Use of Endo-Ovarian Tissue Biopsy and Pelvic Aspirated Fluid for the Diagnosis of Female Genital Tuberculosis by Conventional versus Molecular Methods

Bhanothu, Venkanna; Theophilus, Jane; Rozati, Roya

doi:10.1371/journal.pone.0098005

Cited by 33 publications

(45 citation statements)

References 49 publications

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“…However, PCR is associated with high false positive rates and therefore it is not recommended to start the treatment for FGTB on the basis of PCR results only. 14,15 The use of geneXpert has been advocated by world health organization for the detection of Mycobacterium tuberculosis and rifampicin susceptibility. Gene Xpert was done in 69 patients.…”

Section: Discussionmentioning

confidence: 99%

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

Zahoor¹,

Bhat²,

Kanth³

et al. 2019

IJCMR

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Introduction: 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. Material and methods: Endometrial curetting of 193 infertile women suspected of genital tuberculosis were taken laparoscopically and sent for histopathological examination, ZN staining, culture on LJ media and GeneXpert testing. Results: Out of 193 women, 13 were positive for Mycobacterium tuberculosis making the overall prevalence of FGTB in infertile women to the extent of 6.73%. Of these 11 presented with primary infertility while 2 patients presented with secondary infertility. The histopathological examination of all the samples was non-specific. No case of positive acid fast bacilli on ZN staining was observed. Comparison of culture and GeneXpert revealed that Xpert assay was more sensitive in detecting the positive cases. Conclusion: Our study concluded that 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

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Section: Discussionmentioning

confidence: 99%

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

Zahoor¹,

Bhat²,

Kanth³

et al. 2019

IJCMR

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“…Constitutional symptoms such as sweating, evening rise of temperature and weight loss were not major complaints, while local organ dysfunction manifested in amenorrhoea, omental adhesions and bilateral tubal blockage are seen on hysterosalpingographic studies. All samples collected were examined by haematoxylin and eosin (H & E) staining [ 83 ], Z–N staining for acid fast bacilli (AFB) [ 84 ], as well as culture on Löwenstein—Jensen (L–J) egg media [ 85 ] and the MTB-specific multi-gene/multi-primer polymerase chain reaction (PCR) method [ 86 ] by which FGTB was confirmed. MTB [American type of culture collection (ATCC) 35836] reference stain isolates provided by the Department of Microbiology, Nizam’s Institute of Medical Sciences (NIMS), Hyderabad, India, were used as controls in each assay.…”

Section: Methodsmentioning

confidence: 99%

Investigation of Toll-Like Receptor-2 (2258G/A) and Interferon Gamma (+874T/A) Gene Polymorphisms among Infertile Women with Female Genital Tuberculosis

et al. 2015

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BackgroundToll-like receptor 2 (TLR2) and interferon-gamma (IFN-γ) coordinate with a diverse array of cellular programs through the transcriptional regulation of immunologically relevant genes and play an important role in immune system, reproductive physiology and basic pathology. Alterations in the functions of TLR2 2258G (guanine)/ A, IFN-γ (+874T/A) and signalling molecules that result from polymorphisms are often associated with susceptibility or resistance, which may, in turn, establish the innate host response to various infectious diseases. Presently, we proposed to investigate the risk of common single nucleotide polymorphism (SNP) of TLR2 and IFN-γ genes, for their effect on infertility in women with female genital tuberculosis (FGTB) and healthy women as controls.Methodology/Principal FindingsGenotyping of TLR2 and IFN-γ gene polymorphisms was performed by amplification refractory mutation system multi-gene/multi-primer polymerase chain reaction followed by restriction fragment length polymorphism in 175 FGTB patients and 100 healthy control women (HCW). The TLR2 polymorphism [adenine (A) allele] was observed in 57.7 and 58.0% of FGTB patients and HCW, respectively. The IFN-γ (+874T/A) polymorphism (A allele) was significant in 74.3 and 71.0% of FGTB patients and HCW, respectively, while the odds ratios for the AA and TA genotypes for predisposition of FGTB were found to be 0.304 and 1.650 in HCW, respectively. The SNP of TLR2 was not associated with FGTB but the SNP of IFN-γ was found to be associated with mycobacteria infections and to induce infertility.Conclusions/SignificanceAt present, we hypothesize that infertile women with FGTB and HCW without tuberculosis (TB) have identical frequency of TLR variants, which may be adequate in the production of IFN-γ in response to Mycobacterium tuberculosis infections. Thus, the study appears to be the first of its kind reporting a mutation in the IFN-γ gene [+874 T (thymine) to A] responsible for susceptibility to TB infections and further inducing infertility.

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“…PCR: PCR tests targeting IS6110, hsp65 (Rv0440), mpt64, fbp, mtp40 (Rv2351c), TRC4 (conserved repetitive element) -among others, have been devised using endometrial aspirates, EBs, renal biopsies, menstrual blood and urine specimens [2,4,10] but they often lead to false-positive and false-negative results. Detection of male UGTB within semen samples by PCR has also been reported that revealed superiority over MGIT-960 culture [6].…”

Section: Naatsmentioning

confidence: 99%

“…M-PCR/real-time PCR: To improve the sensitivity of PCR, Bhanothu et al [10] designed M-PCR using mpt64+LpqH (Rv3763)+TRC4+mpt59-α (fbp) within EBs, ovarian biopsies and pelvic aspirates of suspected female UGTB cases. Compared with smear/culture and histopathology, M-PCR showed an improvement for the detection of UGTB cases.…”

Section: Naatsmentioning

confidence: 99%

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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Use of Endo-Ovarian Tissue Biopsy and Pelvic Aspirated Fluid for the Diagnosis of Female Genital Tuberculosis by Conventional versus Molecular Methods

Cited by 33 publications

References 49 publications

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

Investigation of Toll-Like Receptor-2 (2258G/A) and Interferon Gamma (+874T/A) Gene Polymorphisms among Infertile Women with Female Genital Tuberculosis

Recent Trends in Diagnosis of Urogenital Tuberculosis

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