Congenital tuberculosis after in vitro fertilization: suggestion for tuberculosis tests in infertile women in developing countries.

Congenital tuberculosis (CTB) after in vitro fertilization (IVF) is a major new problem in developing countries. Only 16 cases of CTB after IVF have been reported, and no tuberculosis (TB) tests were performed before IVF in these cases. However, on the basis of data in the literature and from the World Health Organization, the incidence of CTB has been substantially underestimated. We describe two cases of CTB after IVF in detail in our center and provide new insight into the important issue of controlling TB vertical transmission in developing countries. Performing an early diagnosis of CTB, mostly based on evidence of maternal infection and a high index of clinical suspicion, is a challenge. However, most mothers have no symptoms of TB infection during prepartum, and infertility may be the only symptom. Infertility caused by genital TB is common in countries with a high TB burden, and IVF is considered to be an effective treatment to improve their fertility. Therefore, this may lead to more CTB cases without thorough TB tests before IVF. We suggest that thorough TB tests should be conducted in infertile women before IVF to prevent CTB.

First case of sexually transmitted asymptomatic female genital tuberculosis from spousal epididymal tuberculosis diagnosed by active screening.

Tuberculosis screening was performed for a healthy asymptomatic woman to determine whether she had been infected with active genital tuberculosis via sexual intercourse with her husband who had epididymal tuberculosis. Vaginal swab culture yielded Mycobacterium tuberculosis. Furthermore, whole genome sequencing revealed that the two causative isolates were genetically identical. This appears to be the first report on the sexual transmission of genital tuberculosis from a man to an asymptomatic woman, detected by active screening for genital tuberculosis and molecular analysis, including whole genome sequencing. Active screening for genital tuberculosis in the female partner should be considered soon after diagnosis of male genital tuberculosis, even when the female partner is asymptomatic.

Intrauterine Tuberculosis Manifesting as Acute Chorioamnionitis: A Case Report and Review of the Literature.

Congenital tuberculosis involving the placenta is an infrequent diagnosis, and the typical features of tuberculous placentitis involve a granulomatous reaction, reflecting a delayed hypersensitivity immune response in the host. However, the first reaction of the placenta to organisms hematogenously transmitted from the maternal circulation typically involves the innate immune response, manifesting as an acute neutrophilic villitis or intervillositis or both. This acute pattern of response to mycobacteria has only been documented rarely. We present a case of acute mycobacterial infection occurring in a preterm female with 28-weeks gestation, who was delivered by cesarean section because of fetal distress and who was subsequently confirmed to have congenital tuberculosis. The placenta showed an acute chorioamnionitis associated with acid-fast bacilli consistent with Mycobacteria tuberculosis. The mother was found to have a necrotizing granulomatous deciduitis, and that was postulated to have resulted in the direct spread of mycobacteria to the amniotic cavity. Thus, our case extends the acute placental response to mycobacteria to include chorioamnionitis. Although extremely rare, mycobacteria should be considered in the differential diagnosis of infectious agents causing acute chorioamnionitis, especially in geographic areas where tuberculosis is more prevalent.

Congenital tuberculosis after in vitro fertilization.

Genital tuberculosis (TB) is a major cause of infertility in the world, notably in developing countries, but its incidence is increasing in the western continents. In vitro fertilization (IVF) represents a useful treatment of infertility after TB. We report the first case of congenital TB after IVF and suggest improvement of usual screening before and after IVF.

Genital tuberculosis and reproductive function.

Interesting hypotheses about the effects of genital tuberculosis on reproductive function are that diseased men may in rare instances transmit the condition to their female partners and that diseased women are usually sterile unless they conceived and gave birth before the onset of their lesions. These two hypotheses were reviewed with the help of biopsy materials obtained from the Igbos of Nigeria and were considered, as a whole, to be valid in this West African ethnic group.

Gynaecological tuberculosis, past, present and future.

Until the introduction of the anti-tuberculosis drugs about 25 years ago, the treatment of tuberculosis of the female genital tract was generally unsatisfactory although many different forms of therapy were employed. Surgery was associated with a high incidence of post-operative complications, particularly of fistula, and an appreciable mortality rate. The position improved greatly after the introduction of the anti-tuberculosis drugs. Several drug programmes were employed by the writer, the best results being obtained with a combination of streptomycin, PAS and isoniazid for at least 18 months. Where drug treatment had failed, or where pelvic masses developed, surgery under drug cover was employed. No serious complications and no fatalities occurred in these patients. The question of possible transmission through sexual intercourse of male genitourinary tuberculosis is being investigated. A new drug programme is now being employed, the drugs used being streptomycin, ethambutol and isoniazid.