Tuberculosis of female genital Tract what options we have now??

 

Q.1: In which diseases  PCR technology is used ?? Ans:  PCR technology is extensively used in analysing clinical specimens for the presence of infectious agents, including 1) HIV, 2) hepatitis,3)  human papillomavirus ., 4) Epstein-Barr virus (glandular fever), 5) malaria and 6) anthrax. Tuberculosis is a disease caused by the bacteria Mycobacterium tuberculosis that generally attacks the lungs however possibly can affect other parts of the body. Genital tuberculosis (GTB) is a potent contributor to irreversible damage to the reproductive system and infertility in females.

Female GTB of the endometrium is a well-recognized entity in the etiology of infertility, especially in TB endemic countries like India.

Q.2: Advantages of PCR technology?? Ans: The diagnosis is a challenge to the clinician as it is mostly either asymptomatic or presents with nonspecific symptoms in affected females.It could be observed through this study that 65% of the cases of infertility were due to the tuberculous involvement of endometrium. Schaefer and Onuigbo in their two different reports have shown an involvement of ET in 50%–60% of the case  of FGB.

 TB PCR is a rapid and reliable test in the diagnosis and management of tuberculosis. The TB-PCR is one of the tests that helps diagnose and confirm an infection of Tuberculosis.  The hsp65 Nested PCR of MB can be used as a noninvasive screening test for early diagnosis of GTB.

. Q.3: How there is subfertility due to genital Kochs?? Ans:  Infertility might,  be occurring due to disturbed implantation of the developing embryo on the endometrium.

Early reproductive age is the most vulnerable period to acquire GTB. This could be because of the fact that after puberty the blood supply to the pelvic organs is increased resulting in more bacilli reaching and seeded in the reproductive organs. Many researchers have studied this aspect of female GTB comparing different diagnostic tests on ET and MB samples .Correct diagnosis often relies on ET sample obtained by biopsy which is an invasive procedure. But by contrast menst blood(MB)  as a sample in the detection of endometrial TB has been used in many studies, but its utility over the endometrial sample in detecting infection is still a subject to explore.

 

 Q,. 4: So as on date , dilemma exists about which method is accurate so far exact diagnois Is made with certainty. Therefore as no gold standard diagnostic tool is yet available, clinical suspicion and relatively insensitive approaches such as A) histopathology, B)  laparoscopy and C) hysterosalpingogram are currently critical determinants in the diagnosis of GTB.

Although a polymerase chain reaction (PCR)-based assay using endometrial tissue seems promising, sampling does require an invasive procedure.

 

Point 5: Points in favour of PCR dependent diag in contrast to histology or Culture??The sensitivity and specificity of PCR were 93%  and 84%, respectively. HIV status did not affect the sensitivity of PCR. A total of 99.7% of the true smear-positive and 82.1% of the true smear-negative TB patients were correctly identified by PCR.

Using Bactec 360 culture as the gold standard, the overall sensitivity of TB PCR was 78.3%, and for pulmonary and extrapulmonary specimens it was 82.3% and 72.0%, respectively. However, mycobacterial culture, which has the highest sensitivity for diagnosing and confirming active TB, requires 2 to 6 weeks for interpretation Conclusions: TB PCR is a rapid and reliable test in the diagnosis and management of tuberculosis. Using culture as the gold standard, the overall sensitivity of TB PCR was 78.3%, and for pulmonary and extrapulmonary specimens it was 82.3% and 72.0%, respectively.: 

The traditional less sensitive, time-consuming, and labor-intensive methods, i.e., histopathalogical and mycobacteriological examinations (smear and culture) in the diagnosis of TB are now been overshadowed by more sensitive, rapid, and easier PCR-based methods. Researchers have recommended direct molecular detection of MTC be used as an adjunct to other methods of laboratory diagnosis of TB,

The specificity (82.9%) and sensitivity (72.3%) of the detection of MTB from MB samples have been reported by various authors . Few studies have reported the sensitivity range between 55% and 90% of the detection of MTB by PCR from clinical specimens.

The limitations of the PCR techniques are the false-negative results (more common with MB samples ) which can be attributed to either paucibacillary nature, or inefficient extraction of the DNA from the sample. Thus, sampling plays an important role in the accuracy of detection of GTB.

 

Since the involvement of the genital tract in TB could be generalized or patchy, and the technique of sample collection is blind, there is a possibility of missing the infected area when ET is collected. However, the overall positivity rate of MB can be increased by repeated sampling over a period of time. While multiple sampling for ET (invasive method) is not feasible, a noninvasive sample like MB which can be taken during different cycles and extracting DNA from a large volume of MB for PCR seems to be a better specimen in these circumstances. An added advantage of MB sample is that the MB can be collected undertaking sterile precautions by the patient itself from the periphery and can be sent to the laboratory for further workup.

Our study is unique as we have assessed the utility of nested PCR on MB over ET samples collected from the same patient. None of the studies conducted so far have made a similar comparison to the best of our knowledge. Nested PCR using MB as a sample has an insignificant difference with that of ET. Thus, MB seems to have a practical utility in being a noninvasive test and could be used as a preliminary screening test for diagnosis of GTB. On the contrary, Q.8: What isnew method of diag of genital Kochs?? Ans :Patil et al. in their study did not find MB to be a potential alternative clinical sample in the diagnosis of endometrial TB. They had MB as well as endometrial aspirates tested by a commercial kit GEN-PROBE AMPLIFIED M. tuberculosis direct test which is a nucleic acid amplification test..