DEFINING THE INDEX OF SUSPICION OF UROGENITAL TUBERCULOSIS IN DOCTORS SPECIALIZING IN VARIOUS FIELDS

Polymorphism of clinical manifestations and absence of pathognomic symptoms are typical of urogenital tuberculosis. Since anti-microbial agents are widely used (fluoruquinolones, amikacin, rifampicin), it is more difficult to verify the diagnosis by pathomorphologic and bacteriological methods. The index of suspicion and certain required minimum level of knowledge on urogenital tuberculosis are crucial for its early diagnostics.

Materials and methods. In order to assess the level of knowledge in doctors specializing in different fields (urologists, gynecologists, general practitioners, phthisiologists) about specific symptoms and early diagnostics of urogenital tuberculosis and to evaluate the level of their awareness of this disease, 265 specialists had a test in the form of a questionnaire. To define preferences of specialists when choosing specific therapy of infectious inflammatory disorders of the urogenital system, the answers to the questionnaire given by 2 groups of doctors were analyzed, Group 1 (103 persons) included urologists, gynecologists and phthisiologists from medical units of Novosibirsk Region and city of Novosibirsk, Group 2 (298 persons) included interns and residents of Novosibirsk State Medical University by the Russian Ministry of Health.

Results. There was no significant difference between the level of knowledge about urogenital tuberculosis among the specialists: urologists, gynecologists, and general practitioners gave the right answers in 59.2-63.7% of cases; phthisiologists had a better level of knowledge and 77.2% of their answers was right. In every third case, the choice of anti-microbial agents for empiric therapy of acute and chronic cystitis was not the best option regarding the drug resistance and inhibiting action against M. tuberculosis.

Conclusion: The results of the questionnaire survey showed the low level of knowledge about urogenital tuberculosis among the specialists of general medical services (urologists, gynecologists, general practitioners). The high number of antibacterial agents with tuberculostatic action which were mentioned as drugs for the empiric treatment of urogenital disorders reflects the fact that importance of urogenital tuberculosis is underestimated by the specialists. 

1. Аlkhovik O.I., Kulchavenya E.V., Cherednichenko А.G. Certain factors of natural human resistance to tuberculous infection. Tuberculosis and Lung Diseases, 2014, no. 5, pp. 22-24. (In Russ.)

2. Bykhalov L.S. The character of pathologic and morphological changes in the kidneys of those died of HIV/TB co-infection. Tuberculosis and Lung Diseases, 2015, no. 7, pp. 26-27. (In Russ.)

3. Zuban O.N., Levashev Yu.N., Skornyakov S.N. Nephroureterectomy in the treatment of renal tuberculosis patients. Tuberculosis and Lung Diseases, 2013, no. 2, pp. 29-35. (In Russ.)

4. Kulchavenya E.V., Krasnov V.А., Mordyk А.V. Аlmanakh vnelegochnogo tuberkuleza. [Almanac of extrapulmonary tuberculosis]. Novosibirsk, Sibprint Publ., 2015, 247 p. ISBN 978-5-94301-579-3.

5. Federalnye klinicheskie rekomendatsii «Аntimikrobnaya terapiya i profilaktika infektsiy pochek, mochevyvodyaschikh putey i muzhskikh polovykh organov». [Federal clinical guidelines on anti-microbial treatment and prevention of infections of kidneys, urinary tracts and male genital organs]. Moscow, 2015.

6. Bacci M.R., Namura J.J., Lera A.T. Complicated urinary infection and extrapulmonary tuberculosis. BMJ Case Reports, 2012, vol. 2012, pp. bcr2012007553.

7. Chen H., Liu Y., Wu D. Diffuse calcification of the urinary system and miliary tuberculosis due to delayed diagnosis of genitourinary tuberculosis: A Case report. Iran. J. Public Health, 2015, vol. 44, no. 2, pp. 276-278.

8. de Oliveira J.L., G. B.vda Silva Junior, Daher E.D.F. Tuberculosis-associated chronic kidney disease. Am. J. Tropical Med. Hygiene, 2011, vol. 84, no. 6, pp. 843-844.

9. Fillion A., Koutlidis N., Froissart A., Fantin B. Investigation and management of genito-urinary tuberculosis. La Revue de medecine interne/fondee... par la Societe nationale francaise de medecine interne. 2014, vol. 35, no. 12, pp. 808-814.

10. Global tuberculosis report 2016. WHO/HTM/TB/2016.13. World Health Organization Geneva 2016: http://www.who.int/tb/publications/global_ report/en/

11. Hwang H.P., Lee H.B., Kang K.P., Kim W., Park S.K., Lee S. Transition of overlooked sterile pyuria. Nephrology, 2013, vol. 18, no. 11, pp. 744-745.

12. Minecan N., Andrei A., Segal A., Herovanu L. Diagnosis of bacteriologically unconfirmed urogenital tuberculosis. Rev. Med. Chir. Soc. Med. Nat. Iasi., 1980, vol. 84, no. 2, pp. 241-244.

13. Norbis L. et al. Challenges and perspectives in the diagnosis of extrapulmonary tuberculosis. Expert review of anti-infective therapy. 2014, vol. 12, no. 5, pp. 633-647.

14. Patil S., Desai A.S., Biradar A.N., Kundargi V.S. Extensive nephroureteric calcification presenting with renal failure: A rare case report. Urology Annals, 2015, vol. 7, no. 3, pp. 375-377. doi: 10.4103/0974-7796.157958.

15. Sutariya H.C., Panchal T.N., Pandya V.K., Patel K.N. Disseminated tuberculosis involving allograft in a renal transplant recipient. J. Global Infectious Diseases, 2016, vol. 8, no. 1, pp. 55-56. doi: 10.4103/0974-777X.176151.