Female genital tuberculosis and infertility: serial cases report in Bandung, Indonesia and literature review

Abstract

BackgroundFemale genital tuberculosis (FGTB) is a Mycobacterium infection in the reproductive organs which often leads to infertility. FGTB is either asymptomatic or causes uncharacteristic clinical presentations, making an early diagnosis is challenging. Our aims were to evaluate the clinical presentations, the process to confirm the diagnosis and followed-up the patients who had undergone laparoscopy at our center. FGTB has been reported from many countries, but has never been reported from Indonesia. Here we present case studies to document the presence of FGTB in Indonesia.Cases presentationThere were three patients admitted to our center; two patients were admitted with irregular menstrual cycle as their chief complaint, while one patient came due to infertility. The results from laparoscopy were suggestive of FGTB; including the presence of caseating granulomas surrounded by epithelioid cells, lymphocytes, plasma cells, and Langhans giant cells. Additionally, PCR testing confirmed presence of MTB. Subsequent to diagnosis, continuous TB medications was administered with excellent clinical outcome in two patients (pregnant in 18 months after under gone laparoscopy). The infertile patient remain in one of the treated patient above.ConclusionIn infertile patients who live in countries where Tuberculosis is an endemic disease, such as Indonesia, a comprehensive history taking, along with ultrasonography results can be used to diagnose FGTB. Confirmation of this diagnosis can be achieved through polymerase chain reactions result. Timely diagnosis and treatment are imperative to prevent any permanent injury to patient’s reproductive organs.

Genital tuberculosis in a Woman Manifested as Secondary Subfertility

“…GTB is frequently acquired by haematogenous spread or lymphatic spread from an extragenital site. Interestingly, genital tract is almost never a primary infection site (1). Most frequent sites of involvement are the fallopian tubes (90-100%), endometrium (50-60%) and ovaries (30%) similar to present case (3,4,5).…”

“…If the endometrium is superficially affected, secretory response of the endometrium to hormones remains intact. Severe involvement leads to ulcerative or fungating lesions and even obliteration of the uterine cavity with adhesions (Ashermans syndrome), grossly mimicking carcinoma (1). Endometrial atrophy can also occur with total destruction of the uterine cavity causing amenorrhoea and occlusion of cavity resulting in pyometron (1,4).…”

“…Tuberculosis can be categorized into pulmonary and extrapulmonary forms based on the affected organ. Genital tuberculosis (GTB) represents 15-20% of cases of extrapulmonary TB and affects 12.1% of patients with pulmonary TB (1). GTB mainly affects women in the reproductive age group (20-40 years).…”

Genital Tract Tuberculosis in a 42-year Female Masquerading as Ovarian Malignancy

“…Other symptoms in their studies included fever, ascites, irregular vaginal bleeding, oligomenorrhoea, chest pain and pain in the flanks [12]. Infertility as the main presenting feature in genital tuberculosis was reported by many authors [5,7,[12][13][14][15][16][17][18][19][20][21][22][23][24]. Ovarian presentation with raised CA125 and therefore mimicry of ovarian cancer is a common way of presentation [25][26][27].…”

Nanoparticle Characterization of Allium sativum, Curcuma mangga and Acorus calamus as a Basic of Nanotechnology on Jamu Subur Kandungan Madura

“…Various factors cause infertility in woman, including intrinsic such as anatomic, 1 genetic, 2 hormonal, and immunological disorder factor or extrinsic like sexually transmitted infection (STI), tuberculosis of the pelvis and obesity. 3,4 The various chemical drugs have been developed to treat infertility, but many of the people in the world has been dependent on herbal medicine for healthcare 5 since it has a fewer negative effect as compared to the synthetic drug. Indonesia is the world's second-largest country by diversity after Brazil that has considerable biodiversity potential in the world.…”