Mohammad Hamid Uddin*, Mohammad Aftab Haleem, Mahmudur Rahman, Imteaz Mahbub, Mohammad Masud Rana and Rosemeri Maurici
Tuberculosis (TB) is a significant disease caused by Mycobacterium tuberculosis, affecting the respiratory, gastrointestinal, lymphoreticular, central nervous, musculoskeletal, reproductive, and hepatic systems. Intestinal TB, primarily affecting the ileocecal region, can affect any part of the gastrointestinal tract. Common symptoms include abdominal pain, fever, diarrhea, constipation, blood in stool, and potential complications. Intestinal TB diagnosis is challenging due to limited diagnostic techniques. Typical approaches include radiological scans and histopathological examinations, but their sensitivity limits their accuracy. Therapeutic response is proposed as a significant factor. Microbiological analysis, including polymerase chain reaction and acid-fast bacilli, is another measure. The GeneXpert Tuberculosis Nucleic Acid Amplification Test has low sensitivity for intestinal TB diagnosis. The National TB Control Program in Bangladesh focuses on timely identification and prevention of TB cases, with the aim of establishing GeneXpert as a diagnostic tool for intestinal tuberculosis, despite limited studies in Bangladesh.
A cross-sectional study was conducted on 55 suspected intestinal TB patients aged 18 years and above in Dhaka, Bangladesh. Data was collected through face-to-face interviews and a questionnaire. Participants were given anti-TB drugs for a two-month trial and underwent colonoscopy with biopsy. Histologically confirmed and non-caseating colitis patients were diagnosed with intestinal TB. Patients not responding to the trial were diagnosed as without TB. Additional mucosal biopsies were sent for the GeneXpert MTB/RIF assay. Obtained data was analyzed by using Statistical Package for Social Sciences version 23.
A study involving 45 individuals diagnosed with intestinal TB found that common symptoms included abdominal pain, loss of appetite, weight loss, and fever. The study also found a significant relationship between ESR and intestinal TB, with a mean of 56.6 mm. Colonoscopy revealed that 60% of patients had mucosal ulceration, while histopathological findings showed granuloma in 84.4% of cases. Ultrasonography revealed abnormal findings in 33 participants, with 54.5% having ascites and 30.3% having bowel wall thickening. The study found that GeneXpert was effective in detecting intestinal tuberculosis, with positive outcomes in 11 instances and 34 false negatives. All ten individuals without the disease were accurately classified as negative. The GeneXpert test had a sensitivity of 24.4% and a specificity of 100%, making it a valuable tool for detecting the condition.
The study, establishes the role of GeneXpert in diagnosing intestinal TB, despite the absence of endoscopy, contrast radiology tests, Acid-Fast Bacilli culture, and a small sample size of suspected cases in a tertiary health facility.
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