Radha Bai Prabhu, T (2009) Diagnosing Genital Tuberculosis in Female Infertility by Clinical, Histopathological, Culture and Polymerase Chain Reaction Techniques. Doctoral thesis, The Tamilnadu Dr. M.G.R. Medical University, Chennai.
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Abstract
Tuberculosis (TB) is one of the oldest diseases as old as human civilization It is a chronic infectious disease and the morbidity associated with this condition has major health implications. The disease has a worldwide distribution and the incidence is high in developing countries. The global burden of tuberculosis remains enormous, mainly because of poor control in Southeast Asia, sub-Saharan Africa, and Eastern Europe. The diagnosis of GTB is difficult and challenging. A high degree of suspicion aided by intensive investigations is important in the diagnosis of the disease. In areas where TB is endemic, while investigating an infertile patient, the possibility of GTB should always be considered and evaluated further. Clinical parameters such as past or contact history of tuberculosis, positive Mantoux test, elevated ESR, positive findings on X-ray, USG, HSG, and laparoscopy would suggest the possibility of tuberculosis, but have their own limitations and are not sufficient criteria to diagnose GTB. However, in an infertile woman, when the above test results are positive (positive clinical criteria) it indicates the need for further investigations to confirm /exclude GTB by specific diagnostic tests. In this study, conventional methods of diagnosis namely HPE and AFB smear and culture have shown low pick up rates. Given the low sensitivity of AFB smear, culture and HPE, and the other diagnostic parameters do not provide conclusive evidence; PCR with its comparatively higher sensitivity may be a useful tool in diagnosing GTB in clinical practice. However, the sensitivity and specificity of PCR are not high enough to use as a single definite test for screening infertile women for GTB. Based on the results of PCR, our study has shown that a positive PCR result should be given due importance. In 18 cases, where clinical criteria were negative, the PCR results were positive. Though this finding raises the possibility of false positive results, adequate precautions were taken to avoid the problem of false positivity by way of strict discipline about collection and processing of the specimen and handling of reagents and measures were taken to avoid carryover contamination. Wax beads were added to minimize non-specific amplification. Our study has shown that PCR is able to pick up early/ latent GTB. Therefore, in women with unexplained infertility, where major causes of infertility (anovulation, male factors, tubal causes, sexual dysfunction) have been ruled out, even in the absence of positive clinical criteria, PCR of the endometrium should be carried out and if positive, should be treated. Further research is required to see whether NTM organisms are responsible for a significant number of infertility cases. As past history of tuberculosis is not available in most cases, whether one should look for genital tuberculosis in male partners for the possibility of sexual mode of transmission. Also, there should be research on areas to simplify and reduce the cost of PCR to make it available for clinical use.
| Item Type: | Thesis (Doctoral) |
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| Uncontrolled Keywords: | Genital tuberculosis, female infertility, polymerase chain reaction techniques, clinical, histopathological, culture. |
| Subjects: | Respiratory Medicine > Obstetrics and Gynaecology > Respiratory Medicine > Obstetrics and Gynaecology |
| Depositing User: | Devi S |
| Date Deposited: | 28 Jun 2017 05:47 |
| Last Modified: | 11 Sep 2022 04:14 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/499 |
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