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Flores-Lovon K, Soriano-Moreno DR, Medina-Ramirez SA, Fernandez-Guzman D, Caira-Chuquineyra B, Fernandez-Morales J, Tuco KG, Turpo-Prieto J, Alave J, Goicochea-Lugo S. Effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis: a systematic review. BMJ Open 2023; 13:e070456. [PMID: 37758670 PMCID: PMC10537868 DOI: 10.1136/bmjopen-2022-070456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy of antituberculosis therapy on pregnancy outcomes in infertile women with genital tuberculosis. DESIGN Systematic review. DATA SOURCES We searched in PubMed/MEDLINE, CENTRAL and EMBASE up to 15 January 2023. Additionally, we manually search the reference lists of included studies. ELIGIBILITY CRITERIA We included randomised controlled trials (RCT), non-RCTs (non-RCT) and cohort studies that evaluated the effects of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis compared with not receiving antituberculosis treatment or receiving the treatment for a shorter period. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data. We used Cochrane Risk of Bias 1.0 and Risk Of Bias In Non-randomised Studies tools for risk of bias assessment and meta-analysis was not performed. We used Grading of Recommendations, Assessment, Development and Evaluations approach to assess the certainty of the evidence. RESULTS Two RCTs and one non-RCT were included. The antituberculosis regimens were based on isoniazid, rifampicin, pyrazinamide and ethambutol for 6-12 months. In women without structural damage, very low certainty of evidence from one RCT showed that the antituberculosis treatment may have little to no effect on pregnancy, full-term pregnancy, abortion or intrauterine death and ectopic pregnancy, but the evidence is very uncertain. In women with structural damage, very low certainty of evidence from one non-RCT showed that the antituberculosis treatment may reduce the pregnancy rate (297 fewer per 1000, 95% CI -416 to -101), but the evidence is very uncertain. In addition, very low certainty of evidence from one RCT compared a 9-month vs 6-month antituberculosis treatment regimen showed similar effects between the schemes, but the evidence is very uncertain. Two RCTs reported that no adverse events of antituberculosis treatment were noted or were similar in both groups. CONCLUSION The effect of antituberculosis treatment on pregnancy outcomes in infertile women with genital tuberculosis is very uncertain. PROSPERO REGISTRATION NUMBER CRD42022273145.
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Affiliation(s)
- Kevin Flores-Lovon
- Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Peru
| | | | | | | | | | | | | | - John Turpo-Prieto
- Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Peru
| | - Jorge Alave
- Medicina, Universidad Peruana Unión, Lima, Peru
| | - Sergio Goicochea-Lugo
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
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2
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Vijay A, Tiwari N, Sharma A, Pandey G. Correlation of Female Genital Tuberculosis and Infertility: A Comprehensive Systematic Review, Meta-analysis, and Female Genital Tuberculosis Infertility Pathway Analysis. J Midlife Health 2023; 14:165-169. [PMID: 38312757 PMCID: PMC10836443 DOI: 10.4103/jmh.jmh_151_23] [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: 08/09/2023] [Accepted: 09/22/2023] [Indexed: 02/06/2024] Open
Abstract
Female genital tuberculosis (FGTB) is a significant health concern that can lead to infertility in women. FGTB is a common form of tuberculosis that affects the female reproductive organs. In India, around 27.5 million individuals are facing infertility issues due to female factors, and FGTB might be one of the leading causes. A systematic review and proportion meta-analysis of six studies was conducted using MedCalc 20.116 to examine the association between FGTB and infertility. The studies were identified through an electronic search of PubMed, MEDLINE, Elsevier, and the Cochrane Library from 2010 to 2023. The results showed that FGTB is significantly associated with infertility, with a prevalence of approximately 34.86%. These findings underscore the need for effective interventions to improve reproductive health in women with FGTB. Based on pathway analysis, we conclude that more clinical trials should be conducted to explore the potential utilization of interferon gamma and nuclear receptors as therapeutic drug targets and biomarkers for the prevention of FGTB. The findings of this review will contribute to raising awareness, facilitating accurate diagnosis, and improving the management of FGTB-related infertility.
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Affiliation(s)
- Anushri Vijay
- Department of Computer Science and IT, IIS (Deemed to be University), Jaipur, Rajasthan, India
| | - Neha Tiwari
- Department of Computer Science and IT, IIS (Deemed to be University), Jaipur, Rajasthan, India
| | - Amita Sharma
- Department of Computer Science and IT, IIS (Deemed to be University), Jaipur, Rajasthan, India
| | - Geeta Pandey
- Department of Zoology, IIS (Deemed to be University), Jaipur, Rajasthan, India
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3
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Lidsky PV, Yuan J, Rulison JM, Andino-Pavlovsky R. Is Aging an Inevitable Characteristic of Organic Life or an Evolutionary Adaptation? BIOCHEMISTRY. BIOKHIMIIA 2022; 87:1413-1445. [PMID: 36717438 PMCID: PMC9839256 DOI: 10.1134/s0006297922120021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 09/27/2022] [Accepted: 11/04/2022] [Indexed: 01/15/2023]
Abstract
Aging is an evolutionary paradox. Several hypotheses have been proposed to explain it, but none fully explains all the biochemical and ecologic data accumulated over decades of research. We suggest that senescence is a primitive immune strategy which acts to protect an individual's kin from chronic infections. Older organisms are exposed to pathogens for a longer period of time and have a higher likelihood of acquiring infectious diseases. Accordingly, the parasitic load in aged individuals is higher than in younger ones. Given that the probability of pathogen transmission is higher within the kin, the inclusive fitness cost of infection might exceed the benefit of living longer. In this case, programmed lifespan termination might be an evolutionarily stable strategy. Here, we discuss the classical evolutionary hypotheses of aging and compare them with the pathogen control hypothesis, discuss the consistency of these hypotheses with existing empirical data, and present a revised conceptual framework to understand the evolution of aging.
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Affiliation(s)
- Peter V Lidsky
- Department of Microbiology and Immunology, University of California San Francisco, CA, USA.
| | - Jing Yuan
- Department of Microbiology and Immunology, University of California San Francisco, CA, USA
| | - Jacob M Rulison
- Department of Microbiology and Immunology, University of California San Francisco, CA, USA
- University of California Berkeley, CA, USA
| | - Raul Andino-Pavlovsky
- Department of Microbiology and Immunology, University of California San Francisco, CA, USA.
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Wang K, Ren D, Qiu Z, Li W. Clinical analysis of pregnancy complicated with miliary tuberculosis. Ann Med 2022; 54:71-79. [PMID: 34955089 PMCID: PMC8725907 DOI: 10.1080/07853890.2021.2018485] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/04/2021] [Accepted: 12/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pregnancy complicated with tuberculosis is increasingly common. The clinical characteristics of pregnancy complicated with miliary tuberculosis are summarized in this study. METHODS A retrospective analysis of pregnant patients with miliary tuberculosis was performed in terms of epidemiology, demography, clinical characteristics, laboratory tests, treatment, and prognosis. RESULTS Of the 23 patients that were included, 12 became pregnant after in vitro fertilization combined with embryo transfer (IVF-ET). The average gestational age at symptom onset was 13.96 weeks, and the average time from symptom onset to diagnosis was 33 days. Clinical symptoms included fever, dyspnoea, cough, headache, abdominal pain, and chest pain. Extrapulmonary tuberculosis occurred in 10 patients, respiratory failure in 11 patients, and ARDS in 9 patients. Chest HRCT showed diffusely distributed miliary nodules in all patients. Six patients were on mechanical ventilation, two underwent ECMO, and one died. Symptoms appeared in the first trimester of nine pregnancies after IVF-ET and in the second trimester of seven natural pregnancies. CONCLUSIONS Miliary tuberculosis can occur in pregnant patients, especially in patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Lacking specificity, the common clinical characteristics include elevated inflammation markers, anaemia, low lymphocyte count, and multiple miliary nodules shown on a chest HRCT scan. Half of patients with miliary tuberculosis may develop respiratory failure, and some may progress to ARDS. Therefore, infertile patients should be required to undergo TB screening before undergoing IVF-ET, and preventive anti-TB treatment should be given to patients with latent TB infections or untreated TB disease.Key MessageMiliary tuberculosis can occur in pregnant patients, especially in pregnant patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Many patients develop respiratory failure or ARDS.
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Affiliation(s)
- Kaige Wang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Donghua Ren
- Department of Pulmonary and Critical Care Medicine, Xining Second People's Hospital, Xining, China
| | - Zhixin Qiu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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5
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Could aging evolve as a pathogen control strategy? Trends Ecol Evol 2022; 37:1046-1057. [PMID: 36096982 DOI: 10.1016/j.tree.2022.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 01/12/2023]
Abstract
Aging is often attributed to the detrimental side effects of beneficial traits but not a programmed adaptive process. Alternatively, the pathogen control hypothesis posits that defense against infectious diseases may provide a strong selection force for restriction of lifespan. Aging might have evolved to remove older individuals who carry chronic diseases that may transmit to their younger kin. Thus, selection for shorter lifespans may benefit kin's fitness. The pathogen control hypothesis addresses arguments typically raised against adaptive aging concepts: it explains the benefit of shorter lifespan and the absence of mutant variants that do not age. We discuss the consistency and explanatory power of this hypothesis and compare it with classic hypotheses of aging.
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Frock-Welnak DN, Tam J. Identification and Treatment of Acute Pelvic Inflammatory Disease and Associated Sequelae. Obstet Gynecol Clin North Am 2022; 49:551-579. [PMID: 36122985 DOI: 10.1016/j.ogc.2022.02.019] [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: 10/14/2022]
Abstract
Pelvic inflammatory disease (PID) is an ascending polymicrobial infection of the upper female genital tract. The presentation of PID varies from asymptomatic cases to severe sepsis. The diagnosis of PID is often one of exclusion. Primary treatment for PID includes broad-spectrum antibiotics with coverage against gonorrhea, chlamydia, and common anaerobic and aerobic bacteria. If not clinically improved by antibiotics, percutaneous drain placement can promote efficient source control, as is often the case with large tubo-ovarian abscesses. Ultimately, even with treatment, PID can result in long-term morbidity, including chronic pelvic pain, infertility, and ectopic pregnancy.
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Affiliation(s)
- Danielle N Frock-Welnak
- Division of Academic Specialists in OB/GYN, University of Colorado School of Medicine, Aurora, CO, USA; Obstetrics and Gynecology, School of Medicine, CU Anschutz, Academic Office One, 12631 East 17th Avenue, 4th Floor, Aurora, CO 80045, USA.
| | - Jenny Tam
- Division of Academic Specialists in OB/GYN, Department of Obstetrics and Gynecology, University of Colorado, School of Medicine, CU Anschutz, Academic Office One, 12631 East 17th Avenue, 4th Floor, Aurora, CO 80045, USA
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Dahiya B, Kamra E, Alam D, Chauhan M, Mehta PK. Insight into diagnosis of female genital tuberculosis. Expert Rev Mol Diagn 2021; 22:625-642. [PMID: 34882522 DOI: 10.1080/14737159.2022.2016395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Female genital tuberculosis (TB) is a common manifestation of extrapulmonary TB (EPTB) with varied clinical presentations, i.e. infertility, pelvic pain and menstrual irregularities. Diagnosis of female genital TB is challenging predominantly due to paucibacillary nature of specimens and inconclusive results obtained by most of the routine laboratory tests. AREAS COVERED This review has briefly summarized the epidemiology, clinical features and transmission of female genital TB. Commonly used laboratory tests include bacteriological examination (smear/culture), tuberculin skin testing, interferon-γ release assays, imaging, laparoscopy/hysteroscopy and histopathological/cytological observations. Further, utility of nucleic acid amplification tests (NAATs), like loop-mediated isothermal amplification, PCR, multiplex-PCR, nested PCR, real-time PCR and GeneXpert® could significantly improve the detection of female genital TB. EXPERT OPINION Currently, there is no single test available for the efficient diagnosis of female genital TB, rather a combination of tests is being employed, which yields moderate diagnostic accuracy. The latest modalities developed for diagnosing pulmonary TB and other clinical EPTB forms, i.e. aptamer-linked immobilized sorbent assay, immuno-PCR (I-PCR), analysis of circulating cell-free DNA by NAATs, and identification of Mycobacterium tuberculosis biomarkers within extracellular vesicles of bodily fluids by I-PCR/nanoparticle-based I-PCR, may also be exploited to further improve the diagnosis of female genital TB.
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Affiliation(s)
- Bhawna Dahiya
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, Haryana, India
| | - Ekta Kamra
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, Haryana, India
| | - Danish Alam
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, Haryana, India
| | - Meenakshi Chauhan
- Dept. of Obstetrics and Gynecology, Pt. B.D. Sharma University of Health Sciences, Rohtak-124001, Haryana, India
| | - Promod K Mehta
- Centre for Biotechnology, Maharshi Dayanand University, Rohtak-124001, Haryana, India
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Ma H, Sun J, Zhang L, Liu Y, Liu H, Wu X, Guo L. Disseminated Hematogenous Tuberculosis Following in vitro Fertilization-Embryo Transfer: A Case Report. Infect Drug Resist 2021; 14:4903-4911. [PMID: 34853518 PMCID: PMC8627859 DOI: 10.2147/idr.s332992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
This study aimed to analyze the diagnosis and treatment process of patients with hematogenous disseminated pulmonary tuberculosis after treatment with in vitro fertilization-embryo transfer (IVF-ET). We retrospectively analyzed the clinical data, including imaging and etiological data, the use of antimicrobials, metagenomic next-generation sequencing (mNGS) results, and the treatment process, of a patient who underwent IVF-ET due to an obstruction in the fallopian tube; after the treatment, she developed a persistent fever with shortness of breath and suffered a spontaneous abortion. Due to the failure of other treatment modalities, fiber optic bronchoscopy was performed, and the alveolar lavage fluid was obtained for mNGS. Tests for Mycobacterium tuberculosis and rifampicin resistance (Xpert MTB/RIF) showed positive and negative results, respectively. Subsequently, anti-tuberculosis treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol was administered. After the patient's condition improved, she was transferred to a specialized tuberculosis hospital for further treatment, where she died one month later from multiple organ failure. From this case, we conclude that clinicians should remain highly vigilant for pulmonary infection with M. tuberculosis in pregnant women, particularly in patients treated with IVF-ET, and check for its presence as soon as possible.
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Affiliation(s)
- Hongye Ma
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
| | - Jingjing Sun
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
| | - Lei Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
| | - Yu Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
| | - Hongjuan Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
| | - Xiaoling Wu
- Department of Critical Care Medicine, The Fifth People's Hospital of ShaanXi, Xi'an, ShaanXi, People's Republic of China
| | - Litao Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, ShaanXi, People's Republic of China
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9
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Genital tuberculosis role in female infertility in Portugal. Arch Gynecol Obstet 2021; 304:809-814. [PMID: 33426568 DOI: 10.1007/s00404-020-05956-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Genitourinary tuberculosis is the fourth most common cause of extrapulmonary tuberculosis, although often underestimated by clinicians due to its rare and non-specific symptoms. One of the disease's complications is infertility. Although Portugal is one of the European countries with the highest prevalence of tuberculosis, its impact on Portuguese female fertility is unknown. With this study, we intend to evaluate the prevalence of genital tuberculosis, its presenting symptoms, and pregnancy outcomes in infertile women followed in a Portuguese tertiary hospital. METHODS Retrospective and descriptive study, performed using an electronic database and consultation of clinical files. Studied population: infertile women followed from 2000 until 2019 at the reproductive unit of a Portuguese tertiary hospital, who underwent endometrial biopsy/curettage in the context of their etiological investigation. The diagnosis of genital tuberculosis was based on histological criteria. RESULTS Over the 19 years, 2653 endometrial specimens were analyzed. Pathological evaluation was positive for tuberculosis in 19 cases (0.72%). There was a decrease in new diagnoses throughout the observation period. CONCLUSION Despite being one of the European countries with the highest prevalence of tuberculosis, genital TB does not appear to have a significant impact on the etiology of female infertility in Portugal. Nevertheless, it is a diagnosis to be considered in selected patients.
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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: 5] [Impact Index Per Article: 1.3] [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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Dai W, Ma L, Cao Y, Wu D, Yu T, Zhai J. In vitro fertilization outcome in women with endometrial tuberculosis and tubal tuberculosis. Gynecol Endocrinol 2020; 36:819-823. [PMID: 31847626 DOI: 10.1080/09513590.2019.1702639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Purpose: To evaluate in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) outcome in women with genital tuberculosis (GTB).Methods: One hundred and fifty-five women with genital tuberculosis constituted the study group (Group A), consisting of 25 patients with endometrial tuberculosis (Group A1) and 130 patients with tubal tuberculosis (Group A2). Women with non-tuberculous tubal infertility were matched by age and study period served as controls (Group B).Results: Patients with GTB had significantly reduced endometrial thickness, high-quality embryos rate, implantation rate as compared with controls (p < .05), no differences were found in other pregnancy parameters. In addition, the endometrial thickness, fertilization rate, high-quality embryos rate and implantation rate were also significantly lower in women with endometrial tuberculosis as compared with controls. And the cumulative pregnancy rate in endometrial tuberculosis was significantly decreased compared with tubal tuberculosis and controls (p < .05). However, IVF/ICSI pregnancy outcomes in patients with tubal tuberculosis showed no difference as compared with controls (p > .05). Also, rates of miscarriage, preterm birth, obstetrical complications, and neonatal problems did not differ among three groups.Conclusions: In conclusion, IVF/ICSI-ET remains the most optimal method for the treatment of female infertility associated with tubal tuberculosis. However, patients with endometrium tuberculosis showed significantly reduced fertilization, implantation and cumulative pregnancy rates.
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Affiliation(s)
- Wenrong Dai
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Linna Ma
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yurong Cao
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Di Wu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Yu
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Zhai
- Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Abstract
Female genital tuberculosis (FGTB) is caused by Mycobacterium tuberculosis (rarely Mycobacterium bovis and/or atypical mycobacteria) being usually secondary to TB of the lungs or other organs with infection reaching through haematogenous, lymphatic route or direct spread from abdominal TB. In FGTB, fallopian tubes are affected in 90 per cent women, whereas uterine endometrium is affected in 70 per cent and ovaries in about 25 per cent women. It causes menstrual dysfunction and infertility through the damage of genital organs. Some cases may be asymptomatic. Diagnosis is often made from proper history taking, meticulous clinical examination and judicious use of investigations, especially endometrial aspirate (or biopsy) and endoscopy. Treatment is through multi-drug antitubercular treatment for adequate time period (rifampicin, isoniazid, pyrazinamide, ethambutol daily for 60 days followed by rifampicin, isoniazid, ethambutol daily for 120 days). Treatment is given for 18-24 months using the second-line drugs for drug-resistant (DR) cases. With the advent of increased access to rapid diagnostics and newer drugs, the management protocol is moving towards achieving universal drug sensitivity testing and treatment with injection-free regimens containing newer drugs, especially for new and previously treated DR cases.
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Affiliation(s)
- Jai Bhagwan Sharma
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Eshani Sharma
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sangeeta Sharma
- Department of Paediatrics, National Institute of TB & Respiratory Diseases, New Delhi, India
| | - Sona Dharmendra
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Fowler ML, Mahalingaiah S. Case report of pelvic tuberculosis resulting in Asherman's syndrome and infertility. FERTILITY RESEARCH AND PRACTICE 2019; 5:8. [PMID: 31388435 PMCID: PMC6670196 DOI: 10.1186/s40738-019-0061-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
Abstract
Approximately one-third of the world’s population is infected with Mycobacterium tuberculosis, and it is a leading cause of infertility in endemic countries. The global incidence of tuberculosis (TB) is growing at approximately 0.4% per year, and much faster in sub-Saharan Africa. TB causing fertility is rare in developed countries. We present a case of genital tuberculosis causing Asherman’s syndrome and resultant infertility. The patient is a 34-year-old P0 who presented to care after a prolonged period of secondary amenorrhea and infertility. She underwent a hysterosalpingogram which demonstrated no free spill and a diagnostic hysteroscopy which had findings of mottled endometrium. Pathology returned positive for Mycobacterium tuberculosis. The patient was treated with 9 months of antituberculous therapy. While she has not yet succeeded in becoming pregnant, the patient has started to notice cyclic spotting, indicating possible return of menses. This case highlights the importance of TB treatment and considering TB in patients who present with unexplained infertility.
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Affiliation(s)
- Mary Louise Fowler
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 E Concord St 6th Floor, Boston, MA 02118 USA
| | - Shruthi Mahalingaiah
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 E Concord St 6th Floor, Boston, MA 02118 USA
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Abdissa S, Abebe T, Ameni G, Teklu S, Bekuretsion Y, Abebe M, Mihret A. Endometrial tuberculosis among patients undergoing endometrial biopsy at Tikur Anbesa specialized hospital, Addis Ababa, Ethiopia. BMC Infect Dis 2018; 18:304. [PMID: 29976147 PMCID: PMC6034314 DOI: 10.1186/s12879-018-3202-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 06/22/2018] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Female genital tuberculosis (FGTB) is known to cause severe tubal disease leading to infertility and its incidence closely parallels with the overall prevalence of tuberculosis (TB) in a community. Its magnitude is underreported because diagnosis is difficult and requires invasive techniques. In this study we determined the prevalence of endometrial tuberculosis and characterized isolates among women who underwent endometrial biopsy for evaluation of various conditions at a Tikur Anbessa Specialized Hospital (TAHS), Addis Ababa, Ethiopia. METHODS A cross sectional study was conducted on 152 consecutive gynecologic patients who underwent endometrial biopsy for different gynecologic diseases. Endometrial tissue taken for routine histopathology examination was shared after informed consent was obtained from the patient and subjected to polymerase chain reaction (PCR) and culture for Mycobacterium tuberculosis (Mtb). RESULTS The prevalence of endometrial TB in this study by IS1081PCR was 4.6% (7/152) while culture proven endometrial TB was 2.6% (4/152). However, histological examination identified only 2/152 (1.3%) endometrial tuberculosis. While all culture proven TB samples were also PCR positive for Mtb, only one histologic proven endometrial TB was culture and PCR positive. All of the four isolates by culture were M. tuberculosis. CONCLUSION This study has shown that the magnitude of endometrial TB is fairly high in gynecologic patients visiting outpatient departments for various complaints and PCR detects more cases than culture or Histopathology.
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Affiliation(s)
- Sileshi Abdissa
- Arsi University, Asella, Ethiopia
- Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gobena Ameni
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sisay Teklu
- Department of Gynecology and Obstetrics, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yonas Bekuretsion
- Department of Pathology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Markos Abebe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adane Mihret
- Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Yue J, Zhang B, Wang M, Yao J, Zhou Y, Ma D, Jin L. Effect of antitubercular treatment on the pregnancy outcomes and prognoses of patients with genital tuberculosis. Front Med 2018; 13:121-125. [PMID: 29947015 DOI: 10.1007/s11684-018-0615-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 10/23/2018] [Indexed: 11/26/2022]
Abstract
This retrospective study aims to demonstrate the effect of antitubercular treatment (ATT) on the pregnancy outcomes and prognoses of patients with genital tuberculosis (GTB) who had received laparoscopy and/or hysteroscopy. This study included 78 patients with infertility and who were diagnosed with GTB through laparoscopy and/or hysteroscopy over the period of November 2005 to October 2015. The recruited patients were divided into ATT and nonATT groups on the basis of ATT duration. The GTB recurrence rates, menstrual patterns, and pregnancy outcomes of the patients were determined at follow-up. Among the 78 patients, 46 received ATT and 32 did not receive ATT. The menstrual volumes of patients in the ATT group significantly decreased relative to those of patients in the nonATT group. GTB did not recur among all patients regardless of treatment. A total of 11 pregnancies (36.7%) in the ATT group and 19 pregnancies (63.3%) in the nonATT group were observed. Pregnancy rates significantly differed (P = 0.002) between the two groups. ATT may decrease the menstrual volume and pregnancy rates of patients who were diagnosed with GTB through laparoscopy and/or hysteroscopy. In addition, ATT did not improve the prognosis of patients with chronic GTB.
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Affiliation(s)
- Jing Yue
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bo Zhang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Mingyue Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Junning Yao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yifan Zhou
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ding Ma
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Sharma JB, Goyal M, Kumar S, Roy KK, Sharma E, Arora R. Concomitant female genital tuberculosis and endometriosis. Indian J Tuberc 2017; 64:173-177. [PMID: 28709484 DOI: 10.1016/j.ijtb.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/17/2017] [Indexed: 11/28/2022]
Abstract
AIMS To demonstrate an association between female genital tuberculosis (FGTB) and endometriosis. METHODS A total of 16 women who underwent laparoscopy (12 cases) or laparotomy (4 cases) and were found to have female genital tuberculosis and endometriosis were enrolled in this retrospective study. RESULTS The mean age and parity were 28.2 years and 0.2, respectively. Past history of tuberculosis was present in 75% of the women (pulmonary in 50%). Menstrual dysfunction (especially oligomenorrhoea and dysmenorrhoea), constitutional symptoms, infertility, abdominal pain and lump were the main complaints. Diagnosis of FGTB was made by positive acid-fast bacilli (AFB) on microscopy, culture of endometrial aspirate, positive polymerase chain reaction (PCR), histopathological finding of epitheliod granuloma or findings of TB on laparoscopy or laparotomy. Diagnosis of endometriosis was made by laparoscopy or laparotomy. Pelvic adhesions were seen in all women, whereas frozen pelvis was seen in 7 (43.7%) women. Surgery was performed, which was laparoscopic adhesiolysis in 12 (75%), drainage of endometrioma in 12 (75%), cystectomy in 8 (50%), and total abdominal hysterectomy with bilateral salpingo-oophorectomy in 4 (25%) cases. With more then one type of (surgery in many cases). DISCUSSION Female genital tuberculosis and endometriosis may have similar manifestations and can co-exist.
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Affiliation(s)
- Jai Bhagwan Sharma
- Professor, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
| | - Manu Goyal
- Senior Resident, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sunesh Kumar
- Professor, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Kallol Kumar Roy
- Professor, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Eshani Sharma
- Senior Research Fellow, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Raksha Arora
- Professor and Head, Department of Obstetrics and Gynecology, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
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Kriplani A, Bahadur A, Kulshrestha V, Agarwal N, Singh S, Singh UB. Role of anti-tubercular treatment for positive endometrial aspirate DNA-PCR reproductive outcome in infertile patients in Indian setting - A randomized trial. Indian J Tuberc 2017; 64:33-39. [PMID: 28166914 DOI: 10.1016/j.ijtb.2016.11.005] [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: 01/08/2016] [Revised: 09/15/2016] [Accepted: 11/01/2016] [Indexed: 11/25/2022]
Abstract
AIMS The aim of the study was to determine the effect of anti-tubercular therapy (ATT) versus no ATT on reproductive outcome in patients with positive endometrial aspirate DNA-PCR for tuberculosis. SETTINGS AND DESIGN Department of Obstetrics and Gynecology in collaboration with the Department of Microbiology at the All India Institute of Medical Sciences, New Delhi, India. METHODS AND MATERIALS This prospective randomized study was conducted on 100 women in the reproductive age group with primary or secondary infertility, attending the Gynecology OPD at AIIMS. Women with positive endometrial DNA-PCR, patent tubes on laparoscopy, and all other tests being negative for genital TB were randomized into two groups. In Group 1, patients received ATT for 6 months while in Group 2, patients were not given ATT. In patients who did not conceive a repeat endometrial sampling for DNA-PCR was performed at 6 months and 12 months post-laparoscopy. STATISTICAL ANALYSIS It was carried out using Stata 11.0 (College Station, TX, USA). RESULTS In Group 1 (ATT), 25 women achieved pregnancy with a pregnancy rate of 50% while in Group 2 (no ATT), 21 women achieved pregnancy with a pregnancy rate of 42% and the difference (95% CI) was 8.0% (-11.5%, 27.5%) which was not statistically significant (p=0.422). Difference (95% CI) in the rate of repeat EA DNA-PCR being positive between the two groups at 6 months was 3.1% (-2.9%, 9.1%), p=0.299, while at the end of 12 months, repeat DNA-PCR remained positive in 23 patients in Group 1 and in 26 patients in Group 2. Difference (95% CI) in the rate of repeat EA DNA-PCR being positive between the two groups at 12 months was 2.3% (-13.0%, 17.7%), p=0.767. CONCLUSION The present study does not validate ATT for positive DNA-PCR; however, it does provide an evidence to stop over-treating patients on the basis of positive EA DNA-PCR even after they have received a 6 months course of ATT. Repeating PCR at 6 months and at 12 months has no role and ATT should not be repeatedly given to the patient on the basis of repeat DNA-PCR alone. CLINICAL TRIAL REGISTRATION NUMBER CTRI/2015/10/006235, www.ctri.nic.in.
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Affiliation(s)
- A Kriplani
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - A Bahadur
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India.
| | - V Kulshrestha
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - N Agarwal
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | | | - U B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Legro RS, Hurtado RM, Kilcoyne A, Roberts DJ. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 28-2016: A 31-Year-Old Woman with Infertility. N Engl J Med 2016; 375:1069-77. [PMID: 27626521 DOI: 10.1056/nejmcpc1609110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Richard S Legro
- From the Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.); and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Massachusetts General Hospital, and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Harvard Medical School - both in Boston
| | - Rocío M Hurtado
- From the Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.); and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Massachusetts General Hospital, and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Harvard Medical School - both in Boston
| | - Aoife Kilcoyne
- From the Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.); and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Massachusetts General Hospital, and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Harvard Medical School - both in Boston
| | - Drucilla J Roberts
- From the Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.); and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Massachusetts General Hospital, and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Harvard Medical School - both in Boston
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Hoo JY, Kumari Y, Shaikh MF, Hue SM, Goh BH. Zebrafish: A Versatile Animal Model for Fertility Research. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9732780. [PMID: 27556045 PMCID: PMC4983327 DOI: 10.1155/2016/9732780] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/20/2016] [Indexed: 02/06/2023]
Abstract
The utilization of zebrafish in biomedical research is very common in the research world nowadays. Today, it has emerged as a favored vertebrate organism for the research in science of reproduction. There is a significant growth in amount numbers of scientific literature pertaining to research discoveries in reproductive sciences in zebrafish. It has implied the importance of zebrafish in this particular field of research. In essence, the current available literature has covered from the very specific brain region or neurons of zebrafish, which are responsible for reproductive regulation, until the gonadal level of the animal. The discoveries and findings have proven that this small animal is sharing a very close/similar reproductive system with mammals. More interestingly, the behavioral characteristics and along with the establishment of animal courtship behavior categorization in zebrafish have laid an even stronger foundation and firmer reason on the suitability of zebrafish utilization in research of reproductive sciences. In view of the immense importance of this small animal for the development of reproductive sciences, this review aimed at compiling and describing the proximate close similarity of reproductive regulation on zebrafish and human along with factors contributing to the infertility, showing its versatility and its potential usage for fertility research.
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Affiliation(s)
- Jing Ying Hoo
- Biomedical Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia; School of Science, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia; Sunway College, Jalan Universiti, Bandar Sunway, 46150 Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Yatinesh Kumari
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Seow Mun Hue
- School of Science, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Bey Hing Goh
- Biomedical Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia; Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao 56000, Thailand
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Sharma JB, Singh N, Dharmendra S, Singh UB, P V, Kumar S, Roy KK, Hari S, Iyer V, Sharma SK. Six months versus nine months anti-tuberculous therapy for female genital tuberculosis: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2016; 203:264-73. [PMID: 27391900 DOI: 10.1016/j.ejogrb.2016.05.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/19/2016] [Accepted: 05/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare six months versus nine months anti-tuberculous therapy in patients of female genital tuberculosis. STUDY DESIGN It was a randomized controlled trial in a tertiary referral center teaching institute on 175 women presenting with infertility and found to have female genital tuberculosis on clinical examination and investigations. Group I women (86 women) were given 9 months of intermitted anti-tuberculous therapy under directly observed treatment short course (DOTS) strategy while Group II (89 women) were given 6 months of anti-tuberculous therapy under DOTS. Patients were evaluated for primary end points (complete cure, partial response, no response) and secondary end points (recurrence rate, pregnancy rate) during treatment. All patients were followed up further for one year after completion of therapy to assess recurrence of disease and further pregnancies. RESULTS Baseline characteristics were similar between two randomized groups. There was no difference in the complete clinical response rate (95.3% vs 97.7%, p=0.441) between 9-months and 6-months groups. Four patients in 9-months group and two patients in 6-months group had recurrence of disease and required category II anti tuberculous therapy (p=0.441). Pregnancy rate during treatment and up to one year follow up was also similar in the two groups (23.2% vs 21.3%, p=0.762). Side effects occurred in 27(31.4%) and 29(32.6%) in 9-months and 6-months of therapy and were similar (p=0.866). CONCLUSIONS There was no difference in complete cure rate, recurrent rate and pregnancy rate for either 6-months or 9-months of intermittent directly observed treatment short course anti-tuberculous therapy in female genital tuberculosis. CLINICAL TRIAL REGISTRATION The trial was registered in clinicaltrials.gov with registration no: CTRI/2009/091/001088.
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Affiliation(s)
- Jai B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Neeta Singh
- 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
| | - Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanamail P
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - K K Roy
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Hari
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - V Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Radhika AG, Bhaskaran S, Saran N, Gupta S, Radhakrishnan G. Comparison of diagnostic accuracy of PCR and BACTEC with Lowenstein–Jensen culture and histopathology in the diagnosis of female genital tuberculosis in three subsets of gynaecological conditions. J OBSTET GYNAECOL 2016; 36:940-945. [DOI: 10.1080/01443615.2016.1174829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sharma JB. Current Diagnosis and Management of Female Genital Tuberculosis. J Obstet Gynaecol India 2015; 65:362-71. [PMID: 26663993 PMCID: PMC4666212 DOI: 10.1007/s13224-015-0780-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 08/25/2015] [Indexed: 01/09/2023] Open
Abstract
Female genital tuberculosis (FGTB) is an important cause of significant morbidity, short- and long-term sequelae especially infertility whose incidence varies from 3 to 16 % cases in India. Mycobacterium tuberculosis is the etiological agent for tuberculosis. The fallopian tubes are involved in 90-100 % cases, endometrium is involved in 50-80 % cases, ovaries are involved in 20-30 % cases, and cervix is involved in 5-15 % cases of genital TB. Tuberculosis of vagina and vulva is rare (1-2 %). The diagnosis is made by detection of acid-fast bacilli on microscopy or culture on endometrial biopsy or on histopathological detection of epithelioid granuloma on biopsy. Polymerase chain reaction may be false positive and alone is not sufficient to make the diagnosis. Laparoscopy and hysteroscopy can diagnose genital tuberculosis by various findings. Treatment is by giving daily therapy of rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) for 2 months followed by daily 4 month therapy of rifampicin (R) and isoniazid (H). Alternatively 2 months intensive phase of RHZE can be daily followed by alternate day combination phase (RH) of 4 months. Three weekly dosing throughout therapy (RHZE thrice weekly for 2 months followed by RH thrice weekly for 4 months) can be given as directly observed treatment short-course. Surgery is rarely required only as drainage of abscesses. There is a role of in vitro fertilization and embryo transfer in women whose fallopian tubes are damaged but endometrium is healthy. Surrogacy or adoption is needed for women whose endometrium is also damaged.
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Affiliation(s)
- Jai B. Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India
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Al-Turki HA. Prevalence of primary and secondary infertility from tertiary center in eastern Saudi Arabia. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2015.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shore EM, Raikhiln A, Yudin MH. Tubal granuloma. Am J Obstet Gynecol 2015; 213:107.e1-107.e2. [PMID: 25757640 DOI: 10.1016/j.ajog.2015.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/01/2015] [Accepted: 03/04/2015] [Indexed: 11/25/2022]
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Bhanothu V, Lakshmi V, Theophilus JP, Rozati R, Badhini P, Vijayalaxmi B. Investigation of Toll-Like Receptor-2 (2258G/A) and Interferon Gamma (+874T/A) Gene Polymorphisms among Infertile Women with Female Genital Tuberculosis. PLoS One 2015; 10:e0130273. [PMID: 26114934 PMCID: PMC4483232 DOI: 10.1371/journal.pone.0130273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 05/19/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Toll-like receptor 2 (TLR2) and interferon-gamma (IFN-γ) coordinate with a diverse array of cellular programs through the transcriptional regulation of immunologically relevant genes and play an important role in immune system, reproductive physiology and basic pathology. Alterations in the functions of TLR2 2258G (guanine)/ A, IFN-γ (+874T/A) and signalling molecules that result from polymorphisms are often associated with susceptibility or resistance, which may, in turn, establish the innate host response to various infectious diseases. Presently, we proposed to investigate the risk of common single nucleotide polymorphism (SNP) of TLR2 and IFN-γ genes, for their effect on infertility in women with female genital tuberculosis (FGTB) and healthy women as controls. METHODOLOGY/PRINCIPAL FINDINGS Genotyping of TLR2 and IFN-γ gene polymorphisms was performed by amplification refractory mutation system multi-gene/multi-primer polymerase chain reaction followed by restriction fragment length polymorphism in 175 FGTB patients and 100 healthy control women (HCW). The TLR2 polymorphism [adenine (A) allele] was observed in 57.7 and 58.0% of FGTB patients and HCW, respectively. The IFN-γ (+874T/A) polymorphism (A allele) was significant in 74.3 and 71.0% of FGTB patients and HCW, respectively, while the odds ratios for the AA and TA genotypes for predisposition of FGTB were found to be 0.304 and 1.650 in HCW, respectively. The SNP of TLR2 was not associated with FGTB but the SNP of IFN-γ was found to be associated with mycobacteria infections and to induce infertility. CONCLUSIONS/SIGNIFICANCE At present, we hypothesize that infertile women with FGTB and HCW without tuberculosis (TB) have identical frequency of TLR variants, which may be adequate in the production of IFN-γ in response to Mycobacterium tuberculosis infections. Thus, the study appears to be the first of its kind reporting a mutation in the IFN-γ gene [+874 T (thymine) to A] responsible for susceptibility to TB infections and further inducing infertility.
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Affiliation(s)
- Venkanna Bhanothu
- Department of Zoology, University College of Science, Osmania University, Hyderabad, Telangana State, India
| | - Vemu Lakshmi
- Department of Microbiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana State, India
| | - Jane P. Theophilus
- Department of Zoology, University College of Science, Osmania University, Hyderabad, Telangana State, India
| | - Roya Rozati
- Department of Obstetrics and Gynecology, Owaisi Hospital & Research Centre, Hyderabad, Telangana State, India
| | - Prabhakar Badhini
- Department of Genetics, University College of Science, Osmania University, Hyderabad, Telangana State, India
| | - Boda Vijayalaxmi
- Department of Obstetrics and Gynecology, Owaisi Hospital & Research Centre, Hyderabad, Telangana State, India
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Caliskan E, Cakiroglu Y, Sofuoglu K, Doger E, Akar ME, Ozkan SO. Effects of salpingectomy and antituberculosis treatments on fertility results in patients with genital tuberculosis. J Obstet Gynaecol Res 2014; 40:2104-9. [PMID: 25131900 DOI: 10.1111/jog.12450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 03/07/2014] [Indexed: 01/02/2023]
Abstract
AIM The aim of this study was to demonstrate the effects of tubal surgery and antituberculosis treatments in patients with genital tuberculosis. MATERIAL AND METHODS A total of 38 infertile women who had been diagnosed with pelvic tuberculosis and who had had laparoscopy and hysteroscopy were recruited into the study. All women with female genital tuberculosis were divided into two groups: group 1 (salpingectomized, n=21) and group 2 (not salpingectomized, n=15). Both of the groups were treated with antitubercular therapy for 6-12 months. RESULTS There was no significant difference in level of gonadotrophins used, estradiol levels on human chorionic gonadotrophin day, mean and mature oocytes retrieved, mean embryos transferred, or cancellation and fertilization rates. Only the number of days of stimulation was statistically significantly higher in group 1 compared to group 2 (10.4±2.3 vs 9.2±1.8; P=0.048). Although it did not reach the statistically significant level, clinical pregnancy rate was higher in group 1 (37.5%, 12/32 vs 23.8%, 5/21; P=0.306). Although not statistically significant, number of ongoing pregnancies per embryo transfer, spontaneous abortion rates before 20 weeks of gestation and take-home baby rates were higher in group 1 compared to group 2 (15.5%, 12/77 vs 6.6%, 3/45; P=0.150; 28.1%, 9 vs 23.8%, 5; P=0.600; 9%, 3 vs 0; P=0.160, respectively). CONCLUSION Salpingectomy is an option for treatment in patients diagnosed with pelvic tuberculosis and infertility to improve both clinical pregnancy rates and take-home baby rates in patients treated with antituberculosis therapy for 12 months.
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Affiliation(s)
- Eray Caliskan
- Department of Obstetrics and Gynecology, Kocaeli University, Kocaeli, Turkey
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Nakahara T, Iwase A, Mori M, Kondo M, Goto M, Kikkawa F. Pelvic tuberculous granuloma successfully treated with laparoscopy to preserve fertility: a case report and review of the published work. J Obstet Gynaecol Res 2014; 40:1814-8. [PMID: 24888956 DOI: 10.1111/jog.12378] [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: 01/17/2013] [Accepted: 12/10/2013] [Indexed: 11/30/2022]
Abstract
Tuberculous granuloma must be considered in the differential diagnosis of pelvic masses in women of reproductive age because the major sequela of pelvic tuberculosis is infertility; however, currently there is very little information about its fertility-preserving treatment. We report the case of a woman with a history of tuberculous peritonitis who referred to our hospital for evaluation of an adnexal mass and primary infertility. The patient underwent excision of pelvic tuberculous granuloma with fertility-preserving laparoscopic surgery. We resected as much of the tuberculous granuloma as possible using the laparoscopic technique without causing damage to the uterus or ovaries. In particular, we report for the first time in the published work the laparoscopic removal of tuberculous granuloma without causing damage to the uterus or ovaries. Our experience from this case suggests that laparoscopic diagnosis and treatment of tuberculous granuloma is a feasible procedure in a patient who wants to conceive.
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Affiliation(s)
- Tatsuo Nakahara
- Department of Obstetrics and Gynecology, Nagoya University, Graduate School of Medicine, Nagoya, Japan
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Occurrence of female genital tuberculosis among infertile women: a study from a tertiary maternal health care research centre in South India. Eur J Clin Microbiol Infect Dis 2014; 33:1937-49. [DOI: 10.1007/s10096-014-2164-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
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Zolton JR, Spirtos NJ, Margocs DiDonato ME, McCarroll ML. Pelvic Tuberculosis Diagnosed During Infertility Evaluation. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica R. Zolton
- Department of Obstetrics and Gynecology, Summa Akron City Hospital, Summa Health System, Akron, OH
| | - Nicholas J. Spirtos
- Department of Obstetrics and Gynecology, Summa Akron City Hospital, Summa Health System, Akron, OH
- Department of Obstetrics and Gynecology, Northeast Ohio Medical University, Rootstown, OH
- Northeastern Ohio Fertility, Akron, OH
| | - Mary Ellen Margocs DiDonato
- Department of Family Medicine, Summa Western Reserve Hospital, Summa Health System, Cuyahoga Falls, Akron, OH
| | - Michele L. McCarroll
- Department of Obstetrics and Gynecology, Summa Akron City Hospital, Summa Health System, Akron, OH
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Bhanothu V, Theophilus JP, Rozati R. Use of endo-ovarian tissue biopsy and pelvic aspirated fluid for the diagnosis of female genital tuberculosis by conventional versus molecular methods. PLoS One 2014; 9:e98005. [PMID: 24849122 PMCID: PMC4029782 DOI: 10.1371/journal.pone.0098005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/27/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Til date, none of the diagnostic techniques available for the detection of female genital tuberculosis (FGTB) are 100% accurate. We therefore, proposed to use the endometrial tissue biopsies (ETBs), ovarian tissue biopsies (OTBs) and pelvic aspirated fluids (PAFs) for the diagnosis of FGTB among infertile women by conventional versus molecular methods. METHODOLOGY/PRINCIPAL FINDINGS A total of 302 specimens were collected both from 202 infertile women highly suspected of having FGTB on laparoscopy examination and 100 control women of reproductive age. Out of 302 specimens, 150 (49.67%) were ETBs, 95 (31.46%) were OTBs and 57 (18.87%) were PAFs. All specimens were tested by conventional techniques, later compared with multi-gene PCR for the detection of Mycobacterium tuberculosis (MTB) and correlated with laparoscopic findings. The presence of MTB DNA was observed in 49.5% of ETBs, 33.17% of OTBs and 5.44% of PAF specimens collected from highly suspected FGTB patients. All women of control group were confirmed as negative for tuberculosis. The conventional methods showed 99% to 100% specificity with a low sensitivity, ranging from 21.78% to 42.08% while hematoxylin and eosin staining showed a sensitivity of 51.48%. Multi-gene PCR was found to have much higher sensitivity of 70.29% with MTB64 gene, 86.63% with 19 kDa antigen gene at species and TRC4 element at regional MTB complex and 88.12% with 32 kDa protein gene at genus level. The specificity of multi-gene PCR was 100%. Compared with culturing and Ziehl-Neelsen's staining, multi-gene PCR demonstrated improvement in the detection of FGTB (χ2 = 214.612, 1 df, McNemar's test value <0.0001). CONCLUSIONS SIGNIFICANCE We suggest site specific sampling, irrespective of sample type and amplification of the 19 kDa antigen gene in combination with TRC4 element as a successful multi-gene PCR for the diagnosis of FGTB and differentiation of mycobacterial infection among endo-ovarian tissue biopsies and PAFs taken from infertile women.
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Affiliation(s)
- Venkanna Bhanothu
- Dept. of Zoology, Osmania University, Hyderabad, Andhra Pradesh, India
| | | | - Roya Rozati
- Dept. of Reproductive Medicine, MHRT Hospital & Research Centre, Hyderabad, Andhra Pradesh, India
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Laabadi K, Alaoui FZF, Jayi S, Chaara HBH, Melhouf MA. [Tuberculous endometritis: about a case and review of the literature]. Pan Afr Med J 2013; 16:94. [PMID: 24772223 PMCID: PMC3996446 DOI: 10.11604/pamj.2013.16.94.3430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/29/2013] [Indexed: 12/05/2022] Open
Abstract
La tuberculose constitue encore un problème de santé préoccupant, aussi bien dans les pays en voie de développement que dans les pays développés, en partie du fait de l’éclosion de l’épidémie mondiale de l’infection par le virus de l’immunodéficience humaine. Dans sa localisation génitale assez rare (6-10% des localisations tuberculeuses), la tuberculose pose des problèmes diagnostiques. Les symptômes communément rencontrés sont non spécifiques, ce qui contribue au retard thérapeutique et majore le risque d’infertilité qui reste la séquelle quasi inéluctable. A travers une observation d’endométrite tuberculeuse et une revue de la littérature nous étudions les aspects épidémio-cliniques, thérapeutiques et pronostiques de cette localisation tuberculeuse.
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Affiliation(s)
- Kamilia Laabadi
- Service de gynécologie obstétrique II, CHU Hassan II, Université Mohamed Ben Abdellah, Fès, Maroc
| | | | - Sofia Jayi
- Service de gynécologie obstétrique II, CHU Hassan II, Université Mohamed Ben Abdellah, Fès, Maroc
| | | | - Moulay Abdilah Melhouf
- Service de gynécologie obstétrique II, CHU Hassan II, Université Mohamed Ben Abdellah, Fès, Maroc
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Flibotte JJ, Lee GE, Buser GL, Feja KN, Kreiswirth BN, McSherry GD, Nolan SM, Tolan RW, Zhang H. Infertility, in vitro fertilization and congenital tuberculosis. J Perinatol 2013; 33:565-8. [PMID: 23803676 DOI: 10.1038/jp.2012.146] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Congenital tuberculosis (CTB) due to maternal genitourinary (GU) TB infection is a rare occurrence, as infection of the genital tract in women generally leads to infertility. Increasing availability of assisted reproductive technology creates the potential for CTB to emerge as a significant problem. We describe five infants (two sets of twins and a singleton birth) conceived by in vitro fertilization who developed CTB. All five infants were born to mothers who had immigrated to the United States from India and none had GU TB diagnosed before the birth of their infected infants.
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Affiliation(s)
- J J Flibotte
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Jindal UN, Verma S, Bala Y. Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Hum Reprod 2012; 27:1368-74. [DOI: 10.1093/humrep/des076] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Malhotra N, Sharma V, Bahadur A, Sharma JB, Roy KK, Kumar S. The effect of tuberculosis on ovarian reserve among women undergoing IVF in India. Int J Gynaecol Obstet 2012; 117:40-4. [DOI: 10.1016/j.ijgo.2011.10.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/21/2011] [Accepted: 12/21/2011] [Indexed: 11/25/2022]
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Hooja S, Vyas L. Rapid Diagnosis of Genital Tuberculosis by Real-time Polymerase Chain Reaction. ACTA ACUST UNITED AC 2012. [DOI: 10.5005/jp-journals-10006-1170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Objective
Rapid diagnosis of genital tuberculosis (GTB) is essential as it is an important cause of infertility among women. Diagnosis can be done by imaging techniques, direct visualization by endoscopy, serology, histopathology, culture and polymerase chain reaction (PCR) tests. Laparoscopy detects macroscopic changes only; histology is only suggestive and not confirmatory unless acid fast bacilli (AFB) are demonstrated in the lesion but sensitivity is poor in paucibacillary disease. Culture methods are the gold standard but slow growth of most pathogenic mycobacteria delays the diagnosis. PCR can rapidly detect even few copies of DNA with high sensitivity and specificity.
Aim
Comparative evaluation of AFB smear examination, culture in Middlebrook 7H9 media and IS6110 based real-time PCR assay for the detection of mycobacteria in various female genital samples.
Materials and methods
A total of 555 female genital samples like endometrial and fallopian tube biopsies, menstrual blood and vaginal discharge were processed by modified Petroff's method. The deposit was used for detection of mycobacteria by AFB smear, culture on Middlebrook 7H9 media and IS6110 based real-time PCR.
Results
Out of 555 samples, 25.22 % (140/555) were positive by the combination of all the methods used. Overall positivity by real-time PCR alone was 23.78% (132/555), by culture 8.28% (46/555) and 2.70% (15/555) by AFB smear examination. Out of total positives, 94.28% (132/140) were positive by PCR alone, 32.85% (46/140) by culture and 10.71% (15/140) by AFB smear. Eight (5.71%) culture positive samples were negative by smear and PCR, six of these were nontubercular mycobacteria (NTM) and two samples had PCR inhibitors as confirmed by spiking with positive DNA. Contamination was observed in 25/555 (4.5%) which were reported negative by culture but three of these were PCR positive. AFB smear results were available in 1 hour, PCR in 1 day and culture in 4 to 6 weeks.
Conclusion
PCR was found to be the most rapid and sensitive (94.28%) method, 9-fold more sensitive than smear examination and 3-fold than the culture for detection of mycobacteria. Results were available in 4 to 6 weeks time for culture but in only 1 day by PCR. IS6110 PCR can detect only MTB and not the NTM. Use of multiplex PCR with genus and MTB specific primers will increase the sensitivity of test but care needs to be taken to prevent false positivity due to cross contamination and false negative due to PCR inhibitors.
How to cite this article
Malhotra B, Sinha P, Hooja S, Vyas L. Rapid Diagnosis of Genital Tuberculosis by Real-time Polymerase Chain Reaction. J South Asian Feder Obst Gynae 2012;4(1):39-42.
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Prasad S, Singhal M, Negi SS, Gupta S, Singh S, Rawat DS, Rai A. Targeted detection of 65 kDa heat shock protein gene in endometrial biopsies for reliable diagnosis of genital tuberculosis. Eur J Obstet Gynecol Reprod Biol 2011; 160:215-8. [PMID: 22142816 DOI: 10.1016/j.ejogrb.2011.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 09/30/2011] [Accepted: 11/10/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To evaluate the clinical utility of PCR compared with other available diagnostic modalities in prompt diagnosis of female genital tuberculosis causing infertility. STUDY DESIGN Prospective case-controlled trial. Premenstrual endometrial biopsy specimens were collected from 150 infertile women of reproductive age group suspected of having genital tuberculosis. All patients underwent diagnostic endoscopy (laparoscopy and hysteroscopy) and the samples obtained were subjected to microscopy, culture by the BACTEC 460 TB System, histopathology and polymerase chain reaction (PCR) for detection of 165 bp region of 65 kDa gene of Mycobacterium tuberculosis. The results were correlated with the laparoscopic findings. RESULTS While the laparoscopy/hysteroscopy findings were indicative of tuberculosis in 12.6% of cases, 14.6% of the specimens showed evidence of 65 kDa gene of M. tuberculosis and only 3.33%, 1.33% and 0.66% were positive by culture, smear and histopathology, respectively. CONCLUSION Since laparoscopy, hysteroscopy other endoscopic procedures are associated with operative risks and may cause flaring of infection, and other conventional laboratory tests including histopathology have poor sensitivity, PCR-based detection of 65 kDa gene of M. tuberculosis in endometrial biopsy specimens could be a promising molecular diagnostic technique compared to conventional methods of diagnosis.
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Affiliation(s)
- Sudha Prasad
- IVF and Reproductive Biology Centre, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi 110002, India.
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Timing of intrauterine insemination: an attempt to unravel the enigma. Arch Gynecol Obstet 2011; 284:1023-7. [DOI: 10.1007/s00404-011-1950-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 06/08/2011] [Indexed: 10/18/2022]
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40
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Utility of reverse transcriptase PCR and DNA-PCR in the diagnosis of female genital tuberculosis. J Med Microbiol 2011; 60:486-491. [DOI: 10.1099/jmm.0.025080-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study was designed to test the utility of mRNA-based RT-PCR to detect viable bacilli, indicating active tubercular involvement, and DNA-PCR to detect present or past infection in the diagnosis of active female genital tuberculosis (TB) infection. A total of 200 subjects with complaints of infertility were enrolled in the study. Multiple sampling was done. One hundred and forty-three endometrial aspirate (EA), 94 peritoneal fluid/peritoneal washing (PF/PW) and six cornual biopsy (CB) specimens were collected for diagnosis using microscopy, culture, RT-PCR and DNA-PCR and results were compared with laparoscopic findings. RT-PCR and culture were concordant [positive in four (2.8 %) EA specimens] signalling sampling from the site of active infection. Smear microscopy showed a poor detection rate while DNA-PCR showed high positivity. Sixty-one (44.85 %) EA specimens, nine (9.57 %) PF/PW specimens and two (33.33 %) CB specimens were positive by DNA-PCR. Genital TB causing infertility (localized or secondary to TB elsewhere) can be picked up early by DNA-PCR, when it can be completely cured prior to the appearance of florid disease.
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Kulshrestha V, Kriplani A, Agarwal N, Singh UB, Rana T. Genital tuberculosis among infertile women and fertility outcome after antitubercular therapy. Int J Gynaecol Obstet 2011; 113:229-34. [DOI: 10.1016/j.ijgo.2010.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/03/2010] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
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Neonakis IK, Spandidos DA, Petinaki E. Female genital tuberculosis: A review. ACTA ACUST UNITED AC 2011; 43:564-72. [DOI: 10.3109/00365548.2011.568523] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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43
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A case study of female genital tuberculosis in a Western European setting. Infection 2010; 39:59-63. [DOI: 10.1007/s15010-010-0066-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 11/08/2010] [Indexed: 11/26/2022]
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Crochet JR, Hawkins KC, Holland DP, Copland SD. Diagnosis of pelvic tuberculosis in a patient with tubal infertility. Fertil Steril 2010; 95:289.e17-20. [PMID: 20663499 DOI: 10.1016/j.fertnstert.2010.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 05/24/2010] [Accepted: 06/01/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a case of pelvic tuberculosis presenting as primary infertility and discuss the various diagnostic modalities. DESIGN Case report. SETTING Academic reproductive medicine center. PATIENT(S) A 28-year-old nulliparous Indian immigrant presenting with primary infertility and known tubal pathology. INTERVENTION(S) Laparoscopic bilateral salpingectomy and adhesiolysis and diagnostic endometrial sampling. MAIN OUTCOME MEASURE(S) Acid-fast bacilli were obtained on polymerase chain reaction and culture of endometrial sample. RESULT(S) The patient was diagnosed with pelvic tuberculosis and treated with a directly observed multidrug regimen. CONCLUSION(S) Tuberculosis is an important cause of gynecologic morbidity and should be considered in the appropriate patients.
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Affiliation(s)
- John R Crochet
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina 27713, USA.
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45
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Epigenetic regulatory mechanisms associated with infertility. Obstet Gynecol Int 2010; 2010. [PMID: 20814440 PMCID: PMC2929612 DOI: 10.1155/2010/198709] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 06/29/2010] [Indexed: 11/21/2022] Open
Abstract
Infertility is a complex human condition and is known to be caused by numerous factors including genetic alterations and abnormalities. Increasing evidence from studies has associated perturbed epigenetic mechanisms with spermatogenesis and infertility. However, there has been no consensus on whether one or a collective of these altered states is responsible for the onset of infertility. Epigenetic alterations involve changes in factors that regulate gene expression without altering the physical sequence of DNA. Understanding these altered epigenetic states at the genomic level along with higher order organisation of chromatin in genes associated with infertility and pericentromeric regions of chromosomes, particularly 9 and Y, could further identify causes of idiopathic infertility. Determining the association between DNA methylation, chromatin state, and noncoding RNAs with the phenotype could further determine what possible mechanisms are involved. This paper reviews certain mechanisms of epigenetic regulation with particular emphasis on their possible role in infertility.
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Rahman SM, Malhotra N, Kumar S, Roy KK, Agarwal A. A randomized controlled trial comparing the effectiveness of single versus double intrauterine insemination in unexplained infertility. Fertil Steril 2010; 94:2913-5. [PMID: 20674901 DOI: 10.1016/j.fertnstert.2010.06.082] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 06/22/2010] [Accepted: 06/23/2010] [Indexed: 10/19/2022]
Abstract
In a prospective randomized trial comparing efficacy of double over single intrauterine insemination (IUI), 160 couples with unexplained infertility underwent controlled ovarian hyperstimulation and IUI. The pregnancy rates were similar and statistically not different between groups, suggesting that double IUI added no advantage over single IUI.
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Affiliation(s)
- Syed Monajatur Rahman
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where infection-related tubal damage is the commonest cause. Most infections causing tubal damage are preventable and assisted conception can treat the infertility. However, assisted conception, despite being available for nearly three decades is either unavailable or inaccessible to most residents of resource poor countries. Infertility has social, economic and personal effects, which go beyond childlessness, and women bear the major brunt of the burden. There is urgent need for a comprehensive sexual and reproductive healthcare initiative involving maternal and child health, safe abortions, family planning and infertility prevention and management. The provision of low cost assisted reproduction for couples in poorly resourced countries also needs to be revisited.
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Affiliation(s)
- S Sharma
- Southport and Ormskirk NHS Trust, Southport, UK.
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Akka L, Khalil H, Gannouni NCI, Jalal H, Samlani Z, Fadil K, Krati K, Essadki O, Ousehal A. La tuberculose ovarienne pseudotumorale : à propos de quatre cas. IMAGERIE DE LA FEMME 2009. [DOI: 10.1016/j.femme.2009.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Agrawal S, Madan M, Leekha N, Raghunandan C. A rare case of cervical tuberculosis simulating carcinoma cervix: a case report. CASES JOURNAL 2009; 2:161. [PMID: 19946532 PMCID: PMC2783117 DOI: 10.1186/1757-1626-2-161] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 10/20/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND This is an unusual case of a 26-year-old P2L2 lady who presented with chief complaints of pain abdomen and irregular bleeding p/v with history of post-coital bleeding. CASE REPORT On per speculum examination, cervix was replaced by an irregular friable growth, which was bleeding on touch. A clinical diagnosis of carcinoma cervix was made but the cervical biopsy revealed granulomatous inflammation with presence of acid-fast bacilli on cervical smear consistent with tuberculosis. The patient responded to six months of anti-tubercular therapy. CONCLUSION To conclude, cervical tuberculosis should be considered in the differential diagnosis of carcinoma cervix in young women with suspicious cervix.
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Affiliation(s)
- Swati Agrawal
- Department of Obstetrics & Gynecology, Lady Hardinge Medical College, New Delhi, India.
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Reproductive healthcare systems should include accessible infertility diagnosis and treatment: an important challenge for resource-poor countries. Int J Gynaecol Obstet 2009; 106:168-71. [PMID: 19535067 DOI: 10.1016/j.ijgo.2009.03.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Infertility is a central issue in the lives of many couples who suffer from it. In resource-poor countries the problem of childlessness is even more pronounced compared with Western societies owing to different sociocultural circumstances. It often leads to severe psychological, social, and economic suffering, and access to infertility treatment is often limited to certain procedures and certain costumers. The issue of infertility in resource-poor countries is underestimated and neglected, not only by local governments but also by the international nonprofit organizations. Simplification of the diagnostic and therapeutic procedures, minimizing the complication rate, and incorporating fertility centers into existing reproductive healthcare programs are essential measures to take in resource-poor countries if infertility treatment is to be accessible for a large part of the population. For reasons of social justice, a search for strategies to implement simplified methods of infertility diagnosis and treatment in resource-poor countries is urgently warranted.
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