Diag of genital Kochs

DNA. PCR is super-sensitive, and will pick up the presence of even a few molecules of mycobacterial DNA.

This technology amplifies a DNA sequence which is unique to mycobacteria. But quite often contaminations occur e.g. tap water, slides etc and giving a false + ve DNA –PCR +ve. AS such, it is important to discriminate between true infection and contamination. The molecular cross-reaction between the ubiquitous non-pathogenic environmental mycobacteria (which are harmless colonisers) and M tuberculosis is what creates the diagnostic dilemma. With a positive TB PCR, the odds are that a positive result (in an asymptomatic patient) means that there is something wrong with the test, not with the patient. In fact, I think we should coin a new term for these mycobacteria which have created so much iatrogenic harm - Non pathogenic Ubiquitous Mycobacteria - NUM!

Relevance of PCR where do we  stand today?? The TB PCR test is highly flawed, because the DNA sequence which the PCR amplifies is common to both the mycobacterium tuberculosis as well as the other species of mycobacteria.

Since these mycobacteria are so common, when the laboratory finds a positive PCR reaction , it doesn’t know whether the mycobacterial DNA is coming from the patient or from the slide on which that sample was sent. Since they have a similar DNA structure, the presence of either will provide a positive result in a PCR test. The PCR test is quite a dumb test - it's not able to determine which type of mycobacteria is providing a positive signal!

Sadly, most gynecologists and pathologists are completely clueless about the prevalence of environmental mycobacteria; and when the TB PCR test result comes back as positive, their knee jerk reaction is to assume that the patient has genital TB ( when in reality, the result is much more likely to be a false positive, because of contamination).

How many of us are aware of the terminology of Environmental mycobacteria?? We live in India!!So we have to shut our clinics and read about environments-Pollutants, Chemicals, Smokes prevailing in India!!

Environmental mycobacteria as because environmental mycobacteria are so prevalent (they are found practically everywhere - even in the water in the lab which is used to clean the instruments!), the chances of the PCR test being positive because of contamination by environmental bacteria is much higher than because the patient actually has genital TB!

Environmental mycobacteria have always been around, so why wasn't this a problem in the past? This is because modern PCR is so sensitive! In the past, it was not easy to grow mycobacteria, which meant that even if a few contaminants were present in the specimen, these would fail to grow. However, PCR is super-sensitive, and will pick up the presence of even a few molecules of mycobacterial DNA.

With a positive TB PCR, the odds are that a positive result (in an asymptomatic patient) means that there is something wrong with the test, not with the patient. In fact, I think we should coin a new term for these mycobacteria which have created so much iatrogenic harm - Non pathogenic Ubiquitous Mycobacteria - NUM!

TB PCR positive

32yr old prim infertility of 7yrs.many failed cycles of Biotic...  endo TB PCR positive in Jan.pt started AKT for. 2 months. No defaulted...pt came to me 2 days back with TB-PCR negative dine 1wk back by another gynecologist. On advising to continue 2nd line AKT pt unwilling due to severe vomiting...him 2 manage? Can I go ahead with HSG without AKT?

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 Take home message:+U might know few pertinent points related to Kochs—Just brush up your knowledge please; TB interferon not done.  A) HSG is usually forbidden in a case of presumed/confirmed case of genital Kochs. But  Lap is reasonably safe B) Secondly, what U have  diagnosed as Kochs may be misdiagnosed/ inappropriate... It is difficult to be certain about Kochs as there is no specific serum marker... PCR ---so long we trusted so much has fallen to disrepute. Therefore elusions/ dilemmas prevails more so with the presence of Environmental Acid fast Rod shaped so many bacilli. C) Thirdly, it is our duty to refer to a Pulmologist and seek opinion about vomiting component if on ATD either in Preg or nonpregnant state along with current LFT report and H/O other medicationswhile on ATDunder your control.’.