Endometritis granulomatosa por tuberculosis en mujer postmenopaúsica / Granulomatous tuberculosis endometritis in a posmenopausal woman

INTRODUCCIÓN: La tuberculosis (TBC) genital es una infección relativamente poco frecuente en la mujer. Afecta principalmente a mujeres menores de 40 años, y el motivo de consulta más usual es la esterilidad, de ahí la importancia de su diagnóstico precoz. CASO CLÍNICO clínico: Se presenta el caso de una paciente con dolor pélvico crónico que acude a nuestras consultas para valoración. Durante el estudio se toma biopsia dirigida de la cavidad endometrial diagnosticándose la presencia de granulomas no necrotizantes. Posteriormente se realiza un cultivo microbiológico que resulta positivo para micobacterias y se determina el DNA, mediante reacción en cadena de la polimerasa, de mycobacterium tuberculosis, como causante del cuadro. DISCUSIÓN: El diagnóstico definitivo de TBC requiere el aislamiento en cultivo del bacilo de Koch, aunque en los casos de TBC genital, al ser una entidad paucibacilar, puede no resultar positivo. En éste caso, sería suficiente el diagnóstico de presunción basado en la sospecha clínica y el hallazgo histológico de granulomas. CONCLUSIÓN: La tuberculosis genital es una entidad poco frecuente en nuestro medio, aunque es una causa importante de infertilidad femenina y su predominio generalmente se subestima debido a la naturaleza paucisintomática de la misma. El diagnóstico temprano y el tratamiento multidisciplinar son fundamentales.

INTRODUCTION: Genital tuberculosis (TB) is a relatively rare afection in women. It mainly affects women younger than 40 years, and the most frequent reason for consultation is sterility, therefore early diagnosis is important. CLINICAL CASE: We presented the case of a patient with chronic pelvic pain who comes to our consultations. During the study, we take an endometrial biopsy diagnosing the presence of non-necrotizing granulomas. Finally, we determined the mycobacterium tuberculosis DNA through the polymerase chain reaction and positive microbiological culture, as the cause of pathology. DISCUSSION: The definitive diagnosis of TB requires the isolation in culture of the Koch bacillus, although in genital TB cases, as it is a paucibacillary entity, it may not be positive. In this case, the presumptive diagnosis based on clinical suspicion and the histological granulomas would be enough. CONCLUSIONS: Genital tuberculosis is a rare entity in our environment, although it is an important cause of female infertility and its prevalence is generally underestimated due to its paucisymptomatic nature. Early diagnosis and multidisciplinary treatment are essential.

Hysterosalpingographic appearances of female genital tract tuberculosis: part II: uterus

Female genital tuberculosis remains as a major cause of tubal obstruction leading to infertility, especially in developing countries. The global prevalence of genital tuberculosis has increased during the past two decades due to increasing acquired immunodeficiency syndrome. Genital tuberculosis [TB] is commonly asymptomatic and it is diagnosed during infertility investigations. Despite of recent advances in imaging tools such as computed tomography [CT] scan, magnetic resonance imaging [MRI] and ultrasongraphy, hysterosalpingography has been considered as the standard screening test for evaluation of tubal infertility and as a valuable tool for diagnosis of female genital tuberculosis. Tuberculosis gives rise to various appearances on hysterosalpingography [HSG] from non-specific changes to specific findings. The present pictorial review illustrates and describes specific and non-specific radiographic features of female genital tuberculosis in two parts. Part I presents specific findings of tuberculosis related to tubes such as "beaded tube", "golf club tube", "pipestem tube", "cobble stone tube" and the "leopard skin tube". Part II will describe adverse effects of tuberculosis on structure of endometrium and radiological specific findings, such as "T-shaped" tuberculosis uterus, "pseudo-unicornuate "uterus, "collar-stud abscess" and "dwarfed" uterus with lymphatic intravasation and occluded tubes which have not been encountered in the majority of non-tuberculosis cases

Evaluating PCR, culture & histopathology in the diagnosis of female genital tuberculosis.

Background & objectives: Genital tuberculosis (GTB) is one of the major causes for severe tubal disease leading to infertility. Unlike pulmonary tuberculosis, the clinical diagnosis of GTB is difficult because in majority of cases the disease is either asymptomatic or has varied clinical presentation. Routine laboratory values are of little value in the diagnosis. An absolute diagnosis cannot be made from characteristic features in hysterosalpingogram (HSG) or laparoscopy. Due to the paucibacillary nature of GTB, diagnosis by mycobacterial culture and histopathological examination (HPE) have limitations and low detection rate. The objective of this study was to evaluate the efficacy of PCR technique, culture and histopathological examination in the diagnosis of GTB in female infertility. Methods: This study included 72 infertile women who met the inclusion and exclusion criteria. After a detailed history and clinical examination all patients were subjected to investigations including pelvic sonogram, HSG and laparoscopy. Endometrial samples from were allocated for AFB smear, culture and HPE examination. Only 49 samples were available for PCR using IS 6110 and TRC4 primers. In seven patients peritoneal fluid was also taken for culture and PCR. Based on the clinical profile and laparoscopic findings, a diagnostic criteria was derived to suspect GTB. Specific diagnostic tests were evaluated against this diagnostic criterion. Results: Laparoscopy was suggestive of tuberculosis in 59.7 per cent of cases, AFB smear was positive in 8.3 per cent, culture was positive in 5.6 per cent, HPE positive in 6.9 per cent and PCR was positive in 36.7 per cent of cases. Based on the diagnostic criteria, GTB was suspected in 28 of the 49 cases. On evaluating against the diagnostic criteria, the sensitivity of PCR, HPE and culture were 57.1, 10.7, 7.14 per cent respectively. The concordance of results between the clinical criteria and specific diagnostic tests were analysed by Kappa measure of agreement. The culture and HPE showed mild agreement with the clinical criteria, whereas PCR showed a moderate agreement. PCR was positive in Two of the 21 cases in whom GTB was not suspected. False positive PCR in these two cases were ruled out by multiple areas of sampling and re-sampling in one case. The PCR results were negative in 12 of the 28 cases. PCR using TRC4 primers had a higher sensitivity (46.4%) than IS 6110 primers (25%) in detecting clinically suspected GTB. Interpretation & conclusions: Our results showed that conventional methods of diagnosis namely, HPE, AFB smear and culture have low sensitivity. PCR was found to be useful in diagnosing early disease as well as confirming diagnosis in clinically suspected cases. False negative PCR was an important limitation in this study.

Adenomyosis with tuberculosis of uterus

AIMS: To establish various factors that affect TB treatment adherence over time. DESIGN/SETTING: Semi-structured questionnaire. All newly diagnosed cases of TB at Bethamia Hospital, Sialkot were interviewed at the beginning of treatment, one month of therapy and at the end of intensive phase. Perception of TB as a stigmatising disease was found related to early defaulting and to a lesser degree to late defaulting. Knowledge of TB in itself did not have a clear impact on defaulting, but the attitude towards interruption of treatment did. The strongest risk factor is irregularity of drug intake and appointment keeping. Strategies to improve treatment adherence should concentrate on methods to increase patient's motivation for treatment

Tuberculose genital e amenorréia primária: descriçäo de caso / Primary amenorrhea and tuberculosis: case report

A associaçao de amenorréia primária e tuberculose genital é rara. Nesse relato descreve-se o caso de uma mulher de 16 anos de idade com história de amenorréia primária com presença de caracteres sexuais secundários normais. Por suspeita clínica de anomalia mulleriana foi feito laparotomia exploradora que foi inconclusiva, e o diagnóstico foi direcionado pelo PPD fortemente reator, sendo definido após pela histeroscopia e análise histológica do material endometrial.

Cytodiagnosis for pelvic tuberculosis.

A 25 yr old married woman with complaints of lower abdominal pain for 2 months, was found to have a irregular nontender mass in pelvis, adherent to uterus. Her Papanicolaou smear was inflammatory. To confirm the diagnosis of either ovarian malignancy or pelvic tuberculosis made on the basis of observations during exploratory laparotomy, ovarian biopsy was taken. The imprint cytodiagnosis was tuberculosis. The patient was then managed surgically and the previous diagnosis was reconfirmed by histopathology. Imprint cytodiagnosis appears to be a valuable technique whenever facilities for frozen section are not available.

Amenorrea primaria por Síndrome de Netter / Primary amenorrhea Netter Syndrome

Se presentan dos casos de amenorrea primaria debida a sinequia espontánea (Síndrome de Netter) y se revisa la literatura nacional e internacional

Tuberculose genital feminina na pós-menopausa / Postmenopause female genital tuberculosis

Säo relatados dois casos de tuberculose genital na pós-menopausa. No primeiro, a paciente com 66 anos de idade apresentara corrimento vaginal purulento, depois sangüíneo. O exame histopatológico, após curetagem fracionada do útero (corpo e colo), revelou lesöes granulomatosas tuberculosas. O segundo em paciente de 53 anos de idade, foi diagnósticado após exame histopatológico de peça cirúrgica retirada por histerectomia total e anexectomia dupla, visando extirpar mioma uterino. É ressaltada a raridade dos casos e revista a literatura do assunto relativa à incidência, sintomas, diagnóstico e tratamento

Tuberculose de colo uterino: relato de caso / Cervix tuberculosis: report of a case

Os autores relatam um caso de tuberculose do colo uterino, sem foco primário em atividade, diagnósticado através de biópsia de colo uterino, pesquisa de BAAR positiva e PPD com leitura de 25 mm após 72 horas. O tratamento utilizado foi o esquema tríplice, com Isoniazida por 7, meses, Ethambutol por 2 meses e Rifampicina por 7 meses, nas doses de 0,4 g/dia, 1,2 g/dia e 0,6 g/dia, respectivamente. Seis meses após o início do tratamento, havia somente pequena área de cicatrizçäo na porçäo anterior do colo uterino