Q: I have a urinary problem for the past one year. There are no pus cells in the urine but the urine PCR tested positive for MOTT/NTM. But AFB culture of urine has not yielded anything. There are changes visible on the IVP which seem to be suggestive of TB. There is no weight loss or loss of appetite or fever. Do I have a MOTT/NTM infection? What is the treatment for it?

A:Genitourinary tuberculosis is usually suspected on the basis of clinical settings (presentation examination and investigations). Classically urine should show sterile pyuria. The proof of the disease lies in demonstrating the tuberculous bacteria (AFB) either in the special urine cultures or in the tissues obtained on some biopsy. Unfortunately, it is not always possible to demonstrate their presence. Depending on the quality of the sample obtained, the lab technique, and the number of times tested (ideally four consecutive samples are submitted) the yield may best be 70 to 90%. PCR, on the other hand, looks for the presence of bacterial DNA. PCR is more sensitive, but may occasionally be false positive. In a setting where AFB culture is negative and PCR is positive, the decision may best be taken by your urologist on the strength of clinical settings suggesting tuberculosis. If still unconvinced, the doctor may try to find further bacteriological or tissue evidence.