Recent updates in diagnosis of abdominal tuberculosis with emphasis on nucleic acid amplification tests

Mor, Preeti; Dahiya, Bhawna; Parshad, Sanjeev; Gulati, Pooja; Mehta, Promod K

doi:10.1080/17474124.2022.2021068

Cited by 9 publications

(12 citation statements)

References 125 publications

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“…In a recent meta-analysis [ 24 ] which included 25 observational studies, the authors concluded that the Xpert MTB/RIF assay has modest sensitivity for diagnosis of peritoneal and intestinal tuberculosis but has a good specificity. Another study by Mor et al also suggested that among various NAATs, such as IS6110 nested PCR, M-PCR targeting mpt64 +IS6110 and mpt64 +IS6110+pstS1 , the Xpert MTB/RIF assay is an excellent rule-in test but is not a good rule-out test [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Acid fast bacillus smear, mycobacterial culture and Xpert MTB/RIF assay for the diagnosis of tuberculous peritonitis in patients with and without end stage renal failure

Misra

Kar

Mohindra

et al. 2022

Access Microbiology

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Introduction. Diagnosis of tuberculous peritonitis (TBP) requires a high index of suspicion. Hypothesis /gap statement. Information about the diagnostic features of TBP among patients with end-stage renal failure (ESRF) from India is limited. Aim. To assess the utility of the Gene Xpert MTB/RIF assay in the diagnosis of TBP in patients with end-stage renal failure (ESRF), compared with those without ESRF. Methodology. This prospective observational single centre cohort study was performed at a tertiary care centre in Northern India. Ascitic fluid and/or whole continuous ambulatory peritoneal dialysis (CAPD) bag with effluent from 300 clinically suspected cases of TBP were included in the study. Diagnosis was based on detection of Mycobacteria on smear, Xpert MTB/RIF assay and/or culture. Cell counting was done in a Neubauer chamber. Cell predominance was seen by Giemsa stain. Line probe assay (LPA) for drug susceptibility testing was performed on all positive cultures. Results. TBP was diagnosed in 168 cases. Diabetes mellitus was a significant risk factor for developing TBP in patients with ESRF (P value<0.01). Lymphocytic predominance was seen in 21 patients without ESRF (P value 0.033) while majority of the patients in both groups had neutrophils in their ascitic and peritoneal fluids (138/168; P value 0.033). We recovered 15 cases of laboratory diagnosed TBP (11 without ESRF and four with ESRF). Microscopy was positive in two cases while ten isolates were recovered on culture. The Xpert MTB/RIF assay was positive in seven ascitic fluid samples out of which three were rifampicin resistant. All these were patients without renal failure (P value 0.010). Eight culture positive samples tested by the line probe assay did not detect any resistance to either rifampicin or isoniazid. Conclusion. The GeneXpert MTB/RIF assay has a limited value in the diagnosis of TBP in patients with ESRF.

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Section: Discussionmentioning

confidence: 99%

Acid fast bacillus smear, mycobacterial culture and Xpert MTB/RIF assay for the diagnosis of tuberculous peritonitis in patients with and without end stage renal failure

Misra

Kar

Mohindra

et al. 2022

Access Microbiology

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“…Its most frequent presentation is pulmonary TB, nevertheless; 10–20% of TB infections are extrapulmonary. Abdominal TB represents 10% of extrapulmonary TB infections, with peritoneal and intestinal TB being ubiquitous 2,3 . Patients may present with chronic diarrhea, weight loss, fever, and ascites.…”

Section: Introductionmentioning

confidence: 99%

“…Abdominal TB represents 10% of extrapulmonary TB infections, with peritoneal and intestinal TB being ubiquitous. 2 , 3 Patients may present with chronic diarrhea, weight loss, fever, and ascites. TB is known as “the great imitator” due to its nonspecific presentation.…”

Section: Introductionmentioning

confidence: 99%

Current role of endoscopic ultrasound for gastrointestinal and abdominal tuberculosis

et al. 2022

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A high incidence of tuberculosis (TB), especially in endemic countries, makes this infectious disease a concern. Abdominal TB contributes to 10% of extrapulmonary TB. Due to nonspecific clinical, radiological, and endoscopic findings, diagnosing abdominal TB continues to be a challenge. Hence, a precise diagnosis is needed. The diagnosis of gastrointestinal disease using endoscopic ultrasound (EUS) is often performed due to its high resolution and ability to provide a real-time visual representation of the gastrointestinal tract and extramural structures. EUS-guided fine-needle aspiration (FNA) and fineneedle biopsy (FNB) have helped diagnose TB as they offer an adequate specimen for cytology or histopathological examination. This method is considered safer, more effective, and more efficient. The capacity of EUS to diagnose abdominal TB based on the affected organs was examined via a literature search. We reviewed the role of EUS in diagnosing esophageal, gastric, pancreatic, peripancreatic, hepatosplenic, peritoneal, and intestinal TB. Generally, EUS aids in diagnosing abdominal TB. In some organs, it is superior to other diagnostic modalities. However, further examinations, such as cytology or histopathology and microbial, are still needed. We also studied the roles of EUS-FNA and EUS-FNB. EUS-FNA has shown a high diagnostic yield in esophageal (94.3-100%), pancreatic and peripancreatic (76.2%), and intestinal TB (84.1%). As minimally invasive methods, EUS-FNA and EUS-FNB can successfully provide sufficient samples. EUS is a functional diagnostic modality for abdominal TB. EUS-FNA and EUS-FNB provide sufficient samples safely and efficiently for further cytology, histopathology, and microbial examinations. Esophageal tuberculosisEsophageal TB is uncommon and has nonspecific clinical, laboratory, radiological, and endoscopic features. With prevalence

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“…3 Peritoneal TB and intestinal TB are the most prevalent forms, which accounts for ~31-58% and ~40%, respectively, of abdominal TB. 4,5 Abdominal TB occurs either as a primary or secondary infection owing to reactivation of latent TB lesions elsewhere, that is, lung, kidney, and fallopian tube. Diagnosis of abdominal TB is an off-putting challenge owing to paucibacillary nature of specimens and non-specific clinical presentations that imitate other abdominal diseases, for example, Crohn's disease and malignancies.…”

Section: Introductionmentioning

confidence: 99%

“…Diagnosis of abdominal TB is an off-putting challenge owing to paucibacillary nature of specimens and non-specific clinical presentations that imitate other abdominal diseases, for example, Crohn's disease and malignancies. 5,6 Delay in diagnosis and treatment can lead to serious complications, such as fistula/stricture formation and bowel perforation/obstruction that may require surgical intervention. 5,7 Various nucleic acid amplification tests (NAATs), including PCR, real-time PCR, and GeneXpert are widely utilized to diagnose abdominal TB, but these assays are often associated with false-positive and false-negative results.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of abdominal tuberculosis by multi‐targeted (mpt64 and IS6110) loop‐mediated isothermal amplification assay

Mor

Sheoran

Dahiya

et al. 2022

J of Gastro and Hepatol

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Background and Aim Diagnosis of abdominal TB is an exigent task due to variable anatomical sites and non‐specific clinical manifestations that closely resemble other diseases. Most of the available diagnostic modalities yield low sensitivities and need expertise to handle the specialized equipment. Hence, there is an urgent need to develop a rapid and reliable diagnostic test, so as to reduce the unnecessary morbidity. Therefore, we designed a multi‐targeted loop‐mediated isothermal amplification (MT‐LAMP) for diagnosing abdominal TB. Methods We evaluated an MT‐LAMP (using mpt64 and IS6110) to diagnose abdominal TB within ascitic fluids and intestinal/peritoneal biopsies and compared these results with multiplex‐PCR (M‐PCR) using the same targets. MT‐LAMP products were analyzed by gel electrophoresis and visual detection methods, that is, hydroxy naphthol blue and SYBR Green I reaction. Results Sensitivities of 80.9% and 84.6% were obtained in suspected (n = 42) and total abdominal TB (n = 52) cases, respectively by gel‐based MT‐LAMP, with 97.3% (n = 37) specificity in non‐TB controls. Notably, sensitivities attained by gel‐based/SYBR Green I MT‐LAMP in both clinically suspected and total abdominal TB cases were significantly higher (P < 0.05) than M‐PCR. Furthermore, sensitivity obtained with SYBR Green I was equivalent to that of gel‐based MT‐LAMP, while somewhat lesser specificity (94.6%) was attained with SYBR Green I, compared with gel‐based MT‐LAMP. Conclusion Both gel‐based and SYBR Green MT‐LAMP exhibited equivalent sensitivities to diagnose abdominal TB. Because SYBR Green LAMP is easier to perform than a gel‐based assay, we are currently focused on improving the specificity of this assay so as to develop a diagnostic kit.

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Recent updates in diagnosis of abdominal tuberculosis with emphasis on nucleic acid amplification tests

Cited by 9 publications

References 125 publications

Acid fast bacillus smear, mycobacterial culture and Xpert MTB/RIF assay for the diagnosis of tuberculous peritonitis in patients with and without end stage renal failure

Acid fast bacillus smear, mycobacterial culture and Xpert MTB/RIF assay for the diagnosis of tuberculous peritonitis in patients with and without end stage renal failure

Current role of endoscopic ultrasound for gastrointestinal and abdominal tuberculosis

Diagnosis of abdominal tuberculosis by multi‐targeted (mpt64 and IS6110) loop‐mediated isothermal amplification assay

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