Genital Koch's

Take home(contd) :D) Ask the couple to use barrier contraceptives till the course is completed E) If U have doubt do not hesitant about etiology Lap-Hysteroscopy & peritoneal/ Lymph node biopsy (histological diagnosis, Rapid culture-Bactec, Delayed culture-L-J media) will of considerable help.

 To confirm ones  initial diagnoses). F)  In case she falls preg during the course of anti-Kochs- do not advocate TOP.(abortion-termination of Preg) . All drugs are safe in pregnancy  . G) INH is notorious to cause peripheral Neuritis - Suppl. of vit B6 will help/ameliorate. H) Not only the very diag bothers us but with great pain I, a senior gynecologist  confess that  (In conclusion) that none of us are worried about MDR( multi drug resistant-No one kolledr in world) .

Unfortunately most of us are busy with color flow, BPP, Growth profile Cx effacement,  Obstet infections, Foetal malformations, and induction of labour. How many of us are really worried about  to avert MDR Kochs which is a  our noble duty to motivate her to continue the ATD in consultation with Pulmologist ( A PATRIOTIC DUTY) . This is our patriotic duty. MDR kochs-- enough is enough.

MTB culture on EB IS VERY IMPORTANT TO NOTE SENSITIVITY TEST OF Kochs it is being done and then select the ATD as relevant is rec fungal infn-Fungal culture is available,. Not to do polypharmacy. The drug sensitivity of both Kochs and in case of white discharge or Pr vulvae or vulvodynia or vaginal soreness à Fungus in  case of president white discharge will be available by 6 weeks time that too with affordable price.?

Is that more specific than pcr &I think

To start ATD we have to know is there any sign of active disease in this pt or you have just done her PCR and assumed her to have TB, was PCR done on menstrual blood or endometrium, which day of cycle?

If you have done the menstrual blood PCR and started ATT it is no more valid and was condemned by GOI TB program. The most likely explanation about these two different findings in two months span is that it was false positive.

 We SHOULD enquire about her:”How is her menstruation? “.If one is scared of doing her HSG please goes for diagnostic lap- hysteroscopy and see for other signs and take biopsy from appropriate places if needed as suggested by Dr. Srimanta. But for God sake don't push the poor female to digest any line of ATT if she is not able to tolerate it until unless you have a solid evidence or a very high degree of suspicion score.

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PCR was false positive n continue further evaluation... That is my query...

Suspicion of genital Kochs does not preclude Lap-Hyst. On the contrary it helps to frame the future planning/ guideline. No hesitation Pl.

Emphasize is that mere PCR positivity doesnt make her a secluded infected case

 32 yr old...less time left ...ovarian reserve? Go ahead with lap hysteroscopy to find more evidence for tb if no evidence, everything normal forgets tb ... Go ahead with further management

Mere PCR +ve does not mandate initiation of ATD as it has poor specificity in the diagnosing human kochs organism. Because there are structural similarity of PCR of this organism with other members of Mycobact.