Comparison of diagnostic accuracy of bactec culture, gene-xpert and histopathology in the diagnosis of genital tuberculosis in women with infertility

Background: Female genital tuberculosis (FGTB) is often a silent disease sparing no age group but majority of patients are in the reproductive age. In infertility patient’s incidence of FGTB varies from 3-16% in India but the actual incidence of genital tuberculosis may be under reported due to asymptomatic presentation and paucity of investigations.Methods: Prospective case control study was conducted from June 2018 to May 2019 in LLRM Medical College Meerut. A total 100 Endometrial samples were collected during diagnostic laparoscopy from all suspected case of genital TB, presented with either primary or secondary infertility and samples sent for histopathology, Gene-xpert and Bactec culture.Results: Out of 100 samples Bactec culture was positive in 2 samples, Gene-xpert positive in 3 samples. On histopathology out of 100 cases, non-specific endometritis was found in 1 case, tubercular-endometritis in 1 case, proliferative enometrium (anovulatory) in 40 cases and secretory endometrium found in 58 cases.Conclusions: Female genital TB poses a diagnostic dilemma because of its varied presentation and lack of sensitive and specific method of diagnosis. Culture though remains the gold standard of diagnosis of female genital TB, gene-xpert, histopathology, Bactec culture or laparoscopy can be used for starting treatment. Endometrial biopsy on histopathology shows not only Tubercular endometritis but also gives hormone response on endometrium, local factors of endometrium concerning non-specific and specific infections and anovulatory cycles.

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A study to compare the diagnostic accuracy of GeneXpert MTB/RIF/assay and its comparison with liquid culture in clinically suspected cases of genital tuberculosis attending outpatient department of tertiary center

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203321 ◽

2020 ◽

Vol 9 (8) ◽

pp. 3345

Author(s):

Anu Pathak ◽

Divya Yadav ◽

Urvashi Verma ◽

Yogita Gautam

Keyword(s):

Liquid Culture ◽

Endometrial Biopsy ◽

Obstetrics And Gynecology ◽

Genital Tuberculosis ◽

Cross Sectional ◽

Active Pulmonary Tuberculosis ◽

Medical College ◽

Tertiary Center ◽

Female Genital Tuberculosis ◽

Female Genital

Background: Tuberculosis is a major health issue globally despite a declining trend in mortality with effective diagnosis and treatment, an estimated 10.4 million persons developing active TB each year with 1.33 million deaths. Objective of this study was to evaluate role of GeneXpert MTB/RIF/assay in diagnosis of female genital tuberculosis in suspected cases of tuberculosis.Methods: It was a cross sectional study done in department of obstetrics and gynecology in S. N. Medical college Agra for a period of 2 year (July 2017 to October 2019). 70 cases were selected from OPD of department of obstetrics and gynecology, S. N. Medical College Agra who met the inclusion and exclusion criteria after taking proper consent. In all selected cases endometrial biopsy sample was taken using endometrial biopsy curette in premenstrual period. All samples of endometrial biopsy were taken under all aseptic precaution from both corneal ends, anterior and posterior wall and lower part of uterus using endometrial biopsy curette and sample was collected in two separate sterile vials having normal saline and was sent for GeneXpert MTB/RIF/assay and liquid culture simultaneously.Results: Out of total 70 clinically suspected cases of female genital tuberculosis in between 20-45 years of age cough with expectoration 94% was the most common respiratory symptom followed by fever 81%, weight loss 56% and anorexia 54%. Prevalence of genital tuberculosis in active pulmonary tuberculosis patients was 30%. Irregular menstruation, vaginal discharge and pelvic pain were present in 69%, 60% and 52% patients respectively.Conclusions: The overall sensitivity of CBNAAT was 22% and specificity was 77%. The overall sensitivity of liquid culture was 28% and specificity was 71%.

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Female Genital Tuberculosis

Faridpur Medical College Journal ◽

10.3329/fmcj.v13i1.38022 ◽

2018 ◽

Vol 13 (1) ◽

pp. 53-55

Author(s):

Shahana Ahmed ◽

Dipti Rani Shaha ◽

Poly Begum ◽

Tahmina Akter

Keyword(s):

Young Women ◽

Reproductive Age ◽

Age Group ◽

Genital System ◽

Genital Tuberculosis ◽

The Social ◽

Female Genital Tuberculosis ◽

Anti Tubercular Therapy ◽

Reproductive Age Group ◽

Female Genital

The incidence of genital tuberculosis varies widely with the social status of the patient and her environment. The incidence is about 1% amongst gynecological patients attending the outpatient department in the developing country. Genital TB may be asymptomatic and the majority of women are diagnosed during investigations of infertility. Genital system TB represents 15-20% of extrapulmonary TB and is usually asymptomatic affecting mainly young women in the reproductive age group. Here we presented a case of genital TB which was diagnosed during laparotomy. After confirmation of diagnosis by histopathology, the case was successfully managed by anti-tubercular therapy for 9 months.Faridpur Med. Coll. J. Jan 2018;13(1): 53-55

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HYSTEROSCOPY FOR DIAGNOSIS OF FEMALE GENITAL TUBERCULOSIS IN INFERTILE WOMEN: AN ESSENTIAL TOOL IN MINIMALLY INVASIVE ERA.

10.36106/gjra/0205464 ◽

2021 ◽

pp. 73-76

Author(s):

Vinita Sarbhai ◽

Aafreen Naaz ◽

Vikram Sarbhai

Keyword(s):

Prospective Observational Study ◽

Uterine Cavity ◽

Endometrial Biopsy ◽

Genital Tuberculosis ◽

Infertile Women ◽

Female Genital Tuberculosis ◽

The Common ◽

Basic Evaluation ◽

Female Genital

INTRODUCTION: Female genital tuberculosis (FGTB) is difcult to diagnose due to asymptomatic presentation and paucity of denitive investigations. Hysteroscopy can be utilized for the diagnosis of genital tuberculosis in infertile women. This study was done to study the role of hysteroscopy in the diagnosis of genital tuberculosis. METHODS: Prospective observational study was performed on 50 infertile women after basic evaluation of infertility. The women with tubal factors for infertility or unexplained infertility were selected for the study. Premenstrual endometrial biopsy (EB) was done for mycobacteria (AFB) detection. Hysteroscopy was performed in the next cycle if no AFB was detected on EB. ATT was given if genital TB was diagnosed on EB, and hysteroscopy was performed after completion of ATT. Hysteroscopic observations were compared with endometrial biopsy results. RESULTS: A total of 4 (8%) cases were diagnosed as bacteriologically positive for genital tuberculosis in endometrial samples. They were given anti-tubercular treatment. On hysteroscopy, pale endometrium (16%), Intrauterine adhesions (46%), and osteal obliteration (18%) were the common abnormal observations. 12 patients had mild adhesions, 6 had moderate and 5 patients had severe adhesions. Overall, 26 (52%) patients had features of intrauterine brosis, like intra-uterine adhesions or ostial obliteration, which could be suggestive of chronic infection like tuberculosis. Hysteroscopic adhesiolysis was performed in 46% and the cavity was restored. CONCLUSION: Endometrial Biopsy and Hysteroscopy are complementary procedures that together can help in the diagnosis of FGTB. Hysteroscopy is not only the gold standard for diagnosing uterine adhesions, distortion of the uterine cavity and tubal ostia, but it can also be a prognostic and therapeutic tool.

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Role of GeneXpert in endometrial biopsy for diagnosis of genital tuberculosis in women presenting with infertility

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211496 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1832

Author(s):

Aafreen Naaz ◽

Vikram Sarbhai ◽

Vinita Sarbhai

Keyword(s):

Cross Sectional Study ◽

Endometrial Biopsy ◽

Genital Tuberculosis ◽

Cross Sectional ◽

Infertile Women ◽

Female Genital Tuberculosis ◽

Diagnostic Modalities ◽

Low Sensitivity ◽

Additional Value ◽

Female Genital

Background: The diagnosis of female genital TB is challenging due to low sensitivity of conventional diagnostic modalities. The new GeneXpert Test on endometrial biopsy is studied for its role in diagnosis of female genital TB.Methods: This is an observational cross-sectional study on 50 infertile women. Premenstrual endometrial biopsy was performed and sent for AFB Smear, M. TB (LJ) medium culture, CB-NAAT by GeneXpert, and histopathology. The results were compared for diagnosis of FGTB.Results: Endometrial Biopsy (EB) could confirm diagnosis of genital TB in 4 cases (8%) out of 50 infertile women. Amongst these 4 cases, GeneXpert was positive in two, AFB were detected on smear in three while one showed both AFB on smear and positive GeneXpert. GeneXpert adds additional value but surely cannot replace any of the other gold standard investigations.Conclusions: GeneXpert is a rapid diagnostic method which is accurate, feasible and affordable. It is useful adjunct to the existing armamentarium in diagnosis of female genital tuberculosis.

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The incidence detection of tuberculosis in patients with infertility and abnormal uterine bleed: a study in North Indian population

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193109 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3041

Author(s):

Simmanjit Kaur ◽

Unmesh Santpur ◽

Sunita Mor

Keyword(s):

Female Genital Tract ◽

Uttar Pradesh ◽

Reproductive Age ◽

Genital Tuberculosis ◽

Immunodeficiency Virus ◽

Female Genital Tuberculosis ◽

Acute Form ◽

Reproductive Age Group ◽

Hiv Negative ◽

Female Genital

Background: Tuberculosis (TB) remains a major global health problem, responsible for ill health among millions of people each year. TB ranks as the second leading cause of death from an infectious disease worldwide, after the human immunodeficiency virus (HIV). The latest estimates included in this report are that there were 9.0 million new TB cases in 2013 and 1.5 million TB deaths (1.1 million among HIV-negative people and 0.4 million among HIV-positive people). In India the incidence of genital tuberculosis is nearly about 18%. And in female genital tract it is estimated that 18% in India suffer from genital TB.Methods: The study was carried-out during November 2014 to March 2016 at Maharishi Markandeshwar deemed to be University, MMIMSR Mullana (Ambala). A total of 100 females of reproductive age attending the Gynaecology Outpatient were finally recruited on the basis of inclusion and exclusion criteria.Results: In our study majority i.e. 39 (39.0%) patient were found in the group of 20-29 years of age followed by 38 (38.0%) patients in the group of 30-39 years of age. Only 23 (23.0%) were found in the group of 40-49 years of age. In our study majority i.e. 54 (54.0%) patients were from Haryana followed by 44 (44.0%) patients were from Uttar Pradesh and only 2 (2.0%) patients were from Punjab. Out of 100 patients majority i.e. 76 (76.0%) patients had negative TB with either of investigation and only 24 (24.0%) patients had positive TB with either of investigation.Conclusions: Female genital tuberculosis affects the females of reproductive age group. The disease manifests itself as pelvic inflammatory disease in its acute form with menstrual irregularities and later infertility, and is almost always secondary to a primary lesion elsewhere.

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ROLE OF CBNAAT IN DIAGNOSIS OF GENITAL TUBERCULOSIS IN WOMEN

10.36106/paripex/3401550 ◽

2021 ◽

pp. 36-37

Author(s):

Simran Kousar ◽

Anuradha Khanna

Keyword(s):

Correct Diagnosis ◽

Young Female ◽

Reproductive Age ◽

Nucleic Acid Amplification ◽

Genital Tuberculosis ◽

Diagnostic Dilemma ◽

Irreversible Damage ◽

Obstetrics And Gynaecology ◽

Female Genital

Objective: Female genital TB referring to TB of the uterus,fallopian tubes and/or Ovaries.It poses a diagnostic dilemma because of its varied presentations and lack of sensitive and specific methods of diagnosis,though CBNAAT gives rapid result. India is a country sharing one fourth of the global incidence of tuberculosis. It is much easier to diagnose pulmonary cases, but challenges are with extrapulmonary cases. Genital tuberculosis is considered as an important cause of infertility in young females in India and difficult to diagnose.It requires incorporation of different modalities that should correctly,timely and rapidly diagnose the case.Methods:This study was conducted prospectively from October 2016 to June 2018 on 200 endometrial samples from reproductive age group females attending Obstetrics and Gynaecology OPD in obstetrics and gynaecology department of SSH, BHU. Nucleic acid amplification technique was done and their sensitivity in diagnosis of genital tuberculosis was ascertained. Results: Out of 200 samples, 1 samples were found positive with CBNAAT.Unlike Pulmonary TB, role of CBNAAT in the diagnosis of female genital TB is limited. Conclusion: Infertility in young female per se is usually heart breaking and distressing. Therefore, it is essential to diagnose and treat the cases of genital tuberculosis before irreversible damage of tube may happen. Although, advancement in diagnostic field is there from microscopy to molecular method,but still diagnosis of genital tuberculosis is challenging. Correct diagnosis prevents young female from mental trauma and toxicity of anti-tuberculosis drugs given on suspicion in high prevalence country like India.

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