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

Abstract

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.

Recent Advances in Diagnosis and Management of Female Genital Tuberculosis

“…It can detect as low as 133 colony-forming units (CFU)/ml of specimen and is used to diagnose TB and can detect rifampicin resistance within 2 h. It has been approved by WHO. We observed a sensitivity of 30% and specificity of almost 100% in FGTB patients with gene Xpert [ 29 , 40 , 41 ]. Xpert Ultra has much higher sensitivity.…”

“…Instead of uniplex PCR, multiplex PCR using multi-gene or multi-primer PCR has higher sensitivity. However, in clinical practice, PCR is not used to diagnose FGTB or to start anti-tubercular therapy but as a method to investigate further for FGTB using endoscopic techniques [ 3 , 29 , 41 ]. Loop-mediated isothermal amplification (LAMP): It is quicker and inexpensive with sensitivity of about 40% in detection of FGTB but cannot diagnose drug resistance [ 42 ].…”

“…Instead of uniplex PCR, multiplex PCR using multi-gene or multi-primer PCR has higher sensitivity. However, in clinical practice, PCR is not used to diagnose FGTB or to start anti-tubercular therapy but as a method to investigate further for FGTB using endoscopic techniques [ 3 , 29 , 41 ].…”

Genital tuberculosis, infertility and assisted reproduction

“…Loop-mediated isothermal amplification (LAMP) is another WHO-approved NAAT for the diagnosis of TB [20]. In a study of 300 patients in India, LAMP performed on endometrial biopsy specimens had a sensitivity of 66% and specificity of 93% [20].…”

“…The reported sensitivity of more than 80% and specificity of more than 98% in urine, cerebrospinal fluid, pleural fluid, and peritoneal fluid, when compared with culture. Sensitivity of Xpert varies from 7 to 50% on endometrial biopsy specimens, with higher sensitivity when compared with a composite reference standard rather than culture [20][21][22][23][24][25][26][27][28][29].…”