Assessment of Endometrial Specimens for Tubercular Infection among Infertile Women using DNA-PCR

Abstract

Introduction: Genital Tuberculosis (GTB) is an important cause of infertility in developing countries like India. Diagnostic dilemma arises because of atypical clinical presentation, different results on imaging and mixed bag of bacteriological and serological tests such as routine microbiological tests such as Acid Fast Bacilli (AFB) staining and culture are of little significance because of its Paucibacillary nature. Specific and rapid diagnosis using Polymerase Chain Reaction (PCR), early anti-tuberculous treatment and appropriate surgical interventions can improve the results for restoration of female reproductive functions and reduction of procedural and postoperative complications. Aim: To assess the diagnostic performance of PCR, AFB culture and staining in infertility due to Female Genital Tuberculosis (FGTB). Materials and Methods: This observational cross-sectional study was conducted in Microbiology Department of Tertiary Care Hospital, Aurangabad, Maharashtra, India. Relevant clinical specimens were collected using standard procedures from 50 infertile women satisfying inclusion and exclusion criteria; and were evaluated by AFB staining, culture and TB-PCR.Categorical variables were compared using Chisquare test. A p-value <0.05 was considered as statistically significant. Results: Presence of FGTB was found in 6 (12%) cases by using all the investigative parameters alone or in combination. AFB smear alone was positive in 2 (4%), culture in 1 (2%) and TB-PCR in 5 (10%) of cases. Conclusion: PCR has highest sensitivity 100% with negative predictive value of 100% compared to microscopy and culture. Therefore, when the clinical suspicion is high and smear and culture results are negative, PCR is the method of choice for identifying the infection in FGTB cases.

Keywords

• acid fast staining
• diagnostic performance
• female genital tuberculosis
• infertility