Drug resistance in intestinal tuberculosis: A reason to worry?

Sonambekar, Ajinkya; Desai, Devendra; Abraham, Philip; Mehta, Vatsal; Samant, Hrishikesh; Joshi, Anand; Gupta, Tarun; Rodrigues, Camilla

doi:10.1002/jgh3.12003

Cited by 10 publications

(5 citation statements)

References 7 publications

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“…This phenomenon could be attributed to the abundant tissue obtained by peritoneoscopy. Gene Xpert also detected MDR TB in two patients (7.14%) in the current study which was less as compared to the other study published from Mumbai [22]. Notably, we could diagnose tuberculosis and rifampicin resistance within four hours, which otherwise could have taken four days to four weeks.…”

Section: Discussioncontrasting

confidence: 90%

Tissue Xpert® MTB/RIF Assay in Peritoneal Tuberculosis: To be (Done) or Not to be (Done)

Dahale¹,

Puri²,

Kumar³

et al. 2019

Cureus

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Introduction Peritoneal tuberculosis (PTB) is a paucibacillary disease with poor mycobacterial yield in ascitic fluid. The Xpert® MTB/RIF assay (Gene Xpert) is a new tool for the diagnosis of tuberculosis (TB) and has not yet been studied on peritoneal tissue. The present study aimed to investigate the yield of the Xpert® MTB/RIF assay on peritoneal tissue obtained at peritoneoscopy. Methods This is a retrospective study and the data were collected from hospital records. The patients who underwent peritoneoscopy along with Xpert® MTB/RIF assay on peritoneal tissue were included in this study. Those with proven PTB were considered as cases while those with other diagnoses as controls. Using the reference standard of TB diagnosis, sensitivity, specificity, and accuracy of Xpert® MTB/RIF assay were calculated. Results Total of 36 patients was analyzed in this study: 28 as cases and eight as controls. Peritoneoscopy was carried out for diagnosis and biopsy. Histopathology in cases revealed caseating granulomas in 16 while 11 had non-caseating granulomas. Nine patients showed acid-fast bacillus positivity on peritoneal tissue. The most common finding on peritoneoscopy was tubercles with adhesions (n = 14, 50%), followed by tubercles only (n = 12, 42.9%). Xpert® MTB/RIF assay was positive in 17 (60.7%) patients with a sensitivity of 60.71%, specificity of 100%, and an accuracy of 69.44%. Two patients expressed rifampicin resistance. Conclusion Xpert® MTB/RIF assay on peritoneal tissue has fair sensitivity and excellent specificity. The multidrug resistance and the ability to provide results rapidly make it clinically useful.

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Section: Discussioncontrasting

confidence: 90%

Tissue Xpert® MTB/RIF Assay in Peritoneal Tuberculosis: To be (Done) or Not to be (Done)

Dahale¹,

Puri²,

Kumar³

et al. 2019

Cureus

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“…The prevalence of MDR-TB in GITB is not very well-studied because the culture sensitivity is low and testing for drug resistance is not routinely done. The few studies that examined this had a modest study sample size and reported a prevalence of single-drug and multi-drug resistance ranging from 4 to 25% and 3 to 25%, respectively[ 126 127 128 129 130 ] [ Table 4 ]. Confirmation of MDR-TB in GITB is important to ensure that the patient gets the most appropriate treatment regimens and to avoid unnecessary delay in the therapy.…”

Section: Treatmentmentioning

confidence: 99%

Gastrointestinal tuberculosis

Alzanbagi¹,

Shariff²

2021

Saudi Journal of Gastroenterology

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Tuberculosis (TB) once considered a disease of the developing world is infrequent in the developing world too. Its worldwide prevalence with a huge impact on the healthcare system both in economic and health terms has prompted the World Health Organization to make it a top priority infectious disease. Tuberculous infection of the pulmonary system is the most common form of this disease, however, extrapulmonary TB is being increasingly recognized and more often seen in immunocompromised situations. Gastrointestinal TB is a leading extrapulmonary TB manifestation that can defy diagnosis. Overlap of symptoms with other gastrointestinal diseases and limited accuracy of diagnostic tests demands more awareness of this disease. Untreated gastrointestinal TB can cause significant morbidity leading to prolonged hospitalization and surgery. Prompt diagnosis with early initiation of therapy can avoid this. This timely review discusses the epidemiology, risk factors, pathogenesis, clinical presentation, current diagnostic tools and therapy.

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“…Several studies have reported drug resistance in GITB. In a culture-based study from Western India, of the 43 patients with culture positivity, 23% had resistance to at least one first-line drug, while 14% had MDR-TB [77]. In a recent study on 30 ileocecal biopsies with positive TB cultures, four each (13.3%) had isoniazid and MDR, while two each (6.7%) were pre-extremely drug resistant (XDR) and mono-fluoroquinolone resistant [78].…”

Section: Drug Resistancementioning

confidence: 99%

Evidence-based approach to diagnosis and management of abdominal tuberculosis

Jha

Pathiyil

Sharma

2023

Indian J Gastroenterol

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Abdominal tuberculosis is an ancient problem with modern nuances in diagnosis and management. The two major forms are tuberculous peritonitis and gastrointestinal tuberculosis (GITB), while the less frequent forms are esophageal, gastroduodenal, pancreatic, hepatic, gallbladder and biliary tuberculosis. The clinicians need to discriminate the disease from the close mimics: peritoneal carcinomatosis closely mimics peritoneal tuberculosis, while Crohn's disease closely mimics intestinal tuberculosis. Imaging modalities (ultrasound, computed tomography, magnetic resonance imaging and occasionally positron emission tomography) guide the line of evaluation. Research in diagnostics (imaging and endoscopy) has helped in the better acquisition of tissue for histological and microbiological tests. Although point-of-care polymerase chain reaction-based tests (e.g. Xpert Mtb/Rif) may provide a quick diagnosis, these have low sensitivity. In such situations, ancillary investigations such as ascitic adenosine deaminase and histological clues (granulomas, caseating necrosis, ulcers lined by histiocytes) may provide some specificity to the diagnosis. A diagnostic trial of antitubercular therapy (ATT) may be considered if all diagnostic armamentaria fail to clinch the diagnosis, especially in TB-endemic regions. Objective evaluation with clear endpoints of response is mandatory in such situations. Early mucosal response (healing of ulcers at two months) and resolution of ascites are objective criteria for early response assessment and should be sought at two months. Biomarkers, especially fecal calprotectin for intestinal tuberculosis, have also shown promise. For most forms of abdominal tuberculosis, six months of ATT is sufficient. Sequelae of GITB may require endoscopic balloon dilatation for intestinal strictures or surgical intervention for recurrent intestinal obstruction, perforation or massive bleeding.

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Drug resistance in intestinal tuberculosis: A reason to worry?

Cited by 10 publications

References 7 publications

Tissue Xpert® MTB/RIF Assay in Peritoneal Tuberculosis: To be (Done) or Not to be (Done)

Tissue Xpert® MTB/RIF Assay in Peritoneal Tuberculosis: To be (Done) or Not to be (Done)

Gastrointestinal tuberculosis

Evidence-based approach to diagnosis and management of abdominal tuberculosis

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