Brief Answer:
You need to submit proper samples.

Detailed Answer:
Menstrual blood is not a proper sample for all the tests you have mentioned. In fact in menstruation, the lining of the uterus(endometrium) that is present is degenerated endometrium, hence not suitable for study.
It is better you submit yourself for proper and adequate endometrial biopsy sample collection. It can be done by curettage (which is an old generation procedure) or hysteroscopic examination and biopsy. By hysteroscopy, direct tissues are also visualized. A single strip by endometrial biopsy cannula is not sufficient and adequate sample.
Submitting the lesions collected by this method can grow the bacteria and find out they are sensitive to which medicines; thus also indicating whether it is a multidrug resistance tuberculosis (MDR TB)or not.
For finding extrauterine lesions and evidences of tuberculosis, ultrasonography, X-rays and laparoscopy (telescopic examination of abdominal cavity) are useful investigative procedures. During laparoscopy, if required, sample of the lesions can be collected for submitting them to the battery of required tests.
Which are the tests you have undergone previously by which you have been diagnosed to be suffering from Genital Tuberculosis? I would encourage you to upload all the reports of those tests so that I can advise you more in this matter.
However, please do not have a short cut of submitting your menstrual discharge for the tests you have mentioned. It may not lead you anywhere, but might misguide you.
Are you already on any anti-tubercular line of treatment? If so, which medicines you are taking and for how long? Is your physician suspecting multidrug resistant tuberculosis in you? If so, based on which evidences?
Please furnish me with the information I have asked for so that I can guide you further more scientifically.
I hope I have given you proper guidance. Please furnish more information for further discussion.

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Brief Answer:
Should contue antitubercular treatment for atleast 9 months

Detailed Answer:
Hi XXXX,
I have gone through all your queries and the reports you have uploaded.
Let us start from your last query first:
1. The gastrointestinal and digestive symptoms you are experiencing are mostly the side effects of the drugs - particularly those for controlling your tuberculosis. For overcoming them your doctor has prescribed you some medicines. Still they are quite notorious and you have to tolerate them - doctors can only decrease their severity.
2. As you have suspected, the band and the adhesions in your abdomen also can cause abdominal symptoms, however, they are more of obstructive type than digestive. These adhesions may give you pain in abdomen sometimes.
3. Your investigations do give evidences of presence of tuberculosis in your body. Mostly, it is present in the band and adhesions present in the abdomen. However, the primary lesion of the infection has to be found out. It does not seem to be from lungs. Whatever may be the source, it is extrapulmonary and hence the treatment should not change till the primary source is detected and demands different treatment. Since there are adhesions to your ovaries, the genital tuberculosis seems to be the site to be suspected.
4. The medication should be taken well in time and doses. Occasionally, little variation in time by a couple of hours may not raise a concern however, by and large, adherence to the antitubercular medicines is very important lest the possibility of resistant infection.
5. Your doctors are taking good care for you. Please cooperate with them for diagnosing the primary lesion to finalize the medicines. If they feel, aundergo the required procedure, particularly hysteroscopy and laparoscopy for clinching the diagnosis.
6. Remember that this is a chronic infection and has to be managed by long term treatment; may be about 9 months or more.
I hope this will clarify the doubts in your mind. If wish to have some more discussion, you may ask me more.

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Brief Answer:
Co-operate for a direct evidence of diagnosis of tuberculosis

Detailed Answer:
Dear XXXX,
I do understand your concern about the diagnosis. Your doctors have started antitubercular line of treatment since there was a suggestion of tuberculosis in your ultrasound scan and IGRA tests.
Now the question is to diagnose where is the primary site of tuberculosis! I presume from your original query that your doctor wants to submit the lining of your uterus (endometrium) to the laboratory for histopathological and microbiological examinations. He/she must have suspected genital/endometrial tuberculosis in you. In XXXXXXX genital tuberculosis is rather very common in extrapulmonary tuberculosis. My advice to you was not to submit the menstrual discharge but to submit endometrial fresh sample after its maximum growth; i.e. just before the menstruation starts. Before taking the biopsy sample, hysteroscopy will have an added advantage. It will reveal the involvement of the tissue, any other pathology inside the uterus and also will visually guide for the selection of the endometrial tissue for biopsy.
I agree with you about your concern for laparoscopy. Not only for the safety but from the utility point of view I have got my own doubts. Even in the ultrasonography scan, the adhesive bands are seen. A major band up to the abdominal wall, adhesions of the both the ovaries to the intestin, I am indeed not sure how much the intra-abdominal organs will be visualized. However, I would advice you to leave this decision to the laparoscopist. If he/she can perform adhesiolysis and collect some sample of adhesions for biopsy, it would also be a positive achievement.
Yes, your diagnosis of tuberculosis has to be supported by direct evidences of finding tubercular lesion and/or bacteria. I feel your doctor is after it otherwise your endometrial sample would not have been asked for. You may pursue the biopsy collection and histopathology examination on it.
Your need not have the concern about prolongation of the antitubercular line of treatment. I agree that these medicines are quite notorious in their side effects and really make you feel sick. However, this treatment, particularly for extra-pulmonary tuberculosis has to be taken many a times for 9 months or so.
And finally about the intra-abdominal obstructive symptoms you are suffering from! Yes, they are most likely to be due to the vast adhesions you are having inside your abdomen. In addition, peritoneal or intestinal tuberculosis may also contribute to your gastro-intestinal symptoms. Usually, in patients of tuberculosis, surgery is performed only when it is a must. If your surgeon advises you and decides to open your abdomen, it will have two main advantages:
1. The lesions can directly be visualized and picked up for laboratory investigations.
2. Adhesiolysis can be performed which will relieve you from the gastro-intestinal obstructive type of symptoms.
In short:
1. Please do not worry about the prolongation of the treatment.
2. Submit yourself for the direct evidences of the diagnosis.
3. Do not resist for surgical procedure if advised.
4. Have a faith in your physician. I have seen the patients of tuberculosis in particular becoming impatient and starting to loose faith in the treating physician because of the side effects of medicines and prolongation of treatment. If you feel so, there is nothing undue in seeking for a second opinion. Unless someone differs in the opinion, please adhere religiously to the medications.
5. Spend lot of time in fresh air full of Oxygen. Do breathing exercise like Pranayama. This helps healing of the tissues and also makes you feel healthy.
6. Consume high protein diet that you can tolerate and digest.
Do not loose your heart XXXX, tuberculosis is a curable disease now.
And lastly a very delicate but vital question. Have you got your HIV test done? It is a dictum and worldwide guideline, particularly strongly applicable in XXXXXXX that each case of tuberculosis has to be tested for HIV and vice a versa. One infection increases the chances of other 6 times. If you have not been tested, please get yourself tested for HIV.

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Brief Answer:
I am more interested in histopathology and culture sensitivity

Detailed Answer:
Dear XXXXXXX
I have gone through your reports - blood and urine.
Decrease in Lymphocytes and increase in Neutrophils suggest acute infection; however, the values are so marginal that I would not give much diagnostic importance to that.
Your other investigations suggest that the kidney and liver functions are affected to some extent. They could be secondary to the antitubercular medicines. Your doctor will monitor it. They too are marginally raised. I would not discontinue anti-tubercular medicines for these values but keep a close watch.
Rest of the reports suggest rise in your bad fats, but marginally. They can be taken care of later on.
Urine report is absolutely normal.
These blood and urine reports do not give any clue for the diagnosis of tuberculosis. However, extra-pulmonary tuberculosis may not also.
Please get the direct evidence of tuberculosis before taking any drastic decision of discontinuing the medicines.
Also, do not ignore HIV test.
Please keep me informed about the biopsy and culture and sensitivity reports. You may later on ask me direct question also if this conversation is closed.

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Brief Answer:
Get direct evidences of your ? tubercular infection

Detailed Answer:
Dear XXXXXXX
You are absolutely justified in having your doubts about the diagnosis and have full right to get them clarified by your physician. I have therefore suggested you two alternatives in my previous communication:
1. Get the tissues biopsy histopathology examination done for direct evidence of tuberculosis and culture sensitivity done for identifying bacteria and the medicines to which they are sensitive.
2. You may go for second opinion.
Yes, I have seen your HIV report and is negative. No concern at present.
C reactive proteins are increased suggesting that there is some inflammation somewhere in the body.
Lymphocytes and Neutrophils values suggest that there is some current infection of some bacteria even other than tuberculosis in the body.
Some other infection also my be present in the body however, tuberculosis has to be either diagnosed or ruled out. Please insist on that. It cannot be taken lightly.
I would weigh the direct evidence of tuberculosis more than only supporting evidences.

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Brief Answer:
Laparoscopy only if the TB Physician and Surgeon jointly feel so.

Detailed Answer:
There is no necessity of blood culture for you.
What is this some kind of infection in the intestines? Please get it diagnosed from the physician. Mostly it could be tubercular infection.
Considering previous intra-abdominal surgery and so many adhesions inside the abdominal cavity I have got a doubt how much laparoscopy will be useful. However, the laparoscopist will have a look at your abdomen, USG reports and will decide whether it is safe and useful to undertake it. Else, you might have to undergo a surgery to open the abdomen. This decision has to be taken jointly by a TB Physician and the Surgeon.
Normally, Caesarean scar on the abdomen heals within a week or so. Since you did not have any dehiscence of the scar after caesarean section, the scar is well healed. Tuberculosis has not caused any problem is scar healing.
I would advise you not to be so sceptic, have a faith in your physician and follow the treatment.

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Brief Answer:
These are circumstancial evidences

Detailed Answer:
Dear XXXXXXX
Dehiscence of the scar means giving away or opening or rupture of the scar which happens usually within first few days if the scar has not healed properly - most of the times due to infection of pressure from inside.
16 or more slice mdct will show the lesions which are read by the imagiologist and an opinion is given as a circumstantial evidence for tuberculosis based on the appearance of the lesions. The final diagnosis has to be mostly by growth of tubercular bacilli or by biopsy of the lesion.
Intestinal tuberculosis is diagnosed by:
1. Endoscopy - telescopic examination
2. Barium meal x-ray
3. MDCT
Still it is better that the diagnosis is supported by bacterial growth and/or biopsy.

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