Female Genital Tuberculosis in Ethiopia: Occurrence and Immunodiagnosis
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Date
2001-06
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Addis Ababa University
Abstract
Female genital tuberculosis (FGTB) causes severe and irreversible damage to the
reproductive organs, most commonly the fallopian tubes and the uterus, ultimately resulting in
infertility. Diagnosis of FGTB is often difficult because of the inaccessibility of the affected
organs, requiring invasive procedures including surgery. There is a strong need for a
simplified and reliable diagnostic technique. This is even more urgent today than in the past
because of the spread of HIV / AIDS and the unknown magnitude of FGTB under the current
epidemic situation. We studied twenty-five gynecological patients diagnosed clinically as
FGTB at the Black Lion Hospital for laboratory evidence of etiology and for possible
associated immunodiagnostic indicators. Biopsy and curettage samples were taken from each
patient and investigated with histopathology, smear microscopy, culture and polymerase chain
reaction (PCR) for Mycobacteria. Culture positive samples were examined for the type of
species. Peripheral blood mononuclear cells were stimulated in vitro with mycobacterial
antigens for recall responses with lymphocyte stimulation Test (LST). Cytokines: IL-IO,
TNF-a and INF-y were measured from the supernatant of cultured PBMC. CD4:CD8 ratio in
blood was evaluated by flow cytometry. Serum IgG, IgA and IgM levels to Mycobacterial
antigen (MPT59) were also measured by ELISA. The study subjects were all in child bearing
age (18-39). Of the 17 patients whose infertility status was known, 6 (35.3) had primary while
II (64.7) had secondary infertility... Among the 25 gynecological patients investigated, only I
was AFB smear positive, 3 were culture positive, 7 were histology positive and 12 were
positive by PCR (a total of 16 positives). CD4:CD8 ratio was not helpful indicator for FGTB.
The serum antibody level did not distinguish between laboratory 'positive' and 'negative'
cases. However, all 'patients' had detectable level of one or more of serum IgG, IgA and IgM
to MPT59. 'Patients' and 'controls' showed remarkable difference in their proliferative
response to PPD suggesting its diagnostic value. The result clearly showed that FGTB is a
rather common clinical problem among Ethiopian gynecological patients and its causative
agent is mainly MTB. As far as this work goes, the only diagnostic method to support the
clinical suspicion is the LST to PPD.
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Biology