Abdominopelvic

Tuberculosis
Stella Marie Legaspi-Jose,
MD.,
M.H.P.Ed.
Reactor

Pertinent data

39 y.o. nulligravid
Amenorrhea, pelvic pain, low grade
afternoon fever
Medical management: quadruple
anti-Kochs therapy for one year
Minimal improvement
Underwent THBSO for failed med mgt
Histopath: TB, endometrium

Multidrug-resistant
tuberculosis

Global incidence of MDR-TB is

424,000 or 4.3% of all new and
previously treated TB
China, India, Russia 62%
Other hot spots S. America, Latin
America, South Africa, Asia
(Vietnam, Thailand, Myanmar,
Korea, Phil.)

WHO: prior but ineffective

treatment is a strong predictor of
drug-resistant TB
Drug-resistant TB usually results
from poor patient adherence &
other causes of failure in
implementation of an effectively
functioning TB control program

DOT

Directly observed therapy- effective in

Madras & HK
DOTS = directly observed therapy
short course
5 Key components1. Network of trained health care prof.
2. Properly equipped lab.
3. Reliable supply of high quality drugs

4. Accurate record keeping &

cohort analysis system for
monitoring
5. Sustained political commitment
& funding

Diagnosis of MDR

Most important strategy in the control

of established MDR-TB is to ensure
rapid detection of drug resistance
Routine lab dx of drug resistance in M.
tuberculosis requires pure culture of
org.
Use of liquid media decreased time
of testing from 4-6 wks to 10-14 days

MDR

Molecular mech of drug resistance in

M. tuberculosis
Drug Genes
Target
Mech
INH katg catlase-peroxidase-(-)
mycolic a syn
Rif
rpoB RNA polymerase (-)transcription

Anti-tuberculosis drugs
used in adult MDR-TB

Aminoglycosides- Streptomycin
Kanamycin, Amik,
Capreomycin
Fluoroquinolones- Ciprofloxacin
Ofloxacin
Levofloxacin
Moxifloxacin

Anti-tuberculosis drugs
used in adult MDR-TB

Thioamides- Ethioamide
Oral bacteriostatic 1st line drugsEtham, pyrazinamide
Oral bacteriostatic 2nd line drugsCycloserine, Terizidone, PAS,
Thiacetazone

Conclusion

Prevention is better than cure

In a young patient desirous of
fertility, medical management must
be optimized.
Lab testing PCR,DNA-based
sequencing, line probe assay- can be
used for rapid detection of resistance
Indications for surgery