Intest Res.  2017 Apr;15(2):187-194. 10.5217/ir.2017.15.2.187.

Evaluation of Xpert MTB/RIF assay performance in the diagnosis of abdominal tuberculosis

• Kumar S
• Bopanna S
• Kedia S
• Mouli P
• Dhingra R
• Padhan R
• Kohli M
• Chaubey J
• Sharma R
• Das P
• Dattagupta S
• Makharia G
• Sharma S
• Ahuja V

• KMID: 2425160
• DOI: http://doi.org/10.5217/ir.2017.15.2.187

Abstract

BACKGROUND/AIMS
The use of genetic probes for the diagnosis of pulmonary tuberculosis (TB) has been well described. However, the role of these assays in the diagnosis of intestinal tuberculosis is unclear. We therefore assessed the diagnostic utility of the Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay, and estimated the prevalence of multidrug-resistant (MDR) TB in the Indian population.
METHODS
Of 99 patients recruited, 37 had intestinal TB; two control groups comprised 43 with Crohn's disease (CD) and 19 with irritable bowel syndrome. Colonoscopy was performed before starting any therapy; mucosal biopsies were subjected to histopathology, acid-fast bacilli staining, Lowenstein-Jensen culture, and nucleic acid amplification testing using the Xpert MTB/RIF assay. Patients were followed up for 6 months to confirm the diagnosis and response to therapy. A composite reference standard was used for diagnosis of TB and assessment of the diagnostic utility of the Xpert MTB/RIF assay.
RESULTS
Of 37 intestinal TB patients, the Xpert MTB/RIF assay was positive in three of 37 (8.1%), but none had MDR-TB. The sensitivity, specificity, positive predictive value, and negative predictive value of the Xpert MTB/RIF assay was 8.1%, 100%, 100%, and, 64.2%, respectively.
CONCLUSIONS
The Xpert MTB/RIF assay has low sensitivity but high specificity for intestinal TB, and may be helpful in endemic tuberculosis areas, when clinicians are faced with difficulty differentiating TB and CD. Based on the Xpert MTB/RIF assay, the prevalence of intestinal MDR-TB is low in the Indian population.

Keyword

Tuberculosis, multidrug-resistant; Crohn disease; Xpert MTB/RIF assay

MeSH Terms

Biopsy
Colonoscopy
Crohn Disease
Diagnosis*
Humans
Irritable Bowel Syndrome
Mycobacterium
Nucleic Acid Amplification Techniques
Prevalence
Sensitivity and Specificity
Tuberculosis*
Tuberculosis, Multidrug-Resistant
Tuberculosis, Pulmonary

Figure

• 

  Fig. 1 Flow chart showing patient recruitment. TB, tuberculosis; ATT, antitubercular therapy; Misc, miscellaneous; ITB, intestinal tuberculosis.

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