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Ekaterina Kulchavenya - One of the best experts on this subject based on the ideXlab platform.
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Typical and unusual cases of female genital Tuberculosis
IDCases, 2014Co-Authors: Ekaterina Kulchavenya, S. DubrovinaAbstract:Tuberculosis is a disease with myriad presentations and manifestations; it can affect any organ or tissue, excluding only hair and nails. Doctors who are not familiar with extrapulmonary Tuberculosis often overlook this disease. Urogenital Tuberculosis (UGTB) is the second most common form of TB in countries with severe epidemic situation and the third most common form in regions with low incidence of TB. The term “Urogenital Tuberculosis” includes Kidney Tuberculosis; male and female Tuberculosis and urinary tract Tuberculosis as complication of Kidney Tuberculosis. We describe rarest case of Tuberculosis of a placenta in young woman, suffered from genital Tuberculosis, which was overlooked before delivery, as well as typical tubo-ovarian tuberculomas.
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How to recognize Kidney Tuberculosis
European Respiratory Journal, 2014Co-Authors: Ekaterina KulchavenyaAbstract:INTRODUCTION: Kidney Tuberculosis (KTB) has non-specific clinical features and mimics on different other urological diseases: urolithiasis, cancer, pyelonephritis, cystitis etc. Moreover clinical features are not stable for ages, they change rather quickly. METHODS: The aim was to compare clinical features of KTB in 1980-1990 (1 st group, 268 patients) and in 2000-2005 (2 nd group, 227 patients); both groups were in-patients of Urogenital Department of Novosibirsk Research TB Institute. RESULTS: The frequency of dysuria was the same (57.1% and 54.3%), but a flank pain in 2 nd group was diagnosed more often (58.9% and 72.8% accordingly). Frequency of renal colic decreased from 16.1% up to 12.3%; haematuria increased from 30.4% up to 48.1%. Pyuria left most common laboratory sign – 91.7 – 91.4% in both groups. Significantly reduced a frequency of positive cultures – mycobacteriuria was revealed in 84.5% in first group and in 44.0% only in novo days. Asymptomatic course was about equal – 8.9% in 1 st group and 6.2% in 2 nd group, but frequency of acute debut changed significantly. In 1 st group 34.5% patients got sick acutely, with manifesting clinical features, fever, pain etc. In second group the same patients there were 4.9% only. On contrary, obscure, vogue symptoms were in 56.6% in 1 st group and in 88.9% - in 2 nd group. Mean age was stable: 40.5 in 1 st group and 43.8 in 2 nd group. A rate male : female was about 2:3 in both groups. CONCLUSION: We can speak about clinical pathomorphosis of KTB. Clinical features of KTB have changed in last years. In 7 times rarer became acute onset of KTB, significantly more often patients have flank pain and haematuria now. Asymptomatic course of KTB is possible too. All this may be a reason for late diagnosis.
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Why do we need a classification of urogenital Tuberculosis
European Respiratory Journal, 2014Co-Authors: Ekaterina KulchavenyaAbstract:Introduction. Urogenital Tuberculosis (UGTB) remains an important problem. Classification of the disease includes dispersion on forms and stages and definition for each stage, which implies different approach to the management. Material and methods. To estimate the benefit of clinical classification of UGTB (Kulchavenya, 2004) we analyzed history cases of 131 pts with UGTB. Results. Among 131 pts in 67.2% the isolated Kidney Tuberculosis (KTB) was diagnosed, in 25.2% – genital Tuberculosis (MGTB); 7.6% men had generalized UGTB (gUGTB), when both urinary and male genital systems were hurted by Tuberculosis; all of them had KTB-4. Thus, KTB was diagnosed in 75% (including 8% of gUGTB). In spectrum of KTB more than half cases were destructive forms (levels 3-4). KTB-3 was diagnosed in 22.4%, isolated KTB-4 - in 21.4%. But as 10 men gUGTB also had KTB-4 too, total share of destructive forms got 54.0%. KTB-1 was diagnosed in 10.2%, KTB-2 – in 39.8%. Clinical features and symptoms significantly varied between different forms of UGTB. KTB 1-2 levels were treated with chemotherapy, KTB-3 required partial nephrectomy, KTB- 4 was indicated for nephrectomy. Stricture of ureter was indicated for reconstructive surgery in KTB 1- 3; KTB-4 with stricture of ureter was indicated for nephrureterectomy. MGTB was treated with chemotherapy; fistula, discharge sinus were indicated for surgery. gUGTB was managed depending on forms of KTB and MGTB. Conclusion. Join term “UGTB” has insufficient information in order to estimate therapy, surgery and prognosis – as well as to evaluate the epidemiology as UGTB is multivariant disease. Using clinical classification will improve the efficiency of the therapy of UGTB.
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Spectrum of urogenital Tuberculosis
Journal of Infection and Chemotherapy, 2013Co-Authors: Ekaterina Kulchavenya, Irina Zhukova, Denis KholtobinAbstract:Urogenital Tuberculosis (UGTB) plays an important role because its complications may be fatal, it significantly reduces quality of life, and it is often associated with AIDS. Diagnosis of UGTB is often delayed. We analyzed 131 case histories of UGTB patients from the years 2009–2011. Gender, age, and the clinical form and main features of the disease were taken into account. The most common form was Kidney Tuberculosis (74.8 %). Isolated Kidney Tuberculosis (KTB) more often occurs in women: 56.8 %. Patients of middle and old age more often showed the stage of cavernous KTB; younger patients had smaller forms. Among all cases, an asymptomatic course was seen in 12.2 % and, among cases of KTB, in 15.9 %. Every third patient complained of flank pain and dysuria (35.2 % and 39.8 %, respectively); 17 % presented with toxicity symptoms, 9.1 % with renal colic, and 7.9 % with gross hematuria. Mycobacterium Tuberculosis (MTB) in urine was found in 31.8 % of cases in all levels of isolated KTB. UGTB has no specific symptom; even sterile pyuria occurs only in 25 %. The acute onset of tuberculous orchiepididymitis was seen in 35.7 % of patients, hemospermia in 7.1 %, and dysuria in 35.7 %. The most common complaints for prostate Tuberculosis were perineal pain (31.6 %), dysuria (also 31.6 %), and hemospermia (26.3 %). MTB in prostate secretion/ejaculate was revealed in 10.5 % of this group. All urogenital tract infections should be suspected as UGTB in patients who are living in a region with a high incidence rate, who have had contact with Tuberculosis infection, and who have a recurrence of the disease that is resistant to standard therapy.
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Kidney Tuberculosis in last century and now – Is it the same disease?
European Respiratory Journal, 2011Co-Authors: Denis Kholtobin, Ekaterina KulchavenyaAbstract:Kidney Tuberculosis (KTB) has non-specific clinical features and mimics on different other urological diseases: urolithiasis, cancer, pyelonephritis, cystitis etc. Moreover clinical features are not stable for ages, they change rather quickly. The aim was to compare KTB in Siberia in 1980-1990 (1st group, 268 patients) and in 2000-2005 (2nd group, 227 patients), all were in-patients of Urogenital Department of Novosibirsk Research TB Institute. A flank pain in 1st group was rarer (58.9% and 72.8% accordingly), but frequency of dysuria was the same (57.1% and 54.3%). Frequency of renal colic decreased from 16.1% up to 12.3%; haematuria increased from 30.4% up to 48.1%. Pyuria left most common laboratory sign – 91.7 – 91.4%. Significantly reduced a frequency of positive cultures – mycobacteriuria was revealed in 84.5% in first group and in 44.0% only in novo days. Asymptomatic course was about equal – 8.9% and 6.2%, but frequency of acute debut changed significantly. In 1st group 34.5% patients got sick acutely, with manifesting clinical features, fever, pain etc. In second group the same patients there were 4.9% only. On contrary, obscure, vogue symptoms were in 56.6% in 1st group and in 88.9% - in 2nd group. Mean age was stable: 40.5 in 1st group and 43.8 in 2nd group. A rate male: female was about 2:3 in both groups. Conclusion: We can speak about clinical pathomorphosis of KTB. Clinical features of KTB has changed in last years. In 7 times rarer became acute onset of KTB, significantly more often patients have flank pain and haematuria now. Asymptomatic course of KTB is possible too. All this may be a reason for late diagnosis.
Denis Kholtobin - One of the best experts on this subject based on the ideXlab platform.
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Spectrum of urogenital Tuberculosis
Journal of Infection and Chemotherapy, 2013Co-Authors: Ekaterina Kulchavenya, Irina Zhukova, Denis KholtobinAbstract:Urogenital Tuberculosis (UGTB) plays an important role because its complications may be fatal, it significantly reduces quality of life, and it is often associated with AIDS. Diagnosis of UGTB is often delayed. We analyzed 131 case histories of UGTB patients from the years 2009–2011. Gender, age, and the clinical form and main features of the disease were taken into account. The most common form was Kidney Tuberculosis (74.8 %). Isolated Kidney Tuberculosis (KTB) more often occurs in women: 56.8 %. Patients of middle and old age more often showed the stage of cavernous KTB; younger patients had smaller forms. Among all cases, an asymptomatic course was seen in 12.2 % and, among cases of KTB, in 15.9 %. Every third patient complained of flank pain and dysuria (35.2 % and 39.8 %, respectively); 17 % presented with toxicity symptoms, 9.1 % with renal colic, and 7.9 % with gross hematuria. Mycobacterium Tuberculosis (MTB) in urine was found in 31.8 % of cases in all levels of isolated KTB. UGTB has no specific symptom; even sterile pyuria occurs only in 25 %. The acute onset of tuberculous orchiepididymitis was seen in 35.7 % of patients, hemospermia in 7.1 %, and dysuria in 35.7 %. The most common complaints for prostate Tuberculosis were perineal pain (31.6 %), dysuria (also 31.6 %), and hemospermia (26.3 %). MTB in prostate secretion/ejaculate was revealed in 10.5 % of this group. All urogenital tract infections should be suspected as UGTB in patients who are living in a region with a high incidence rate, who have had contact with Tuberculosis infection, and who have a recurrence of the disease that is resistant to standard therapy.
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Kidney Tuberculosis in last century and now – Is it the same disease?
European Respiratory Journal, 2011Co-Authors: Denis Kholtobin, Ekaterina KulchavenyaAbstract:Kidney Tuberculosis (KTB) has non-specific clinical features and mimics on different other urological diseases: urolithiasis, cancer, pyelonephritis, cystitis etc. Moreover clinical features are not stable for ages, they change rather quickly. The aim was to compare KTB in Siberia in 1980-1990 (1st group, 268 patients) and in 2000-2005 (2nd group, 227 patients), all were in-patients of Urogenital Department of Novosibirsk Research TB Institute. A flank pain in 1st group was rarer (58.9% and 72.8% accordingly), but frequency of dysuria was the same (57.1% and 54.3%). Frequency of renal colic decreased from 16.1% up to 12.3%; haematuria increased from 30.4% up to 48.1%. Pyuria left most common laboratory sign – 91.7 – 91.4%. Significantly reduced a frequency of positive cultures – mycobacteriuria was revealed in 84.5% in first group and in 44.0% only in novo days. Asymptomatic course was about equal – 8.9% and 6.2%, but frequency of acute debut changed significantly. In 1st group 34.5% patients got sick acutely, with manifesting clinical features, fever, pain etc. In second group the same patients there were 4.9% only. On contrary, obscure, vogue symptoms were in 56.6% in 1st group and in 88.9% - in 2nd group. Mean age was stable: 40.5 in 1st group and 43.8 in 2nd group. A rate male: female was about 2:3 in both groups. Conclusion: We can speak about clinical pathomorphosis of KTB. Clinical features of KTB has changed in last years. In 7 times rarer became acute onset of KTB, significantly more often patients have flank pain and haematuria now. Asymptomatic course of KTB is possible too. All this may be a reason for late diagnosis.
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Kidney Tuberculosis in last century and now is it the same disease
European Respiratory Journal, 2011Co-Authors: Denis Kholtobin, Ekaterina KulchavenyaAbstract:Kidney Tuberculosis (KTB) has non-specific clinical features and mimics on different other urological diseases: urolithiasis, cancer, pyelonephritis, cystitis etc. Moreover clinical features are not stable for ages, they change rather quickly. The aim was to compare KTB in Siberia in 1980-1990 (1st group, 268 patients) and in 2000-2005 (2nd group, 227 patients), all were in-patients of Urogenital Department of Novosibirsk Research TB Institute. A flank pain in 1st group was rarer (58.9% and 72.8% accordingly), but frequency of dysuria was the same (57.1% and 54.3%). Frequency of renal colic decreased from 16.1% up to 12.3%; haematuria increased from 30.4% up to 48.1%. Pyuria left most common laboratory sign – 91.7 – 91.4%. Significantly reduced a frequency of positive cultures – mycobacteriuria was revealed in 84.5% in first group and in 44.0% only in novo days. Asymptomatic course was about equal – 8.9% and 6.2%, but frequency of acute debut changed significantly. In 1st group 34.5% patients got sick acutely, with manifesting clinical features, fever, pain etc. In second group the same patients there were 4.9% only. On contrary, obscure, vogue symptoms were in 56.6% in 1st group and in 88.9% - in 2nd group. Mean age was stable: 40.5 in 1st group and 43.8 in 2nd group. A rate male: female was about 2:3 in both groups. Conclusion: We can speak about clinical pathomorphosis of KTB. Clinical features of KTB has changed in last years. In 7 times rarer became acute onset of KTB, significantly more often patients have flank pain and haematuria now. Asymptomatic course of KTB is possible too. All this may be a reason for late diagnosis.
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Masks of Kidney Tuberculosis
European Respiratory Journal, 2011Co-Authors: Denis Kholtobin, Ekaterina KulchavenyaAbstract:Introduction & objectives: Urogenital Tuberculosis (UGTB) is the second most common form of TB in countries with a severe epidemic situation and the third most common form in regions with low incidence of TB. 77% of men who died from Tuberculosis of all localizations had prostate Tuberculosis which had mostly been overlooked during their life time. In actual figures, this means about 19,000 men yearly in Russia. The main reason for late diagnosis is an atypical clinical feature of UGTB, it courses under the mask of another disease. Material & methods: We analyzed 816 history cases of UGTB patients to estimate clinical features. Results: Most common complains were flank pain (68%), dysuria (48%) and renal colic (24%); laboratory signs - pyuria (78%) and haematuria (34%). Patients were treated by urologists or GPs with diagnoses pyelonephritis (27%), cystitis (43%), cancer (8%) or urolithiasis (22%) during 5.6 years on average. Positive smear was in 17% and positive culture of Mycobacterium Tuberculosis was in 44%. 64% were diagnosed in late complicated cavernous stage, when surgery is necessary – and 90% of operations were nephrectomy due to total involvement of Kidney tissue. Conclusions: Most common masks of UGTB are pyelonephritis, cystitis and urolithiasis. UGTB presents non-specific symptoms and laboratory findings, except for positive MBT culture, but only about 44% cases are culture-positive. This is one of the main reasons for late and poor diagnosis of UGTB. The significance of UGTB may be considerable when the high prevalence of overall TB and the asymptomatic nature of UGTB are taken into account.
Salima Ikram - One of the best experts on this subject based on the ideXlab platform.
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a Kidney s ingenious path to trimillennar preservation renal Tuberculosis in an egyptian mummy
International Journal of Paleopathology, 2015Co-Authors: Carlos Prates, Carlos Sousa Oliveira, Sandra Sousa, Salima IkramAbstract:Irtieru is a male mummy enclosed in cartonnage, dating to the Third Intermediate Period in the Egyptian collection of the Museu Nacional de Arqueologia in Lisbon. The computed tomography scans of this mummy showed a small dense bean-shaped structure at the left lumbar region. Its anatomical location, morphologic and structural analysis support a diagnosis of end-stage renal Tuberculosis. If this diagnosis is correct, this will be the oldest example of Kidney Tuberculosis, and the first one recorded in an intentionally mummified ancient Egyptian.
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A Kidney’s ingenious path to trimillennar preservation: Renal Tuberculosis in an Egyptian mummy?
International journal of paleopathology, 2015Co-Authors: Carlos Prates, Carlos Sousa Oliveira, Sandra Sousa, Salima IkramAbstract:Irtieru is a male mummy enclosed in cartonnage, dating to the Third Intermediate Period in the Egyptian collection of the Museu Nacional de Arqueologia in Lisbon. The computed tomography scans of this mummy showed a small dense bean-shaped structure at the left lumbar region. Its anatomical location, morphologic and structural analysis support a diagnosis of end-stage renal Tuberculosis. If this diagnosis is correct, this will be the oldest example of Kidney Tuberculosis, and the first one recorded in an intentionally mummified ancient Egyptian.
Alex Shteynshlyuger - One of the best experts on this subject based on the ideXlab platform.
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An update on lower urinary tract Tuberculosis
Current urology reports, 2008Co-Authors: Gilbert J. Wise, Alex ShteynshlyugerAbstract:Tuberculosis of the genitourinary tract presents with atypical manifestations. Only 20% to 30% of patients with genitourinary Tuberculosis have a history of pulmonary infection. Tuberculosis often affects the lower genitourinary system rather than the Kidney. Tuberculosis of the lower genitourinary tract most commonly affects the epididymis and the testis, followed by bladder, ureter, prostate, and penis. Use of bacillus Calmette-Guerin therapy for bladder cancer can cause symptomatic tubercular infections of the lower genitourinary tract. Tuberculosis of the lower genitourinary tract can present with irritative voiding symptoms, hematuria, epididymo-orchitis, prostatitis, and fistulas. Tuberculosis of the seminal vesicles, vas, fallopian tubes, and the uterus can cause infertility. Urinalysis may demonstrate sterile pyuria, hematuria, or albuminuria. Identification of acid-fast bacilli in culture or tissue or by polymerase chain reaction studies is diagnostic. Medical treatment may not result in resolution of symptoms. Surgical intervention and reconstruction of the urinary tract are frequently indicated.
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An update on lower urinary tract Tuberculosis
Current Prostate Reports, 2007Co-Authors: Gilbert J. Wise, Alex ShteynshlyugerAbstract:Tuberculosis of the genitourinary tract presents with atypical manifestations. Only 20% to 30% of patients with genitourinary Tuberculosis have a history of pulmonary infection. Tuberculosis often affects the lower genitourinary system rather than the Kidney. Tuberculosis of the lower genitourinary tract most commonly affects the epididymis and the testis, followed by bladder, ureter, prostate, and penis. Use of bacillus Calmette-Guérin therapy for bladder cancer can cause symptomatic tubercular infections of the lower genitourinary tract. Tuberculosis of the lower genitourinary tract can present with irritative voiding symptoms, hematuria, epididymo-orchitis, prostatitis, and fistulas. Tuberculosis of the seminal vesicles, vas, fallopian tubes, and the uterus can cause infertility. Urinalysis may demonstrate sterile pyuria, hematuria, or albuminuria. Identification of acid-fast bacilli in culture or tissue or by polymerase chain reaction studies is diagnostic. Medical treatment may not result in resolution of symptoms. Surgical intervention and reconstruction of the urinary tract are frequently indicated.
Victor Khomyakov - One of the best experts on this subject based on the ideXlab platform.
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Male genital Tuberculosis in Siberians
World Journal of Urology, 2006Co-Authors: Ekaterina Kulchavenya, Victor KhomyakovAbstract:To study the epidemiology and the clinical picture of male genital Tuberculosis in Siberia, Russia. Five hundred and fourteen patients with genitourinary Tuberculosis were enrolled in the study: 414 had Kidney Tuberculosis only, 100 had genital involvement. The clinical picture and structure of genital Tuberculosis were investigated: 42 had Tuberculosis of scrotal organs and 58 had Tuberculosis of the prostate. Urinary cultures, urinalysis, three-glass test, and investigation of the prostate secretion, Mycobacteria culture, and susceptibility testing were performed in all 514 patients. 33.6% of all patients earlier suffered from pulmonary or extrapulmonary Tuberculosis and were successfully cured. In 61.9% nephroTuberculosis was diagnosed alongside with an orchiepididymitis. In 30.9% of patients bilateral epididymorchitis was diagnosed. Mycobacteriuria was present in 38.1%. Scrotal fistula was found in 11.9%. In 66.7% the symptoms appeared acutely. Half of the patients with prostate Tuberculosis complained of dysuria, 23 (39.6%) had perineal pain, 34 (58.6%) had flank pain. Leucocytes in urine were present in 49 (84.5%) patients, and in prostatic secretion in 45 (77.6%) patients. Erythrocytes in urine were present in 31 (53.4%) patients, and in prostatic secretions in 17 (29.3%) patients. Male genital Tuberculosis has no specific pathognomonic signs. Using a special algorithm for the management of patients with prostatitis or epididymitis is recommended.
