rifampin and Tuberculosis--Female-Genital

Female genital tuberculosis (FGTB) is an infection caused by

Topics: Antitubercular Agents; Female; Humans; Infertility, Female; Isoniazid; Mycobacterium tuberculosis; Pregnancy; Rifampin; Tuberculosis, Female Genital

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.

Topics: Biopsy; Endoscopy; Ethambutol; Fallopian Tubes; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Pregnancy; Rifampin; Tuberculosis, Female Genital

A 66-year-old woman was referred to our hospital because of lochiorrhea. Uterus MRI and ultrasonography showed hydrometra. Endometrium biopsy revealed epithelioid cell granuloma, and vaginal discharge and endometrium culture was positive for M. tuberculosis. She was diagnosed as endometrial tuberculosis. After treatment with INH, RFP, and EB for 9 months, she recovered.

Topics: Aged; Antitubercular Agents; Drug Therapy, Combination; Endometrium; Ethambutol; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Rifampin; Treatment Outcome; Tuberculosis, Female Genital; Uterine Diseases; Vaginal Discharge

Recent literature concerning genital tuberculosis in women is reviewed. In Denmark, 25% of the cases are observed in immigrants. The symptoms are non-specific in the form of infertility, metrorrhagia or abdominal pain. Positive culture or specific histology are necessary to establish the diagnosis. Approximately one third of the cases are recognized first during or after operation in connection with laparotomy on suspicion of another condition. Treatment is primarily combined therapy with rifampicin, isoniazide and ethambutol for nine months. If treatment fails or pain persists, total hysterectomy and bilateral salpingectomy are indicated. Bilateral oophorectomy in younger patients with normal ovaries has been discussed. The prognosis as regards survival is good but the patients must be considered to be infertile.

Topics: Denmark; Drug Therapy, Combination; Emigration and Immigration; Ethambutol; Female; Humans; Infertility, Female; Isoniazid; Rifampin; Tuberculosis, Female Genital

Topics: Aminosalicylic Acids; Ethambutol; Female; Humans; Hypersensitivity, Delayed; Isoniazid; Male; Mycobacterium tuberculosis; Recurrence; Rifampin; Streptomycin; Tuberculosis; Tuberculosis, Cardiovascular; Tuberculosis, Female Genital; Tuberculosis, Lymph Node; Tuberculosis, Male Genital; Tuberculosis, Meningeal; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary; Tuberculosis, Renal; United States

To compare modalities for diagnosing genital tuberculosis (GTB) and to assess fertility outcome after antitubercular therapy (ATT).. Infertile women underwent endometrial aspiration (EA) and peritoneal washing (PW) for histopathologic examination, PCR, and acid-fast bacilli (AFB) smear and culture of Mycobacterium tuberculosis; laparoscopy and hysteroscopy were also performed. Women with a positive laboratory test and/or laparoscopic finding classified as definitive/probable received ATT for 6 months.. Of 196 women recruited, 187 underwent laparoscopy. Genital tuberculosis was diagnosed in 118 (60.2%). In 41.3%, EA PCR was positive; PW PCR was positive in 7.6%. The remaining laboratory tests were positive in a small number. Laparoscopy indicated definitive GTB in 9.1% and probable GTB in 37.4%. Among the 118 women treated for GTB, 22.9% conceived without in vitro fertilization; of these women, 74.1% had a positive EA PCR and 59.3% had a positive laparoscopy finding. A quarter of the women received ATT solely on the basis of the PCR result and 31.0% of these women conceived.. No single test can detect all instances of GTB. A combination of tests is needed to increase the detection rate. Treatment given solely on the basis of a positive PCR result can result in conception.

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Fertilization; Humans; Infertility, Female; Isoniazid; Laparoscopy; Polymerase Chain Reaction; Pregnancy; Prospective Studies; Pyrazinamide; Rifampin; Treatment Outcome; Tuberculosis, Female Genital

To evaluate Gene Xpert for diagnosis of Female Genital Tuberculosis (FGTB) as compared to conventional methods.. It was a prospective study conducted over 167 cases of infertile female genital tuberculosis (FGTB) diagnosed on composite reference standard (CRS) (smear for AFB, histopathological evidence of epithelioid granuloma or definite or possible findings of tuberculosis on laparoscopy). All women underwent endometrial biopsy for AFB microscopy, culture, gene Xpert, PCR and histopathology) and laparoscopy and hysteroscopy for diagnosis and prognostication of disease. The results of Gene Xpert were compared with conventional methods in detection of FGTB. All patients were treated with 6 months course of rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) (RHZE for 2 months, RHE for 4 months) using directly observed treatment short course strategy.. Mean age, parity, body mass index and history of contact was 28.3 years, 0.28, 22.9 Kg/m. Gene Xpert is a very useful test to rule in tuberculosis whereas when it is negative it is not a good test to rule out tuberculosis.

Topics: Adult; Endometrium; Female; Humans; Infertility, Female; Mycobacterium tuberculosis; Pregnancy; Prospective Studies; Rifampin; Sensitivity and Specificity; Tuberculosis, Female Genital

Genitourinary tuberculosis (GUTB) accounts for up to 40% of extrapulmonary tuberculosis cases. Rapid tests for GUTB are urgently needed because it is often associated with delayed health-care seeking, leading to serious consequences. This study evaluated the performance of the Xpert MTB/RIF assay in the rapid diagnosis of urinary tract tuberculosis (UTB) and rifampicin-resistant tuberculosis with urine specimens. In all, 302 patients were included from four hospitals in China. Suspected UTB patients were tested with Xpert, smear, and MGIT 960 culture. Drug susceptibility testing (DST) was conducted for culture-positive cases. The performance of the assays was evaluated against MGIT 960 culture and a composite reference standard (CRS). Among all participants, 150 (49.7%) had CRS-positive UTB, of whom 36 (24.0%) were culture-confirmed. Against culture, Xpert and smear achieved a sensitivity of 94.4% (95% CI: 81.3-99.3%) and 22.2% (95% CI: 10.1-39.2%), respectively. Against CRS, the sensitivity of Xpert, smear and culture was 41.3% (95% CI: 33.4-49.7%), 7.3% (95% CI: 3.7-12.7%), and 24.0% (95% CI: 17.4-31.6%). Xpert had better performance than smear and culture in detecting UTB from urine samples and could be considered for the diagnosis of UTB. Moreover, Xpert showed better performance than MGIT 960-based DST using urine culture.

Topics: Adult; Aged; Aged, 80 and over; Antibiotics, Antitubercular; Drug Resistance, Bacterial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium tuberculosis; Rifampin; Tuberculosis, Female Genital; Tuberculosis, Male Genital; Tuberculosis, Multidrug-Resistant; Young Adult

Topics: Adult; Antibiotics, Antitubercular; Automation, Laboratory; Bacterial Proteins; Biopsy; DNA-Directed RNA Polymerases; Drug Resistance, Bacterial; Endometrium; Female; Granuloma; Hospitals, University; Humans; India; Infertility, Female; Molecular Typing; Mycobacterium tuberculosis; Real-Time Polymerase Chain Reaction; Rifampin; Sensitivity and Specificity; Tuberculosis, Female Genital; Young Adult

Tuberculosis of the cervix is a rare disease and accounts for 0.1-0.65% of all cases of tuberculosis. We present an unusual case of a 57 years old female who presented with chief complaints of Serosaguineous vaginal discharge of one year duration and irregular firm cervix with contact bleeding and was clinically diagnosed to have cervical cancer. Histopathology revealed typical findings of cervical tuberculosis. Cervical tuberculosis should be considered as a differential diagnosis of cervical malignancy. The clinical presentation and diagnosis of cervical tuberculosis is reviewed.

Topics: Antitubercular Agents; Cervix Uteri; Diagnosis, Differential; Ethambutol; Female; Gynecological Examination; Humans; Middle Aged; Pyrazinamide; Rifampin; Treatment Outcome; Tuberculosis, Female Genital; Ultrasonography; Uterine Cervical Neoplasms

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Drug Therapy, Combination; Female; Humans; Infertility, Female; Isoniazid; Middle Aged; Pelvic Pain; Pyrazinamide; Retrospective Studies; Rifampin; Tuberculosis, Female Genital; Young Adult

Genital ulcers in adolescent girls present a complex diagnostic dilemma. Of all the causes of painful vulval ulcer in a virgin girl, tuberculosis is an extremely rare possibility with no case reported in literature.. We are reporting a case of tubercular vulval ulcer in a sexually inactive pubertal girl. She had a close contact with active tuberculosis, positive tuberculin skin test, and chronic granulomatous inflammation on vulval biopsy. Therapeutic trial was offered and on follow up visit after 4 weeks, lesion had completely resolved.. Unlike previous case reports that describe tubercular vulval ulcers in sexually active or post menopausal women our patient was sexually inactive. In endemic areas tuberculosis should be considered in differential diagnosis of vulval ulcers irrespective of sexual history of the patient.

Topics: Adolescent; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Pyrazinamide; Rifampin; Skin Ulcer; Tuberculin Test; Tuberculosis, Female Genital; Vulvar Diseases

Dysuria is a very common symptom, which is taken lightly. It can lead to a diagnosis of disseminated Koch's, which if identified early can prevent permanent sequelae.

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Dysuria; Ethambutol; Female; Humans; Isoniazid; Pyrazinamide; Rifampin; Tuberculosis, Female Genital; Tuberculosis, Renal; Urine

Topics: Abdominal Pain; Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Humans; Isoniazid; Laparoscopy; Pregnancy; Pregnancy Outcome; Rifampin; Tuberculosis, Female Genital

Genital tuberculosis is reported to be a major pelvic factor causing infertility in Indian women and often exists without any apparent signs and symptoms. The role of latent tuberculosis in repeated IVF failure in unexplained infertility is examined. 81 women with unexplained infertility having repeated IVF failure tested for Mycobacterium tuberculosis using PCR, ZN staining and BACTEC-460 culture were selected. Fresh IVF-ET or frozen embryo transfer (FET) was attempted on patients successfully treated with anti-tubercular drugs (ATD). ATD-treated fresh cycles (group A1) and frozen cycles (group B1) were compared to previously failed fresh cycles (group A2) and FET attempts (group B2), respectively. Main outcome measures were gonadotropin required, terminal E2, number of oocytes retrieved, fertilization rate, embryo quality, endometrial thickness and sub-endometrial blood flow (V(max)). Gonadotropin required in group A1 was significantly less as compared to group A2. Number of oocytes retrieved and grade I embryos, endometrial thickness and V(max) were significantly higher in group A1. Endometrial thickness and V(max) were significantly increased in group B1 as compared to B2. The study indicates that latent tuberculosis should be considered in young Indian patients presenting with unexplained infertility with apparently normal pelvic and non-endometrial tubal factors and repeated IVF failure.

Topics: Adult; Antitubercular Agents; Endometrium; Ethambutol; Female; Fertilization; Fertilization in Vitro; Humans; India; Infertility, Female; Polymerase Chain Reaction; Pregnancy; Pregnancy Rate; Pyrazinamide; Rifampin; Tuberculosis, Female Genital

Tuberculosis most often affects the pulmonary system; however, 8-15% of cases infect the genitourinary system. The primary treatment of uterine tuberculosis is medical therapy, and only when that fails is surgical intervention warranted.. A 75-year-old woman presented with chronic back pain and fatigue. She had been on prednisone for 9 years for autoimmune hepatitis and had earlier exposure to tuberculosis. Evaluation led to the diagnosis of uterine tuberculosis. The patient was unable to tolerate a full course of antituberculin therapy, so she underwent an abdominal hysterectomy and bilateral salpingo-oophorectomy.. We believe the patient had latent uterine tuberculosis that was reactivated from her chronic steroid use. If she had a purified protein derivative test prior to the start of prednisone therapy, latent tuberculosis may have been diagnosed and treated before she developed a clinically active infection.

Topics: Aged; Antitubercular Agents; Ethambutol; Female; Hepatitis, Autoimmune; Humans; Hysterectomy; Isoniazid; Ovariectomy; Recurrence; Rifampin; Tuberculosis, Female Genital

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Diagnosis, Differential; Female; Humans; Isoniazid; Ovarian Diseases; Pelvis; Rifampin; Tuberculosis, Female Genital; Tuberculosis, Miliary; Uterine Neoplasms

Tuberculosis in the genital and peritoneal region is increasing in last years. For this reason, the high value and efficacy of laparoscopy using a small caliber endoscope for the diagnosis of this disease, which often presents no specific and heterogeneous clinical features, is underlined.. A case of peritoneal tuberculosis in a young female presenting fever, asthenia and peritoneal effusion, is reported. Blood tests, X-ray and cytological examination of the peritoneal fluid all failed to point out the right diagnosis. Then multiple biopsies of the peritoneum and the external surface of uterus and ovaries were made using laparoscopy.. Laparoscopy clearly showed the miliary nodules. The histology showed multiple granulomas composed by inner caseous necrosis and outer layer of epithelioid histiocytes and Langhans cells, leading thus to the diagnosis of peritoneal tuberculosis. The patient, treated with streptomycin and rifampicin, five months after diagnosis, did not show any feature of tubercular disease.. Because of its safety, laparoscopy is a very useful and powerful diagnostic technique especially in those young women presenting with painful abdominal symptoms without any clear evident cause.

Topics: Adolescent; Female; Humans; Isoniazid; Laparoscopes; Peritoneum; Peritonitis, Tuberculous; Rifampin; Treatment Outcome; Tuberculosis, Female Genital

A rare case of vulvovaginal tuberculosis is reported. A 76-year-old woman presented with a painful ulcer at the posterior fourchette and lower vagina for 6 weeks. Direct biopsy for histologic examination revealed mycobacterial infection. Anti-tuberculosis treatment was effective for this patient. We suggest prompt biopsies for suspicious vulvar or vaginal lesions.

Topics: Aged; Anti-Bacterial Agents; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; HIV Seronegativity; Humans; Isoniazid; Pyrazinamide; Rifampin; Tuberculosis, Female Genital; Vulvovaginitis

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.

Topics: Adnexal Diseases; Adult; Antigens, Tumor-Associated, Carbohydrate; Ascitic Fluid; Diagnosis, Differential; Ethambutol; Female; Humans; Infertility, Female; Isoniazid; Menopause; Middle Aged; Peritonitis, Tuberculous; Pyrazinamide; Rifampin; Tuberculosis, Female Genital; Uterine Diseases

Short course chemotherapy with 2SHRZ/7HR of 9 months duration was given in 41 proven cases of female genital tuberculosis. Thirty-two (78%) patients completed 9 months of therapy. Twenty-five (61%) were pronounced cured. Short course chemotherapy appears to be quite effective in patients of genital tract tuberculosis.

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Female; Humans; Isoniazid; Middle Aged; Prospective Studies; Pyrazinamide; Rifampin; Streptomycin; Time Factors; Treatment Outcome; Tuberculosis, Female Genital

A daily regimen of rifampicin (450 mg) and isoniazid (300 mg) was tried for 9 months in 14 women with histologically diagnosed endometrial tuberculosis (TB). Follow-up endometrial biopsies were negative for tubercular disease in all patients. Three (21.4%) of the 14 women conceived between 3 and 12 months after starting treatment.

Topics: Adult; Drug Therapy, Combination; Female; Humans; Isoniazid; Rifampin; Tuberculosis, Female Genital

A study has been made of 710 patients with proved gynaecological tuberculosis investigated between January 1, 1951 and March 31, 1985. The main presenting symptoms in order of frequency were infertility, pelvic pain, excessive menstrual loss and amenorrhoea. The average age was 31 years at first attendance, only 16% of married women had been pregnant and palpable adnexal masses were found in 47%. Seven drug programmes have been used, the best results being obtained with the current regimen employing rifampicin, ethambutol and isoniazid. Where drug treatment failed, surgery under further drug cover was successfully employed. Toxic drug reactions occurred in 114 patients.

Topics: Adolescent; Adult; Aged; Drug Administration Schedule; Ethambutol; Fallopian Tube Diseases; Female; Humans; Isoniazid; Middle Aged; Ovarian Diseases; Rifampin; Tuberculosis, Female Genital; Uterine Diseases

Topics: Adult; Aminosalicylic Acid; Anti-Bacterial Agents; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Rifampin; Streptomycin; Tuberculosis, Female Genital

From 1964 to 1979 we diagnosed 185 new cases of female genital tuberculosis. We report the used diagnostic methods and the changes observed in this time relating to age distribution, subjective symptoms, previous and present specific lesions, clinical and anatomo-pathologic manifestations. We show either the therapeutic schedule, including rifampin, isoniazid and ethambutol, or the surgical treatment indications. With evolution and therapy of pulmonary manifestations, we debate the decrease in genital forms of extrapulmonary tuberculosis and, within the limits of that, the pelviperitonitis disappearance and the reduced incidence of tubal and ovarian inflammations and of genito-pelvic manifestations.

Topics: Amenorrhea; Ethambutol; Female; Humans; Infertility, Female; Isoniazid; Rifampin; Tuberculosis, Female Genital

A study was made of women with postmenopausal tuberculosis of the genital tract investigated between January 1, 1951, and March 1, 1981. Twenty-six of 701 patients (3.7%) with proved gynecologic tuberculosis had postmenopausal infection. The age incidence of gynecologic tuberculosis has changed in recent years; the proportion of patients over 40 years of age is now much higher than in the past. Since January 1, 1976, a combination of rifampicin, ethambutol, and isoniazid has been employed in the treatment of this disease. Six new cases treated with this drug program are described. No patient showed evidence of recurrence at follow-up.

Topics: Adult; Age Factors; Aged; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Menopause; Middle Aged; Rifampin; Tuberculosis, Female Genital

Topics: Ethambutol; Female; Humans; Isoniazid; Male; Rifampin; Tuberculosis, Female Genital

Between 1st January 1950 and 15th June 1978, 638 women with proved tuberculosis of the genital tract were investigated. 7 different drug programmes were used to treat 581 patients. Apart from the most recent regimens employing ethambutol and rifampicin, the best results were obtained with a combination of streptomycin, PAS and isoniazid for 18 mth or 2 yr. Today the treatment of choice is a combination of rifampicin, ethambutol and isoniazid for 1 yr. Surgery should be employed where drug treatment has failed. It is essential that women with tuberculosis of the pelvic organs should be followed up indefinitely after drug treatment.

Topics: Aminosalicylic Acid; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Rifampin; Scotland; Streptomycin; Tuberculosis, Female Genital

Successful pregnancy following proven endometrial tuberculosis is rare. Such a case is reported where conception occurred within three months of finishing treatment. It is suggested that rifampin may offer a better prospect of subsequent fertility than other chemotherapuetic agents.

Topics: Adult; Endometritis; Female; Humans; Infant, Newborn; Pregnancy; Rifampin; Tuberculosis, Female Genital

Topics: Adult; Female; Fetus; Humans; Pregnancy; Pregnancy Trimester, First; Rifampin; Teratogens; Tuberculosis, Female Genital; Uterine Cervical Diseases

A study has been made of women with proved, tuberculosis of the genital tract who were treated with drugs between 1st January, 1951, and 1st July, 1976. Seven different drug programmes were employed and 566 women were treated. Apart from the last two schedules employing the newer antituberculosis drugs, which were too recent for a follow-up to be available, the best results were obtained with a combination of streptomycin, PAS and isoniazid for 18 months or two years. In this group, 87.7 per cent were regarded as cured after an average follow-up of six years and six months. Drug cover was employed in 79 patients in whom surgery was found to be necessary and the results were uniformly satisfactory. Toxic drug reactions occurred in 18.2 per cent of the patients treated.

Topics: Aminosalicylic Acid; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Rifampin; Streptomycin; Tuberculosis, Female Genital

Topics: Ethambutol; Female; Glucocorticoids; Humans; Isoniazid; Pregnancy; Pregnancy Complications, Infectious; Rifampin; Salpingitis; Tuberculosis, Female Genital

Topics: Antigen-Antibody Reactions; Cortisone; Drug Hypersensitivity; Female; Humans; Hydrocortisone; Knee; Male; Middle Aged; Prednisolone; Rifampin; Salpingitis; Tuberculosis, Female Genital; Tuberculosis, Osteoarticular