Cases Of Genital Tuberculosis Research Articles

Tuberculosis of Uterus: A Case Report

Female Genital Tract Tuberculosis is caused by Mycobacterium tuberculosis, being usually secondary to tuberculosis of the lungs. In Female Genital Tract Tuberculosis, fallopian tubes are affected in 90 percent woman, whereas uterine endometrium is affected in 70 percent and ovaries in about 20 percent. HIV induced immunosuppresion paves the way for several infections, tuberculosis being very common. This is a case of genital tuberculosis which was diagnosed after hysterectomy by histopathological examination in HIV patient. To describe an uncommon case of female genital tract tuberculosis diagnosed by histopathology. Total abdominal hysterectomy specimen was received. Brief clinical history was taken and clinical examination was done. Histopathological examination of hematoxylin & eosin stained sections was done. AFB staining was done to look for bacilli. Sections studied from endometrium and cervix revealed granulomas comprised of epithelioid cells, langhan’s type of giant cells. Testing for Tuberculosis & HIV should be undertaken because these are the infections which can affect any organ in the body. In patients with extra pulmonary tuberculosis, early institution of therapy & close clinical monitoring are keys to timely diagnosis and treatment of such co-infections. Keywords: Tuberculosis, HIV, Female genital tract

Etiology of primary amenorrhea: Experience from a tertiary care hospital in Western India

Objectives: The etiology of primary amenorrhea is varied and can involve different organ systems. Gonadal dysgenesis and Mullerian agenesis are two most common disorders contributing to it. However, there is no consensus about the prevalence of different etiologies among studies reported from different parts of the world. The present study was carried out to evaluate different etiological factors responsible for primary amenorrhea in Western India. Materials and Methods: This was a prospective observational study carried out at a tertiary care hospital in Maharashtra. Thirty cases of primary amenorrhea were evaluated over a period of 2 years and data were analyzed regarding etiology and various management options. Results: Fourteen out of 30 cases had Mullerian agenesis and gonadal dysgenesis was reported in five cases. No case of genital tuberculosis was reported in our study. Most cases of Mullerian agenesis were managed with vaginoplasty, whereas cases of gonadal dysgenesis were managed with cyclical hormonal therapy. Conclusion: Mullerian agenesis was the most common etiology of primary amenorrhea followed by gonadal dysgenesis in our study. Diagnosis of patients of amenorrhea should be meticulous and their management depends on the underlying etiology.

Vaginal tuberculosis as differential diagnosis of cancer: A case report

Tuberculosis remains a worrying public health problem. But if pulmonary tuberculosis’s symptomatology is well known by the medical profession, this is not the case of genital tuberculosis. We take advantage of a case of vaginal tuberculosis to review the international literature about clinical diagnosis, further tests, and treatment of this extremely rare tuberculosis localization.

Case report of pelvic tuberculosis resulting in Asherman\u2019s syndrome and infertility

Approximately one-third of the world’s population is infected with Mycobacterium tuberculosis, and it is a leading cause of infertility in endemic countries. The global incidence of tuberculosis (TB) is growing at approximately 0.4% per year, and much faster in sub-Saharan Africa. TB causing fertility is rare in developed countries. We present a case of genital tuberculosis causing Asherman’s syndrome and resultant infertility. The patient is a 34-year-old P0 who presented to care after a prolonged period of secondary amenorrhea and infertility. She underwent a hysterosalpingogram which demonstrated no free spill and a diagnostic hysteroscopy which had findings of mottled endometrium. Pathology returned positive for Mycobacterium tuberculosis. The patient was treated with 9 months of antituberculous therapy. While she has not yet succeeded in becoming pregnant, the patient has started to notice cyclic spotting, indicating possible return of menses. This case highlights the importance of TB treatment and considering TB in patients who present with unexplained infertility.

ВНЕЛЕГОЧНЫЙ ТУБЕРКУЛЕЗ В СИБИРИ И НА ДАЛЬНЕМ ВОСТОКЕ

Extrapulmonary tuberculosis still remains a mysterious problem greatky due to significant degree of divergence in definitions. Materials and methods. Extrapulmonary tuberculosis incidence and its structure have been analyzed for Siberian and Far Eastern Federal Districts for the last 10 years – from 2006 to 2015. Results. In 2006 in Siberian and Far Eastern Federal Districts there were 871 patients suffering from isolated extrapulmonary tuberculosis, the structure of the forms was as follows: tuberculosis of central nervous system (CNS) – 5.7%; bone and joint tuberculosis – 28.7%; urogenital tuberculosis – 35.9%; tuberculosis of peripheral lymph nodes – 15.8%; ocular tuberculosis – 5.2%, other forms – 8.7%. Starting from 2008 ocular tuberculosis was excluded from reporting, despite the fact that the number of such patients was almost the same as the number of CNS tuberculosis cases. 10 years later in 2015 isolated forms of tuberculosis were diagnosed in 699 (-172) people, forms were the following: CNS tuberculosis – 10.6%, double increase; bone and joint tuberculosis – 39.8%, 1.5 fold increase; urogenital tuberculosis – 24.5%, 1.5 fold decrease respectively. Number of those suffering from tuberculosis of peripheral lymph nodes remained the same – 14.2%, other forms inclusive tuberculosis of salivary glands, pancreas, gall bladder, intestine, breast, skin etc. increased respectively up to 11%. Conclusions. The problem of extrapulmonary tuberculosis in Russia as in the whole world still needs to be resolved. Extrapulmonary tuberculosis incidence greatly depends on the number of properly trained specialists and sufficient technical facilities of dispensaries. The following changes are to be made to Form 8: firstly, urological and genital tuberculosis cases are to be recorded separately; secondly, all forms are to be recorded separately according to HIV status.

A case of genital tuberculosis with tuberculous peritonitis suspected by a high level of adenosine deaminase (ADA) in her ascites

A case of genital tuberculosis with tuberculous peritonitis suspected by a high level of adenosine deaminase (ADA) in her ascites

Genital tuberculosis and infertility

Female genital tuberculosis (TB) is an important cause of significant morbidity, short- and long-term sequelae especially in infertility in which incidence varies from 5 to 15% cases in India. The causative agent is Mycobacterium tuberculosis. The fallopian tubes are mainly involved in 90 to 100% cases, endometrium in 60 to 80% cases, ovaries in 30% cases, and cervix in 15% cases of genital TB. Vagina and vulva TB is rare involving 1 to 2% cases. Diagnosis is made by detection of acid fast bacilli on microscopy or culture on endometrial biopsy or on histopathological detection of epithelioid granuloma on biopsy. Polymerase chain reaction (PCR) may be false positive and alone is not sufficient to make the diagnosis. Laparoscopy and hysteroscopy is the gold standard for the diagnosis of the disease. Treatment is by giving daily therapy of rifampicin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E) for 2 months followed by rifampicin (R) and isoniazid (H) daily for 4 months. Three weekly dosing throughout therapy (RHZE thrice weekly for 2 months followed by RH thrice weekly for 4 months) can be given as Directly Observed Treatment Short Course. Surgery is rarely required only for drainage of abscesses. Role of in vitro fertilization and embryo transfer is required in women whose fallopian tubes are damaged but endometrium is healthy. Surrogacy or adoption is needed for women whose endometrium is damaged.

A case of Genital Tuberculosis

Background: genital tuberculosis is a misleading health problem. Methods: Laparascopic surgery of a multiparous woman revealed a complex mass adhering to the pelvic floor. Collected samples were cultured for microbial infection. Polymerase Chain Reaction test was done for presence of Mycobacterium tuberculosis. Results: Mantoux test and Polymerase Chain Reaction test were negative. Caseous necrosis on frozen section specimens were seen. Granulomatous inflammation composed of epithelial cells and multinucleated giant cells were found. Patient was cured with anti-tuberculosis treatment. Conclusions: In the present case only histopathological investigation of the smear could detect the genital tuberculosis.

Nodulo-ulcerative Tuberculosis of the Glans Penis-A Case Report and a Discussion on Nomenclature of Genital Tuberculosis.

Lupus vulgaris is a chronic paucibacillary form of cutaneous tuberculosis occurring in a person with a moderate to high degree of immunity. It commonly occurs over the buttocks and trunk in India. Involvement of the genitalia is uncommon, and lesions involving the penis, extremely rare with few cases reported worldwide. There also exists a confusion regarding nosology of tuberculosis of the genitalia. A brief discussion and review of literature are being discussed along with the report of a case of genital tuberculosis involving the glans penis.

Abdominopelvic Tuberculosis Masquerading Ovarian Malignancy - Histopathology Key to Management

Abdominopelvic tuberculosis (genital tuberculosis) may mimic ovarian malignancy in clinical presentation, ultrasound findings and laboratory tests. We present two cases of genital tuberculosis where a provisional diagnosis of ovarian carcinoma was made. One patient underwent surgery and the other was treated conservatively. These cases underline the mandatory need of a high index of suspicion in our country, towards pelvic tuberculosis preoperatively in a patient with adnexal mass.

Role of newer methods of diagnosing genital tuberculosis in infertile women

Genital tuberculosis is an important under-diagnosed factor of infertility. A vast majority of cases are asymptomatic and diagnosing them will help in treating such patients. We conducted a retrospective study in a tertiary care hospital of Delhi with an aim to compare different methods i.e., histopathological examination (HPE), acid-fast bacilli (AFB) smears, Lowenstein-Jensen (LJ) culture, BACTEC culture and polymerase chain reaction deoxyribonucleic acid (PCR-DNA) for diagnosing endometrial tuberculosis in infertile women. The data from 546 samples of endometrial biopsy histopathology, AFB smears and LJ culture was collected and then analyzed. Of these, HPE for tuberculosis was positive in 13, LJ culture in 10, AFB smear was positive in one case. BACTEC and PCR-DNA were feasible for 90 patients and PCR-DNA was positive in 20 and BACTEC in eight patients. Out of 20 patients with PCR positive results, 15 were only PCR positive and were subjected to hyster-laparoscopy and five had evidence of tuberculosis. Thus, none of the available tests can pick up all cases of genital tuberculosis, but conventional methods i.e., histopathology and LJ culture still has an important role in the diagnosis of endometrial tuberculosis in government setups where BACTEC and PCR are not performed routinely due to lack of resources.

Genital tuberculosis mimicking ovarian malignancy: A series of two cases

Introduction: Genital tuberculosis is a common occurrence in developing countries such as India where pulmonary tuberculosis is widespread. case series: We hereby discuss two interesting case reports. First case was a 34-year-old female who presented with bilateral ovarian mass with high level of serum cA-125. second case was a 25-year-old female who presented with complaint of infertility, huge lump and pain in lower abdomen in a reproductive age, both mimic like ovarian malignancy but ultimately diagnosed as case of genital tuberculosis. conclusion: Genital tuberculosis should be ruled out before performing any extended surgery. both hydrosalpinx and ovarian malignancy present as bilateral adnexal masses, transabdominal ultrasonography was also non discriminative, serum cA-125 level was also elevated in both the conditions.

Genital Tuberculosis: A New Challenge in an Old Disease

In this issue of the Southern Medical Journal a case of genital tuberculosis (GTB) was reported in a young African refugee woman presenting with primary infertility intermittent pelvic pain and menstrual irregularities. Tuberculosis (TB) is a rare disease in some developed countries but it is a frequent cause of chronic pelvic inflammatory disease (PID) and infertility in other parts of the world. GTB is common in women of childbearing age from developing countries. However GTB is not frequently reported in Southeast Asia including Malaysia which is surprising due to the remarkably high incidence of TB in these areas. This patients HIV status was unknown; however she came from a region that is undoubtedly one of the most affected by the HIV epidemic and the global resurgence of TB. Therefore the incidence of GTB may be higher than one might imagine especially among young women living with HIV/AIDS. It is imperative that clinicians have a high index of suspicion for GTB in young immigrant women presenting with unexplained infertility nonspecific menstrual disturbances/ gynecological problems pain or abdominal distension. Diagnosing GTB remains a challenge for clinicians and is based on clinical grounds and confirmed by laboratory investigations such as a TST. Polymerase chain reaction (PCR) is a rapid sensitive and specific molecular technique for detecting GTB and can be used in combination with other available methods. This technique requires invasively obtained biopsy material and therefore noninvasively obtained samples (eg menstrual blood) are beneficial. Interestingly a few other tests such as the detection of Mycobacterium tuberculosis (MTB) antigens using enzyme-linked immunosorbent assay (ELISA) techniqueor the elevation of serum CA-125 levels have shown promising results. However more studies are warranted to elucidate their usefulness for routine diagnosis. Once GTB is confirmed treatment is straightforward and is basically the same regimen used for pulmonary TB. After completion of treatment 95% of patients are considered cured and the patient should be followed by x-ray urine culture and endometrial sampling.10 Empirical treatment is the other option for treating GTB in women who have the characteristic changes on hysterosalpingogram a positive tuberculin skin test and a strong contact history although such cases lack the classic diagnostic criteria.11 This case report highlights the importance of TB as one of the major causative agents of infertility especially in resource-poor countries. A substantial influx of refugees or migrants from TB-endemic countries may cause a significant increase in the incidence of TB/GTB in the host countries and may potentially impact the future of TB control. (full-text)

Female genital tuberculosis

Mycobacterium tuberculosis has been identified as the aetiological agent of tuberculosis for many centuries. Genital tuberculosis is a chronic disease and often has low-grade symptomatology, with very few specific complaints. A study from South Africa found an incidence of 6% of culture-positive tuberculosis in an infertile population. The fallopian tubes are involved in most cases of genital tuberculosis and, together with endometrial involvement, cause infertility in patients. Many patients present with a symptom complex similar to that of ovarian carcinoma, i.e. abdominal distension, pelvic tumour and ascites, which may easily be confused with ovarian carcinoma. Biopsies should be obtained by either laparoscopy or laparotomy if examination of the ascitic fluid could not confirm the diagnosis. Genital tuberculosis is an elusive diagnosis and requires a high index of suspicion as a first step in the diagnostic process. Excellent cure rates are reported on all of the standard treatment regimens.

Genital tuberculosis presenting as pyrexia of undetermined origin.

A case of Genital tuberculosis in a female patient is presented. The key presenting features in this lady were chronic weight loss, colicky lower abdominal pains, fever, and amenorrhea. The fact that tuberculosis is still very much around and could present in unpredictable ways is emphasised.

Genital Tuberculosis Manifesting As Sinus Tracts

Two cases of genital tuberculosis are reported. One is a parous woman with multiple sinuses draining through forchette as well as the anal wall and the other is an unmarried young girl with a discharging sinus at the vulva. We stress upon the need to keep the possibility of tuberculosis in mind while managing women with persistent vulvo-vaginal discharge.

Endometritis granulomatosa: hallazgo histológico en procesos de diferente etiología

Granulomatous endometritis is a chronic inflammation histologically characterized by the presence of granulomas in an endometrium with lymphoplasmacytic infiltrate. A finding of granulomatous endometritis in the biopsy or endometrial specimen should lead to suspicion of genital tuberculosis. This infection used to be rare in women. Tubal, endometrial and ovarian localizations are almost always secondary to a focus in another location. This entity is less frequent in postmenopausal women, probably because the atrophic endometrium provides a poor environment for growth of the tuberculosis bacillus. The definitive diagnosis of genital tuberculosis is culture of the Koch bacillus. A presumptive diagnosis can be made on the basis of granulomas in biopsy and a positive Mantoux test. Treatment is medical and the prognosis is good. We present five cases of genital tuberculosis in postmenopausal women, diagnosed between June 2001 and April 2003.

Genital tuberculosis in women: Analysis of 187 newly diagnosed cases from 47 Swedish hospitals during the ten-year period 1968 to 1977

A retrospective analysis of symptomatology, diagnostic procedures, and treatment of all 155 new cases of genital tuberculosis at 47 Swedish gynecology departments in the period 1968–1977 was performed. The frequency of genital tuberculosis was 0.002% of all patients admitted for gynecologic disease. Genital tuberculosis occurred more frequently in the postmenopausal period. The most common symptoms were metorrhagia, pain, and infertility. Chemotherapy alone was used in 40% of the cases. Conservative surgery was attempted in 8%, and 38% had radical surgery. No intrauterine and four tubal pregnancies occurred after therapy. We conclude that primary treatment should be conservative, although the chances of having a normal pregnancy are almost nil and the risk of an ectopic pregnancy is great.