Genital tuberculosis

9,361 views

Published on

laboratory diagnosis of genital tuberculosis

Published in: Health & Medicine, Technology
0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
9,361
On SlideShare
0
From Embeds
0
Number of Embeds
15
Actions
Shares
0
Downloads
457
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide

Genital tuberculosis

  1. 1. Diagnosis of Genital Tuberculosis Direct Visualization Techniques Culture : Conventional & Rapid Dr Ashok Rattan, Chairman : Laboratory Medicinee 1
  2. 2. Commonest method for diagnosis of TB 1882 2002 2
  3. 3. Slow diagnostic methodsTwentieth Century Mentality AFB smear Culture on LJ Identification by Niacin & Nitrate test Sensitivity by RR Culture report in 8wk DST report in 8 wks Treatment duration from 9 M to 18 M 3
  4. 4. Progress made inlaboratory diagnosis of tuberculosisFluorochrome stain for AFB smear Mid 1970sBACTEC 460TB Early 1980sDNA probes for AFB +ve respiratory Late 1980sAutomated broth systems for culture Early 1990sHPLC on AFB +ve cultures Early 1990sDrug susceptibility by Bactec Early 1990sNucleic acid amplification on all smear +ve 1996Use of courier to transport specimen 1997Lipa for identification and Rif resistance 1997Use of NAA TB testing on smear –ve 2000Reporting of results by fax 2000Genotype MTBDR for subspecies 2003Expert group recommends Hain’s test 2008Expert group recommends Xpert system 2011 4
  5. 5. Genital Tuberculosis Hospital Associated InfectionTuberculosis : 1. Pulmonary 2. Extra pulmonary • Genital tuberculosis: represents 15 – 20% of all Extra pulmonary cases 12% of pulmonary tuberculosis cases 20% of infertility cases have tuberculosis 5
  6. 6. Microbiology90 to 95% due to Mycobacterium tuberculosis5 – 10% due to M bovisMostly secondary to TB elsewhereRarely primary : direct inoculation (? STD)Routes of infection:• Haematogenous : 90% from lungs, LN, Skeletal system• Descending : via lymphatics• Directly from GIT, mesenteric LN or peritoneum 6
  7. 7. Genital Organs InfectedFallopian tube 95 – 100 %Endometrium 50 – 60 %Ovaries 20 – 30 %Cervix 5 – 15 %Vulva / Vagina 1%Myometrum 2.5 %Haematogenous spread: involvement of submucosa, endosalpingitis 7Direct spread: exosalpingitis, tubercles on the surface
  8. 8. Diagnosis• Combination of • high index of suspecion • thorough clinical examination • Appropriate investigations• High Risk Factors • Previous pulmonary tuberculosis or contact with a case • Socio economic background • Drug use • HIV status • H/o chronic chest symptoms 8
  9. 9. InvestigationsFull blood counts, ESR, HIV testTST or Quantiferon Gold ITChest X RaySmear & CultureHistopathologyNAAT : PCR, SDA, TMA, NASBA, LAMP, RT PCRImagingHysterosalpingogram 9
  10. 10. Culture : Conventional & Rapid Samples:• Biopsy of suspected lesion in accessible site• Endometrial tissue (pre menstrual period)• Menstrual fluid (on 1st day of cycle)• Urine (early morning x 3)• Blood for Quantiferon Gold IT• Serological tests for IgG/IgM/IgA  NO diagnostic value• WHO has expressed NEGATIVE opinion on their use• Govt of India should BAN import of Serological test kits• clinicians should STOP requesting it 10
  11. 11. AFB SMEAR 11
  12. 12. PNA 12
  13. 13. Culture : Conventional Slow : weeksLowenstein Jensen (LJ) Low sensitivity (102 AFB/ml) 13 Middlebrook 7 H 10 Agar
  14. 14. Dr Tanil Kocagoz 14
  15. 15. Liquid Culture : Rapid Bactec 460 C Palmatic Acid  14CO2 14 MGIT 960 15
  16. 16. Liquid Culture : Rapid BacT/Alert 3D MB 16
  17. 17. Microscopically Observed Drug Susceptibility (MODS) Zip lock, examined from 4 to 15 days daily, A/D 40 24 wells plate (BD), 12 wells used per sample, 4 drug free control, 8 containing drugs Middlebrook 7H9 broth (BD) INH 0.1 & 0.4 ug/ml OACD RMP 1 & 2 PENTA Etham 2.5 & 5 720 ul inoculum used SM 2 & 6 17
  18. 18. Thin Layer Agar 18
  19. 19. MDR & XDR TB are Laboratory DiagnosisClinicians should not label “non responding” infections MDR M. tuberculosis Drug susceptible INH + RIF Resistant M. tuberculosis = MDR Drug susceptibile FQ Injectable XDR Resistant Resistant 19
  20. 20. Clinicians should not label “non responding” infections MDR without Laboratory support MDR TB XDR TB2 most important INH INH RIF RIF1 line drugs st PZA PZA Etham Etham 2 most important FQ FQ Injectable Injectable2nd line drugs Ethio Ethio Cyclo Cyclo PAS PAS 20
  21. 21. Sample & culture positive load for AFB Bactec at GGN sample number = 1656 885900 Culture Positive800 Total Samples700600500 379400 245300200 157 158 69100 31 55 21 43 44 10 2 4 3 3 0 P ulmo na ry L ymph N o de T is s ue E ndo me tria l B o dy F luids CSF Urine O the rs & P us 21 Data courtesy Religare SRL Gurgaon Lab
  22. 22. Total samples processed = 1656 (smear +ve=302, --ve=1354) Total culture positive =453 (M tb=393, MOTT=60)Smear Mycobacteria MGIT LJ +ve Speed of Speed ofResult spp. +ve growth on growth on MGIT in days LJ in daysSmear M.tb 258 191 9.64 26.12Positive(n=302) MOTT 21 10 6.6 28Smear M.tb 133 66 17.15 34.28Negative MOTT 41 8 13.79 30.62(n=1354) Data courtesy Religare SRL Gurgaon Lab 22
  23. 23. Liquid Culture improves detection and speed of definitive diagnosis Speed Of Growth Of M.tb (MGIT 960 vs LJ Media)166 132 63 55 46 48 23 23 24 13 2 0 1st wk 2nd wk 3rd wk 4th wk 5th wk 6th wk Data courtesy Religare SRL Gurgaon Lab 23
  24. 24. Genital TB Algorithm 21st century approachTests ResultsSmear + -- -- + --&/orcultureNAAT + + -- -- --Quantiferon + + + -- --Gold ITDiagnosis Genital TB Genital TB Latent MOTT No TB contamination evidence of TB infection 24
  25. 25. Carry Home Messages : Diagnostic Methods• Smear is rapid but insensitive (104 AFB/ml), can be improved by using Fluorescent Microscopy• Liquid culture is sensitive & specific, faster than solid culture but still slow• Diagnostic tests : culture & non culture tests should be used simultaneously in an algorithm to improve definitive diagnosis• Serological tests, available at present, have no diagnostic value 25
  26. 26. Carry Home Messages : Diagnostic Methods 5. Laboratory must validate tests that they use 6. Laboratories must participate in EQAS 26Data courtesy Religare SRL Gurgaon Lab
  27. 27. 27

×