Multi Drug Resistant Female Genital Tuberculosis: A Preliminary Report

Objective: Evaluation of 6 patients presenting with tubo-ovarian mass or infertility with multi drug resistant (MDR) female genital tuberculosis (FGTB).

Study Design: It was an observational study in a tertiary referral centre, India on subjects with MDR FGTB on clinical examination and investigations. All patients were given category IV drugs using kanamycin (intramuscular), levofloxacin, pyrazinamide, cycloserine, ethionamide and ethambutol (or para aminosalicylic acid [PAS] for ethambutol resistant cases) for 6 months intensive phase followed by oral levofloxacin, cycloserine, ethionamide and ethambutol (or PAS for ethambutol resistant cases) for 18 months continuation phase. Patients were evaluated for primary end points (complete cure, partial response, no response, treatment completed) and secondary end points (recurrence rate, pregnancy rate) during treatment.

Results: There were 2 (33.3%) primary MDR FGTB patients and 4 (66.6%) secondary MDR FGTB (three pulmonary MDR and one MDR lymphadenitis) patients. Mean age was 23.6 years. Presenting features were menstrual dysfunction in all patients (100%) especially oligomenorrhea in 3 (50%) patients, weight loss in all the patients (100%), cough with expectoration in three patients (50%), tubo-ovarian masses in five (83.3%) patients. Endometrial biopsy showed positive culture for AFB with rifampicin and isoniazid (INH) resistance in both primary MDR FGTB patients and in two secondary MDR FGTB patients who were sexually active. In secondary MDR FGTB, three pulmonary MDR patients had positive sputum AFB smear and culture, while the patient with MDR lymphadenitis had lymph node aspirate for AFB smear and culture positive with all showing resistance to rifampicin and isoniazid. Gene Xpert on endometrial biopsy or sputum was positive in 5 (83.3%) patients. Three (50%) patients (one primary and two secondary) have completed therapy while other 3 (50%) are in continuation phase. All patients are asymptomatic with one having 12 weeks ongoing successful pregnancy.

Conclusion: MDR FGTB should be thought of in women of FGTB with tubo- ovarian masses who are not responding to first line drugs. Gene Xpert can be used in early diagnosis of MDR FGTB.