An Epidemiological Study of Urinary Tuberculosis in Iraq
Kerbala Journal of Medicine,
Volume 7, Issue 2, Pages 1901-1911
AbstractGenitourinary tuberculosis is almost always secondary to symptomatic or asymptomatic primary lesion in the lung. After lymphadenopathy, the most common form of nonpulmonary tuberculosis is genitourinary disease. Most patients are between 20 to 40 years of age with a male to female ratio of 2:1. 4. However, a negative test does not exclude clinical disease. This is a cross sectional double centered study of patients with recurrent urinary tract infections attends the private and public outpatient's clinics in Basra teaching hospital and Imam Husain medical city-AlZahra teaching hospital in Kerbala holy. Patients who full fill two out of the following three diagnostic criteria were considered to have urinary tuberculosis..Thesecriteria were: demonstration of mycobacterium tuberculosis in urine by microbiological ,histopathological methods ,and intravenous urography.We exclude patients who prove to have genital tuberculosis ,and those who had only positive findings in intravenous urography. Statistical analyses were performed using IBM-SPSS version 20. Among our 1500 patients enrolled in this study,35(2%) full fill the diagnostic criteria of urinary tuberculosis. The mean age was 50.7 ± 14.9 SD.The urine for acid fast bacili was positive in 1patient(4%) and urine culture for mycobacterium was positive in only 2patients(16%).The tuberculin skin test was positive in 26 patients(74%).The intravenous urography showed abnormalities in 29patients(84%).40% of patients had a positive findings in histopathology of kidney tissue. At a cut off value of 0.6 the sensitivity was 82% and specificity was 50% for the tuberculin skin test in the diagnosis of urinary tuberculosis. The low prevalence rate 2% of urinary tuberculosis in our study is because our diagnosis was hypothesized in the setting of non-specific bacterial cystitis associated with a therapeutic failure or a urinalysis with a persistent leukocyturia and absence of bacteriuria.The clinical characteristics of urinary tuberculosis in older adults can be unusual and may be confused with age-related illnesses. Generally in Iraq like many other Middle East countries, Women spent more time at home and are more likely to be infected within the home than outside it, with a corresponding higher infectious dose. Our patients were less likely to offered histological diagnoses, a situation that points to late diagnosis. In such instance,urinary tuberculosis is consequently more severe, with a higher frequency of renal failure. When kidney and bladder tuberculosis are concerned ,the kidneys are mute and the bladder plays the role of vocal cords. In the context of immunosuppression, urinary tuberculosis behaves as a severe bacterial infection, with bacteremia and visceral metastatic foci. Sterile pyuria was found in 80 % in this study. This could be explained by more liberal use of antibiotics that has anti-mycobacterial effects in our country which render the urine sterile even in the presence of secondary bacterial infection. A high index of suspicion should be made in cases of sterile pyuria who resist antibiotic therapy that have no antituberculous effects. We recommend further studies to detect the prevalence of urinary tuberculosis among immunocompramised patients including those on chronic dialysis program.
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