HISTOPATHOLOGY AND CULTURE IN THE DIAGNOSIS OF FEMALE GENITAL TUBERCULOSIS

Abstract

Introduction: About 60 per cent of TB cases and deaths occur among males, but the disease burden is also high among women also. In 2015 nearly 500,000 women died from TB, and among them, 28 per cent had human immunodeficiency virus (HIV) co-infection. A common form of extra pulmonary TB (EPTB) is Genitourinary TB is and worldwide (27%) with genital TB alone contribute for 9 per cent of all EPTB cases. TB bacilli can infect the genital tract by four routes - haematogenous route in which lungs as the common primary focus, descending direct spread, lymphatic spread and rarely as primary infection of the genitalia through sexual transmission. The most common age group affected is the reproductive age group i.e.15-45 years. A definite diagnosis can be made by positive mycobacterial culture and by demonstrating specific histopathological lesion in the specimen

Material and Methods: Women who showed tubal factor infertility which is proved either by hysterosalpingogram (HSG) and/or laparoscopy. and those presenting with unexplained infertility were included in the study. Evidence of past chronic infection in the form of thickened tubes, intraluminal caseation, and terminal hydrosalpinx with retort shaped tubes, tubo-ovarian masses, flimsy adhesions in the pouch of Douglas (POD) were also looked for.  

Results: A total of 25 patients with suspected tuberculosis were included in the study. Age group was between 23 to 34 years. Of the 25 patients 22 (88%) females were less than 30 years of age. In 2 patients there was a past history of tuberculosis. laparoscopy was carried out on all 25 cases, features suggesting genital tuberculosis was seen in 11 (44%)patients. distorted endometrial cavity, beaded appearance of the tubes, retort shaped hydrosalpinx, calcified areas and cornual blocks were considered as the features of genital tuberculosis. On histopathological examination 8 (32%) of patients shown positivity for tuberculosis. On culture 5 (20%) were positive of which all were positive by histopathological examination.

Conclusion: Histopathological examination is easy, quick and cheap and provides characteristic features of M. tuberculosis in genital tuberculosis. Even though Culture is the gold standard for diagnosis of MTB, histopathological methods can be considered as culture are negative in most of the cases and diagnosis can be missed.

Keywords: TB, hysterosalpingogram, Laparoscopy and EPTB