The burden of tuberculosis (TB) in India is the highest, accounting for one-fifth (21%) of the global incidence [1]. TB affecting organs other than the lungs is known as extrapulmonary TB (EPTB). The fetus_368-minpaucibacillary smear status and localization into sites with limited ability to transmit makes EPTB potentially less contagious and thus is not addressed as a priority. The percentage of patients with EPTB in tertiary care centers in India is reported between 30% and 53%, while the percentage estimated by the national control program in India for HIV-negative adults is between 15% and 20% [2]. It has been found that the burden of EPTB is more among the productive age group and females are at a higher risk of contracting EPTB in comparison to males [3].

However, genital TB is less assessed and reported because of asymptomatic disease presentation, diagnostic challenges and absence of supporting literature. Genital TB, a reproductive tract infection (RTI) is known to result in infertility through an irreversible damage to the fallopian tubes [4]. Independent studies from India have found genital TB to be prevalent in infertility in the range of 13-39 % [5,6].  Development of better diagnostic techniques for genital TB in women will help identify asymptomatic disease and also assist in the treatment of infection and thereby infertility.

Many studies for diagnosis of genital TB have identified biopsy combined with swab or menstrual blood and have consequently reported varying success rates of TB detection [4,6,7,8].

Diagnosis of genital TB is primarily done through clinical observation and confirmed using histopathology. Recent studies indicate the superiority of PCR-based detection over conventional techniques [9,10,11]. Use of sensitive PCR-based diagnostics would not only add specificity to the assay but also reduce the turnaround time as compared to the conventional techniques such as culture and smear microscopy.

The incidence of pulmonary infections by NTM is more or less known [12], but that of EPTB and in particular genital TB has received less attention in a TB endemic region, like India [9,13]. Reliance on techniques which do not allow distinction between typical and atypical mycobacteria delays access to targeted treatment resulting in avoidable complications and fatalities

The increased prevalence of multidrug resistant strains of tuberculosis in the environment and thus an increased exposure necessitates knowledge of the infecting strain to guide treatment regimens for complete bacterial clearance.

As the treatment regimen is several months long, it is important to ensure bacterial clearance during and after therapy. There are also reports of bacterium acquiring drug resistance even with a compliant Directly observed treatment short course (DOTS) [14,15].

References

  1. Global tuberculosis report 2013. Geneva: World Health Organisation.
  2. Prakasha SR, Suresh G, D’Sa I P, Shetty SS, Kumar SG (2013) Mapping the pattern and trends of extrapulmonary tuberculosis. J Glob Infect Dis 5: 54-59.
  3. Musellim B, Erturan S, Sonmez Duman E, Ongen G (2005) Comparison of extra-pulmonary and pulmonary tuberculosis cases: factors influencing the site of reactivation. Int J Tuberc Lung Dis 9: 1220-1223.
  4. Thangappah RB, Paramasivan CN, Narayanan S (2011) Evaluating PCR, culture & histopathology in the diagnosis of female genital tuberculosis. Indian J Med Res 134: 40-46.
  5. Parikh FR, Nadkarni SG, Kamat SA, Naik N, Soonawala SB, et al. (1997) Genital tuberculosis–a major pelvic factor causing infertility in Indian women. Fertil Steril 67: 497-500.
  6. Bose M (2011) Female genital tract tuberculosis: how long will it elude diagnosis? Indian J Med Res 134: 13-14.
  7. Satwik R, Majumdar A (2013) Endometrial TB-PCR positivity in women with unexplained infertility with no visible, microbiological or histopathological evidence of disease in a high TB burden area: whether to ignore or treat. Human Reproduction 28: 3377-3378.
  8. Bhanothu V, Theophilus JP, Rozati R (2014) Use of Endo-Ovarian Tissue Biopsy and Pelvic Aspirated Fluid for the Diagnosis of Female Genital Tuberculosis by Conventional versus Molecular Methods. PLoS One 9: e98005.
  9. Sankar MM, Kumar P, Munawwar A, Kumar M, Singh J, et al. (2012) Usefulness of multiplex PCR in the diagnosis of genital tuberculosis in females with infertility. European Journal of Clinical Microbiology & Infectious Diseases 32: 399-405.
  10. Malhotra BS, P; Hooja, S; Vyas, L (2012) Rapid diagnosis of Genital tuberculosis by real time Polymerase chain reaction. Journal of South Asian Federation of Obstetrics and Gynaecology 4: 4.
  11. Goel G, Khatuja R, Radhakrishnan G, Agarwal R, Agarwal S, et al. (2013) Role of newer methods of diagnosing genital tuberculosis in infertile women. Indian Journal of Pathology and Microbiology 56: 155.
  12. Menzies D, Nahid P (2013) Update in Tuberculosis and Nontuberculous Mycobacterial Disease 2012. American Journal of Respiratory and Critical Care Medicine 188: 923-927.
  13. Hoefsloot W, Boeree MJ, van Ingen J, Bendien S, Magis C, et al. (2008) The rising incidence and clinical relevance of Mycobacterium malmoense: a review of the literature. Int J Tuberc Lung Dis 12: 987-993.
  14. Bonnet M, Pardini M, Meacci F, Orru G, Yesilkaya H, et al. (2011) Treatment of tuberculosis in a region with high drug resistance: outcomes, drug resistance amplification and re-infection. PLoS One 6: e23081.
  15. Matthys F, Rigouts L, Sizaire V, Vezhnina N, Lecoq M, et al. (2009) Outcomes after chemotherapy with WHO category II regimen in a population with high prevalence of drug resistant tuberculosis. PLoS One 4: e7954.