Genital Koch’s:- Take home message:
When to suspect
tuberculosis of the pelvis leading to tubal blocks causing infertility. For
diag we the clinicians have to rely on many things, For instance 1) history, 2)
pelvic examination like any pelvic adhesion, immobility of uterus, fixity 3)
findings in ultrasound, 4) HSG, 5)
laparoscopy, 6) culture, 7) histopathology .If any one or two criteria offers a
suspicion i.e. whichever could make us suspect tuberculosis of the pelvis
leading to tubal blocks causing infertility.
Diagnosing Koch’s with great
caution!!What caution in the diagnostic path? What is the caveat in Koch’s?? The sheer presence of the bacilli in the body (without
damaging the tubes), at least in subfertility cases does not stop the women
from becoming pregnant. All over the world including the western part of
the world where tuberculosis is unheard off, tubal blocks are responsible for
25% to 30% female infertility (poly-microbial infections, Chlamydia and
miscellaneous pelvic infections are responsible for the tubal disease). India
being a developing overpopulated country will logically also have the same
share a
There is no comparison
between the use of ATT and empirical use of doxycycline (as quoted to be used
by some clinicians in the west) for infections like Chlamydia. The duration of
treatment, toxicity, morbid complications, difficulty in ingestion and the risk
of emergence of drug resistance of ATT compared to aforementioned drug is world
apart.
Indiscriminate use of anti-tubercular
treatment?? Indiscriminate use of
anti-tubercular treatment based on a flimsy and flawed premise such as positive
TB PCR or other indirect screening test for latent tuberculosis (incidence of
latent TB is more than 40%) leads to a very real and present danger of the
emergence of multi-drug resistant strain, which remains the biggest challenge
for NRTCP health personnel’s battling
active tuberculosis in India today.
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