Aspergillus Salpingitis: A Rare Case Report Published in Journal of Basic and Clinical Reproductive Sciences
A 45-year-old woman, P3 L3 presented with lump, pain in abdomen, and amenorrhea since 4 months. Clinically, a large mass of size 15 cm × 10 cm was palpated in the lower abdomen, right side, and on per vaginum examination. Past history was not significant. Hence a provisional clinical diagnosis of adnexal tumor was kept. The laboratory tests such as hemogram, liver function test, kidney function test, as well as CA 125 showed normal results.
Abdominal USG revealed a mass likely originating from right ovary. The patient underwent a total abdominal hysterectomy with right salpingo-oophorectomy. Pathological findings Gross Specimen of the uterus with cervix with right salpingo-oophorectomy was received. The right fallopian tube was dilated (measuring 6 cm × 4 cm) and contained yellow material in the lumen. Ovary showed a cyst measuring 1.5 cm × 0.5 cm. Microscopy The fallopian tube showed a dilated lumen of the tube and fused plicae. The lumen contained fungal filaments surrounded by dense inflammation in the wall. Thin septate hyphae with acute angle branching were diagnosed as those of Aspergillus species. There was follicular cyst in the ovary.
Acute salpingitis is a spontaneous infection that occurs among sexually active, menstruating, nonpregnant women. The majority of infections are caused by bacteria, and a polymicrobial bacterial infection is common Neisseria gonorrhoeae, chlamydia trachomatis, and a wide variety of aerobic and anaerobic bacteria are most frequently isolated from women with acute salpingitis. Genital mycoplasmas also have been recovered from a small number of infections. A tuberculous, parasitic or fungal salpingitis is rare among women in industrialized countries.
Salpingitis occurs in an estimated 15% of reproductive-age women, and 2.5% of all women become infertile as a result of salpingitis by age 35. Acute salpingitis with or without oophoritis often coexists with various degrees of pelvic peritonitis. The infertility results from tubal occlusion, peritubal adhesions, or adhesions encasing the ovary in any combination. Salpingitis is usually bilateral, but an 8% incidence of the unilateral disease is reported; this manifestation may be more common in women using intrauterine devices. Prompt recognition and Vigorous treatment reduces subsequent severe complications of salpingo-oophoritis such as generalized pelvic peritonitis, abscess formation, and adnexal destruction. It deserves reemphasis that salpingitis often produces minimal clinical signs. The genital tract infections spread by (a) direct extension along luminal surfaces which are characteristic of gonococcal and chlamydial infection (b) Through lymphatics and blood vessels (nongonococcal bacterial and genital mycoplasma infections). Fungi are rare causes of granulomatous salpingitis, with cases of blastomycosis, and more commonly coccidioidomycosis being reported in the American literature.The overall prevalence of fungal infection has shown a rising trend in the last two decades. Similar reports have been published from India earlier, and this is attributed to variability of climatic conditions of this country. The newer chemotherapeutic and antibiotic modalities, transplant facilities, stay in critical care units, are additional factors that contribute to the overall increase in the incidence of fungal infection. In our case, the fungal infection was not suspected clinically so fungal culture could not be done on the specimen received in formalin. Many studies also reported that fungal infections are frequently missed clinically and often diagnosed only at autopsy. Aspergilli are very common and frequently occur in compost heaps, air vents, and airborne dust. Inhalation of Aspergillus spores is the primary cause of aspergillosis. Aspergillosis has several forms: Pulmonary aspergilloma, invasive aspergillosis: Allergic bronchopulmonary aspergillosis. It is common for spores of Aspergillus to enter our bodies continuously through the respiratory system, at rates of hundreds per day without creating any complications in healthy individuals. However, those individuals with compromised immune systems, especially those recipients of stem-cell and solid organ transplants, those undergoing chemotherapy and those with advanced HIV infection, are particularly at risk in developing the disease when exposed to the fungus.A case of aspergillosis in a broiler breeder flock having respiratory and nervous system problems caused by Aspergillus fumigatus and Aspergillus niger is documented
Even though it is a rare disease, the correct diagnosis is of paramount importance for the indication of proper therapy.
Journal of Basic and Clinical Reproductive Sciences