TUBERCULOSIS: Genital tuberculosis major cause of tubal infertility in women

Bobby Ramakant - CNS


Genital tuberculosis (TB) is a major cause of tubal infertility, said Mamta Jacob of Global Health Advocates (GHA) at a meeting on importance of addressing TB in context of women's health in New Delhi, India, to mark the International Women's Day (8th March). Only two per cent of women with genital TB have live births. It is usually asymptomatic so needs higher degree of suspicion so that proper diagnosis can be made and standard treatment provided as early as possible, said Dr Nerges Mistry, Director, The Foundation for Medical Research, Mumbai, who was another keynote speaker at the above mentioned meet.
Genital TB is responsible for infertility in 5-10 per cent of women. In Australia, 1 per cent infertility in women is attributed to genital TB but in India, 19 per cent infertility in women is attributed to genital TB, said Dr Nerges Mistry.
Also the impact of genital TB is more severe on lives of women because mostly genital TB impacts women of age group 15-35 years. Only 10% of genital TB in women is post-menopausal, said Dr Nerges Mistry.
Women with genital TB present with bleeding discharge, ulcers, among other symptoms if any. Genital TB is always hard to diagnose, because of the fact that it is a silent invader of the genital tract. For diagnosing genital TB, AFB smears, polymerase Chain Reaction (PCR) tests, CT or MRI scanning or ultrasound might be used as appropriate, said Dr Nerges Mistry. The treatment of genital TB is same in case of drug-susceptible TB - 6 months of WHO recommended directly observed treatment shortcourse (DOTS). However, 2 per cent of genital TB cases are likely to be of multidrug-resistant TB (MDR-TB). Surgery might be required if medicines fail said Dr Nerges Mistry.
The solution lies in early case detection and providing standard treatment for genital TB. Sadly if women with genital TB are diagnosed late, the infertility risk and other harm done to their tissue are likely to be much more severe.
In 2008, 3.6 million women were sick with TB. "Compared to pregnant women without TB disease, pregnant women with TB have more severe impact on pregnancy outcomes. Rates per 1000 pregnancies of low birth weight (< 2.5 kg) for women without TB is 165, and for women with TB is double at 342; for prematurity (< 37 weeks) the rate for women without TB is 111 and for those with TB is 228 (twice); for perinatal death, the rates for women without TB is 16, but for those with TB is nearly five times higher at 101; for foetal death (16-28 weeks), the rates for women without TB is 2, but for those with TB is nearly ten times higher at 20" said Mamta Jacob.
Raising awareness about genital TB is surely a key. Engaging women with TB or who have successfully completed TB treatment as equal partners in addressing the challenge posed by genital TB will go a long way in saving human agony, morbidity and lives.
http://www.citizen-news.org/2011/03/genital-tuberculosis-major-cause-of.html

TUBERCULOSIS: Preventing tuberculosis deaths in India

In the New Yorker, Michael Specter reports on tuberculosis, the world's deadliest infectious disease -- worldwide, more than 5000 people die from it every day. In India, misdiagnosis and improper treatment result in tens of thousands of unnecessary deaths a month and even new genetic screening machines might not help matters. Since late 2009, the hospital has had one unique asset: a piece of equipment called a P.C.R., which can multiply tiny samples of DNA and analyze them. The device is not as fast as the GeneXpert, but it can examine the genetics of virtually any organism, including tuberculosis. The hospital's machine, which was purchased with money from a government research grant, has never been used. "The hospital has had this for months," Mannan said. "But nobody knows how it works." We were standing at the door of the virology lab, where the new P.C.R. Cobas TaqMan 48, made by Roche and sold for roughly fifty thousand dollars, was resting on a shelf, still wrapped in its shipping material.
How could that be? I was staring at a machine that could alter, even save, the lives of scores of the people who were sitting nearby in the gathering heat. Mannan said nothing, though his anger was palpable.
[...] "It's a nice lab," Mannan said when we left. "Beautiful, actually. But if the doctors used it properly that would interfere with their private practice."
I asked what he meant.
"It is simple," he said. "If patients are treated at the hospital, they won't need to pay for anything else."
http://kottke.org/10/11/preventing-tuberculosis-deaths-in-india

PCR assays

Scientists from the US Centers for Disease Control have for the first time directly compared the ability of three types of PCR assays to detect DNA from various species of Plasmodium, the parasite that causes malaria.
According to the results of their work, the so-called "nested" PCR assay — currently considered the gold standard despite being more time- and labor-intensive — is still more effective than easier-to-perform semi-nested or single-tube multiplex PCR assays for detecting Plasmodium.
http://www.genomeweb.com/pcrsample-prep/cdc-researchers-verify-nested-pcr-assay-gold-standard-malaria-dx