused with menstrual cramps.[babyns.com]
Pelvic Pain
  • After 3 years of embolisation, the patient started having chronic pelvic pain, dysmenorrhoea and polymenorrhagia along with inability to conceive. Abdominal examination showed 16 weeks size mass arising from the pelvis.[ncbi.nlm.nih.gov]
  • Causes · Bacteria, During abortion · Tuberculosis, Pelvic infection Signs and symptoms · Pelvic pain, Vaginal discharge · Fever, Headache · Nausea and vomiting · Irregular menses Diagnosis test · History taking ,Physical examination · X-ray pelvic area[disease-1.blogspot.com]
  • This can lead to infertility, ectopic pregnancy, pelvic pain, abscesses, and other serious problems. PID is the most common preventable cause of infertility in the United States.[icdlist.com]
Secondary Amenorrhea
  • With corticosteroid therapy, the percentage decreased to 2 percent and menses resumed after secondary amenorrhea of two years' duration.[ncbi.nlm.nih.gov]
  • A 38-year-old female presented with a 3 years history of secondary amenorrhea. She was on treatment for Hashimoto's thyroiditis and Addison's disease.[ncbi.nlm.nih.gov]
  • Signs and symptoms may include: never starting menstruation (primary amenorrhea), stopping menstruation (secondary amenorrhea), infertility, and sex hormone deficiency. An ovarian laparoscopy biopsy can be used to diagnose this condition.[diseaseinfosearch.org]
  • Its symptoms are: Primary amenorrhea (menstruation has never occurred); secondary amenorrhea (menstruation appeared at puberty but subsequently stopped) ; infertility and sex hormone deficiency Related Journals of Autoimmune Oophoritis Journal of Autoimmune[imedpub.com]
Dyspareunia
  • There are quite a few symptoms associated with this diseases, and some of these symptoms are pelvic pain, pain in the abdominal region, fever, vaginal discharge, chills, dyspareunia, vomiting and nausea.[medigoo.com]

Workup

To make the diagnosis of oophoritis, it is imperative to conduct a thorough patient history that will note the appearance and course of symptoms, as well as risk factors and preexisting conditions that may predispose women to an infection [2] [7]. A detailed physical examination should follow, with an emphasis on the inspection and palpation of the abdomen, especially the right upper quadrant, and a complete gynecological exam (including bimanual and a vaginal speculum exam that will inspect the cervix, cervical motion, and assess the presence of a pelvic mass that may point to an abscess) [2] [4]. Uterine, adnexal, or cervical motion tenderness, together with high fever and abdominal pain are hallmarks of PID and oophoritis. The diagnosis is often made solely on clinical grounds, but the use of laboratory and imaging studies are used for confirmation [2] [4]. A complete blood count (CBC) will almost always show leukocytosis, while erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and fibrinogen are important inflammatory parameters that are frequently elevated [2] [4]. Abdominal (or sometimes vaginal) ultrasonography, computed tomography (CT) or magnetic resonance imaging (MRI) can all be used to identify the exact stage of PID and confirm oophoritis [2] [3] [4]. An extensive microbiological investigation, however, is essential in women with suspected infection of the upper genital tract. Cultivation of cervicovaginal discharge, serology testing (if suspicion toward mumps exists), and polymerase chain reaction (PCR) testing can be used to identify the microorganism responsible for the infection [6] [7] [8].

Suppression
  • The elevated inhibin A and B levels, which accompany the development of multiple small and dominant follicles in these women, suppress FSH relative to LH levels, virtually independent of estradiol.[ncbi.nlm.nih.gov]
  • It has been suggested that NK cells have a suppressive action on B cells, and that impaired NK cell activity may play a role in some types of autoimmunity. NK cell abnormalities have been reported in women with premature ovarian failure.[ncbi.nlm.nih.gov]
  • There is a bearing-down sensation in the pubic region and perineum; at times, metrorrhagia; at others, suppression of the menses, leucorrhea. The swelling is not distinctly perceived at first. § 239.[chestofbooks.com]
  • There is a bearing-down sensation in the pubic region and perineum; at times, metrorrhagia; at others, suppression of the menses, leucorrhea. The swelling is not distinctly perceived at first.[medigoo.com]
Chlamydia
  • The major cause of oophoritis, as with salpingitis and pelvic inflammatory disease in general is gonorrhea or chlamydia which infect the vagina and move into the uterus, fallopian tubes and then the ovaries.[prostatitis.support]
  • Moller BR, Märdh PA: Experimental salpingitis in Grivet monkeys by Chlamydia trachomatis . Acta Path Microbiol Scand 88: 107, 1980 Google Scholar 32.[link.springer.com]
Lymphocytic Infiltrate
  • The ovaries are cystic macroscopically, with a lymphocytic infiltrate in the steroidogenic theca cells. The immune infiltrate results in low estradiol levels and a compensatory increase in FSH levels.[ncbi.nlm.nih.gov]
  • infiltration Destruction of theca cells with preservation of granulosa cells (that produce low amounts of estradiol because of lack of substrates) results in a subsequent increase in FSH levels, which stimulates viable granulosa cells to produce increased[pathologyoutlines.com]
  • In a second, delayed phase, the activation of CD4 T cells results in a lymphocytic infiltration of the ovary that occurs in parallel with a progressive decrease in fertility and ovarian function ( 37 ).[academic.oup.com]

Treatment

  • Treatment is aimed at symptom relief with further investigation needed to assess treatment options such as immunosuppression.[ncbi.nlm.nih.gov]
  • In the past, the established methods of surgical treatment for salpingo-oophoritis were extraperitoneal drainage of a pelvic abscess or total abdominal and bilateral salpingo-oophorectomy.[ncbi.nlm.nih.gov]
  • During treatment and post treatment, douching and abstinence of sexual activities is advised until the condition has resolved. Surgical treatment Surgical treatment is applied if the medical treatment described above does not resolve the problem.[babyns.com]
  • She was on treatment for Hashimoto's thyroiditis and Addison's disease.[ncbi.nlm.nih.gov]
  • Inpatient treatment is required for patients who (1) have already failed outpatient treatment, (2) are pregnant, (3) are infected with HIV, or (4) have evidence of a TOA.[www1.cgmh.org.tw]

Prognosis

  • The prognosis depends upon the extent and character of the inflammation, and upon the diseases with which the inflammation happens to be complicated.[chestofbooks.com]
  • Prognosis - Autoimmune oophoritis Not supplied. Treatment - Autoimmune oophoritis No immunosuppressive has been proven safe and effective by prospective randomized placebo-controlled study.[checkorphan.org]
  • The prognosis is difficult to evaluate given the rarity of this condition, but some patients may resume normal menses after therapy. [7] , [9] To conclude, although the condition is rare, AIO must be recognized histologically as it leads to ovarian failure[ijpmonline.org]

Etiology

  • […] to the underlying etiology.[icd10data.com]
  • Eschenbach DA, Holmes KK: The etiology of acute pelvic inflammatory disease. Sex Trans Dis 6: 224, 1979 CrossRef Google Scholar 23. Eschenbach DA, Buchanan TM, Pollock HM, et al.: Polymicrobial etiology of acute pelvic inflammatory disease.[link.springer.com]

Epidemiology

  • Gabica, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Christine Hahn, MD - Infectious Disease, Epidemiology[myhealth.alberta.ca]
  • HLA complex Selective mononuclear cell infiltration into the theca layer of developing follicles of the ovary Association with other autoimmune diseases such as Addison disease, autoimmune thyroiditis and type I diabetes mellitus Epidemiology If normal[pathologyoutlines.com]
  • Epidemiology The age specific incidence of spontaneous primary ovarian failure is around 1 case in every 250 women by the age of 35 years, and 1 case in every 100 women by the age of 40 years.[xpertdox.com]
Sex distribution
Age distribution

Pathophysiology

  • Because little is known about the pathophysiology of human autoimmune oophoritis , experimental animal models have been used to gain insight into possible mechanisms [ 22 23 ] .[my.vocabularysize.com]
  • Pathophysiology: Infection ascends from bacterial colonization of the cervix and extends to the uterus, fallopian tubes, and the ovary.[www1.cgmh.org.tw]
  • This finding is of high relevance because it allows us to conclude that the pathophysiology of autoimmune oophoritis is distinct from that of other forms of ovarian insufficiency.[academic.oup.com]
  • Pathophysiology Most cases of PID are presumed to occur in 2 stages. The first stage is acquisition of a vaginal or cervical infection. This infection is often sexually transmitted and may be asymptomatic.[emedicine.medscape.com]

Prevention

  • Recognition of this aspect of autoimmune oophoritis may help to prevent oophorectomy in patients whose functioning ovarian tissue is already compromised by autoimmune destruction.[ncbi.nlm.nih.gov]
  • Prophylaxis is aimed at preventing the causative agents from penetrating the body during childbirth or abortion. Gonorrheal and tubercular salpingo-oophoritis are prevented by following the general rules for controlling gonorrhea and tuberculosis.[encyclopedia2.thefreedictionary.com]
  • PID is the most common preventable cause of infertility in the United States. Gonorrhea and chlamydia, two sexually transmitted diseases, are the most common causes of PID. Other bacteria can also cause it.[icdlist.com]

References

Article

  1. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  2. Crossman SH. The challenge of pelvic inflammatory disease. Am Fam Physician. 2006;73(5):859-864.
  3. Sivalingam N, Vanitha NS, Loh KY. Managing pelvic inflammatory disease. Med J Malaysia. 2007;62(5):425-427.
  4. Mitchell C, Prabhu M. Pelvic Inflammatory Disease: Current concepts in pathogenesis, diagnosis and treatment. Infect Dis Clin North Am. 2013;27(4):10.1016/j.idc.2013.08.004.
  5. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
  6. Singh N, Tripathi R, Mala YM, Arora S. Xanthomatous oophoritis following uterine artery embolisation: successful conservative surgical management with favourable outcome. BMJ Case Reports. 2013;2013:bcr2013010184.
  7. Çakır EDP, Özdemir Ö, Eren E, Sağlam H, Okan M, Tarım ÖF. Resolution of Autoimmune Oophoritis after Thymectomy in a Myasthenia Gravis Patient. J Clin Res Pediatr Endocrinol. 2011;3(4):212-215.
  8. Jacob S, Koc M. Autoimmune oophoritis: a rarely encountered ovarian lesion. Indian J Pathol Microbiol. 2015;58(2):249-251.

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Last updated: 2017-08-09 17:55