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Indian Journal of Gastroenterology

, Volume 37, Issue 3, pp 226–230 | Cite as

Do additional colonoscopic biopsies increase the yield of Mycobacterium tuberculosis culture in suspected ileo-colonic tuberculosis?

  • Vatsal Mehta
  • Devendra Desai
  • Philip Abraham
  • Tarun Gupta
  • Camilla Rodrigues
  • Anand Joshi
  • Ramesh Deshpande
  • Prabha Sawant
  • Mehgraj Ingle
  • Pravin Rathi
  • Ameet Mandot
Original Article

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.

Keywords

Colonoscopy Intestinal tuberculosis MGIT culture 

Notes

Acknowledgements

We gratefully acknowledge the help received from Dr. Arun Nanivadekar and from Dr. Sudeep Shah and Dr. Lancelot Pinto (P D Hinduja Hospital) for the statistical inputs and Dr. Rajiv Baijal, Department of Gastroenterology, Jagjivan Ram Hospital, for sending samples for TB culture.

Contribution of authors

Vatsal Mehta: analysis and interpretation of data and drafting of the manuscript. Devendra Desai: concept and study design, study supervision, analysis and interpretation of data, and drafting and critical revision of the manuscript. Philip Abraham: interpretation of data and critical revision of the manuscript. Camilla Rodrigues: blinded conduct of microbiology studies. Ramesh Deshpande: blinded conduct of histology studies. All authors: acquisition of data and approval of final manuscript.

Funding information

The study was funded by the National Health and Education Society, P D Hinduja Hospital, Mumbai 400 016, India.

Compliance with ethical standards

Conflict of interest

VM, DD, PA, TG, CR, AJ, RD, PS, MI, PR, and AM declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was conducted conforming to the Declaration of Helsinki, 1975 (and subsequent revisions) for human rights. Written informed consent was obtained from all participating subjects, and the protocol was reviewed and approved by the institution’s ethics committee. The study was registered to the Clinical Trials Registry - India.

References

  1. 1.
    Wares F, Balasubramanian R, Mohan A. Extrapulmonary tuberculosis: management and Control. In: Agarwal SP, Chauhan LS. Eds. Tuberculosis Control in India. New Delhi: Directorate General of Health Services, Ministry of Health and Family Welfare; 2005. pp. 95–114.Google Scholar
  2. 2.
    Pulimood AB, Ramakrishna BS, Kurian G, et al. Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn’s disease from tuberculosis. Gut. 1999;45:537–41.Google Scholar
  3. 3.
    Yönal O, Hamzaoǧlu HÖ. What is the most accurate method for the diagnosis of intestinal tuberculosis? Turkish J Gastroenterol. 2010;21:91–6.CrossRefGoogle Scholar
  4. 4.
    Economou M, Zambeli E, Michopoulos S. Incidence and prevalence of Crohn’s disease and its etiological influences. Ann Gastroenterol. 2009;22:158–67.Google Scholar
  5. 5.
    Shah SR, Shenai S, Desai DC, Joshi A, Abraham P, Rodrigues C. Comparison of Mycobacterium tuberculosis culture using liquid culture medium and Lowenstein Jensen medium in abdominal tuberculosis. Indian J Gastroenterol. 2010;29:237–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Vij JC, Malhotra V, Choudhary V, et al. A clinicopathological study of abdominal tuberculosis. Indian J Tuberc. 1992;39:213–20.Google Scholar
  7. 7.
    Samant H, Desai D, Abraham P, et al. Acid-fast bacilli culture positivity and drug resistance in abdominal tuberculosis in Mumbai, India. Indian J Gastroenterol. 2014;33:414–9.Google Scholar
  8. 8.
    Ye BD, Yang SK, Kim D, et al. Diagnostic sensitivity of culture and drug resistance patterns in Korean patients with intestinal tuberculosis. Int J Tuberc Lung Dis. 2012;16:799–804.Google Scholar
  9. 9.
    Bojang AL, Mendy FS, Tientcheu LD, et al. Comparison of TB-LAMP, GeneXpert MTB/RIF and culture for diagnosis of pulmonary tuberculosis in The Gambia. J Inf Secur. 2015;72:332–7.Google Scholar
  10. 10.
    Shah S, Thomas V, Mathan M, et al. Colonoscopic study of 50 patients with colonic tuberculosis. Gut. 1992;33:347–51.Google Scholar
  11. 11.
    Amarapurkar DN, Patel ND, Rane PS. Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent. World J Gastroenterol. 2008;14:741–6.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Hillemann D, Galle J, Vollmer E, Richter E. Real-time PCR assay for improved detection of Mycobacterium tuberculosis complex in paraffin-embedded tissues. Int J Tuberc Lung Dis. 2006;10:340–2.PubMedGoogle Scholar
  13. 13.
    Pulimood AB, Peter S, Rook GWA, Donoghue HD. In situ PCR for Mycobacterium tuberculosis in endoscopic mucosal biopsy specimens of intestinal tuberculosis and Crohn disease. Am J Clin Pathol. 2008;129:846–51.CrossRefPubMedGoogle Scholar
  14. 14.
    Gan HT, Chen YQ, Ouyang Q, Bu H, Yang XY. Differentiation between intestinal tuberculosis and Crohn’s disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol. 2002;97:1446–51.CrossRefPubMedGoogle Scholar
  15. 15.
    Pimkina E, Zablockis R, Nikolayevskyy V, Danila E, Davidaviciene E. The Xpert® MTB/RIF assay in routine diagnosis of pulmonary tuberculosis: a multicentre study in Lithuania. Respir Med. 2015;109:1484–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Leung VKS, Law ST, Lam CW, et al. Intestinal tuberculosis in a regional hospital in Hong Kong: a 10-year experience. Hong Kong Med J. 2006;12:264–71.PubMedGoogle Scholar
  17. 17.
    Kirsch R, Pentecost M, Hall PDM, Epstein DP, Watermeyer G, Friederich PW. Role of colonoscopic biopsy in distinguishing between Crohn’s disease and intestinal tuberculosis. J Clin Pathol. 2006;59:840–4.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Tandon HD, Prakash A. Pathology of intestinal tuberculosis and its distinction from Crohn’s disease. Gut. 1972;13:260–9.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  • Vatsal Mehta
    • 1
  • Devendra Desai
    • 1
  • Philip Abraham
    • 1
  • Tarun Gupta
    • 1
  • Camilla Rodrigues
    • 2
  • Anand Joshi
    • 1
  • Ramesh Deshpande
    • 3
  • Prabha Sawant
    • 4
  • Mehgraj Ingle
    • 4
  • Pravin Rathi
    • 5
  • Ameet Mandot
    • 6
  1. 1.Division of GastroenterologyP D Hinduja HospitalMumbaiIndia
  2. 2.Division of MicrobiologyP D Hinduja HospitalMumbaiIndia
  3. 3.Division of PathologyP D Hinduja HospitalMumbaiIndia
  4. 4.Department of GastroenterologyLokmanya Tilak Municipal General HospitalMumbaiIndia
  5. 5.Department of GastroenterologyB Y L Nair HospitalMumbaiIndia
  6. 6.Department of GastroenterologyBombay HospitalMumbaiIndia

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