Diagnostic moderne de la tuberculose

Endometrial tuberculosis among patients undergoing endometrial biopsy at Tikur Anbesa specialized hospital, Addis Ababa, Ethiopia

BACKGROUND

Female genital tuberculosis (FGTB) is known to cause severe tubal disease leading to infertility and its incidence closely parallels with the overall prevalence of tuberculosis (TB) in a community. Its magnitude is underreported because diagnosis is difficult and requires invasive techniques. In this study we determined the prevalence of endometrial tuberculosis and characterized isolates among women who underwent endometrial biopsy for evaluation of various conditions at a Tikur Anbessa Specialized Hospital (TAHS), Addis Ababa, Ethiopia.

METHODS

A cross sectional study was conducted on 152 consecutive gynecologic patients who underwent endometrial biopsy for different gynecologic diseases. Endometrial tissue taken for routine histopathology examination was shared after informed consent was obtained from the patient and subjected to polymerase chain reaction (PCR) and culture for Mycobacterium tuberculosis (Mtb).

RESULTS

The prevalence of endometrial TB in this study by IS1081PCR was 4.6% (7/152) while culture proven endometrial TB was 2.6% (4/152). However, histological examination identified only 2/152 (1.3%) endometrial tuberculosis. While all culture proven TB samples were also PCR positive for Mtb, only one histologic proven endometrial TB was culture and PCR positive. All of the four isolates by culture were M. tuberculosis.

CONCLUSION

This study has shown that the magnitude of endometrial TB is fairly high in gynecologic patients visiting outpatient departments for various complaints and PCR detects more cases than culture or Histopathology.

Comparison of the VersaTREK system and Löwenstein-Jensen medium for the recovery of mycobacteria from clinical specimens

Laboratory services for the detection of tuberculosis form an essential component of the DOTS strategy. Our objective was to evaluate the recovery rate and mean time to detection (TTD) of mycobacteria of 2 culture media: the VersaTREK system and the Löwenstein-Jensen medium (LJ). Clinical specimens were processed using the standard N-acetyl-L-cysteine (NALC)-NaOH method, and then inoculated onto VersaTREK system and LJ slants. Of 1510 specimens cultured, a total of 200 mycobacterial isolates (159 Mycobacterium tuberculosis and 41 no M. tuberculosis mycobacteria) were detected. The recovery rates were 84.8% (168/198) for the VersaTREK system and 89.4% (168/188) for LJ (p=0.2); while the contamination rates were 4.2% for the VersaSATREK system and 7.4% for LJ (p<0.001). The TTDs for mycobacteria spp. were 18.2 (+/-11.4) d for the VersaTREK system and 27.9 (+/-10.9) d for LJ (p<0.001). The TTDs for M. tuberculosis were 19.8 (+/-11.2) d for the VersaTREK system and 27.3 (+/-10.2) d for LJ (p<0.001). The difference in TTD between smear-positive and smear-negative specimens for Mycobacterium spp. was 15.9 (+/-10.0) vs 23.0 (+/-12.5) d, and for M. tuberculosis 16.7 (+/-9.5) vs 28.4 (+/-11.1) d for the VersaTREK system. The VersaTREK system significantly reduces the TTDs of mycobacteria detection, which is clinically relevant.