ﺑﺴﻢ اﷲ اﻟﺮﲪﻦ اﻟﺮﺣﻴﻢ ALNEELIN University College of Postgraduate& Scientific Research Medical Laboratory Science Department of Histopathology and Cytology Detection of Fungal Infection in the Product of Conception in Khartoum Bahri Teaching Hospital Athesis Submitted in Partial Fulfillment of the Requirements for M .Sc. Degree in Histopathology Presented By Sara Salih Musa Bakhiet B.Sc of medical laboratory sciences Supervisor: Ageeb Mohammed Hassan Abdellah M D Clinical pathology Assistant Professor Alribat National University May 2018 1 ﺑﺴﻢ ﷲ اﻟﺮﺣﻤﻦ اﻟﺮﺣﯿﻢ اﻵﯾــــﺔ ﻗﺎل ﺗﻌﺎﻟﻲ : َ . ﱠﷲُ ُﻧورُ ﱠاﻟﺳ َﻣ َﺎو ِات َو ْاﻷ ْر ِض َﻣ َﺛلُ ُﻧ ِور ِه َﻛ ِﻣ ْﺷ َﻛ ٍﺎة ِﻓ َﯾﮭﺎ ِﻣ ْﺻ َﺑ ٌﺎح ْاﻟ ِﻣ ْﺻ َﺑﺎحُ ِﻓﻲ ُز َﺟ َﺎﺟ ٍﺔ ﱡاﻟز َﺟ َﺎﺟ ُﺔ َﻛﺄَ ﱠﻧ َﮭﺎ َﻛ ْو َﻛ ٌب ُد ﱢر ﱞي َﯾُوﻗ ُد ِﻣ ْن َﺷ َﺟ َر ٍة َﻣُﺑ َﺎر َﻛ ٍﺔ َز ْﯾ ُﺗ َوﻧ ٍﺔ َﻻ َﺷ ْر ِﻗ ﱠﯾ ٍﺔ َو َﻻ َﻏ ْر ِﺑ ﱠﯾ ٍﺔ َﯾ َﻛ ُﺎد َز ْﯾ ُﺗ َﮭﺎ ِﯾُﺿﻲءُ َو َﻟ ْو َﻟ ْم َﺗ ْﻣ َﺳ ْﺳﮫُ َﻧ ٌﺎر ُﻧ ٌور َﻋ َﻠﻰ ُﻧ ٍور َﯾ ْﮭ ِدي ﱠﷲُ ﻟِ ُﻧ ِور ِه َﻣ ْن َﯾ َﺷﺎءُ َو َﯾ ْﺿ ِر بُ ﱠﷲ ُ َ ْاﻷ ْﻣ َﺛ َﺎل ﻟِ ﱠﻠﻧ ِﺎس َو ﱠﷲُ ِﺑ ُﻛ ﱢل َﺷ ْﻲ ٍء َﻋﻠِ ٌﯾم (35) ﺻﺪق ﷲ اﻟﻌﻈﯿﻢ ﺳﻮرة اﻟﻨﻮر 2 Dedication Those who do not thank people do not thank God My mother, spring of tenderness, source of happiness My brethren the eye of the sun My friends and companions People like me and as much as I can My great family Supported me Every Body Support me For the patient and encouragements Our Lord appreciates me and I will make you happy I give you my research 3 Acknowledgements Thanks to all members of University of Alnelain and deans of medical laboratory science and Khartoum North Technical Hospital 4 Abbreviations - H&E; Haematoxylin and Eosin - PAS; Periodic Acid Schiff's reagent - GS; Giemsa stain - GHS; Grocott Hexamine Silver. - Spp; Species. 5 Abstract Background: Candida guilliermondii is saprophytic opportunistic pathogenic yeast considered to have low virulence. It is related to local or systemic host immune system, as consequence, disease develops from massive contamination of uterus during gynecological procedures, leading to ascending of infection up through the cervix to placenta then abortion induced. Aim of the study: This study aimed to detect the presence of fungi in the product of conception and abortion. Materials and Methods: Hundred formalin fixed paraffin blocks (FFPB) of concepts were enrolled from samples of married women from the age between 19 and 45 years, the samples were cut into 4 µm thickness by rotary microtome then stained by two types of special stains PAS& Grocott hexamine silver. Results: The results no fungi found. Conclusion: This study concludes that there is no relation between Candida infection and abortion but not may be found. 6 اﻟﻤﺴﺘﺨﻠﺺ ﺧﻠﻔﯿﺔ: اﻟﻔﻄﺮﯾﺎت ﻏﯿﻠﯿﺮﻣﻮﻧﺪي ھﻮ اﻟﺨﻤﯿﺮة اﻻﻧﺘﮭﺎزﯾﺔ اﻟﻌﺪوى اﻻﻧﺘﮭﺎزﯾﺔ ﺗﻌﺘﺒﺮ ﻣﻨﺨﻔﻀﺔ اﻟﻀﺮاوة . وﺗﺮﺗﺒﻂ ب اﻟﺠﮭﺎز اﻟﻤﻨﺎﻋﻲ اﻟﻤﻀﯿﻒ اﻟﻤﺤﻠﻲ أو اﻟﻨﻈﺎﻣﯿﺔ، وﻧﺘﯿﺠﺔ ﻟﻠﻌﻼﻗﺔ اﻟﺠﻨﺴﯿﺔ ، ﯾﺘﻄﻮر اﻟﻤﺮض ﻣﻦ اﻟﺘﻠﻮث اﻟﻀﺨﻢ ﻟﻠﺮﺣﻢ أﺛﻨﺎء اﻹﺟﺮاءات اﻟﻨﺴﺎﺋﯿﺔ، ﻣﻤﺎ ﯾﺆدي إﻟﻰ ﺗﺼﺎﻋﺪي اﻟﻌﺪوى ﺣﺘﻰ ﻋﻨﻖ اﻟﺮﺣﻢ إﻟﻰ اﻟﻤﺸﯿﻤﺔ ﺛﻢ اﻹﺟﮭﺎض اﻟﺘﻲ ﯾﺴﺒﺒﮭﺎ. اﻟﮭﺪف ﻣﻦ اﻟﺪراﺳﺔ: ﺗﮭﺪف ھﺬه اﻟﺪراﺳﺔ إﻟﻰ اﻟﻜﺸﻒ ﻋﻦ وﺟﻮد ﻋﻼﻗﺔ ﺑﯿﻦ اﻟﻔﻄﺮﯾﺎت واﻹﺟﮭﺎض. اﻟﻤﻮاد واﻷﺳﺎﻟﯿﺐ: ﺗﻢ اﺳﺘﺨﺪام ﻣﺎﺋﺔ ﻛﺘﻠﺔ ﻣﻦ اﻟﺒﺎراﻓﯿﻦ اﻟﺜﺎﺑﺘﺔ ﻓﻲ اﻟﻔﻮرﻣﺎﻟﯿﻦ ﻣﻦ ﻋﯿﻨﺎت ﻣﻦ اﻟﻨﺴﺎء اﻟﻤﺘﺰوﺟﺎت اﻟﻼﺗﻲ ﺗﺘﺮاوح اﻋﻤﺎرھﻦ ﺗﺘﺮاوح ﺑﯿﻦ 19 و 45 ﻋﺎﻣﺎ، ﺛﻢ ﺗﻢ ﻗﻄﻊ اﻟﻌﯿﻨﺎت إﻟﻰ 4 ﻣﯿﻜﺮون ﺳﻤﻚ ﺑﻮاﺳﻄﺔ ﺷﺮاﺋﺢ زﺟﺎﺟﯿﺔ ﺛﻢ ﺻﺒﻐﮭﺎ ﻣﻦ ﻗﺒﻞ ﻧﻮﻋﯿﻦ ﻣﻦ اﻟﺼﺒﻎ اﻟﺨﺎﺻﺔ وھﻲ اﻟﻔﻀﺔ واﻟﺒﯿﺮودك اﺳﺪ ﺷﻒ اﻟﻨﺘﺎﺋﺞ: وﻛﺎﻧﺖ اﻟﻨﺘﺎﺋﺞ ﺳﺎﻟﺒﺔ. اﻟﺨﻼﺻﺔ: ﺗﺨﻠﺺ ھﺬه اﻟﺪراﺳﺔ إﻟﻰ ﻋﺪم وﺟﻮد ﻋﻼﻗﺔ ﺑﯿﻦ اﻻﺟﮭﺎض و اﻟﻔﻄﺮﯾﺎت وﻟﻜﻦ ھﺬا ﻻ ﯾﻨﻔﻲ اﻧﮫ ﻗﺪ ﺗﻮﺟﺪ ﻋﻼﻗﺔ. 7 Contents I.……………………………………………….………………………………………………………………………اﻵﯾﮫ Dedication ................................................................................................................. II Acknowledgements ..................................................................................................III Abbreviations .......................................................................................................... IV Abstract ................................................................................................................... V VI.…………………………………………………………………………..اﻟﻤﺴﺘﺨﻠﺺ Chapter One 1-Introduction and literature review……………………………………………….2 1-1. Female Genital System……………………………...…………………..……2 1-1-1. Vagina……………………………………………………………………....2 1-1-2. Cervix…………………………………………………………………….…3 1-1-3. Uterus…………………………………………………………………….…3 1-1-4. Fallopian tube………...……………………………………………….….....3 1-1-5. Ovaries……..…………………………………………………………….…4 1-2.External organ …………………….…………………………………….…….4 1-2-1.Vulva………………………………………………………………….……..4 1-3.Clinical significance…………...……………………………………………....5 8 1-3-1. Vaginitis……………...…………………………………………..…….……5 1-3-2. Bacterial vaginosis……...………………………………………………...…5 1-3-3. Yeast infection...…………………...…………………….…….…5 1-4.Female genital mutiations………...………………………………………...….6 1-5.Genital surgery….………...………………………………...…………7 1-6.Placental specimens and products of conception………….………..9 1-7. Classification………………………………….………………………...…...10 1-8. Rationale…..…………..,………………………………………………….…10 1-9. Hypothesis……………..…………………………...……………...………....10 1-9-1.Null hypothesis……..………………………………...…………………….10 1-9-2.Alternative hypothesis……..……………………...………………...……...10 1-10. Objectives…..…….…………………………………………………………10 1-10-1. General objective…..………………………………………………......…10 1-10-2.Specific objectives……………..…………………………………..….…..11 Chapter Two 2- Material and methods………………………………………………………….13 2-1. Materials…………….……………...……………………………………….13 2-2.Methodology…………………………………………………………………13 9 2-2-1.Study design……………………………………………………………….13 2-2-2.Study area………………………………………………………………….13 2-2-3.Study sample, sample size…………………………………………………13 2-2-4. Sample processing…………………………………………………………13 2-2-5. staining…………………………………………………………………….13 2-2-5-1. Haematoxlyin and Eosin………………….……………………………..14 2-2-5-2.PAS……..…………………………………..………….…………….…..14 2-2-5-3. GHS ………………………………………………….…………….……14 2-6.Result Interpretation…………………………………………………..……...15 2-7.Data analysis……………………………………………………………….....15 Chapter Three 3-1. Results..………..……………………..……………………………………...17 3-2. Tables..……………………………………….………………………....18__20 Chapter four 4-1. Discussion……………………………………………………………………22 4-2. Recommendations…………………………………………………….….......23 References..…………………………………………………………………....24-27 10 CHAPTER ONE 11 1. Introduction and Literature Review 1.1. Female Genital System: The female reproductive system (or female genital system) is made up of the internal and external sex organs that function in human reproduction. The female reproductive system is immature at birth and develops to maturity at puberty to be able to produce gametes, and to carry a fetus to full term. The internal sex organs are the uterus and Fallopian tubes, and the ovaries. The uterus or womb accommodates the embryo which develops into the fetus. The uterus also produces vaginal and uterine secretions which help the transit of sperm to the Fallopian tubes. The ovaries produce the ova (egg cells). The external sex organs are also known as the genitals and these are the organs of the vulva including the labia, clitoris and vaginal opening. The vagina is connected to the uterus at the cervix (Juniordoctors13thed). The female internal reproductive organs are the vagina, uterus, Fallopian tubes, and ovaries. 1.1.1. Vagina: the vagina is the canal between the hymen (or remnants of the hymen) and the cervix, while, legally, it begins at the vulva (between the labia) It may be that the incorrect use of the term vagina is due to not as much thought going into the anatomy of the female genitals as has gone into the study of male genitals, and that this has contributed to an absence of correct vocabulary for the external female genitalia among both the general public and health professionals. Because of this 12 and because a better understanding of female genitalia can help combat sexual and psychological harm with regard to female development, researchers endorse correct terminology for the vulva (Kirkpatrick M (2012). 1.1.2. Cervix: The cervix is part of the female reproductive system. Around 2–3 centmeters' (0.8– 1.2 in) in length, it is the lower narrower part of the uterus continuous above with the broader upper part—or body—of the uterus. The lower end of the cervix bulges through the anterior wall of the vagina, and is referred to as the vaginal portion of cervix or ectocervix while the rest of the cervix above the vagina is called the supravaginal portion of cervix.[3] A central canal, known as the cervical canal, runs along its length and connects the cavity of the body of the uterus with the lumen of the vagina (Sáenz2014). 1.1.3. Uterus: The uterus or womb is the major female reproductive organ, the cervix is part of the female reproductive system. Around 2–3 centimetres (0.8–1.2 in) in length, it is the lower narrower part of the uterus continuous above with the broader upper part—or body—of the uterus.[3] The lower end of the cervix bulges through the anterior wall of the vagina, and is referred to as the vaginal portion of cervix (or ectocervix) while the rest of the cervix above the vagina is called the supravaginal portion of cervix. A central canal, known as the cervical canal, runs along its length and connects the cavity of the body of the uterus with the lumen of the vagina (Grayet al., 1995). 1.1.4. Fallopian tube: The Fallopian tubes are two tubes leading from the ovaries into the uterus. The tube allows passage of the egg from the ovary to the uterus. When an oocyte is 13 developing in an ovary, it is encapsulated in a spherical collection of cells known as an ovarian follicle. Just prior to ovulation