A relação entre a cervicite linfocítica e a infecção por Chlamydia trachomatis
Data
2019-11-29
Autores
Dummer, Sara Palm
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A cervicite folicular ou linfocítica é caracterizada pela presença de infiltrado linfoide no tecido conjuntivo sub epitelial, sendo este, identificado em esfregaços de Papanicolaou. As características citológicas da cervicite folicular observadas nos esfregaços cervicais foram descritas primeiramente por Eisenstein & Battifora em 1965, consistiam em uma população polimórfica de linfócitos com ou sem macrófagos com corpos tingíveis, visualizados em agrupamentos ou espalhados em muco cervical (Robert & Ng, 1975). Essa alteração inflamatória é encontrada prevalentemente em mulheres na menopausa e na pós-menopausa, e tem sido associada à infecção por microrganismos misturados na flora vaginal normal, como: Streptococos, Enterococos (E. coli) Staphylococos, Gonococos, Trichomonas vaginalis, Candida albicans, Chlamydia trachomatis e Herpes simples. Particularmente, acredita-se que a infecção sexualmente transmissível causada pela bactéria intracelular obrigatória Chlamydia trachomatis, possibilita posteriormente o desenvolvimento da cervicite linfocítica. Há poucos relatos na literatura abordando o diagnóstico da cervicite folicular, por ser uma alteração benigna e não necessitar de seguimento, e muitas vezes embora detectada no esfregaço de Papanicolaou, seu relato no laudo citopatológico é facultativo. Assim, o objetivo desse estudo foi realizar uma revisão bibliográfica para verificar a relação entre a cervicite folicular e a infecção por Chlamydia trachomatis (CT). As alterações citológicas sugestivas de CT são pouco evidentes nos esfregaços cervicais, sendo a presença de cervicite folicular indicativo da possibilidade de infecção por esta bactéria. A maior parte das pacientes com CT são assintomáticas, sendo favorável a implementação de exames de biologia molecular no Sistema Único de Saúde (SUS), por ser uma tecnologia mais sensível e adequada, principalmente nas situações em que há troca de parceiros sexuais. Quanto ao direcionamento específico da resposta imune, foi encontrada uma predominância de linfócitos Th1 (CD4+) e níveis aumentados de anticorpos IgA e IgG das amostras de muco cervical e vaginal em mulheres com a infecção por Chlamydia sp.
Follicular or lymphocytic cervicitis is characterized by the presence of a lymphoid infiltrate in the sub epithelial connective tissue and is identifiable on Pap smears. The cytological characteristics of follicular cervicitis observed on Pap smears were first described by Eisenstein & Battifora in 1965. They consisted of a polymorphic population of lymphocytes with or without tingible body macrophages, seen in clumps or scattered in cervical mucus (Robert & Ng. 1975). This inflammatory change is prevalent in menopausal and postmenopausal women and has been associated with infection by microorganisms mixed in the normal vaginal flora, such as Streptococci, Staphylococci (E. coli), Gonococci, Trichomonas vaginalis, Candida albicans, Chlamydia trachomatis and Herpes Simplex. In particular, it is believed that the sexually transmitted infection caused by the obligate intracellular bacterium Chlamydia trachomatis, later enables the development of lymphocytic cervicitis. There are few reports in the literature that address the diagnosis of follicular cervicitis, as it is a benign entity and does not require follow-up, often detected on Pap smear, and its report is optional. Thus, the aim of this study was to perform a literature review to verify the relationship between follicular cervicitis and Chlamydia trachomatis (CT) infection. Cytological changes suggestive of CT are not evident in cervical smears, and the presence of follicular cervicitis is indicative of the possibility of infection with this bacterium. Most patients with CT are asymptomatic, and favor the implementation of molecular biology exams in the Sistema Único de Saúde (SUS), because it is a more sensitive and appropriate technology, especially when there is an exchange of sexual partners. Regarding the specific targeting of the immune response, a predominance of lymphocytes Th1 (CD4+) and increased levels of IgA and IgG antibodies from cervical and vaginal mucus samples were found in women with Chlamydia sp.
Follicular or lymphocytic cervicitis is characterized by the presence of a lymphoid infiltrate in the sub epithelial connective tissue and is identifiable on Pap smears. The cytological characteristics of follicular cervicitis observed on Pap smears were first described by Eisenstein & Battifora in 1965. They consisted of a polymorphic population of lymphocytes with or without tingible body macrophages, seen in clumps or scattered in cervical mucus (Robert & Ng. 1975). This inflammatory change is prevalent in menopausal and postmenopausal women and has been associated with infection by microorganisms mixed in the normal vaginal flora, such as Streptococci, Staphylococci (E. coli), Gonococci, Trichomonas vaginalis, Candida albicans, Chlamydia trachomatis and Herpes Simplex. In particular, it is believed that the sexually transmitted infection caused by the obligate intracellular bacterium Chlamydia trachomatis, later enables the development of lymphocytic cervicitis. There are few reports in the literature that address the diagnosis of follicular cervicitis, as it is a benign entity and does not require follow-up, often detected on Pap smear, and its report is optional. Thus, the aim of this study was to perform a literature review to verify the relationship between follicular cervicitis and Chlamydia trachomatis (CT) infection. Cytological changes suggestive of CT are not evident in cervical smears, and the presence of follicular cervicitis is indicative of the possibility of infection with this bacterium. Most patients with CT are asymptomatic, and favor the implementation of molecular biology exams in the Sistema Único de Saúde (SUS), because it is a more sensitive and appropriate technology, especially when there is an exchange of sexual partners. Regarding the specific targeting of the immune response, a predominance of lymphocytes Th1 (CD4+) and increased levels of IgA and IgG antibodies from cervical and vaginal mucus samples were found in women with Chlamydia sp.
Descrição
Palavras-chave
Cervicite folicular, Chlamydia trachomatis, Esfregaço cervical, Fatores imunológicos., Follicular cervicitis, Chlamydia trachomatis, Cervical smear, Immunological factors