Journal of Postgraduate Medicine
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CASE REPORT
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Year : 1997  |  Volume : 43  |  Issue : 1  |  Page : 16  

Echinococcosis as a cause of infertility.

N Bakshi, RK Saran, R Nada 
 Department of Cytology and Gynaecological Pathology, P.G.I.M.E.R., Chandigarh.

Correspondence Address:
N Bakshi
Department of Cytology and Gynaecological Pathology, P.G.I.M.E.R., Chandigarh.




How to cite this article:
Bakshi N, Saran R K, Nada R. Echinococcosis as a cause of infertility. J Postgrad Med 1997;43:16-16


How to cite this URL:
Bakshi N, Saran R K, Nada R. Echinococcosis as a cause of infertility. J Postgrad Med [serial online] 1997 [cited 2020 Apr 9 ];43:16-16
Available from: http://www.jpgmonline.com/text.asp?1997/43/1/16/421


Full Text




  ::   IntroductionTop


Echinococcosis or hydatid disease is an infestation by the larval tapeworm, Echinococcus granulosus. Hydatid disease in human is a serious and potentially dangerous problem. However, size and organ location greatly influence the clinical presentation and outcome. The common sites are the liver (60%), lungs (20%), kidney (4%), spleen, soft tissue and brain (3%) each and bone (2%)[1]. The female genital tract is uncommonly involved and is rarely the primary site of hydatid cyst formation. The Bickerís series[2] of 532 Lebanese patients reported only four and two cases with ovarian and uterus involvement respectively. Clinical presentation includes a pelvic mass and if the patient is pregnant, obstructed labour[3]. But infertility as a presenting feature has not been documented in literature.


  ::   Case reportTop


A 29-year-old female, presented with eight years history of primary infertility. Investigations revealed bilateral tubal block. Laproscopy was done and a diagnosis of tubercular salpingitis was suggested. Endometrial biopsy showed focal granulomatous inflammation only. However positivity for acid fast bacilli could not be documented. The patient was empirically put on combination chemotherapy for tuberculosis. After a nine month course of triple drug anti-tubercular therapy the patient still had bilateral tubal block. At this stage diagnostic laproscopy was repeated, which showed multiple tubercle like nodules ranging from 0.5 to 1.5 cm in diameter on the serosal aspect of the uterus, the tubes and pelvic peritoneum. Histological section of the excised tubal nodules showed many parasitic profiles comprising of scolices, acid fast hooklets and calcareous corpuscles [Figure:1]. There was synechiae formation between tubal plicae and granulomatous reactions around scolices in the tubal wall, features conforming to the histological picture of degenerated hydatid cyst[4].


  ::   DiscussionTop


Echinococcus may invade any site of the body, but its occurrence in fallopian tube has not been reported. This case of echinococcosis is unusual because of its peculiar presentation of long-standing primary infertility. The cause of primary infertility in this case was due to tubal blockage by echinococcus. Although other parasites causing primary infertility are known[5], but echinococcosis of tubal area causing infertility is a rare occurrence. Radiographic and related imaging studies like CT scan and ultrasonography are important in detecting and evaluating echinococcal cysts. Serological diagnosis can be useful, although a negative test does not exclude the diagnosis of echinococcosis. Detection of antibody to a specific echinococcal antigen (antigen 5 or Arc 5) has the highest degree of specificity, especially in combination with the new enzyme linked immunoelectrotransfer blot test (EITB)[6].

References

1
2Sparks AK, Connor DH, Neafie RC. Pathology of tropical and extraordinary diseases. Washington DC: AFIP; 1976, pp 533.
3Bickers WM. Hydatid disease of female pelvis. Am J Obstet Gynecol 1970; 107:477-483.
4Dhar KK, Dey P, Sau A. Hydatid cyst causing obstructed labour (Letter). Int J Gynecol Obst 1993; 41:284-285.
5Manson Bahr PEC, Bell DR. Mansonís Tropical Disease. London: Bailliere Tindall; 1989, pp 541-544.
6Lucas SB, Hutt MSR. Tropical pathology of the female genital tract. In: Fox H, editor. Haines & Tayler Obstetric and Gynaecological Pathology, 3rd ed. New York, NY: Churchill Livingstone; 1987; 2:916.
7Verstegui M, Moro P, Guevara A, Rodriguez T, Mitanda E, Gilman H. Enzyme linked immunotransfer blot test for diagnosis of human hydatid disease. J Clin Microbiol 1994; 30:1157-1161.

 
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