Tuberculous vaginitis

　　First, Etiology

　　Tuberculous vaginitis mainly originates from pulmonary tuberculosis and peritoneal tuberculosis. There are three causes and pathways for the development of tuberculous vaginitis:

　　1, Hematogenous spread is due to a history of active pulmonary tuberculosis, renal tuberculosis, or osteal tuberculosis, spreading through the blood.

　　2, Direct extension is caused by下行性 infection of the cervix and vagina from severe pelvic tuberculosis.

　　3, Primary infection is due to severe orchitis, seminal vesicle tuberculosis, or ulcerative lymphadenitis in males.

　　Second, Pathogenesis

　　The causative agent of tuberculous vaginitis is acid-fast tuberculosis bacilli. According to the metabolic and growth characteristics of the tuberculosis bacilli, the tuberculous flora in the tuberculosis lesions are divided into four categories:

　　1, Group A is an early active tuberculosis bacterium, which is abundant in extracellular spaces in early active lesions.

　　2, Group B grows in macrophages in an acidic environment as the disease progresses, in quantities that are less.

　　3, Group C reproduces slowly or intermittently in neutral caseous lesions.

　　4, Group D is in a dormant state, not reproducing at all.

　　The complications of tuberculous vaginitis are the concomitant infection with other pathogens. Therefore, symptoms may include those caused by other organs, such as pleuritic pain, abdominal pain, frequent urination, and hematuria. When tuberculosis of other reproductive organs, such as fallopian tubes and uterine tuberculosis, is present simultaneously, symptoms may include infertility, lower abdominal坠痛, abnormal menstruation, and abundant purulent or serous leukorrhea.

　　Tuberculous vaginitis often has normal appearance in many patients, with no obvious discomfort or complaints. Some patients with vaginal tuberculosis commonly complain of vaginal discomfort, pain, tenderness, and vaginal discharge of white or brownish secretions. Severe cases may present with systemic symptoms such as loss of appetite, low fever, and weight loss. Secondary to tuberculosis of the lungs, peritoneum, intestines, joints, and urinary system, symptoms may include those caused by other organs, such as pleuritic pain, abdominal pain, frequent urination, hematuria, and so on. When tuberculosis of other reproductive organs, such as fallopian tubes and uterine tuberculosis, is present simultaneously, symptoms may include infertility, lower abdominal坠痛, abnormal menstruation, and abundant purulent or serous leukorrhea. Lesions often have two morphologies: ulcerative and proliferative. The initial stage of the lesion often presents as local infiltration and swelling, which gradually becomes ulcerative, often in multiple foci. The base of the ulcer is yellowish, with granular protuberances, and tenderness may be present locally. After healing, scars form, leading to vaginal stenosis. Swelling of the inguinal lymph nodes may occur, and after rupture, sinus tracts or vesicovaginal fistula and rectovaginal fistula may form. A large amount of purulent or serous secretion may be discharged from the ulcer and sinus tract, and tenderness may be present locally.

　　. 1, Prognosis after treatment:Tuberculosis vaginitis, in addition to the risk of infertility, has no other adverse prognosis. Patients with AIDS infected with tuberculosis vaginitis have a poor prognosis..

　　2, Health care:Strengthen the publicity and education on anti-tuberculosis, enhance physical fitness and nutrition, and strengthen children's health care. For adolescents with negative tuberculin skin test results, BCG vaccination should be performed. Pregnancy should be avoided during the active stage of tuberculosis.

　　1, Find acid-fast Mycobacterium tuberculosis in the smear of vaginal secretions.

　　2, Pathological tissue examination.

　　2, Culture of Mycobacterium tuberculosis and animal inoculation, observe the positive results of Mycobacterium tuberculosis culture in vaginal secretions after 2 months; or inoculate these secretions onto the abdominal wall of guinea pigs, and perform dissection and examination 6-8 weeks later. If tuberculosis bacteria are found around the inoculation site, it can be diagnosed. This method has certain technical requirements, takes a long time, and is difficult to popularize.

　　4, Polymerase chain reaction detection (polymerase chain reaction, PCR) PCR amplification of Mycobacterium tuberculosis DNA is a relatively sensitive and rapid method, but the judgment of the results should consider the course of the disease.

　　5, Other examinations such as tuberculin skin test, generally negative indicates no history of tuberculosis infection, positive indicates previous tuberculosis infection, and strongly positive suggests active foci in the body, but does not determine the location of the focus. White blood cell count is generally not high, with an increase in lymphocytes in the classification, and an accelerated erythrocyte sedimentation rate during the active stage, which can also be used as a reference for diagnosis.

　　6, X-ray diagnosis includes chest X-ray, abdominal X-ray, uterine salpingography with iodine oil, etc.

　　7, Hysteroscopy and laparoscopy.

　　First, tuberculosis vaginitis dietetic treatment

　　1, Prescribed from 'Comprehensive Treasure of Male and Female Medicine Diet'

　　4 eggs, 200 grams of Zhi, break the eggs and add them to the flour, grind them with a sand pot into an old yellow color, do not burn them, and grind them into fine powder. Take 12 grams twice a day in the morning and evening. This recipe has the effects of clearing heat and detoxifying, promoting blood circulation and removing blood stasis, and activating meridians and collaterals.

　　2, Prescribed radish stewed mutton from 'Health-preserving Dietetic Recipe Book'

　　Radish 1000 grams, mutton 800 grams, an appropriate amount of scallion, ginger, monosodium glutamate, Sichuan pepper, and salt. Clean and cut the mutton and radish into pieces. Place the mutton in a pot, add water, and cook over medium heat. Add scallion, ginger, and Sichuan pepper, and simmer for 30 minutes. Then, transfer to low heat and cook until almost done, add radish to cook through, and finally add salt and monosodium glutamate. This recipe has the function of invigorating the Qi and blood, and tonifying the body to relieve consumptive diseases.

　　Second, drug and diet taboos

　　1. Avoid eating eggplant when taking anti-tuberculosis drugs

　　In the treatment of tuberculosis, eating eggplant is prone to allergic reactions. Relevant experts have found that patients with tuberculosis who eat eggplant and take anti-tuberculosis drugs within 40-60 minutes after meals may experience varying degrees of allergic reactions such as facial flushing, skin itching, erythema all over the body, nausea and vomiting, and in severe cases, blood pressure drop, chest oppression. After stopping eating eggplant, the allergic reactions will subside. Therefore, it should be avoided to eat eggplant during the period of taking anti-tuberculosis drugs.

　　1. Avoid eating eggplant when taking anti-tuberculosis drugs

　　2. Isoniazid and rifampicin should not be taken after meals

　　3. Avoid eating histamine-rich foods during the period of taking isoniazid

　　Because isoniazid can slow down the metabolism of histamine in the human body and increase its concentration. If histamine-rich foods such as long-stored fish are eaten again, it may further increase the concentration of histamine in the body and cause poisoning.

　　4. Isoniazid should not be taken with foods containing iron, magnesium, aluminum, and calcium ions

　　Because isoniazid is prone to form chelates with iron, magnesium, aluminum, and calcium ions, which can affect enzyme activity and lead to reduced efficacy, so it is necessary to avoid eating foods rich in iron, magnesium, aluminum, and calcium such as soy products, fried dough sticks, cooked preserved meat, salted fish, jellyfish, kelp, etc. during the period of taking isoniazid.

　　5. Avoid eating dairy products when taking isoniazid

　　Because eating dairy products (such as milk) after taking isoniazid can cause symptoms such as flushing, cold sensation, chills, headache, palpitations, loose stools, abnormal pulse, and increased blood pressure, which can worsen the condition.

　　Prevention: Vaginal tuberculosis is mostly secondary infection, the primary infection site is mostly pulmonary tuberculosis, the preventive measures are the same as pulmonary tuberculosis, it is necessary to strengthen the publicity and education of anti-tuberculosis, enhance physical fitness and nutrition, and strengthen children's health care. Currently, the anti-tuberculosis organization stipulates that newborns weighing more than 2200g and born more than 24 hours can be vaccinated with BCG. If the weight is less than 2200g or BCG is not vaccinated after birth, it can be supplemented within 3 months. Infants after 3 months should first undergo a tuberculin skin test, if negative, can be vaccinated. Young girls with negative tuberculin skin test during puberty should be vaccinated with BCG. It should be avoided to get pregnant during the active phase of tuberculosis.