Clinical characteristics and outcome of genitourinary tuberculosis in Sri Lanka: an observational study.

BACKGROUND: Although genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains low. The characteristics of GUTB in Sri Lanka have not been studied and documented so far. We aimed to study the clinical and imaging characteristics, treatment modalities and outcome of GUTB in Sri Lanka. METHODS: Data collected from patients treated by a single urological surgeon in two institutes consecutively over a period of 21 years were analysed. All patients with a microbiological and/or histopathological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6-96). RESULTS: There were 82 patients and 45 (54.9%) were men. The median age was 51 (range: 26-75) years. Most patients (39%, n = 32) had vague non-specific symptoms at presentation. Common specific symptoms at presentation were haematuria (15.8%, n = 13) and scrotal manifestations (15.8%, n = 13). Mantoux test was done in 70 patients and was > 10 mm in 62 (88.5%). Erythrocyte sedimentation rate was available in 69 patients and was > 30 mm in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent cystoscopy and 73.8% (n = 31) had abnormal findings. Microbiological diagnosis was feasible in 43 (52.4%) and rest were diagnosed histopathologically. Commonest organs involved were kidney (64.6%, n = 53), ureter (51.2%, n = 42), bladder (43.9%, n = 36) and testis/epididymis (15.8%, n = 13). One patient had TB of the prostate. All were treated primarily with anti-TB drugs however, 50 (61%) required ancillary therapeutic interventions. The majority of interventions were reconstructive surgeries (n = 20, 24.4%) followed by excisional surgeries (n = 19, 23.2%) and drainage procedures (n = 11, 13.4%). Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder with disabling storage symptoms. Eight patients had deranged renal functions at diagnosis and three patients developed progressive deterioration of renal function and two patients died of end stage renal disease. CONCLUSIONS: The combination of urine for acid-fast bacilli, Mantoux test, CT-Urography, cystoscopy and histopathology is necessary to diagnose GUTB in resource-poor settings. Most ureteric strictures, non-functioning kidneys and epididymal masses need surgical treatment. Long-term follow up is essential to detect progressive deterioration of renal function.

Serotyping of invasive and colonizing group B Streptococcus (GBS) isolates at selected hospitals in Sri Lanka: a multicenter study.

Background: Group B Streptococcus (GBS) causes significant morbidity and mortality in neonates, pregnant women and patients with underlying comorbidities. Intrapartum antibiotic prophylaxis (IAP) is currently the mainstay of prevention and effective vaccine against invasive GBS disease is under clinical trial. Objectives: To describe the serotype distribution of invasive and colonizing GBS isolates in Sri Lanka. Methods: Probable GBS isolates from high vaginal swabs (HVS) and sterile body sites were collected from eight selected hospital laboratories. Following confirmation of the identification as group B Streptococcus by phenotypic methods including Lancefield grouping test (Plasmatic UK), isolates were tested for serotyping by latex agglutination test kit (STATEN serum institute, Denmark). Results: Out of the 145 probable GBS isolates only 100 from HVS and 37 from sterile body sites were confirmed as GBS. Serotype III was the most predominant in invasive GBS isolates followed by Ia, Ib, VI, II and V in the descending order of frequency. Serotype VI was the most predominant in HVS isolates followed by serotype III, V, Ia, II, Ib and IV. Difference of GBS serotype distribution between the invasive and HVS group was statistically significant (P value = 0.038). Conclusion: Serotype distribution pattern of the study isolates was comparable to most of the other developing and developed countries and hence will be beneficial in future vaccine introduction. GBS vaccine which is currently under clinical trial (Ia, Ib and III) is potentially effective for preventing 68% of the early onset disease in neonates in this study setting.