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CASE REPORT Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 2  |  Page : 265-266
Bartholinitis caused by Streptococcus pneumoniae : Case report and review of literature


1 Microbiologist, National Hospital, Riyadh, Saudi Arabia
2 Assistant Professor in Clinical and Chemical Pathology Department, Ains Shams University, Egypt and Laboratory Director, National Hospital, P.O.Box 2715, Riyadh 11461, Saudi Arabia
3 Consultant, Obstetrics and Gynecology, National Hospital, P.O.Box 2715, Riyadh 11461, Saudi Arabia

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   Abstract 

Most of the Bartholin's gland abscesses have been thought to be caused by colonizing micro-organisms of the perineal region. We encountered an interesting case of acute Bartholins abscess caused by Streptococcus pneumoniae in a primigravida. The abscess was incised and drained. The patient was treated with Cefuroxime. This case is presented for its rarity.

Keywords: Bartholin′s gland, abscess, Streptococcus pneumoniae

How to cite this article:
Parvathi S, Imara AS, Thoduka TG. Bartholinitis caused by Streptococcus pneumoniae : Case report and review of literature. Indian J Pathol Microbiol 2009;52:265-6

How to cite this URL:
Parvathi S, Imara AS, Thoduka TG. Bartholinitis caused by Streptococcus pneumoniae : Case report and review of literature. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 Mar 30];52:265-6. Available from: http://www.ijpmonline.org/text.asp?2009/52/2/265/48941



   Introduction Top


Bartholinitis is one of the most common infections in the gynecologic field. [1] Most tumors of the pudendovaginal region belong to cysts and abscesses of the Bartholins gland. [2] Abscess formation involving the Bartholins gland in women may require emergency admission to the hospital. Etiology is frequently polymicrobial, with Bacteroides spp. and  Escherichia More Details coli being the predominant organisms while Chlamydia trachomatis has also been implicated as a cause of bartholinitis. [3],[4] We report here a case of Bartholins abscess caused by Streptococcus pneumoniae .


   Case Report Top


A 19-year-old primigravida of 27 weeks gestation was admitted with history of pain and swelling of 5 days duration on the left side of the vulva. On examination, the patient was afebrile and vital signs were normal. Laboratory investigations revealed hemoglobin of 10.8g%, white blood cell count of 9,900/dL with differential count showing polymorphs of 68% and lymphocytes of 25%. Random blood sugar was normal and there was no previous history of diabetes.

Local examination of the vulva revealed swollen and inflamed left labia majora, with marked tenderness and a pain score of [2],[3].

Under general anesthesia, the abscess was incised and drained and marsupialization of the cyst was performed. Pus was drained and sent for culture. The gram stain of the pus showed plenty of pus cells with gram-positive diplococci. The smear was negative for  Neisseria More Details gonorrhoea. Culture of the pus yielded heavy growth of S. pneumoniae , which was sensitive to a wide range of antibiotics. Post-operatively, the patient was treated with injection Cefuroxime 1gm IV stat followed by 500mg bid for 5 days along with analgesics, fucidin cream and local Sitz bath. Repeat culture on follow-up was found to be sterile.


   Discussion Top


Diseases of the Bartholins gland are quite a common problem in clinical practice. It ranks with abortion, pelvic inflammatory disease, ectopic pregnancy and gynecological malignancies as an entity that often requires urgent hospital management. Septic shock is an uncommon life-threatening complication of this condition. [5]

Previous studies in the 1960s and the 1970s on the bacteriology of Bartholins gland abscess have emphasized the significance of gonococci, which had been reported in more than one-third of the cases. [6] In contrast, the incidence of C. trachomatis has increased during the last decade and it is of no special significance in causing Bartholins gland abscess. C. trachomatis should be considered as a rare cause of bartholinitis and it is unlikely that the Bartholins gland is not the primary site for chlamydial infection. Anaerobic bacteria have also been implicated in the causation of the disease. Polymicrobial abscesses caused by aerobes and anaerobes were detected with a high frequency (53.6%). Anaerobes were mostly derived from the vaginal flora and may strengthen the pathogenicity of the aerobes. [7]

In addition to its role as a major cause of urinary tact infections, E. coli has been implicated as an important cause of various infections in the female genital tract, including bartholinitis. [1]

In studies from Japan, the isolation rates of S. pneumoniae and Haemophilus influenzae from Bartholins gland abscesses have also been documented. Orogenital contact as a sexual activity has been common in normal Japanese women. The increasing rates of isolation for respiratory organisms such as S. pneumoniae and H. influenzae might be strongly associated with this tendency. [8]

Case reports of bartholinitis due to S. pneumoniae although unusual, but important, have been described in the literature. The organism has been found to inhabit the genital tract of some women but this appears to occur rarely. The outcome of these infections appears to be no different from those caused by common pathogens. [9] S. pneumoniae is also a causative agent of primary peritonitis, another uncommon infection originating from the female genital tract. [10]

The recommended treatment of Bartholins gland abscess is incision and drainage. Opinions on the benefit of including antimicrobial agents are somewhat discordant. As there are reports of septic shock arising as a complication of bartholinitis, it is advisable to include antimicrobial agents in addition to surgical procedures.

 
   References Top

1.Zeger W, Holt K. Gynecologic infections. Emerg Med Clin North Am 2003;21:631-48.  Back to cited text no. 1    
2.Sos´nik H, Sos´nik K, Ha?on´ A. The pathomorphology of Bartholin's gland. Analysis of surgical data. Pol J Pathol 2007;58:99-103.  Back to cited text no. 2    
3.Quentin R, Pierre F, Dubois M, Soutoul JH, Goudeau A. Frequent isolation of capnophilic bacteria in aspirate from Bartholin's gland abscesses and cysts. Eur J Clin Microbiol Infect Dis 1990;9:138-41.  Back to cited text no. 3    
4.Saul HM, Grossman MB. The role of Chlamydia trachomatis in Barthoiln's gland abscess. Am J Obstet Gynecol 1988;158:76-7.  Back to cited text no. 4    
5.Lopez-Zeno JA, Ross E, O"Grady JP. Septic shock complicating drainage of a Bartholin's gland. Obstet Gynecol 1990;76:915-6.  Back to cited text no. 5    
6.Lee YH, Rankin JS, Alpert S, Daly AK, McCormack WM. Microbiological investigation of Bartholin's gland abscesses and cysts. Am J Obstet Gynecol 1977;129:150-4.  Back to cited text no. 6    
7.Tanaka K, Mikamo H, Ninomaya M, Tamaya T, Izumi K, Yamaoka K, et al . Microbiology of Bartholin's gland abscess in Japan. J Clin Microbiol 2005;43:4258-61.  Back to cited text no. 7    
8.Mikamo H, Ninomiya M, Tamaya T. Clinical efficacy of clarithromycin against uterine cervical and pharyngeal Chlamydia trachomatis and the sensitivity of polymerase chain reaction to detect C.trachomatis at various points of treatment. J Infect Chemother 2003;9:282-3.  Back to cited text no. 8    
9.Sing A, Roggenkamp A, Kress K, Autenrieth IB, Heesemann J. Bartholinitis due to Streptococcus pneumoniae : Case report and review. Clin Infect Dis 1998;27:1324-5.  Back to cited text no. 9    
10.Pipingas A, Dangor Y, Radebe F, Fehler HG, Khumalo S, de Gouveia L, et al . Microbiological investigation of Bartholin's gland abscesses in urban women in Johannesburg. South Afr J Epidemiol Infect 2007;22:18-22.  Back to cited text no. 10    

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Correspondence Address:
S Parvathi
Medical Microbiologist, National Hospital, P.O. Box 2715, Riyadh - 11461
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.48941

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