|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
pasteurellaFrom: Robert J. Woolley (wooll005@tc.umn.edu)Wed Mar 31 22:30:41 1999
Today I sent off to a journal the manuscript for one of those dull case-report-and-literature-review pieces that clog journals. (Mine, of course, is vitally important, whereas all the others are mere trifles.) It concerns a woman who had salpingitis caused by Pasteurella multocida. BTW, I'll solicit opinions as to whether "salpingitis" and "pelvic inflammatory disease" are functionally interchangeable terms. More precisely, can a patient have salpingitis but *not* have PID, or vice-versa? I'll spare everybody the literature review portion, but you might find the case itself mildly interesting. Case report In August, 1991, a 38-year-old Southeast Asian immigrant, who had lived in the United States for several years, presented with acute right lower quadrant abdominal pain and tenderness, fever (38.5 C), nausea, diarrhea, right-sided rectal tenderness, and white blood cell (WBC) count of 13,900/mm3 (91% neutrophils) and other signs and symptoms consistent with acute appendicitis. At laparotomy the appendix was grossly and microscopically normal, but purulent material was spilling from the distended right fallopian tube and collecting in the pelvic gutter. The ovaries were grossly normal. Aerobic and anaerobic cultures of the pus revealed a single species, P multocida; serotyping was not performed. The patient was treated postoperatively for three days with intravenous aztreonam and clindamycin (before culture results were known), recovering quickly. She then completed a ten-day course of oral doxycycline. After identification of the nature and location of the offending organism, the patient and her husband were questioned in detail for clues as to the origin of the infection. She had delivered her seventh child at 39 weeksÕ gestation 40 days previously, a pregnancy complicated by preterm labor and successful tocolysis (cervical cultures not performed), but no premature rupture of membranes or clinically apparent infectious complications. The delivery was vaginal, without instrumentation; the only intrapartum complication was ÒmildÓ shoulder dystocia, the only intervention for which was suprapubic pressure. She had also had two spontaneous first-trimester abortions between her fifth and sixth successful pregnancies. Prenatal records from all except her first two pregnancies were reviewed, with no unusual features noted. She and her husband were stated to be mutually monogamous, and had not resumed sexual intercourse since parturition. Neither had a history of any sexually transmitted disease. She had never used an intrauterine device (IUD). They had no pets, and she could recall no contact with any animals over the several months preceding her illness. There had been no vaginal discharge or other premonitory symptoms except several hours of crampy right lower quadrant abdominal pain one week before presentation, which had subsided spontaneously. She used essentially no ethanol, had no clinical evidence of hepatic disease, and was negative for hepatitis B surface antigen. A routine cervical Papanicolaou smear during prenatal care had been normal. Her husband and the infant were asymptomatic. Twenty-five days later the patient presented again with similar but less severe symptoms. She had vaginal bleeding (presumably her first postpartum menses), temperature 38 C, bilateral lower quadrant tenderness, cervical motion tenderness, WBC 12,200 (91% neutrophils), and questionable right adnexal mass, difficult to examine in detail due to abdominal guarding. Computed tomography scan revealed a right hydrosalpinx but no abscess. Again there was no vaginal discharge and cervical cultures were negative. She was not ill enough to require surgical exploration and so was treated empirically with intravenous antibiotics (aztreonam plus ampicillin/sulbactam) for presumed non-sexually-transmitted pelvic inflammatory disease (PID). She again recovered quickly. ---------------------------------------------------------------------------
--------------------------------------------------------------------------- Bob Woolley -- --------------------------------------------------------------------------- St. Paul, Minnesota
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 05:31:02 2009 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.