Gunasekaran Jayanthi, Ranjan Rahul, Karlapudi Priya, Pandey Pooja, Chichhal Karteeka, Gupta Sonam, Rai Ankita, Joshi Ina, Kumar Umesh, Gupta Rajiv M
Department of Microbiology, ESIC Medical College and Hospital, Faridabad, IND.
Cureus. 2024 Dec 9;16(12):e75358. doi: 10.7759/cureus.75358. eCollection 2024 Dec.
This study aimed to determine the prevalence of microbiologically confirmed female genital tuberculosis (FGTB) infection in patients attending a tertiary care hospital in North India.
A total of 623 endometrial biopsy samples were processed in the mycobacteriology laboratory from the outpatient and inpatient gynecology departments between May 2022 and February 2024. Ziehl-Neelsen (ZN) smear was performed on all samples. Each sample was subsequently subjected to cartridge-based nucleic acid amplification test (CBNAAT) Xpert (MTB)/rifampicin (RIF) Ultra (Cepheid, Sunnyvale, California), and LJ culture irrespective of the ZN smear result and demographic details of the patients were recorded simultaneously.
Of the 623 endometrial biopsy samples tested, 17 (2.73%) samples were positive for MTB by CBNAAT Ultra. The disease was most commonly observed in the reproductive age group between 21 and 35 years. ZN smear and culture were negative for all the samples received for endometrial TB. Of these 17 positive samples, one (5.9 %) was MTB detected (medium), four (23.5 %) (low), two (11.8 %) (very low), and 10 (58.8 %) (trace). RIF resistance was detected in one (5.9 %) of these 17 samples. However, the 10 samples that were detected as MTB trace and RIF indeterminate ideally need to be processed further by culture or by line probe assay to determine the drug resistance.
Genital TB is characterized by a low bacterial load. Therefore, a highly sensitive and specific molecular test is essential for confirming the diagnosis microbiologically. Our study found that Xpert MTB/RIF Ultra is particularly valuable because it detected 58.8% of cases as "TRACE," which might be missed by other testing methods. Early diagnosis using this test can significantly impact patient management, especially in cases related to infertility. This study effectively highlights the role of GeneXpert Ultra in documenting extra-pulmonary TB, including genital TB.
本研究旨在确定印度北部一家三级护理医院就诊患者中微生物学确诊的女性生殖器结核（FGTB）感染的患病率。
2022年5月至2024年2月期间，从门诊和住院妇科收集了共623份子宫内膜活检样本，在分枝杆菌实验室进行处理。对所有样本进行萋-尼（ZN）涂片检查。随后，无论ZN涂片结果如何，每个样本均进行基于 cartridge 的核酸扩增试验（CBNAAT）Xpert（MTB）/利福平（RIF）Ultra（赛沛公司，加利福尼亚州桑尼维尔）检测，并进行罗氏培养，同时记录患者的人口统计学细节。
在检测的623份子宫内膜活检样本中，有17份（2.73%）样本经CBNAAT Ultra检测MTB呈阳性。该疾病最常见于21至35岁的育龄组。所有送检的子宫内膜结核样本的ZN涂片和培养均为阴性。在这17份阳性样本中，1份（5.9%）MTB检测为（中等），4份（23.5%）（低），2份（11.8%）（极低），10份（58.8%）（微量）。在这17份样本中有1份（5.9%）检测出对利福平耐药。然而，检测为MTB微量且利福平结果不确定的10份样本，理想情况下需要进一步通过培养或线性探针检测来确定耐药性。
生殖器结核的特点是细菌载量低。因此，高灵敏度和特异性的分子检测对于微生物学确诊至关重要。我们的研究发现，Xpert MTB/RIF Ultra特别有价值，因为它将58.8%的病例检测为“微量”，而其他检测方法可能会遗漏这些病例。使用该检测进行早期诊断可显著影响患者管理，尤其是在与不孕症相关的病例中。本研究有效地突出了GeneXpert Ultra在记录肺外结核（包括生殖器结核）方面的作用。
