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Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Which radiological feature is most suggestive of gastrointestinal tuberculosis rather than Crohn’s disease?Increased bowel wall enhancementLymph node enlargementPresence of fissuresSmall volume of ascitesThickened ileocaecal valve
Tropical Colorectal Surgery
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Meheshinder Singh, Kemal I. Deen
In endemic areas the local population is always at risk. The experience of tuberculosis in the UK has been subdivided by Addison22 into two eras: 1) prior to 1960, when effective chemotherapy was not available and when Crohn’s disease was rarely recognised, and 2) more recently dominated by Asian immigrants. His views were supported by the British Thoracic and Tuberculosis Association (1975), which reported that tuberculosis had declined amongst lifetime residents of the British Isles but increased in immigrants, so that the latter’s rate of notification remained higher even up to 20 years after immigration. Thus in the UK, centres in areas densely populated by immigrants have a special experience of the clinical problems of gastrointestinal tuberculosis. In one Birmingham hospital, 60 of 72 patients (83%) with abdominal tuberculosis seen between 1969 and 1986 had origins in the Indian subcontinent. Their average time in Britain prior to diagnosis ranged from one month to ten years (mean five years two months). In the larger British series from Blackburn in the north of England,23 patients had been living locally for as long as 20 years before presentation. A prolonged period of residence prior to symptomatic disease and diagnosis is found in all studies. Since the immigrant sufferers carry the same phage type of mycobacterium as their fellow sufferers in Asia, it is postulated that an earlier infection had become reactivated. Poor living conditions are frequently blamed, although the association is unproven.5
Non-Respiratory Tuberculosis
Published in Peter D O Davies, Stephen B Gordon, Geraint Davies, Clinical Tuberculosis, 2014
This form of tuberculosis is uncommon in the indigenous populations of developed countries. In the United Kingdom in 1993, only 6% of white non-pulmonary disease was in the gastrointestinal tract [4]. In 1983, the rate in the south Asian ethnic group was 50 times that of the white population [37]. In developing countries, gastrointestinal tuberculosis is reported commonly in both HIV-negative and HIV-positive patients. In the pre-HIV era, one-third of all ascites were tuberculous in aetiology [64], with a proportion of more than 40% being reported in Lesotho in 1986 [65]. Pulmonary and abdominal tuberculosis have been shown to contribute significantly to the wasting in HIV-positive persons known as ‘slim disease’ that is seen in Africa, with intra-abdominal lymphadenopathy being a significant feature in such cases [66].
Diagnostic accuracy of the Xpert MTB/RIF assay for abdominal tuberculosis: a systematic review and meta-analysis
Published in Expert Review of Anti-infective Therapy, 2021
Vishal Sharma, Hariom Soni, Praveen Kumar-M, Saurabh Dawra, Shubhra Mishra, Harshal S Mandavdhare, Harjeet Singh, Usha Dutta
In the present systematic review, we found that the sensitivity of Xpert MTB/RIF for diagnosis of peritoneal tuberculosis from peritoneal fluid is modest (30%) when compared to CRS although the specificity is excellent. The present report demonstrates that the sensitivity for diagnosis of peritoneal tuberculosis falls considerably when the gold standard for diagnosis is changed from culture positivity (64%) to CRS (30%). Further, the current meta-analysis also demonstrates that the sensitivity of intestinal tissue for diagnosis of gastrointestinal tuberculosis is 23% with a high specificity (100%). Because of limited number of studies, a pooled estimation of yield based on comparison with omental/peritoneal tissue was not done.
IS1081-based Multi-targeted LAMP: An Opportunity to Detect Tubercular Uveitis
Published in Ocular Immunology and Inflammation, 2022
Megha Sharma, Ramandeep Singh, Aman Sharma, Vishali Gupta, Kusum Sharma
Nucleic acid amplification tests (NAAT), with their rapid turn-around time in detecting the DNA of M. tuberculosis, have revolutionized the diagnosis of paucibacillary EPTB including TBU. Conventional polymerase chain reaction including multiplex (MPCR),5–7 nested PCR,8,9 high-resolution melt-curve analysis10 and even commercial systems like Xpert MTB/RIF assay (GX)11 and MTBDRplus assay11 have been utilized for diagnosing TBU, with varying results. These NAATs, however, require electricity-driven sophisticated equipment for amplification and commercial platforms offer limited throughput, thus making them unsuitable for resource-limited high-endemic regions like India. The loop-mediated isothermal amplification (LAMP) assay,12 circumvents these limitations by enabling amplification in battery-operated simple water baths with minimally trained staff. Only three studies have evaluated the use of LAMP in diagnosing TBU that too using different gene targets (either MPB64 or IS6110).13–15 Using a combination of these genes, i.e. multitargeted LAMP (MLAMP), has proved its diagnostic potential in cases of tuberculous meningitis,16 tubercular lymphadenitis,17 osteo-articular tuberculosis18 and gastrointestinal tuberculosis,19 however, MLAMP has never been evaluated for TBU. The current study was, therefore, planned to evaluate the role of MLAMP in diagnosing TBU. The first-of-its-kind attempt was made to evaluate a new combination of three gene targets using MLAMP, the conventional IS6110 and MPB64 and the novel IS1081. For thorough comparison, conventional PCRs for these genes were also included: IS6110 and MPB64 from our previous experience5 and IS1081 was evaluated in the present study.