Diagnostic dilemma in female genital tuberculosis- staining techniques\nrevisited

Abstract

Background: Tuberculosis (TB) is an increasing public health concern\nworldwide. On a global scale it has a devastating impact in developing\nnations. Genital TB, an extrapulmonary form, is not uncommon\nparticularly in areas where pulmonary TB is prevalent. Genital TB may\nbe asymptomatic or may even masquerade as other gynaecological\nconditions; hence, diagnosis requires a high degree of suspicion and\nthe use of appropriate investigations. Objective: This study attempted\nto identify endometrial TB in endometrial biopsies taken from women\nevaluated for infertility by comparison of various staining techniques.\nMaterials and Methods: A comparative cross sectional study was\nconducted from February 2011 to April 2011 in Guru Teg Bahadur\nHospital, New Delhi. Endometrial biopsy specimens from 55 endometrial\nTB suspects were stained for acid fast bacilli by Ziehl Neelson\nstaining and Gabbet staining. The biopsy samples were also subjected to\nAuramine Phenol fluroscent staining and H and E staining. Culture on\nLowenstein Jensen medium was taken as the gold standard. Results: Three\nsamples were culture positive giving positivity rate of 5.4%.\nConsidering culture as the gold standard the senstivities of ZN,\nGabbet, fluorescent and H and E staining were 33, 33, 66, and 66%\nrespectively while their specificities were 100, 100, 98, and100%\nrespectively. Conclusion: Combination of fluorescent staining\ntechniques along with one of the acid fast staining techniques or\nhistopathology achieves sufficient sensitivity and specificity for the\ndiagnosis of female genital tuberculosis. There is an urgent need for\ndeveloping definitive diagnostic methods to make a conclusive diagnosis\nof genital TB.