Tuberculosis In Infertile Women Research Articles

Diagnosis of Genital Tuberculosis in Infertile Women by Using the Composite Reference Standard.

Female genital tuberculosis (FGTB) can be asymptomatic or even masquerade as other gynecological conditions. Conventional methods of FGTB diagnosis include various imaging, bacteriological, molecular, and pathological techniques that are only positive in a small percentage of patients, leaving many cases with undiagnosed condition. In the absence of a perfect diagnostic method, composite reference standards (CRSs) have been advocated in this diagnostic study. This study assesses the agreement between traditional diagnostic modalities using CRS and prevalent TB groups among different fallopian tube infertility manifestations. A total of 86 women with primary and secondary infertility were included in the study and subjected to bacteriological, pathological, and radiological examination for the diagnosis of FGTB. Results were evaluated statistically for concordance of the diagnostic tests to the CRS by sensitivity and specificity, while PPV and NPV were calculated for the performance of diagnostic tests of FGTB. We observed that 11.2% of women were found to be true positives by means of CRS. The positive findings by CRS were as follows: ultrasonography (13.9%), laparoscopy (14%), hysteroscopy (12%), GeneXpert (4.8%), culture (4.8%), polymerase chain reaction (4.8%), and histopathology (6.4%). GeneXpert and culture were found to have a perfect agreement with CRS. Hysterosalpingography, laparoscopy, and hysteroscopy have a fair agreement with CRS. Out of 43 women with tubal factor infertility, 6 women were found in the definitive TB group with mixed conditions of tubal manifestations. This study evaluates and demonstrates the reliability of the collective assessment of various diagnostic methods with CRS findings that help in identifying different TB groups of genital tuberculosis patients from all infertile patients by applying the criteria of CRS.

Female Genital Tuberculosis in Infertile Women

Background: Keeping in view the endemicity of tuberculosis in Jammu and Kashmir and the lack of information about the prevalence of Female Genital TB, this study was primarily undertaken to diagnose the genital tuberculosis in infertile women and to determine the utility of the existing standard diagnostic tests in our hospital.
 Methods: A prospective cross-sectional study was conducted over a period of 1 year. A total of 500 women attended Gynaecology OPD to evaluate the incidence of genital tuberculosis using CBNAAT (Cartridge based nucleic acid amplification test) and culture to diagnose female genital tuberculosis.
 Results: Majority of the respondents (82.35%) were having primary infertility. Majority of the respondents (91.20%) were negative for genital tuberculosis and followed by positive patients for genital tuberculosis (8.80%). the sensitivity and specificity for CBNAAT (Catridge Nucleic Acid Amplification) samples 82.40% and 100% respectively while as, the sensitivity and specificity for microscopic culture (Ziehl Neelsen) were 37.84% and 98.20% respectively.
 Conclusion: FGTB is a prevalent condition, particularly among infertile women. Early detection and treatment can lead to successful pregnancies. Individualization, counselling, and a multidisciplinary approach will produce greater results in the advanced stages. ART should only be provided to a select few patients after establishing that the disease is dormant, as hormonal treatment of ART can result in disease reactivation, which is highly counterproductive.

Comparison of Conventional Methods with Newer Diagnostic Modalities to Detect Genital Tuberculosis in Infertile Women.

Genital tuberculosis is one of the leading causes of female infertility. Paucibacillary nature of the disease in the female genital system often makes its diagnosis difficult. No single test has been able to accurately diagnose genital tuberculosis. In this study we aim to compare conventional diagnostic tests for tuberculosis like Acid Fast Bacilli (AFB) Staining, Lowenstein Jensen (LJ) Culture and Histopathology with newer tests like PCR, MGIT 960, GeneXpert. This study included 67 infertile women from Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. They were subjected to detailed history and routine investigations, namely Haemogram, ESR, Mantoux test, Chest X-ray and pelvic ultrasound to look for the findings of tuberculosis. A premenstrual endometrial aspirate was taken and was subjected to the AFB Staining, LJ Culture, Histopathology, PCR, MGIT 960, Gene Xpert, and the test results were compared. 35.8% (24/67) of women were diagnosed with genital tuberculosis using the diagnostic criteria. With culture as the gold standard, the positivity of genital TB was 19.4% (13/67). Majority of infertile patients with low index of suspicion clinically were positive for genital tuberculosis. Therefore, all the patients of infertility should be routinely evaluated for genital tuberculosis. PCR and MGIT 960 have shown promising results in the newer methods. LJ culture and histopathology are still the most reliable and available diagnostic methods. The usefulness of AFB Staining and GeneXpert remains questionable.

Comparison of Various Diagnostic Modalities for Genital Tuberculosis in Sub-Fertile Women in Rural Hospital

In India, tuberculosis of the genital tract, particularly of the Fallopian tubes and endometrium, is a leading cause of persistent infertility in women. The identification of FGTB so that therapy can begin as soon as possible is still a clinical problem. The paucibacillary character of the illness, as well as the few diagnostic assays available, make laboratory diagnosis problematic. Because of the lengthy and tough treatment, a confirmed diagnosis of tuberculosis (TB) is required to assist and urge the patient to comply. In a rural hospital, the review compares multiple diagnostic methods for genital TB in infertile women. This review includes descriptions of the condition as well as reports that are now accessible and focus on the tests and procedures required for early identification and treatment of female genital tuberculosis [FGTB].

Female Genital Tuberculosis Can Cause Infertility in Women or Not?

One of the important issues is infertility that is increasing today and the causes are various. Bacterium Tuberculosis is viable in pulmonary and extrapulmonary [1]. Female genital tuberculosis is an extrapulmonary type that makes up 9% of the cases [1]. Tuberculosis infection of the female genitalia leads to secondary infertility, dyspareunia, amenorrhea, irregular menstruation, and chronic pelvic inflammatory disease [2]. In 90% of cases, female genital tuberculosis affects young women aged 18 to 38 years old [3]. The global prevalence of female genital tuberculosis in infertile women is about 5% to 10% [2]. Hence, it should be considered as a differential diagnosis of the infertility causes in areas with tuberculosis infection prevalence. The gold standard method for diagnosis of this bacterium is culture, but the minimum number of bacteria should be 10-100 bacilli per milligram in this method [4]. Moreover, its long incubation period in this method leads to delays in diagnosis and treatment [4]. Also, laparoscopy can be used for diagnosis. Both laparoscopic and molecular tests are complementary tests and together they can effectively confirm the diagnosis of female genital tuberculosis [4]. For the treatment of female genital tuberculosis, multidrug therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol is used, while in more severe cases, surgery is recommended [5]. However, even after using multidrug therapy, infertile women with genital tuberculosis are less likely to be fertilized, and if they do become pregnant, the consequences of pregnancy such as ectopic pregnancy or miscarriage remain high [5]. Since, untreated tuberculosis causes extrapulmonary tuberculosis, preventative measures such as BCG vaccination at birth, identification of people with tuberculosis, early diagnosis, and treatment of tuberculosis can prevent extrapulmonary tuberculosis [2]. Therefore, similar to any other disease and infection, the best way to treat and reduce this infection and then reduce the rate of infertility is to diagnose and treat it early.

Correlation of past tuberculosis with current screening for female genital tuberculosis in infertile women in a tertiary care hospital

ObjectivesTo analyse correlation of past history of tuberculosis with present state of infertility with respect to HSG and diagnostic findings, with a view to assess the frequency of genital tuberculosis in infertile women, its clinical presentation and association with infertility. Materials and methodsThe study is an ongoing study conducted in the Department of Obstetrics and Gynaecology, Kasturba Hospital, Delhi and included 174 infertile women enrolled as OPD patients in our hospital. A detailed history with special emphasis on past history of tuberculosis, thorough clinical examination, all routine investigations for Infertility & special investigations for genital tuberculosis was done. Diagnostic tests and laparoscopy was further performed as per the protocol. ResultsFemale genital tuberculosis has been described as a disease of the younger population. The present study shows that 87.9% patients diagnosed for genital tuberculosis were between 20 and 35 yrs of age. It was observed that amongst 174 infertile patients who attended our OPD, 40 patients had a positive history of present or previous incidence of Koch's, pulmonary or extra pulmonary, namely 22.9% (Group I) and the remaining patient comprising 77.1%, who had no record of any previous tuberculosis (Group II). Active Tuberculosis was seen in 5 patients out of a total of 40 females. Out of the total of 174 infertile patients suffering from tubal disorder 52.5% of Group I patients had evidences of tubal disease as compared to only 27.6% in Group II thus suggesting a strong correlation of tubal destruction and subsequent infertility to a positive history of tuberculosis. Out of the 56 laparoscopies performed, it was seen that 75% of Group I patients with past history of TB had abnormal laparoscopic findings (18 out of 24 patients), as compared to Group II which had only 9 out of 32 patients (28%) showing positive pelvic pathology. This seems to be very significant. ConclusionIn conclusion the results of the present study validate arguments in favour of incorporating screening for genital tuberculosis as a part of the baseline investigation for all patients of infertility, in countries like ours and especially in such patients who have suffered from Tuberculosis sometimes earlier in their lives.

A STUDY ON CO-RELATION BETWEEN INFERTILITY AND FEMALE GENITAL TUBERCULOSIS

Background: Female genitourinary tuberculosis (FGTB) is an important cause of infertility in women of reproductive age group. The disease remains undetected due to its asymptomatic nature and lack of sensitive tests. This study was conducted with the aim of detecting the prevalence of genital tuberculosis in infertile women. Aim And Objectives: To evaluate the rate of female genital tuberculosis in patients of infertility. Method And Materials: Questionnaire survey was done among 100 infertile women in 6 months from May 2020 to October 2020. Females of reproductive age group from 18 years to 35 years with the duration of infertility of more than 2 years were included. Results: Total 100 infertile females were included in the study. Out of 100 subjects, 81 cases had primary infertility & 19 had secondary infertility. There was positive history of extra genital TB in past in 30 cases and family history was positive in 26 cases. FGTB was diagnosed in 14 females in past on basis of diagnostic methods used in alone or in combination. Conclusion: FGTB is common in our population and women presenting with infertility should be evaluated for genital tuberculosis. A high degree of suspicion and combination of histopathological and microbiological tests are important methods for the detection of genital tuberculosis

Genital footprints of extragenital tuberculosis in infertile women: Comparison of various diagnostic modalities

BackgroundGenital tuberculosis (TB) continues to remain an important cause of infertility in women, especially in developing countries. It is mostly consequent to a primary infection elsewhere in the body. The diagnosis is challenging, considering its paucibacillary nature. Although there are many studies on association of genital tuberculosis with infertility, there is paucity of literature on impact of extragenital tuberculosis on fertility of women through involvement of female reproductive organs. The various diagnostic modalities available have limitations and quest is ongoing for the best diagnostic test. MethodThis was a prospective observational study conducted at the infertility clinic of a tertiary care health facility where 60 infertile women with either tubal factor or unexplained infertility with or without past history of extragenital tuberculosis were enrolled as study subjects or controls respectively. Mantoux test was performed in all women and diagnostic laparo-hysteroscopy was performed in all women to look for any evidence of uterine and/or tubal damage. The peritoneal fluid was sent for GeneXpert and Liquid culture for mycobacterium tuberculosis. Results of Mantoux test, GeneXpert and liquid culture were compared with the laparohysteroscopic findings. ResultOf the thirty infertile women in the study group, 27/30 (90%) had a history of pulmonary tuberculosis and 3/30 (10%) had history of tubercular cervical lymphadenopathy. It was observed that Mantoux test was positive (induration >10 mm) in 27/30 (90%) of women in the study group as compared to only 4/30 (13.3%) controls. Abnormal hysteroscopic findings were documented in 26.6% (8/30) study group women as compared to 6.6% (2/30) women in the control group. Similarly, 60% (18/30) of women in the study group had abnormal laparoscopic findings compared to 33% (10/30) in the control group. Seven out of thirty (23.3%) women were positive for GeneXpert in the study group compared to only 1/30 (3.3%) in the control group. Similarly, liquid culture was positive in 6/30 (20%) of women in the study group as compared to 1/30 (3.3%) in the control group. All the above differences were statistically significant. We observed that the sensitivity of Mantoux test (75.8%) stand alone was higher than the other tests combined (50%). However, specificity and positive predictive value (PPV) increases markedly (up to 100%) to when all the three tests are combined. ConclusionThe authors conclude that all women presenting with infertility should be screened for a past history of tuberculosis and actively worked up for genital tuberculosis in case the history is positive. The various available tests (Mantoux test, GeneXpert and liquid culture) have their limitations for the diagnosis of genital tuberculosis. Thus an approach of early resort to laparohysteroscopy in suspected patients is desirable so that definitive management may be instituted timely and promptly.

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

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.

Limited role of GeneXpert in peritoneal fluid in the diagnosis of genital tuberculosis in infertile women.

Background and Objectives:Genital tuberculosis (TB) is an important cause of infertility in women that poses many challenges in diagnosis. The study is done to understand the utility of GeneXpert test in peritoneal fluid in the diagnosis of genital TB in infertile women.Methods:All infertile women in postmenstrual phase who were planned for laparoscopy in study period were included. Women who were already on anti-TB therapy were excluded. Peritoneal fluid/washings were retrieved during laparoscopy to test for Mycobacterium tuberculosis by GeneXpert. A note was made of laparoscopy evidence of TB. Endometrial sample was sent for microbiological testing of mycobacterium on smear and liquid culture. Histopathological test of endometrium was also done to look for granulomas.Results:In a total of 57 women, 8 (14.03%) women were diagnosed with TB on the basis of laparoscopy or microbiological or histopathological tests. Six women had caseating tubercles in pelvis, of them two women had presence of mycobacterium on smear, one woman also had positive liquid culture. In two women endometrial smear was positive. None of the women had a positive GeneXpert test in peritoneal fluid.Conclusion:Genital TB is a clinical problem in infertile women. Even in women with confirmed genital TB the peritoneal fluid/washings were negative for mycobacterium. GeneXpert did not pick Mycobacterium in peritoneal fluid in women with genital TB. Hence, it is not a sensitive and good tool for the diagnosis of female genital TB.

Genital tuberculosis screening at an academic fertility center in the United States

Infertility is a common presentation of female genital tuberculosis in endemic areas. Female genital tuberculosis-related maternal and neonatal complications have increased in recent years after assisted reproductive technology treatments. Despite rising emigration rates to the United States, guidelines to identify those with latent tuberculosis or female genital tuberculosis in fertility centers do not exist. This study aimed to characterize the prevalence of female genital tuberculosis in infertile patients at our academic fertility center. This is a prospective cohort study. All patients presenting for infertility evaluation between January 2014 and January 2017 were assessed for risk factors for latent tuberculosis. Patients at risk for latent tuberculosis underwent screening using QuantiFERON-TB Gold serum assay. QuantiFERON-TB Gold-positive patients underwent further testing for female genital tuberculosis consisting of endometrial biopsy with histopathologic examination by a clinical pathologist, polymerase chain reaction for tuberculosis, and culture for acid-fast Mycobacterium tuberculosis. Twenty-five of 323 infertility patients (7.7%) screened for latent tuberculosis had positive QuantiFERON-TB Gold results. A greater number of patients with a positive test result for QuantiFERON-TB Gold were foreign born than those with a negative test result for QuantiFERON-TB Gold (92% vs 29%; P<.001). Of note, the QuantiFERON-TB Gold-positive population had a higher incidence of both recurrent pregnancy loss (28% vs 7%; P=.003) and Asherman syndrome (8% vs 0.3%; P<.001). Among those with a positive test result for QuantiFERON-TB Gold, chest x-ray was abnormal in only 2 patients (8.0%). Endometrium evaluation revealed abnormalities in 2 patients (8.0%), in whom chest x-ray was normal, with 1 showing evidence of female genital tuberculosis. This was indicated by histology consistent with chronic granulomatous endometritis and positive endometrial testing for tuberculosis by polymerase chain reaction, acid-fast bacilli smear, and culture for Mycobacterium tuberculosis. Although the prevalence of female genital tuberculosis in infertile women in the United States seems to be low, this study indicates that it can be underdiagnosed without utilization of multiple diagnostic modalities including endometrial sampling. Given the potential for serious maternal and neonatal morbidity in affected patients utilizing assisted reproductive technology, we propose that all at-risk women seeking infertility care in the United States be screened for latent tuberculosis. In patients who screen positive, endometrial biopsy should be obtained for evaluation by histology, polymerase chain reaction, and culture for Mycobacterium tuberculosis to rule out female genital tuberculosis before infertility treatments are initiated.

Prevalence of Genital Tuberculosis in Infertile Women; a Study from a Tertiary Care Center in North India

Prevalence of Genital Tuberculosis in Infertile Women; a Study from a Tertiary Care Center in North India

Role of newer methods of diagnosing genital tuberculosis in infertile women

Genital tuberculosis is an important under-diagnosed factor of infertility. A vast majority of cases are asymptomatic and diagnosing them will help in treating such patients. We conducted a retrospective study in a tertiary care hospital of Delhi with an aim to compare different methods i.e., histopathological examination (HPE), acid-fast bacilli (AFB) smears, Lowenstein-Jensen (LJ) culture, BACTEC culture and polymerase chain reaction deoxyribonucleic acid (PCR-DNA) for diagnosing endometrial tuberculosis in infertile women. The data from 546 samples of endometrial biopsy histopathology, AFB smears and LJ culture was collected and then analyzed. Of these, HPE for tuberculosis was positive in 13, LJ culture in 10, AFB smear was positive in one case. BACTEC and PCR-DNA were feasible for 90 patients and PCR-DNA was positive in 20 and BACTEC in eight patients. Out of 20 patients with PCR positive results, 15 were only PCR positive and were subjected to hyster-laparoscopy and five had evidence of tuberculosis. Thus, none of the available tests can pick up all cases of genital tuberculosis, but conventional methods i.e., histopathology and LJ culture still has an important role in the diagnosis of endometrial tuberculosis in government setups where BACTEC and PCR are not performed routinely due to lack of resources.

Genital tuberculosis in infertile women: Assessment of endometrial TB PCR results with laparoscopic and hysteroscopic features

Mycobacterial infections of the genital tract have been implicated in the etiology of female infertility. The correlation of endometrial TB PCR with laparoscopic and hysteroscopic features in patients with infertility was evaluated. Women suffering from infertility and undergoing diagnostic laparoscopic and hysteroscopic examination were included. Endometrial specimens were assayed by Nested PCR for mycobacterium complex and the results were then retrospectively correlated with laparoscopic and hysteroscopic features. Positive TB PCR was observed in 32.18% (n=56) women. Out of these 56 patients, 48 had endoscopic abnormalities suggestive of tuberculosis (TB) and rest 8did not reveal any endoscopic abnormalities. However, of 174 patients 139 had endoscopic abnormalities with positive TB PCR in only 48. Sensitivity and specificity of endoscopic evaluation was 85.71 and 22.8%, respectively. The presence of periovarian adhesions, cornual block, tubal beading, tubercles, intrauterine adhesions, and ostial fibrosis had very strong association with positive TB PCR. Total predictive value of endoscopic evaluation in diagnosis of genital TB was 42.52%. This study highlights that endoscopic evaluation is an important diagnostic tool, but can neither confirm nor exclude genital TB. Endometrial TB PCR may have to be routinely resorted to make a definite diagnosis of mycobacterial infection in endemic areas.

O564 Role of messenger RNA PCR in the diagnosis of genital tuberculosis in infertile women

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S253-S254 Free communication (oral) presentations O564 Role of messenger RNA PCR in the diagnosis of genital tuberculosis in infertile women D. Maheswari, D. MaheswariSearch for more papers by this authorA. Kriplani, A. KriplaniSearch for more papers by this authorN. Agarwal, N. AgarwalSearch for more papers by this authorU. Singh, U. SinghSearch for more papers by this authorN. Bhatla, N. BhatlaSearch for more papers by this authorP. Garg, P. GargSearch for more papers by this author D. Maheswari, D. MaheswariSearch for more papers by this authorA. Kriplani, A. KriplaniSearch for more papers by this authorN. Agarwal, N. AgarwalSearch for more papers by this authorU. Singh, U. SinghSearch for more papers by this authorN. Bhatla, N. BhatlaSearch for more papers by this authorP. Garg, P. GargSearch for more papers by this author First published: 06 October 2011 https://doi.org/10.1016/S0020-7292(09)60937-1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S253-S254 RelatedInformation

O499 Diagnosis of genital tuberculosis in infertile women and the effect of anti-tubercular therapy on fertility outcome – AIIMS Experience

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S235-S235 Free communication (oral) presentations O499 Diagnosis of genital tuberculosis in infertile women and the effect of anti-tubercular therapy on fertility outcome – AIIMS Experience V. Kulshrestha, V. KulshresthaSearch for more papers by this authorA. Kriplani, A. KriplaniSearch for more papers by this authorN. Agarwal, N. AgarwalSearch for more papers by this authorU. Singh, U. SinghSearch for more papers by this authorT. Rana, T. RanaSearch for more papers by this author V. Kulshrestha, V. KulshresthaSearch for more papers by this authorA. Kriplani, A. KriplaniSearch for more papers by this authorN. Agarwal, N. AgarwalSearch for more papers by this authorU. Singh, U. SinghSearch for more papers by this authorT. Rana, T. RanaSearch for more papers by this author First published: 06 October 2011 https://doi.org/10.1016/S0020-7292(09)60872-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S235-S235 RelatedInformation

O743 Diagnostic value of endometrial TB PCR in detection of genital tuberculosis in infertile women

O743 Diagnostic value of endometrial TB PCR in detection of genital tuberculosis in infertile women

Comparative evaluation of laparoscopy and endometrial polymerase chain reaction for the diagnosis of female genital tuberculosis in infertile women in India

OBJECTIVE: To compare the efficiency of laparoscopic examination versus endometrial tuberculosis polymerase chain reaction (endo TB PCR) as gold standard for the diagnosis of female genital tuberculosis (FGTB) in India, a high prevalence country. DESIGN: Retrospective case study. MATERIALS AND METHODS: Of 255 women who underwent laparoscopy during the study period, both laparoscopy and endo TB PCR were done in 162 infertile patients whose data were analyzed. Laparoscopic findings were categorized as Type I i.e. strongly suspicious of TB, and Type II i.e. normal or other diagnoses. Considering a positive endo TB PCR as the gold standard, efficiency of other tests was evaluated with the help of descriptive statistics, cross comparison and receiver operator curves (ROC). RESULTS: There were 52 endo TB PCR positive patients who were diagnosed as definite GTB, of whom 44 (84.6%) had also shown Type I laparoscopic findings suspicious of TB subgroup analysis of Type I laparoscopic findings showed a similar PCR positivity of 54.5% (24 of 44) in the strongly suspicious and 54.1% (20 of 37) in the mildly suspicious patients. Conversely, of 81 patients with Type II laparoscopic findings, only 8 had shown a positive PCR. Thus, the overall sensitivity and specificity of laparoscopy was 0.85 and 0.66 respectively with an efficiency (correct classification rate) of 0.72. Laparoscopy had a positive predictive value of 0.54 (95% C.I. = 0.429 – 0.654) and a negative predictive value of 0.901 (95% C.I. = 0.815 – 0.956). The ROC curve for laparoscopy revealed a correlation of 0.76 with the PCR. Other tests such as the ELISA (IgG and IgM) test, ultrasonography, hysteroscopy and hysterosalpingography did not show any significant differences in the PCR positive and negative patients. CONCLUSIONS: There was a good correlation of endo TB PCR with laparoscopic diagnosis of GTB in infertile women in India. Even mild or subtle abnormalities on laparoscopy should be investigated with PCR for TB.

Genital tuberculosis in Indian infertility patients

Objectives To analyze the clinical and laparoscopic features of 40 infertile women with genital tuberculosis. Materials and methods This prospective clinical study was carried out at a tertiary care hospital from October 1, 2004, to August 30, 2006, with 150 infertile women in whom there was clinical suspicion of genital tuberculosis. All underwent diagnostic laparoscopy and biopsy for confirmation and other causes of infertility were excluded. Results Among the 40 infertile women affected with genital tuberculosis there were cases of primary ( n = 30) and secondary ( n = 10) infertility; pelvic pain ( n = 8); menorrhagia ( n = 9); oligomenorrhea ( n = 7); hypomenorrhea ( n = 8); and primary ( n = 2) and secondary ( n = 2) amenorrhea. There were histories of pulmonary ( n = 9) and abdominal tuberculosis ( n = 6), ectopic pregnancy ( n = 4), and antitubercular treatment ( n = 10) in 10. There were cases of positive Mantoux test results ( n = 2); endometrial aspiration showing tubercular endometritis ( n = 10); positive acid-fast bacillus culture results ( n = 1); and positive polymerase chain reaction results ( n = 9). Laparoscopic examination revealed abnormally dilated, tortuous, and blocked fallopian tubes ( n = 13); peritubal and periovarian adhesions ( n = 18); Fitz Hugh Curtis syndrome ( n = 15); omental adhesions ( n = 18); and bowel adhesions ( n = 15). Hysteroscopy revealed flimsy intrauterine adhesions ( n = 7). All patients were treated for tuberculosis and 13 were counseled for in-vitro fertilization and embryo transfer or adoption. Conclusion Genital tuberculosis is common in India and a combination of clinical and laparoscopic diagnoses, along with endometrial histopathologic studies, acid-fast bacillus culture, and polymerase chain reaction assays provides the best available method for the diagnosis of genital tuberculosis in infertile women.

Short course chemotherapy for endometrial tuberculosis in infertile women

A daily regimen of rifampicin (450 mg) and isoniazid (300 mg) was tried for 9 months in 14 women with histologically diagnosed endometrial tuberculosis (TB). Follow-up endometrial biopsies were negative for tubercular disease in all patients. Three (21.4%) of the 14 women conceived between 3 and 12 months after starting treatment.