7
Microbiology, inflammation, and Viral infections
Fig. 7.61 Human papillomavirus (HPV) infection cervix, HSIL.
(A) LBGS (Papanicolaou 60 x MP). (B) In situ hybridization on the same specimen reveals
intranuclear HPV high-risk localization in an integrated form. (In situ hybridization with DAB changes x MP).
Fig. 7.62 Molluscum bodies.
Note the dark, large intracytoplasmic
inclusions (arrow). Vulvar smear (Papanicolaou x HP).
Time will tell whether some of these assays will include ISH,
viral load, and detection of individual HPV genotypes.
Polyomavirus
In addition to HPV, another member of the papovavirus
family—BK or polyomavirus—may rarely be observed in the
vaginopancervical smear. BK virus is seen frequently as an
urothelial infection following renal transplantation with immu-
notherapy and immunosuppression. Rarely, intranuclear large
basophilic inclusions may be seen in the vaginal smear. Cross-
contamination of the vaginal contents from the urinary tract,
however, is a distinct possibility.
Molluscum Contagiosum
Thomas Bateman first described this in 1814. Like other poxvi-
ruses, the genome is a single, linear molecule of double-stranded
DNA. The virus contains a virus-specified, DNA-dependent RNA
polymerase and has not been cultured in in vitro systems.
A typical molluscum contagiosum lesion consists of a local-
ized mass of hypertrophic, hyperplastic epidermal cells that
push the basement membrane down and produce on the
epidermal surface a pearl-white, somewhat umbilicated nod-
ule. The germinal cells in the lesion multiply rapidly. Each cell
enlarges and is filled with dense acidophilic intracytoplasmic
inclusion called molluscum bodies (Fig. 7.62). To be diagnos-
tic, each molluscum body must be intracytoplasmic and should
have a compressed hematoxylinophilic nucleus on the outside.
The tinctorial character of the inclusion may change with the
age of the lesion.
Adenovirus
Adenovirus infection may occur in the female genital tract and
be asymptomatic (Fig. 7.63). Virus often affects the columnar
cell, producing intranuclear inclusions. These may be acidophilic
or basophilic, depending on the duration of infection. Intra-
cytoplasmic inclusions are not well recognized in the cervical
smears. Newborn infants may be infected from the maternal
adenovirus infection.114
Chlamydial infection
Chlamydia trachomatis
infection is one of the most common
sexually transmitted diseases.115 Although documented perhaps
earlier, Halberstaedter and Von Prowazek first visualized
C. tra-
chomatis
in 1907 in a conjunctival scraping.116 The growth cycle of
C. trachomatis
was described in the early 1930s.117,118 The first iso-
lation of
C. trachomatis
from a nonlymphogranuloma venereum
case was done in 1959 by Jones and co-workers. The patient
was the mother of a newborn infant with ophthalmia neona-
torum. In addition to the well-known culture techniques,117
immunodiagnostic techniques, including immunofluorescence
and immunoenzymatic techniques, radioimmunoassays, and
more recently molecular hybridization techniques, have been
introduced in the diagnostic armamentarium for
C. trachomatis
.
Nearly 50% of women with
C. trachomatis
infection may
be asymptomatic. Genitourinary disease, including urethritis,
vaginitis, cervicitis, endometritis, salpingitis, and pelvic inflam-
matory disease (PID), may occur in women infected with
C. tra-
chomatis
organisms.119 The infection can also affect the neonate
during passage through the birth canal and cause neonatal
pneumonia or may be transmitted to the sexual partner, causing
urethritis, prostatitis, and epididymitis. Systemic disease may be
119
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