巴基斯坦女性生殖器结核 - 10 年实验室数据的回顾性分析及 32 例病例分析。

Female genital tuberculosis in Pakistan - A retrospective review of 10-year laboratory data and analysis of 32 cases.

机构信息

Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan.

Bloomberg School of Public Health, Johns Hopkins School of Public Health, Baltimore, MD, USA.

出版信息

Int J Mycobacteriol. 2021 Jan-Mar;10(1):66-70. doi: 10.4103/ijmy.ijmy_6_21.

DOI:10.4103/ijmy.ijmy_6_21

PMID:33707374

Abstract

BACKGROUND

Female genital tuberculosis (FGTB) is an underobserved clinical entity owing to diagnostic challenges stemming from difficulty of obtaining diagnostic specimens and paucibacillary nature of the disease. Yet, FGTB is a cause of infertility, pelvic pain, or menstrual irregularities in high-burden countries. To assess laboratory and microbiology diagnostic utilization for FGTB in Pakistan, we have collected data from 2007 to 2016 to inform the need for improved laboratory diagnostics. The objectives of this study were to determine the proportion of FGTB as culture-confirmed extrapulmonary tuberculosis (EPTB) and to describe the characteristics of women with culture-confirmed FGTB in a nationwide laboratory network in Pakistan.

METHOD

A retrospective database was established by accessing laboratory archives and analyzed by sex and source to determine extrapulmonary cases among women. Data were checked for quality, and after removing patient identifiers and duplicate samples, frequencies were calculated in MS Excel. Clinical characteristics of patients were derived from a linked hospital database for those patients who were diagnosed and managed at the affiliated university hospital in Karachi, Pakistan.

RESULTS

Over 10 years, 410,748 mycobacterial cultures were received from multiple geographic sites throughout Pakistan and processed at the study laboratory. The overall mean culture positivity rate was 5.9% ± 3.5%, while the mean culture positivity rate among females was 2.8% ± 0.8%. Among female culture-confirmed tuberculosis cases, the pulmonary-to-EPTB ratio of infection was 5. Over 10 years, a total of 32 FGTB cases were reported on the basis of positive cultures for Mycobacterium tuberculosis; 3 (9.4%) were rifampin resistant.

CONCLUSIONS

FGTB currently constitutes a small but significant proportion of culture-confirmed EPTB. A fewer number of laboratory requisitions suggest the need to increase awareness and testing. The advent of high-sensitivity molecular testing on extrapulmonary specimens has the potential to improve diagnostic accuracy and improved detection of FGTB cases in high-burden regions.

摘要

背景

由于获取诊断标本的困难以及疾病的少菌性，女性生殖器结核（FGTB）是一种观察不足的临床实体。然而，在高负担国家，FGTB 是导致不孕、盆腔疼痛或月经不规律的原因之一。为了评估巴基斯坦 FGTB 的实验室和微生物学诊断利用情况，我们收集了 2007 年至 2016 年的数据，以了解改进实验室诊断的需求。本研究的目的是确定 FGTB 在培养确认为肺外结核（EPTB）中的比例，并描述在巴基斯坦全国性实验室网络中培养确认为 FGTB 的女性的特征。

方法

通过访问实验室档案建立了一个回顾性数据库，并按性别和来源进行分析，以确定女性中的肺外病例。数据经过质量检查，在删除患者标识符和重复样本后，在 MS Excel 中计算频率。对于在巴基斯坦卡拉奇附属大学医院诊断和管理的患者，从相关医院数据库中获取患者的临床特征。

结果

在 10 年期间，从巴基斯坦多个地理地点收到了 410,748 份分枝杆菌培养物，并在研究实验室进行了处理。总体平均培养阳性率为 5.9%±3.5%，而女性的平均培养阳性率为 2.8%±0.8%。在女性培养确认为结核病的病例中，肺部到 EPTB 的感染比例为 5。在 10 年期间，共报告了 32 例基于分枝杆菌培养阳性的 FGTB 病例；其中 3 例（9.4%）对利福平耐药。