Repozitorij Medicinskog fakulteta Sveučilišta u Zagrebu

Osobitosti infekcije parazitom Trichomonas vaginalis u muškaraca sa simptomima uretritisa

Sviben, Mario (2010) Osobitosti infekcije parazitom Trichomonas vaginalis u muškaraca sa simptomima uretritisa. PhD thesis, Sveučilište u Zagrebu.

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    Croatian abstract

    Infekcija parazitom T. vaginalis predstavlja značajan javnozdravstveni problem širom svijeta. U muškaraca se trihomonoza može manifestirati kao uretritis, prostatitis, balanopostitis i epididimitis. Sindrom uretritisa jedan je od najčešćih kliničkih entiteta u muškaraca s kojim se u svojem radu susreću mikrobiolozi. U radu je analizirana učestalost T. vaginalis infekcije u 500 muškaraca s kliničkom slikom uretritisa (skupina bolesnika) i u 200 muškaraca bez kliničke slike uretritisa (kontrolna skupina). Kao uzorak korišten je sediment prvog mlaza jutarnjeg urina. Za dijagnostiku trihomonoze korištene su sljedeće metode: mikroskopija nativnog preparata, kultivacija po Diamondu i real time PCR. T. vaginalis infekcija dokazana je korištenjem metode mikroskopije nativnog preparata u 2,4%, kultivacije u 4,8%, i real time PCR-om u 8,2% ispitanika sa simptomima uretritisa. T. vaginalis dokazan je korištenjem metode mikroskopije nativnog preparata u 1,0%, kultivacije u 1,5% i real time PCR-om u 2,0% ispitanika kontrolne skupine. Učestalost infekcije parazitom T. vaginalis u skupini muškaraca s kliničkom slikom uretritisa razlikuje se od učestalosti infekcije ovim organizmom u kontrolnoj skupini muškaraca bez simptoma uretritisa, na način da je trihomonoza dokazana metodom kultivacije i real tim PCR-om statistički značajno češća u muškaraca s kliničkom slikom uretritisa (p=0,041; p=0,002). Korištenjem metode mikroskopije nativnog preparata nije nađena statistički značajna razlika u učestalosti nalaza trihomonoze između ispitanika obje skupine (p=0,232). Osjetljivost real time PCR metode u dijagnostici trihomonoze bila je veća od osjetljivosti rutinskih dijagnostičkih metoda – mikroskopije i kultivacije. Usporedba rezultata dobivenih metodom kultivacije i mikroskopije pokazala je osjetljivost metode mikroskopije od 50,0% i specifičnost od 99,3%. Pozitivna prediktivna vrijednost mikroskopiranja iznosila je 64,3%, dok je negativna prediktivna vrijednost iznosila 97,4%. Usporedba metode kultivacije i real time PCR-a ukazala je na osjetljivost real time PCR-a od 100,0%, dok je specifičnost iznosila 97,3%. Pozitivna prediktivna vrijednost iznosila je 60%, dok je negativna prediktivna vrijednost iznosila 100,0%. Dokazanao je statistički značajno češće oboljevanje od trihomonoze u heteroseksualnih muškaraca (p=0,036), muškaraca koji su imali spolne odnose izvan Republike Hrvatske (p=0,035), onih koji su plaćali za spolne usluge (p‹0,001), te onih koji su bili stariji prilikom prvog spolnog odnosa (p=0,049). Nije nađena statistički značajna povezanost trihomonoze s mjestom prebivališta (p=0,213), razinom obrazovanja (p=0,968), zaposlenjem (p=0,673) i čestoćom korištenja kondoma prilikom spolnog odnosa (p=0,573). Također nije nađeno da su bračni status (p=0,330), roditeljstvo (p=0,652), broj seksualnih partnera u posljednjih godinu dana (p=0,109), korištenje droge ili alkohola prije spolnog odnosa (p=0,611), kao ni testiranje na prisutvo HIV protutijela (p=0,297) rizični čimbenik za trihomonozu. Uzimajući u obzir brojne moguće neželjene posljedice neliječene trihomonoze, nezanemarivu učestalost same infekcije kako u populaciji simptomatskih muškaraca, tako i u općoj populaciji smatram da će se dosadašnji često ignorirajući pristup trihomonozi promijenti, posebno s obzirom na dostupnost novih neinvazivnih, brzih i visoko osjetljivih metoda za dijagnostiku.

    English abstract

    Infection with T. vaginalis parasite presents a significant global public health problem. In men trichomoniasis may be manifested as urethritis, prostatitis, balanoposthitis and epididymitis. Urethritis syndrome is one of the most common clinical entities in men microbiologists are faced with in their profession. This study analyzes the incidence of T. vaginalis infection in men with a clinical picture of urethritis. The sediment of first void urine was used as sample. The following methods were used in the diagnosis of trichomoniasis: wet smear microscopy, cultivation in Diamond’s medium and real time PCR. This study included a total of 700 examinees who were grouped according to either presence or absence of urethritis syndrome. One group contained 500 men with urethritis symptoms, the other 200 men without urethritis symptoms. In 2.4% men with urethritis symptoms T. vaginalis infection was proved using wet smear microscopy, in 4.8% by cultivation, in 8.2% cases using real time PCR. In 1.0% men from the asymptomatic male group T. vaginalis infection was proved by wet smear microscopy, in 1.5% by cultivation, and in 2.0% using real time PCR. The incidence of infection caused by T. vaginalis in the male group with urethritis differs from the incidence of the same organism in the control group who manifested no urethritis symptoms in the following way: trichomoniasis proved by cultivation and real time PCR is statistically significantly more common in the group of men with clinical urethritis (p=0.041; p=0.002). The wet smear method in the diagnosis of trichomoniasis discovered no statistically significant difference in the incidence of trichomoniasis between the symptomatic and asymptomatic groups (p=0.232). The sensitivity of real time PCR in trichomoniasis diagnostic was higher than the sensitivity of routine diagnostic methods – microscopy and cultivation. A comparison of results obtained by cultivation and microscopy showed that microscopy sensitivity was 50.0% and specificity 99.3%. Positive predicative value of microscopy was 64.3%, negative 97.4%. A comparison of cultivation and real time PCR showed that the latter had 100.0% sensitivity and 97.3% specificity. Positive predicative value was 60%, negative 100.0%. Trichomoniasis was proven statistically significantly more common in heterosexual men (p=0.036), men who had sexual intercourse outside of Croatia (p=0.035), men who purchased sexual services (p‹0.001) and men who were of relatively older age during their first sexual intercourse (p=0.049). No statistically significant connection was found between trichomoniasis and place of residence (p=0.213), educational background (p=0.968), employment (p=0.673) or frequency of condom use during sex (p=0.573). Marital status (p=0.330), parenthood (p=0.652), number of sexual partners in the last year (p=0.109), drug or alcohol use prior to sexual intercourse (p=0.611) and testing for HIV antibodies (p=0.297) were not identified as risk factors for trichomoniasis. Taking into consideration the numerous potential undesired sequelae resulting from untreated trichomoniasis and the significant incidence of this infection both in symptomatic men and the general population, we believe that the present, often disregarding, approach to trichomoniasis will change, primarily in regard to the availability of new noninvasive, rapid and highly sensitive diagnostic methods.

    Item Type: Thesis (PhD)
    Mentor: Mlinarić-Missoni, Emilija
    Divisions: Katedra za dermatovenerologiju
    Depositing User: dr.med. Helena Markulin
    University: Sveučilište u Zagrebu
    Institution: Medicinski fakultet
    Number of Pages: 129
    Status: Unpublished
    Creators:
    CreatorsEmail
    Sviben, Mario
    Date: 17 May 2010
    Date Deposited: 06 Nov 2012 14:45
    Last Modified: 06 Nov 2012 14:45
    Subjects: WC Communicable Diseases > WC 680-950 Tropical and Parasitic Diseases
    Related URLs:
      URI: http://medlib.mef.hr/id/eprint/1669

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