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Infectious Diseases BRAZ J INFECT DIS. 2012;16(3):273-278 The Brazilian Journal of INFECTIOUS DISEASES www.elsevier.com/locate/bjid Original Article Mycoplasmateceae species are not found in Fallopian tubes of women with tubo-peritoneal infertility Alberto Costoyaa, Francisco Moralesb, Paula Bordaa, Renato Vargasc, Juan Fuhrera, Nicole Salgadob, Hugo Cárdenasb, Luis Velasquezd,* aDepartament of Obstetrics and Gynecology, Medical School, Universidad de Santiago de Chile, Santiago, Chile bSchool of Chemistry and Biology, Universidad de Santiago de Chile, Santiago, Chile cObstetrics and Gynecology Unit, Complejo Hospitalario San José, Santiago de Chile, Santiago, Chile dCenter for Integrative Medicine and Innovative Science, Universidad Andres Bello, Santiago, Chile ARTICLE INFO ABSTRACT Article history: Background: The role of mycoplasmas on the development and sequelae of pelvic Received 30 November 2011 inflammatory disease remains controversial. The objective of the present study is to Accepted 4 January 2012 correlate directly the presence of Mycoplasmateceae through polimerase chain reaction (PCR) determinations in cervix and Fallopian tubes of infertile patients with tubo-peritoneal Keywords: factor diagnosed through laparoscopy. Mycoplasma Methods: Thirty patients with tubo-peritoneal infertility and 30 normal fertile patients were Mycoplasmateceae included in the study; cervical samples and tubal flushings were obtained during laparoscopy. Fallopian tubes PCR determinations for the detection of genetic material of Mycoplasma genitalium, Mycoplasma Tuboperitoneal infertility hominis, Ureaplasma urealiticum, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas Infections transmitted sexually vaginalis in cervix and tubal flushings were performed. Results: No Mycoplasmataceae species as “only” microorganisms were found in tubal flushings of tubo-peritoneal infertility patients, whereas three (10%) fertile patients with normal tubes were positive for mycoplasma presence. This difference was not significant (p = 0.237). Among the 30 patients suffering from tubal infertility diagnosed through laparoscopy, Mycoplasmatecae species were not detected in the Fallopian tubes by PCR determinations, while in normal tubes from fertile patients these and other microorganisms could be found without distorting tubal anatomy. Conclusion: Mycoplasmateceae species were not detected in Fallopian tubes of women with tubo-peritoneal infertility. © 2012 Elsevier Editora Ltda. All rights reserved. reproductive potential, and pelvic inflammatory disease is Introduction often the origin of these altered factors.1-4 Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are Tubal and peritoneal factors are important causes of infertility bacteria that have been clearly identified as etiologic agents of among couples investigated for this condition affecting their pelvic inflammation causing infertility.4 Nevertheless, in recent *Corresponding author at: Center for Integrative Medicine and Innovative Science (CIMIS), Facultad de Medicina, Universidad Andrés Bello, Echaurren 183, 8370071, Santiago, Chile E-mail address: [email protected] (Luis Velasquez) 1413-8670/© 2012 Elsevier Editora Ltda. All rights reserved. 274 BRAZ J INFECT DIS. 2012;16(3):273-278 years, Mycoplasma and Ureaplasma, two genera belonging to During laparoscopy, the tubes were flushed with 2-4 mL the family mycoplasmateceae, order Mycoplasmatales, class 9%-saline solution, immediately after the laparoscope Mollicutes, have been proposed as causatives of genitourinary and auxiliary instruments were introduced. The tubes disease in both men and women. Both microorganisms, often were flushed by gently grasping the tubal ampulla near called generically mycoplasmas, are characterized by the lack the fimbrial portion with an atraumatic tubal forceps and of cell wall, being the smallest prokaryotic organisms with self- introducing an epidural catheter (BD Perisafe I® – Mexico, replication capability. Of the various Mycoplasmateceae that have Cal. 19 G) inside the ampulla through the abdominal tubal been detected in the genitourinary tract, Mycoplasma hominis (MH), ostium via a suprapubic puncture with a BD® Tuohy type Ureaplasma urealyticum (UU), and Mycoplasma genitalium (MG) have needle Cal. 16 G, 88.9 mm long. been associated with disease; of importance is the fact that MH The cervical and tubal samples were stored in sterile tubes and UU are frequently isolated from the lower urogenital tract of containing SP2 transport media, at 4°C for a maximum of two healthy adults, men and women, but the presence of MG in the hours before being frozen and stored at -20°C. genital tract of healthy people is less frequently documented and therefore has been strongly correlated with disease.5 Moreover, Sample preparation experimental animal models show that direct inoculation with MG can cause upper tract inflammatory disease.6,7 Of importance, In the present study CT, NG, MG, MH, UU and Trichomonas is the fact that culture isolation is not clinically practical for MG, vaginalis (TV) were assayed by duplex PCR in cervical and so the presence of this microorganism is mainly determined Fallopian tube flushings from women with laparoscopically- through polimerase chain reaction (PCR),8 or indirectly through confirmed Fallopian tube damage, and from healthy controls. serum antibodies.9-11 MG appears to be an increasing agent of sexually transmitted diseases. DNA extraction The question if the above mentioned Mycoplasmateceae are the cause of tubal and/or peritoneal infertility has been studied Genomic DNA for the multiplex PCR assays was prepared mostly indirectly, mainly through serological determinations, from clinical specimens using a Favorgen genomic DNA even though these microorganisms have been isolated from extraction kit (Ping Tung – Taiwan) in accordance with the the cervix, endometrium, recto uterine pouch, and in one case manufacturer’s instructions. The extracted DNA samples from acute salpingitis.5 (undiluted) were measured using a spectrophotometer The objective of the present study was to correlate (SmartSpec 3000; BioRad) at 260 nm and the correct DNA directly the presence of these Mycoplasmateceae through dilution for PCR was calculated. PCR determinations in cervix and Fallopian tubes of infertile patients in which a tubo-peritoneal factor was diagnosed Multiplex PCR method through a laparoscopic procedure. A multiplex PCR assay for simultaneous detection of the six pathogens was performed using the DPO-based Seeplex STD Material and methods detection assay according to the manufacturer’s (Seegene) instructions. The target genes for multiplex PCR were as This is a prospective case-control study conducted between follow: the DnaB-like protein gene on the cryptic plasmid April 2008 and May 2010 at the Complejo Hospitalario San of CT, the porin protein A (porA) gene (pseudogene) of NG, Jose, Santiago, Chile, a hospital associated to the Facultad the DNA gyrase (gyrA) gene of MG, the glyceraldehyde de Ciencias Medicas of the Universidad de Santiago de 3-phosphate dehydrogenase (gap) gene of MH, the urease Chile. During this period, 30 infertile women, with a mean (ureG-D) gene of UU, and the b-tubulin 1 (btub1) gene of TV. age of 33 ± 5 years (range 24-41), in which a laparoscopy, The kit includes amplification of the Arabidopsis cellulose performed as part of their infertility investigation, revealed synthase (CesA3) gene as an internal control (IC), which a tubal abnormality (tubal fimosis, hydrosalpinx, and/or is designed to detect the presence of PCR inhibitors. The periampular or fimbrio tubal adherences) were included CesA3 gene was amplified with a specific primer pair (forward: in this study (tubo-peritoneal infertility). Patients with 5¢-GCATCTTCTTAGCCATCCCAAGAIIIIICTCTTCGTCT-3¢ and a history of antibiotic treatment in the previous three reverse: 5¢-CAAGCCGCAGCATAATAACCATIIIIIAAGGATT months before laparoscopy, and also those in which tubal GATCC- 3¢). or peritubal endometriosis was observed were excluded Amplified fragments were separated by agarose gel from this study. Thirty patients, mean age 36 ± 5 years, electrophoresis (agarose, 2%;) and identified by SYBR Safe (range 27-47), undergoing laparoscopic tubal ligation, and DNA gel stain (Invitrogen, Life Technologies – Carlsbad, in which normal tubes were identified, were included as California, USA). controls. This study was approved by the Ethics Committee and an informed consent was obtained before the procedure. Statistical analysis Material sampling Statistical analysis was performed using the STATA (Statacorp) statistical software, version 11.1. Analysis of the distribution of An intracervical sample was taken immediately before discrete parameters was performed using Fisher’s exact test. A laparoscopy by rotating a rayon sterile swap (Copan, Italy). p-value < 0.05 was considered statistically significant. BRAZ J INFECT DIS. 2012;16(3):273-278 275 When comparing frequency of positive PCR Results determinations for detection of ≥ 1 microorganisms in FT flushings during laparoscopy, a significant difference Positive PCR determinations for detection of genetic material (26.7%) for fertile patients with normal tubes versus of Mycoplasmataceae species (MH, MG, and UU) and three other infertile patients with altered tubo-peritoneal factor, microorganisms (NG, CT and TV) obtained from samples (p = 0.005) was observed. No Mycoplasmataceae species of both endocervix and Fallopian tubes flushings from 60 patients, 30 of them
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