1
|
Sharma JB. JB Sharma's white cotton ball sign: A new laparoscopic sign in abdominopelvic tuberculosis. J Minim Access Surg 2024; 20:24-29. [PMID: 36695245 PMCID: PMC10898634 DOI: 10.4103/jmas.jmas_227_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/31/2022] [Accepted: 12/02/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Abdominopelvic tuberculosis (TB) is a variant of extrapulmonary TB causing significant morbidity, including infertility. MATERIALS AND METHODS Results of 87 cases of diagnostic laparoscopy in cases of abdominopelvic TB diagnosed on composite reference standard (CRS) for demonstration of new laparoscopic white cotton ball sign are presented. RESULTS Mean age, parity and duration of infertility were 27.2 years, 0.21 and 3.1 years, respectively. Oligomenorrhoea and hypomenorrhea were seen in 35 (40.22%) and 32 (36.78%) cases, while infertility was seen in all 87 (100%) cases while abdominal mass was seen in 27 (31.03%) cases and pelvic mass in 37 (42.58%) cases. Positive acid fast bacilli on microscopy and culture of endometrial biopsy was seen in 3.34% and 6.89% cases while epithelioid granuloma was seen in 12.64% cases on endometrial biopsy and in 13.79% cases on peritoneal biopsy. Positive polymerase chain reaction was seen in all cases while definitive abdominal pelvic TB was seen in 35 (40.1%) cases and probable findings in 42 (48.27%) cases. A new laparoscopic white cotton ball sign (resembling a large white cotton ball) was observed in 5 (5.74%) cases and biopsy from 3 showed it to be epithelioid granulomas positive. CONCLUSION Demonstration of a new white cotton ball sign on laparoscopy seems to be a useful finding in abdominal pelvic TB.
Collapse
Affiliation(s)
- Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
2
|
Flores-Lovon K, Soriano-Moreno DR, Medina-Ramirez SA, Fernandez-Guzman D, Caira-Chuquineyra B, Fernandez-Morales J, Tuco KG, Turpo-Prieto J, Alave J, Goicochea-Lugo S. Effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis: a systematic review. BMJ Open 2023; 13:e070456. [PMID: 37758670 PMCID: PMC10537868 DOI: 10.1136/bmjopen-2022-070456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy of antituberculosis therapy on pregnancy outcomes in infertile women with genital tuberculosis. DESIGN Systematic review. DATA SOURCES We searched in PubMed/MEDLINE, CENTRAL and EMBASE up to 15 January 2023. Additionally, we manually search the reference lists of included studies. ELIGIBILITY CRITERIA We included randomised controlled trials (RCT), non-RCTs (non-RCT) and cohort studies that evaluated the effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis compared with not receiving antituberculosis treatment or receiving the treatment for a shorter period. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data. We used Cochrane Risk of Bias 1.0 and Risk Of Bias In Non-randomised Studies tools for risk of bias assessment and meta-analysis was not performed. We used Grading of Recommendations, Assessment, Development and Evaluations approach to assess the certainty of the evidence. RESULTS Two RCTs and one non-RCT were included. The antituberculosis regimens were based on isoniazid, rifampicin, pyrazinamide and ethambutol for 6-12 months. In women without structural damage, very low certainty of evidence from one RCT showed that the antituberculosis treatment may have little to no effect on pregnancy, full-term pregnancy, abortion or intrauterine death and ectopic pregnancy, but the evidence is very uncertain. In women with structural damage, very low certainty of evidence from one non-RCT showed that the antituberculosis treatment may reduce the pregnancy rate (297 fewer per 1000, 95% CI -416 to -101), but the evidence is very uncertain. In addition, very low certainty of evidence from one RCT compared a 9-month vs 6-month antituberculosis treatment regimen showed similar effects between the schemes, but the evidence is very uncertain. Two RCTs reported that no adverse events of antituberculosis treatment were noted or were similar in both groups. CONCLUSION The effect of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis is very uncertain. PROSPERO REGISTRATION NUMBER CRD42022273145.
Collapse
Affiliation(s)
- Kevin Flores-Lovon
- Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Peru
| | | | | | | | | | | | | | - John Turpo-Prieto
- Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Peru
| | - Jorge Alave
- Medicina, Universidad Peruana Unión, Lima, Peru
| | - Sergio Goicochea-Lugo
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| |
Collapse
|
3
|
Sharma JB, Sharma S, Sharma E, Dharmendra S, Singh S. Immune disturbances in female genital tuberculosis and latent genital tuberculosis. Am J Reprod Immunol 2023; 89:e13632. [PMID: 36494901 DOI: 10.1111/aji.13632] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 09/07/2022] [Accepted: 10/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Female genital tuberculosis (FGTB), an important clinical sub-type of extra-pulmonary tuberculosis (EPTB) is responsible for about 10% cases of infertility in India. Both FGTB and latent genital tuberculosis (LGTB) can cause infertility through blockage of fallopian tubes and through altered uterine endometrial receptivity. AIMS This review tries to elucidates the role of various immune factors in FGTB and LGTB. CONTENT Various immune disturbances are observed in FGTB and LGTB like growth factors and cytokines which inhibit implantation and several inflammatory signaling pathways like mitogen activated protein kinase (MAPK), natural killer (NK) cells, nuclear factor kappa-B (NF-KB), tumor necrosis factor (TNF), and toll like receptors (TLR) signaling are dysregulated. These altered immune factors and pathways may be detected in the endometrial biopsies at the early stages of disease before permanent damage. Prompt and adequate treatment with the four anti-tubercular drugs (rifampicin [R], isoniazid [H], pyrazinamide [Z], and ethambutol [E]) can increase pregnancy rates in some of these women. Assisted reproduction especially in-vitro fertilization and embryo transfer may be required for some women. IMPLICATIONS Inflammatory pathways identified from the gene profiling have enabled development of potential biomarkers for early diagnosis of FGTB. Immunomodulation and novel biotechniques like stem cell transplantation, nanoparticles and host directed therapies are being tried in selected patients of FGTB and LGTB with promising results.
Collapse
Affiliation(s)
- Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Eshani Sharma
- Department of Medicine, KU School of Medicine, Wichita, Kansas, USA
| | - Sona Dharmendra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sheena Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
4
|
Muacevic A, Adler JR. Primary Extrapulmonary Rifampicin Mono-Resistant Tuberculosis (TB) of the Endometrium in a Sexually Inactive 20-Year-Old Indian Female: A Very Rare Case. Cureus 2022; 14:e32223. [PMID: 36620786 PMCID: PMC9812340 DOI: 10.7759/cureus.32223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Female genital tract tuberculosis (TB) is less frequently reported, even in endemic countries. Often, the diagnosis is incidental and is seen with the involvement of pulmonary or extrapulmonary sites. Isolated female genital tract TB is quite rare, and cases of primary extrapulmonary rifampicin mono-resistant TB of the genital tract are rarest of the rare. In this case, a 20-year-old sexually inactive female with no history of TB presented with complaints of pain in her abdomen for past two months and absence of menstrual cycles since two years and was later diagnosed based on hysteroscopy, endometrial biopsy, and cartridge-based nucleic acid amplification test (CBNAAT) with primary extrapulmonary rifampicin mono-resistant TB of the endometrium. She was started on a WHO-recommended rifampicin mono-resistant TB regimen for 24 months but was ultimately lost to follow-up.
Collapse
|
5
|
Female Genital Tuberculosis: Clinical Presentation, Current Diagnosis, and Treatment. Infect Dis Obstet Gynecol 2022; 2022:3548190. [PMID: 36438172 PMCID: PMC9699775 DOI: 10.1155/2022/3548190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 09/07/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
Abstract
Female genital tuberculosis is a disease caused by Mycobacterium tuberculosis infection in the female reproductive tract. The disease burden among women leads to infertility is significant, especially in developing countries. The bacteria can spread from the lung into the reproductive organ through lymphatic or hematogenous. Many patients present with atypical symptoms, which mimic other gynecological conditions. Several investigations are needed to establish the diagnosis. Almost all cases of genital TB affect the fallopian tube and cause infertility in patients and endometrial involvement. Current treatment still relies on antituberculosis therapy with a combination of tubal surgery. The present review describes the epidemiological data, clinical presentation, diagnosis, and currently available treatment to cure the disease and for in vitro fertilization.
Collapse
|
6
|
Tzelios C, Neuhausser WM, Ryley D, Vo N, Hurtado RM, Nathavitharana RR. Female Genital Tuberculosis. Open Forum Infect Dis 2022; 9:ofac543. [PMID: 36447614 PMCID: PMC9697622 DOI: 10.1093/ofid/ofac543] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/20/2022] [Indexed: 06/21/2024] Open
Abstract
Female genital tuberculosis (FGTB) is an important cause of morbidity and infertility worldwide. Mycobacterium tuberculosis most commonly spreads to the genital tract from a focus elsewhere in the body and affects the bilateral fallopian tubes and/or endometrium. Many patients with FGTB have indolent disease and are only diagnosed after evaluation for infertility. Women may present with menstrual irregularities, lower abdominal or pelvic pain, or abnormal vaginal discharge. Given the low sensitivity of diagnostic tests, various composite reference standards are used to diagnose FGTB, including some combination of endoscopic findings, microbiological or molecular testing, and histopathological evidence in gynecological specimens. Early treatment with a standard regimen of a 2-month intensive phase with isoniazid, rifampin, ethambutol, and pyrazinamide, followed by a 4-month continuation phase with isoniazid and rifampin, is recommended to prevent irreversible organ damage. However, even with treatment, FGTB can lead to infertility or pregnancy-related complications, and stigma is pervasive.
Collapse
Affiliation(s)
- Christine Tzelios
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Werner M Neuhausser
- Division of Reproductive Endocrinology and Infertility, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - David Ryley
- Division of Reproductive Endocrinology and Infertility, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
- Boston IVF, Boston, Massachusetts, USA
| | - Nhi Vo
- Division of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Rocio M Hurtado
- Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ruvandhi R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Sharma JB, Khurana A, Hari S, Singh U, RituYadav, Dharmendra S. Evaluation of Role of Transabdominal and Transvaginal Ultrasound in Diagnosis of Female Genital Tuberculosis. J Hum Reprod Sci 2021; 14:250-259. [PMID: 34759614 PMCID: PMC8527078 DOI: 10.4103/jhrs.jhrs_161_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 08/27/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022] Open
Abstract
Background: Female genital tuberculosis (FGTB) is a common problem in developing countries causing significant morbidity, especially infertility. Radiological imaging, especially ultrasound, can help in diagnosis of FGTB with tubo-ovarian masses. Aims: The present study was performed to evaluate the role of ultrasound in diagnosis of FGTB and to see various findings of FGTB on ultrasound. Study Setting and Design: It was a prospective cross-sectional study over 4-year period between August 2015 and August 2019 in a tertiary referral center. Subjects and Methods: One hundred and seventy-five patients of infertility diagnosed to have FGTB on composite reference standard (CRS) of positive acid-fast bacilli on microscopy or culture of endometrial biopsy, positive polymerase chain reaction, positive GeneXpert, epithelioid granuloma on histology of endometrial biopsy, or definite or probable finding of FGTB on laparoscopy were subjected to transvaginal ultrasound by an experienced sonographer for various findings of FGTB. Statistical Analysis: Data analysis was carried out using STATA software 12.0. Comparison of categorical values was tested using Chi-square Fisher's exact test, with P < 0.05 being taken as significant. Results: Mean age, body mass index, parity, and duration of infertility were 28.9 years, 22.9 kg/m2, 0.26, and 6.06 years, respectively. Menstrual dysfunction was common (44%). Diagnosis of FGTB was made by CRS. Ultrasound was normal in 112 (64%) cases and was abnormal in 63 (36%) cases. Various ultrasound findings were ovarian cyst (23.42%), tubo-ovarian masses (15.42%), unilateral or bilateral hydrosalpinx (13.71%), pyosalpinx (0.57%), adhesion (1.14%), adnexal fixity (6.28%), thin endometrium (24.57%), endometrial fluid (12.57%), endometrial calcification (1.7%), endometrial synechiae (4.57%), cornual synechiae (2.28%), impaired endometrial vascularity (21.71%), ascites (6.85%), and peritoneal or omental thickening (1.75%). Conclusion: Carefully performed ultrasound is a useful modality in diagnosis of FGTB, especially in adnexal masses.
Collapse
Affiliation(s)
- Jai Bhagwan Sharma
- Professor, Department of obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Ashok Khurana
- Consultant Radiology and Ultrasonologist, AIIMS, New Delhi, India
| | - Smriti Hari
- Professor, Department of Radiodiagnosis, AIIMS, New Delhi, India
| | - Urvashi Singh
- Professor, Department of Microbiology, AIIMS, New Delhi, India
| | - RituYadav
- Senior Resident, Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Sona Dharmendra
- PhD Scholar, Department of obstetrics and Gynaecology, AIIMS, New Delhi, India
| |
Collapse
|
8
|
Sharma JB. Sharma's parachute sign a new laparoscopic sign in abdomino pelvic tuberculosis. ACTA ACUST UNITED AC 2021; 68:389-395. [DOI: 10.1016/j.ijtb.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 06/15/2019] [Indexed: 10/26/2022]
|
9
|
Yang S, Yang Z, Zhang S, Len T, Yang L. Coexistence of genital tuberculosis and ovarian serous cystadenofibroma in a young female patient: a case report. J Int Med Res 2021; 48:300060520949410. [PMID: 33045892 PMCID: PMC7563830 DOI: 10.1177/0300060520949410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Most cases of female genital tuberculosis (TB) are asymptomatic and are thus difficult to diagnose. Coexistence of genital TB and ovarian serous cystadenofibroma (OSCAF) is rare and easily ignored or misdiagnosed. We report a 26-year-old woman with coexistence of genital TB and OSCAF, and with an adnexal mass detected by B-ultrasound. Laparoscopic biopsy of diffuse miliary white nodules was performed on the surface of the peritoneum and both fallopian tubes. Right ovarian cystectomy was performed. Postoperative pathology showed that the right ovarian mass was a benign serous cystadenofibroma, and both fallopian tubes and miliary white nodules on the surface of pelvic organs showed chronic granulomatous inflammation. Polymerase chain reaction for Mycobacterium tuberculosis and acid-fast bacilli culture were positive in biopsies of the fallopian tubes, omentum, and peritoneum. The patient received anti-TB treatment after surgery. Six months after the operation, the patient had no abdominal pain and no major changes in menstruation. Our findings suggest that a timely operation is required for patients with an adnexal mass. During surgery, even if the lesion is similar to a malignant tumor, the surgical approach needs to be cautiously chosen for young patients without children. The patient’s postoperative fertility must be taken into consideration.
Collapse
Affiliation(s)
- Shaoyan Yang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Zhengjuan Yang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Suxian Zhang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Tianyan Len
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Lihua Yang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan, China
| |
Collapse
|
10
|
Sharma's abdominal compartmentalization sign: A new laparoscopic sign for abdomino-pelvic tuberculosis. Indian J Tuberc 2020; 67:578-585. [PMID: 33077063 DOI: 10.1016/j.ijtb.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/25/2020] [Indexed: 11/22/2022]
|
11
|
Sharma JB, Sharma E, Sharma S, Singh J, Chopra N. Genital tb-diagnostic algorithm and treatment. Indian J Tuberc 2020; 67:S111-S118. [PMID: 33308655 DOI: 10.1016/j.ijtb.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
Female genital tuberculosis (FGTB) is a common cause of infertility in India but its diagnosis remains elusive due to paucibacillary nature of disease. Traditional methods of diagnosis include demonstration of acid fast bacilli on endometrial or peritoneal biopsy or epithelioid granuloma on the biopsy or positive gene Xpert on the biopsy, but they are positive in small percentage of cases only missing diagnosis in many cases. Positive polymerase chain reaction (PCR) alone is not taken for diagnosis due to high false positivity. Diagnostic laparoscopy and hysteroscopy can detect many cases by direct demonstration of TB lesions. Composite reference standard is a useful method to diagnose FGTB. This review discusses various diagnostic modalities including endometrial or peritoneal biopsy to detect acid fast bacilli on microscopic or culture or epithelioid granuloma, role of PCR, role of radiological imaging (hysterosalpingography, ultrasound, CT scan, MRI and PET-CT scan) and role of endoscopic techniques (laparoscopy and hysteroscopy) in diagnosis of FGTB including role of composite reference standard. The International and National studies highlight the role of composite reference standard and its components like demonstration of AFB on microscopy or culture of endometrial or peritoneal biopsy or epithelioid granuloma or gene Xpert or PCR or latest tests like loop-mediated isothermal amplification (TB-LAMP) test and other newer molecular methods like Xpert Ultra for diagnosis of FGTB. It also detects role of endoscopy in FGTB and role of diagnostic algorithm for diagnosis of FGTB. Treatment is with four primary drugs (rifampicin, isoniazid, ethambutol and pyrazinamide) for two months followed by three drugs (rifampicin, isoniazid and ethambutol) daily orally for 4 months for drug sensitive FGTB. Shorter Multidrug-resistant TB (MDR-TB) regimen is given for Rifampicin resistant (RR)/MDR confined to only FGTB while longer all oral regimen is given for RR/MDR with or without additional drug resistance, HIV seropositives with FGTB or involvement of other sites or pulmonary TB (PTB) along with FGTB. Composite reference standard which combines various diagnostic modalities is a useful strategy to diagnose FGTB.
Collapse
Affiliation(s)
- Jai Bhagwan Sharma
- Professor, Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Eshani Sharma
- Senior Research Fellow, Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sangeeta Sharma
- Professor and Head, Department of Paediatrics, National Institute of Tuberculosis& Respiratory Diseases, New Delhi, India
| | - Janmeeta Singh
- Research Officer, Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Namita Chopra
- Medical Officer, Department of Obstetrics & Gynecology, Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
12
|
Sharma JB, Dharmendra S, Jain S, Sharma SK, Singh UB, Soneja M, Sinha S, Vanamail P. Evaluation of Gene Xpert as compared to conventional methods in diagnosis of Female Genital Tuberculosis. Eur J Obstet Gynecol Reprod Biol 2020; 255:247-252. [PMID: 33256922 DOI: 10.1016/j.ejogrb.2020.09.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/01/2022]
Abstract
To evaluate Gene Xpert for diagnosis of Female Genital Tuberculosis (FGTB) as compared to conventional methods. STUDY DESIGN It was a prospective study conducted over 167 cases of infertile female genital tuberculosis (FGTB) diagnosed on composite reference standard (CRS) (smear for AFB, histopathological evidence of epithelioid granuloma or definite or possible findings of tuberculosis on laparoscopy). All women underwent endometrial biopsy for AFB microscopy, culture, gene Xpert, PCR and histopathology) and laparoscopy and hysteroscopy for diagnosis and prognostication of disease. The results of Gene Xpert were compared with conventional methods in detection of FGTB. All patients were treated with 6 months course of rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) (RHZE for 2 months, RHE for 4 months) using directly observed treatment short course strategy. RESULTS Mean age, parity, body mass index and history of contact was 28.3 years, 0.28, 22.9 Kg/m2 and 38.92% respectively. Primary infertility was seen in 87.42% cases with mean duration of 2.42 years. Menstrual dysfunctions, abdominal or pelvic pain and lump were seen in 38.92%, 14.37% and 10.77% cases. Abnormal vaginal discharge and adnexal mass were seen in 28.14% and 13.17 % cases. On diagnostic laparoscopy, definite findings of tuberculosis (beaded tubes, tuebrcles and caseous nodules) were seen in 96 (57.48%) women while probable findings of tuberculosis (pelvic or abdominal adhesions, hydrosaplinx, tubo-ovarian mass, pyosalpinx) were seen in 81 (48.50%) women. On laboratory investigations, positive AFB on microscopy or culture was seen in 2.99% casess, PCR was positive in 47.90% gene Xpert was positive in 18.56% cases while epitheloid granuloma was seen on histopathology in 16 (9.58%) cases. Gene Xpert had sensitivity of 35.63%, specificity of 100%, positive predictive value of 100% and negative predictive value of 58.82% and diagnostic accuracy of 66.47% in the present study. CONCLUSION Gene Xpert is a very useful test to rule in tuberculosis whereas when it is negative it is not a good test to rule out tuberculosis.
Collapse
Affiliation(s)
- Jai B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sona Dharmendra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Shefali Jain
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - P Vanamail
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
13
|
Hammami F, Koubaa M, Ben Ayed H, Rekik K, Ben Jemaa M, Ben Hmida M, Trigui M, Marrakchi C, Dammak J, Ben Jemaa M. Update on urogenital tuberculosis in Southern Tunisia: a review of a 26-year period. Germs 2020; 10:150-156. [PMID: 33134192 DOI: 10.18683/germs.2020.1200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 11/08/2022]
Abstract
Introduction Tuberculosis affects commonly the lungs, but any other organs can be affected as well. Urogenital tuberculosis is usually misdiagnosed. In this perspective, we aimed to give an update on the epidemiological, clinical and evolutionary features of urogenital tuberculosis in Southern Tunisia. Methods We conducted a retrospective study including all patients with extrapulmonary tuberculosis notified during the period from 1992 to 2017 in Southern Tunisia. We specified the particularities of urogenital tuberculosis cases, and we compared them with other extrapulmonary tuberculosis cases. Results Overall, we analyzed 240 cases with urogenital tuberculosis, among 1702 patients with extrapulmonary tuberculosis (14.1%). There were 121 women (50.4%). The mean age was 49±17 years. Multifocal tuberculosis was noted in 29 cases (12.1%). There were 169 cases with urinary tract tuberculosis (70.4%). Chronological trends analysis showed that the median age at diagnosis increased significantly (Rho=0.41; p=0.039) and the number of urogenital tuberculosis declined during the study period, without a statistical significance (Rho = -0.07; p=0.721). Compared to other extrapulmonary tuberculosis sites, patients aged 60 years and above (OR=2.7; p<0.001) and coming from rural areas (OR=1.4; p=0.021) were more frequently diagnosed with urogenital tuberculosis. Treatment duration was significantly longer in patients with urogenital tuberculosis (10.13±3.79 vs 9.20±3.77 months; p<0.001). As for the disease evolution, relapse was significantly more frequent in patients with urogenital tuberculosis (OR=4.1; p=0.045). Conclusions Although decreasing trends over time were noted, the prognosis of urogenital tuberculosis was more severe compared to other extrapulmonary tuberculosis sites.
Collapse
Affiliation(s)
- Fatma Hammami
- MD, Infectious Diseases Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Makram Koubaa
- MD, Infectious Diseases Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Houda Ben Ayed
- MD, Community Health and Epidemiology Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Khaoula Rekik
- MD, Infectious Diseases Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Maissa Ben Jemaa
- MD, Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Mariem Ben Hmida
- MD, Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Maroua Trigui
- MD, Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Chakib Marrakchi
- MD, Infectious Diseases Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Jamel Dammak
- MD, Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| | - Mounir Ben Jemaa
- MD, Infectious Diseases Department and Extra-pulmonary Research Unity, Hedi Chaker University Hospital, University of Sfax, 3029, Tunisia
| |
Collapse
|
14
|
Urogenital tuberculosis - epidemiology, pathogenesis and clinical features. Nat Rev Urol 2019; 16:573-598. [PMID: 31548730 DOI: 10.1038/s41585-019-0228-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) is the most common cause of death from infectious disease worldwide. A substantial proportion of patients presenting with extrapulmonary TB have urogenital TB (UG-TB), which can easily be overlooked owing to non-specific symptoms, chronic and cryptic protean clinical manifestations, and lack of clinician awareness of the possibility of TB. Delay in diagnosis results in disease progression, irreversible tissue and organ damage and chronic renal failure. UG-TB can manifest with acute or chronic inflammation of the urinary or genital tract, abdominal pain, abdominal mass, obstructive uropathy, infertility, menstrual irregularities and abnormal renal function tests. Advanced UG-TB can cause renal scarring, distortion of renal calyces and pelvic, ureteric strictures, stenosis, urinary outflow tract obstruction, hydroureter, hydronephrosis, renal failure and reduced bladder capacity. The specific diagnosis of UG-TB is achieved by culturing Mycobacterium tuberculosis from an appropriate clinical sample or by DNA identification. Imaging can aid in localizing site, extent and effect of the disease, obtaining tissue samples for diagnosis, planning medical or surgical management, and monitoring response to treatment. Drug-sensitive TB requires 6-9 months of WHO-recommended standard treatment regimens. Drug-resistant TB requires 12-24 months of therapy with toxic drugs with close monitoring. Surgical intervention as an adjunct to medical drug treatment is required in certain circumstances. Current challenges in UG-TB management include making an early diagnosis, raising clinical awareness, developing rapid and sensitive TB diagnostics tests, and improving treatment outcomes.
Collapse
|
15
|
Abstract
Female genital tuberculosis (FGTB) is caused by Mycobacterium tuberculosis (rarely Mycobacterium bovis and/or atypical mycobacteria) being usually secondary to TB of the lungs or other organs with infection reaching through haematogenous, lymphatic route or direct spread from abdominal TB. In FGTB, fallopian tubes are affected in 90 per cent women, whereas uterine endometrium is affected in 70 per cent and ovaries in about 25 per cent women. It causes menstrual dysfunction and infertility through the damage of genital organs. Some cases may be asymptomatic. Diagnosis is often made from proper history taking, meticulous clinical examination and judicious use of investigations, especially endometrial aspirate (or biopsy) and endoscopy. Treatment is through multi-drug antitubercular treatment for adequate time period (rifampicin, isoniazid, pyrazinamide, ethambutol daily for 60 days followed by rifampicin, isoniazid, ethambutol daily for 120 days). Treatment is given for 18-24 months using the second-line drugs for drug-resistant (DR) cases. With the advent of increased access to rapid diagnostics and newer drugs, the management protocol is moving towards achieving universal drug sensitivity testing and treatment with injection-free regimens containing newer drugs, especially for new and previously treated DR cases.
Collapse
Affiliation(s)
- Jai Bhagwan Sharma
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Eshani Sharma
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of TB & Respiratory Diseases, New Delhi, India
| | - Sona Dharmendra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
16
|
Sharma JB. Sharma's sigmoid colonic adhesive band - A new laparoscopic sign in female genital tuberculosis. Indian J Tuberc 2019; 67:327-332. [PMID: 32825859 DOI: 10.1016/j.ijtb.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/14/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Female genital tuberculosis (FGTB) is a form of extra pulmonary tuberculosis (EPTB) affecting women of reproductive age group. It causes significant morbidity in women especially infertility particularly in developing countries. Diagnosis is by endometrial sampling for acid fast bacilli (AFB) microscopy, culture, gene Xpert, polymerase chain reaction (PCR), histopathological evidence of epithelioid granuloma and by laparoscopic findings suggestive of tuberculosis. AIM Present study was conducted to observe the prevalence of a new "Sharma's Sigmoid colonic adhesive band "in FGTB on laparoscopy. METHODS It was a prospective study in a tertiary referral center as a part of our ongoing tuberculosis project on 148 infertile women found to have FGTB on microbiological or laparoscopic findings over previous 10 years. A new laparoscopic "Sharma's Sigmoid colonic adhesive band" was looked for in these cases on laparoscopy. RESULTS The mean age, parity and duration of infertility and incidence of poor socioeconomic status was 26.9 years, 0.49, 5.3 years and 65.54% respectively. All patients had infertility with 83.78% primary and 16.22% secondary infertility while menstrual dysfuction especially hypomenorrhoea (31.75%), oligomenorrhoea (32.48%) were seen in respective cases. Constitutional symptoms like pyrexia (21.62%), weight loss (31.75%) appetite loss (33.5%) and abdominal pain (11.48%) and pelvic pain (27.70%) or abdominal mass (8.78%) and pelvic masses (35.81%) were also seen. Diagnosis of FGTB was made on endometrial or peritoneal biopsy microscopy or culture for AFB or positive gene Xpert or positive polymerase chain reaction (PCR) or histopathological demonstration of epithelioid granuloma or on laparoscopic findings of FGTB. Various laparoscopic findings were tubercles on pelvic organs (45.27%), shaggy areas (white deposits) on pelvic organs (43.91%),beaded or convoluted tubes (9.45%), hyperemic tubes (29.05%), caseous nodules in pelvis (29.72%), encysted ascites (14.18%), abdominal adhesions (32.43%), pelvic adhesions (42.56%), calcified and rigid tubes (6.08%). The new laparoscopic sigmoid colonic adhesive band was seen in 49 (33.10%) patients of FGTB. CONCLUSION The new laparoscopic "Sharma's Sigmoid colonic adhesive band" appears to be an important finding in patients with FGTB.
Collapse
Affiliation(s)
- Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi, 110029, India.
| |
Collapse
|
17
|
Sharma JB, Goyal M, Kumar S, Roy KK, Sharma E, Arora R. Concomitant female genital tuberculosis and endometriosis. Indian J Tuberc 2017; 64:173-177. [PMID: 28709484 DOI: 10.1016/j.ijtb.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/17/2017] [Indexed: 11/28/2022]
Abstract
AIMS To demonstrate an association between female genital tuberculosis (FGTB) and endometriosis. METHODS A total of 16 women who underwent laparoscopy (12 cases) or laparotomy (4 cases) and were found to have female genital tuberculosis and endometriosis were enrolled in this retrospective study. RESULTS The mean age and parity were 28.2 years and 0.2, respectively. Past history of tuberculosis was present in 75% of the women (pulmonary in 50%). Menstrual dysfunction (especially oligomenorrhoea and dysmenorrhoea), constitutional symptoms, infertility, abdominal pain and lump were the main complaints. Diagnosis of FGTB was made by positive acid-fast bacilli (AFB) on microscopy, culture of endometrial aspirate, positive polymerase chain reaction (PCR), histopathological finding of epitheliod granuloma or findings of TB on laparoscopy or laparotomy. Diagnosis of endometriosis was made by laparoscopy or laparotomy. Pelvic adhesions were seen in all women, whereas frozen pelvis was seen in 7 (43.7%) women. Surgery was performed, which was laparoscopic adhesiolysis in 12 (75%), drainage of endometrioma in 12 (75%), cystectomy in 8 (50%), and total abdominal hysterectomy with bilateral salpingo-oophorectomy in 4 (25%) cases. With more then one type of (surgery in many cases). DISCUSSION Female genital tuberculosis and endometriosis may have similar manifestations and can co-exist.
Collapse
Affiliation(s)
- Jai Bhagwan Sharma
- Professor, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
| | - Manu Goyal
- Senior Resident, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sunesh Kumar
- Professor, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kallol Kumar Roy
- Professor, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Eshani Sharma
- Senior Research Fellow, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Raksha Arora
- Professor and Head, Department of Obstetrics and Gynecology, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
| |
Collapse
|
18
|
Koch A, Lecointre L, Garbin O. Pelvic tuberculosis mimicking deep endometriosis. J Gynecol Obstet Hum Reprod 2017; 46:463-464. [PMID: 28411084 DOI: 10.1016/j.jogoh.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 11/25/2022]
Abstract
Pelvic tuberculosis is most frequently observed in developing countries and often leads to the misdiagnosis of pelvic malignancy. We report the first case of pelvic tuberculosis mimicking deep endometriosis.
Collapse
Affiliation(s)
- A Koch
- Pôle de gynécologie-obstétrique, centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, BP 120, 67300 Schiltigheim, France.
| | - L Lecointre
- Pôle de gynécologie-obstétrique, centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, BP 120, 67300 Schiltigheim, France
| | - O Garbin
- Pôle de gynécologie-obstétrique, centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, BP 120, 67300 Schiltigheim, France
| |
Collapse
|
19
|
Multi drug resistant female genital tuberculosis: A preliminary report. Eur J Obstet Gynecol Reprod Biol 2017; 210:108-115. [DOI: 10.1016/j.ejogrb.2016.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/02/2016] [Accepted: 12/08/2016] [Indexed: 11/18/2022]
|
20
|
Sharma JB. Sharma's Kissing Fallopian Tubes Sign: A New Tubal Sign in Female Genital Tuberculosis. J Obstet Gynaecol India 2016; 67:227-229. [PMID: 28546673 DOI: 10.1007/s13224-016-0944-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Jai B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
| |
Collapse
|
21
|
Sharma JB, Kriplani A, Dharmendra S, Chaubey J, Kumar S, Sharma SK. Role of Gene Xpert in diagnosis of female genital tuberculosis: a preliminary report. Eur J Obstet Gynecol Reprod Biol 2016; 207:237-238. [PMID: 27837932 DOI: 10.1016/j.ejogrb.2016.10.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 08/27/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Affiliation(s)
- J B Sharma
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi 110029, India.
| | - A Kriplani
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi 110029, India
| | - S Dharmendra
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi 110029, India
| | - J Chaubey
- Department of Internal Medicine, AIIMS, New Delhi, India
| | - S Kumar
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi 110029, India
| | - S K Sharma
- Department of Internal Medicine, AIIMS, New Delhi, India
| |
Collapse
|