Two tissue sections are sent to lab for detection of mycobacteium tuberculosis in endometrium, histopathology report shows Granulomatous endometritis and PCR shows negative for mycobacterium tuberculosis what are the possibilities in this issue and is this situation common or uncommon. primers specific to IS6110 were used, Dear researchers can any one provide your suggestions and information in this regard
I'm going to presume that the patient has a positive skin test for TB and special stains for mycobacteria and fungi are negative which explains why TB PCR was requested. If that's not the case then you should look at a nice review by Almoujahed et al (AM j Clin PAth 2002:117, 771-775) Many of these granulomatous lesions are focal and a reaction to a previous surgery (foreign bodies) or hemorrhage (necrobiosis, endometrial ablation). Systemic conditions like sarcoidosis and Crohn's disease should be ruled out but tuberculosis is the most common systemic etiology. In rare cases, cytomegalovirus infection has been implicated.
PCR is not flawless. The IS6110 primers test for Mtb complex organisms with about 85-95% sensitivity in some studies but only 30-75% sensitivity in other studies depending on extraction methods. The specificity runs about 75% so false positives are possible including positive tests for distantly related organisms like M. simiae. It will not detect other mycobacteria like M. avium/intacellulare complex, M. xenopi, M. gordonae, M. fortuitum, M. kansasii. In reality positive tests by this method should be confirmed by another method and negative tests do not rule out involvement of other mycobacteria.
Have you considered the possibility that there is a different aetiology from tuberculosis? Can you say something more about the characteristics of granulomas?
http://www.medscape.com/viewarticle/444328_4
Either different etiology or contamination from the control section (if the control section is on the same slide as sample)
You have to check how the tissue was sampled and each specimen sent. is there a possibilty focal granuloma which was seen on histopathology
TB cultures can take till 8 week for its final result. Other possibilities to be consider: Sarcoidosis (non-caseating granulomas), fungal and histoplasma, atypical mycobateria... Can you provide us a more complete medical history and complete histology report? Best regards and happy 2015
I'm going to presume that the patient has a positive skin test for TB and special stains for mycobacteria and fungi are negative which explains why TB PCR was requested. If that's not the case then you should look at a nice review by Almoujahed et al (AM j Clin PAth 2002:117, 771-775) Many of these granulomatous lesions are focal and a reaction to a previous surgery (foreign bodies) or hemorrhage (necrobiosis, endometrial ablation). Systemic conditions like sarcoidosis and Crohn's disease should be ruled out but tuberculosis is the most common systemic etiology. In rare cases, cytomegalovirus infection has been implicated.
PCR is not flawless. The IS6110 primers test for Mtb complex organisms with about 85-95% sensitivity in some studies but only 30-75% sensitivity in other studies depending on extraction methods. The specificity runs about 75% so false positives are possible including positive tests for distantly related organisms like M. simiae. It will not detect other mycobacteria like M. avium/intacellulare complex, M. xenopi, M. gordonae, M. fortuitum, M. kansasii. In reality positive tests by this method should be confirmed by another method and negative tests do not rule out involvement of other mycobacteria.
I have the patient with history of abortion (curettage) after IVF. After histeroscopy the biopsy revealed Granulomatous Endometritis - the patients underwent antibiotics therapy - 10 days of Doksycykline. The second blind biopsy also revealed Granulomatous Endometritis .... What test should I do?
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