Cases Of Female Genital Tuberculosis Research Articles

Hysterosalpingography Observations in Female Genital Tuberculosis with Infertility.

Hysterosalpingography (HSG) is radiographic evaluation of uterine cavity and tubal patency. The aim of this study was to evaluate the safety and utilisation of HSG in female genital tuberculosis (FGTB) with infertility. The study was conducted in a tertiary referral centre of North India. It was a prospective study on 87 cases of FGTB with infertility. Diagnosis of FGTB was made by composite reference standard using the presence of acid-fast bacilli on microscopy/culture or positive GeneXpert, positive polymerase chain reaction or epithelioid granuloma on endometrial biopsy or definitive or probable findings on laparoscopy or hysteroscopy. Suitable statistical methods were used with STATA software version 12.0. HSG findings were normal in 49 (56.32%) cases. There were filling defects in 14 (16.09%), short and shrunken cavity in 4 (4.49%), intrauterine synechiae in 14 (16.09%), T-shaped cavity in 3 (3.44%) and deformed uterine cavity in 5 (5.74%) cases. Fallopian tube findings were hydrosalpinx in 12 (13.79%) and 11 (12.64%) cases, beading of tube in 4 (4.59%) and 2 (2.29%) cases, pipestem appearance in 2 (2.29%) cases each and Maltese cross appearance in 3 (3.44%) and 2 (2.29%) cases, respectively. Tubal blockage was seen in 69 (79.31%) and 67 (77.01%) cases being cornual block in 28 (32.18%) and 26 (29.88%) cases, mid-tubal block in 16 (18.39%) and 15 (17.24%) cases, multiple blocks in 10 (11.49%) and 12 (13.79%) cases and fimbrial block in 15 (17.24%) and 14 (16.09%) cases. None of the cases had flare-up of the disease after HSG in the current study. HSG is a useful modality in FGTB with infertility.

Hysteroscopic observations in 348 consecutive cases of female genital tuberculosis: A prospective study

Study objectiveTo evaluate the hysteroscopic findings in female genital tuberculosis. DesignIt was a prospective study of hysteroscopic findings performed on 348 cases of female genital tuberculosis (FGTB). SettingIt was a prospective cross-sectional study in a tertiary referral centre. PatientsA total of 348 patients with infertility with FGTB on various tests. InterventionA total of 348 patients of infertility found to have FGTB on various investigations were enrolled in the study. A detailed history was taken. Clinical examination, endometrial sampling and diagnostic laparoscopy were performed was also performed in selected cases. All patients underwent hysteroscopy as part of evaluation for infertility and tuberculosis (TB) findings. Measurements and main resultsThe mean age, parity, body mass index and duration of infertility was 28.2 years, 0.31,23.1kg/m2 and 3.44 years respectively. Infertility was primary in 81.03% and secondary in 18.96% cases. Diagnosis of FGTB was made by endometrial aspirate findings of positive AFB on microscopy (4.02%), positive culture (4.88%), positive PCR (83.90%), epithelioid granuloma (14.65%), positive AFB on microscopy or culture of peritoneal cytology (1.14%) or epithelioid granuloma on peritoneal biopsy (1.72%), definitive findings of TB on laparoscopy (41.95%) or probable findings of TB on laparoscopy (58.05%). Various hysteroscopic findings observed were normal findings (28.16%), pale endometrial cavity (54.31%), features of active TB (7.47%), features of chronic TB (19.54%), features of TB sequelae like obstructed ostia (both ostia in 13.79%, one ostia 14.94%, periostial fibrosis; (bilateral 4.59%, unilateral 5.17%), endometrial glands atrophy (12.35%), small shrunken cavity (6.32%), distorted cavity (5.17%), various grades of intrauterine adhesions (29.88%). Hysteroscopy in FGTB was associated with increased difficulties and complications like failed procedures, difficult visualisation, false passage and uterine perforation. ConclusionHysteroscopy is useful modality to detect endometrial TB but is associated with increased difficulty and complications.

Computed tomographic findings in female genital tuberculosis tubo-ovarian masses

Female genital tuberculosis (FGTB) is a common cause of infertility in developing countries. It can manifest as menstrual disturbances, infertility and pelvic masses. ObjectiveTo evaluate the role of computed tomography in diagnosis of female genital tuberculosis with tubo-ovarian (adnexal) masses. MethodsIt was a prospective study over a four year period (July 2015 to August 2019) in a tertiary referral centre over 33 patients presenting with tuberculosis and tubo ovarian masses only. 75 total cases of FGTB diagnosed on composite reference standard (evaluation of AFB bacilli in microscopy or culture or endometrial biopsy, gene expert, epitheloid granulomas on endometrial biopsy or definitive or possible findings of FGTB on laparoscopy). Detailed history taken, clinical examination, baseline investigations and endometrial biopsy were done in all cases. Computed tomography was performed in women presenting with infertility, tubo ovarian masses on clinical examination and laboratory investigations. A total of 33 cases were evaluated. ResultsMean age, body mass index, parity and history of TB contact were 27.5 ± 4.2 year, 22.7 ± 3.6 kg/m2, 0.27 ± 0.13 and 44.4% respectively. Infertility was primary in 72.72% and secondary in 27.23%. Case wise mean duration being 5.8 years, menstrual dysfunction was seen in 45.45% cases. Abdominal discomfort with pain and lump were seen in all 33 (100%) cases. Abdominal lumps were felt in 4 (12.12%) cases while adnexal mass was seen in all 33 (100%) cases being unilateral in 18 (54.54%) and bilateral in 15 (45.45%). Mean ESR was 33.4mm in first hour while mean leucocyte count was 6128 ± 2854 per cubic mm. Infectious mantoux test (>10mm) was seen in 14 (42.82%) cases while abnormal X ray chest was seen in 9 (27.27%) cases.Diagnosis of FGTB was made by positive AFB n microscopy or culture of endometrial biopsy in 5 (15.15%) cases, positive gene expert in 6 (18.18%) cases, positive polymerase chain reaction in 32 (96.96%) cases, epitheloid granulomas on histopathology of endometrial biopsy in 7 (21.21%) cases, definitive findings of tuberculosis in 15 (45.45%) cases and a possible findings of tuberculosis inn 18 (54.54%) cases. Various CT findings were pelvic mass (100%), unilateral pelvic mass in 18 (54.54%), bilateral pelvic mass in 15 (45.45%), cystic mass (24.2%), solid mass (21.2%), mixed mass (54.54%), mass showing multilocular caseous necrotic enhancements (12.12%), ascites (42.4%), thickening and enhancement of peritoneum in 14 (42.42%), nodules in 24.2%, smooth in 18.8%, pelvic adhesion in 6 (18.18%), lymphadenopathy in 8 (24.3%) with calcifications (9.09%) and central necrosis (52.5%). Other CT findings were thickening and enhancement of bowel wall (12.12%), hepatic TB (3.03%), splenic TB (3.03%), omental thickening (9.09%) and omental calcification (3.03%) cases. ConclusionComputed tomography appears to be a useful diagnostic modality in diagnosis of tuberculosis tubo ovarian masses and may help avoid unnecessary surgery.

Female genital tuberculosis in Pakistan - A retrospective review of 10-year laboratory data and analysis of 32 cases.

Female genital tuberculosis (FGTB) is an underobserved clinical entity owing to diagnostic challenges stemming from difficulty of obtaining diagnostic specimens and paucibacillary nature of the disease. Yet, FGTB is a cause of infertility, pelvic pain, or menstrual irregularities in high-burden countries. To assess laboratory and microbiology diagnostic utilization for FGTB in Pakistan, we have collected data from 2007 to 2016 to inform the need for improved laboratory diagnostics. The objectives of this study were to determine the proportion of FGTB as culture-confirmed extrapulmonary tuberculosis (EPTB) and to describe the characteristics of women with culture-confirmed FGTB in a nationwide laboratory network in Pakistan. A retrospective database was established by accessing laboratory archives and analyzed by sex and source to determine extrapulmonary cases among women. Data were checked for quality, and after removing patient identifiers and duplicate samples, frequencies were calculated in MS Excel. Clinical characteristics of patients were derived from a linked hospital database for those patients who were diagnosed and managed at the affiliated university hospital in Karachi, Pakistan. Over 10 years, 410,748 mycobacterial cultures were received from multiple geographic sites throughout Pakistan and processed at the study laboratory. The overall mean culture positivity rate was 5.9% ± 3.5%, while the mean culture positivity rate among females was 2.8% ± 0.8%. Among female culture-confirmed tuberculosis cases, the pulmonary-to-EPTB ratio of infection was 5. Over 10 years, a total of 32 FGTB cases were reported on the basis of positive cultures for Mycobacterium tuberculosis; 3 (9.4%) were rifampin resistant. FGTB currently constitutes a small but significant proportion of culture-confirmed EPTB. A fewer number of laboratory requisitions suggest the need to increase awareness and testing. The advent of high-sensitivity molecular testing on extrapulmonary specimens has the potential to improve diagnostic accuracy and improved detection of FGTB cases in high-burden regions.

Etiopathogenesis, Challenges and Remedies Associated With Female Genital Tuberculosis: Potential Role of Nuclear Receptors.

Extra-pulmonary tuberculosis (EPTB) is recognized mainly as a secondary manifestation of a primary tuberculosis (TB) infection in the lungs contributing to a high incidence of morbidity and mortality. The TB bacilli upon reactivation maneuver from the primary site disseminating to other organs. Diagnosis and treatment of EPTB remains challenging due to the abstruse positioning of the infected organs and the associated invasiveness of sample acquisition as well as misdiagnosis, associated comorbidities, and the inadequacy of biomarkers. Female genital tuberculosis (FGTB) represents the most perilous form of EPTB leading to poor uterine receptivity (UR), recurrent implantation failure and infertility in females. Although the number of TB cases is reducing, FGTB cases are not getting enough attention because of a lack of clinical awareness, nonspecific symptoms, and inappropriate diagnostic measures. This review provides an overview for EPTB, particularly FGTB diagnostics and treatment challenges. We emphasize the need for new therapeutics and highlight the need for the exaction of biomarkers as a point of care diagnostic. Nuclear receptors have reported role in maintaining UR, immune modulation, and TB modulation; therefore, we postulate their role as a therapeutic drug target and biomarker that should be explored in FGTB.

Female genital tuberculosis cases with distinct clinical symptoms: Four case reports

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Genital TB (GTB) is a form of extrapulmonary TB that occurs more frequently in women, in whom it classically presents in association with menstrual irregularity, pregnancy loss and short and long-term sequelae especially infertility in infected women. Patients with GTB are usually young women diagnosed during workup for infertility. GTB is rare in postmenopausal women and responsible for only approximately 1% of postmenopausal bleeding. In this study, we aimed to evaluate the laboratory, clinical and demographic characteristics of female GTB cases. We presented four female GTB cases with distinct clinical symptoms. All patients have no history of TB, and no acid-fast bacilli were seen in smears prepared from the clinical materials of the patients. Histopathological examinations revealed granulomatous inflammation in all patients. In the light of the clinical features of these cases we aimed to emphasize that, female GTB must be taken into account in the patients with different clinical symptoms like postmenopausal bleeding, menometrorrhagia, infertility, and menstrual irregularities. We believe that these symptoms will be helpful for the diagnosis and treatment of female GTB.

A Hospital Based Study on Female Genital Tuberculosis in Central India

Introduction: In developing countries like India tuberculosis (TB) is common and still a major cause of infertility. Female genital tuberculosis is one form of extra pulmonary TB. Genital TB may be asymptomatic and diagnosis requires a high index of suspicion. Early diagnosis may improve the outcome before permanent tissue damage get established. The objective of this study was to evaluate the prevelance and clinico-pathological aspects and diagnosis of female genital tuberculosis (FGTB). Method: A total of 21 cases of female genital tuberculosis were diagnosed from 1672 patients over a period of 2 years, studied from January 2013 to December 2015. The diagnostic procedure used were endometrial curettage and biopsy, histopathological examination, culture, stain for Acid fast bacilli in correlation with clinical presentation ,organ involvement, hysterosalpingography(HSG), Ultrasonography (USG)and laparoscopy. Most of the specimens received were endometrial curettage and biopsies. Result: Female genital TB accounted for 1.25% of all tuberculosis patients in this study. The highest incidence was between 21-30 years of ages, but the patient ranged from 18-60 years. FGTB involves the endometrium (16 ), fallopian tube (4),cervix (1). Out of all cases, 7 demonstrate typical epitheloid granuloma and rest with atypical tuberculous lesion, acid-fast bacilli in tissue section were detected in 3 cases of endometrium, 1 case of fallopian tube and culture positive in 3 cases of endometrium, 1 case of fallopian tube. Conclusion: Female genital tuberculosis is not uncommon in developing countries like India and indicates a strong relation between genital TB and infertility. The diagnosis of FGTB is challenging. Therefore, if possible genital TB is to be frequently diagnosed and considered in differential diagnosis of causes of infertility, in correlation with clinical and other diagnostic modalities.

Sharma's dried tree branch fallopian tubes sign: A new laparoscopic sign in female genital tuberculosis with infertility

Background: Female genital tuberculosis (FGTB) involves fallopian tubes in 95%–100% cases causing various tubal abnormalities. Objective: To evaluate the laparoscopic findings in FGTB with special reference to a new dried tree branch fallopian tubes sign. Materials and Methods: A total of eighty cases of FGTB diagnosed by demonstration of acid-fast bacilli on microscopy or culture on endometrial or peritoneal biopsy or positive endometrial or peritoneal biopsy or demonstration of epithelioid granuloma on biopsy or positive polymerase chain reaction to Mycobacterium tuberculosis on endometrial biopsy with findings of FGTB on laparoscopy or hysteroscopy were included in this prospective study. Diagnostic laparoscopy was performed in all cases. Results: Definite findings of FGTB such as caseous nodules, tubercles, beaded tubes were seen in 33 (41.2%) cases while probable findings of FGTB such as congested and hyperemic fallopian tubes, hydrosalpinx obstructed tubes, pelvic adhesions, and straw-colored fluid were observed in rest 47 (58.8%) cases. A new dried tree branch fallopian tubes sign was seen in 7 (8.0%) cases being bilateral in 4 (5%) and unilateral in 3 (3.7%) cases. Conclusion: The new sign Sharma's dried tree branch fallopian tubes sign appears to be a useful sign in FGTB. However, larger prospective studies are needed before its routine recommendation in clinical practice.

P184 Female Genital Tuberculosis: The Long Road To Diagnosis

Introduction Female genital tuberculosis (TB) is rarely encountered in the UK but early diagnosis and treatment can prevent significant morbidity. Methods We conducted a retrospective study of all patients treated at our institution for female genital TB between 2004 and 2014. Data including demographics, symptoms, microbiological and histological diagnoses and treatment outcomes were recorded. Results 10 cases of female genital TB were identified. These account for approximately 0.71% of our TB cases, giving a local incidence of female genital TB of approximately 0.5/100,000 population. Mean age was 37.9 +/-14.3. Five patients were from Bangladesh, two from India and one from Pakistan, Cyprus and Somalia. Mean duration of symptoms prior to diagnosis was 24.3 months, range: 0–84. Presenting symptoms included infertility (50%), menorrhagia (10%), amenorrhoea (20%), irregular menstrual bleeding (40%), dyspareunia (20%), vaginal discharge (10%), post coital bleeding (10%) and lower abdominal pain (50%). Patients also experienced fevers (30%), night sweats (10%) and weight loss (10%). All patients had either a laparoscopy or hysteroscopy with biopsy of the endometrium in nine cases and the ovary in one case. Seven cases were found to have necrotising granuloma on biopsy of which two were positive for Ziehl-Neelson (ZN) staining, two were negative and three were not performed. Non-necrotising granuloma was seen in one case and histology was unrecorded for two cases but PCR was positive in both these biopsies. Samples were sent for culture in three cases and all had fully sensitive TB. All cases were treated with standard TB treatment. In two cases treatment is ongoing. One patient died from a co-existing condition. Seven patients completed treatment, of which four had full symptom resolution, two remain under the infertility team and one has ongoing abdominal pain. Median treatment duration was six months. Conclusion This case series highlights the delay in diagnosis and the significant morbidity – particularly infertility – experienced by patients with genital TB. Samples were frequently not sent for culture. Raising awareness of TB within obstetrics and gynaecology and highlighting the importance of considering TB in patients from high incidence countries may help reduce diagnostic delay for these women.

Occurrence of female genital tuberculosis among infertile women: a study from a tertiary maternal health care research centre in South India.

The purpose of this investigation was to estimate the proportion of female genital tuberculosis (FGTB) among infertile women, along with the mean cost of diagnosis by different methods. The study was carried out on 211,335 women, of which 31,755 (15.02 %) were infertile. 202 women were highly suspected of FGTB on laparoscopy, which was later ascertained by multi-gene polymerase chain reaction (PCR), and the cost was estimated. The majority of the patients were infertile (77.23 %), with menstrual disturbances (61.88 %). Many of them were having beaded tubes (68.81 %), tubal block with hydrosalpinx (58.91 %) and tubercular salpingitis (48.01 %). Out of 302 case-controls, 105 infertile women were positive by haematoxylin and eosin staining, 14.57 % were acid-fast bacilli-positive and 86 infertile women were positive on culture. 178 (58.94 %) endo-ovarian tissue biopsies and pelvic aspirated fluid specimens were positive for a 32-kDa protein gene as amplified using multi-gene PCR. The proportion of proven FGTB cases was very high (58.94 %) among infertile women highly suspected of FGTB. The estimated cost in rupees (Rs) of FGTB diagnosis by the conventional method ranges from Rs 3.36 to 38.11, while multi-gene PCR was established as being very expensive (Rs 254.21). The expected time of FGTB diagnosis by the conventional method ranges from 0.5 to 1.83 h, whereas culture took 4-8 weeks. The logical time of FGTB diagnosis by multi-gene PCR was 6.48 h. Compared to Ziehl-Neelsen's staining and culturing, multi-gene PCR improved the detection rate of suspected FGTB. Therefore, FGTB can be diagnosed if multi-gene PCR is considered in the evaluation of infertile patients in areas where tuberculosis is endemic.

Histopathologic analysis of female genital tuberculosis: a fifteen-year retrospective study of 110 cases in eastern india

Tuberculosis remains a global health problem and is an important cause of morbidity and mortality. Female genital tuberculosis is rare in the western world, but relevant in developing countries like India. The aim of this study was to determine histologic findings of different parts of the female genital tract affected by tuberculosis and to correlate it with other features. A total number of 110 cases of female genital tuberculosis from 92 patients were included over a period of 15 years. The age range of the patients was 17 to 45 years with a mean of 26.3. The diagnostic procedures used were curettage biopsy, hysterectomy, histologic examination, culture, Mycobacterium Tuberculosispolymerase chain reaction, laparoscopy, hysterosalpingography and ultrasonography. Patients with female genital tuberculosis presented with infertility (65-70%), pelvic/ abdominal pain (50-55%) and menstrual disturbances (20-25%). Female genital tuberculosis involved the vulva (2), vagina (1), cervix (5), endometrium (66), fallopian tube (24) and ovaries (12). Out of 66 endometrial tuberculosis cases, proliferative, secretory endometrium and atrophic endometrium were seen in 53, 9, and 4 cases, respectively. HIV co-infection was found only in 5 cases and acid-fast bacilli in tissue sections were detected in 7 cases. Female genital tuberculosis is not uncommon in developing countries and is an important cause of infertility. Though the fallopian tube was the most common site in many studies, the endometrium was the commonest site in this study.

Clinical presentation and epidemiology of female genital tuberculosis in eastern Sudan

ObjectiveTo describe the epidemiology and clinical presentation of female genital tuberculosis (FGTB) among women in eastern Sudan. MethodsA cross-sectional survey was conducted at Kassala Maternity Hospital, Sudan, from January 1 to December 31, 2010. ResultsOf the 2778 women presenting with various gynecologic symptoms, 44 suspected cases of FGTB were identified. Granulomatous tissue reactions were observed in 25 of the suspected FGTB cases, yielding an incidence of 0.9%. The majority (20/25; 80%) of these patients presented with chronic pelvic and lower abdominal pain; however, 68.0% (17/25) presented with pelvic mass, cyst and/or abscess; 48.0% (12/25) had dyspareunia; 40.0% (10/25) were infertile; 28% (7/25) had menstrual dysfunction; 20.0% (5/25) had dysmenorrhea; and 4.0% (1/25) experienced postmenopausal bleeding. Body mass index, residence, and educational level were significantly different between women diagnosed with FGTB and those where FGTB was excluded (P values=0.02, 0.03, and 0.01, respectively). However, no significant differences were found in age and Bacillus Calmette-Guérin vaccination status. ConclusionClinical suspicion may facilitate and improve the detection of FGTB, with chronic pelvic pain identified as the predominant clinical presentation among women in eastern Sudan.

Female genital system tuberculosis: a retrospective clinicopathological study of 1,548 cases in Turkish women

The incidence of tuberculosis (TB) has increased worldwide in the past decade and it still remains an important global public health problem. A retrospective clinicopathological study of 1,548 cases of female genital tuberculosis between 1940 and 2011 was conducted. The mean age of the cases was 29.49 years. Involvement of the endometrium was noted in 1,073, fallopian tubes in 164, cervix in 157, and 154 had multiple organ involvement. Clinically, 115 cases (7.4%) were diagnosed as having primary infertility and 12 cases (0.8%) as having secondary infertility. There was a coexistent carcinoma in 1.5% of the cases. Peritoneal tuberculosis in 21 cases and tuberculous lymphadenitis in 7 cases were seen as well. The clinicopathological criteria of female genital tuberculosis in the different organs are described, and special attention is paid to infertility associated with tuberculous lesion, and awareness of the fact that the disease is still with us is thus particularly important.

Histopathologic analysis of female genital tuberculosis with clinical correlation: A fifteen year study in a tertiary hospital of India

Background: Tuberculosis remains a global health problem and is an important cause of morbidity and mortality. Female genital tuberculosis (FGTB), though rare in western world, is relevant in developing countries like India. Aims and Objective: The aim of this study was to determine histologic findings of different parts of female genital tract affected by TB and to correlate it with clinical and other features. Materials and Methods: A total number of 110 cases of FGTB from 92 patients were included over a period of 15 years. (April, 1997 to March, 2012) The age range of the patients was 17 to 45 years with mean of 26.3 years. The diagnostic procedures used were curettage biopsy, hysterectomy, histologic examination, culture, Mycobacterium tuberculosis-polymerase chain reaction, laparoscopy, hysterosalpingography, and ultrasonography. Patients of FGTB presented with infertility (65-70%), pelvic/ abdominal pain (50-55%), and menstrual disturbances (20-25%). Results: FGTB involved vulva (2), vagina (1), cervix (5), endometrium (66), fallopian tube (24), and ovaries (12). Out of 66 endometrial TB, proliferative, secretory endometrium, and atrophic endometrium were seen in 53, 09, and 04 cases. HIV co-infection was found only in 5 cases, and acid-fast bacilli in tissue sections were detected in 7 cases. Conclusions: FGTB is not uncommon in developing countries and is an important cause of infertility. Though fallopian tube was the most common site in many studies, in this study, endometrium emerges as the commonest site. Keywords: Female genital tuberculosis, histopathology, HIV

Anti-mycobacterial recall responses differentiate female patients with genital tuberculosis from patients with other gynecological problems

Background : Female Genital Tuberculosis (FGTB) is one form of extra pulmonary tuberculosis affecting the female reproductive organs, most commonly the fallopian tubes and the endometrium. It affects young women aged between 20 and 40 years of age and is an important cause of infertility. It often occurs as a secondary complication following pulmonary tuberculosis. Diagnosis depends mainly on clinical suspicion in countries where facilities for mycobacterial culture and histopathology are unavailable. Even in places where these facilities exist, diagnosis still remains difficult because of the lower sensitivity and specificity of the methods as well as the invasive procedure of acquiring biopsy specimens. Objective : To explore the immunological profiles of female genital tuberculosis (FGTB) patients in response to mycobacterial antigens. Methods : Twenty-five clinically suspected cases of FGTB and 12 control subjects who came to the Black Lion hospital for unrelated gynecological problems were included in the study. Peripheral blood samples were collected from each subject. Plasma was separated by centrifugation and PBMC were isolated over ficoll-hypaque and stimulated in vitro with mycobacterial antigens to examine their proliferative response as incorporation of tritiated thymidine using a β-counter. HIV status and total IgG-, IgA- and IgM- antibody levels were determined by ELISA tests. Results : In vitro recall responses to M. tuberculosis antigens (PPD and BCG sonicate) as well as plasma levels of IgGIgA- and IgM-antibodies to MPT59 showed statistically significant differences between the patients and the controls (p Conclusion : The results show that PBMC of FGTB patients recognize M. tuberculosis antigens more strongly than PBMC of patients with other gynecological problems. Ethiopian Journal of Health Development Vol. 19(3) 2005: 219-24

Female genital tuberculosis in Ethiopia

Objectives: To study the occurrence of female genital tuberculosis (FGTB) in Ethiopia and to compare the different methods available for its diagnosis. Methods: Biopsy or curettage samples from 25 clinically suspected cases of FGTB were investigated with histopathology, smear microscopy, TB culture and PCR for mycobacteria. HIV status was determined by ELISA. CD4:CD8 ratio was evaluated by flow cytometry. Results: Among the 25 clinically suspected patients investigated, only one was AFB smear positive, three were culture positive, seven were histology positive and 12 were positive by PCR (a total of 16 positives). Samples taken from the fallopian tube were more frequently positive than those from the endometrium. Conclusions: The results showed that FGTB is a significant clinical problem in Ethiopia. A combination of PCR with the other available methods was found to be the best alternative to achieve sufficient sensitivity and specificity for the diagnosis of FGTB in this setting.

Female genital tuberculosis: hysterosalpingographic appearances.

Genital tuberculosis is an important cause of infertility in developing countries and hysterosalpingography (HSG) is the initial procedure performed for the evaluation. Reviewing 37 cases of female genital tuberculosis, we encountered various appearances on HSG. Of 579 HSGs performed over a period of 4 years, 492 (85%) were performed as part of infertility work up. Genital tuberculosis was found in 6.3% of all the patients who underwent HSGs and 7.5% of all patients investigated for infertility. The various features of proven tuberculosis cases are illustrated in this pictorial review. We briefly discuss the pathology and these appearances along with radiopathological correlation.

Prospective analysis of short course chemotherapy in female genital tuberculosis

Short course chemotherapy with 2SHRZ/7HR of 9 months duration was given in 41 proven cases of female genital tuberculosis. Thirty-two (78%) patients completed 9 months of therapy. Twenty-five (61%) were pronounced cured. Short course chemotherapy appears to be quite effective in patients of genital tract tuberculosis.

THE RELATIVE VALUE OF CULTURE AND ENDOMETRIAL BIOPSY IN THE DIAGNOSIS OF GENITAL TUBERCULOSIS

Abstract One hundred and twenty cases of female genital tuberculosis which have been diagnosed by means of cultures of the genital secretions and the menstrual discharge in particular are surveyed and the results of this method are compared with those obtained by means of endometrial biopsy which was done simultaneously in most cases. One hundred and three cases were of the latent and 17 of the exudative form of genital tuberculosis. In 103 cases of latent genital tuberculosis in which both methods could be applied, the cultures of the menstrual and intermenstrual discharge gave positive results in 89.3 per cent, whereas the endometrial biopsy revealed endometrial tuberculosis only in 63 per cent.

The relative value of culture and endometrial biopsy in the diagnosis of genital tuberculosis

One hundred and twenty cases of female genital tuberculosis which have been diagnosed by means of cultures of the genital secretions and the menstrual discharge in particular are surveyed and the results of this method are compared with those obtained by means of endometrial biopsy which was done simultaneously in most cases.One hundred and three cases were of the latent and 17 of the exudative form of genital tuberculosis.In 103 cases of latent genital tuberculosis in which both methods could be applied, the cultures of the menstrual and intermenstrual discharge gave positive results in 89.3 per cent, whereas the endometrial biopsy revealed endometrial tuberculosis only in 63 per cent.