Contrary to popular belief, tuberculosis or tuberculosis does not only affect the lungs, but can also impact other vital organs like the liver, bones, brain and even reproductive health, according to medical experts. Declared a public health emergency by the World Health Organization (WHO) in 2005, TB also contributes significantly to maternal mortality as it is among the top three causes of death among women aged 15-45. years in high-prevalence areas, according to a study by the National Center for Biotechnology Information.
Why does this happen?
Explaining how it affects reproductive health, Dr Bharati Dhorepatil, consultant infertility expert, NOVA IVF Fertility, Pune said that tuberculosis bacteria (TB bacillus) infects the fallopian tubes, in turn causing it to become blocked. It also affects the lining of the uterus, which leads to thinning of the endometrial lining and rare menstruation. “This blockage of the fallopian tubes and the thinning of the endometrial lining leads to fertility issues,” she said.
Female genital tuberculosis (FGTB) affects the fallopian tubes, uterine lining, ovaries, cervix and vagina/vulva. It can damage the fallopian tubes and cause infertility. Genital tuberculosis damages the lining of the uterus, as a result of which adhesions are seen in the uterus causing Asherman’s syndrome, said Dr. Richa Jagtap, Clinical Director and Consultant, Reproductive Medicine, NOVA IVF Fertility, Mumbai. indianexpress.com.
Once the fallopian tubes are impacted, the fertilized egg can no longer enter the tube and reach the uterus or uterus. If the endometrial lining is affected, there will be no implantation of a fertilized embryo in the uterus. The quality and chronic inflammation will also reduce the egg supply, Dr. Dhorepatil explained.
Why does tuberculosis occur?
It occurs due to bacteria called mycobacterium tuberculosis which spreads from person to person via the tiny droplets released into the air when you cough and sneeze. Active TB, one type, is a disease in which TB bacteria multiply rapidly and invade different organs in the body. Miliary tuberculosis affects all the lung tissue which may be fatal.
Cough, chest pain, weight loss, lack of appetite, fatigue, fever, night sweats and chills. Other reported symptoms are menstrual irregularities such as oligomenorrheahypomenorrhea, amenorrhea, menorrhagia, dysmenorrhea, metrorrhagia, pelvic pain and abnormal vaginal discharge, informed Dr. Gowri Kulkarni, Chief Operating Officer, MediBuddy.
Complications of tuberculosis in pregnant women include spontaneous abortion, small-for-date uterus, preterm labor, low birth weight, and increased neonatal mortality. Acquiring an active tuberculosis infection during pregnancy can put both mother and baby at risk, warned Dr. Padma Srivastava, Consultant Obstetrician and Gynecologist, Motherhood Hospitals, Lullanagar, Pune.
“Genital tuberculosis can lead to spontaneous abortion and ectopic pregnancy. An endometrial biopsy and menstrual blood culture can help diagnose genital tuberculosis. A laparoscopy can help understand damage to the genitals. It is essential to attack genital tuberculosis as soon as it is detected. People with genital tuberculosis are treated with ATT (anti-tuberculosis treatment), which helps during pregnancy if diagnosed earlier. Women with genital TB can conceive using assisted reproductive technologies (ART) like IVF when there is a blockage in the tubes and when the mucosa is very thin. They can only be treated with IVF (test tube baby process),” Dr Dhorepatil said.
Based on the medical history and symptoms, a complete physical examination is done through various tests such as tissue-based PCR or genetic expert for the diagnosis of this disease, Dr. Jagtap informed.
“Pelvic tuberculosis is best diagnosed by laparoscopy and hysteroscopy, which gives a direct view and the ability to do a specific tissue biopsy for testing. Hysterosalpingography (HSG) can also be done to assess tubal patency, where a radiopaque dye is introduced via the cervix into the uterus to check for tubal blockage, irregular structure of fallopian tubes and signs of adhesions,” she said.
Pregnant women with a confirmed diagnosis of TB should start treatment without delay.
“Maximum case of infertility are due to tuberculosis, which can affect both partners. Tuberculosis of the uterus may not be symptomatic, but may complain of vague periods or periods without periods or scanty periods. The multidisciplinary approach with a pulmonologist, if necessary, gives excellent cure rates. However, if patients come late with multiorgan involvement, the prognosis is poor. Active tuberculosis is not a contraindication to termination of pregnancy. But TB drugs can have specific effects in the first trimester. Even though there are many government programs, there is still a taboo related to TB and even after that, diagnosed patients are reluctant to treatment,” noted Dr. Meeta Nakhare, Gynecologist at Lokmanya Hospital.
Dr. Deepak Namjoshi, pulmonologist and director of CritiCare Asia Multispeciality Hospital, explained that genital tuberculosis not only affects the mother, but the baby is also at risk because the baby may have low birth weight and there is also a risk neonatal mortality. “With medication, therapy and a balanced diet, genital TB can be treated. In some cases, surgeries are also chosen to treat this condition,” Dr. Namjoshi said.
Treatment is similar to pulmonary TB and requires long-term TB treatment, Dr. Kulkarni said. “This is done using four drugs in the intensive phase and then two drugs in the maintenance phase for a total of six months of treatment. However, the treatment varies in case of multidrug resistant cases,” she said.
How to deal with the sequelae of tuberculosis?
Eat a well-balanced dietfollowing good personal hygiene, trying to be in a ventilated room, taking medicine prescribed by the doctor, getting enough rest, staying hydrated, regular check-ups and avoiding crowded places are prescribed.
According to Dr. Jagtap, childhood vaccinations, good nutrition and healthy habits may be helpful in preventing disease.
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