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Paulose RR, Kumar VA, Sharma A, Damle A, Saikumar D, Sudhakar A, Koshy AK, Damle RPVP. An outcome-based composite approach for the diagnosis of intestinal tuberculosis: a pilot study from a tertiary care centre in South India. J R Coll Physicians Edinb 2021; 51:344-350. [PMID: 34882131 DOI: 10.4997/jrcpe.2021.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The diagnosis of intestinal TB (ITB) is challenging because of its overlapping features with Crohn's disease. This outcome-based study evaluated the combination of colonoscopy, histopathology, Xpert MTB/RIF and TB culture for best sensitivity and specificity. METHOD This was a four-year retrospective, observational study of 426 clinically suspected patients who underwent colonoscopy with biopsies for histopathology, Xpert MTB/RIF and TB culture. ITB was diagnosed using the composite reference standard (CRS), which comprised either histological features or culture or Xpert MTB/RIF positivity, and positive response to anti-tuberculous treatment on follow up. RESULTS 35 (8.2%) patients were diagnosed with ITB. Histopathology had the highest sensitivity (91.4%) and negative predictive value (99.2%), MTB/RIF had the highest specificity (100%) and positive predictive value (100%). A combinatorial approach with Xpert MTB/RIF and histopathology had optimal diagnostic value (97%), approaching 100% sensitivity with culture. 40% of cases were diagnosed within 12 hours with Xpert MTB/RIF and 97% cases within three days. CONCLUSION This combinatorial diagnostic model provides rapid and reliable diagnosis of ITB which may be useful in endemic areas.
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Affiliation(s)
- Roopa Rachel Paulose
- Amrita Institute of Medical Sciences and Research Centre Amrita VishwaVidyapeetham, Ponekkara P.O, Kochi - 682041, Kerala, India,
| | - V Anil Kumar
- Amrita Institute of Medical Sciences and Research Centre, Amrita VishwaVidyapeetham, Kochi, Kerala, India
| | - Aparna Sharma
- Amrita Institute of Medical Sciences and Research Centre, Amrita VishwaVidyapeetham, Kochi, Kerala, India
| | - Aditi Damle
- Amrita Institute of Medical Sciences and Research Centre, Amrita VishwaVidyapeetham, Kochi, Kerala, India
| | - Divya Saikumar
- Amrita Institute of Medical Sciences and Research Centre, Amrita VishwaVidyapeetham, Kochi, Kerala, India
| | - Abish Sudhakar
- Amrita Institute of Medical Sciences and Research Centre, Amrita VishwaVidyapeetham, Kochi, Kerala, India
| | - Anoop K Koshy
- Amrita Institute of Medical Sciences and Research Centre, Amrita VishwaVidyapeetham, Kochi, Kerala, India
| | - Rama P Venu P Damle
- Amrita Institute of Medical Sciences and Research Centre, Amrita VishwaVidyapeetham, Kochi, Kerala, India
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Abstract
Gastrointestinal tuberculosis (TB) is a fascinating disease which can be observed both in the clinical context of active pulmonary disease and as a primary infection with no pulmonary involvement. It represents a significant clinical challenge because of the resurgence of TB as well as the diagnostic challenges it poses. A high clinical suspicion remains the most powerful tool in an era of medicine when reliance on diagnostic technology increases. Antimicrobial therapy is the mainstay of therapy, but surgical and endoscopic interventions are frequently required for intestinal TB. Gastrointestinal TB is truly the "great mimic" and continues to require the astute clinical acumen of skillful clinicians to diagnose and treat.
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Kentley J, Ooi JL, Potter J, Tiberi S, O'Shaughnessy T, Langmead L, Chin Aleong J, Thaha MA, Kunst H. Intestinal tuberculosis: a diagnostic challenge. Trop Med Int Health 2017; 22:994-999. [PMID: 28609809 DOI: 10.1111/tmi.12908] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe characteristics, presentation, time to diagnosis and diagnostic findings of patients with intestinal tuberculosis (ITB) in a low-burden country. METHOD Retrospective study of 61 consecutive ITB patients diagnosed between 2008 and 2014 at a large East London hospital. RESULTS Forty of sixty-one patients were male. Mean age was 34.6 years. 93% of patients were born abroad, mostly from TB-endemic areas (Indian subcontinent: 88%, Africa: 9%). 25% had concomitant pulmonary TB. Median time from symptom onset to ITB diagnosis was 13 weeks (IQR 3-26 weeks). Ten patients were initially treated for IBD, although patients had ITB. The main sites of ITB involvement were the ileocaecum (44%) or small bowel (34%). Five patients had isolated perianal disease. Colonoscopy confirmed a diagnosis of ITB in 77% of those performed. 42 of 61 patients had a diagnosis of ITB confirmed on positive histology and/or microbiology. CONCLUSION Diagnosis of ITB is often delayed, which may result in significant morbidity. ITB should be excluded in patients with abdominal complaints who come from TB-endemic areas to establish prompt diagnosis and treatment. Diagnosis is challenging but aided by axial imaging, colonoscopy and tissue biopsy for TB culture and histology.
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Affiliation(s)
- J Kentley
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - J L Ooi
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - J Potter
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Tiberi
- Department of Infectious Diseases, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T O'Shaughnessy
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - L Langmead
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Chin Aleong
- Department of Pathology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M A Thaha
- Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - H Kunst
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Clinical and laboratory presentation of abdominal tuberculosis in Shillong, Meghalaya: Experience from Northeast India. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2017. [DOI: 10.1016/j.injms.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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