tuberculous oophoritis

What is Tuberculous Oophoritis?

Tuberculous oophoritis is a rare and serious condition where the ovaries become infected with tuberculosis (TB). This infection can cause inflammation, scarring, and damage to the ovaries, leading to various symptoms and complications.

Characteristics of Tuberculous Oophoritis

• Inflammation: The ovaries become inflamed due to the TB infection, which can lead to pain, swelling, and redness in the pelvic area.
• Caseating granulomas: In tuberculous oophoritis, typical tubercles or larger foci with caseous centers may be recognized on cross-sections in the hilum of the ovary [3].
• Pathogenic inflammatory response: The infection causes a pathogenic inflammatory response in the ovaries, leading to inflammation and damage [4].

Symptoms and Complications

• Pelvic pain: Pain in the pelvic area is a common symptom of tuberculous oophoritis.
• Infertility: Tuberculous oophoritis can lead to infertility due to the damage caused to the ovaries.
• Genital TB: Genital tuberculosis (TB) is a cause of female infertility in up to 17% of cases [15].

References

[3] - In TB oophoritis, typical tubercles or larger foci with caseous centers may be recognized on cross-sections in the hilum of the ovary. [4] - An urogenital tuberculosis involving a pathogenic inflammatory response in the ovary. [15] - Genital tuberculosis (TB) is a cause of female infertility in up to 17% of cases, ranging from 1% in developed countries to 17% in developing countries.

Common Signs and Symptoms

Tuberculous oophoritis, a rare form of tuberculosis affecting the ovaries, can manifest with various symptoms. While not exhaustive, some common signs and symptoms include:

• Pelvic pain: A persistent ache in the lower abdomen, which may worsen over time [9].
• Infertility: Difficulty conceiving or experiencing recurrent miscarriages due to tuberculous oophoritis affecting the ovaries' function [13][15].
• Abnormal uterine bleeding: Irregular menstrual cycles, heavy or light bleeding, or postmenopausal bleeding due to inflammation and scarring in the reproductive tract [10][13][15].
• Pelvic mass: A palpable lump or swelling in the lower abdomen, which may be tender to touch [11].
• Systemic symptoms: Fever, night sweats, weight loss, and fatigue, as seen in other forms of tuberculosis [12].

Important Considerations

It's essential to note that these symptoms can also be indicative of other conditions. A definitive diagnosis of tuberculous oophoritis requires a combination of clinical evaluation, imaging studies (e.g., ultrasound or CT scans), and laboratory tests (e.g., biopsy or culture) to confirm the presence of Mycobacterium tuberculosis in the affected tissues.

References

[9] Oophoritis is typically caused by a bacterial infection, and may result from chronic pelvic inflammatory disease (PID). This form differs from autoimmune oophoritis, a disorder caused by a... (Source: #9)

[10] TB of the reproductive tract presents with complaints that resemble cancer of the endometrium, namely post-menopausal bleeding, continuous... (Source: #10)

[11] The signs are typical of the cardinal signs of inflammation: redness, heat, swelling, pain, and loss of function. (Source: #11)

[12] The constitutional symptoms of TB such as anorexia, weight loss, night sweats, and evening rise in temperature have been reported in up to 45% of patients. (Source: #12)

[13] The four major presenting complaints in symptomatic patients are: infertility, abnormal uterine bleeding, pelvic pain, and amenorrhea [4]. (Source: #13)

[14] Symptoms vary by site but generally include fever, malaise, and weight loss. Diagnosis is most often by sputum smear and culture and, increasingly, by rapid... (Source: #14)

[15] The four major presenting complaints in symptomatic patients are: infertility, abnormal uterine bleeding, pelvic pain, and amenorrhea [4]. (Source: #15)

Diagnostic Tests for Tuberculous Oophoritis

Tuberculous oophoritis, a rare form of tuberculosis affecting the ovaries, can be challenging to diagnose. However, various diagnostic tests can help confirm the condition.

• Sputum Smear and Culture: While not directly related to tuberculous oophoritis, sputum smear and culture are essential for diagnosing pulmonary TB, which is often associated with genital TB [5].
• Hysterosalpingogram (HSG) and Ultrasound: These imaging modalities can detect tubercular changes in the fallopian tubes and uterus, making them useful for diagnosing tuberculous oophoritis [2][3].
• Cross-Sectional Imaging: This is essential for detecting tubercular changes in the ovaries and surrounding tissues [2].
• Seroologic Examination: Most patients with autoimmune oophoritis will have antibodies to steroid cell antigens in their serum, which can be a useful diagnostic marker [7].
• Histologic or Bacteriologic Examination: The definitive diagnosis of tuberculous oophoritis lies in identifying the tubercle bacilli through histologic or bacteriologic examination [8].

It's worth noting that the diagnosis of tuberculous oophoritis can be made with certainty only by histologic or bacteriologic examination. However, these tests may not always be available or feasible.

References:

[1] H Kesharwani (2022) - For diagnostic testing, on the first day of menstruation, blood and fluid can be removed from the genital tract [30]. [2] A Aggarwal (2022) - Hysterosalpingogram and ultrasound can best detect tubercular changes in fallopian tubes and uterus whereas cross-sectional imaging is essential for the diagnosis of tuberculous oophoritis. [3] HU Shah (2015) - Hysterosalpingography (HSG) and ultrasonography (US) remain the main imaging modalities used in the diagnosis of genital TB. [4] M Naeem (2021) - Patients with genitourinary symptoms can undergo urinalysis and urine culture testing. [5] Diagnosis is most often by sputum smear and culture and, increasingly, by rapid molecular-based diagnostic tests. Treatment is with multiple antimicrobial drugs ... [6] W Gudu (2018) - The definitive diagnosis of pelvic Tb lies in identifying the tubercle bacilli by microbiologic examinations including culture or PCR which can be used to diagnose tuberculous oophoritis. [7] SEROLOGIC EXAMINATION. Most patients with autoimmune oophoritis will have antibodies to steroid cell antigens in their serum. [8] The diagnosis can be made with certainty only by histologic or bacteriologic examination. If bacteriologic examination of endocervical mucus was performed for the diagnosis of tuberculous oophoritis, it would provide a definitive diagnosis.

Treatment Overview

The treatment of tuberculous oophoritis, also known as tubo-ovarian abscess or pelvic tuberculosis, typically involves a combination of medications to combat the infection.

• Standard Regimens: The standard treatment for most cases of tuberculous oophoritis is a 6-9 month course of anti-tuberculous therapy using four drugs: rifampicin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E) [6][9].
• Treatment Duration: The treatment duration may vary depending on the severity of the infection, but 6-9 months of therapy is usually sufficient for most cases [10].

Medications Used

The following medications are commonly used to treat tuberculous oophoritis:

• Doxycycline: This antibiotic is often prescribed as a first-line treatment for oral therapy [5].
• Azithromycin: This antibiotic can also be used in some cases, especially when doxycycline is not effective [5].

Importance of Early Treatment

Early treatment is crucial to prevent complications and ensure the best possible outcome. Delaying treatment can lead to scarring and damage to the reproductive system [14].

References

• [1] Kesharwani H (2022) - During the first two months of the intensive phase, four medications rifampicin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E) are used.
• [6] Gudu W (2018) - The management of pelvic tuberculosis is in general medical (6 to 9 months of anti-tuberculous therapy).
• [10] Salpingo-oophoritis can occur after menarche, when the fallopian tubes become vascular. ... Drug treatment is the most important modality and follows standard regimens and principles.
• [14] Treatment is usually successful in curing PID and oophoritis. However, treatment will not reverse any damage to the reproductive system, such as scarring.

Differential Diagnosis of Tuberculous Oophoritis

Tuberculous oophoritis, a form of genital tuberculosis affecting the ovaries, can be challenging to diagnose due to its rarity and similarity in symptoms with other conditions. The differential diagnosis for tuberculous oophoritis includes:

• Pelvic Inflammatory Disease (PID): A bacterial infection that can cause inflammation in the female reproductive organs, including the ovaries.
• Ectopic Pregnancy: A pregnancy where the fertilized egg implants outside the uterus, often in the fallopian tube.
• Ovarian Cyst: A fluid-filled sac on the surface of the ovary.
• Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, leading to pain and infertility.
• Carcinoma of the Colon: A type of