Elusive Presentations of Female Genital Tuberculosis: A Case Series

Abstract

The Ministry of Health and Family Welfare has made a target of eliminating tuberculosis by 2025 under the National Tuberculosis Elimination Plan (NTEP). For this, it is important to identify cases, notify and treat them effectively. This case series is on women with unique presentations of the Female Genital Tract TB (FGTB). It further explores the diagnostic and treatment modalities of such cases. The cases include four women with atypical presentations- a young nulliparous woman with repeated episodes of pyometra, a woman with tubo-ovarian mass and chronic fever and two women with adnexal masses mimicking dermoid and endometriosis, respectively. The diagnosis was based on the unique presentations, exclusion of other diseases and on the operative findings. One should target to get a tissue based diagnosis. Now the government has advised Cartridge-Based Nucleic Acid Amplification Test (CBNAAT), for all samples of FGTB, to get an accurate estimation of drug resistance. It can be used in very interior areas, gives a result within the same day and also gives sensitivity results to the antitubercular drugs. CBNAAT may give incorrect results with small specimens. That makes clinical judgement by specialists very important. The antitubercular regime has changed and there are no separate regimes for relapses or treatment failures. It is now therapy with daily intake of rifampicin, isoniazid, pyrazinamide and ethambutol for two months and rifampicin, isoniazid and ethambutol for four months. For all cases of FGTB, a working definition should be given and notification should be done by the Nikshay online portal. Future structured studies are required to investigate the sensitivity and specificity of different tissues for CBNAAT in different clinical scenarios of genital Tuberculosis (TB).