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

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Abstract

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.

Related collections

Most cited references 26

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Rapid detection of Mycobacterium bovis DNA in cattle lymph nodes with visible lesions using PCR

G Michael Taylor, Danny Worth, Si Palmer … (2007)

Background We have evaluated a sensitive screening assay for Mycobacterium tuberculosis (MTB) complex organisms and a specific assay for detecting Mycobacterium bovis DNA in lymph nodes taken from cattle with evidence of bovine tuberculosis. Underlying these series of experiments was the need for a versatile DNA extraction protocol which could handle tissue samples and with the potential for automation. The target for the screening assay was the multi-copy insertion element IS1081, present in 6 copies in the MTB complex. For confirmation of M. bovis we used primers flanking a specific deletion in the genome of M. bovis known as region of difference 4 (RD4). The sensitivity and specificity of these PCRs has been tested on genomic DNA from MTB complex reference strains, mycobacteria other than tuberculosis (MOTT), spiked samples and on clinical material. Results The minimum detection limits of the IS1081 method was < I genome copy and for the RD4 PCR was 5 genome copies. Both methods can be readily adapted for quantitative PCR with the use of SYBR Green intercalating dye on the RotorGene 3000 platform (Corbett Research). Initial testing of field samples of bovine lymph nodes with visible lesions (VL, n = 109) highlighted two shortfalls of the molecular approach. Firstly, comparison of IS1081 PCR with the "gold standard" of culture showed a sensitivity of approximately 70%. The sensitivity of the RD4 PCR method was 50%. Secondly, the success rate of spoligotyping applied directly to clinical material was 51% compared with cultures. A series of further experiments indicated that the discrepancy between sensitivity of detection found with purified mycobacterial DNA and direct testing of field samples was due to limited mycobacterial DNA recovery from tissue homogenates rather than PCR inhibition. The resilient mycobacterial cell wall, the presence of tissue debris and the paucibacillary nature of some cattle VL tissue may all contribute to this observation. Any of these factors may restrict application of other more discriminant typing methods. A simple means of increasing the efficiency of mycobacterial DNA recovery was assessed using a further pool of 95 cattle VL. Following modification of the extraction protocol, detection rate with the IS1081 and RD4 methods increased to 91% and 59% respectively. Conclusion The IS1081 PCR is a realistic screening method for rapid identification of positive cases but the sensitivity of single copy methods, like RD4 and also of spoligotyping will need to be improved to make these applicable for direct testing of tissue extracts.

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Improved diagnostic value of PCR in the diagnosis of female genital tuberculosis leading to infertility.

Naga Veerapu, Pradeep Seth, N Bhanu … (2005)

Histopathological and mycobacteriological examinations have limited utility in the diagnosis of genital tuberculosis. In this double-blind study, 61 samples, consisting of endometrial aspirates (EAs), endometrial biopsies (EBs) and fluid from the pouch of Douglas (POD), from 25 women suffering from infertility were investigated for the presence of the mpt64 gene of Mycobacterium tuberculosis by PCR and correlated with laparoscopic findings. PCR demonstrated M. tuberculosis DNA in 14 out of 25 patients (56.0 %), compared to one smear with acid-fast bacilli (1.6 %) and two culture-positive samples (3.2 %). The presence of M. tuberculosis DNA was observed in 53.3 % of EBs, 47.6 % of EAs and 16.0 % of POD fluid samples. All patients with laparoscopy suggestive of tuberculosis, 60 % of those with a probable diagnosis and 33 % of those with incidental findings were positive by PCR. However, one EA sample from an infertile patient with normal laparoscopy was also positive. Multiple sampling from different sites and amplification of the mpt64 gene segment by PCR offered increased sensitivity in determining tuberculous aetiology in female infertility.

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Genital tuberculosis--a major pelvic factor causing infertility in Indian women.

Firuza Parikh, Suparna Nadkarni, Sudesh A. Kamat … (1997)

To study the effect of tuberculosis, a common infectious disease in the Indian subcontinent, on the female pelvic factor and its subsequent effect on female fertility. Retrospective case studies. Department of Infertility Management and Assisted Reproduction, Jaslok Hospital and Research Centre, Bombay, India. Three hundred women, between the ages of 25 and 35 years, with tubal factor as a cause of their infertile state. One hundred seventeen women with a tubal factor were found to have tuberculosis as the cause of tubal blockage. On laparoscopy, 49.5% were found to have simple tubal blockage, 15.3% showed tubo-ovarian masses, and 23.9% had a frozen pelvis. Seventy-five percent complained of menstrual irregularities, thus indicating endometrial involvement; 25.6% of these women underwent an IVF procedure. The pregnancy rate after IVF-ET was 16.6% per transfer. This study highlights the fact that tuberculosis, a chronic infectious disease, is one of the major etiologic factors of female tubal infertility, especially on the Indian subcontinent.

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Author and article information

Contributors

Sileshi Abdissa: silejes@gmail.com

Tamrat Abebe: tamrat.abebe@aau.edu.et

Gobena Ameni: gobena.ameni@aau.edu.et

Sisay Teklu: siteet@yahoo.com

Yonas Bekuretsion: yonasbtsion@yahoo.com

Markos Abebe: Markosabebe@yahoo.com

Adane Mihret:

ORCID: http://orcid.org/0000-0003-3183-4772

Adane_mihret@yahoo.com

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect. Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 5 July 2018

Publication date PMC-release: 5 July 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 304

Affiliations

[1 ]Arsi University, Asella, Ethiopia

[2 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, Department of Microbiology, Immunology and Parasitology, School of Medicine, , Addis Ababa University, ; Addis Ababa, Ethiopia

[3 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, Aklilu Lemma Institute of Pathobiology, , Addis Ababa University, ; Addis Ababa, Ethiopia

[4 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, Department of Gynecology and Obstetrics, School of Medicine, , Addis Ababa University, ; Addis Ababa, Ethiopia

[5 ]ISNI 0000 0001 1250 5688, GRID grid.7123.7, Department of Pathology, School of Medicine, , Addis Ababa University, ; Addis Ababa, Ethiopia

[6 ]ISNI 0000 0000 4319 4715, GRID grid.418720.8, Armauer Hansen Research Institute, ; Addis Ababa, Ethiopia

Author information

Adane Mihret http://orcid.org/0000-0003-3183-4772

Article

Publisher ID: 3202

DOI: 10.1186/s12879-018-3202-x

PMC ID: 6034314

PubMed ID: 29976147

SO-VID: 47827a51-c9e1-48c4-a09c-450856170ba8

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.