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Mir N, Pal L. Genital tuberculosis, infertility and assisted reproduction. Curr Opin Obstet Gynecol 2023; 35:263-269. [PMID: 36912346 DOI: 10.1097/gco.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to familiarize a global readership on the subtilities of clinical presentation and the mayhem that a missed diagnosis of genital tuberculosis (GTB) is capable of inflicting on the health and wellbeing of infertile women with untreated GTB attempting to conceive with assisted reproductive technology (ART). RECENT FINDINGS Emerging and recent literature relating to the epidemiology and clinical presentation of GTB and reporting of unique risks of ART for maternal and fetal morbidity in untreated cases of GTB are reviewed. Evidence relating to a broadening spectrum of screening methodologies for GTB detection of GTB is additionally considered. SUMMARY Genital TB must be considered as a mechanism for couple's infertility in at-risk populations. Attempting to treat female GTB-related infertility with in-vitro fertilization poses unique and potentially life-threatening risks, both to the mother and to the conceptus; these risks can be avoided through vigilance, appropriate screening and timely treatment prior to proceeding with IVF.
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Affiliation(s)
| | - Lubna Pal
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, Connecticut, USA
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2
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Kundasamy P, Kemp B, Kearns D, McCallum A, Nazir S, Lyon PC. A rare case of disseminated genitourinary tract tuberculosis complicated by emphysematous prostatitis and seminal vesicle abscess. BJR Case Rep 2023; 9:20220101. [PMID: 36873231 PMCID: PMC9976721 DOI: 10.1259/bjrcr.20220101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/13/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Preeya Kundasamy
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ben Kemp
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Daniel Kearns
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Andrew McCallum
- Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sarfraz Nazir
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Paul C Lyon
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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3
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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.
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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
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4
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Liu P, Cai G, Gu H, Qin Y. Diagnostic nomogram to differentiate between epididymal tuberculosis and bacterial epididymitis. Infection 2022; 51:447-454. [PMID: 36114385 DOI: 10.1007/s15010-022-01916-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
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.
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Liu P, Gu H, Liu Y, Qin Y. Application of core needle biopsy in the diagnosis of epididymal tuberculosis: a retrospective analysis of 41 cases. Int J Infect Dis 2022; 122:33-37. [PMID: 35605951 DOI: 10.1016/j.ijid.2022.05.044] [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: 11/27/2021] [Revised: 05/07/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Pengju Liu
- Department of Urology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hai Gu
- Department of Urology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Liu
- Department of Urology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong Qin
- Department of Urology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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6
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Datta A, Gupta P, Bhattacharya B, Das A, Chatterjee S, Banerjee A. Evidence of sexual transfer of mycobacteria from male to female partners reporting to an IVF clinic. Trop Doct 2022; 52:331-334. [PMID: 35196202 DOI: 10.1177/00494755221074754] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Abira Datta
- Central Research Laboratory, PGIMSR and ESI hospital, Kankurgachhi, Kolkata, West Bengal, India.,Reproductive Medicine Unit, Calcutta Fertility Mission, Kolkata, West Bengal, India
| | - Prabuddha Gupta
- Amity Institute of Biotechnology Kolkata, 530170Amity University Kolkata, Major Arterial Road (South-East), Action Area II, Newtown, Kolkata, West Bengal, India
| | - Basudev Bhattacharya
- Reproductive Medicine Unit, Calcutta Fertility Mission, Kolkata, West Bengal, India
| | - Arabinda Das
- Department of Statistics, 271538Acharya Prafulla Chandra College, West Bengal, India
| | | | - Asesh Banerjee
- Amity Institute of Biotechnology Kolkata, 530170Amity University Kolkata, Major Arterial Road (South-East), Action Area II, Newtown, Kolkata, West Bengal, India
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7
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Assessing the diagnostic accuracy of the Xpert MTB/RIF assay in detecting epididymal tuberculosis. Eur J Clin Microbiol Infect Dis 2022; 41:615-620. [DOI: 10.1007/s10096-022-04418-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
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8
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Fellag M, Loukil A, Drancourt M. The puzzle of the evolutionary natural history of tuberculosis. New Microbes New Infect 2021; 41:100712. [PMID: 33996102 PMCID: PMC8094893 DOI: 10.1016/j.nmni.2020.100712] [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: 04/28/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/02/2022] Open
Abstract
Several pieces of the puzzle of the natural history of tuberculosis are assembled in this review to illustrate the potential reservoirs and sources of the Mycobacterium tuberculosis complex (MTBC) mycobacteria, their transmission to animals and humans, and their fate in populations, in a co-evolutionary perspective. Millennia-old companions of mammalian and human populations, MTBC are detected in the soil, in which they infect and survive within vegetative amoebae and cysts, except for Mycobacterium canettii. Never detected in the sphere of plants, they are transmissible by transcutaneous, digestive and respiratory routes and cause an infection of the lymphatic system with secondary dissemination in most tissues, in which they determine a specific and non-pathognomonic granulomatous inflammatory reaction; in which MTBC survives in dormant form irrespective of MTBC species and mammalian species; indicating that the current epidemiology in mammalian populations is essentially governed by the probabilities of contact between mammalian species and MTBC species. Individual variabilities in clinical expression of tuberculosis are related to MTBC species, strain and inoculum; host genetic factors; acquired modulations of the inflammatory response; and probably human microbiota. This review of the literature suggests an evolutionary natural history of telluric environmental mycobacteria, satellites of unicellular eukaryotes, transmissible to mammals via the digestive and then respiratory tracts, in which they determine a fatal contagious infection that is primarily lymphatic and a quiescence-mimicking encysted form. This review opens perspectives for microbiological and translational medical research.
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Affiliation(s)
- M. Fellag
- Aix-Marseille-Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
- IHU Méditerranée Infection, Marseille, France
| | - A. Loukil
- Aix-Marseille-Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - M. Drancourt
- Aix-Marseille-Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
- IHU Méditerranée Infection, Marseille, France
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9
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Nuwagira E, Yekosani M, Abraham B, Atwine R, Caleb T, Baluku JB. Drug-Resistant Tuberculosis Presenting as a Testicular Mass: A Case Report. Int Med Case Rep J 2021; 14:145-149. [PMID: 33688269 PMCID: PMC7936665 DOI: 10.2147/imcrj.s300216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background Extrapulmonary drug-resistant tuberculosis is extremely rare and is almost always associated with poor treatment outcomes. This is partly due to the difficulty in confirming the diagnosis. Case Presentation A 40-year-old HIV-negative male presented with a painless scrotal mass, low-grade fever, general malaise, night sweats, and no pulmonary symptoms. He was initially treated for malaria with no improvement. His final diagnosis was rifampicin-resistant tuberculosis following Xpert® MTB/RIF Ultra (Xpert-Ultra) assay performed on a fine needle aspirate of the scrotal mass. Second-line anti-tuberculosis medication was initiated, and the patient is being followed up with directly observed therapy. Conclusion With the scale-up of Gene-Xpert technology, this case raises awareness about tuberculosis masquerading as a testicular mass and the possibility of extrapulmonary drug-resistant tuberculosis in high endemic areas.
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Affiliation(s)
- Edwin Nuwagira
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mitala Yekosani
- Department of Pathology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Birungi Abraham
- Department of Pathology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Raymond Atwine
- Department of Pathology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tuhumwire Caleb
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
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10
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Vielmo A, Lopes BC, Panziera W, Bianchi RM, Mayer FQ, Vielmo LA, Barros CSL, Driemeier D. Penile Tuberculosis in a Bull. J Comp Pathol 2020; 180:5-8. [PMID: 33222874 DOI: 10.1016/j.jcpa.2020.08.001] [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: 04/07/2020] [Revised: 06/19/2020] [Accepted: 08/03/2020] [Indexed: 11/16/2022]
Abstract
We describe a case of penile tuberculosis in a bull. The prepuce was thickened, firm and pale with multifocal to coalescent caseous nodules, and the inguinal and mesenteric lymph nodes were moderately enlarged. Lesions in the prepuce, penis and lymph nodes were characterized by multifocal to coalescent areas of caseous necrosis and marked granulomatous inflammation. Acid-fast bacilli were seen within necrotic foci and Langhans giant cells. Mycobacteriumtuberculosis var. bovis was identified in inguinal lymph nodes by the polymerase chain reaction technique and by bacterial isolation. Although rare, tuberculosis should be considered in the differential diagnosis of granulomatous lesions in the genital tract of bulls.
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Affiliation(s)
- Andréia Vielmo
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - Bruna Correa Lopes
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Welden Panziera
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ronaldo Michel Bianchi
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fabiana Quoos Mayer
- Centro de Pesquisa em Saúde Animal, Instituto de Pesquisas Veterinárias Desidério Finamor, Eldorado do Sul, Brazil
| | | | | | - David Driemeier
- Setor de Patologia Veterinária, Departamento de Patologia Clínica Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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11
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Elkhachine Y, Sinaa M, Sakkah A, Hallab I, Ouarssani A, Jakar A, Elbenaye J. [Tuberculosis of the glans penis]. Ann Dermatol Venereol 2020; 147:672-675. [PMID: 32919751 DOI: 10.1016/j.annder.2020.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/26/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Y Elkhachine
- Service de dermatologie, hôpital militaire Moulay-Ismail, 50000 Meknès, Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohammed-Ben-Abdellah USMBA, 30000 Fès, Maroc.
| | - M Sinaa
- Faculté de médecine et de pharmacie, université Sidi-Mohammed-Ben-Abdellah USMBA, 30000 Fès, Maroc; Service d'anatomie pathologique, hôpital militaire Moulay-Ismail, 50000 Meknès, Maroc
| | - A Sakkah
- Service de dermatologie, hôpital militaire Moulay-Ismail, 50000 Meknès, Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohammed-Ben-Abdellah USMBA, 30000 Fès, Maroc
| | - I Hallab
- Service de dermatologie, hôpital militaire Moulay-Ismail, 50000 Meknès, Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohammed-Ben-Abdellah USMBA, 30000 Fès, Maroc
| | - A Ouarssani
- Faculté de médecine et de pharmacie, université Sidi-Mohammed-Ben-Abdellah USMBA, 30000 Fès, Maroc; Service de pneumo-phtisiologie, hôpital militaire Moulay-Ismail, 50000 Meknès, Maroc
| | - A Jakar
- Service de dermatologie, hôpital militaire Moulay-Ismail, 50000 Meknès, Maroc
| | - J Elbenaye
- Service de dermatologie, hôpital militaire Moulay-Ismail, 50000 Meknès, Maroc; Faculté de médecine et de pharmacie, université Sidi-Mohammed-Ben-Abdellah USMBA, 30000 Fès, Maroc
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12
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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.
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13
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Bhanothu V, Venkatesan V. Conventional polymerase chain reaction and amplification refractory mutation system-multi-gene/ multi-primer PCR in the diagnosis of female genital tuberculosis. Arch Microbiol 2019; 201:267-281. [DOI: 10.1007/s00203-019-01631-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/12/2019] [Indexed: 01/18/2023]
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14
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Kimura M, Araoka H, Baba H, Okada C, Murase Y, Takaki A, Mitarai S, Yoneyama A. First case of sexually transmitted asymptomatic female genital tuberculosis from spousal epididymal tuberculosis diagnosed by active screening. Int J Infect Dis 2018; 73:60-62. [PMID: 29879525 DOI: 10.1016/j.ijid.2018.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022] Open
Abstract
Tuberculosis screening was performed for a healthy asymptomatic woman to determine whether she had been infected with active genital tuberculosis via sexual intercourse with her husband who had epididymal tuberculosis. Vaginal swab culture yielded Mycobacterium tuberculosis. Furthermore, whole genome sequencing revealed that the two causative isolates were genetically identical. This appears to be the first report on the sexual transmission of genital tuberculosis from a man to an asymptomatic woman, detected by active screening for genital tuberculosis and molecular analysis, including whole genome sequencing. Active screening for genital tuberculosis in the female partner should be considered soon after diagnosis of male genital tuberculosis, even when the female partner is asymptomatic.
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Affiliation(s)
- Muneyoshi Kimura
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan.
| | - Hideki Araoka
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Hiromi Baba
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
| | - Chikako Okada
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
| | - Yoshiro Murase
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
| | - Akiko Takaki
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
| | - Satoshi Mitarai
- Department of Mycobacterium Reference and Research, the Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Kiyose, Tokyo, Japan
| | - Akiko Yoneyama
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
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15
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Abdelmaksoud A. Lichen scrofulosorum: a clinical marker for sexually transmitted tuberculosis. Clin Exp Dermatol 2017; 42:917-918. [DOI: 10.1111/ced.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2017] [Indexed: 11/30/2022]
Affiliation(s)
- A. Abdelmaksoud
- Mansoura Dermatology; Venerology and Leprology Hospital; 5 Amien Alsamanoudy Street, from AbdelsalamAaref Street Mansoura Egypt Mansoura Egypt
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Abstract
Cutaneous tuberculosis (TB) may present in various clinical manifestations. Skin involvement may occur as a result of exogenous inoculation, contiguous spread from a nearby focus of infection, or by hematogenous spread from a distant focus. Because the clinical presentation of cutaneous TB can vary widely, it is important to have a high index of suspicion in appropriate clinical settings. In this chapter, the various clinical manifestations of clinical TB are classified by source of infection (exogenous, endogenous, and hematogenous spread). These are linked to the clinical appearance and histology of the skin lesions. Hopefully, this will resolve the confusion created by the myriad of terms previously used in the medical literature. Once a diagnosis of cutaneous TB is entertained, a biopsy for both culture and histopathology should be submitted. In some cases histopathology may show nonspecific inflammation without classic granuloma formation. In these cases, monoclonal antibodies and polymerase chain reaction (PCR) testing may be useful. In fact, in recent years, PCR amplification has proven to be invaluable in assisting identification of M. tuberculosis from skin biopsies in patients with negative TB cultures. In most instances, treatment of cutaneous TB requires combination chemotherapy. This is especially important in patients with extra cutaneous disease, multiple skin lesions, and those with profound immunosuppression. Surgery also may play both a diagnostic and therapeutic role.
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Yadav S, Singh P, Hemal A, Kumar R. Genital tuberculosis: current status of diagnosis and management. Transl Androl Urol 2017; 6:222-233. [PMID: 28540230 PMCID: PMC5422679 DOI: 10.21037/tau.2016.12.04] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Genitourinary Tuberculosis (GUTB) is the second most common extra-pulmonary manifestation of tuberculosis (Tb) and an isolated involvement of genital organs is reported in 5–30% of the cases. Genital involvement results from primary reactivation of latent bacilli either in the epididymis or the prostate or by secondary spread from the already infected urinary organs. The epididymis are the commonest involved organs affected primarily by a hematogenous mode of spread. Tb is characterized by extensive destruction and fibrosis, thus an early diagnosis may prevent function and organ loss. The gold standard for diagnosis is the isolation and culture of mycobacterium tuberculosis bacilli and in the cases of suspected GUTB, it is commonly looked for in the urinary samples. All body fluid specimens from possible sites of infection and aspirates from nodules must also be subjected to examination. Radiologic investigations including ultrasonography and contrast imaging may provide supportive evidence. Anti-tubercular chemotherapy is the first line of management for all forms of genital Tb and a 6 months course is the standard of care. Most patients with tubercular epididymo-orchitis respond to antitubercular therapy but may require open or percutaneous drainage. Infertility resulting from the tubercular affliction of the genitalia is multifactorial in origin and may persist even after successful chemotherapy. Multiple organ involvement with obstruction at several sites is characteristic and most of these cases are not amenable to surgical reconstruction. Thus, assisted reproduction is usually required. Post treatment, regular annual follow up is recommended even though, with the current multi drug therapy, the chances of relapse are low.
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Affiliation(s)
- Siddharth Yadav
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Hemal
- Baptist Medical Centre, Wake Forest University, Winston-Salem, NC, USA
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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18
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Gupta V, Bhatia R, Singh UB, Ramam M, Gupta S. Penile 'tuberculid': could it be sexually acquired primary inoculation tuberculosis? J Eur Acad Dermatol Venereol 2016; 30:e164-e166. [PMID: 26515329 DOI: 10.1111/jdv.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- V Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - R Bhatia
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - U B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - M Ramam
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - S Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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19
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Tuberculosis of the glans penis mimicking as carcinoma. Int J Mycobacteriol 2016; 5:341-342. [PMID: 27847021 DOI: 10.1016/j.ijmyco.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/20/2016] [Indexed: 11/21/2022] Open
Abstract
Penile tuberculosis (TB) is an uncommon variety of genitourinary TB. It is either primary (via local spread) or secondary (spread of infection from other organs). We encountered a case of rapidly growing penile ulceration, resembling carcinoma. Biopsy revealed the classic picture of TB, which responded well to antitubercular treatment.
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El Moussaoui N, Ismaili N, Abdou A, Benzekri L, Ait Ourhroui M, Senouci K, Rimani M, Hassam B. Ulcération pénienne tuberculeuse. Presse Med 2016; 45:150-2. [DOI: 10.1016/j.lpm.2015.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/17/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022] Open
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Deb S, Mukherjee S, Seth J, Samanta AB. Nodulo-ulcerative Tuberculosis of the Glans Penis-A Case Report and a Discussion on Nomenclature of Genital Tuberculosis. Indian J Dermatol 2015; 60:506-8. [PMID: 26538704 PMCID: PMC4601424 DOI: 10.4103/0019-5154.159661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Samujjala Deb
- Department of Dermatology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Soumya Mukherjee
- Department of Pathology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Joly Seth
- Department of Dermatology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Asit Baran Samanta
- Department of Dermatology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
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22
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Regmi SK, Singh UB, Sharma JB, Kumar R. Relevance of semen polymerase chain reaction positive for tuberculosis in asymptomatic men undergoing infertility evaluation. J Hum Reprod Sci 2015; 8:165-9. [PMID: 26538860 PMCID: PMC4601176 DOI: 10.4103/0974-1208.165148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE: Male partners of infertile women with genital tuberculosis (TB) are often screened for genital TB. We aimed to evaluate the clinical significance of a positive screening semen polymerase chain reaction (PCR) for Mycobacterium tuberculosis test (TB-PCR) in asymptomatic men undergoing infertility evaluation and determine the need for a detailed investigation and treatment for TB. MATERIALS AND METHODS: Between March 2012 and January 2013, male partners of 15 infertile women with a diagnosis of genitourinary TB (GUTB) as the cause of infertility, tested positive either on semen PCR for TB (13 cases), or Mycobacterium Growth Indicator Tube-960 test (2 cases). These asymptomatic men underwent infertility evaluation along with evaluation for GUTB. Diagnosis of GUTB was based on standard clinical criteria, which included a high index of suspicion along with clinical, laboratory, and/or radiological evidence of GUTB. Men who had no clinical evidence of GUTB were followed up with clinical evaluation, semen analysis, and repeat semen PCR for TB after 6 months. RESULTS: Fourteen subjects consented for inclusion in the study. One had a history of pulmonary TB 20 years earlier. Another patient was found to have mediastinal lymphadenopathy (tubercular). All except one had a normal semen analysis. None of the patients met the standard clinical criteria for GUTB diagnosis. 8 patients followed up at 6 months with repeat semen analysis, which was similar to the baseline values and no clinical evidence of TB. INTERPRETATION AND CONCLUSIONS: Asymptomatic men with positive screening semen PCR for TB do not have clinical evidence of TB. Male partners of women with infertility and GUTB should not be screened if they have no symptoms.
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Affiliation(s)
- Subodh Kumar Regmi
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Venyo AKG. Tuberculosis of the Penis: A Review of the Literature. SCIENTIFICA 2015; 2015:601624. [PMID: 26435877 PMCID: PMC4578738 DOI: 10.1155/2015/601624] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/23/2015] [Accepted: 08/13/2015] [Indexed: 06/05/2023]
Abstract
Background. Tuberculosis of the penis (TBP) is rare. Aim. To review the literature. Method. Various internet data bases were searched. Literature Review. TBP could be primary or secondary, may develop following circumcision performed by a person who had pulmonary Tb, and may be transmitted to the penis from ejaculation, contamination from clothing, or from contact with endometrial secretions, following an earlier pulmonary Tb or Tb elsewhere. TBP presents with a painless/painful small nodule, ulcer, mass on penis which gradually enlarges, and induration/swelling of penis, with or without erectile dysfunction. Inguinal lymph nodes may or may not be palpable. The patient's voiding is normal. There may or may not be history of circumcision, pulmonary Tb, and BCG immunization. TBP mimics penile carcinoma, granulomatous syphilis penile ulcer, genital herpes simplex, granuloma inguinale, and HIV infection. Diagnosis is established by microscopic examination finding of granulomas +/-AFB in penile discharge or biopsy of lesion or culture of Tb organism from discharge or biopsy specimens or positive Elisa serology/PCR for Tb. PTBs respond to first- or 2nd-line anti-Tb 6-month treatment. Close contacts should be screened. Extrapulmonary Tb should be excluded. Conclusions. Clinicians should consider possibility of PTB in cases of penile lesions and erectile failure.
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Zarrabi AD, Heyns CF. Tuberculosis of the urinary tract and male genitalia—a diagnostic challenge for the family practitioner. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2009.10873888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Occurrence of female genital tuberculosis among infertile women: a study from a tertiary maternal health care research centre in South India. Eur J Clin Microbiol Infect Dis 2014; 33:1937-49. [DOI: 10.1007/s10096-014-2164-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
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27
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Sinha RK, Mukherjee S, Kamal MR, Karmakar D. Tuberculosis of the glans penis healing with meatal stenosis. BMJ Case Rep 2014; 2014:bcr-2013-202155. [PMID: 24501335 DOI: 10.1136/bcr-2013-202155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 45-year-old man presented with ulceroproliferative lesion of the glans penis. Clinical diagnosis was penile carcinoma and incisional biopsy was performed. Histopathology report came as penile tuberculosis. The lesion healed with antitubercular treatment. Meatal stenosis occurred at 2 months follow-up and was managed with meatotomy.
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28
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[Primary penile tuberculosis]. Ann Dermatol Venereol 2013; 140:666-8. [PMID: 24090903 DOI: 10.1016/j.annder.2013.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 05/24/2013] [Accepted: 06/14/2013] [Indexed: 11/22/2022]
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Affiliation(s)
- V. Ramesh
- Departments of Dermatology & STD; Vardhman Mahavir Medical College & Safdarjang Hospital and All India Institute of Medical Sciences; New Delhi; India
| | - M. Ramam
- Departments of Dermatology & STD; Vardhman Mahavir Medical College & Safdarjang Hospital and All India Institute of Medical Sciences; New Delhi; India
| | - Pooja Pahwa
- Departments of Dermatology & STD; Vardhman Mahavir Medical College & Safdarjang Hospital and All India Institute of Medical Sciences; New Delhi; India
| | - Shalini Malhotra
- Departments of Dermatology & STD; Vardhman Mahavir Medical College & Safdarjang Hospital and All India Institute of Medical Sciences; New Delhi; India
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30
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31
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Balci O, Karatayli R, Capar M. Pelvic tuberculosis mimicking peritonitis carcinomatosis and diagnosed by laparoscopy. Taiwan J Obstet Gynecol 2009; 48:311-3. [PMID: 19797029 DOI: 10.1016/s1028-4559(09)60313-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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32
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33
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Semaan R, Traboulsi R, Kanj S. Primary Mycobacterium tuberculosis complex cutaneous infection: report of two cases and literature review. Int J Infect Dis 2008; 12:472-7. [DOI: 10.1016/j.ijid.2008.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 02/15/2008] [Accepted: 03/04/2008] [Indexed: 11/26/2022] Open
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35
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Baveja CP, Vidyanidhi G, Jain M, Kumari T, Sharma VK. Drug-resistant genital tuberculosis of the penis in a human immunodeficiency virus non-reactive individual. J Med Microbiol 2007; 56:694-695. [PMID: 17446296 DOI: 10.1099/jmm.0.46960-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The genitourinary tract is the most common site for extrapulmonary tuberculosis (TB). Penile TB is extremely rare comprising less than 1 % of all genital TB cases in males. It most commonly presents either as a superficial ulcer on the glans or around the corona. Diagnosis of penile TB is often difficult because it can mimic numerous other diseases. The association of TB with AIDS, and the increasing incidence of multiple drug resistance has further compounded the problem. The case described herein involves a patient with multidrug-resistant smear-positive penile TB that was undiagnosed initially due to the lack of clinical suspicion of TB, and once diagnosed failed to respond to first line antitubercular drugs because of multiple drug resistance.
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Affiliation(s)
- C P Baveja
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India
| | - Gumma Vidyanidhi
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India
| | - Manisha Jain
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India
| | - Trishla Kumari
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India
| | - V K Sharma
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India
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37
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Abstract
Background. Dramatic worsening of epidemiological situation with tuberculosis (TB) in the world has made extra- pulmonary tuberculosis actual again. Female genital TB is very rare, but each case still remains a serious medical problem. Case report. A 23-year-old human immunodeficiency virus (HIV) seronegative woman with two-month duration amenorrhea underwent surgery due to lower abdominal mass simulating a left ovary carcinoma, suggested by ultrasound examinations. During sampling, we found a mass of round, up to 3 mm, necrotizing nodules, diffuse in the uterus, ovarian and tubarial surfaces, in cervical and endometrial mucosa, and even in myometrium and fat omental tissue. No tumor mass was found. Microscopically, the tissue samples from all reproductive organs and omentum contained numerous tuberculous caseating granulomas. Mycobacteria were identified by Ziehl-Neelsen method. Antituberculosis treatment had been completed. Conclusion. In the differential diagnosis of an ovarian tumor and ascites TB should always be considered. It should also be suspected in recent Mycobacterium tuberculosis infection in younger women with amenorrhea, either HIV-seropositive or not.
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38
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Hassoun A, Jacquette G, Huang A, Anderson A, Smith MA. Female genital tuberculosis: uncommon presentation of tuberculosis in the United States. Am J Med 2005; 118:1295-6. [PMID: 16271923 DOI: 10.1016/j.amjmed.2005.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 06/21/2005] [Indexed: 10/25/2022]
MESH Headings
- Adult
- Aged
- Antitubercular Agents/administration & dosage
- Antitubercular Agents/therapeutic use
- DNA, Bacterial/analysis
- Drug Therapy, Combination
- Endometritis/diagnosis
- Endometritis/drug therapy
- Endometritis/microbiology
- Ethnicity/statistics & numerical data
- Female
- Flank Pain/etiology
- Humans
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/isolation & purification
- Polymorphism, Restriction Fragment Length
- Pregnancy
- Pregnancy Complications, Infectious/microbiology
- Puerperal Disorders/diagnosis
- Puerperal Disorders/microbiology
- Tuberculoma/diagnosis
- Tuberculoma/drug therapy
- Tuberculoma/microbiology
- Tuberculosis/congenital
- Tuberculosis, Female Genital/diagnosis
- Tuberculosis, Female Genital/drug therapy
- Tuberculosis, Female Genital/epidemiology
- Tuberculosis, Female Genital/ethnology
- United States/epidemiology
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Affiliation(s)
- Ali Hassoun
- Alabama Infectious Disease Center, Huntsville, Ala 35801, USA.
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Cek M, Lenk S, Naber KG, Bishop MC, Johansen TEB, Botto H, Grabe M, Lobel B, Redorta JP, Tenke P. EAU Guidelines for the Management of Genitourinary Tuberculosis. Eur Urol 2005; 48:353-62. [PMID: 15982799 DOI: 10.1016/j.eururo.2005.03.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 03/03/2005] [Indexed: 10/25/2022]
Abstract
Nearly one third of the world's population is estimated to be infected with Mycobacterium tuberculosis. Moreover, tuberculosis is the most common opportunistic infection in AIDS patients. Genitourinary tuberculosis is not very common but it is considered as a severe form of extra-pulmonary tuberculosis The diagnosis of genitourinary tuberculosis is made based on culture studies by isolation of the causative organism; however, biopsy material on conventional solid media may occasionally be required. Drug treatment is the first line therapy in genitourinary tuberculosis. Treatment regimens of 6 months are effective in most of the patients. Although chemotherapy is the mainstay of treatment, surgery in the form of ablation or reconstruction may be unavoidable. Both radical and reconstructive surgery should be carried out in the first 2 months of intensive chemotherapy.
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Affiliation(s)
- Mete Cek
- Department of Urology, Taksim Teaching Hospital, Istanbul, Turkey.
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40
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Hay RJ. Cutaneous infection with Mycobacterium tuberculosis: how has this altered with the changing epidemiology of tuberculosis? editorial review. Curr Opin Infect Dis 2005; 18:93-5. [PMID: 15735409 DOI: 10.1097/01.qco.0000160894.89739.9c] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Drobniewski FA, Gibson A, Ruddy M, Yates MD. Evaluation and utilization as a public health tool of a national molecular epidemiological tuberculosis outbreak database within the United Kingdom from 1997 to 2001. J Clin Microbiol 2003; 41:1861-8. [PMID: 12734218 PMCID: PMC154681 DOI: 10.1128/jcm.41.5.1861-1868.2003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to develop a national model and analyze the value of a molecular epidemiological Mycobacterium tuberculosis DNA fingerprint-outbreak database. Incidents were investigated by the United Kingdom PHLS Mycobacterium Reference Unit (MRU) from June 1997 to December 2001, inclusive. A total of 124 incidents involving 972 tuberculosis cases, including 520 patient cultures from referred incidents and 452 patient cultures related to two population studies, were examined by using restriction fragment length polymorphism IS6110 fingerprinting and rapid epidemiological typing. Investigations were divided into the following three categories, reflecting different operational strategies: retrospective passive analysis, retrospective active analysis, and retrospective prospective analysis. The majority of incidents were in the retrospective passive analysis category, i.e., the individual submitting isolates has a suspicion they may be linked. Outbreaks were examined in schools, hospitals, farms, prisons, and public houses, and laboratory cross-contamination events and unusual clinical presentations were investigated. Retrospective active analysis involved a major outbreak centered on a high school. Contact tracing of a teenager with smear-positive pulmonary tuberculosis matched 14 individuals, including members of his class, and another 60 cases were identified in schools clinically and radiologically and by skin testing. Retrospective prospective analysis involved an outbreak of 94 isoniazid-resistant tuberculosis cases in London, United Kingdom, that began after cases were identified at one hospital in January 2000. Contact tracing and comparison with MRU databases indicated that the earliest matched case had occurred in 1995. Subsequently, the MRU changed to an active prospective analysis targeting linked isoniazid-monoresistant isolates for follow up. The patients were multiethnic, born mainly in the United Kingdom, and included professionals, individuals from the music industry, intravenous drug abusers, and prisoners.
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Affiliation(s)
- F A Drobniewski
- Public Health Laboratory Service Mycobacterium Reference Unit and Regional Center for Mycobacteriology, Department of Infection, GKT School of Medicine, King's College Hospital, Dulwich, London SE22 8QF, United Kingdom.
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