Diagnosis of genital tuberculosis: correlation between polymerase chain reaction positivity and laparoscopic findings

Background: Female genital tuberculosis (FGTB) is often a silent disease sparing no age group but majority of patients are in the reproductive age. In infertility patient’s incidence of FGTB varies from 3-16% in India but the actual incidence of genital tuberculosis may be under reported due to asymptomatic presentation and paucity of investigations.Methods: Prospective case control study was conducted from June 2018 to May 2019 in LLRM Medical College Meerut. A total 100 Endometrial samples were collected during diagnostic laparoscopy from all suspected case of genital TB, presented with either primary or secondary infertility and samples sent for histopathology, Gene-xpert and Bactec culture.Results: Out of 100 samples Bactec culture was positive in 2 samples, Gene-xpert positive in 3 samples. On histopathology out of 100 cases, non-specific endometritis was found in 1 case, tubercular-endometritis in 1 case, proliferative enometrium (anovulatory) in 40 cases and secretory endometrium found in 58 cases.Conclusions: Female genital TB poses a diagnostic dilemma because of its varied presentation and lack of sensitive and specific method of diagnosis. Culture though remains the gold standard of diagnosis of female genital TB, gene-xpert, histopathology, Bactec culture or laparoscopy can be used for starting treatment. Endometrial biopsy on histopathology shows not only Tubercular endometritis but also gives hormone response on endometrium, local factors of endometrium concerning non-specific and specific infections and anovulatory cycles.

Section: Distribution Of Samples According To Bactec Culturesupporting

confidence: 92%

Comparison of diagnostic accuracy of bactec culture, gene-xpert and histopathology in the diagnosis of genital tuberculosis in women with infertility

Chaudhary

Dhama

Singh

et al. 2020

“…Arpitha et al in their study reported 60% patients having features of genital T.B with various tubal conditions like hydrosalpinx (15.9%), short and rigid tubes (4.3%), fimbrial phimosis (8.7%), tubal sacculation (20.2%), cornual block (21.7%) and endometriosis (13.1%) on laparoscopic visual examination. 19 All the 15 cases in the present study with similar tubal pathology were tested for GTB. Out of them 7 cases later reported positive for T.B and were promptly started on AKT regimen.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of infertility in women from an industrial area in Telangana, India by diagnostic hysterolaparoscopy: can it explain the unexplained?

Kanungo

Haritha

Chaitanya

et al. 2018

Background: Infertility with a prevalence of 10-15% worldwide has been showing a rising trend. Diagnostic hysterolaparoscopy (DHL) procedure in infertility cases uncovers conditions which even a detailed clinical examination or hysterosalpingography or transvaginal ultrasound can miss. Correction of these factors improves chances of conception, naturally or by subsequent ART procedures.Methods: This is a prospective study conducted from January 2014 to December 2015. The objective of this study is to evaluate the factors causing infertility by diagnostic hystertolaparoscopy among primary and secondary infertility women coming from an industrial area, attending infertility clinic at Employees State Insurance Corporation Hospital, Telangana. 80 cases of primary infertility (65%)and secondary infertility (35%) belonging to age group of 19 to 35 years and above, satisfying the inclusion criteria underwent a systematic way of evaluation by diagnostic hysteroscopy followed by diagnostic laparoscopy procedure.Results: 40.38% of primary infertility and 35.72% of secondary infertility had abnormal pelvic pathology. 27% of primary and 32.14% of secondary infertility had abnormal intrauterine abnormality. Diagnostic hysteroscopy found intrauterine septum and endometrial polyp in 12.5% and tubal ostial fibrosis in 5% of total cases. Pelvic peritoneal adhesion (23.75%), pelvic endometriosis (13.75%) and tubal pathology (18.75%) were most common laparoscopic findings. 32.5% of all cases had no significant abnormality. Bilateral tubal block was seen in 20% of cases on chromopertubation. DHL also facilitated operative interventions like adhesionolysis, endometriotic tissue ablation, ovarian cyst drilling, septal resection, polypectomy in the same sitting.Conclusions: DHL procedure has become the gold standard diagnostic modality, as it explains 30-70% of factors that remained undetected during routine investigative workup of female infertility, especially those grouped under unexplained infertility. Industrial toxin exposure may lead to infertility as this study among industrial workers showed a greater incidence of tubo-peritoneal pathology than other factors.

“…Features suggestive of genital tuberculosis were looked for by noting the presence of: suprahepatic adhesions, pelvic adhesions, pelvic congestion, bowel/omental adhesions, peritubal adhesions, cornual block, delayed spillage, fimbrial phimosis, hydrosalphynx, granulomas, short tubes, sacculations/beaded tubes, rigid tubes, TO mass, other incidental findings: fibroids, endometriosis, PCOS. 12…”

Section: Laparoscopymentioning

confidence: 99%

A prospective study of outcome in infertility patients diagnosed with genital tuberculosis

Yadav

Kumar

2020

Background: Tuberculosis is an increasing health problem worldwide with around 9.6 billion new cases reported every year. Female genital tuberculosis (FGTB) has a varying incidence ranging from a very low of 0.69% in developed nations to as high as 19% in developing nations like India. The average incidence of infertility due to tuberculosis is 5-10% worldwide.Methods: The study was a hospital based prospective clinical study, from September 2014-2017 with sample size of 355 infertility cases. Endometrial sampling and diagnostic hystero-laparoscopy were used for diagnosis. Endometrial sample subjected for both the test CBNAAT and HPR was used for confirmation of positive patients. Inclusion criteria were, infertile patients diagnosed with genital tuberculosis who were then given treatment. Patients diagnosed to have infertility due to causes other than TB were excluded from the study. Highly suspected cases and those who were willing underwent diagnostic laparoscopy.Results: Out of 355 cases of infertility, 83 were because of genital TB, received treatment out of which 32 conceived. CBNAAT was very sensitive than histopathology or laparoscopy. The live birth rate and conception rate were 20.24% and 38.09 % respectively.Conclusions: CBNAAT is OPD based economical test (free by GOI), very sensitive and picked up more cases than histopathology or laparoscopy. The live birth rate and conception rate were found to be higher than other studies possible due to intervention at an earlier stage of the disease process. This test should be widely used by gynecologist for early detection of genital tuberculosis.