To compare the Sensitivity of Urinary Polymerase Chain Reaction with Intravenous Urography and Urine Acid Fast Bacilli in a clinically Suspected Case of Genito Urinary Tuberculosis

Abstract

INTRODUCTION: Tuberculosis is as old as human race. Old literature shows evidence of Mycobacterium Tuberculosis even in egyptian mummies. During the 19th century this disease was called as consumption disease as it was considered a major killer. With the introduction of anti tuberculous drugs, there is decrease in incidence of new cases as well as death due to tuberculous infection, but still tuberculosis is a large public health problem. In healthy persons, tuberculous infection is clinically in apparent. 10% to 15% of people who are infected with TB are prone to develop GUTB. Poor nutrition, people living in crowded situations and poverty are the greatest risk factor for acquiring this disease. The recent trend of resistant strains of M.Tuberculosis form a major obstacle for the treating physician. The recent resurgence of tuberculosis and its association with HIV infection leading onto acquired Immuno Deficiency Syndrome (AIDS) in another worrying problem. OBJECTIVE: To compare the sensitivity of urinary polymerase chain reaction with intravenous urography and urine acid fast bacilli in a clinically suspected case of Genito urinary tuberculosis. METHODS: It is a prospective study. Study Period : from Jan 2013 to Dec 2013. Total of 25 patients were included in the study sample. These patients had clinical symptoms suggestive of GUTB. The sensitivity of urinary PCR was compared with that of IVU and urine AFB. RESULTS: Our study had a total of 18 males and 7 female patients. The most common age group affected was 20-40 years. All 25 patients had irritative LUTS about 56% of patients had past history of PT, of which only 65% of patients completed ATT. About 60% of patients presented to hospital in less than 3 months of symptoms. 12% of patients were found to be positive for retro virus. The most common symptoms of patients were irritative LUTS 100%, sterile pyuria 70%, hematuria 56%. RFT was normal in 80% of our patients. 60% had raised ESR. 80% of patients had constitutional symptoms like low grade fever, loss of appetite, weight. IVU was positive in 50% of patients (12/25), urine AFB 20%(5/25), urine PCR 76%. (19/25). CONCLUSION: A high index of suspicion is necessary for diagnosis of GUTB, IVU may be suggestive of GUTB, but it is not specific. In our study IVU was positive only in 50% of patients, urine AFB 20% of patients, PCR were positive in 76% of patients. Urine PCR for MTB was the most sensitive indicator and also it gives a rapid, sensitive and specific method to diagnose GUTB