O significado do infiltrado inflamatório em pacientes diagnosticados com vaginose bacteriana em citologia em meio líquido (SUREPATH)

Abstract

Vulvovaginitis ( VV ) are reported since the fi fth century BC as a major health problem in women. Infectious agents are the main causes . The most commons are bacterial vaginosis (BV ) and vulvovaginal candidiasis ( VC ) . BV is the leading cause of VV, characterized by a change in bacterial vaginal popu lation with a prevalence of an aerobes strains. It is been observed in BV , which by defini tion is a non-inflammatory c ondition, some cases with the presence of inflammatory cells. However, this finding is not yet well defined. In the presence of two simultaneous microorganisms the pictur es would be defined as mixed vaginitis, in which cytological features are poorly defined and perhaps to influence the inflammatory infiltration presence. At the same time, it has been suggested that BV may play a role in carcinogenesis of the cervix since it has been observed that cytologic atypia is more frequent in women with shift of the vaginal flora, it is questionable whether th e inflammatory finding deserve the attention of the cyt opathologist . Objective: to ev aluate findings of liquid-based cytology ( SurePath ® ) in patients diagnosed with BV according to the presence of inflammatory cells. It was an observational , an alytical and cross-sectional study conducted in 1132 women diagnosed with BV , in the pe riod of October 2012 to June 2013. For the diagnosis of BV was used criteria of more than 20 % of clue cells in the smear ( SurePath ® ). The smears were evaluated for identification of morphotypes of pathogens, inflammatory infiltration and epithelial cell atypia . Trichom onas vaginalis , Candida sp ., Mobiluncus sp ., Actinomyces sp ., Cytopathy suggestive of Herpes Simplex Virus were searched . The presence of more than five polymorphonuclear leukocytes per epithelial cell in high power field (1000 x ) was considered in flammatory infiltrate . The ag e of patients ranged from 14 to 73 years (mean = 34.3, SD = 10.9) . The number of pregnancies was between 0 and 11 (mean = 1.5, SD = 2.08 ) . Two hundred and nine ( 34 % ) patients reported use of contraception and 828 ( 73.1 % ) were conducting a rou tine examination.The most fr equent clinical complaint was discharge in 130 cases (11.5 % ). Macroscopic ev aluation of vaginal discharge revealed that the white / milky color 115 ( 46,7 % ) pr evailed. On speculum examination was noted that 994 ( 87.8 % ) cases had described finding of normal mucosa and 50 ( 4.4% ) of vaginal mucosa inflamation. The morphotypes associated with bact erial vaginosis were mostly Mobiluncus sp. in 208 cases (66 %) and Candida sp. in 86 cases (27.3%) . The atypical cells were found in 84 cases ( 7.5%) and among these, AS C -US in 43 cases ( 51.2 % ) , LSIL in 31 ( 37 % ) and HSIL in 03 ( 3.6% ) . It was obser ved in the presence of inflammatory infiltrate 55 ( 4.9% ) cases with Mobiluncus sp ( p < 00.1 , RR = 0.61 [ 0.55 to 0.68 ] ) . Candida sp and 81 ( 7.2% ) cases ( p < 0.001, RR = 5.47 [ 2.93-10.19 ] ) . regarding cytological atypia was observed in the presence of leukocyte infiltrate atypia in 51 cases ( 4.5 % ) . RR = 1.27 [ 1.05 to 1.52 ] ) Among these the most frequent atyp ia was ASC -US with 24 ( 2.1% ) cases with leukocyte infiltration and 19 ( 1.7 % ) cases without infiltrate ( p = 0.2729 , RR = 0 , 86 [ 0.63 to 1.18 ] ) . For cases of LSIL observed 11 case s (1.0 % ) in the group w ithout infiltrate and 20 cases ( 1.8 % ) with inflammatory inf iltrate ( p = 0.0298 , RR = 1.346 [ 1.02 to 1.76 ]). In cases of bacterial vaginosis, by its current de finition, the presence of inflammtory infiltration suggests the possibility of mixed vaginitis (with Candida sp ) or epithelial atypia .