Diagnostic Value of PCR compared to Urine Culture for Urinary Tuberculosis in Adult Women: An Evidence-Based Case Report
Background: genitourinary tuberculosis (GUTB) refers to a Mycobacterium tuberculosis infection of the urinary tract with clinical manifestation masquerading as various urological diagnostic entities. With an incidence rate of 192-232 per 100,000 individuals, current diagnoses have fallen short in comparison to the total incidence. Combined with an atypical and non-specific manifestation, a high false negative rate of acid-fast bacilli (AFB) staining, and long AFB culture duration has made diagnosis difficult. We aim to gather current available evidence regarding the diagnostic performance of polymerase chain reaction (PCR) in the diagnosis of GUTB. Methods: a literature search was conducted in four different, well-known databases using a predetermined PICO, keywords, and Boolean operators. All included articles will be subjected to rigorous appraisal according the University of Oxford’s Centre for Evidence-Based Medicine (CEBM) Diagnostic Variability Criteria. Review and meta-analysis will be subjected to the QFAITH appraisal checklist to assess its quality. Results: out of a total of 243 initial search results, 11 relevant studies were determined after title and abstract screening. Additionally, nine articles were excluded based on the predetermined criteria. Two fully appraised articles were included in the study: one systematic review article, revealing a heterogenous (I2 = unstated; p = unstated) result of sensitivity mean above 85% and specificity above 75%; and one cross-sectional diagnostic study that reported the use of two different PCR primers: IS6110-PCR and 16SrRNA-PCR primer with a sensitivity of 95.99% and 87.05% and specificity of 98.11% and 98.9%, respectively. Conclusion: current limited evidence showed that PCR could not be solely used for the diagnosis of GUTB, but its use is recommended to guide patient treatment and monitoring.
World Health Organization (WHO). Global tuberculosis report 2019. New York, 2019; World Health Organization. [Cited March 28th, 2020]. Available from: https://www.who.int/tb/publications/global_report/en/
Kim JY, Shakow A, Castro A, Vande C, Farmer P. Tuberculosis Control. New York, 2019; World Health Organization (WHO). [Cited March 28th, 2020]. Available from: https://www.who.int/trade/distance_learning/gpgh/gpgh3/en/index5.html
Health Ministry of Republic of Indonesia. Hasil Utama Riset Kesehatan Dasar (RISKESDAS) 2018. Jakarta, 2019; Health Ministry of Republic of Indonesia. [Cited March 28th, 2020]. Available from: http://www.kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Hasil-riskesdas-2018_1274.pdf
Lee JY. Diagnosis and treatment of Extrapulmonary tuberculosis. Tuberc Respir Dis (Seoul). 2015;78(2): 47-55.
Yadav S, Singh P, Hemal A, Kumar R. Genital tuberculosis: current status of diagnosis and management. Trans Androl Urol. 2019; 6(2): 222-33.
Merchant S, Bharati A, Merchant N. Tuberculosis of the genitourinary system-Urinary tract tuberculosis: Renal tuberculosis-Part I. Indian J Radiol Imaging. 2013;23(2):46-63.
Figueiredo AA, Lucon AM. Urogenital tuberculosis: Update and Review of 8961 cases from the world literature. Rev Urol. 2008;10(3):207-17.
Kim EJ, Lee W, Jeong WY, et al. Chronic kidney disease with genitourinary tuberculosis: old disease but ongoing complication. BMC Nephrol. 2018;19:193.
Goonewardene S, Persad R. Sterile pyuria: a forgotten entity. Ther Adv Urol. 2015;7(5):295-8.
Kulchavenya E, Cherednichenko A. Urogenital tuberculosis, the cause of ineffective antibacterial therapy for urinary tract infection. Ther Adv Urol. 2018;10(3):95-101.
Wong N, Hoag NA, Jones EC, Rowley A, McLoughlin MG, Paterson RF. Genitourinary tuberculosis masquerading as a ureteral calculus. Can Urol Assoc J. 2013;7(5-6):E363-66.
Kumar S, Shankaregowda SA, Choudhary GR, Singla K. Rare presentation of Genitourinary Tuberculosis masquerading as Renal Cell Carcinoma: A Histopathological Surprise. J Clin Imaging Sci. 2014;4:26.
Ghaleb K, Afifi M, El-Gohary M. Assessment of Diagnostic Techniques of Urinary Tuberculosis. Mediterr J Hematol Infect Dis. 2013;5(1):e2013034.
Hemal AK. Polymerase chain reaction in clinically suspected genitourinary tuberculosis: comparision with intravenous urography, bladder biopsy, and urine acid fast bacilli culture. Urology. 2020;56:570–4.
Newby C., Barhaghi K., Maylin M. Sterile pyuria – a classic tale with a modern twist. J Gen Intern Med. 2014;29:S438–S439
The Center for Evidence-Based Medicine, University of Oxford. Critical appraisal of prognostic studies (checklist). Online [cited 24 February 2020]. Available from: https://www.cebm.net/wp-content/uploads/2018/11/Prognosis.pdf
The Center for Evidence-Based Medicine, University of Oxford. Systematic Review (checklist). Online [cited 24 February 2020]. Available from: https://www.cebm.net/wp-content/uploads/2019/01/Systematic-Review.pdf
van Vollenhoven P, Heyns CF, de Beer PM, Whitaker P, van Helden PD, Victor T. Polymerase chain reaction in the diagnosis of urinary tract tuberculosis. Urol Res. 1996;24(2):107-111. doi:10.1007/BF00431088
Gamboa F, Dominguez J, Padilla E, et al. Rapid diagnosis of extrapulmonary tuberculosis by ligase chain reaction amplification. J Clin Microbiol. 1998;36(5):1324-9.
Moussa OM, Eraky I, El-Far MA, et al. Rapid diagnosis of genitourinary tuberculosis by polymerase chain reaction and non-radioactive DNA hybridization. J Urol 2000; 164:584-8. 10.1016/S0022-5347(05)67427-7.
García-Elorriaga G, Gracida-Osorno C, Carrillo-Montes G, González-Bonilla C. Clinical usefulness of the nested polymerase chain reaction in the diagnosis of extrapulmonary tuberculosis. Salud Publica Mex. 2009;51(3):240-245. doi:10.1590/s0036-36342009000300015.
Khosravi AD, Hashemzadeh M, Ghorbani A, Seghatoleslami S. Comparison of Nested-PCR technique and culture method in detection of Mycobacterium tuberculosis from patients suspected to genitourinary tuberculosis. Afr J Biotechnol. 2010; 9(14): 2151-5.
Hillemann D, Rusch-Gerdes S, Boehme C, Richter E. Rapid molecular detection of extrapulmonary tuberculosis by the automated GeneXpert MTB/RIF system. J Clin Microbiol. 2011; 49:1202–5.
Tortoli E, Russo C, Piersimoni C, et al. Clinical validation of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis. Eur Respir J. 2012; 40:442–7.
Khan FUR, Cheema FA, Khan MU. Accuracy of urinary PCR as compared with urine culture for early diagnosis of genitourinary tuberculosis. Pak J Med Sci. 2013; 7(3):675-678.
Yang D, Kong Y. The bacterial and host factors associated with extrapulmonary dissemination of Mycobacterium tuberculosis. Front Biol. 2015; 10(3): 252-61.
Hartman DS, Stagg PL. Diagnosis please. Case 3: Renal tuberculosis. Radiology. 1998; 209:69–72.
Abbara, A., & Davidson, R. N. (2011). Etiology and management of genitourinary tuberculosis. Nature Reviews Urology, 8(12), 678–688. doi:10.1038/nrurol.2011.172
Konety BR, Metro Mj, Melham MF, Salup RR. Diagnostic value of voided urine and bladder barbotage cytology in detecting transitional cell carcinoma of the Urinary tract. Urol Int. 2019; 62(1): 26-30.
EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam 2020. ISBN 978-94-92671-07-3.
Barkan GA. Enough is enough: adequacy of voided urine cytology. Cancer Cytopathology. 2015; 124(3): 174-80.
Garcia-Rodrigues, JA et al. Genitourinary Tuberculosis in Spain: review of 81 Cases. Clin. Infect. Dis. 1994; 18: 557–561.
Salian NV, Rish JA, Eisenach KD, Cave MD, Bates JH. Polymerase Chain Reaction to Detect Mycobacterium tuberculosis in Histologic Specimens. Am J Respir Crit Care Med. 1998; 158(4): 1150-5.
Marangu D, Devine B, John-Stewart G. Diagnostic accuracy of nucleic acid amplification tests in urine for pulmonary tuberculosis: a meta-analysis. Int J Tuberc Lung Dis. 2015;19(11):1339-1347. doi:10.5588/ijtld.15.0209
Altez-Fernandez C, Ortiz V, Mirzazadeh M, Zegarra L, Seas C, Ugarte-Gil C. Diagnostic accuracy of Nucleic Acid Amplification Tests (NAAT) in Urine for Genitourinary Tuberculosis: A Systematic Review and Meta-Analysis. BMC Infect Dis. 2017; 17(1): 390.
Center for Disease Control and Prevention. Chapter 4 – Diagnosis of tuberculosis disease. CDC. Atlanta, 2019. [Website]. [Cited March 28th, 2020]. Available from: https://www.
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