Etiopathogenesis, Challenges and Remedies Associated With Female Genital Tuberculosis: Potential Role of Nuclear Receptors

Abstract

Extra-pulmonary tuberculosis (EPTB) is recognized mainly as a secondary manifestation of a primary tuberculosis (TB) infection in the lungs contributing to a high incidence of morbidity and mortality. The TB bacilli upon reactivation maneuver from the primary site disseminating to other organs. Diagnosis and treatment of EPTB remains challenging due to the abstruse positioning of the infected organs and the associated invasiveness of sample acquisition as well as misdiagnosis, associated comorbidities, and the inadequacy of biomarkers. Female genital tuberculosis (FGTB) represents the most perilous form of EPTB leading to poor uterine receptivity (UR), recurrent implantation failure and infertility in females. Although the number of TB cases is reducing, FGTB cases are not getting enough attention because of a lack of clinical awareness, nonspecific symptoms, and inappropriate diagnostic measures. This review provides an overview for EPTB, particularly FGTB diagnostics and treatment challenges. We emphasize the need for new therapeutics and highlight the need for the exaction of biomarkers as a point of care diagnostic. Nuclear receptors have reported role in maintaining UR, immune modulation, and TB modulation; therefore, we postulate their role as a therapeutic drug target and biomarker that should be explored in FGTB.

Recent Advances in Diagnosis and Management of Female Genital Tuberculosis

“… Newer generation sequencing (NSG) technology can allow increasingly rapid and accurate sequencing of entire Mycobacterial genome and has the potential for amplifying the diagnosis and management of drug-sensitive and drug-resistant pulmonary and extra-pulmonary TB (including FGTB) but is not yet routinely available [ 43 ]. Nuclear Receptors: As nuclear receptors have important role in maintenance of uterine receptivity and immune modulation, they can be used as a biomarker for early detection of FGTB, especially latent FGTB and as a therapeutic drug target, but are still experimental [ 44 ]. …”

“…Nuclear Receptors: As nuclear receptors have important role in maintenance of uterine receptivity and immune modulation, they can be used as a biomarker for early detection of FGTB, especially latent FGTB and as a therapeutic drug target, but are still experimental [ 44 ].…”

Frequency of Genital Tuberculosis in Patients Undergoing Diagnostic Laparoscopy for Infertility

“…57% of the sample size had primary type of infertility and 43% had secondary type of infertility. 18 . As all cases of salphingitis and endometriosis may not present together, salphingitis alone is mostly missed by the histopathological sample of endometrium for tuberculosis polymerase chain reaction but can be doubted by cautious but thorough endoscopic evaluation for the existence of tubercles, peritubal and periovarian adhesions, and cornual and fimbrial block.…”

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“…5,6,8,16,17 Tuberculous peritonitis is observed in combination with female genital TB in 45%. In peritonitis, an associated pleural effusion is not uncommon; most do not present parenchymal abnormalities on chest radiography; 8,12,[13][14][15][16][17][18][19][20][21][22] Endometrial sampling is recommended for histological and microbiological examination to make the diagnosis of genital TB, it is useful if granulomas are found or, if smears or cultures are positive for TB. Laparoscopy with targeted biopsies of suspicious areas may be helpful if less invasive methods do not provide the necessary diagnostic information.…”