Agentes infecciosos infrecuentes que afectan los parámetros seminales y la fertilidad
Palabras clave:
infección seminal, glándulas accesorias, infertilidad masculina, bacteriospermia.Resumen
Introducción: La investigación bacteriológica del semen es fundamental para la detección de microorganismos comúnmente asociados a la infertilidad. La mayoría de las infecciones seminales a menudo son asintomáticas y pasan desapercibidas, especialmente cuando deterioran la calidad espermática. Otras infecciones poco comunes como las parasitarias, micóticas y virales alteran la calidad seminal.
Objetivo: Determinar los agentes infecciosos infrecuentes, bacterianos y no bacterianos, que alteran los parámetros seminales.
Métodos: En las bases de datos Medline, PubMed y Google Scholar se consultaron estudios iniciales de larga data publicados entre los años 2004 y 2020. La versión a texto completo se obtuvo a través de acceso libre en Pubmed, HINARI y otras fuentes.
Desarrollo: En la literatura revisada se mencionan algunos agentes etiológicos asociados con oligozoospermia y astenozoospermia como Trichomonas vaginalis, Tripanosoma cruzy y Toxoplasma gondii, mientras que la hemospermia se relacionó con Leishmania spp., Schistosoma haematobium y citomegalovirus. La disfunción de las glándulas accesorias y la hiperviscosidad seminal se asociaron con infecciones virales por citomegalovirus, herpes simple, Epstein Barr y con los parásitos T. vaginalis, Leishmania spp. y S. haematobium.
Conclusiones: El porcentaje de casos de infertilidad idiopática podría reducirse con el estudio de los agentes infecciosos infrecuentes y su combinación con los parámetros seminales en base a la patogenicidad de cada microorganismo. Se necesitan estudios dirigidos a gran escala para estandarizar las variables que determinan rasgos específicos y valores de referencia que ayudarán a optimizar el diagnóstico, el tratamiento y la prevención de estos agentes infecciosos en la infertilidad masculina.
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2. Lozano Hernández JR. Male accessory glands and sperm function. En: Spermatozoa. Facts and perspectives. Intech Londres: Open; 2018; 101-16. DOI: http://dx.doi.org/10.5772/intechopen.74321
3. Lozano-Hernández R, Vivas-Acevedo G, Muñoz MG. Mycoplasmas y anticuerpos anti-Chlamydia en semen de hombres infértiles y su relación con la calidad seminal y los marcadores de glándulas sexuales accesorias masculinas. Invest Clin. 2012 [acceso 12/06/2019];53(2):138-47. Disponible en: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0535-51332012000200003&lng=es
4. Chemaitelly H, Weiss HA, Smolak A, Majed E, Abu-Raddad LJ. Epidemiology of Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus type 2 among female sex workers in the Middle East and North Africa: systematic review and meta-analytics. J Glob Health. 2019; 9(2):020408. DOI: https://doi.org/10.7189/jogh.09.020408
5. Franco JVA, Turk T, Jung JH, Xiao YT, Iakhno S, Garrote V, et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU Int. 2019;124(2):197-208. DOI: https://doi.org/10.1111/bju.14492
6. Mashaly M, Masallat DT, Elkholy AA, Abdel I, Mostafa T. Seminal Corynebacterium strains in infertile men with and without leucocytospermia. Andrologia. 2015 [acceso 16/06/2019];48:355-9. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/and.12457
7. Kaur S, Prabha V. Infertility as a consequence of spermagglutinating Staphylococcus aureus colonization in genital tract of female mice. PLoSOne 2012; 7(12):e52325. DOI: https://doi.org/10.1371/journal.pone.0052325
8. Lozano-Hernández R, Velasco J, Pacheco L, Sayago A, Peña J. Impacto de Staphylococcus epidermidis en el testículo murino. RSVM 2018 [acceso 16/06/2019];38(1):10-14. Disponible en: https://www.researchgate.net/publication/328073183_Impacto_de_Staphylococcus_epidermidis_en_el_testiculo_murino/citation/download
9. Guerrero-Hurtado LS, Puerta-Suárez J, Cardona-Maya WD. Papel de los espermatozoides en la transmisión de bacterias uropatógenas: Escherichia coli y Enterococcus faecalis. Clin Invest Ginecol Obstet. 2016;45(1):2-6. DOI: https://doi.org/10.1016/j.gine.2016.03.003
10. Belga S, Chen W, Low G, Cervera C. Xanthogranulomatous prostatitis presenting as Pseudomonas aeruginosa prostatic abscesses: An uncommon complication after kidney transplantation. ID Cases. 2019; 17:e00559. DOI: https://doi.org/10.1016/j.idcr.2019.e00559
11. Massari F, Mollica V, Di Nunno V, Gatto L, Santoni M, Scarpelli M, et al. The Human Microbiota and Prostate Cancer: Friend or Foe? Cancers (Basel). 2019; 11(4):459. DOI: https://doi.org/10.3390/cancers11040459
12. Thaper D, Rahi DK, Prabha V. Amelioration of sperm immobilization factor-induced infertility by bacterial antigenic determinants cross-reacting with spermatozoa. Reprod Fertil Dev. 2019;31(3):602-12. DOI: https://doi.org/doi 10.1071/RD18300
13. Ubeda JL, Ausejo R, Dahmani Y, Falceto MV, Usan A, Malo C, et al. Adverse effects of members of the Enterobacteriaceae family on boar sperm quality. Theriogenology. 2013; 80(6):565-70. DOI: https://doi.org/10.1016/j.theriogenology.2013.05.022
14. Ricci S, De Giorgi S, Lazzeri E, Luddi A, Rossi S, Piomboni P, et al. Impact of asymptomatic genital tract infections on in vitro Fertilization (IVF) outcome. PLoS One. 2018 [acceso 04/11/2019];13(11):e0207684. Disponible en: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207684
15. Zuleta-González MC, Zapata-Salazar ME, Guerrero-Hurtado LS, Puerta-Suárez J, Cardona-Maya WD. Klebsiella pneumoniae and Streptococcus agalactiae: Passengers in the sperm travel. Arch Esp Urol. 2019; 72(9):939-47.
16. Vilvanathan S, Kandasamy B, Jayachandran AL, Sathiyanarayanan S, Tanjore V, Krishnamurthy V, et al. Bacteriospermia and its impact on basic semen parameters among infertile men. Interdiscip Perspect Infect Dis. 2016;2016:2614692. DOI: http://dx.doi.org/10.1155/2016/2614692
17. Zhu XR, Li LH, Fan LX, Li BJ, Lan Y, Li F, et al. Semen quality and HIV RNA level in HIV/AIDS male patients after treated by highly active antiretroviral therapy. Zhonghua Nan KeXue. 2018;24(5):414-8.
18. Salam AP, Horby PW. The breadth of viruses in human semen. Emerg Infect Dis. 2017;23(11):1922-24. DOI: https://doi.org/10.3201/eid2311.171049
19. Du Plessis S, Agarwal A, Sabanegh E. Male infertility. New York: Springer; 2014, p. 134.
20. Gheit T. Mucosal and cutaneous human papillomavirus infections and cancer biology. Front Oncol. 2019; 9:355. DOI: https://doi.org/10.3389/fonc.2019.00355
21. Paz-Zulueta M, Fernández-Feito A, Amparán Ruiz M, Azofra Olave A, Martin Seco Y, Ojugas Zabala S, et al. Prevalencia de genotipos del virus del papiloma humano de alto riesgo no vacunables dentro del programa de detección precoz de cáncer de cérvix en Cantabria. Aten Primaria. 2016; 48(6):347-55. DOI: https://doi.org/10.1016/j.aprim.2015.07.006
22. Lippold S, Braun B, Krüger F, Harms M, Müller JA, GroB R, et al. Natural Inhibitor of human cytomegalovirus in human seminal plasma. J Virol. 2019; 93(6):e01855-18. DOI: https://doi.org/10.1128/JVI.01855-18
23. Alikhan MB, Tesic V, Taxy JB, Antic T. Cytomegalovirus Infection of Seminal Vesicles. Int J Surg Pathol. 2016; 24(8):720. DOI: https://doi.org/10.1177/1066896916657592
24. Tang Q, Roan NR, Yamamura Y. Seminal plasma and semen amyloids enhance cytomegalovirus infection in cell culture. J Virol. 2013; 87(23):12583-91. DOI: https://doi.org/10.1128/JVI.02083-13
25. Gianella S, Ginocchio CC, Daar ES, Dube MP, Morris SR. Genital Epstein Barr Virus is associated with higher prevalence and persistence of anal human papillomavirus in HIV-infected men on antiretroviral therapy. BMC Infect Dis. 2016; 16:24. DOI: https://doi.org/10.1186/s12879-016-1356-y
26. Karamolahi S, Yazdi RS, Zangeneh M, Makiani MJ, Farhoodi B, Gilani MAS. Impact of hepatitis B virus and hepatitis C virus infection on sperm parameters of infertile men. Int J Reprod Biomed (Yazd). 2019; 17(8):551-6. DOI: https://doi.org/10.18502/ijrm.v17i8.4820
27. Nicopoullos JDM, Almeida PA, Ramsay JWA, Gilling-Smith C. The effect of human immunodeficiency virus on sperm parameters and the outcome of intrauterine insemination following sperm washing. Hum Reprod. 2004; 19(10):2289-97. DOI: https://doi.org/10.1093/humrep/deh426
28. Uraki R, Hwang J, Ann K, Jurado K, Householder S, Yockey L, et al. Zika virus causes testicular atrophy. Sci Adv. 2017; 3(2):e1602899. DOI: https://doi.org/10.1126/sciadv.1602899
29. Haby MM, Pinart M, Elias V, Reveiz L. Prevalence of asymptomatic Zika virus infection: a systematic review. Bull World Health Organ. 2018;96(6):402-13. DOI: https://doi.org/10.2471/BLT.17.201541
30. Capra G, Schillaci R, Bosco L, Roccheri MC, Perino A, Ragusa MA. HPV infection in semen: results from a new molecular approach. Epidemiol Infect. 2019; 147: e177. DOI: https://doi.org/10.1017/S0950268819000621
31. Wang D, Li L, Xie Q, Hou Z, Yu X, Ma M, et al. Factors affecting sperm fertilizing capacity in men infected with HIV. J Med Virol. 2014; 86(9):1467-72. DOI: https://doi.org/10.1002/jmv.23991
32. Jersovienė V, Gudlevicienė Z, Rimienė J, Butkauskas D. Human Papillomavirus and Infertility. Medicina (Kaunas). 2019; 55(7):377. DOI: https://doi.org/10.3390/medicina55070377
33. Moghimi M, Zabihi-Mahmoodabadi S, Kheirkhah-Vakilabad A, Kargar Z. Significant Correlation between high-risk HPV DNA in semen and impairment of sperm quality in infertile men. Int J Fertil Steril. 2019;12(4):306-9. DOI: https://doi.org/10.22074/ijfs.2019.5421
34. Dubaut J, Gurung S, Trammell M, Myers D, Reuter D, Preno A, et al. Semen parameters during zika virus infection in the olive baboon (Papio anubis). Fertil Steril. 2017; 108(3):e52-e53. DOI: https://doi.org/10.1016/j.fertnstert.2017.07.168
35. Kang X, Xie Q, Zhou X, Li F, Huang J, Liu D, et al. Effects of hepatitis B virus S protein exposure on sperm membrane integrity and functions. PLoS ONE 2012; 7:e33471. DOI: https://doi.org/10.1371/journal.pone.0033471
36. Lorusso F, Palmisano M, Chironna M, Vacca M, Masciandaro P, Bassi E, et al. Impact of chronic viral diseases on semen parameters. Andrologia. 2010; 42:121-6. DOI: https://doi.org/10.1111/j.1439-0272.2009.00970.x
37. La Vignera S, Condorelli RA, Vicari E, D'Agata R, Calogero AE. Sperm DNA damage in patients with chronic viral C hepatitis. Eur J Intern Med. 2012; 23:e19-e24. DOI: https://doi.org/10.1016/j.ejim.2011.08.011
38. Shiadeh MN, Niyyati M, Fallahi S, Rostami A. Human parasitic protozoan infection to infertility: A systematic review. Parasitol Res. 2016; 115:469-47.
39. Iqbal J, Al-Rashed J., Kehinde EO. Detection of Trichomonas vaginalis in prostate tissue and serostatus in patients with asymptomatic benign prostatic hyperplasia. BMC Infect Dis. 2016;16:506. DOI: https://doi.org/10.1186/s12879-016-1843-1
40. Abdel-Naser MB, Wollina U, Lohan M, Zouboulis CC, Altenburg A. Schistosomiasis (Bilharziasis) ova: An incidental finding in testicular tissue of an obstructive azoospermic man. Andrología. 2018; 50(10):e13131. DOI: https://doi.org/10.1111/and.13131
41. Tayra E, Ashmaig A, Shareef H, Bedawi S, Aradaib I. Association of Schistosoma mansoni with infertility in a Sudanese patient from schistosomiasis area of endemicity: A case report. Res J Med Sci. 2010; 4(3):125-7. DOI: https://doi.org/10.3923/rjmsci.2010.125.127
42. Dalimi A, Abdoli A. Toxoplasma gondii an male reproduction impairment: a new aspect of toxoplasmosis. Jundishapur J Microbiol. 2013; 6:e7184. DOI: https://doi.org/10.5812/jjm.7184
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2. Lozano Hernández JR. Male accessory glands and sperm function. En: Spermatozoa. Facts and perspectives. Intech Londres: Open; 2018; 101-16. DOI: http://dx.doi.org/10.5772/intechopen.74321
3. Lozano-Hernández R, Vivas-Acevedo G, Muñoz MG. Mycoplasmas y anticuerpos anti-Chlamydia en semen de hombres infértiles y su relación con la calidad seminal y los marcadores de glándulas sexuales accesorias masculinas. Invest Clin. 2012 [acceso 12/06/2019];53(2):138-47. Disponible en: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0535-51332012000200003&lng=es
4. Chemaitelly H, Weiss HA, Smolak A, Majed E, Abu-Raddad LJ. Epidemiology of Treponema pallidum, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus type 2 among female sex workers in the Middle East and North Africa: systematic review and meta-analytics. J Glob Health. 2019; 9(2):020408. DOI: https://doi.org/10.7189/jogh.09.020408
5. Franco JVA, Turk T, Jung JH, Xiao YT, Iakhno S, Garrote V, et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU Int. 2019;124(2):197-208. DOI: https://doi.org/10.1111/bju.14492
6. Mashaly M, Masallat DT, Elkholy AA, Abdel I, Mostafa T. Seminal Corynebacterium strains in infertile men with and without leucocytospermia. Andrologia. 2015 [acceso 16/06/2019];48:355-9. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/and.12457
7. Kaur S, Prabha V. Infertility as a consequence of spermagglutinating Staphylococcus aureus colonization in genital tract of female mice. PLoSOne 2012; 7(12):e52325. DOI: https://doi.org/10.1371/journal.pone.0052325
8. Lozano-Hernández R, Velasco J, Pacheco L, Sayago A, Peña J. Impacto de Staphylococcus epidermidis en el testículo murino. RSVM 2018 [acceso 16/06/2019];38(1):10-14. Disponible en: https://www.researchgate.net/publication/328073183_Impacto_de_Staphylococcus_epidermidis_en_el_testiculo_murino/citation/download
9. Guerrero-Hurtado LS, Puerta-Suárez J, Cardona-Maya WD. Papel de los espermatozoides en la transmisión de bacterias uropatógenas: Escherichia coli y Enterococcus faecalis. Clin Invest Ginecol Obstet. 2016;45(1):2-6. DOI: https://doi.org/10.1016/j.gine.2016.03.003
10. Belga S, Chen W, Low G, Cervera C. Xanthogranulomatous prostatitis presenting as Pseudomonas aeruginosa prostatic abscesses: An uncommon complication after kidney transplantation. ID Cases. 2019; 17:e00559. DOI: https://doi.org/10.1016/j.idcr.2019.e00559
11. Massari F, Mollica V, Di Nunno V, Gatto L, Santoni M, Scarpelli M, et al. The Human Microbiota and Prostate Cancer: Friend or Foe? Cancers (Basel). 2019; 11(4):459. DOI: https://doi.org/10.3390/cancers11040459
12. Thaper D, Rahi DK, Prabha V. Amelioration of sperm immobilization factor-induced infertility by bacterial antigenic determinants cross-reacting with spermatozoa. Reprod Fertil Dev. 2019;31(3):602-12. DOI: https://doi.org/doi 10.1071/RD18300
13. Ubeda JL, Ausejo R, Dahmani Y, Falceto MV, Usan A, Malo C, et al. Adverse effects of members of the Enterobacteriaceae family on boar sperm quality. Theriogenology. 2013; 80(6):565-70. DOI: https://doi.org/10.1016/j.theriogenology.2013.05.022
14. Ricci S, De Giorgi S, Lazzeri E, Luddi A, Rossi S, Piomboni P, et al. Impact of asymptomatic genital tract infections on in vitro Fertilization (IVF) outcome. PLoS One. 2018 [acceso 04/11/2019];13(11):e0207684. Disponible en: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207684
15. Zuleta-González MC, Zapata-Salazar ME, Guerrero-Hurtado LS, Puerta-Suárez J, Cardona-Maya WD. Klebsiella pneumoniae and Streptococcus agalactiae: Passengers in the sperm travel. Arch Esp Urol. 2019; 72(9):939-47.
16. Vilvanathan S, Kandasamy B, Jayachandran AL, Sathiyanarayanan S, Tanjore V, Krishnamurthy V, et al. Bacteriospermia and its impact on basic semen parameters among infertile men. Interdiscip Perspect Infect Dis. 2016;2016:2614692. DOI: http://dx.doi.org/10.1155/2016/2614692
17. Zhu XR, Li LH, Fan LX, Li BJ, Lan Y, Li F, et al. Semen quality and HIV RNA level in HIV/AIDS male patients after treated by highly active antiretroviral therapy. Zhonghua Nan KeXue. 2018;24(5):414-8.
18. Salam AP, Horby PW. The breadth of viruses in human semen. Emerg Infect Dis. 2017;23(11):1922-24. DOI: https://doi.org/10.3201/eid2311.171049
19. Du Plessis S, Agarwal A, Sabanegh E. Male infertility. New York: Springer; 2014, p. 134.
20. Gheit T. Mucosal and cutaneous human papillomavirus infections and cancer biology. Front Oncol. 2019; 9:355. DOI: https://doi.org/10.3389/fonc.2019.00355
21. Paz-Zulueta M, Fernández-Feito A, Amparán Ruiz M, Azofra Olave A, Martin Seco Y, Ojugas Zabala S, et al. Prevalencia de genotipos del virus del papiloma humano de alto riesgo no vacunables dentro del programa de detección precoz de cáncer de cérvix en Cantabria. Aten Primaria. 2016; 48(6):347-55. DOI: https://doi.org/10.1016/j.aprim.2015.07.006
22. Lippold S, Braun B, Krüger F, Harms M, Müller JA, GroB R, et al. Natural Inhibitor of human cytomegalovirus in human seminal plasma. J Virol. 2019; 93(6):e01855-18. DOI: https://doi.org/10.1128/JVI.01855-18
23. Alikhan MB, Tesic V, Taxy JB, Antic T. Cytomegalovirus Infection of Seminal Vesicles. Int J Surg Pathol. 2016; 24(8):720. DOI: https://doi.org/10.1177/1066896916657592
24. Tang Q, Roan NR, Yamamura Y. Seminal plasma and semen amyloids enhance cytomegalovirus infection in cell culture. J Virol. 2013; 87(23):12583-91. DOI: https://doi.org/10.1128/JVI.02083-13
25. Gianella S, Ginocchio CC, Daar ES, Dube MP, Morris SR. Genital Epstein Barr Virus is associated with higher prevalence and persistence of anal human papillomavirus in HIV-infected men on antiretroviral therapy. BMC Infect Dis. 2016; 16:24. DOI: https://doi.org/10.1186/s12879-016-1356-y
26. Karamolahi S, Yazdi RS, Zangeneh M, Makiani MJ, Farhoodi B, Gilani MAS. Impact of hepatitis B virus and hepatitis C virus infection on sperm parameters of infertile men. Int J Reprod Biomed (Yazd). 2019; 17(8):551-6. DOI: https://doi.org/10.18502/ijrm.v17i8.4820
27. Nicopoullos JDM, Almeida PA, Ramsay JWA, Gilling-Smith C. The effect of human immunodeficiency virus on sperm parameters and the outcome of intrauterine insemination following sperm washing. Hum Reprod. 2004; 19(10):2289-97. DOI: https://doi.org/10.1093/humrep/deh426
28. Uraki R, Hwang J, Ann K, Jurado K, Householder S, Yockey L, et al. Zika virus causes testicular atrophy. Sci Adv. 2017; 3(2):e1602899. DOI: https://doi.org/10.1126/sciadv.1602899
29. Haby MM, Pinart M, Elias V, Reveiz L. Prevalence of asymptomatic Zika virus infection: a systematic review. Bull World Health Organ. 2018;96(6):402-13. DOI: https://doi.org/10.2471/BLT.17.201541
30. Capra G, Schillaci R, Bosco L, Roccheri MC, Perino A, Ragusa MA. HPV infection in semen: results from a new molecular approach. Epidemiol Infect. 2019; 147: e177. DOI: https://doi.org/10.1017/S0950268819000621
31. Wang D, Li L, Xie Q, Hou Z, Yu X, Ma M, et al. Factors affecting sperm fertilizing capacity in men infected with HIV. J Med Virol. 2014; 86(9):1467-72. DOI: https://doi.org/10.1002/jmv.23991
32. Jersovienė V, Gudlevicienė Z, Rimienė J, Butkauskas D. Human Papillomavirus and Infertility. Medicina (Kaunas). 2019; 55(7):377. DOI: https://doi.org/10.3390/medicina55070377
33. Moghimi M, Zabihi-Mahmoodabadi S, Kheirkhah-Vakilabad A, Kargar Z. Significant Correlation between high-risk HPV DNA in semen and impairment of sperm quality in infertile men. Int J Fertil Steril. 2019;12(4):306-9. DOI: https://doi.org/10.22074/ijfs.2019.5421
34. Dubaut J, Gurung S, Trammell M, Myers D, Reuter D, Preno A, et al. Semen parameters during zika virus infection in the olive baboon (Papio anubis). Fertil Steril. 2017; 108(3):e52-e53. DOI: https://doi.org/10.1016/j.fertnstert.2017.07.168
35. Kang X, Xie Q, Zhou X, Li F, Huang J, Liu D, et al. Effects of hepatitis B virus S protein exposure on sperm membrane integrity and functions. PLoS ONE 2012; 7:e33471. DOI: https://doi.org/10.1371/journal.pone.0033471
36. Lorusso F, Palmisano M, Chironna M, Vacca M, Masciandaro P, Bassi E, et al. Impact of chronic viral diseases on semen parameters. Andrologia. 2010; 42:121-6. DOI: https://doi.org/10.1111/j.1439-0272.2009.00970.x
37. La Vignera S, Condorelli RA, Vicari E, D'Agata R, Calogero AE. Sperm DNA damage in patients with chronic viral C hepatitis. Eur J Intern Med. 2012; 23:e19-e24. DOI: https://doi.org/10.1016/j.ejim.2011.08.011
38. Shiadeh MN, Niyyati M, Fallahi S, Rostami A. Human parasitic protozoan infection to infertility: A systematic review. Parasitol Res. 2016; 115:469-47.
39. Iqbal J, Al-Rashed J., Kehinde EO. Detection of Trichomonas vaginalis in prostate tissue and serostatus in patients with asymptomatic benign prostatic hyperplasia. BMC Infect Dis. 2016;16:506. DOI: https://doi.org/10.1186/s12879-016-1843-1
40. Abdel-Naser MB, Wollina U, Lohan M, Zouboulis CC, Altenburg A. Schistosomiasis (Bilharziasis) ova: An incidental finding in testicular tissue of an obstructive azoospermic man. Andrología. 2018; 50(10):e13131. DOI: https://doi.org/10.1111/and.13131
41. Tayra E, Ashmaig A, Shareef H, Bedawi S, Aradaib I. Association of Schistosoma mansoni with infertility in a Sudanese patient from schistosomiasis area of endemicity: A case report. Res J Med Sci. 2010; 4(3):125-7. DOI: https://doi.org/10.3923/rjmsci.2010.125.127
42. Dalimi A, Abdoli A. Toxoplasma gondii an male reproduction impairment: a new aspect of toxoplasmosis. Jundishapur J Microbiol. 2013; 6:e7184. DOI: https://doi.org/10.5812/jjm.7184
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2020-06-05
Cómo citar
1.
Pacheco Rodríguez L, Lozano Hernández R, Velasco Carrillo J. Agentes infecciosos infrecuentes que afectan los parámetros seminales y la fertilidad. Rev. Cubana Urol. [Internet]. 5 de junio de 2020 [citado 30 de enero de 2025];9(3):128-42. Disponible en: https://revurologia.sld.cu/index.php/rcu/article/view/592
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