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Genital Tuberclosis - Undiagnosed
My wife was diagnosed with Endometriotic Cysts on both ovaries in May 2015 after several blood/hormones tests and Transvaginal Ultrasounds. She consulted many doctors,some of them prescribed her medicines to suppress the cysts while others suggested to go for Laproscopic removal of endometriotic cysts.
After consulting various gynaecologist and going through various Ultrasounds and Follicular Monitoring and all of them being diagnosed with Endometriosis she finally decided to go for surgical removal of Laproscopic removal of bilateral endometriomas in June, 2016, the surgery was performed by a Senior Surgeon (HOD - Gynecology)
After the surgery Docto told us that it was not a case of Endometriosis. The cysts were not endometritic cysts and were not on the ovaries. There were two cysts each located at the fimbrial ends of the fallopian tubes filled with some caseous material. The doctors first punctured the cyst on one side considering it an endometriotic cyst and then removed rest of the tissue by burning it. While on the other side she removed the cyst along with the fimbrial end.
The doctor claim this to be a rare case of Tuberclosis where this caseous material is being generated in uterus and flows into the fallopian tubes. Both the tubes are found thick in size. Various tuberculosis test like Montoux, PCR TB, Quantiferon TB Gold are done but all show negative results. But the Biopsy test confirms Genital Tuberclosis.
Now, I have 2 questions:
1. What should be the line of treatment?
2. Can my wife conceive naturally?
After consulting various gynaecologist and going through various Ultrasounds and Follicular Monitoring and all of them being diagnosed with Endometriosis she finally decided to go for surgical removal of Laproscopic removal of bilateral endometriomas in June, 2016, the surgery was performed by a Senior Surgeon (HOD - Gynecology)
After the surgery Docto told us that it was not a case of Endometriosis. The cysts were not endometritic cysts and were not on the ovaries. There were two cysts each located at the fimbrial ends of the fallopian tubes filled with some caseous material. The doctors first punctured the cyst on one side considering it an endometriotic cyst and then removed rest of the tissue by burning it. While on the other side she removed the cyst along with the fimbrial end.
The doctor claim this to be a rare case of Tuberclosis where this caseous material is being generated in uterus and flows into the fallopian tubes. Both the tubes are found thick in size. Various tuberculosis test like Montoux, PCR TB, Quantiferon TB Gold are done but all show negative results. But the Biopsy test confirms Genital Tuberclosis.
Now, I have 2 questions:
1. What should be the line of treatment?
2. Can my wife conceive naturally?
Contact the United States CDC, who contracts with two different labs for purposes of genotyping. They will tell you the procedure to have this acomplished.
From a trust resource this is what I was told as I had not even heard of it before.
Yeah, this is actually a thing. Penile tuberculosis as well.
Anti-tubercular therapy can be tried, though it is not always successful. Current consensus states "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." If infertility persists, surrogacy might be indicated. Sometimes surgery in combo with ATT is more successful.
Are they Indian perchance? This is a growing problem overseas; we don't see it a lot here. Most of the research also comes out of India and Asia. It's difficult but not impossible to treat and maintain/restore fertility.
Hope that helps
Yeah, this is actually a thing. Penile tuberculosis as well.
Anti-tubercular therapy can be tried, though it is not always successful. Current consensus states "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." If infertility persists, surrogacy might be indicated. Sometimes surgery in combo with ATT is more successful.
Are they Indian perchance? This is a growing problem overseas; we don't see it a lot here. Most of the research also comes out of India and Asia. It's difficult but not impossible to treat and maintain/restore fertility.
Hope that helps
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This is an extremely complex question. There are over 6,000 varieties of tb, and they require different treatments. I researched tb for almost a year in the past. Square one is to identify the specific variety. There is no cure for tb. You can only put the organism into remission. It can spread to every part of the body. It hides within walls of biofilm and the antibiotics will not reach it. Therefore, without identifying the specific variety, it is is inapproriate to suggest a protocol. In general several antibiotics are adminstered simultaneously over an extended period of time and it is essential not to miss a dose. You are going to search hard for a lab that will identify the specific variety, but this is essential. You need to contact a tb specialist for advice as to a treatment protocol. Almost any one of the varieties can cause an infection anywhere in the body. Treatment is based on identification of the variety - not the place where the infection is. Some varieties are extremely difficult to treat. Recently in New York, an illegal alien from Russia who had been in a prison was identified with a rare strain called 148 that does not appear to respond to any treatment. The New York City Department of health has the ability to identify specific strains.
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