Tuberculosis not only affects the lungs, but also women’s reproductive health; know more

Unlike commonly believed, tuberculosis or TB does not only affect the lungs but may also impact other vital organs like the liver, bones, brain, and even the reproductive health, medical experts say. Declared as a public health emergency by World Health Organization (WHO) in 2005, tuberculosis is also a significant contributor to maternal mortality as it is among the three leading causes of death among women aged 15–45 years in high burden areas, according to a National Center for Biotechnology Information study.

Why does it happen?

Explaining how it affects reproductive health, Dr Bharati Dhorepatil, consultant infertility expert, NOVA IVF fertility, Pune said the tuberculosis bacteria (TB bacillus) infects the fallopian tubes, in turn, leading to its blockage. It also affects the uterus lining, which leads to thinning of the endometrium lining and scanty menses. “This blockage of the fallopian tubes and thinning of endometrium lining leads to fertility issues,” she said.

Pregnant women with a confirmed diagnosis of TB should initiate treatment without any dela (Source: Getty Images/Thinkstock)

Female genital tuberculosis (FGTB) takes a toll on the fallopian tubes, uterine lining, ovaries, cervix, and vagina/vulva. It can damage the fallopian tubes and cause infertility. Genital TB damages the lining of the uterus, following which adhesions are seen within the womb causing Asherman’s syndrome, Dr Richa Jagtap, clinical director and consultant, reproductive medicine, NOVA IVF Fertility, Mumbai, told indianexpress.com.

Once the fallopian tubes are impacted, the fertilised egg is not be able to enter the tube and reach the uterus or the womb. If the endometrium lining is impacted, then there will be no fertilised embryo implantation in the uterus. The quality and chronic inflammation will reduce the egg reserve as well, explained Dr Dhorepatil.

Why does TB occur?

It occurs owing to a bacterium called mycobacterium tuberculosis that spreads from person to person via the tiny droplets released into the air when one coughs and sneezes. Active TB, a type, is an illness in which the TB bacteria are rapidly multiplying and invading different organs of the body. Miliary tuberculosis affects the entire lung tissue which can prove fatal.

Symptoms

Coughing, chest pain, weight loss, poor appetite, tiredness, fever, night sweats, and chills. Other symptoms reported are menstrual irregularities such as oligomenorrhoea, hypomenorrhoea, amenorrhoea, menorrhagia, dysmenorrhoea, metrorrhagia, pelvic pain and abnormal vaginal discharge, informed Dr Gowri Kulkarni, head of operations, MediBuddy.

Complications of TB in pregnant women include spontaneous abortion, small for date uterus, preterm labour, low birth weight, and increased neo-natal mortality. Acquiring an active TB infection in pregnancy can put the mother and baby at risk, cautioned Dr Padma Srivastava, consultant obstetrician and gynaecologist, Motherhood Hospitals, Lullanagar, Pune.

“Genital TB can lead to spontaneous abortion and ectopic pregnancy. An endometrial biopsy, and menstrual blood culture, can help in diagnosing genital TB. A laparoscopy can help to understand the damage caused to the genital organs. It is essential to tackle genital TB as soon as it is detected. Those with genital TB are treated with ATT (anti-tubercular treatment), which helps in pregnancy if diagnosed earlier. Women with genital TB can conceive with the help of assisted reproductive technologies (ART) like IVF when there is a blockage of tubes and when the lining is very thin. They can be treated only with IVF(test tube baby process),” said Dr Dhorepatil.

Diagnosis

Based on one’s medical history and symptoms, a complete physical examination is done through various tests like tissue-based PCR or gene expert for the diagnosis of this condition, Dr Jagtap informed.

“Pelvic tuberculosis is best diagnosed on laparoscopy and hysteroscopy which gives direct view and opportunity to take specific tissue biopsy for testing. Hysterosalpingogram (HSG) can also be done to evaluate tubal patency, where a radio-opaque dye is introduced via the cervix into the uterus to check for tubal block, irregular structure of fallopian tubes and signs of adhesions,” she said.

Pregnant women with a confirmed diagnosis of TB should initiate treatment without delay.

“Maximum cases of infertility are due to TB, which can affect both partners. TB of the uterus may not be symptomatic, but she may come with vague period complaints, or no periods/scanty periods complaints. Multi-disciplinary approach with a chest physician, if needed gives excellent cure rates. However, if patients come late with multi-organ involvement, then prognosis is poor. Active TB is not a contraindication for the termination of pregnancy. But the anti-TB drugs may cause effects specifically in first trimester. Even though, there are many government programs, there is still a taboo related to TB and even afterwards, diagnosed patients are reluctant to treatment,” noted Dr Meeta Nakhare, gyneocologist Lokmanya Hospital.

tuberculosis day Multi-disciplinary approach with a chest physician, if needed gives excellent cure rates (Source: Getty Images/Thinkstock)

Treatment

Dr Deepak Namjoshi, pulmonologist and director, CritiCare Asia Multispeciality Hospital explained that genital TB not only affects the mother but the baby is also at risk as the baby can have low birth weight and there’s also a chance of neonatal mortality. “With medication, therapy, and a balanced diet, genital TB can be treated. In some cases, surgeries are also opted for treating this condition,” Dr Namjoshi said.

Treatment is similar to pulmonary tuberculosis and needs long term anti-tubercular treatment, said Dr Kulkarni. “It is done using four drugs in the intensive phase and then two drugs in the maintenance phase lasting a total of six months of treatment. However,  treatment varies in case of multi-drug resistant cases,” she said.

How to deal with after-effects of TB?

Eating a well-balanced diet, following good personal hygiene, trying to be in a ventilated room, taking medication as prescribed by the doctor, enough rest, staying hydrated, going for regular follow-ups, and avoiding crowded places are prescribed.

Prevention

According to Dr Jagtap, immunisation in childhood, good diet, and healthy habits can be helpful in preventing the condition.

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