HYSTEROSCOPY FOR DIAGNOSIS OF FEMALE GENITAL TUBERCULOSIS IN INFERTILE WOMEN: AN ESSENTIAL TOOL IN MINIMALLY INVASIVE ERA.

The Common ◽

Basic Evaluation ◽

INTRODUCTION: Female genital tuberculosis (FGTB) is difcult to diagnose due to asymptomatic presentation and paucity of denitive investigations. Hysteroscopy can be utilized for the diagnosis of genital tuberculosis in infertile women. This study was done to study the role of hysteroscopy in the diagnosis of genital tuberculosis. METHODS: Prospective observational study was performed on 50 infertile women after basic evaluation of infertility. The women with tubal factors for infertility or unexplained infertility were selected for the study. Premenstrual endometrial biopsy (EB) was done for mycobacteria (AFB) detection. Hysteroscopy was performed in the next cycle if no AFB was detected on EB. ATT was given if genital TB was diagnosed on EB, and hysteroscopy was performed after completion of ATT. Hysteroscopic observations were compared with endometrial biopsy results. RESULTS: A total of 4 (8%) cases were diagnosed as bacteriologically positive for genital tuberculosis in endometrial samples. They were given anti-tubercular treatment. On hysteroscopy, pale endometrium (16%), Intrauterine adhesions (46%), and osteal obliteration (18%) were the common abnormal observations. 12 patients had mild adhesions, 6 had moderate and 5 patients had severe adhesions. Overall, 26 (52%) patients had features of intrauterine brosis, like intra-uterine adhesions or ostial obliteration, which could be suggestive of chronic infection like tuberculosis. Hysteroscopic adhesiolysis was performed in 46% and the cavity was restored. CONCLUSION: Endometrial Biopsy and Hysteroscopy are complementary procedures that together can help in the diagnosis of FGTB. Hysteroscopy is not only the gold standard for diagnosing uterine adhesions, distortion of the uterine cavity and tubal ostia, but it can also be a prognostic and therapeutic tool.

Role of GeneXpert in endometrial biopsy for diagnosis of genital tuberculosis in women presenting with infertility

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211496 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1832

Author(s):

Aafreen Naaz ◽

Vikram Sarbhai ◽

Vinita Sarbhai

Keyword(s):

Cross Sectional Study ◽

Endometrial Biopsy ◽

Genital Tuberculosis ◽

Cross Sectional ◽

Infertile Women ◽

Diagnostic Modalities ◽

Low Sensitivity ◽

Additional Value ◽

Background: The diagnosis of female genital TB is challenging due to low sensitivity of conventional diagnostic modalities. The new GeneXpert Test on endometrial biopsy is studied for its role in diagnosis of female genital TB.Methods: This is an observational cross-sectional study on 50 infertile women. Premenstrual endometrial biopsy was performed and sent for AFB Smear, M. TB (LJ) medium culture, CB-NAAT by GeneXpert, and histopathology. The results were compared for diagnosis of FGTB.Results: Endometrial Biopsy (EB) could confirm diagnosis of genital TB in 4 cases (8%) out of 50 infertile women. Amongst these 4 cases, GeneXpert was positive in two, AFB were detected on smear in three while one showed both AFB on smear and positive GeneXpert. GeneXpert adds additional value but surely cannot replace any of the other gold standard investigations.Conclusions: GeneXpert is a rapid diagnostic method which is accurate, feasible and affordable. It is useful adjunct to the existing armamentarium in diagnosis of female genital tuberculosis.

Role of AFB culture, histopathology and laparoscopy in female genital tuberculosis as a cause for chronic pelvic pain

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172940 ◽

2017 ◽

Vol 6 (7) ◽

pp. 3091

Author(s):

Hemlata Sharma ◽

Saurabh Sharma ◽

Neelam Bharadwaj ◽

Indira Lamba

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Endometrial Biopsy ◽

Menstrual Blood ◽

Genital Tuberculosis ◽

Noninvasive Test ◽

Pelvic Congestion ◽

Background: As Female genital tuberculosis is an important cause of significant morbidity presenting mainly as infertility and chronic pelvic pain so the study was proposed to estimate the prevalence of genital tuberculosis in women with idiopathic chronic pelvic pain by AFB culture, histopathology and laparoscopy.Methods: In this prospective study, we enrolled 65 women with idiopathic chronic pelvic pain. Diagnostic laparoscopy was done and Endometrial biopsy or menstrual blood was taken and sent for AFB culture and histopathological examination.Results: In this study, the prevalence of genital TB in women with CPP was 35.38% (24/65) of which23 had gross findings of genital TB and one had pelvic congestion with positive result in AFB culture. Laparoscopic findings were normal in 13 out of 65 women (20%) whereas these were abnormal in 52 women. Histological evidence of genital TB was reported in 12.5% (3/24) women. AFB culture reported positive in 16.66% (4/24) women.Conclusions: Genital tuberculosis is an important cause for idiopathic chronic pelvic pain mainly in developing countries. AFB culture of menstrual blood is a simple, noninvasive test that is useful many times especially in unmarried girls or those who are not willing for invasive tests. Laparoscopy is an excellent tool in diagnosis of genital TB as it allows direct visualization.

Emerging progress on diagnosis and treatment of female genital tuberculosis

Journal of International Medical Research ◽

10.1177/03000605211014999 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110149

Author(s):

Ying Wang ◽

Ruifeng Shao ◽

Chihua He ◽

Ligang Chen

Keyword(s):

Blood Circulation ◽

Histopathological Examination ◽

Epidemiological Data ◽

Endometrial Biopsy ◽

Effective Management ◽

Menstrual Disorders ◽

Genital Tuberculosis ◽

Infertile Women ◽

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.

Effect of Antitubercular Therapy on Endometrial Function in Infertile Women with Female Genital Tuberculosis

Infectious Disorders - Drug Targets ◽

10.2174/1871526516666151223103534 ◽

2016 ◽

Vol 16 (2) ◽

pp. 101-108 ◽

Cited By ~ 3

Author(s):

Jai Bhagwan Sharma ◽

Jayaramaiah Sneha ◽

Urvashi B. Singh ◽

Sunesh Kumar ◽

Kallol Kumar Roy ◽

...

Keyword(s):

Antitubercular Therapy ◽

Genital Tuberculosis ◽

Infertile Women ◽

Correlation of past tuberculosis with current screening for female genital tuberculosis in infertile women in a tertiary care hospital

Indian Journal of Tuberculosis ◽

10.1016/j.ijtb.2021.08.036 ◽

2021 ◽

Author(s):

Maruti Sinha ◽

Rekha Rani ◽

Poonam Bagga

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Genital Tuberculosis ◽

Infertile Women ◽

Current Screening ◽

Etiopathogenesis, Challenges and Remedies Associated With Female Genital Tuberculosis: Potential Role of Nuclear Receptors

Frontiers in Immunology ◽

10.3389/fimmu.2020.02161 ◽

2020 ◽

Vol 11 ◽

Author(s):

Shalini Gupta ◽

Pawan Gupta

Keyword(s):

Nuclear Receptors ◽

Potential Role ◽

Genital Tuberculosis ◽

Comparison of diagnostic accuracy of bactec culture, gene-xpert and histopathology in the diagnosis of genital tuberculosis in women with infertility

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201233 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1614

Author(s):

Rachna Chaudhary ◽

Vandana Dhama ◽

Manisha Singh ◽

Shakun Singh

Keyword(s):

Endometrial Biopsy ◽

Reproductive Age ◽

Specific Method ◽

Suspected Case ◽

Genital Tuberculosis ◽

Diagnostic Dilemma ◽

Medical College ◽

Actual Incidence ◽

Background: Female genital tuberculosis (FGTB) is often a silent disease sparing no age group but majority of patients are in the reproductive age. In infertility patient’s incidence of FGTB varies from 3-16% in India but the actual incidence of genital tuberculosis may be under reported due to asymptomatic presentation and paucity of investigations.Methods: Prospective case control study was conducted from June 2018 to May 2019 in LLRM Medical College Meerut. A total 100 Endometrial samples were collected during diagnostic laparoscopy from all suspected case of genital TB, presented with either primary or secondary infertility and samples sent for histopathology, Gene-xpert and Bactec culture.Results: Out of 100 samples Bactec culture was positive in 2 samples, Gene-xpert positive in 3 samples. On histopathology out of 100 cases, non-specific endometritis was found in 1 case, tubercular-endometritis in 1 case, proliferative enometrium (anovulatory) in 40 cases and secretory endometrium found in 58 cases.Conclusions: Female genital TB poses a diagnostic dilemma because of its varied presentation and lack of sensitive and specific method of diagnosis. Culture though remains the gold standard of diagnosis of female genital TB, gene-xpert, histopathology, Bactec culture or laparoscopy can be used for starting treatment. Endometrial biopsy on histopathology shows not only Tubercular endometritis but also gives hormone response on endometrium, local factors of endometrium concerning non-specific and specific infections and anovulatory cycles.