An Approach to the Detection of Mycobacteria in Clinically Suspected Cases of Urinary Tract Infection in Immunocompromised Patients

Urinary tract infections (UTIs) are one of the most common infections in human beings. Most of these infections are caused by bacterial agents. Mycobacterial agents causing UTIs are less frequent in immunocompetent individuals; they are more common and severe in immunocompromised individuals.The incidence of tuberculosis is rising, particularly due to Human Immunodeficiency Virus (HIV) infection. The HIV sero-prevalence among tuberculosis (TB) patients in India ranges from around 2 to 20%, with an estimated 60% of HIV infected persons breaking down with active TB disease in their lifetime.The diagnosis of TB with HIV positive is more difficult than in those without HIV infection. Extra pulmonary tuberculosis (EPTB) represents a progressively greater proportion of new cases and the genitourinary tract (GUT) is the most common site of EPTB.The most common causative organism of kidney and urinary tract tuberculosis is the Mycobacterium tuberculosis & occasionally Mycobacterium bovis can also be responsible. Mycobacterium tuberculosis (MTB) has an important impact on kidney transplant recipients, particularly during the first year after surgery. The sure criterion for definite diagnosis of TB is the demonstration of the presence of tubercle bacillus in clinical specimens. This is based on traditional and conventional methods Ziehl Neelsen (ZN) acid fast stain and laboratory culture of M. tuberculosis on Lowenstein Jensen (LJ) medium. However, ZN staining lacks specificity and sensitivity, while confirmation by culture requires several weeks. Rapid diagnostic methods have been developed that are based either on liquid culture techniques, such as BACTEC or molecular techniques but they are expensive, requires specialist personnel and equipment hence limited their use especially in developing countries. Apart from this, FASTPlaque TB is a phage based tes t , wh ich uses the mycobacteriophage to detect the presence of M. tuberculosis directly from the specimens. It is a rapid, manual test, easy to perform and has an overall higher sensitivity when compared with sputum smear microscopy, in newly diagnosed smear positive TB patients.