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Mremi A, Pyuza JJ, Amsi P, Shao ER, Nkya G, Jaabir U, Andongolile AA, Pallagyo A. The haunting diagnosis of malignancy in women with treatable reproductive system tuberculosis. SAGE Open Med Case Rep 2023; 11:2050313X231184958. [PMID: 37425140 PMCID: PMC10328179 DOI: 10.1177/2050313x231184958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
This study reports a case of female genital tuberculosis in a 46-year-old woman who presented to emergency department with abdominal pain and progressive abdominal distension. The patient was initially thought to have ovarian cancer based on clinical diagnosis and elevated cancer antigen-125 (CA-125) levels. Intra-operatively, no obvious ovarian tumor was encountered instead; disseminated creamy white patches on the uterus and left adnexa were seen. About 4500-mL straw-colored ascitic fluid and disseminated creamy white patches were also found on the bowels and omentum giving an impression of carcinomatosis. However, histopathology of the fallopian tube and ovary confirmed the diagnosis of female genital tuberculosis as the underlying cause. Female genital tuberculosis often mimics tumors in its clinical appearance and symptoms, leading to misdiagnosis and unnecessary treatment. The key to diagnosing female genital tuberculosis is being suspicious as it is challenging to diagnose through laboratory tests or radiology. The mainstay of treatment for female genital tuberculosis is a combination of four antituberculosis drugs. Consideration of female genital tuberculosis as a differential diagnosis in women presenting with symptoms mimicking reproductive tumors is highly recommended as highlighted in this case report.
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Affiliation(s)
- Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jeremia J Pyuza
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Patrick Amsi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Elichilia R Shao
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Gilbert Nkya
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Ummil Jaabir
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Angela Pallagyo
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Fan H, Li A, Li J, Du Z, Wang L, Zhou X, He P, Ren Z. Construction of Tetrazole Derivatives via Sequential Ugi‐N
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/Pd‐Catalyzed Isocyanide Insertion Reactions. ChemistrySelect 2023. [DOI: 10.1002/slct.202204294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Hao‐Jie Fan
- College of Chemical Engineering Hubei University of Arts and Science Xiangyang Hubei Province 441053 P. R. of China
| | - A‐Ting Li
- College of Chemical Engineering Hubei University of Arts and Science Xiangyang Hubei Province 441053 P. R. of China
| | - Jun Li
- College of Chemical Engineering Hubei University of Arts and Science Xiangyang Hubei Province 441053 P. R. of China
| | - Zi‐Qi Du
- College of Chemical Engineering Hubei University of Arts and Science Xiangyang Hubei Province 441053 P. R. of China
| | - Long Wang
- College of Materials and Chemical Engineering China Three Gorges University Yichang Hubei 443002 P. R. of China
- Hubei Three Gorges Laboratory Yichang Hubei 443007 P. R. of China
| | - Xian‐Min Zhou
- Hubei Institute of Aerospace Chemical Technology Xiangyang Hubei 441053 P. R. of China
| | - Ping He
- College of Chemical Engineering Hubei University of Arts and Science Xiangyang Hubei Province 441053 P. R. of China
| | - Zhi‐Lin Ren
- College of Chemical Engineering Hubei University of Arts and Science Xiangyang Hubei Province 441053 P. R. of China
- College of Materials and Chemical Engineering China Three Gorges University Yichang Hubei 443002 P. R. of China
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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.
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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
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Albrici C, Cefalo J, Mondoni M, Moro A, Bimbatti M, Gianelli U, Centanni S. Left pleural effusion in a young woman with genital tuberculosis. Monaldi Arch Chest Dis 2022. [DOI: 10.4081/monaldi.2022.2450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
Disseminated tuberculosis is a rare form of tuberculosis that can cause severe illness if diagnosed and treated late. We present the case of a young Senegalese woman who had a miscarriage due to a pelvic inflammatory disease, followed by the development of a left pleural effusion. Despite laparoscopic findings and a salpinx biopsy that revealed necrotizing granulomas, only microbiological examinations of pleural biopsies revealed the final diagnosis of disseminated, drug-sensitive tuberculosis.
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Saxena R, Shrinet K, Rai SN, Singh K, Jain S, Jain S, Singh D, Anupurba S, Jain M. Diagnosis of Genital Tuberculosis in Infertile Women by Using the Composite Reference Standard. DISEASE MARKERS 2022; 2022:8078639. [PMID: 36016849 PMCID: PMC9398877 DOI: 10.1155/2022/8078639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/13/2022] [Accepted: 07/29/2022] [Indexed: 12/03/2022]
Abstract
Female genital tuberculosis (FGTB) can be asymptomatic or even masquerade as other gynecological conditions. Conventional methods of FGTB diagnosis include various imaging, bacteriological, molecular, and pathological techniques that are only positive in a small percentage of patients, leaving many cases with undiagnosed condition. In the absence of a perfect diagnostic method, composite reference standards (CRSs) have been advocated in this diagnostic study. This study assesses the agreement between traditional diagnostic modalities using CRS and prevalent TB groups among different fallopian tube infertility manifestations. A total of 86 women with primary and secondary infertility were included in the study and subjected to bacteriological, pathological, and radiological examination for the diagnosis of FGTB. Results were evaluated statistically for concordance of the diagnostic tests to the CRS by sensitivity and specificity, while PPV and NPV were calculated for the performance of diagnostic tests of FGTB. We observed that 11.2% of women were found to be true positives by means of CRS. The positive findings by CRS were as follows: ultrasonography (13.9%), laparoscopy (14%), hysteroscopy (12%), GeneXpert (4.8%), culture (4.8%), polymerase chain reaction (4.8%), and histopathology (6.4%). GeneXpert and culture were found to have a perfect agreement with CRS. Hysterosalpingography, laparoscopy, and hysteroscopy have a fair agreement with CRS. Out of 43 women with tubal factor infertility, 6 women were found in the definitive TB group with mixed conditions of tubal manifestations. This study evaluates and demonstrates the reliability of the collective assessment of various diagnostic methods with CRS findings that help in identifying different TB groups of genital tuberculosis patients from all infertile patients by applying the criteria of CRS.
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Affiliation(s)
- Riden Saxena
- Department of Obstetrics & Gynecology, Institute of Medical Sciences, Banaras Hindu University, 221005, Varanasi, India
| | - Kriti Shrinet
- School of Biotechnology, Banaras Hindu University, 221005, Varanasi, India
- School of Biotechnology, IFTM University, 244102, Moradabad, India
| | - Sachchida Nand Rai
- Centre of Biotechnology, University of Allahabad, 211002, Prayagraj, India
| | - Kamal Singh
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, 221005, Varanasi, India
- Virus Research & Diagnostic Laboratory, Department of Virology, Rajendra Memorial Research Institute of Medical Science, 800007, Patna, Bihar, India
| | - Shivi Jain
- Department of Radiology, Institute of Medical Sciences, Banaras Hindu University, 221005, Varanasi, India
| | - Shuchi Jain
- Department of Obstetrics & Gynecology, Institute of Medical Sciences, Banaras Hindu University, 221005, Varanasi, India
| | - Deeksha Singh
- Department of Obstetrics & Gynecology, Institute of Medical Sciences, Banaras Hindu University, 221005, Varanasi, India
| | - Shampa Anupurba
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, 221005, Varanasi, India
| | - Madhu Jain
- Department of Obstetrics & Gynecology, Institute of Medical Sciences, Banaras Hindu University, 221005, Varanasi, India
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Dahiya B, Kamra E, Alam D, Chauhan M, Mehta PK. Insight into diagnosis of female genital tuberculosis. Expert Rev Mol Diagn 2021; 22:625-642. [PMID: 34882522 DOI: 10.1080/14737159.2022.2016395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Female genital tuberculosis (TB) is a common manifestation of extrapulmonary TB (EPTB) with varied clinical presentations, i.e. infertility, pelvic pain and menstrual irregularities. Diagnosis of female genital TB is challenging predominantly due to paucibacillary nature of specimens and inconclusive results obtained by most of the routine laboratory tests. AREAS COVERED This review has briefly summarized the epidemiology, clinical features and transmission of female genital TB. Commonly used laboratory tests include bacteriological examination (smear/culture), tuberculin skin testing, interferon-γ release assays, imaging, laparoscopy/hysteroscopy and histopathological/cytological observations. Further, utility of nucleic acid amplification tests (NAATs), like loop-mediated isothermal amplification, PCR, multiplex-PCR, nested PCR, real-time PCR and GeneXpert® could significantly improve the detection of female genital TB. EXPERT OPINION Currently, there is no single test available for the efficient diagnosis of female genital TB, rather a combination of tests is being employed, which yields moderate diagnostic accuracy. The latest modalities developed for diagnosing pulmonary TB and other clinical EPTB forms, i.e. aptamer-linked immobilized sorbent assay, immuno-PCR (I-PCR), analysis of circulating cell-free DNA by NAATs, and identification of Mycobacterium tuberculosis biomarkers within extracellular vesicles of bodily fluids by I-PCR/nanoparticle-based I-PCR, may also be exploited to further improve the diagnosis of female genital TB.
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Affiliation(s)
- Bhawna Dahiya
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, Haryana, India
| | - Ekta Kamra
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, Haryana, India
| | - Danish Alam
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, Haryana, India
| | - Meenakshi Chauhan
- Dept. of Obstetrics and Gynecology, Pt. B.D. Sharma University of Health Sciences, Rohtak-124001, Haryana, India
| | - Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, Haryana, India
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