Tuberculosis, TB or Pulmonary tuberculosis is a bacterial contagious disease caused by Mycobacterium tuberculosis. Persons with weakened immune system, infants and elderly people are at higher risk for tuberculosis. You can be at greater risk if you are in frequent contact with persons suffering TB. Poor nutrition and sanitation contribute to the risk factor. Many drug-resistant strains of TB have made it more difficult to treat the disease. Pulmonary tuberculosis shows up with symptoms like fatigue, fever, cough with mucus and blood, chest pain, difficulty in breathing and unexplained weight loss. A person suffering TB will have enlarged lymph nodes and pleural effusion. Bronchoscopy, chest x-ray and sputum culture can aid diagnosis of pulmonary tuberculosis. Pulmonary TB is treated with Isoniazid, Rifampin, Ethambutol, Streptomycin or Moxifloxacin. Treatment usually lasts for 6 months or longer.
Extra pulmonary tuberculosis or Miliary tuberculosis
Tuberculosis can also affect other parts of the body such as bones, lymphatic system, central nervous system and genital or urinary system. Disseminated tuberculosis or Miliary tuberculosis is a contagious bacterial infection that has spread from the lungs to other parts of the body through the blood or lymph system. This type of TB can also affect the larynx, skin and pericardium too.
The Mantoux test or tuberculin sensitivity test is a diagnostic test for tuberculosis. This test, also known as Piquet Test is endorsed by the American Thoracic Society and Centers for Disease Control and Prevention (CDC). The other diagnostic tests for tuberculosis are Tine test and Heaf test. Since the Mantoux test makes use of purified protein derivatives (PPD), it is also referred to as PPD test. This tuberculosis test does not indicate how long the infection has been festering or if it is in the active stage. This tuberculosis test is prescribed for persons who have abnormal chest x-rays or symptoms such as weight loss and persistent cough for many months. A Mantoux test is not recommended for those suffering from any skin conditions or allergy. Women who are pregnant or breastfeeding must not be subjected to the Mantoux test.
This PPD test involves injecting a dose of TB antigens into the top layer of skin on the forearm. The dose includes 10 Tuberculin units (0.2 ml) as this exposes the person to enough bacteria to mount an immune reaction in the skin. A little bump (wheal) is noticed under the skin. This area is then observed for any reaction in then next 48 - 72 hours. Reactions such as fever or swollen lymph nodes in the armpit must be brought to the notice of health professionals immediately. The results of this test must be interpreted carefully. A positive result indicates tuberculosis. There may be cases of false positives or false negative results. The significance of the Mantoux test on those vaccinated with BCG is still controversial.
Asherman's syndrome refers to the formation of adhesions or scar tissues on the endometrium (uterine lining). Most often endometrial scarring occurs as a result of scraping of tissue from the uterine wall while performing dilation and curettage (D& C). Though D&C is mainly responsible for adhesions, uterine surgery and severe infections of the endometrium such as genital tuberculosis are some of the other factors that cause Asherman's syndrome. Normally, Asherman's syndrome shows up with decreased menstrual flow or even amenorrhea, cramping, abdominal pain and is even associated with infertility and recurrent miscarriages.
Causes of Asherman's syndrome
D&C procedure is performed for miscarriages, excess bleeding, elective abortion or to remove the retained products of conception. Some gynecological disorders call for uterine surgery. Sometimes trauma occurs to the uterine lining while performing D&C procedure or other surgery. In case of damage, the wound begins to heal and in the process, fuses with the affected portion causing adhesions. The risk of Asherman's syndrome increases with repeated D&Cs.
Diagnosis and treatment of Asherman's syndrome
Hysteroscopy is the widely used method to diagnose the Asherman's syndrome as it allows the doctor to have a complete view of the uterus directly. However other methods such as sonohysterography (SHG), hysterosalpingogram (HSG) and transvaginal ultrasound examination are also used to evaluate adhesions. Blood tests are done to detect tuberculosis or schistosomiasis.
Asherman's syndrome is normally treated with surgery to remove the adhesions or scar tissue. The surgery involves hysteroscopy procedure wherein scar tissue is removed by using small instruments, micro scissors and a camera. Once the scar tissue is removed, an intra uterine balloon is placed inside the uterus to keep the uterine cavity open. This procedure aids the healing process and prevents adhesions from returning. Patient may also be prescribed oral estrogen medications for promoting growth of regular uterine lining. Patient may be called in for review hysteroscopy after two weeks of the procedure to make sure that there is no reformation of adhesions.
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Bibliography / Reference
Collection of Pages - Last revised Date: June 25, 2022