PELVIC TUBERCULOSIS: How To go about it?
PELVIC TUBERCULOSIS: How To go about it?
By Dr. Karen Acosta, OB-GYN
Tuberculosis caused by mycobacterium tuberculosis or Mycobacterium bovis can thrive not only in the lungs, but essentially throughout the body. One rare location of affectation is in the upper reproductive tract. The primary site of infection for tuberculosis is usually the lung, and then spread to the pelvic organs through the lymph or blood. The fallopian tubes are the predominant site of pelvic tuberculosis, but the bacilli also spread to the endometrium and occasionally the ovaries.
Pelvic tuberculosis occurs most often in patients between the ages of 20 and 40 years. The most common clinical symptoms of pelvic tuberculosis include pelvic pain, body malaise, menstrual irregularity, and infertility. Among patients with pulmonary tuberculosis, the incidence of pelvic tuberculosis generally varies between 10% and 20%.
In general, extrapulmonary tuberculosis may present as either an insidious or as a rapidly progressing disease. Mild-to-moderate chronic abdominal and pelvic pain occurs in 35% of cases. Some women may be asymptomatic the findings at pelvic examination are normal in approximately 50% of patients. The rest has mild adnexal tenderness and bilateral adnexal masses.
A dilatation and curettage or endometrial biopsy are diagnostic in some cases, especially if performed in the late premenstrual phase of the menstrual cycle. 1n addition to standard microscopic sections, the specimen can be examined by fluorescent antibody technique. Acid-fast staining of tissue or culture of menstrual blood is effective in detecting the organism in only about 10°/0 of cases. A more reliable test the Polymerase Chain Reaction test to TB DNA — which is available in the Palawan MMG Multipurpose Cooperative Hospital can also be done.
The diagnosis of tuberculosis cannot be made with certainty from a hysterosalpingogram, but it may be helpful. Although a conclusive diagnosis of pelvic tuberculosis can be made only from a positive culture, hysterosalpingography is a useful aid, especially in patients who are asymptomatic except for infertility. When the diagnosis of pelvic tuberculosis cannot be made in other ways, laparoscopy has been used. If possible, biopsy specimens of tubal fimbriae or other suspicious areas should be examined histologically or cultured to confirm the diagnosis.
The treatment of pelvic tuberculosis is medical. Initial therapy in a patient with newly diagnosed tuberculosis usually will include five drugs because of the emergence of multidrug-resistant organisms. Operative therapy for pelvic tuberculosis is reserved for women with persistent pelvic masses, some women with resistant organisms, women older than 40, and women whose endometrial cultures remain positive. Although the major sequelae of pelvic tuberculosis are infertility, occasionally a woman will become pregnant after medical therapy.
References:
Comprehensive Gynecology 5th ed – V. Katz, et al., (Mosby, 2007) Te Linde’s Operative Gynecology 10th ed J. Rock, et al., (Lippincott Williams, 2008)