First case of sexually transmitted asymptomatic female genital tuberculosis from spousal epididymal tuberculosis diagnosed by active screening

Influence of preoperative antituberculosis chemotherapy duration on perioperative complications in patients treated with epididymectomy for epididymal tuberculosis

OBJECTIVES

We aimed to investigate the influence of preoperative antituberculosis chemotherapy duration on perioperative epididymectomy complications in patients with epididymal tuberculosis (ETB).

METHODS

This retrospective study examined patients with ETB between January 1, 2013, and March 31, 2023, who underwent unilateral epididymectomy at our hospital. We selected preoperative antituberculosis chemotherapy duration of 2, 4, and 8 weeks as the cutoffs for this study, to explore whether there are differences in the incidence of intraoperative and 30-day postoperative complications among the patients with different preoperative antituberculosis chemotherapy durations. Intraoperative complications were graded according to the Satava classification, and 30-day postoperative complications were defined according to the Clavien-Dindo classification. The study groups were compared using the unpaired t-test, Wilcoxon rank-sum test, Pearson's chi-square test, or Fisher's exact test, as appropriate.

RESULTS

Overall, 155 patients were included. Statistical analysis revealed that there were no significant differences in the incidence of intraoperative and 30-day postoperative complications between patients with shorter preoperative antituberculosis chemotherapy duration and those with longer preoperative antituberculosis chemotherapy duration.

CONCLUSIONS

In patients with ETB, preoperative antituberculosis chemotherapy duration did not significantly affect the incidence of perioperative complications after epididymectomy.

Magnetic Resonance Imaging Manifestations in 13 Cases of Seminal Vesicle Tuberculosis

Objective

This study aimed to examine the radiographic manifestations of seminal vesicle tuberculosis (SVT) on magnetic resonance imaging to gain a deeper understanding of this disease.

Methods

The clinical symptoms, general conditions, relevant laboratory tests and radiological data of 13 patients diagnosed with SVT were collected through bacteriological examination. A descriptive analysis was used to explore the composition ratio and rate values of the collected data.

Results

All 13 cases (100.0%) showed isointense signals on T1WI and hypointense signals on T2WI in the affected seminal vesicles, with the disappearance of the multi-chambered high signal on T2WI in normal seminal vesicles. Eight cases (61.5%) showed diffusion restriction on DWI of the affected seminal vesicle and significant enhancement on the contrast scan, whereas five cases (38.5%) showed unrestricted diffusion and mild enhancement on the contrast scan. Patients with significant enhancements exhibited higher counts and neutrophil percentages than patients with mild enhancements, with statistically significant differences (Z = 2.196, P = 0.030; Z = 2.781, P = 0.003, respectively). The counts and percentage of lymphocytes, CD3+T cells and CD4+T cells were significantly lower in patients with significant enhancements than in those with mild enhancements, with statistically significant differences (Z = -2.196, P = 0.030; Z = -2.928, P = 0.002; Z = -2.928, P = 0.002; Z = -2.928, P = 0.002, respectively). Patients with significant enhancements were more likely to have active pulmonary tuberculosis than those with mild enhancements, with a statistically significant difference (P = 0.035).

Conclusion

Magnetic resonance imaging reveals distinct radiographic features of SVT, and variations in imaging presentations can indicate a patient's immune status.

The Imaging Features and Diagnostic Value of Computerised Tomography in Seminal Duct Tuberculosis

Objective

To analyse the computerised tomography (CT) imaging features and diagnostic value of seminal duct tuberculosis (TB).

Methods

The imaging data of male patients with ejaculatory duct TB who underwent surgical treatment in our hospital from 1 January 2019 to 31 December 2019 were retrospectively analysed. Through CT images, seminal duct TB was divided into different types, and the CT image features of different types of TB were analysed. The differences in diagnosis between CT and pathological results were compared.

Results

According to the CT manifestations of TB of the intrapelvic segment of seminal duct TB, this disease could be divided into an intra-tubular calcification type, a lumen dilatation and effusion type and a wall thickening type, among which 6 cases (15.8%) were intra-tubular calcification types, 14 cases (36.8%) were lumen dilatation and effusion types and 18 cases (47.4%) were wall thickening types. The diagnostic efficacy of CT in the diagnosis of ejaculatory duct TB: sensitivity = 63.89% (23/36), specificity = 80.01% (44/53), accuracy = 75.28% (67/89), positive predictive value = 51.87% (43/109), negative predictive value = 77.19% (44/57) and kappa = 0.558.

Conclusion

CT has high sensitivity and specificity in the diagnosis of seminal duct TB. The classification of seminal duct TB using CT images is of great significance for the diagnosis and treatment of the disease.

Joint Modeling of Longitudinal Outcome and Competing Risks: Application to HIV/AIDS Data

BACKGROUND

Tuberculosis (TB) and human immunodeficiency virus (HIV) are major public health challenges globally, and the number of TB infections and death caused by HIV are high because of HIV/ TB co-infection. On the other hand, CD4 count plays a significant role in TB/HIV co-infections. We used a joint model of longitudinal outcomes and competing risks to identify the potential risk factors and the effect of CD4 cells on TB infection and death caused by HIV in HIV-infected patients.

STUDY DESIGN

This was a retrospective cohort study.

METHODS

The current study was performed on 1436 HIV+patients referred to Behavioral Diseases Counseling Centers in Kermanshah Province during 1998-2019. In this study, joint modeling was used to identify the effect of potential risk factors and CD4 cells on TB and death caused by HIV.

RESULTS

The results demonstrated that the decreasing CD4 cell count was significantly associated with an increased risk of death, while it had no significant relation with the risk of TB. In addition, patients with TB were at a higher risk of death. Based on the results, a significant relationship was found between CD4 count and sex, marital status, education level, antiretroviral therapy (ART), time, and the interaction between time and ART. Further, people infected with HIV through sexual relationships were at higher risk of TB, while those with a history of imprisonment who received ART or were infected with HIV through drug injection had a lower risk of TB.

CONCLUSION

The findings revealed that the decreasing CD4 count had a significant association with an increased risk of death caused by HIV. However, it was not significantly related to the risk of TB. Finally, patients with TB were at higher risk of death caused by HIV.

A rare case of disseminated genitourinary tract tuberculosis complicated by emphysematous prostatitis and seminal vesicle abscess

Urogenital tuberculosis (UGTB) can affect the entire urinary tract including the kidneys, ureters (strictures), urinary bladder, prostate in addition to involving reproductive tracts. In modern day practice, both ultrasound and cross-sectional imaging play an important role in the radiological diagnosis of UGTB. The sequalae of untreated UGTB is morbid and can lead to end-stage renal failure, infertility, and life-threatening systemic infection. UGTB is less commonly observed in developed countries and may mimic other pathologies including malignancy. Thus, it is important that radiologists consider the differential diagnosis early, particularly individuals with risk factors such as travel to endemic regions, to allow optimal treatment and ensure best prognostic outcomes. UGTB can typically be managed by Infectious Disease clinicians with multidrug chemotherapy. We have presented a case of microbiologically proven extrapulmonary tuberculosis (TB) predominantly involving the genitourinary tract. The response to TB agents and lack of evidence of co-infection with another organism, might suggest this as the first published case of emphysematous tuberculous prostatitis. Emphysematous prostatitis is indicative of a gas-forming infection of the prostate, and is associated with abscess formation in the vast majority of case and is an easily identified radiological feature on CT. It is not a well-recognised feature of Mycobacterium tuberculosis infection and thus microbiological diagnosis should be sought to confirm the diagnosis.

Female Genital Tuberculosis

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.

Diagnostic nomogram to differentiate between epididymal tuberculosis and bacterial epididymitis

PURPOSE

We developed and validated a diagnostic nomogram for differentiating epididymal tuberculosis (TB) from bacterial epididymitis.

METHODS

In this retrospective study, we developed a prediction model based on demographics and clinical characteristics. Eligible patients were randomly divided into derivation and validation cohorts (ratio 7:3). Univariate and multivariate regression analyses were used to filter variables and select predictors. Multivariate logistic regression was used to construct the nomogram. Concordance index (C-index), calibration plots, and decision curves analysis (DCA) were used to assess the discrimination, calibration, and clinical usefulness of the nomogram.

RESULTS

We included 147 patients (epididymal TB, 93; bacterial epididymitis, 54). The derivation cohort included 66 patients with epididymal TB and 38 with bacterial epididymitis; the validation cohort included 27 patients with epididymal TB and 16 with bacterial epididymitis. One regression model was built from three differential variables: body mass index, purified protein derivative, and chronic infection. Accordingly, one nomogram was developed. The model had good discrimination and calibration. C-indexes of the derivation and validation cohorts were 0.89 and 0.98 (95% confidence intervals, 0.83-0.95 and 0.94-1.01), respectively. DCA showed that the proposed nomogram was useful for differentiation.

CONCLUSION

The nomogram can differentiate between epididymal TB and bacterial epididymitis.

Application of core needle biopsy in the diagnosis of epididymal tuberculosis: a retrospective analysis of 41 cases

OBJECTIVE

We aimed to investigate the use of core needle biopsy (CNB) in epididymal tuberculosis (TB) diagnosis.

METHODS

We analyzed 41 samples collected between January 1, 2018, and January 31, 2021, from patients who underwent CNB for suspected epididymal TB. All specimens were examined using histopathological examination and the Xpert Mycobacterium tuberculosis bacilli/rifampicin (MTB/RIF) assay. We analyzed the examination results to determine the application value of CNB in epididymal TB diagnosis and evaluate its safety.

RESULTS

According to the comprehensive reference standard established in this study, 37 of the 41 patients had epididymal TB and four patients had chronic epididymitis. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of histopathological examination were 86.49% (71.23-95.46%), 100.00% (39.76-100.00%), 100.00% (89.11-100.00%), 44.44% (13.70-78.80%), and 0.93 (0.81-0.99), respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of the Xpert MTB/RIF assay were 62.16% (44.76-77.54%), 100.00% (39.76-100.00%), 100.00% (85.18-100.00%), 22.22% (6.41-47.76%), and 0.81 (0.66-0.92), respectively. No postoperative complication attained a Clavien-Dindo classification grade of >2.

CONCLUSION

CNB was useful in diagnosing epididymal TB. Therefore, we recommend using CNB as a sample collection tool for diagnosing epididymal TB.

Evidence of sexual transfer of mycobacteria from male to female partners reporting to an IVF clinic

Female genital tuberculosis (GTB) contributes significantly to infertility in low- and middle-income countries. Dissemination of infection from pulmonary and extrapulmonary sites is the major reason for causation of GTB. Additionally, sexual transmission of GTB from male partners has been reported. We selected 81 couples desiring babies from an in vitro fertilization clinic. We used multiplex-PCR for mycobacterial detection in semen of males, in the endometrium of their female counterparts and in the products of conception (POC) from miscarriage. Data interpretation shows that these pregnancies failed owing to sexual transmission of mycobacteria. We noticed by multiplex PCR that mycobacterial infestation in the female can take place in either endometrium or POC from asymptomatic males harbouring mycobacteria in their semen. Therefore, we propose sexual transfer of mycobacteria to be a probable cause of miscarriage. Thus, we suggest multiplex PCR based screening of semen for all males of the couples attempting successful childbirth.

Increased Risk of Stillbirth among Women whose Partner Has Tuberculosis

BACKGROUND

The relationship between tuberculosis (TB) and adverse pregnancy outcomes remains unclear. The aim of our study was to investigate whether TB is a risk factor for adverse pregnancy outcomes including premature birth, low birth weight, and stillbirth.

METHOD

We conducted a population-based retrospective cohort study in mainland China. A total of 3,668,004 Chinese women, along with their partners, were included in this study, within the National Free Pre-Pregnancy Checkups Project, during 2015-2018. Propensity score matching was used to balance the two groups (cases: women or partners with TB; controls: women and partners without TB). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Multivariate logistic regression showed that the OR of stillbirth for cases was 1.89 (95% CI: 1.09-3.16), in comparison with the control group. In the subgroup analysis, women whose partner had TB had a higher risk of stillbirth (OR: 2.13, 95% CI: 1.10-3.86) than women whose partner did not have TB. There was no significant difference in adverse pregnancy outcomes, including preterm birth, low birth weight, and stillbirth, between women with and without TB.

CONCLUSIONS

Women whose partner had TB were more likely to have stillbirth than women whose partners did not have TB.