Diseases masking and delaying the diagnosis of urogenital tuberculosis

Kulchavenya, Ekaterina; Kholtobin, D P

doi:10.1177/1756287215592604

Cited by 26 publications

(24 citation statements)

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“…Urogenital tuberculosis (UGTB) is the second most common form of extrapulmonary TB (EPTB) in developing nations with severe epidemic situations. For example, India (comprising 45% of EPTB cases) and the third most common form in locations with a lower incidence of TB [1,2], which include both renal and genital TB. However, concomitant UGTB and pulmonary TB (PTB) are found in 2-10 and 15-20% of patients in developed and developing nations, respectively [2].…”

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“…Though urine culture is considered the gold standard, it requires skillful technicians and has a prolonged turnaround time of approximately 6-8 weeks [7] when irreparable damage to the fallopian tubes and epididymis already occurs. Delayed diagnosis also leads to nonfunctioning unilateral kidney, contracted bladder and renal failure [1]. Endoscopic procedures such as laparoscopy/hysteroscopy are often linked with operative risks and mostly cause flaring of infection [5], while histopathological examination can be confirmatory only when it demonstrates acid-fast bacilli in the tissues that are very scarce in endometrial biopsies (EBs) [7].…”

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Recent Trends in Diagnosis of Urogenital Tuberculosis

Mehta

Kamra

2020

Future Microbiol.

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the efficient diagnosis of UGTB by reliable tests would certainly reduce the infertility in both men and women and the other sequelae associated with disease. " Urogenital tuberculosis (UGTB) is the second most common form of extrapulmonary TB (EPTB) in developing nations with severe epidemic situations. For example, India (comprising 45% of EPTB cases) and the third most common form in locations with a lower incidence of TB [1,2], which include both renal and genital TB. However, concomitant UGTB and pulmonary TB (PTB) are found in 2-10 and 15-20% of patients in developed and developing nations, respectively [2]. In fact, UGTB occurs after a prolonged period of latent infection followed by hematogenous spread to the kidneys, fallopian tubes and epididymis [3]. The clinical manifestations of female UGTB include primary or secondary infertility, menstrual dysfunction and pelvic inflammatory disease [4]. Infertility is the most common complication, which occurs in 5-16% of Indian women caused by irreversible damage to the fallopian tubes. Mostly, fallopian tubes are associated with congestion and miliary tubercles, while endometrium is linked with caseation and ulceration in 50-80% cases, resulting in Asherman's syndrome [5]. Similarly, the most frequent sites for male UGTB are the epididymis and prostate followed by seminal vesicles and testicles originating from renal foci, which also lead to infertility [6]. Owing to asymptomatic nature and varied clinical presentations (ranging from vague urinary symptoms to chronic kidney disease) that mimic several urologic and genital diseases, diagnosis of UGTB is a daunting challenge [3].Smear/culture, histopathology, interferon-γ release assays (IGRAs), intravenous pyelography, laparoscopy and nucleic acid amplification tests (NAATs) are the main modalities employed in the diagnosis of UGTB [6][7][8], which have certain limitations. Smear microscopy and culture for Mycobacterium tuberculosis identification (on Lowenstein-Jensen medium or BACTEC-460/MGIT-960) are commonly used methods but they lead to poor sensitivities due to paucibacillary nature of specimens [7]. Though urine culture is considered the gold standard, it requires skillful technicians and has a prolonged turnaround time of approximately 6-8 weeks [7] when irreparable damage to the fallopian tubes and epididymis already occurs. Delayed diagnosis also leads to nonfunctioning unilateral kidney, contracted bladder and renal failure [1]. Endoscopic procedures such as laparoscopy/hysteroscopy are often linked with operative risks and mostly cause flaring of infection [5], while histopathological examination can be confirmatory only when it demonstrates acid-fast bacilli in the tissues that are very scarce in endometrial biopsies (EBs) [7]. Intravenous pyelography may be suggestive of UGTB but it is nonspecific and often mimics other pathologic lesions [1]. IGRAsImmunological procedures such as IGRAs are widely employed for the early detection of UGTB cases. Notably, Kim et al. [8] reported a sensitivity of 52.6%...

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Recent Trends in Diagnosis of Urogenital Tuberculosis

Mehta

Kamra

2020

Future Microbiol.

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Diseases masking and delaying the diagnosis of urogenital tuberculosis

Altez-Fernandez

Seas

Zegarra

et al. 2016

Therapeutic Advances in Urology

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To the editor:We read with interest the article by Kulchavenya and Kholtobin on urogenital tuberculosis (UGTB) [Kulchavenya and Kholtobin, 2015], in which the authors provide information about unusual UGTB cases. While the authors claim that they have carried out a systematic review of the topic, we completely disagree with that statement. Systematic reviews represent the highest level of evidence available for making clinical decisions, particularly if they are based on high quality studies and a strict and accurate methodology has been followed [Akobeng, 2005].A comprehensive and exhaustive search for primary studies that attempt to answer a clinical question is a key starting point to every systematic review; in the manuscript it is not clear what the authors want to answer. The title points towards diseases that mimic and delay diagnosis of UGTB, but the authors instead reviewed uncommon presentations of UGTB with no focus at all on diagnosis delay. Second, the search strategy included reviewing only the PubMed database, which has been considered an insufficient strategy for performing a literature search [SuarezAlmazor et al. 2000]. Other databases such as Embase should have been incorporated. In addition, most of the studies included were case reports, and guidelines for reviewing cases reports such as the CARE guidelines and the Institute of Health Economics tool for case series were not followed [Gagnier et al. 2013;Moga et al. 2012]. Third, no clear information on the selection criteria is provided; it is not clear what was considered a usual or a rare case of UGTB. Finally, the results were presented as a narrative review with no clear outcomes of their investigation.Considering that UGTB is a difficult entity to diagnose, the review of unusual UGTB presentations can be a first step to fill the lack of evidence on the topic. We suggest the authors should use the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines [Moher et al. 2009]. These guidelines stand for high quality systematic reviews ensuring a transparent and thorough report of data. Authors' endorsement of this kind of checklists warrants excellence in research and evidence-based medicine. FundingThis research received no specific grant from any funding agency in the public, commercial, or notfor-profit sectors. Conflict of interest statementThe authors declare no conflicts of interest in preparing this article.

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“…However, diagnosis is often delayed and a number of children present with non-functioning kidneys, obstructured ureters, shrunken bladders and even chronic renal failure [1,8].…”

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confidence: 99%