Genital tuberculosis as the cause of tuboovarian abscess in an immunosuppressed patient.

BACKGROUND: Although tuberculosis (TB) is a major health problem worldwide, primary extrapulmonary tuberculosis (EPTB), and in particular female genital tract infection, remains a rare event. CASE REPORT: A 35-year-old human immunodeficiency virus (HIV) seropositive woman of African descent with lower abdominal pain and fever of two days duration underwent surgery due to left adnexal mass suggesting pelvic inflammatory disease. The surgical situs showed a four quadrant peritonitis, consistent with the clinical symptoms of the patient, provoked by a tuboovarian abscess (TOA) on the left side. All routine diagnostic procedures failed to determine the causative organism/pathogen of the infection. Histopathological evaluation identified a necrotic granulomatous salpingitis and specific PCR analysis corroborated Mycobacterium tuberculosis (M. Tb). Consequently, antituberculotic therapy was provided. CONCLUSION: In the differential diagnosis of pelvic inflammatory disease, internal genital tuberculosis should be considered. Moreover, physicians should consider tuberculous infections early in the work-up of patients when immunosuppressive conditions are present.

Pelvic-peritoneal tuberculosis with elevated serum and peritoneal fluid Ca-125 levels. A report of two cases.

We report 2 patients with pelvic-peritoneal tuberculosis and elevated serum and peritoneal fluid levels of Ca-125. The first was a young and infertile women who had cul-de-sac nodularity and dysmenorrhea. The other was postmenopausal and presented with weight loss and ascites. While a preoperative diagnosis of endometriosis was made in the former, intraperitoneal malignancy was considered in the latter. The diagnosis of pelvic-peritoneal tuberculosis was reached by laparoscopic-directed biopsy in both patients. Serum levels of Ca-125 returned to normal limits following antituberculous drug treatment.

[A new method of B-cell rosette-forming reaction]. / Novyi sposob postanovki reaktsii B-rozetkoobrazovaniia.

To increase the effectiveness of diagnosing tuberculosis, a new procedure of defining B-rosette forming lymphocytes is proposed. A commercially available product, i.e. dry erythrocytic tuberculous phosphatidic diagnosticum produced by the Leningrad Vaccine and Serum Research Institute and meant for serologic examinations and antiphosphatidic antibody detection, was used in the above reaction for the first time. The following groups were selected for the examination: 51 patients with female genital, locomotor and ocular tuberculosis; 33 persons with nonspecific diseases of the same sites; and 19 donors. A significant drop in the absolute percentage of B-rosette forming lymphocytes (EAC-RFC-ph) in patients with active tuberculosis of all sites was found out. High diagnostic informativeness of the procedure is demonstrated. There was an inverse correlation between the level of antiphosphatidic antibodies and the content of B-rosette forming lymphocytes in tuberculosis patients and the examined controls.

[Immunity indices in tuberculosis of the female genital organs]. / Pokazateli immuniteta pri tuberkuleze zhenskikh polovykh organov.

A study is presented of the cellular and humoral immunity in patients with tuberculosis of the female genital organs. The examination was carried before and after tuberculin provocation (25 and 50 TU). It was established that complex examination of the cellular and humoral immunity in the diagnosis of genital tuberculosis provides essential information on the presence of a specific process, particularly, when it is performed against the background of subcutaneous administration of tuberculin.

[Effect of terrilytin on tissue bacteriostatic activity in the chemotherapy of renal and female genital tuberculosis in an experiment]. / Vliianie terrilitina na bakteriostaticheskuiu aktivnost' tkanei pri khimioterapii tuberkuleza pochek i zhenskikh polovykh organov v éksperimente.

The effect of terrilytin on the bacteriostatic activity of the tissues (BAT) under conditions of antibacterial therapy was studied on experimental models of tuberculosis of the kidneys and female genitalia in 46 rabbits. It was shown statistically that terrilytin promoted an increase in the BAT and might be used as an agent increasing the effect of antibacterial therapy of tuberculosis. The level of the increase of the BAT depended on its initial level which was inversely proportional to the level of the lesions. At the same time the effect of terrilytin was directly proportional to the level of these lesions unfavourable for the drug penetration into the tissues and tuberculous foci. The results of the study are promising in increasing the efficacy of antibacterial therapy of extrapulmonary tuberculosis of the above localizations by the use of terrilytin.

Antibodies of ovarian antigens in different diseases of the ovary.

Using the test of antiglobulin serum consumption against the human ovarian antigen, investigations were conducted on the presence of antiovarian antibodies in the blood serum of 432 women with different diseases of the ovary and 50 healthy women as control group. Autoantibodies were found in 12 of 172 patients with inflammatory lesions of the ovary (7.0%), in 18 of 118 patients with ovarian failure (15.3%), and in 21 of 65 patients with malignancies of the ovary (32.3%). No autoantibodies were detected in any of the healthy women from the control group, in any of the 10 patients with tuberculosis of the adnexa, or in any of the 67 women operated upon for benign neoplasms of the ovary. The authors formulate the suppression that there may be a correlation between the occurrence of autoantibodies, lesions of the ovarian tissue, and the malignancy of the neoplastic process.