Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Tuberc. 2023 Jan;70(1):70-76. doi: 10.1016/j.ijtb.2022.03.014. Epub 2022 Mar 26.
Female genital tuberculosis (FGTB) is a common cause of infertility in developing countries. Its diagnosis is difficult due to its paucibacillary nature, with no single test having high sensitivity and specificity. This study is to share the experience of using Composite Reference Standard (CRS) for the diagnosis of FGTB.
This is a prospective study conducted between September 2017 to June 2019, over 100 infertile females found to have FGTB on composite reference standard which consisted of acid-fast bacilli on microscopy or culture, histopathological evidence of epithelioid granuloma, positive gene Xpert on endometrial sample or definite or probable finding of FGTB on laparoscopy.
A total of 100 infertile women (78% primary, 22% secondary) found to have FGTB on CRS were enrolled in this study. Mean age, body mass index, parity and duration of infertility were 28.2 years, 23.17 kg/m, 0.24 ± 0.12 and 2.41 years respectively. Various symptoms were scanty menses (16%), irregular cycle (7%), dysmenorrhea (11%), pelvic pain (11%). Various signs were vaginal discharge (65%), adnexal mass (6%), tubo-ovarian mass on ultrasound (15%), abnormal hysterosalpingography findings (57.14%), positive polymerase chain reaction test (65%) and abnormal hysteroscopy (82.2%). The positive findings on CRS were positive AFB on microscopy or culture (3%), positive gene Xpert (28%) (done in some cases), epithelioid granuloma on histopathology (13%), definite findings on laparoscopy like tubercles, caseous nodules and beaded tubes in (57.19%) patients while probable findings of FGTB like straw colored fluid in POD, extensive dense pelvic, peri-tubal, peri-ovarian adhesions; hydrosalpinx; tubo-ovarian mass; thick fibrosed tubes; mid tubal block; peri hepatic adhesions (Fitz Hugh Curtis Syndrome); hyperemia of tubes/blue uterus on chromotubation were seen in (48.8%) patients. All patients found to be positive on CRS were given 6 months of anti-tubercular therapy.
This study demonstrates the high reliability of use of composite reference standard for diagnosis of FGTB.
女性生殖器结核（FGTB）是发展中国家不孕的常见原因。由于其菌量少，没有单一的检测方法具有高灵敏度和特异性，因此其诊断较为困难。本研究旨在分享使用综合参考标准（CRS）诊断 FGTB 的经验。
这是一项前瞻性研究，于 2017 年 9 月至 2019 年 6 月进行，共有 100 名经 CRS 证实患有 FGTB 的不孕女性入组，CRS 由显微镜下或培养物中发现抗酸杆菌、子宫内膜样本上的 Xpert 基因阳性、组织病理学上皮样肉芽肿证据、腹腔镜下明确或可能存在 FGTB 组成。
本研究共纳入 100 名经 CRS 证实患有 FGTB 的不孕女性（78%原发性，22%继发性）。平均年龄、体重指数、孕次和不孕持续时间分别为 28.2 岁、23.17kg/m²、0.24±0.12 和 2.41 年。各种症状为月经过少（16%）、月经不规律（7%）、痛经（11%）、盆腔痛（11%）。各种体征为阴道分泌物（65%）、附件包块（6%）、超声下输卵管卵巢包块（15%）、子宫输卵管造影异常（57.14%）、聚合酶链反应检测阳性（65%）和宫腔镜异常（82.2%）。CRS 的阳性发现包括显微镜或培养物中抗酸杆菌阳性（3%）、Xpert 基因阳性（28%）（某些情况下进行）、组织病理学上皮样肉芽肿阳性（13%）、腹腔镜下明确发现如结节、干酪样结节和串珠状管（57.19%），而可能的 FGTB 发现如 POD 中的稻草色液体、广泛致密的盆腔、输卵管周围、卵巢周围粘连；输卵管积水；输卵管卵巢包块；增厚纤维化的输卵管；中输卵管阻塞；肝周围粘连（Fitz Hugh Curtis 综合征）；染色通液术时的输卵管/蓝色子宫充血（48.8%）。所有 CRS 阳性的患者均给予 6 个月的抗结核治疗。
本研究表明，使用综合参考标准诊断 FGTB 的可靠性很高。
