Abdominal tuberculosis (TB) is an important public health problem in developing countries. Because of overlap in the signs and symptoms of the chronic mycobacterial diseases like intestinal tuberculosis (ITB), Crohn\'s disease (CD), ulcerative colitis, and other inflammatory diseases, there is a need to arrive at a specific diagnosis. Several investigations like computed tomography scan, different endoscopy procedures, ascitic fluid adenosine deaminase (ADA), tuberculosis polymerase chain reaction (TB-PCR), GeneXpert, laparoscopy, etc., are being increasingly used to diagnose TB. Advances in imaging methods and direct access to affected sites by endoscopy have made significant contribution in improving the diagnosis. A combined evaluation of clinical features, endoscopy, histology, and response to treatment has been recommended to differentiate between CD and ITB. Various studies show that clinical features and histopathology, especially granuloma characteristics, have a major role in moving toward specific diagnosis of these conditions. Development of a large number of probes and gene amplification (different variants of PCR and isothermal methods) for TB and other mycobacteria has provided very powerful tools. If used properly they can significantly help in arriving at specific diagnosis of chronic mycobacterial diseases of intestinal tract. Detection of mycobacterial genetic/antigenic components in biopsies by in situ hybridization (ISH), in situ PCR, and immunohistochemistry (IHC) has been observed to be quite useful in differentiating ITB from CD. A number of newer methods based on expression of angiotensin converting enzyme (ACE), aptamers and biosensors have already appeared on the horizon and have potential diagnostic as well as therapeutic value for various forms of TB including abdominal TB. While many of these approaches/techniques have shown promise, they have not been adequately studied to become part of diagnostic strategy for clinical settings in countries like India.
Lakhe P, Khalife A, Pandya J. Ileocaecal and transverse colonic tuberculosis mimicking colonic malignancy—a case report. Int J Surg Case Rep 2017 Apr;36:4-7.
Kim YS, Kim YH, Lee KM, Kim JS, Park YS; IBD Study Group of the Korean Association of the Study of Intestinal Diseases. Diagnostic guideline of intestinal tuberculosis. Korean J Gastroenterol 2009 Mar;53(3):177-186.
Sharma SK, Ryan H, Khaparde S, Sachdeva KS, Singh AD, Mohan A, Sarin R, Paramasivan CN, Kumar P, Nischal N, et al. Index-TB guidelines: guidelines on extrapulmonary tuberculosis for India. Indian J Med Res 2017 Apr;145(4):448-463.
Kim ES, Chen M, Lee J, Lee CK, Kim YS. Diagnosis of inflammatory bowel disease in Asia: the results of a multinational web-based survey in the 2nd Asian Organization for Crohn's and Colitis (AOCC) meeting in Seoul. Intest Res 2016 Jul;14(3):224-230.
Bourreille A, Ignjatovic A, Aabakken L, Loftus EV Jr, Eliakim R, Pennazio M, Bouhnik Y, Seidman E, Keuchel M, Albert JG, et al. Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED-ECCO consensus. Endoscopy 2009 Jul;41(7):618-637.
Arabi NA, Musaad AM, Ahmed EE, Ibnouf MMAM, Abdelaziz MSE. Primary gastric tuberculosis presenting as gastric outlet obstruction: a case report and review of the literature. J Med Case Rep 2015 Nov;9:265.
Nagahashi M, Aoyagi T, Yamada A, Rashid OM, Adams BJ, Takabe K. Intestinal co-infection of tuberculosis and CMV can cause massive lower GI bleeding in a patient with HIV. J Surg Sci 2013 Dec;1(1):12-15.
Kapoor VK. Abdominal tuberculosis: the Indian contribution. Indian J Gastroenterol 1998 Oct-Dec;17(4):141-147.
Vaishnavi C. Diagnostic options for gastrointestinal tuberculosis. J Gastrointest Infect 2015 Oct;5:1-4.
Rathi P, Gambhire P. Abdominal tuberculosis. Assoc Physicians India 2016 Feb;64:38-47.
Mishra PK, Bhargava A, Punde RP, Pathak N, Desikan P, Jain A, Varshney S, Maudar KK. Diagnosis of gastrointestinal tuberculosis: using cytomorphological, microbiological, immunological and molecular techniques—a study from Central India. Indian J Clin Biochem 2010 Apr;25(2):158-163.
Gupta V, Bansal N. Intestinal tuberculosis: a diagnostic dilemma. J Gastrointest Infect 2011;1:1-2.
Shah I, Uppuluri R. Clinical profile of abdominal tuberculosis in children. Indian J Med Sci 2010 May;64(5):204-209.
Piñeiro R, Mellado MJ, Cilleruelo MJ, García-Ascaso M, Medina-Claros A, García-Hortelano M. Tuberculin skin test in Bacille Calmette-Guérin-vaccinated children: how should we interpret the results? Eur J Pediatr 2012 Nov;171(11):1625-1632.
Liao CH, Chou CH, Lai CC, Huang YT, Tan CK, Hsu HL, Hsueh PR, et al. Diagnostic performance of an enzyme-linked immunospot assay for interferon-gamma in extrapulmonary tuberculosis varies between different sites of disease. J Infect 2009 Dec;59(6):402-408.
Chong VH, Lim KS. Gastrointestinal tuberculosis. Singapore Med J 2009 Jun;50(6):638-645.
Sato S, Yao K, Yao T, Schlemper RJ, Matsui T, Sakurai T, Iwashita A. Colonoscopy in the diagnosis of intestinal tuberculosis in asymptomatic patients. Gastrointest Endosc 2004 Mar;59(3):362-368.
Ihama Y, Hokama A, Hibiya K, Kishimoto K, Nakamoto M, Hirata T, Kinjo N, Cash HL, Higa F, Tateyama M, et al. Diagnosis of intestinal tuberculosis using a monoclonal antibody to Mycobacterium tuberculosis. World J Gastroenterol 2012 Dec;18(47):6974-6980.
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 Mar;10(3):340-342.
Hallur V, Sharma M, Sethi S, Sharma K, Mewara A, Dhatwalia S, Yadav R, Bhasin D, Sinha SK, Rana S, et al. Development and evaluation of multiplex PCR in rapid diagnosis of abdominal tuberculosis. Diagn Microbiol Infect Dis 2013 May;76(1):51-55.
Kaur D, Singh KD, Gupta V, Gupta R, Kaur J, Arora C. Comparison of direct detection of Mycobacterium tuberculosis complex by gene probe and culture for diagnosis of abdominal tuberculosis. J Gastrointest Infect 2014;4:54-55.
Sharma SK, Chaubey J, Singh BK, Sharma R, Mittal A, Sharma A. Drug resistance pattern among extrapulmonary tuberculosis cases in a tertiary care centre in North India. Int J Tuberc Lung Dis 2017 Oct;21(10):1112-1117.
Kumari R, Tripathi R, Pandey AP, Banerjee T, Sinha P, Anupurba S. Rapid screening of MDR-TB in cases of extrapulmonary tuberculosis using genotype MTBDR plus. PLoS One 2016 Jul;11(7) e0159651.
Singh UB, Pandey P, Mehta G, Bhatnagar AK, Mohan A, Goyal V, Ahuja V, Ramachandran R, Sachdeva KS, Samantaray JC. Genotypic, phenotypic and clinical validation of GeneXpert in extra-pulmonary and pulmonary tuberculosis in India. PLOS One 2016 Feb;11(2):e0149258.
Shojaei E, Layali ZA, Hormozi SF, Moradnejad P. Intestinal tuberculosis sometimes mimics Crohn's disease. Acta Med Iran 2013 Feb;51(11):814-815.
Dutta AK, Sahu MK, Gangadharan SK, Chacko A. Distinguishing Crohn's disease from intestinal tuberculosis—a prospective study. Trop Gastroenterol 2011 Jul-Sep;32(3):204-209.
Larsson G, Shenoy T, Ramasubramanian R, Balakumaran LK, Småstuen MC, Bjune GA, Moum BA. Routine diagnosis of intestinal tuberculosis and Crohn's disease in Southern India. World J Gastroenterol 2014 May;20(17):5017-5024.
Amarapurkar DN, Patel ND, Rane PS. Diagnosis of Crohn's disease in India where tuberculosis is widely prevalent. World J Gastroenterol 2008 Feb;14(5):741-746.
Debi U, Shankar A, Kartik MV, Prasad KK, Thapa BR. An unusual case of small intestinal tuberculosis with enteroenteric fistula—a case report. J Gastro Infect 2016;5:46-49.
Yu H, Liu Y, Wang Y, Peng L, Li A, Zhang Y. Clinical, endoscopic and histological differentiations between Crohn's disease and intestinal tuberculosis. Digestion 2012 Feb;85(3):202-209.
Ye Z, Lin Y, Cao Q, He Y, Xue L. Granulomas as the most useful histopathological feature in distinguishing between Crohn's disease and intestinal tuberculosis in endoscopic biopsy specimens. Medicine (Baltimore) 2015 Dec;94(49):e2157.
Schaffer T, Flogerzi B, Schoepfer AM, Seibold F, Müller S. Increased titers of anti-Saccharomyces cerevisiae antibodies in Crohn's disease patients with reduced H-ficolin levels but normal MASP-2 activity. J Crohn's Colitis 2013 Feb;7(1):e1-e10.
Makharia GK, Sachdev V, Gupta R, Lal S, Pandey RM. Anti-Saccharomyces cerevisiae antibody does not differentiate between Crohn's disease and intestinal tuberculosis. Dig Dis Sci 2007 Jan;52(1):33-39.
Kwon CI, Park PW, Kang H, Kim GI, Cha ST, Kim KS, Ko KH, Hong SP, Hwang SG, Rim KS. The usefulness of angiotensin converting enzyme in the differential diagnosis of Crohn's disease and intestinal tuberculosis. Korean J Intern Med 2007 Mar;22(1):1-7.
Lei Y, Yi FM, Zhao J, Luckheeram RV, Huang S, Chen M, Huang MF, Li J, Zhou R, Yang GF, et al. Utility of in vitro interferon- release assay in differential diagnosis between intestinal tuberculosis and Crohn's disease. J Dig Dis 2013 Feb;14(2):68-75.
Bull TJ, McMinn EJ, Sidi-Boumedine K, Skull A, Durkin D, Neild P, Rhodes G, Pickup R, Hermon-Taylor J. Detection and verification of Mycobacterium avium subsp. paratuberculosis in fresh ileocolonic mucosal biopsy specimens from individuals with and without Crohn's disease. J Clin Microbiol 2003 Jul;41(7):2915-2923.
Jeyanathan M, Boutros-Tadros O, Radhi J, Semret M, Bitton A, Behr MA. Visualization of Mycobacterium avium in Crohn's tissue by oil-immersion microscopy. Microbes Infect 2007 Nov-Dec;9(14-15):1567-1573.
Ince AT, Güne P, Senate E, Sezikli M, Tiftikçi A, Ovünç O. Can an immunohistochemistry method differentiate intestinal tuberculosis from Crohn's disease in biopsy specimens? Dig Dis Sci 2011 Apr;56(4):1165-1170.
Khan IA, Pilli S A S, Rampal R, Chauhan SK, Tiwari V, Mouli VP, Kedia S, Nayak B, Das P, Makharia GK, et al. Prevalence and Association of Mycobacterium avium subspecies paratubercu- losis with disease course in patients with ulcero-constrictive ileocolonic disease. PLoS One 2016 Mar;11(3):e0152063.
Ramadass B, Chittaranjan S, Subramanian V, Ramakrishna BS. Fecal polymerase chain reaction for Mycobacterium tuber- culosis IS6110 to distinguish Crohn's disease from intestinal tuberculosis. Indian J Gastroenterol 2010 Jul;29(4):152-156.
Jin XJ, Kim JM, Kim HK, Kim L, Choi SJ, Park IS, Han JY, Chu YC, Song JY, Kwon KS, et al. Histopathology and TB-PCR kit analysis in differentiating the diagnosis of intestinal tuberculosis and Crohn's disease. World J Gastroenterol 2010 May;16(20):2496-2503.
Jin T, Fei B, Zhang Y, He X. The diagnostic value of polymerase chain reaction for Mycobacterium tuberculosis to distinguish intestinal tuberculosis from Crohn's disease: a meta-analysis. Saudi J Gastroenterol 2017 Jan-Feb;23(1):3-10.
Sechi LA, Mura M, Tanda F, Lissia A, Solinas A, Fadda G, Zanetti S. Identification of Mycobacterium avium subsp. para- tuberculosis in biopsy specimens from patients with Crohn's disease identified by in situ hybridization. J Clin Microbiol 2001 Dec;39(12):4514-4517.
Sechi LA, Mura M, Tanda E, Lissia A, Fadda G, Zanetti S. Mycobacterium avium sub. paratuberculosis in tissue samples of Crohn's disease patients. New Microbiol 2004 Jan;27(1):75-77.
Sechi LA, Scanu AM, Molicotti P, Cannas S, Mura M, Dettori G, Fadda G, Zanetti S. Detection and Isolation of Mycobacterium avium subspecies paratuberculosis from intestinal mucosal biopsies of patients with and without Crohn's disease in Sardinia. Am J Gastroenterol 2005 Jul;100(7):1529-1536.
Pulimood AB, Peter S, Rook GW, Donoghue HD. In situ PCR for Mycobacterium tuberculosis in endoscopic mucosal biopsy specimens of intestinal tuberculosis and Crohn disease. Am J Clin Pathol 2008 Jun;129(6):846-851.
Aimaiti R, Qin L, Cao T, Yang H, Wang J, Lu J, Huang X, Hu Z. Identification and application of ssDNA aptamers against H37Rv in the detection of Mycobacterium tuberculosis. Appl Microbiol Biotechnol 2015 Nov;99(21):9073-9083.
Mozioglu E, Gokmen O, Tamerler C, Kocagoz ZT, Akgoz M. Selection of nucleic acid aptamers specific for Mycobacterium tuberculosis. Appl Biochem Biotechnol 2016 Feb;178(4):849-864.
Tang XL, Wu SM, Xie Y, Song N, Guan Q, Yuan C, Zhou X, Zhang XL. Generation and application of ssDNA aptamers against glycolipid antigen Man LAM of Mycobacterium tuber- culosis for TB diagnosis. J Infect 2016 May;72(5):573-586.
Pan Q, Wang Q, Sun X, Xia X, Wu S, Luo F, Zhang XL. Aptamer against mannose-capped lipoarabinomannan inhibits virulent Mycobacterium tuberculosis infection in mice and rhesus monkeys. Mol Ther 2014 May;22(5):940-951.
Perkins AC, Missailidis S. Radiolabelled aptamers for tumour imaging and therapy. Q J Nucl Med Mol Imaging 2007 Dec;51(4):292-296.
Calzada V, Moreno M, Newton J, González J, Fernández M, Gambini JP, Ibarra M, Chabalgoity A, Deutscher S, Quinn T, et al. Development of new PTK7-targeting aptamer-fluorescent and radiolabelled probes for evaluation as molecular imaging agents: lymphoma and melanoma in vivo proof of concept. Bioorg Med Chem 2016 Dec;25(3):1163-1171.
Lele, RD. Imaging tuberculosis with radiolabelled aptamers. In: Kulkarni SV, editor. Pursuit of excellence—an autobiography. Mumbai: Granthali Woollen Mill Public School; 2017. pp. 154-156.
Fogel R, Limson J. Developing biosensors in developing countries: South Africa as a case study. Biosensors (Basel) 2016 Feb;6(1):E5.
Chen F, Zhou J, Luo F, Mohammed AB, Zhang XL. Aptamer from whole-bacterium SELEX as new therapeutic reagent against virulent Mycobacterium tuberculosis. Biochem Biophys Res Commun 2007 Jun;357(3):743-748.
Baig IA, Moon JY, Lee SC, Ryoo SW, Yoon MY. Development of ssDNA aptamers as potent inhibitors of Mycobacterium tuberculosis acetohydroxy acid synthase. Biochim Biophys Acta 2015 Oct;1854(10 Pt A):1338-1350.
Sohal JS, Sheoran N, Narayanasamy K, Brahmachari V, Singh S, Subodh S. Genomic analysis of local isolate of Mycobacte- rium avium subspecies paratuberculosis. Vet Microbiol 2009 Mar;134(3-4):375-382.