PID Without Sex?
Abstract & Commentary
Synopsis: A case of Plesiomonas shigelloides pyosalpinx occurred in a swimmer.
Source: Roth T, et al. Pyosalpinx: Not always a sexually transmitted disease? Pyosalpinx caused by Plesiomonas shigelloides in an immunocompetent host. Clin Microbiol Infect. 2002;8:803-805.
Plesiomonas shigelloides is a facultatively anaerobic Gram-negative rod associated with diarrheal illness. A range of extraintestinal infections caused by this organism has been described, including bacteremia and cholecystitis.
This Swiss group describes a 49-year-old woman presenting with right lower abdominal pain 3 weeks after traveling to Spain where she regularly swam in warm seawater. She had tenderness in the right lower quadrant, and her WBC was 16,900 and C-reactive protein was 81 mg/L (normal < 5 mg/L).
Laparoscopy showed a fibrinous right Fallopian tube. Salpingectomy was performed and samples of the tube were sent for culture. All cultures and PCR reactions were negative for genital pathogens, but the culture grew P shigelloides susceptible to amoxicillin. The patient was discharged home after a 4-day hospital stay.
Comment by Joseph F. John, Jr, MD
This is the first reported case of P shigelloides pyosalpinx. The patient never had a symptomatic diarrhea and was not immunosuppressed, usually the setting for P shigelloides infection. She likely acquired the infection through a direct ascending infection of the Fallopian tube while swimming in warm estuarine water.
This case simply remains as a reminder that not all pyosalpinx is sexually transmitted and that environmental pathogens, though uncommon, may cause what looks like garden-variety disease. Luckily, P shigelloides is a highly susceptible facultative anaerobe and once identified as the cause of an infection, most infections can be treated with standard antimicrobials.
Dr. John is Co-Editor of Infectious Disease Alert, Chief of Medical Subspecialty Services at Ralph H. Johnson Veterans Administration Medical Center, and Professor of Medicine at the Medical University of South Carolina, Charleston, SC.
A case of Plesiomonas shigelloides pyosalpinx occurred in a swimmer.
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