We read with keen interest the paper on abdominal tuberculosis by Udgirkar and colleagues where the authors reported a large number of patients with abdominal tuberculosis from Western India11. Udgirkar S, Jain S, Pawar S, Chandnani S, Contractor Q, Rathi P. Clinical profile, drug resistance pattern and treatment outcomes of abdominal tuberculosis patients in western india. Arq Gastroenterol. 2019;56:178-83..
This report is one of the few reports which have highlighted the use of GeneXpert for diagnosis of abdominal tuberculosis. Previous reports have suggested that the positivity of GeneXpert in intestinal tuberculosis to be 8% and 32% respectively22. Kumar S, Bopanna S, Kedia S, Mouli P, Dhingra R, Padhan R, et al. Evaluation of Xpert MTB/RIF assay performance in the diagnosis of abdominal tuberculosis. Intest Res. 2017;15:187-94.,33. Bellam BL, Mandavdhare HS, Sharma K, Shukla S, Soni H, Kumar-M P, et al. Utility of tissue Xpert-Mtb/Rif for the diagnosis of intestinal tuberculosis in patients with ileocolonic ulcers. Ther Adv Infect Dis. 2019;6:2049936119863939.. Bellam et al. also found one patient to have rifampin resistance amongst their cases33. Bellam BL, Mandavdhare HS, Sharma K, Shukla S, Soni H, Kumar-M P, et al. Utility of tissue Xpert-Mtb/Rif for the diagnosis of intestinal tuberculosis in patients with ileocolonic ulcers. Ther Adv Infect Dis. 2019;6:2049936119863939.. As per the findings reported by Udgirkar et al., GeneXpert was positive in 26% of patients. The report includes a mixture of cases of peritoneal and intestinal tuberculosis and the sensitivity of GeneXpert is likely to vary in these two settings. The authors report that none of the ascitic fluid samples were positive. Interestingly, a Cochrane review combining 20 studies has reported the sensitivity of Gene Xpert in peritoneal fluid to be 50%44. Kohli M, Schiller I, Dendukuri N, Dheda K, Denkinger CM, Schumacher SG, et al. Xpert(®) MTB/RIF assay for extrapulmonary tuberculosis and rifampicin resistance. Cochrane Database Syst Rev. 2018;8:CD012768.. It is unclear why the sensitivity was so low in the present study. Also it would be worthwhile to know the sensitivity in the intestinal tissue samples and the therapeutic approach to patients who tested positive for rifampin resistance.
REFERENCES
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1Udgirkar S, Jain S, Pawar S, Chandnani S, Contractor Q, Rathi P. Clinical profile, drug resistance pattern and treatment outcomes of abdominal tuberculosis patients in western india. Arq Gastroenterol. 2019;56:178-83.
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2Kumar S, Bopanna S, Kedia S, Mouli P, Dhingra R, Padhan R, et al. Evaluation of Xpert MTB/RIF assay performance in the diagnosis of abdominal tuberculosis. Intest Res. 2017;15:187-94.
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3Bellam BL, Mandavdhare HS, Sharma K, Shukla S, Soni H, Kumar-M P, et al. Utility of tissue Xpert-Mtb/Rif for the diagnosis of intestinal tuberculosis in patients with ileocolonic ulcers. Ther Adv Infect Dis. 2019;6:2049936119863939.
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4Kohli M, Schiller I, Dendukuri N, Dheda K, Denkinger CM, Schumacher SG, et al. Xpert(®) MTB/RIF assay for extrapulmonary tuberculosis and rifampicin resistance. Cochrane Database Syst Rev. 2018;8:CD012768.
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Disclosure of funding: no funding received
Publication Dates
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Publication in this collection
07 Nov 2019 -
Date of issue
Oct-Dec 2019
History
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Received
05 Sept 2019 -
Accepted
12 Sept 2019
