Vatsal Mehta1, Devendra Desai2, Philip Abraham1, Tarun Gupta1, Camilla Rodrigues3, Anand Joshi1, Ramesh Deshpande4, Prabha Sawant5, Mehgraj Ingle5, Pravin Rathi6, Ameet Mandot7. 1. Division of Gastroenterology, P D Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India. 2. Division of Gastroenterology, P D Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India. devendracdesai@gmail.com. 3. Division of Microbiology, P D Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India. 4. Division of Pathology, P D Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India. 5. Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital, Mumbai, 400 022, India. 6. Department of Gastroenterology, B Y L Nair Hospital, Mumbai, 400 008, India. 7. Department of Gastroenterology, Bombay Hospital, Mumbai, 400 020, India.
Abstract
BACKGROUND: Isolation of Mycobacterium tuberculosis on culture is vital for differentiating intestinal tuberculosis (ITB) from Crohn's disease (when histology is not diagnostic) and for diagnosis of multidrug-resistant tuberculosis. The current yield of TB culture (< 50%) from colonoscopic biopsy tissue is not satisfactory. AIM: To determine whether more colonoscopic biopsies can increase the yield of TB culture in patients with ITB. METHODS: In this prospective study, in patients who underwent colonoscopy for suspected ITB, four biopsies were taken (container 1) followed by an additional four biopsies (container 2) for TB culture, from involved regions. The culture was done using Mycobacterium Growth Indicator Tube (MGIT) 960. A final diagnosis of ITB was made if TB culture was positive, there was unequivocal histological evidence of TB, or there was unequivocal evidence of TB elsewhere in the body, in the absence of another diagnosis. RESULTS: Of 182 patients enrolled (mean age 37.5 [SD 17.2] years; 93 [51.5%] women), 70 (38.4%) were finally diagnosed to have ITB. MGIT culture was positive in 29 (41.4%), 27 (38.5%), and 37 (52.8%) of 70 patients from containers 1, container 2, and combined eight biopsies, respectively. The incremental yield of eight biopsies was 11.4% (95% confidence interval [CI] 5.1 to 21.3%) as compared to container 1 and 14.3% (95% CI 7.1 to 24.7%) as compared to container 2. CONCLUSION: Additional four (total eight) colonoscopic biopsies improved the yield of TB culture positivity over four biopsies by 11.4% to 14.3%, to 52.8%; this increase is clinically useful.
BACKGROUND: Isolation of Mycobacterium tuberculosis on culture is vital for differentiating intestinal tuberculosis (ITB) from Crohn's disease (when histology is not diagnostic) and for diagnosis of multidrug-resistant tuberculosis. The current yield of TB culture (< 50%) from colonoscopic biopsy tissue is not satisfactory. AIM: To determine whether more colonoscopic biopsies can increase the yield of TB culture in patients with ITB. METHODS: In this prospective study, in patients who underwent colonoscopy for suspected ITB, four biopsies were taken (container 1) followed by an additional four biopsies (container 2) for TB culture, from involved regions. The culture was done using Mycobacterium Growth Indicator Tube (MGIT) 960. A final diagnosis of ITB was made if TB culture was positive, there was unequivocal histological evidence of TB, or there was unequivocal evidence of TB elsewhere in the body, in the absence of another diagnosis. RESULTS: Of 182 patients enrolled (mean age 37.5 [SD 17.2] years; 93 [51.5%] women), 70 (38.4%) were finally diagnosed to have ITB. MGIT culture was positive in 29 (41.4%), 27 (38.5%), and 37 (52.8%) of 70 patients from containers 1, container 2, and combined eight biopsies, respectively. The incremental yield of eight biopsies was 11.4% (95% confidence interval [CI] 5.1 to 21.3%) as compared to container 1 and 14.3% (95% CI 7.1 to 24.7%) as compared to container 2. CONCLUSION: Additional four (total eight) colonoscopic biopsies improved the yield of TB culture positivity over four biopsies by 11.4% to 14.3%, to 52.8%; this increase is clinically useful.
Authors: B D Ye; S-K Yang; D Kim; T S Shim; S-H Kim; M-N Kim; Y J Lee; H K Na; S H Park; D-H Yang; K J Kim; J-S Byeon; S-J Myung; J-H Kim Journal: Int J Tuberc Lung Dis Date: 2012-04-09 Impact factor: 2.373
Authors: Adama L Bojang; Francis S Mendy; Leopold D Tientcheu; Jacob Otu; Martin Antonio; Beate Kampmann; Schadrac Agbla; Jayne S Sutherland Journal: J Infect Date: 2015-12-24 Impact factor: 6.072