Microbiology and resistance in urogenital tuberculosis

Mycobacteria are less common than other infections but still represent a significant threat to patients. Their slow growing nature and the late appearance of symptoms of urogenital mycobacterial infections often result in a delayed diagnostic and more severe consequences. UGTB is mostly linked to an active or inactive lung tuberculosis, as a consequence a similar immune response is expected. Unfortunately, compared to TB, very little is known on specific response to urinary tract infection caused by MOTT, still knowledge from BCG instillation for bladder cancer treatment suggest a similar process as well. With respect to treatment and drug resistance, considering the late onset of symptoms, the potentially large populations of mycobacteria in some lesion and their mutation rate, monotherapy should be avoided. Such monotherapy would mostly lead to the emergence of resistant subpopulations. In addition, some studies focusing on persisters emphasize that at least PZA and RIF should be included in the treatment regimen as those drugs have shown some activity on persisters.