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Harouachi A, Jabri L, Bouhout T, Serji B. Ovarian tuberculosis mimicking ovarian malignancy in an unvaccinated patient: A case report. Int J Surg Case Rep 2024; 122:110031. [PMID: 39059239 PMCID: PMC11332202 DOI: 10.1016/j.ijscr.2024.110031] [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: 05/27/2024] [Revised: 07/06/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Ovarian tuberculosis is a rare form of extra-pulmonary tuberculosis that usually present with atypical symptoms mimicking ovarian carcinoma. CASE REPORT We report a case of non-vaccinated 20-years-old women who present with non-specific symptoms and for whom imaging techniques weren't conclusive for ovarian tuberculosis. The ultrasound shows hydronephrosis secondary to the compressive pelvic mass. Regarding the compressive character of the mass and it's consequence on the urinary system as well as the suspicion of malignant origin, laparotomy was performed. Based on histopathological analysis of surgical biopsies a diagnosis of ovarian tuberculosis was made and the patient was put under anti-TB drugs. During the follow up there was a good response to treatment with improvement of health state, regression of the abdominopelvic mass as well as the hydronephrosis. DISCUSSION Ovarian tuberculosis can occur even in the absence of previous pulmonary TB. The major risk with female genital tuberculosis is infertility. CONCLUSION Ovarian tuberculosis is a rare form of extra pulmonary TB that should be always considered in differential diagnosis of ovarian TB.
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Affiliation(s)
- Abdelhakim Harouachi
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco.
| | - Lamyae Jabri
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Tariq Bouhout
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Badr Serji
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco; Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
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2
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Masilamani T, Jayanthi N, Elaiyalwar A, B K, Ganapati S. An Unusual Case Report of Male Genital Tuberculosis. Cureus 2024; 16:e64950. [PMID: 39161489 PMCID: PMC11331003 DOI: 10.7759/cureus.64950] [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] [Received: 06/24/2024] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
The burden of extrapulmonary tuberculosis (EPTB) is significant, constituting up to 20% of all TB cases in HIV-negative patients and 50% of new cases in HIV-positive individuals. However, diagnosing EPTB remains challenging due to its pauci-bacillary nature and the necessity for invasive sampling methods in many forms of the disease. Urogenital tuberculosis represents approximately 4% of the annual cases of extra-pulmonary tuberculosis in India, with isolated testicular tuberculosis being a particularly rare manifestation. In this report, we present three cases of testicular tuberculosis, diagnosed through tissue biopsy and Acid Fast Bacilli (AFB) smears.
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Affiliation(s)
| | - Nalini Jayanthi
- Respiratory Medicine, SRM Medical College Hospital and Research Centre, Chennai, IND
| | - Anitha Elaiyalwar
- Respiratory Medicine, SRM Medical College Hospital and Research Centre, Chennai, IND
| | - Karniha B
- Respiratory Medicine, SRM Medical College Hospital and Research Centre, Chennai, IND
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3
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Alvitez J, Huarachi L, Temoche A, Rojas M, Alvitez-Temoche D, Espinoza-Carhuancho F, Mayta-Tovalino F. A 32-year global analyses on dynamic trends and geospatial visualization of genital tuberculosis and female infertility: A scientometric study. Heliyon 2024; 10:e31396. [PMID: 38818201 PMCID: PMC11137401 DOI: 10.1016/j.heliyon.2024.e31396] [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: 11/16/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Genital tuberculosis (GT) is an infection that can affect the female reproductive system, including the uterus, cervix, and ovaries. Objective To perform a scientometric exploration to analyze the spatiotemporal trend, evolution, and emerging patterns of scholarly output on GT and female infertility. Methods An observational, descriptive, retrospective study employing a scientometric methodology was carried out. Metadata from scholarly articles spanning the years 1990-2022 were extracted from the Web of Science. The metadata from the chosen articles, totaling 172 manuscripts, were exported on May 17, 2023, in plain text format, which will allow the analysis and integration of the data in the software used. Results We found at 111 sources and found 172 documents on tuberculosis and female infertility. We observed an average annual growth rate of 7.46 %, and the average age of the documents was 10.4 years. The dual overlay map showed the distribution of scientific publications on tuberculosis and female infertility. Journals on the left side of the map are cited mainly in the journals on the right. We found that Clinical Infectious Diseases and Lancet journals condensed patterns and trends in 1995, while the Indian Journal of Tuberculosis did so in 1996. Dheda K., Joubert JJ., and Wang Y. were the authors who had India, Iran, and China as their main affiliation, respectively, and they mainly published their studies in the "American Journal of Respiratory and Critical Care Medicine" and "Tropical Doctor," among others. Conclusions This bibliometric study examined different sources and found an average annual growth rate of 7.46 %. Each article received an average of 16.48 citations. Different collaborative networks between countries were observed. In addition, there was a steady growth in published research in the field of tuberculosis and female infertility.
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Affiliation(s)
- Juan Alvitez
- Department of Social Medicine and Conduct, Faculty of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Luis Huarachi
- Department of Social Medicine and Conduct, Faculty of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Abigail Temoche
- Department of Social Medicine and Conduct, Faculty of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Miriam Rojas
- Department of Physiological Sciences, Faculty of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Daniel Alvitez-Temoche
- Academic Department, Faculty of Dentistry, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Fran Espinoza-Carhuancho
- Grupo de Bibliometria, Evaluacion de evidencia y Revisiones Sistematicas (BEERS), Human Medicine Career, Universidad Cientifica del Sur, Lima, Peru
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4
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Wang Z, Zhang X, Dai B, Li D, Chen X. Analysis of the potential regulatory mechanisms of female and latent genital tuberculosis affecting ovarian reserve function using untargeted metabolomics. Sci Rep 2024; 14:9519. [PMID: 38664479 PMCID: PMC11045857 DOI: 10.1038/s41598-024-60167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Female and latent genital tuberculosis (FGTB and LGTB) in young women may lead to infertility by damaging ovarian reserve function, but the regulatory mechanisms remain unclear. In this study, we investigated the effects of FGTB and LGTB on ovarian reserve function and potential regulatory mechanisms by untargeted metabolomics of follicular fluid, aiming to provide insights for the clinical management and treatment approaches for afflicted women. We recruited 19 patients with FGTB, 16 patients with LGTB, and 16 healthy women as a control group. Clinical data analysis revealed that both the FGTB and LGTB groups had significantly lower ovarian reserve marker levels compared to the control group, including lower anti-Müllerian hormone levels (FGTB: 0.82 [0.6, 1.1] μg/L; LGTB: 1.57 [1.3, 1.8] μg/L vs. control: 3.29 [2.9, 3.5] μg/L), reduced antral follicular counts (FGTB: 6 [5.5, 9.5]; LGTB: 10.5 [7, 12.3] vs. control: 17 [14.5, 18]), and fewer retrieved oocytes (FGTB: 3 [2, 5]; LGTB: 8 [4, 8.3] vs. control: 14.5 [11.5, 15.3]). Conversely, these groups exhibited higher ovarian response marker levels, such as longer gonadotropin treatment days (FGTB: 12 [10.5, 12.5]; LGTB: 11 [10.8, 11.3] vs. control: 10 [8.8, 10]) and increased gonadotropin dosage requirements (FGTB: 3300 [3075, 3637.5] U; LGTB: 3037.5 [2700, 3225] U vs. control: 2531.25 [2337.5, 2943.8] U). All comparisons were statistically significant at P < 0.05. The results suggested that FGTB and LGTB have adverse effects on ovarian reserve and response. Untargeted metabolomic analysis identified 92 and 80 differential metabolites in the control vs. FGTB and control vs. LGTB groups, respectively. Pathway enrichment analysis revealed significant alterations in metabolic pathways in the FGTB and LGTB groups compared to the control group (P < 0.05), with specific changes noted in galactose metabolism, biotin metabolism, steroid hormone biosynthesis, and nicotinate and nicotinamide metabolism in the FGTB group, and caffeine metabolism, primary bile acid biosynthesis, steroid hormone biosynthesis, and glycerophospholipid metabolism in the LGTB group. The analysis of metabolic levels has revealed the potential mechanisms by which FGTB and LGTB affect ovarian reserve function, namely through alterations in metabolic pathways. The study emphasizes the importance of comprehending the metabolic alterations associated with FGTB and LGTB, which is of considerable relevance for the clinical management and therapeutic approaches in afflicted women.
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Affiliation(s)
- Zhimin Wang
- Reproductive Medicine Center, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, People's Republic of China
| | - Xueyan Zhang
- Reproductive Medicine Center, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, People's Republic of China
| | - Bai Dai
- Reproductive Medicine Center, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, People's Republic of China
| | - Debang Li
- Reproductive Medicine Center, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, People's Republic of China
| | - Xiujuan Chen
- Reproductive Medicine Center, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, People's Republic of China.
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5
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Malik N, Sidhar M, Sehgal NP, Gupta A, Gupta I. Upstaging of Tuberculosis in the Post-COVID-19 Era: A Case Series. Cureus 2024; 16:e54687. [PMID: 38524066 PMCID: PMC10960560 DOI: 10.7759/cureus.54687] [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: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
The COVID-19 pandemic has significantly impacted the global health system as well as the social and economic impact on tuberculosis (TB) treatment and diagnostic services. A high volume of patients diagnosed and treated for TB were impacted by the pandemic restrictions, particularly reduced access to TB services provided by the National Tuberculosis Elimination Programme in India; this in turn increased the number of deaths due to TB. The Indian healthcare system has been struggling with the eradication of TB, and this additional worldwide health crisis caused by SARS-CoV-2 has put the Indian healthcare system under severe stress. Both COVID-19 and TB are infectious diseases that primarily affect the lungs and have similar symptoms such as cough, fever, and difficulty breathing. The need of the hour is to take proper actions to mitigate and reverse these impacts urgently. The immediate priority is to aggressively step up the provision of essential TB services so that the levels of TB case detection and treatment return to at least pre-COVID-19 levels. The diagnosis of genital TB especially needs a high index of suspicion, as most of the cases are asymptomatic and diagnosed by chance in young women being evaluated for fertility. Here, we present a series of advanced genital TB cases that required intensive care and could have been detected and treated at an early stage.
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Affiliation(s)
- Neeru Malik
- Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, IND
| | - Meenakshi Sidhar
- Pathology, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, IND
| | - Nidhi Prabha Sehgal
- Anaesthesiology and Critical Care, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, IND
| | - Anurag Gupta
- Pathology, University College of Medical Sciences and Guru Teg Bahadur (GTB) Hospital, New Delhi, IND
| | - Ishita Gupta
- Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, IND
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6
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Gunasekaran J, Ranjan R, Joshi I, Karlapudi P, Gupta RM. Isolated Unilateral Testicular Tuberculosis in a Young, Immunocompetent Patient: A Case Report. Cureus 2024; 16:e52902. [PMID: 38405999 PMCID: PMC10892368 DOI: 10.7759/cureus.52902] [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: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Testicular or epididymal tuberculosis is a rare form of extrapulmonary tuberculosis. Extrapulmonary tuberculosis of any form is very difficult to diagnose by microscopy because it is usually paucibacillary. Therefore, molecular methods play a major role in the diagnosis of extrapulmonary tuberculosis. We present a rare case of unilateral testicular tuberculosis in a 23-year-old immunocompetent patient with no history of contact with a known tuberculosis case. He presented to us with swelling on his testis for one month and a discharging sinus in the left testis for 15 days, along with an intermittent fever for a week. A pus swab from the discharging sinus of the testis was sent to microbiology, where a cartridge-based nucleic acid amplification test (CBNAAT) was done, which detected Mycobacterium tuberculosis complex (MTBC), but resistance to rifampicin was not detected. A line probe assay was also done on the sample for first-line drugs, and no resistance was detected for rifampicin or isoniazid. The patient was started on first-line drugs in the intensive phase, and after the completion of two months of treatment, the patient's discharge stopped and he showed clinical improvement. Being a young patient, if he had not been diagnosed and treated as early as possible, it could have led to infertility. This again emphasizes the importance of molecular methods for the diagnosis of extrapulmonary tuberculosis.
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Affiliation(s)
- Jayanthi Gunasekaran
- Department of Microbiology, Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, IND
| | - Rahul Ranjan
- Department of Microbiology, Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, IND
| | - Ina Joshi
- Department of Microbiology, Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, IND
| | - Priya Karlapudi
- Department of Microbiology, Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, IND
| | - Rajiv M Gupta
- Department of Microbiology, Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, IND
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7
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Mondal R, Jaiswal N, Bhave P, Mandal P. Laparoscopic and hysteroscopic findings in women with sub-fertility and tuberculosis: A case series. BJOG 2023. [PMID: 37973605 DOI: 10.1111/1471-0528.17701] [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: 02/02/2023] [Revised: 10/07/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Evaluation of hysteroscopic and laparoscopic findings in subfertile women predictive of tuberculosis. DESIGN Retrospective case series analysis. SETTING Tertiary hospital in India. POPULATION A retrospective analysis of 16 784 subfertile women who had undergone diagnostic hysterolaparoscopy (DHL) was conducted between February 2014 and June 2021. METHODS Histopathological evidence, acid-fast bacilli (AFB), culture and GeneXpert MTB/RIF assay were used to diagnose female genital tuberculosis (FGTB). Various hysteroscopic and laparoscopic findings were analysed, and a binary logistic regression assessed associations between these findings and positive diagnostic outcomes. MAIN OUTCOME MEASURES Various hysteroscopic and laparoscopic findings correspond to tubercular manifestation. RESULTS Of the 16,784 patients, 1083 had hysteroscopy and laparoscopy findings suggestive of tuberculosis, and 309 were diagnosed with FGTB based on diagnostic tests. Logistic regression identified variables strongly predictive of positive status outcomes; tuberculous abdomino-pelvic adhesions of various grades, isthmo-ampullary block, tubercle, tubo-ovarian mass, tuberculous hydrosalpinx, complete tubal destruction, tubal diverticula and rigid tube emerged as strong predictors. CONCLUSIONS Logistic regression-derived predictors, alongside specific laparoscopic and hysteroscopic findings, can enhance diagnostic accuracy and clinical decision-making to start antitubercular therapy in subfertile women.
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Affiliation(s)
- Rana Mondal
- Department of Reproductive Medicine, Bansal Hospital, Bhopal, India
| | - Neha Jaiswal
- Department of Reproductive Medicine, Bansal Hospital, Bhopal, India
| | - Priya Bhave
- Department of Reproductive Medicine, Bansal Hospital, Bhopal, India
| | - Priyadarshi Mandal
- Department of Obstetrics and Gynaecology, NRS Medical College and Hospital, Kolkata, India
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8
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Pretreatment CT differential diagnosis of tuberculous peritonitis from peritoneal carcinomatosis of advanced epithelial ovarian cancer. Sci Rep 2023; 13:1085. [PMID: 36658262 PMCID: PMC9852573 DOI: 10.1038/s41598-023-27771-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Delayed diagnosis of female genital tuberculosis (FGTB) can lead to inappropriate treatment and unnecessary surgical procedures rather than standard anti-TB medication. We tried to evaluate the use of computed tomography (CT) imaging to differentiate TB peritonitis from peritoneal carcinomatosis of advanced epithelial ovarian cancer (AEOC). We investigated women who underwent CT to distinguish between TB peritonitis and peritoneal carcinomatosis of AEOC. We evaluated various CT imaging features to identify differences between the two diseases. In addition, we performed univariate and multivariate logistic regression analyses to identify the independent imaging parameters associated with TB peritonitis and evaluated the diagnostic performance of the combined imaging parameters. We also performed the histopathological analysis of the available salpinx specimens of TB peritonitis. We included 25 women with TB peritonitis and 34 women with peritoneal carcinomatosis of AEOC. A multivariate analysis of the discriminant CT imaging features between the two diseases revealed that changes in fallopian tubes and peritoneal micronodules were independent parameters associated with TB peritonitis (p ≤ 0.012). Combining the two imaging parameters showed an area under the receiver operating characteristic curve of 0.855, a sensitivity of 88.0%, and a specificity of 67.7% for differentiating TB peritonitis from peritoneal carcinomatosis. Furthermore, changes in fallopian tubes were correlated with histopathological abnormalities in salpinx specimens. Pretreatment CT evaluation with useful imaging features could help differentiate TB peritonitis from peritoneal carcinomatosis of AEOC.
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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.
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10
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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.
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11
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Ahmad MF, Mohamad N, Sapiai NA, Razali NA, Anuar AH. A case of concurrent gastrointestinal, peritoneal and urinary bladder tuberculosis. Indian J Tuberc 2022; 69:706-709. [PMID: 36460413 DOI: 10.1016/j.ijtb.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/09/2021] [Indexed: 06/17/2023]
Abstract
Tuberculosis is a top 10 leading cause of death worldwide. Lungs are primarily involved organs in tuberculosis. The rest of cases are extrapulmonary tuberculosis (14% reported in 2017). Extrapulmonary tuberculosis always presents with non-specific symptoms, thus at risk of delay diagnosis and management. In genitourinary tuberculosis, kidney alone and kidney with urinary bladder or ureter is affected in more than 70% of cases. The ureter and urinary bladder infections are almost always secondary to tuberculous involvement of the kidney. Bacilli haematogenic spreading is a known transmission pathway to the kidney. In this case, we diagnosed isolated urinary bladder tuberculosis caused by direct gastrointestinal tuberculosis infiltration, a rare occurrence of extrapulmonary tuberculosis. We illustrate the multiorgan involvement in tuberculosis infection including pulmonary, gastrointestinal, peritoneal and urinary bladder.
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Affiliation(s)
- Mohamad Firdaus Ahmad
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia; Department of Radiology, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nasibah Mohamad
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia; Department of Radiology, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia.
| | - Nur Asma Sapiai
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia; Department of Radiology, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia
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12
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Sethi A, Bajaj B, Nair D, Pachauri D, Gupta M, Mahajan A. Comparison of Conventional Methods with Newer Diagnostic Modalities to Detect Genital Tuberculosis in Infertile Women. J Obstet Gynaecol India 2022; 72:426-432. [PMID: 36458068 PMCID: PMC9568646 DOI: 10.1007/s13224-022-01629-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/26/2022] [Indexed: 10/18/2022] Open
Abstract
Background Genital tuberculosis is one of the leading causes of female infertility. Paucibacillary nature of the disease in the female genital system often makes its diagnosis difficult. No single test has been able to accurately diagnose genital tuberculosis. In this study we aim to compare conventional diagnostic tests for tuberculosis like Acid Fast Bacilli (AFB) Staining, Lowenstein Jensen (LJ) Culture and Histopathology with newer tests like PCR, MGIT 960, GeneXpert. Methods This study included 67 infertile women from Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. They were subjected to detailed history and routine investigations, namely Haemogram, ESR, Mantoux test, Chest X-ray and pelvic ultrasound to look for the findings of tuberculosis. A premenstrual endometrial aspirate was taken and was subjected to the AFB Staining, LJ Culture, Histopathology, PCR, MGIT 960, Gene Xpert, and the test results were compared. Result and Conclusion 35.8% (24/67) of women were diagnosed with genital tuberculosis using the diagnostic criteria. With culture as the gold standard, the positivity of genital TB was 19.4% (13/67). Majority of infertile patients with low index of suspicion clinically were positive for genital tuberculosis. Therefore, all the patients of infertility should be routinely evaluated for genital tuberculosis. PCR and MGIT 960 have shown promising results in the newer methods. LJ culture and histopathology are still the most reliable and available diagnostic methods. The usefulness of AFB Staining and GeneXpert remains questionable.
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Affiliation(s)
- Anugeet Sethi
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029 India
- Hoshiarpur, Punjab India
| | - Bindu Bajaj
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029 India
| | - Deepthi Nair
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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13
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Zhu W, Li Z, Fan S, Wang X, Yang K, Xiong G, Li X, Zhou L. Management of tuberculous-contracted bladder with bilateral duplex collecting system: a case report with modified robotic urinary tract reconstructive surgery. Transl Androl Urol 2021; 10:3891-3898. [PMID: 34804831 PMCID: PMC8575570 DOI: 10.21037/tau-21-535] [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: 06/15/2021] [Accepted: 09/01/2021] [Indexed: 11/20/2022] Open
Abstract
Tuberculous bladder contracture with a bilateral duplicated collecting system is rare. According to anatomic variation, the surgical treatment strategy is highly individualized. We illustrate our robotic technique of urinary tract reconstruction. A 19-year-old girl with a history of pulmonary tuberculosis (TB) as a young child presented with a complaint of increasing frequency of micturition, nocturia, urgency, and urge incontinence starting at the age of 17. Clinical and imaging examinations demonstrated tuberculous contracted bladder with a bilateral duplex collecting system. The patient underwent a robot-assisted Institute of Urology Peking University (IUPU) orthotopic ileal neobladder reconstruction. This is a modified urinary tract reconstructive method, including resection of the end of the duplex ureters and diseased contracted bladder with preservation of the proximal urethra and bladder neck, ileal harvesting and IUPU strategy to reconstruct an ileal neobladder, uretero-ileal anastomosis and neobladder-bladder neck anastomosis. The patient remained symptom-free without recurrence of TB and had improved renal function during the one-year follow-up after surgery. Thus, our robot-assisted IUPU orthotopic ileal neobladder reconstruction method is an effective approach for this benign case. It can effectively increase bladder capacity, reduce intravesical pressure, and improve symptoms such as urination frequency and urgency.
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Affiliation(s)
- Weijie Zhu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Centre, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Centre, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Centre, Beijing, China
| | - Xiang Wang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Centre, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Centre, Beijing, China
| | - Gengyan Xiong
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Centre, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Centre, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Centre, Beijing, China
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14
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Iyer VK, Malhotra N, Singh UB, Gupta P, Dhaliwal L, Gainder S, Jain A, Jaiswar SP, Srikantam A, Hari A, Ahmad A, Chandhiok N. Immunohistochemical evaluation of infiltrating immune cells in endometrial biopsy of female genital tuberculosis. Eur J Obstet Gynecol Reprod Biol 2021; 267:174-178. [PMID: 34800826 DOI: 10.1016/j.ejogrb.2021.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/17/2021] [Accepted: 10/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Female Genital Tuberculosis (FGTB) causes infertility in a large number of females in developing countries. Presence of granuloma on histopathological examination of endometrial samples is diagnostic of FGTB. But immunohistochemical evaluation of endometrial aspirates has not been explored before. AIM To evaluate the immunohistochemical delineation of immune cells in FGTB. METHODS 1515 infertile women from 20 to 35 years were enrolled and underwent endometrial aspiration (EA), which was subjected to microbiological and histopathological examination along with PCR. Patients positive for conventional tests like granulomas, acid fast bacilli, mycobacterial culture on LJ medium or liquid (MGIT) culture were started on antitubercular therapy. Conventional test negative but PCR positive patients were posted for laparoscopy. Immunohistochemistry (IHC) for LCA, CD68, CD3, CD4, CD8, CD 20, CD138, IFN gamma and IL10 were evaluated. RESULT 38/1515 (2.5%) subjects tested positive for conventional methods. PCR-TB was positive in 615/1515 samples (40.59%). On IHC, the number of CD45 (LCA) positive immune cells (p = 0.03) and IFN gamma (p = 0.002) and IL10 expression (p = 0.012) at 1 + level were higher in the PCR positive samples. Laparoscopy done in 418/463 patients and 89/418 (21.3%) showed definitive findings of tuberculosis. CD3, CD4, CD8, CD20, CD68 and CD138 showed no correlation with PCR and laparoscopy. CONCLUSION Increased IFN gamma and IL 10 expressing immune cells in PCR positive EA suggests subclinical early changes, and can be useful as a research tool but have no role in diagnosing FGTB.
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Affiliation(s)
- Venkateswaran K Iyer
- Department of Pathology, Department of Obstetrics and Gynaecology, and Department of Microbiology, AIIMS, New Delhi, India.
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, and Department of Microbiology, AIIMS, New Delhi, India
| | | | - Pankush Gupta
- Department of Obstetrics and Gynaecology, and Department of Microbiology, AIIMS, New Delhi, India
| | - Lakhbir Dhaliwal
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | - Shalini Gainder
- Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, India
| | - Amita Jain
- Department of Microbiology, KGMC and Department of Obstetrics and Gynaecology, KGMC, Lucknow, India
| | - S P Jaiswar
- Department of Obstetrics and Gynaecology, KGMC, Lucknow, India
| | - Aparna Srikantam
- Department of Microbiology, LEPRA- Blue Peter Public Health and Research Center, Hyderabad, India
| | - Anupama Hari
- Department of Obstetrics and Gynaecology, Gandhi Medical College and Hospital, Hyderabad, India
| | - Aijaz Ahmad
- Department of Pathology, Department of Obstetrics and Gynaecology, and Department of Microbiology, AIIMS, New Delhi, India
| | - Nomita Chandhiok
- Consultant and Former Scientist G, Indian Council of Medical Research, New Delhi, India
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15
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So PNH, Villanueva ART. Serologic and urinary characteristics of laboratory-confirmed genitourinary tuberculosis at a tertiary hospital in the Philippines. BMC Urol 2021; 21:125. [PMID: 34503465 PMCID: PMC8431859 DOI: 10.1186/s12894-021-00888-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/23/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Genitourinary tuberculosis (GUTB) is known to cause high rates of structural organ damage, however, literature on its biochemical manifestations is limited. Additionally, local studies in the Philippine setting, where cases are rampant, are few and dated. This study aimed to determine the serologic and urinary profile of patients with GUTB admitted at a tertiary hospital within January 2009 to March 2020 and their association with short-term outcomes. METHODS This retrospective study included 112 patients with laboratory-confirmed GUTB (i.e., positivity in acid-fast smear, polymerase chain reaction, culture, or histology). Demographic data, clinical characteristics, laboratory and radiologic findings, histopathology reports, treatment, and short-term outcomes were recorded. RESULTS Bladder (54.5%) and kidney (36.4%) were the most affected organs. The male:female ratio was 1:1.15, and the mean age was 35.79 ± 18.29 years. Weakness (14.29%) was the most common chief complaint. A majority presented with anemia (83.04%), while several had leukocytosis (41.96%) and thrombocytosis (26.79%). Hypoalbuminemia (58.10%), impairment of renal function (36.94%), and electrolyte abnormalities such as hyponatremia (50.93%), hypercalcemia (20.19%), and hypokalemia (21.82%) were common. Proteinuria (67.96%) and pyuria (67.96%) were the most frequent abnormal findings, followed by hematuria (51.46%), acidic urine (45.63%) and low specific gravity (31.07%). Age, leukocytosis, and the need for pressors were all significantly associated with mortality (p values of <0.001, 0.010, and <0.001, respectively). CONCLUSIONS The young age at presentation with severe clinical and laboratory manifestations may reflect local epidemiology as TB continues to be widespread in the country. Apart from the more commonly cited abnormalities in literature, multiple electrolyte imbalances and urinary concentration defects were also observed in many cases, possibly indicating tubulointerstitial involvement-a complication increasingly mentioned in case reports. As several patient characteristics were found to be associated with the high mortality rates observed in the study, further research is recommended to explore predictive modeling.
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Affiliation(s)
- Paolo Nikolai H So
- Division of Nephrology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Ermita, 1000, Manila, Philippines.
| | - Anthony Russell T Villanueva
- Division of Nephrology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Ermita, 1000, Manila, Philippines
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16
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Dorval G, Berteloot L, Pio L, Boyer O, Blanc T. A rare cause of transitory hematuria and urinary tract dysfunction in children: Answers. Pediatr Nephrol 2021; 36:2131-2135. [PMID: 33768327 DOI: 10.1007/s00467-021-05006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Guillaume Dorval
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France. .,Université de Paris, Faculté de Médecine, Paris, France.
| | - Laureline Berteloot
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'Imagerie Pédiatrique, Paris, France
| | - Luca Pio
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
| | - Olivia Boyer
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | - Thomas Blanc
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
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17
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Wang Y, Shao R, He C, Chen L. Emerging progress on diagnosis and treatment of female genital tuberculosis. J Int Med Res 2021; 49:3000605211014999. [PMID: 33983063 PMCID: PMC8127763 DOI: 10.1177/03000605211014999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Female genital tuberculosis (FGTB) is an infection caused by Mycobacterium tuberculosis and usually occurs secondary to pulmonary tuberculosis (TB) through the blood circulation, lymph circulation, or direct spreading from abdominal TB. FGTB is an uncommon type of TB that can destroy genital organs, and lead to menstrual disorders and infertility. The diagnosis of FGTB is often made by detection of acid-fast bacilli under microscopy, culture with endometrial biopsy, or histopathological examination of epithelioid granuloma on a biopsy. A multidrug anti-TB regimen is the major management of FGTB, including rifampicin, isoniazid, pyrazinamide, and ethambutol, while surgery is proposed in more deteriorated cases. However, the conception rate in infertile women with FGTB is still low, even after multidrug anti-TB therapy. Additionally, the risk of complications, such as ectopic pregnancy or miscarriage, remains high. In this review, we summarize the characteristics of FGTB, present current epidemiological data, and focus on its early diagnosis and effective management.
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Affiliation(s)
- Ying Wang
- The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China.,Reproductive Medicine Center, Jingzhou Central Hospital, Jingzhou, Hubei, China
| | - Ruifeng Shao
- The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China.,Reproductive Medicine Center, Jingzhou Central Hospital, Jingzhou, Hubei, China
| | - Chihua He
- The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, China.,Reproductive Medicine Center, Jingzhou Central Hospital, Jingzhou, Hubei, China
| | - Ligang Chen
- Department of Respiratory Medicine, Jingzhou Chest Hospital, Jingzhou, Hubei, China
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18
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Perumal P, Abdullatif MB, Garlant HN, Honeyborne I, Lipman M, McHugh TD, Southern J, Breen R, Santis G, Ellappan K, Kumar SV, Belgode H, Abubakar I, Sinha S, Vasan SS, Joseph N, Kempsell KE. Validation of Differentially Expressed Immune Biomarkers in Latent and Active Tuberculosis by Real-Time PCR. Front Immunol 2021; 11:612564. [PMID: 33841389 PMCID: PMC8029985 DOI: 10.3389/fimmu.2020.612564] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022] Open
Abstract
Tuberculosis (TB) remains a major global threat and diagnosis of active TB ((ATB) both extra-pulmonary (EPTB), pulmonary (PTB)) and latent TB (LTBI) infection remains challenging, particularly in high-burden countries which still rely heavily on conventional methods. Although molecular diagnostic methods are available, e.g., Cepheid GeneXpert, they are not universally available in all high TB burden countries. There is intense focus on immune biomarkers for use in TB diagnosis, which could provide alternative low-cost, rapid diagnostic solutions. In our previous gene expression studies, we identified peripheral blood leukocyte (PBL) mRNA biomarkers in a non-human primate TB aerosol-challenge model. Here, we describe a study to further validate select mRNA biomarkers from this prior study in new cohorts of patients and controls, as a prerequisite for further development. Whole blood mRNA was purified from ATB patients recruited in the UK and India, LTBI and two groups of controls from the UK (i) a low TB incidence region (CNTRLA) and (ii) individuals variably-domiciled in the UK and Asia ((CNTRLB), the latter TB high incidence regions). Seventy-two mRNA biomarker gene targets were analyzed by qPCR using the Roche Lightcycler 480 qPCR platform and data analyzed using GeneSpring™ 14.9 bioinformatics software. Differential expression of fifty-three biomarkers was confirmed between MTB infected, LTBI groups and controls, seventeen of which were significant using analysis of variance (ANOVA): CALCOCO2, CD52, GBP1, GBP2, GBP5, HLA-B, IFIT3, IFITM3, IRF1, LOC400759 (GBP1P1), NCF1C, PF4V1, SAMD9L, S100A11, TAF10, TAPBP, and TRIM25. These were analyzed using receiver operating characteristic (ROC) curve analysis. Single biomarkers and biomarker combinations were further assessed using simple arithmetic algorithms. Minimal combination biomarker panels were delineated for primary diagnosis of ATB (both PTB and EPTB), LTBI and identifying LTBI individuals at high risk of progression which showed good performance characteristics. These were assessed for suitability for progression against the standards for new TB diagnostic tests delineated in the published World Health Organization (WHO) technology product profiles (TPPs).
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Affiliation(s)
- Prem Perumal
- Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | | | - Harriet N. Garlant
- Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
| | - Isobella Honeyborne
- Centre for Clinical Microbiology, University College London, Royal Free Campus, London, United Kingdom
| | - Marc Lipman
- UCL Respiratory, University College London, Royal Free Campus, London, United Kingdom
| | - Timothy D. McHugh
- Centre for Clinical Microbiology, University College London, Royal Free Campus, London, United Kingdom
| | - Jo Southern
- Institute for Global Health, University College London, London, United Kingdom
| | - Ronan Breen
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - George Santis
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Kalaiarasan Ellappan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, India
| | - Saka Vinod Kumar
- Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, India
| | - Harish Belgode
- Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, India
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, United Kingdom
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Seshadri S. Vasan
- Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
- Department of Health Sciences, University of York, York, United Kingdom
| | - Noyal Joseph
- Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Puducherry, India
| | - Karen E. Kempsell
- Public Health England, Porton Down, Salisbury, Wiltshire, United Kingdom
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19
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Rajabi MH, Ahmadi Gharaei H, ArabAhmadi A, Yarmohammadi M. Isolated tuberculosis of testis: A case report. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:111-114. [PMID: 33680408 PMCID: PMC7919169 DOI: 10.22088/cjim.12.1.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background Extrapulmonary tuberculosis accounts for only 15% of new cases of tuberculosis. In extrapulmonary tuberculosis, usually affected areas include bone, pleura, lymph nodes, genitourinary system, joints, peritoneum and meninges. Tuberculosis epididymo-orchitis is an uncommon type of extrapulmonary tuberculosis. Case presentation We reported a case of tuberculosis epididymo-orchitis and involvement of the left testicle in a 37-year-old male patient. The left testicle had a heterogeneous parenchymal echo, and multiple hypo-echo and ill-defined areas were evident in the left testicle. In the color Doppler ultrasound, the left testicle with the epididymis on both sides was completely hyperemic. The findings were primarily in the favor of extrapulmonary tuberculosis. Therefore, after a 2-month first-stage treatment with four-drug therapy of anti-TB drugs such as rifampin 150 mg, isoniazid 75 mg, pyrazinamide 400 mg and ethambutol 275 mg, considering the weight of the patient (56 kg), 4 pills per day and the second phase with two-drug therapy, rifampin 150 mg and 75 mg of isoniazid, 4 pills per day for 4 months, extrapulmonary tuberculosis symptoms improved to a large extent. Conclusion To prevent epididymectomy and the effects that the disease may have on fertility, it should be tried to quickly diagnose and treat the disease at the same early stage of the disease.
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Affiliation(s)
- Mohammad Hassan Rajabi
- Department of Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasan Ahmadi Gharaei
- Department of Health, Faculty of Public Health, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Ali ArabAhmadi
- Department of Health, Faculty of Public Health, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mobina Yarmohammadi
- Department of Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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20
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Sali G, Kalavampara SV, Kandasamy SG, Kumar A, Mathew G, Thomas A. Genitourinary non-tuberculous mycobacterial (GU-NTM) infections: A single institution experience in South India. Indian J Tuberc 2021; 68:65-72. [PMID: 33641853 DOI: 10.1016/j.ijtb.2020.08.018] [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: 07/21/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Non-tuberculous mycobacterial (NTM) infections are rarely reported, and more so with genitourinary infections. This retrospective study was designed to understand the proportion and behaviour of genitourinary non-tuberculous mycobacterial (GU-NTM) infections compared with genitourinary mycobacterial tuberculosis (GU-MTB) treated at a tertiary care hospital in South India. MATERIALS AND METHODS The hospital records of every bacteriologically proved GU-MTB and GU-NTM infections treated at this centre from 2010 to 2016 were retrospectively reviewed. RESULTS There were ten patients of GU-NTM and 15 patients of GU-MTB. There was no significant difference in presentation other than lesser frequency of irritative lower urinary tract symptoms (LUTS) among patients with GU-MTB. Urine smear for AFB was positive in 60% and 47% of GU-NTM and GU-MTB patients. 40% of GU-NTM patients had history of urinary tract instrumentation. Mycobacterium abscessus was grown in four patients and one had Mycobacterium fortuitum/chelonae complex; all the rest were rapid growers. No patient had multi-drug resistant tuberculosis. Imaging studies of GU-NTM patients were indistinguishable from GU-MTB with renal, ureteral and bladder involvements, and stone formation. The drug sensitivities varied among the NTM patients but all showed sensitivity to clarithromycin uniformly. Need for varieties of surgeries in the early and late phases were also comparable. CONCLUSIONS GU-MTB and GU-NTM infections are indistinguishable from their clinical presentation and imaging studies. All cases of suspected genitourinary mycobacterial infections must be subjected to nucleic acid testing. Treatments based on clinical and radiological features without culture studies may misdiagnose GU-NTM infections as MDR GU-MTB, thereby delaying the appropriate treatment.
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Affiliation(s)
- Gaurav Sali
- University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom; Former Senior Resident, Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Ponekkara, Cochin, Kerala, 682041, India.
| | - S V Kalavampara
- Former Senior Resident, Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Ponekkara, Cochin, Kerala, 682041, India
| | - S G Kandasamy
- Former Senior Resident, Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Ponekkara, Cochin, Kerala, 682041, India
| | - Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Ponekkara, Cochin, Kerala, 682041, India
| | - Georgie Mathew
- Former Senior Resident, Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Ponekkara, Cochin, Kerala, 682041, India
| | - Appu Thomas
- Former Senior Resident, Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Ponekkara, Cochin, Kerala, 682041, India
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21
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Gupta S, Gupta P. Etiopathogenesis, Challenges and Remedies Associated With Female Genital Tuberculosis: Potential Role of Nuclear Receptors. Front Immunol 2020; 11:02161. [PMID: 33178178 PMCID: PMC7593808 DOI: 10.3389/fimmu.2020.02161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022] Open
Abstract
Extra-pulmonary tuberculosis (EPTB) is recognized mainly as a secondary manifestation of a primary tuberculosis (TB) infection in the lungs contributing to a high incidence of morbidity and mortality. The TB bacilli upon reactivation maneuver from the primary site disseminating to other organs. Diagnosis and treatment of EPTB remains challenging due to the abstruse positioning of the infected organs and the associated invasiveness of sample acquisition as well as misdiagnosis, associated comorbidities, and the inadequacy of biomarkers. Female genital tuberculosis (FGTB) represents the most perilous form of EPTB leading to poor uterine receptivity (UR), recurrent implantation failure and infertility in females. Although the number of TB cases is reducing, FGTB cases are not getting enough attention because of a lack of clinical awareness, nonspecific symptoms, and inappropriate diagnostic measures. This review provides an overview for EPTB, particularly FGTB diagnostics and treatment challenges. We emphasize the need for new therapeutics and highlight the need for the exaction of biomarkers as a point of care diagnostic. Nuclear receptors have reported role in maintaining UR, immune modulation, and TB modulation; therefore, we postulate their role as a therapeutic drug target and biomarker that should be explored in FGTB.
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Affiliation(s)
- Shalini Gupta
- Department of Molecular Biology, CSIR-Institute of Microbial Technology, Chandigarh, India
| | - Pawan Gupta
- Department of Molecular Biology, CSIR-Institute of Microbial Technology, Chandigarh, India
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22
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Malhotra N, Singh UB, Iyer V, Gupta P, Chandhiok N. Role of Laparoscopy in the Diagnosis of Genital TB in Infertile Females in the Era of Molecular Tests. J Minim Invasive Gynecol 2020; 27:1538-1544. [PMID: 31945469 DOI: 10.1016/j.jmig.2020.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To assess diagnostic value of polymerase chain reaction (PCR) in endometrial aspirates (EAs) in comparison with conventional tests for diagnosis of female genital tuberculosis (TB) and to find agreement between EA PCR done for endometrial TB and laparoscopic findings of pelvic TB in women with unexplained infertility. DESIGN Prospective observational cohort study. SETTING Tertiary care hospital. PATIENTS A total of 732 infertile females screened and 385 enrolled to undergo procedure to obtain EAs. INTERVENTIONS EAs were tested by conventional tests (histopathology, acid-fast bacilli, Lowenstein-Jensen staining, liquid culture) and PCR for Mycobacterium tuberculosis. Patients with positive conventional tests were started on antitubercular treatment (ATT). Patients with negative conventional tests underwent laparohysteroscopy irrespective of PCR results to assess changes of tubercular infection in the pelvis. Peritoneal washings were also sent for liquid culture and PCR for TB, and suspicious lesions were biopsied at laparohysteroscopy. Findings at laparoscopy upgraded the diagnosis in these women. EAPCR results were analyzed to find agreement with the findings at laparoscopy. MEASUREMENTS AND MAIN RESULTS Conventional tests were positive in 8 of 385 (2%) patients. PCR was positive in 58.1% (n = 224) of endometrial samples, with sensitivity of 62.5% (95% confidence interval [CI], 24.49-91.48), specificity of 41.91% (95% CI, 36.88-47.07), positive predictive value of 2.23% (95% CI, 1.31-3.78), negative predictive value of 98.14% (95% CI, 95.53-99.24), and a diagnostic accuracy of 42.34% (95% CI, 37.35-47.45) with conventional tests. A total of 265 patients underwent laparoscopy, of whom 165 were PCR positive and 100 were PCR negative. Laparoscopic findings suggestive of TB were found in 39.3% of patients who were PCR positive and 9% of patients who were PCR negative. Kappa agreement was 0.25, suggesting fair agreement between PCR and laparoscopy. CONCLUSION PCR as a stand-alone diagnostic test for endometrial TB is not justified to confirm diagnosis and initiate ATT. The addition of laparohysteroscopy improves diagnostic yield for genital TB. Referring patients with a suspicion of female genital TB to tertiary care for 1-time laparoscopy is better than initiating ATT solely on the basis of PCR results.
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MESH Headings
- Adult
- Biopsy, Needle
- Cohort Studies
- Diagnostic Tests, Routine
- Endometrium/microbiology
- Endometrium/pathology
- Endometrium/surgery
- Female
- Humans
- Infertility, Female/diagnosis
- Infertility, Female/etiology
- Infertility, Female/microbiology
- Infertility, Female/pathology
- Laparoscopy/methods
- Molecular Diagnostic Techniques/methods
- Molecular Diagnostic Techniques/trends
- Mycobacterium tuberculosis/genetics
- Mycobacterium tuberculosis/isolation & purification
- Polymerase Chain Reaction/methods
- Predictive Value of Tests
- Prospective Studies
- Sensitivity and Specificity
- Tuberculosis, Female Genital/complications
- Tuberculosis, Female Genital/diagnosis
- Tuberculosis, Female Genital/microbiology
- Tuberculosis, Female Genital/pathology
- Young Adult
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Affiliation(s)
- Neena Malhotra
- Departments of Obstetrics and Gynaecology (Drs. Malhotra and Gupta).
| | | | | | - Pankush Gupta
- Departments of Obstetrics and Gynaecology (Drs. Malhotra and Gupta)
| | - Nomita Chandhiok
- Division of Reproductive Health and Nutrition, Indian Council of Medical Research (Dr. Chandhiok), New Delhi, India
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23
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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.
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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
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Naik SN, Chandanwale A, Kadam D, Sambarey PW, Dhumal G, DeLuca A, Jain D, Gupta A, Bollinger R, Mave V. Detection of genital tuberculosis among women with infertility using best clinical practices in India: An implementation study. Indian J Tuberc 2020; 68:85-91. [PMID: 33641856 DOI: 10.1016/j.ijtb.2020.08.003] [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: 10/18/2019] [Revised: 07/13/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diagnosis of genital tuberculosis (TB) as a cause of infertility still remains a diagnostic dilemma for clinicians, as no standard guidelines exist. The recently proposed best practices for genital TB diagnosis have not been evaluated yet in India. OBJECTIVES To implement best practices to diagnose and treat likely genital TB as a cause of infertility. METHODS Between April 2016 and June 2018, consenting women seen at a tertiary hospital infertility clinic were assessed by thorough TB related clinical history, ultrasonography, tuberculin skin test (TST), and ESR. Those with suspected genital TB underwent laparohysteroscopy. Clinical and laboratory characteristics were compared between likely (microbiologically confirmed or probable TB) and unlikely (possible and no genital TB) genital TB. Fertility outcome was assessed among women initiated on anti-TB treatment (ATT). RESULTS Of 185 women seeking infertility care, likely genital TB was identified among 29 (15.7%) women, with 6 (21%) confirmed and 23 (79%) probable genital TB. Compared to unlikely genital TB cases, the likely genital TB group were found to have past history of TB (p < 0.001); positive TST (p = 0.002) and elevated ESR (p = 0.001). Among the likely genital TB group, all 6 confirmed genital TB were started on ATT and 2 (33.3%) conceived. Of 5 probable genital TB started on ATT, 3 (60%) conceived. CONCLUSION Approximately 1/6th of women seeking infertility care met the criteria for likely genital TB. Conception among over-half of treated probable genital TB cases provides preliminary evidence that best clinical practices can be utilized, but needs further confirmatory studies.
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Affiliation(s)
- Shilpa N Naik
- Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospitals, Jay Prakash Narayan Road, Pune, 411001, Maharashtra, India.
| | - Ajay Chandanwale
- Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospitals, Jay Prakash Narayan Road, Pune, 411001, Maharashtra, India
| | - Dileep Kadam
- Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospitals, Jay Prakash Narayan Road, Pune, 411001, Maharashtra, India
| | - P W Sambarey
- Byramjee Jeejeebhoy Government Medical College/Sassoon General Hospitals, Jay Prakash Narayan Road, Pune, 411001, Maharashtra, India
| | - Gauri Dhumal
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Andrea DeLuca
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, MD USA
| | - Divyashri Jain
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, MD, USA
| | - Robert Bollinger
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, MD, USA
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College/Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
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25
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Ponnayyan NK, Ganapath AS, Ganapathy V. Spectrum of tuberculosis in urology: Case series and review of the literature. Urol Ann 2020; 12:107-111. [PMID: 32565645 PMCID: PMC7292423 DOI: 10.4103/ua.ua_121_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/11/2019] [Indexed: 11/12/2022] Open
Abstract
Urologists are confronted with various forms of extrapulmonary tuberculosis (TB) having an atypical presentation. The disease presents late with complications and sequelae. Four cases of extrapulmonary TB who presented to the urology department are reported here. The cases reported are TB adrenalitis, tuberculous cystitis, renal TB, and TB prostatitis. The prsentation of these cases shows GUTB as being a great imitator of other diseases. So there is a need for a very high index of suspicion for early diagnosis and to avoid misdiagnosis to prevent the devastating sequelae like organ damage. Furthermore, there is a need to develop better diagnostic tools for TB. Multidrug chemotherapy and judicious use of surgery form the mainstay of management.
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Affiliation(s)
| | | | - Venugopal Ganapathy
- Department of Urology, Government Medical College, Trivandrum, Kerala, India
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26
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Abstract
Genital tuberculosis (TB) in women is a chronic disease with low-grade symptoms. Genital tract tuberculosis is usually secondary to extragenital TB. The fallopian tubes are most commonly affected, and along with endometrial involvement, it causes infertility in such patients. Involvement of the cervix and the vulva is very rare. We present one such rare case of vulvar tuberculosis presented with a large ulcer diagnosed on histopathology and treated with antitubercular chemotherapy.
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Affiliation(s)
- Vishwajeet Singh
- Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Gyanendra Singh
- Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul Janak Sinha
- Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Suresh Babu
- Pathology, King George Medical University, Lucknow, Uttar Pradesh, India
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Complicated Urinary Tract Tuberculosis in a 13-Year-Old Adolescent with Chronic Kidney Disease and Antituberculous Drug-Induced Hepatotoxicity. Case Rep Infect Dis 2019; 2019:7370150. [PMID: 31781434 PMCID: PMC6855035 DOI: 10.1155/2019/7370150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/29/2019] [Indexed: 11/17/2022] Open
Abstract
Urinary tract tuberculosis (TB) is a rare extrapulmonary manifestation of TB in children. The disease is potentially underdiagnosed because it clinically resembles other urinary tract infections. A 13-year-old adolescent girl presented with pain, difficulty in micturition, and gross hematuria for almost two years before admission, and she had left flank pain since one year ago and significant loss of body weight during the illness. The close TB contact was her grandmother who was on TB treatment. Acid-fast bacilli yielded positive result, Mantoux test was positive (17 mm), urine GeneXpert MTB/Rif was positive; tuberculoma was identified on kidney histopathology, and a diuretic renogram revealed an uncorrected glomerular filtration rate (GFR) of the right and left kidney to be 32.5 mL/min/1.73 m2 and 5 mL/min/1.73 m2, respectively. During the treatment, oral anti-TB drug-induced hepatotoxicity (ADIH) occurred to the patient. This problem was solved with management according to the British Thoracic Society (BTS) guidelines. Screening TB in children is very important for a better outcome. If children complain of some complicated urinary tract infection, TB should be suspected. Optimaly treating children with urinary tract TB exagerrated with ADIH and CKD is very challenging.
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28
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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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Agrawal M, Roy P, Bhatia V, Dutt S, Gaur R. Role of microbiological tests in diagnosis of genital tuberculosis of women with infertility: A view. Indian J Tuberc 2019; 66:234-239. [PMID: 31151490 DOI: 10.1016/j.ijtb.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/16/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE India is a country sharing one fourth of the global incidence of tuberculosis. It is much easier to diagnose pulmonary cases, but challenges are with extrapulmonary cases. Genital tuberculosis is considered as an important cause of infertility in young females in India and difficult to diagnose. It requires incorporation of different modalities that should correctly, timely and rapidly diagnose the case. METHODS This study was conducted retrospectively for a period of 12 months on 438 endometrial samples from females with history of infertility. Three modalities namely Ziehl-Neelsen staining, Automated liquid culture and Nucleic acid amplification technique (TB-PCR) were compared and their sensitivity in diagnosis of genital tuberculosis was ascertained. RESULTS Out of 438 samples, 18 samples were found positive with at least one modality. TB-PCR positivity was 3.6% (16 cases) in comparison to culture where positivity was 1.59% (7 cases). Five samples were found culture and TB-PCR positive and only one sample was positive by all three diagnostic tests. CONCLUSION Infertility in young female per se is usually heart breaking and distressing. Therefore, it is essential to diagnose and treat the cases of genital tuberculosis before irreversible damage of tube may happen. Although, advancement in diagnostic field is there from microscopy to molecular method, but still diagnosis of genital tuberculosis is challenging. Correct diagnosis prevents young female from mental trauma and toxicity of anti-tuberculosis drugs given on suspicion in high prevalence country like India.
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Affiliation(s)
| | | | | | - Sarjana Dutt
- Molecular Immunology and Molecular Biology, India
| | - Ravi Gaur
- Pathology, Oncquest Laboratories Limited, India
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30
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Garg G, Singh A, Goel B, Bhagat R. An Uncommon Cause of Postmenopausal Bleeding. J Midlife Health 2019; 10:213-215. [PMID: 31942160 PMCID: PMC6947718 DOI: 10.4103/jmh.jmh_17_18] [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: 11/24/2022] Open
Abstract
A 65-year-old multiparous female was evaluated for postmenopausal bleeding. Imaging was strongly suggestive of malignancy. However, hysteroscopic-guided endometrial biopsy revealed tuberculous endometritis. The patient responded to antitubercular therapy and recovered completely. Genital tuberculosis is typically considered a disease of young women presenting with infertility. However, tuberculous endometritis should be considered in a patient of postmenopausal bleeding, particularly in developing countries. It is a rare, but curable cause of postmenopausal bleeding.
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Affiliation(s)
- Geetika Garg
- Department of Obstetrics and Gynecology, Government Medical College and Hospital, Chandigarh, India
| | - Anju Singh
- Department of Obstetrics and Gynecology, Government Medical College and Hospital, Chandigarh, India
| | - Bharti Goel
- Department of Obstetrics and Gynecology, Government Medical College and Hospital, Chandigarh, India
| | - Ranjeev Bhagat
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
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31
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Mondal K, Mandal R. Two unusual reports of urogenital tuberculosis: One ‘putty’ kidney and another in association with benign prostatic hyperplasia. ACTA ACUST UNITED AC 2018; 65:356-359. [DOI: 10.1016/j.ijtb.2018.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
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Abstract
The morbidity and mortality due to tuberculosis (TB) is high worldwide, and the burden of disease among women is significant, especially in developing countries. Mycobacterium tuberculosis bacilli reach the genital tract primarily by haematogenous spread and dissemination from foci outside the genitalia with lungs as the common primary focus. Genital TB in females is a chronic disease with low-grade symptoms. The fallopian tubes are affected in almost all cases of genital TB, and along with endometrial involvement, it causes infertility in patients. Many women present with atypical symptoms which mimic other gynaecological conditions. A combination of investigations is needed to establish the diagnosis of female genital TB (FGTB). Multidrug anti-TB treatment is the mainstay of management and surgery may be required in advanced cases. Conception rates are low among infertile women with genital TB even after multidrug therapy for TB, and the risk of complications such as ectopic pregnancy and miscarriage is high. More research is needed on the changing trends in the prevalence and on the appropriate methods for diagnosis of FGTB.
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Affiliation(s)
- G Angeline Grace
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - D Bella Devaleenal
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Mohan Natrajan
- Department of Clinical Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
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Bharti JN, Dey B, Bhattacharya J, Jain S. Cytomorphological spectrum of epididymal nodules: An institution's experience. Cytojournal 2017; 14:26. [PMID: 29259652 PMCID: PMC5721597 DOI: 10.4103/cytojournal.cytojournal_51_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/09/2017] [Indexed: 11/15/2022] Open
Abstract
Background: Epididymal lesions are uncommon in clinical practice. Few case series has been described in the literature documenting the role of cytology in the evaluation of epididymal nodules. This study was undertaken to analyze the cytomorphology of epididymal nodules and to evaluate role of fine-needle aspiration biopsy (FNAB) in early definitive diagnosis of epididymal nodules. Materials and Methods: A total of seventy cases of epididymal nodules were aspirated over a period of 6 years in the Department of Pathology. These cases were taken from the cytology record as a part of this study. The aspiration was performed using 22/23-gauge needle. Smears were stained with May-Grunwald-Giemsa and Papanicolaou stains. Special stains and immunocytochemistry were performed, wherever required. Results: The cytological features were adequate to establish the diagnosis in sixty cases. The lesions diagnosed were tuberculosis 16 (22.85%), spermatoceles 12 (17.14%), benign cystic lesion 8 (11.42%), encysted hydrocele 8 (11.42%), acute suppurative lesion 6 (8.57%), filariasis 4 (5.71%), chronic epididymitis 3 (4.28%), nodular fasciitis 1 (1.42%), epidermal inclusion cyst 1 (1.42%), and cystic adenomatoid tumor 1 (1.42%). Ten cases were inadequate to establish the diagnosis. FNAB was useful in diagnosis of 86% of cases. Infectious lesions of the epididymis were more common than neoplastic lesions. Patients with infection responded well to medical treatment. Conclusions: FNAB is an easily available technique for palpable lesions of epididymis, and it helps in making an early, near definitive diagnosis of epididymal lesions. It also helps to avoid unnecessary surgical interventions and helps in timely management.
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Affiliation(s)
| | - Biswajit Dey
- Address: Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Jenna Bhattacharya
- Address: Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Shyama Jain
- Address: Department of Pathology, Maulana Azad Medical College, New Delhi, India
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Verma A, Singh A, Kishore K, Kant S. A rare presentation of disseminated tuberculosis: Prostatic abscess. Indian J Tuberc 2017; 64:330-333. [PMID: 28941859 DOI: 10.1016/j.ijtb.2016.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/31/2016] [Indexed: 06/07/2023]
Abstract
Involvement of the prostate by tuberculosis (TB) occurs rarely and tuberculosis prostate abscess is an even rarer occurrence. It has been reported in immunocompromised patients, mainly human immunodeficiency virus seropositive individuals. We are reporting a case of tuberculosis prostatic abscess in an immunocompetent patient with relapse of TB.
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Affiliation(s)
- Ajay Verma
- Department of Respiratory Medicine, King George's Medical University, Chowk, Lucknow 226003, Uttar Pradesh, India
| | - Anubhuti Singh
- Department of Respiratory Medicine, King George's Medical University, Chowk, Lucknow 226003, Uttar Pradesh, India
| | - Kislay Kishore
- Department of Respiratory Medicine, King George's Medical University, Chowk, Lucknow 226003, Uttar Pradesh, India
| | - Surya Kant
- Department of Respiratory Medicine, King George's Medical University, Chowk, Lucknow 226003, Uttar Pradesh, India.
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35
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Martínez-Girón R, Martínez-Torre S, Martínez-Torre C. Tuberculous cervicitis: A brief report with cytohistological correlation and differential diagnosis. Diagn Cytopathol 2017; 45:1153-1155. [PMID: 28891141 DOI: 10.1002/dc.23815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/10/2017] [Accepted: 08/29/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Rafael Martínez-Girón
- CFGS Anatomic Pathology and Cytodiagnosis, Institute of Piedras Blancas, Asturias, Spain
| | - Santiago Martínez-Torre
- Departament of Family and Community Medicine, Hospital Universitario La Paz., Madrid, 261-28046, Spain
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Mayilvaganan KR, Naren Satya Srinivas M, Reddy VN, Singh RK. Tuberculosis Penis with 'Watering Can Penis' Appearance: Report of a Rare Case with Retrograde Urethrography and Voiding Cystourethrography Findings. Pol J Radiol 2016; 81:454-457. [PMID: 27733889 PMCID: PMC5032851 DOI: 10.12659/pjr.897943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/22/2016] [Indexed: 11/25/2022] Open
Abstract
Background A ‘watering can penis’ secondary to penile tuberculosis is an extremely rare clinical entity. Retrograde Urethrography – Voiding Cystourethrography evaluation of the urethra and the urinary bladder plays a very important role in the diagnostics as well as further management of the urethral abnormalities. To the best of our knowledge, this is only the second case in literature where a ‘watering can penis’ was noted secondary to penile TB. This is also the first documented case of ‘watering can penis’ as a consequence of venereal transmission of TB. Case Report A 50-year-old male presented with multiple discharging sinuses along the penis. RGU revealed multiple, contrast-filled, narrow, irregular, fistulous tracts arising from the pendulous part of the anterior urethra. This distal segment of the pendulous part of the anterior urethra also showed significant distortion and irregular, beaded narrowing. VCUG showed a markedly-contracted and small-capacity urinary bladder with a thickened, irregular and edematous wall with multiple hypertrophied trabeculae along its walls. The patient was administered anti-tubercular treatment. At the end of this treatment regimen, a repeat RGU-VCUG will be performed and decision regarding urethroplasty and further management will be planned depending upon the presence of any remaining fistulas or strictures involving the urethra. Conclusions ‘Watering can penis’ as a result of penile TB is a very rare clinical entity. The differential diagnoses of a ‘watering can penis’ should be kept in mind in the evaluation of these patients. RGU and VCUG evaluation is an important conventional imaging modality used in the evaluation of urethral strictures and fistulas in case of ‘watering can penis’.
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Affiliation(s)
- Kamala Retnam Mayilvaganan
- Department of Radiodiagnosis, M.V. Jayaram Medical College and Research Hospital, Hosakote, Bangalore, India
| | - M Naren Satya Srinivas
- Department of Radiodiagnosis, M.V. Jayaram Medical College and Research Hospital, Hosakote, Bangalore, India
| | - Vikram N Reddy
- Department of Radiodiagnosis, M.V. Jayaram Medical College and Research Hospital, Hosakote, Bangalore, India
| | - Ranjeet Kumar Singh
- Department of Radiodiagnosis, M.V. Jayaram Medical College and Research Hospital, Hosakote, Bangalore, India
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Cherif S, Yoganathan K, Banks T, Abdulla R. Unmasking immune reconstitution inflammatory syndrome: a report of tuberculous epididymo-orchitis mimicking a testicular tumour in a Caucasian AIDS patient. Int J STD AIDS 2016; 28:100-103. [PMID: 27222288 DOI: 10.1177/0956462416652536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Worldwide, it is estimated that 14.8% of all new tuberculosis cases in adults are attributable to HIV infection. Genitourinary tuberculosis is a known complication and is considered to be a severe form of extrapulmonary tuberculosis. Isolated tuberculous epididymo-orchitis is rare. We report a Caucasian HIV-positive heterosexual male with a clinical diagnosis of testicular tumour for which he underwent a right orchidectomy. Tuberculous epididymo-orchitis was confirmed by histology. In this case, all Immune Reconstitution Inflammatory Syndrome (IRIS) criteria were met. We want to convey the message that in HIV-positive patients presenting with testicular swelling, an infective aetiology should be considered. This will increase the possibility of early diagnosis and proper management.
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Affiliation(s)
- S Cherif
- 1 Department of Genitourinary and HIV Medicine, Singleton Hospital, Swansea, UK
| | - K Yoganathan
- 1 Department of Genitourinary and HIV Medicine, Singleton Hospital, Swansea, UK
| | - T Banks
- 2 Department of General Surgery, Singleton Hospital, Swansea, UK
| | - R Abdulla
- 1 Department of Genitourinary and HIV Medicine, Singleton Hospital, Swansea, UK
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Verma AK, Mishra AK, Kumar M, Kant S, Singh A, Singh A. Renal tuberculosis presenting as acute pyelonephritis – A rarity. ACTA ACUST UNITED AC 2016; 63:210-213. [DOI: 10.1016/j.ijtb.2015.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/19/2015] [Accepted: 07/13/2015] [Indexed: 11/25/2022]
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Subramani E, Jothiramajayam M, Dutta M, Chakravorty D, Joshi M, Srivastava S, Mukherjee A, Datta Ray C, Chakravarty BN, Chaudhury K. NMR-based metabonomics for understanding the influence of dormant female genital tuberculosis on metabolism of the human endometrium. Hum Reprod 2016; 31:854-65. [PMID: 26851602 DOI: 10.1093/humrep/dew003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/05/2016] [Indexed: 01/13/2023] Open
Abstract
STUDY QUESTION Does investigation of metabolic perturbations in endometrial tissue of women with dormant genital tuberculosis (GTB) during the window of implantation (WOI) assist in improving the understanding of endometrial receptivity? SUMMARY ANSWER In dormant GTB cases significant alterations in endometrial tissue metabolites occur, largely related to energy metabolism and amino acid biosynthesis in dormant GTB cases. WHAT IS KNOWN ALREADY As an intracellular pathogen, Mycobacterium tuberculosis strongly influences the metabolism of host cells causing metabolic dysregulation. It is also accepted that dormant GTB impairs the receptive status of the endometrium. Global metabolic profiling is useful for an understanding of disease progression and distinguishing between diseased and non-diseased groups. STUDY DESIGN, SIZE, DURATION Endometrial tissue samples were collected from patients reporting at the tertiary infertility care center during the period September 2011-March 2013. Women having tested positive for GTB were considered as the study group (n = 24). Normal healthy women undergoing sterilization (n = 26) and unexplained infertile women with repeated IVF failure (n = 21) volunteered to participate as controls. PARTICIPANTS/MATERIALS, SETTING, METHODS Endometrial tissue samples were collected 6-10 days after confirmation of ovulation. PCR and BACTEC-460 culture were used for diagnosing GTB. Proton nuclear magnetic resonance (1H NMR) spectra of tissue were recorded using a 700 MHz Bruker Avance AV III spectrometer. Following phase and baseline correction of all NMR spectra by Bruker Topspin 2.1 software, spectral peak alignment of the data was performed. Multivariate analysis was applied to all spectra and individual metabolites identified and multiple correlation analysis was performed. MAIN RESULTS AND THE ROLE OF CHANCE Leucine, isoleucine, acetate, lactate, glutamate, glutamine, methionine, lysine, creatine, glycogen, glycine, proline and choline were found to be significantly increased (P < 0.05) in endometrial tissue of women with dormant GTB compared with unexplained infertile women with repeated implantation failure. Valine, citrate, succinate and aspartate were also observed to be significantly up-regulated (P < 0.01). Furthermore, a significant decrease in glucose (P < 0.05), threonine (P < 0.05), tyrosine (P < 0.01) and phenylalanine (P < 0.0001) was observed in women with dormant GTB. Pearson's correlation analysis between the expression of various endometrial receptivity markers and metabolites showed a significant negative correlation (-0.236 to -0.545, P < 0.05). Also, the metabolites were positively correlated with endometrial receptivity markers (0.207 to 0.618, P < 0.05). LIMITATIONS, REASONS FOR CAUTION It is often difficult to diagnose dormant GTB because it tends to exist without any clinical signs or symptoms. In addition, the diagnosis of GTB by culture remains a challenge due to low detection rates and its paucibacillary nature. Testing for prostate-specific antigen or the Y chromosome in order to account for the possible influences of recent exposure to semen on endometrial metabolism would be important. WIDER IMPLICATIONS OF THE FINDINGS The metabolic changes associated with the dormant tubercle infection are of potential relevance to clinicians for the treatment of dormant GTB-related infertility. STUDY FUNDING/COMPETING INTERESTS Government of India, Indian Council of Medical Research. There are no conflicts of interest.
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Affiliation(s)
- E Subramani
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - M Jothiramajayam
- Cell Biology and Genetic Toxicology Laboratory, Centre of Advanced study, Department of Botany, University of Calcutta, Kolkata 700019, India
| | - M Dutta
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - D Chakravorty
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - M Joshi
- National Facility for High-field NMR, Tata Institute of Fundamental Research, Mumbai 400005, India
| | - S Srivastava
- National Facility for High-field NMR, Tata Institute of Fundamental Research, Mumbai 400005, India
| | - A Mukherjee
- Cell Biology and Genetic Toxicology Laboratory, Centre of Advanced study, Department of Botany, University of Calcutta, Kolkata 700019, India
| | - C Datta Ray
- Department of Obstetrics and Gynaecology, Institute of Post-Graduate Medical Education and Research (IPGME&R) and SSKM Hospital, Kolkata 700020, India
| | | | - K Chaudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
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Subramani E, Madogwe E, Ray CD, Dutta SK, Chakravarty B, Bordignon V, Duggavathi R, Chaudhury K. Dysregulated leukemia inhibitory factor and its receptor regulated signal transducers and activators of transcription 3 pathway: a possible cause for repeated implantation failure in women with dormant genital tuberculosis? Fertil Steril 2016; 105:1076-1084.e5. [PMID: 26776907 DOI: 10.1016/j.fertnstert.2015.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/24/2015] [Accepted: 12/09/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To investigate the influence of dormant Mycobacterium tuberculosis on the expression of various endometrial receptivity markers and leukemia inhibitory factor (LIF)-signal transducers and activators of transcription 3 (STAT3) signaling pathway. Expression of endometrial receptivity markers and LIF-STAT3 signaling in in vitro decidualized human endometrial stromal cells (hESC) treated with 65 kDa mycobacterial heat shock protein (HSP65) is also explored. DESIGN A prospective study. SETTING Tertiary care hospital and reproductive health research unit. PATIENT(S) Endometrial tissue samples were collected from 38 women who tested positive for Mycobacterium tuberculosis and 30 normal women with proven fertility undergoing sterilization. In vitro decidualization of hESC was performed. INTERVENTION(S) Endometrial biopsies collected from all women during implantation window and treatment of hESC with HSP65. MAIN OUTCOME MEASURE(S) Measurement of various endometrial receptivity markers including αvβ3 integrin, E-cadherin, MECA-79, mucin-1, and pinopodes and LIF/LIFR-STAT3 signaling molecules expressed in the endometrium of women with dormant genital tuberculosis (GTB) during implantation window and measured also in HSP65-treated hESC. RESULT(S) Significantly reduced levels of endometrial receptivity markers LIF, LIFR, and pSTAT3 were observed in endometrium of women with dormant GTB as compared with controls. A similar trend was observed under in vitro conditions with decreased level of phosphorylated STAT3 in HSP65-treated hESC. However, no change in the expression of endometrial receptivity markers under in vitro conditions was observed. CONCLUSION(S) Our findings suggest that endometrium of women with dormant GTB is associated with poor receptivity, as evidenced by reduced receptivity markers and aberrant LIF-STAT3 signaling. In vitro treatment of hESC with HSP65 also confirms compromised endometrial decidualization.
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Affiliation(s)
- Elavarasan Subramani
- School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, India; Department of Animal Science, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Ejimedo Madogwe
- Department of Animal Science, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Chaitali Datta Ray
- Department of Gynaecology and Obstetrics, Institute of Post-Graduate Medical Education and Research and SSKM Hospital, Kolkata, India
| | - Subir Kumar Dutta
- Department of Pathology, Scientific Clinical Research Laboratory, Kolkata, India
| | | | - Vilceu Bordignon
- Department of Animal Science, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Raj Duggavathi
- Department of Animal Science, McGill University, Ste-Anne-de-Bellevue, Quebec, Canada
| | - Koel Chaudhury
- School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, India.
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Mahajan N, Naidu P, Kaur SD. Insight into the diagnosis and management of subclinical genital tuberculosis in women with infertility. J Hum Reprod Sci 2016; 9:135-144. [PMID: 27803580 PMCID: PMC5070394 DOI: 10.4103/0974-1208.192043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Genital tuberculosis (GTB) is an important cause of infertility in India. Lack of an accurate diagnostic test has led to an indiscriminate use of antitubercular treatment in infertile women. Apart from concerns of drug toxicity, this may be a contributing factor in the increasing incidence of multidrug-resistant TB reported in India. We conducted a study to analyze whether a combination of tests could help improve diagnostic accuracy. An algorithm for the management of GTB in infertile women based on the use of multiple tests is presented.
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Affiliation(s)
- Nalini Mahajan
- Department of Reproductive Medicine, Mother and Child Hospital, New Delhi, India; Milann Fertility Centre, New Delhi, India
| | | | - Simran Deep Kaur
- Department of Reproductive Medicine, Mother and Child Hospital, New Delhi, India
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43
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Gupta R, Singh P, Kumar R. Should men with idiopathic obstructive azoospermia be screened for genitourinary tuberculosis? J Hum Reprod Sci 2015; 8:43-7. [PMID: 25838748 PMCID: PMC4381382 DOI: 10.4103/0974-1208.153126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/15/2015] [Accepted: 02/04/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Infertility may be the sole manifestation of genitourinary tuberculosis (TB) and men with idiopathic obstructive azoospermia are often screened for TB using semen polymerase chain reaction (PCR) test. We assessed the benefits of such screening. DESIGN Totally, 100 infertile men with idiopathic obstructive azoospermia were screened with a kit-based PCR for semen TB. Confirmatory tests for TB were performed in PCR positive men before administering anti-tubercular therapy (ATT) for 6 months. Semen analysis was repeated to assess benefits of treatment. RESULTS Seven subjects (7%) had positive semen PCR for TB. Four of them had other clinical evidence of TB (history and physical signs) and were administered ATT. None had any improvement in semen parameters. No subject had any other laboratory evidence of TB and no other subject (96%) was administered ATT. CONCLUSIONS Screening for TB using semen PCR did not identify any men who would have been missed on clinical evaluation and is thus not indicated in men with idiopathic obstructive azoospermia.
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Affiliation(s)
- Rajan Gupta
- 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
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Fillion A, Koutlidis N, Froissart A, Fantin B. [Investigation and management of genito-urinary tuberculosis]. Rev Med Interne 2014; 35:808-14. [PMID: 25240482 DOI: 10.1016/j.revmed.2014.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 05/28/2014] [Accepted: 07/28/2014] [Indexed: 11/27/2022]
Abstract
Genito-urinary tuberculosis is the fourth most common manifestation of the disease, but it is often underestimated by clinicians because of few and non-specific symptoms and insidious disease course. The most common urinary findings are multiple ureteral stenosis. The most common genital involvement is an epididymal nodule for men and a chronic salpingitis for women. The definite diagnosis of genito-urinary tuberculosis is obtained on the basis of culture studies. Due to the paucibacillary nature of the disease, especially of genital location in woman, a probable or presumptive diagnosis is frequently considered with several parameters including radiological imaging (abdominal CT-scan, pelvic ultrasound, pelvic MRI). Endoscopic and surgical procedures are frequently required to obtain specimens for histopathologic and bacteriological studies. Medical treatment is the method of choice, with a combination of four drugs, namely isoniazid, rifampicin, ethambutol and pyrazinamide, followed by a two-drug regimen, for a total of six month duration. Surgery might be indicated in complicated genito-urinary tuberculosis (decreased renal function, infertility, urologic complaints).
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Affiliation(s)
- A Fillion
- Département d'infectiologie, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
| | - N Koutlidis
- Service d'urologie, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - A Froissart
- Service de médecine interne, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil cedex, France
| | - B Fantin
- Service de médecine interne, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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46
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Dogra PN, Regmi SK, Singh P, Bora G, Saini AK, Aggarwal S. Robot-assisted laparoscopic augmentation ileocystoplasty in a tubercular bladder. Urol Ann 2014; 6:152-5. [PMID: 24833829 PMCID: PMC4021657 DOI: 10.4103/0974-7796.130647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 07/31/2013] [Indexed: 11/04/2022] Open
Abstract
Some of the patients with genitourinary tuberculosis (GUTB) present to the urologist with small contracted bladders or with significant renal damage.[1] Additional reconstructive procedures are often required along with anti-tubercular treatment in these patients. These procedures commonly performed via the open approach, now have the advantage of minimally invasive approach provided by laparoscopic and robotic surgery. The technique of robot-assisted laparoscopic augmentation ileocystoplasty in a patient with a small contracted bladder due to GUTB will be described. The procedure was performed via a completely intra-corporeal technique using an ileal "cap" created from a 15 cm segment of distal ileum which was anastomosed to the urinary bladder bi-valved in the mid-sagittal plane. The procedure lasted for 420 minutes and the patient was discharged on postoperative day 5. At 6 month follow-up, the patient has no irritative urinary symptoms and voiding with insignificant post-void residual urine.
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Affiliation(s)
| | | | | | | | - A K Saini
- Department of Urology, AIIMS, New Delhi, India
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Tuberculous orchitis mimicking a testicular tumor: A diagnostic dilemma. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2014. [DOI: 10.1016/s2305-0500(14)60007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dharmapalan A, Vijaykumar R, Bhoopal S. Renal tuberculosis presenting as thigh abscess. Indian J Surg 2014; 75:446-8. [PMID: 24426644 DOI: 10.1007/s12262-012-0747-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 09/11/2012] [Indexed: 11/26/2022] Open
Abstract
Tuberculosis is one of the major health problems in India. Genitourinary tuberculosis, 20 % of all extrapulmonary tuberculosis, is the most common extrapulmonary system to be affected by this disease. Kidney is the most common genitourinary organ to be affected. A 50-year-old female presented with renal tuberculosis presenting as right upper thigh abscess, an uncommon presentation managed effectively by anti-tubercular therapy (ATT) and nephroureterectomy.
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Affiliation(s)
| | - R Vijaykumar
- MVJ Medical College and Research Hospital, Hoskote, Bangalore, Karnataka 562114 India
| | - Sumanth Bhoopal
- MVJ Medical College and Research Hospital, Hoskote, Bangalore, Karnataka 562114 India
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Abstract
Diabetes is known to increase the risk of infection and the commonest amongst them are the ones involving the genitourinary tract. The infections in a diabetic patient are unique in that they are recurrent, more severe, requiring hospitalization, and also have higher mortality than nondiabetics. Some infections are exclusively found in diabetics like the emphysematous pyelonephritis while others have their natural history complicated due to hyperglycemia. Asymptomatic bacteriuria may lead to albuminuria and urinary tract infection and may need to be treated in diabetics. Not just this certain organisms have a predilection for the genitourinary tract of the diabetic patient. All of the above makes the diabetic patient vulnerable to infections and therefore early diagnosis and appropriate treatment is mandatory.
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Affiliation(s)
- Sandeep Julka
- Director Endocrinology, Synergy Multispeciality Hospital, Indore, Madhya Pradesh, India
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50
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Sankar MM, Kumar P, Munawwar A, Kumar M, Singh J, Singh A, Parashar D, Malhotra N, Duttagupta S, Singh S. Usefulness of multiplex PCR in the diagnosis of genital tuberculosis in females with infertility. Eur J Clin Microbiol Infect Dis 2013; 32:399-405. [PMID: 23052988 DOI: 10.1007/s10096-012-1755-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/19/2012] [Indexed: 02/07/2023]
Abstract
The purpose of this investigation was to evaluate the usefulness of multiplex polymerase chain reaction (m-PCR) in detecting uterine tuberculosis in women with infertility. In a prospective study, endometrial curetting from 620 females with infertility were investigated using laparoscopy, hysteroscopy, histopathology, smear microscopy, mycobacterial culture in BACTEC MGIT™ 960, and in-house m-PCR. The mean age of the women was 29.75 ± 4.66 years. The majority (596) sought medical attention for infertility; of them, 455 (76.34 %) presented with primary and 141 (23.65 %) with secondary infertility. A total of 158 (25.48 %) women were diagnosed as having uterine tuberculosis by at least one of the diagnostic methods. Among them, laparoscopy was positive in 46 (29.11 %), hysteroscopy in 77 (48.73 %), histopathology in only 8 (5.06 %), smear for acid fast bacilli in 4 (2.53 %), and liquid culture in 24 (15.18 %) patients. The in-house m-PCR was positive in 135 (85.44 %) women. Of these, 129 (95.55 %) samples were positive for Mycobacterium tuberculosis, while 6 (4.44 %) were positive for non-tuberculous mycobacterial DNA. Of the 129 M. tuberculosis PCR-positive women, 112 received anti-tubercular treatment and 23 of these conceived and fell pregnant after the completion of treatment. For the diagnosis of uterine tuberculosis, m-PCR was found to be the most efficient diagnostic tool compared to the other methods.
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Affiliation(s)
- M M Sankar
- Clinical Microbiology Division, Department of Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110 029, India
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