Professional Documents
Culture Documents
517-522, 2014
Available online at http://www.ijsrpub.com/ijsrk
ISSN: 2322-4541; 2014; Author(s) retain the copyright of this article
http://dx.doi.org/10.12983/ijsrk-2014-p0517-0522
Abstract. Female genital tract tuberculosis is a rare disease, the exact incidence is not accurately known as it is under reported
due to asymptomatic cases and lack of reliable confirmatory investigations. Observational study held at Elwiya maternity
teaching hospital, from the beginning of June 2012 until the beginning of October 2014. During this period, nine patients
diagnosed as cases of female genital tract tuberculosis. Patients admitted as emergency or elective cases, symptoms at
presentation were fever, vomiting, loss of weight, loss of appetite, mild abdominal pain, acute abdomen, abdominal mass,
ascites, ovarian cyst with elevated CA-125 serum levels, infertility, infected cesarean section wound. All these nine cases were
diagnosed and followed up for one year. The diagnostic dilemma arises due to varied clinical presentation so clinical suspicion
with detailed general physical examination should always be there especially in high prevalence areas of tuberculosis.
Keywords: pulmonary tuberculosis, extra pulmonary tuberculosis, ovarian cysts, infertility
1. INTRODUCTION
Tuberculosis (TB) is as old as human civilization
(Rao, 1981). In 2012, 8.6 million people fell ill with
TB and 1.3 million died from TB. Over 95% of TB,
deaths occur in low- and middle-income countries,
and it is among the top three causes of death for
women aged 15 to 44 (Tuberculosis Fact sheet, 2013).
Tuberculosis is a preventable and curable infective
disease, caused mainly by Mycobacterium
tuberculosis, it exists in two forms: pulmonary and
extra pulmonary tuberculosis (Sarawat et al., 2010).
Tuberculosis is seen in all ages and Mycobacterium
tuberculosis is the causative organism in 90-95% of
cases where as Mycobacterium bovis can also cause
the disease (Duggal et al., 2009).
In humans, tuberculosis can affect any organ
including genital system. Manifestations include the
traditional symptoms of fever, night-sweats and
weight-loss. There is a host of different clinical,
radiological, microbiological and pathological features
that are used to diagnose TB. In 2009, World Health
Organization (WHO) reported that there was a global
reduction in the number of TB cases since 2006
(WHO, 2013). TB can affect the female genital
system and can cause a variety of symptoms and
signs, spanning from fertility problems to pregnancy
complications including pregnancy losses. Genital
system tuberculosis represents 15-20% of extrapulmonary TB and is usually asymptomatic affecting
517
Sarsam
Presentation of Tuberculosis in Gynecology
Family history
of tuberculosis
1
33
high
urban
Health
worker
Chest
infection
with plural
effusion four
months
before
presentation
-ve
2
32
low
rural
House wife
3
15
middle
urban
student
4
24
low
rural
House wife
Fever during
pregnancy 2
months before
presentation was
diagnosed as
chorioamnitis
and ended with
cesarean section
+ve
-ve
Chest
infection 8
months
before
presentation.
She is
diabetic
-ve
+ve
5
24
middle
urban
House
wife
-ve
6
22
low
rural
House
wife
-ve
7
30
low
rural
House
wife
-ve
8
17
middle
urban
House
wife
-ve
9
25
middle
urban
worker
+ve
-ve
+ve
+ve
-ve
-ve
518
3. RESULTS
As shown in Table 1, all patients were of reproductive
age, of different social status. Five patients were from
rural areas, one of the patients was a health worker,
two patients gave history of chest infection more than
four months before presentation and one had fever
with pregnancy diagnosed as chorioamnitis and ended
with cesarean section.
Five patients had family
history of tuberculosis and one discovered to be
diabetic. Table 2 shows the symptoms at presentation.
Three cases presented with acute abdominal pain and
abdominal mass, two had high CA125 with ovarian
cysts and four cases presented with infertility.
2
yes
yes
yes
-ve
yes
yes
yes
yes
yes
Right
ovarian
cyst
3
yes
yes
yes
-ve
-ve
yes
-ve
yes
yes
Right
ovarian
cyst
4
yes
yes
yes
yes
yes
yes
-ve
-ve
yes
Left
ovarian
cyst
5
yes
-ve
yes
yes
yes
-ve
Yes
-ve
-ve
-ve
6
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
Left
ovarian
cyst
7
-ve
-ve
-ve
-ve
-ve
-ve
yes
-ve
-ve
Left
ovarian
cyst
8
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
-ve
Bilateral
ovarian
cysts
9
-ve
-ve
-ve
-ve
-ve
-ve
Yes
-ve
-ve
-ve
Infertility
1
-ve
-ve
-ve
yes
yes
-ve
-ve
-ve
-ve
Bilateral
ovarian cyst
for three
months
-ve
-ve
-ve
-ve
hysterosalpigography
Not done
Not done
Not done
Infected cesarean
section wound
-ve
-ve
-ve
Secondary
infertility
Patent
tubes
-ve
Primary
infertility
Blocked
tubes
-ve
Primary
infertility
Blocked
tubes
-ve
Secondary
infertility
Blocked
tubes
-ve
Primary
infertility
Blocked
tubes
-ve
Not
done
yes
519
Sarsam
Presentation of Tuberculosis in Gynecology
2
Laparoto
my
Wet TB
Biopsy
done
3
Laparotomy
Wet TB
Biopsy
done
4
PCR
from
ascetic
fluid
Wet
TB
5
Biopsy from
the infected
wound not
responding to
treatment
Biopsy done
6
Laparoscopy
Fibro
adhesive
Biopsy done
7
Laparoscopy
Fibro
adhesive
8
Laparoscopy
fibroadhes
ive
Biopsy
done
9
Laparoscopy
Beaded
tubes with
small right
ovarian cyst
biopsy done
Caseating
granulom
a with
histiocyte
s and
Langhans
cells
Caseating
granuloma
with
histiocytes
and
Langhans
cells
Not
done
non-caseating
granulomatous
inflammation
with
histiocytes and
Langhans cells
Caseating
granuloma
with
histiocytes
and
Langhans
cells
Caseating
granuloma
with
histiocytes
and
Langhans
cells
Caseating
granuloma
with
histiocytes
and
Langhans
cells
Caseating
granuloma
with
histiocytes
and
Langhans
cells
1
Ovarian
cysts
disappeared
2
Responded
to treatment
3
Responded
to treatment
4
Ascites and
ovarian
cyst
disappeared
5
Got
well
6
She
regained
tubal
patency
7
Still having
amenorrhea
and blocked
tubes
8
Responded
to
treatment
9
Undergoing
In Vitro
Fertilization
program
4. DISCUSSION
The World Bank provides data about tuberculosis in
Iraq from 1990 to 2012. The average value for Iraq
during that period was 49.61 cases of tuberculosis per
100,000 people with a minimum of 45 cases per
100,000 people in 2010 and a maximum of 54 cases
per 100,000 people in 1990. Doctors say TB had been
largely under control in Iraq for the past 50 years but
is now making a comeback due to widespread
poverty, large amounts of dust in the air and a lack of
health awareness programs and medicines. "The
spread of TB after more than 50 years is something
worrying," The Iraqi health system was badly affected
by extended years of conflict and international
sanctions. Due to the absence of a national census in
Iraq, estimation of national prevalence of TB cases
was a significant challenge. Disease patterns have
changed, with a higher incidence of disseminated and
extra pulmonary disease now found (The World Bank,
2012; Golden and Vikram, 2005).
Tuberculosis annual report in Iraq 2012 republic of
Iraq ministry of health chest and respiratory diseases
specialized center reported 9099 cases of TB in the
year 2012, of these 3261 were extra pulmonary
(35.82%) of all detected cases of tuberculosis.
This study revealed, female genital tract
tuberculosis is present and it can present in different
presentation as we can see in these cases, ovarian cyst
is an important presentation with high CA 125 there
will be suspicion of malignancy, acute abdomen and
abdominal mass was another presentation which
520
5. CONCLUSION
Extra pulmonary tuberculosis is unpredictable and
female genital tract tuberculosis can present in
unusual presentation, it is recommended that Clinical
suspicion with detailed general physical examination
should always be there in consideration to the
prevalence of tuberculosis in Iraq.
REFERENCES
Alhakeem M, Schneider A. (2013).
Genital
tuberculosis: A rare cause of vulvovaginal
discharge
and
swelling.
Journal
of
Microbiology and Infectious Diseases, 3 (3):
141-143.
521
Sarsam
Presentation of Tuberculosis in Gynecology
Assistant prof. Dr. Samar Dawood Y. Sarsam was born in Baghdad (1960), got
her M.B.Ch.B Degree (1984); Post graduate diploma in Obs. & Gye. (D.O.G)
1992; Board in Obs. & Gye. (C.A.B.O.G) 1992; Worked as Specialist in Mosul
(1992-2006); She joined the academic staff at University of Mosul (2002- 2005);
She joined the academic staff at University of Baghdad, Al Kindey Medical
College (2005 Until now) and got the assistant professor degree at (2008). Areas
of specialization and interest: infertility and laparoscopy.
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