Diagnostyic dillemma in Kochs

1-10-19

How to diagnose GENITAL KOCHS.  There are usually 5 tests that are in vogue in India. Those are Test No 1:- 1) Slide smear-AFB stainà The stain used is Ziehl Nielsen stain will stain rod shaped Acid Fast BacilliàThis test of slide making & then Z N stain will be only +ve if bacilli load in the tissue examined is > 10  ⁵ form samples from Endo biopsy and or peritoneal biopsy Test no 2:-?   AFB cultureà There are two broad kind of culture 2A: rapid culture is called BACTEC 460 –Radiometric system in Co2 incubator for about 4 weeks time but will be +ve only if bacilli load in the sample removed from body is > 10 bacilli per /ml of tissue sampled, Test No 2B:-culture contd for identification after growth is special media (called Lowenstein Jensen Media) where plenty of foods are there for growth of AFB including marinating adequate CO₂ tension. But even if adequate bacilli are present then also there will be only 75% positivity,

Test 2C:- Culture contd-third type culture media: - Test 2C:- MGIT (mycobacterium Growth Indicated Tube culture),

Test 4:-Traditional histology –Langhans type of giants cells in the removed sample,

Test 5 G Pig inoculation-not done nowadays.

Test 6 PCR of endometrium for DNA & PCR for RNA( using RFLP-DNA- –( 165 KD ) 6110. mpt 64 (nested DNA PCR). .

Others which are not so confirmed are enlarged hilar nodes in routine Chest X-ray, Unexplained peripheral lymphocytosis with normal less Total WBC count, raised ESR &in urine RE, C/s: - Abacteric Pyuria. ( Repeated Culture Negative Dysuria)  .If some undiagnosed –unexplained abdominal  mass is palpated and diag dilemma prevails than Gynae is in dilemma .At that point of time MRI / CT may show  enlarged mesenteric nodes  .In such set up PET-Scan will be better option if affordable. DOT-ELISA to detect Mycobacterium antigen –in   serum is no longer done

Why diagnosis of genital Kochs is so difficult?The false negative & false +ve rate is very high. Why? Why?? But there are three problems for confirming the very diag female genital Kochs 1) material obtained from endo /peritoneal biopsy is too scanty for all 5 commonalty used. In most cases we are able to do 2 tests for less amount of tissue obtained. Someone administers Premarin for 25 days so that Endo becomes thicker to easy the adequacy of sample (barriers methods in that cycle)     2)   It is a paucibacillary diseases –i.e. it can cause disease even with few thousands of bact. Therefore there remains a possibility of Kochs even if we fail to demonstrate the presence of bacilli from endo due to presence of minimal number of  bacilli,3) Most have received ATD/ATT befirethey come to us-we are in dilemea whether we start again ATD >;What are the tests for recativity causing Gynae disesa or Subfertility ?       4)  Mostofthe diagnostic tests will be +ve with other Mycobacteria –not concerned with genital Kochs .It is difficult to substantiate which are  Mycobacteria are a diverse group of rod-shaped bacteria that include more than 100 different species. The others, which are far commoner, environmental mycobacteria 5)  Kochs bacilli can affect from F copartner to males (it is more difficult tocionfirm diag of epididymal orchitus) & when to initiate Tr to males?