Diagnosis of anorectal tuberculosis by polymerase chain reaction, GeneXpert and histopathology in 1336 samples in 776 anal fistula patients

Garg, Pankaj; Goyal, Ankita; Yagnik, Vipul D; Dawka, Sushil; Menon, Geetha R

doi:10.4240/wjgs.v13.i4.355

Cited by 14 publications

(15 citation statements)

References 22 publications

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“…It is reported that PCR was also significantly higher than histopathology in detecting TB fistulas. 33 However, using a single indicator to distinguish between the two diseases is not comprehensive. Jung et al 27 integrated seven clinical indicators and achieved 98% sensitivity and 92.4% specificity in the validation dataset for the differential diagnosis between CD and ITB.…”

Section: Discussionmentioning

confidence: 99%

A Novel Clinical Radiomics Nomogram to Identify Crohn’s Disease from Intestinal Tuberculosis

Zhu

Wang

et al. 2021

JIR

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Purpose To establish a clinical radiomics nomogram to differentiate Crohn’s disease (CD) from intestinal tuberculosis (ITB). Patients and Methods Ninety-three patients with CD and 67 patients with ITB were recruited (111 in training cohort and 49 in test cohort). The region of interest (ROI) for the lesions in the ileocecal region was delineated on computed tomography enterography and radiomics features extracted. Radiomics features were filtered by the gradient boosting decision tree (GBDT), and a radiomics score was calculated by using the radiomics signature-based formula. We constructed a clinical radiomics model and nomogram combining clinical factors and radiomics score through multivariate logistic regression analysis, and the internal validation was undertaken by ten-fold cross validation. Analyses of receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were used to evaluate the prediction performance. DeLong test was applied to evaluate the performance of the clinical, radiomics and combined model. Results The clinical radiomics nomogram, which was based on the 9 radiomics signature and two clinical factors, indicated that the clinical radiomics model had an area under the ROC curve (AUC) value of 0.96 (95% confidence interval [CI]: 0.93–0.99) in the training cohort and 0.93 (95% CI: 0.86–1.00) in validation cohort. The clinical radiomics model was superior to the clinical model and radiomics model, and the difference was significant ( P = 0.006, 0.004) in the training cohort. DCA confirmed the clinical utility of clinical radiomics nomogram. Conclusion CTE-based radiomics model has a good performance in distinguishing CD from ITB. A nomogram constructed by combining radiomics and clinical factors can help clinicians accurately diagnose and select appropriate treatment strategies between CD and ITB.

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Section: Discussionmentioning

confidence: 99%

A Novel Clinical Radiomics Nomogram to Identify Crohn’s Disease from Intestinal Tuberculosis

Zhu

Wang

et al. 2021

JIR

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“…In regions where Crohn’s disease is common, a colonoscopy should be done in all cases of high fistulas[ 28 ]. On the other hand, in regions where tuberculosis is common, polymerase chain-reaction (PCR) should be done in samples from the fistula (pus or fistula tract wall or tract lining)[ 24 , 29 ]. In a large series published from a TB-endemic region (India), tuberculosis was detected in 10% (133/1336) of tested samples (fistula tract lining or pus)[ 29 ].…”

Section: Challenges In Managing These Fistulasmentioning

confidence: 99%

“…The detection rate of tuberculosis was 12.5% (129/1034) by PCR, 1.5% (3/197) by histopathology, and 0.9% (1/105) by GeneXpert tests[ 29 ]. Therefore, PCR is significantly more sensitive than histopathology or GeneXpert to detect tuberculosis[ 29 ]. However, in spite of high sensitivity, it is not uncommon that tuberculosis is missed and goes undetected in the first sample.…”

Section: Challenges In Managing These Fistulasmentioning

confidence: 99%

Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas

Garg¹,

Yagnik²,

Dawka³

et al. 2022

WJG

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Supralevator, suprasphincteric, extrasphincteric, and high intrarectal fistulas (high fistulas in muscle layers of the rectal wall) are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to manage. Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas. Along with these fistulas, a new type of complex fistula in high outersphincteric space, a fistula at the roof of ischiorectal fossa inside the levator ani muscle (RIFIL), has been described. The diagnosis, management, and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas. There is a lot of confusion regarding the anatomy, diagnosis, and management of these five types of fistulas. The main reason for this is the paucity of literature about these fistulas. The common feature of all these fistulas is their complete involvement of the external anal sphincter. Therefore, fistulotomy, the simplest and most commonly performed procedure, is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed. Recent advances have provided new insights into the anatomy, radiological modalities, diagnosis, and management of these five types of high fistulas. These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper.

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“…2 Anti-TB treatment for extrapulmonary TB consists of a four-drugs (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol) for the first 2 months (intensive phase) followed by the two-drug regimen (Isoniazid and Rifampicin) for the next 4 months (maintenance phase). 3 Pyridoxine is added to this regimen to prevent peripheral neuropathy, an adverse reaction with isoniazid.…”

mentioning

confidence: 99%

Re: Distinguishing peritoneal tuberculosis from peritoneal carcinomatosis: a challenge

Yagnik¹,

Garg

2022

ANZ Journal of Surgery

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Re: Distinguishing peritoneal tuberculosis from peritoneal carcinomatosis: a challenge Dear Editor, We read with great interest an article entitled: 'Distinguishing peritoneal tuberculosis from peritoneal carcinomatosis: a challenge' by El-Hajj Hussein et al. 1 It is an exciting and challenging case to distinguish peritoneal carcinomatosis from tuberculosis, particularly in a non-endemic area. We would like to congratulate all the authors for reporting such an unusual case. We have a few comments regarding the article, which will help us, and the field in general, better understand peritoneal tuberculosis (TB).The authors had used antituberculous treatment for 12 months and were given four drugs plus pyridoxine as continuous therapy. 1 We would like to mention that recommended treatment regimen for extrapulmonary tuberculosis; like peritoneal tuberculosis, includes six-month treatment as there is no significant difference in the outcome between 6 months and 9 months regimen. 2 Anti-TB treatment for extrapulmonary TB consists of a four-drugs (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol) for the first 2 months (intensive phase) followed by the two-drug regimen (Isoniazid and Rifampicin) for the next 4 months (maintenance phase). 3 Pyridoxine is added to this regimen to prevent peripheral neuropathy, an adverse reaction with isoniazid.Authors also mentioned that ascites due to TB and malignancy are exudative, and patients may present with elevated CA 125 levels. 1 We do entirely agree with the authors regarding this statement. However, we would like to state that adenosine deaminase (ADA) activity in the ascitic fluid has sensitivity and specificity of 100% and 97%, respectively, using the optimal cut-off point of 39 IU/L. 4 ADA in ascitic fluid is highly specific and sensitive to confirm or rule out tuberculosis. It can be considered a biomarker of tuberculosis.

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Diagnosis of anorectal tuberculosis by polymerase chain reaction, GeneXpert and histopathology in 1336 samples in 776 anal fistula patients

Cited by 14 publications

References 22 publications

A Novel Clinical Radiomics Nomogram to Identify Crohn’s Disease from Intestinal Tuberculosis

A Novel Clinical Radiomics Nomogram to Identify Crohn’s Disease from Intestinal Tuberculosis

Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas

Re: Distinguishing peritoneal tuberculosis from peritoneal carcinomatosis: a challenge

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