Leptotrichia amnionii and the Female Reproductive Tract

摘要

To the Editor: Detection of newbacteria, human complex microflora,by using 16S rRNA gene amplifica-tion and sequencing has been reported(1). 16S rRNA gene amplification andsequencing detected pyosalpinx,caused by Leptotrichia amnioni, in apatient whose samples were culture-negative.This anaerobic gram-negative bac-terium has been isolated onlyonce before (2). A 41-year-old womanfrom the island of Comoros who hadbeen having lower abdominal pain for6 days was admitted to the emergencydepartment of H.pital Nord inMarseille. The patient's historyincluded type 2 diabetes mellitustreated by metformin and laparoscopyto explore infertility. On examination,the patient had a pulse rate of 90 beatsper min, a blood pressure of 130/80mm Hg, and a temperature of 38.5°C.Her abdomen was not distended, butdiffused lower abdominal tenderness,especially at the right iliac fossa, waspresent. Blood testing showeda leukocyte count of 7.7x109/L,hemoglobin of 13.1g/dL, and plateletcount of 213x109/L. The chemistrypanel showed hyperglycemia (14.1mmol/L) and elevated C-reactive pro-tein (254 mg/L). Renal and liver func-tion test results were all within normallimits. Serum β-human chorionicgonadotropin was negative. A com-puted tomographic scan of theabdomen and pelvis showed two sep-tated adnexal masses, a 12x7x5 cmmass on the right and a 6x4x2 cmmass on the left; the patient wasreferred to the gynecologic surgerydepartment. Gynecologic examina-tion showed greenish, purulent vagi-nal discharge and a fluctuant mass inthe pouch of Douglas. Uterine cervi-cal motion caused pain to the patient.Transabdominal and transvaginalultrasound scan showed a 10x7x5 cmhomogeneous liquid mass in thepouch of Douglas. The patient was taken to the oper-ating room and prepared for surgery.The gynecologic team performed alaparotomy that showed a 5-cm, lefthydrosalpinx and a 10-cm, righttuboovarian abscess adherent to theuterus, sigmoid colon, pelvic side-wall, and pouch of Douglas. Theappendix and other viscera were nor-mal. The adhesiolysis led to the rup-ture of the abscess and discharge ofclear greenish pus, a sample of whichwas sent to the laboratory for culture.Antimicrobial drug treatment wasstarted with intravenous cefazolin,gentamicin, and metronidazole. Onthe first postoperative day, the patientwas afebrile. Oral amoxicillin plusclavulanic acid was administered for15 days, and oral ciprofloxacin wasadministered for 20 days. The patientwas discharged on day 7 of hospital-ization and was well at the follow-upexamination 1 month later