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Perianal Tuberculosis

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Tuberculosis of the Gastrointestinal system

Abstract

The association of tuberculosis (TB) with anal fistulas and abscesses is not uncommon, especially in TB endemic regions. TB can afflict 0.3–16% cases of anal fistulas in endemic areas. The significance of the association of TB with anal fistulas is that if the TB infection is not detected and treated timely, it would lead to non-healing or recurrence of the fistula. Despite several tests in vogue (acid-fast bacilli smear, histopathology, culture, GeneXpert, polymerase chain reaction etc.), there is no gold-standard test that can detect TB with reasonably high sensitivity and specificity. TB culture has high specificity but its sensitivity is low and it takes a long time (6 weeks to 6 months). The other commonly done test is histopathology (HPE) but the latest data has demonstrated that polymerase chain reaction (PCR) is significantly more sensitive than HPE as well as GeneXpert to detect TB. As PCR can detect both live and dead bacilli, it is recommended that a positive PCR test should be correlated with the clinical picture before initiating anti-TB treatment. It has been highlighted that TB may not always be detected in the first sample. Therefore, repeated samples may be required to detect TB especially in patients with high levels of suspicion. The chances of fistula healing are highest when anti-TB therapy is started within 6 weeks of fistula surgery. TB fistulas are much more complex than non-TB fistulas. However, with timely detection and treatment, a high cure rate can be achieved in TB fistulas.

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References

  1. World Health Organization. Global tuberculosis report 2018. Geneva: World Health Organization; 2018. Available from: https://www.who.int/tb/publications/global_report/en/. [Last accessed on 2021 Jan7].

  2. World Health Organization (WHO). Global Tuberculosis Report 2017. http://www.who.int/tb/publications/global_report/en/. Published, December 2017. Accessed January 08, 2021.

  3. Garg P, Garg M, Das BR, Khadapkar R, Menon GR. Perianal tuberculosis: lessons learned in 57 patients from 743 samples of histopathology and polymerase chain reaction and a systematic review of literature. Dis Colon Rectum. 2019;62:1390–400.

    Article  PubMed  Google Scholar 

  4. Shukla HS, Gupta SC, Singh G, Singh PA. Tubercular fistula in ano. Br J Surg. 1988;75:38–9.

    Article  CAS  PubMed  Google Scholar 

  5. Kraemer M, Gill SS, Seow-Choen F. Tuberculous anal sepsis: report of clinical features in 20 cases. Dis Colon Rectum. 2000;43:1589–91.

    Article  CAS  PubMed  Google Scholar 

  6. Shan YS, Yan JJ, Sy ED, Jin YT, Lee JC. Nested polymerase chain reaction in the diagnosis of negative Ziehl-Neelsen stained mycobacterium tuberculosis fistula-in-ano: report of four cases. Dis Colon Rectum. 2002;45:1685–8.

    Article  PubMed  Google Scholar 

  7. Sultan S, Azria F, Bauer P, Abdelnour M, Atienza P. Anoperineal tuberculosis: diagnostic and management considerations in seven cases. Dis Colon Rectum. 2002;45:407–10.

    Article  CAS  PubMed  Google Scholar 

  8. Stupart D, Goldberg P, Levy A, Govender D. Tuberculous anal fistulas--prevalence and clinical features in an endemic area. S Afr J Surg. 2009;47:116–8.

    PubMed  Google Scholar 

  9. Moujahid M, Tajdine MT, Achour A, Janati IM. Anoperineal tuberculosis: 40 cases. Gastroenterol Clin Biol. 2010;34:98–9.

    Article  CAS  PubMed  Google Scholar 

  10. Abcarian H. Anal fistula: principles and management. 1st ed. New York: Springer; 2014.

    Book  Google Scholar 

  11. Betlloch I, Banuls J, Sevila A, Morell A, Botella R, Roman P. Perianal tuberculosis. Int J Dermatol. 1994;33:270–1.

    Article  CAS  PubMed  Google Scholar 

  12. Garg P, Goyal A, Yagnik VD, Dawka S, Menon GR. Diagnosis of anorectal tuberculosis by polymerase chain reaction, GeneXpert and histopathology in 1336 samples in 776 anal fistula patients. World J Gastroenterol. 2021;13(4):355–65. (under submission)

    Google Scholar 

  13. Garg P. Nontuberculous mycobacteria in fistula-in-ano: a new finding and its implications. Int J Mycobacteriol. 2016;5:276–9.

    Article  PubMed  Google Scholar 

  14. Wagner D, Young LS. Nontuberculous mycobacterial infections: a clinical review. Infection. 2004;32:257–70.

    Article  CAS  PubMed  Google Scholar 

  15. Shrestha NK, Tuohy MJ, Hall GS, Reischl U, Gordon SM, Procop GW. Detection and differentiation of mycobacterium tuberculosis and nontuberculous mycobacterial isolates by real-time PCR. J Clin Microbiol. 2003;41:5121–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Garg P, Kaur B, Goyal A, Yagnik VD, Dawka S, Menon GR. Lessons learned from an audit of 1250 fistula patients operated at a single center: a retrospective review. World J Gastrointest Surg. 2021;13(4):340–54. (Accepted; under print)

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jamil D, Ismail R, Cherkaoui A. Secondary tuberculous infection of a pilonidal sinus. Ann Gastroenterol Hepatol (Paris). 1991;27:205–6.

    CAS  Google Scholar 

  18. Degos R, Garnier G, Caron J. Tuberculous inguinal adenopathy with perianal cutaneous ulceration (primo-infection)? Bull Soc Fr Dermatol Syphiligr. 1950;57:283–4.

    CAS  PubMed  Google Scholar 

  19. Myers SR. Tuberculous fissure-in ano. J R Soc Med. 1994;87:46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kato K, Shudo H, Makihara S. Anal stricture caused by tuberculosis. Shujutsu. 1967;21:107–10.

    CAS  PubMed  Google Scholar 

  21. Borki K, Saissy JM, Benomar S, Okheira H, Dimou M, Ducourau JP. Anorectal tuberculosis disclosed by hemorrhoidal thrombosis. Med Trop (Mars). 1986;46:75–7.

    CAS  Google Scholar 

  22. Yanagida T, Oya M, Iwase N, et al. Rectal submucosal tumor-like lesion originating from intestinal tuberculosis. J Gastroenterol. 1997;32:822–5.

    Article  CAS  PubMed  Google Scholar 

  23. Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics. 2000;20:623–35. discussion 35-7

    Article  CAS  PubMed  Google Scholar 

  24. Garg P. Garg classification for anal fistulas: is it better than existing classifications?—a review. Indian Journal of Surgery. 2018;80:606–8.

    Article  Google Scholar 

  25. Garg P. Assessing validity of existing fistula-in-ano classifications in a cohort of 848 operated and MRI-assessed anal fistula patients - cohort study. Ann Med Surg (Lond). 2020;59:122–6.

    Article  Google Scholar 

  26. Garg P, Sodhi SS, Garg N. Management of complex cryptoglandular anal fistula: challenges and solutions. Clin Exp Gastroenterol. 2020;13:555–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Tao Y, Zheng Y, Han JG, et al. Long-term clinical results of use of an anal fistula plug for treatment of low trans-Sphincteric anal fistulas. Med Sci Monit. 2020;26:e928181.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Garg P. Comparison of histopathology and real-time polymerase chain reaction (RT-PCR) for detection of mycobacterium tuberculosis in fistula-in-ano. Int J Color Dis. 2017;32:1033–5.

    Article  Google Scholar 

  29. Gupta PJ. Ano-perianal tuberculosis--solving a clinical dilemma. Afr Health Sci. 2005;5:345–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Wijekoon NS, Samarasekera DN. The value of routine histopathological analysis in patients with fistula in-ano. Color Dis. 2010;12:94–6.

    Article  CAS  Google Scholar 

  31. Gupta PJ. A case of multiple (eight external openings) tubercular anal fistulae. Case report. Eur Rev Med Pharmacol Sci. 2007;11:359–61.

    CAS  PubMed  Google Scholar 

  32. Katoch VM. Newer diagnostic techniques for tuberculosis. Indian J Med Res. 2004;120:418–28.

    CAS  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. Pulimood AB, Amarapurkar DN, Ghoshal U, et al. Differentiation of Crohn's disease from intestinal tuberculosis in India in 2010. World J Gastroenterol. 2011;17:433–43.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Shah S, Thomas V, Mathan M, et al. Colonoscopic study of 50 patients with colonic tuberculosis. Gut. 1992;33:347–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Alvares JF, Devarbhavi H, Makhija P, Rao S, Kottoor R. Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital. Endoscopy. 2005;37:351–6.

    Article  CAS  PubMed  Google Scholar 

  37. Patel B, Yagnik VD. Clinical and laboratory features of intestinal tuberculosis. Clin Exp Gastroenterol. 2018;11:97–103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Amarapurkar DN, Patel ND, Amarapurkar AD, Agal S, Baigal R, Gupte P. Tissue polymerase chain reaction in diagnosis of intestinal tuberculosis and Crohn's disease. J Assoc Physicians India. 2004;52:863–7.

    CAS  PubMed  Google Scholar 

  39. Song H, Lee H, Choi G, Shin J. Cutaneous nontuberculous mycobacterial infection: a clinicopathological study of 7 cases. Am J Dermatopathol. 2009;31:227–31.

    Article  PubMed  Google Scholar 

  40. Park DY, Kim JY, Choi KU, et al. Comparison of polymerase chain reaction with histopathologic features for diagnosis of tuberculosis in formalin-fixed, paraffin-embedded histologic specimens. Arch Pathol Lab Med. 2003;127:326–30.

    Article  CAS  PubMed  Google Scholar 

  41. Tai WC, Hu TH, Lee CH, Chen HH, Huang CC, Chuah SK. Ano-perianal tuberculosis: 15 years of clinical experiences in southern Taiwan. Color Dis. 2010;12:e114–20.

    Google Scholar 

  42. Sahu M, Mishra JK, Sharma A, Fatmi U. A prospective study on tubercular fistula in ano and its management. J Coloproctol. 2017;37:211–5.

    Article  Google Scholar 

  43. Halse TA, Edwards J, Cunningham PL, et al. Combined real-time PCR and rpoB gene pyrosequencing for rapid identification of mycobacterium tuberculosis and determination of rifampin resistance directly in clinical specimens. J Clin Microbiol. 2010;48:1182–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Wada T, Maeda S, Tamaru A, Imai S, Hase A, Kobayashi K. Dual-probe assay for rapid detection of drug-resistant mycobacterium tuberculosis by real-time PCR. J Clin Microbiol. 2004;42:5277–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Helb D, Jones M, Story E, et al. Rapid detection of mycobacterium tuberculosis and rifampin resistance by use of on-demand, near-patient technology. J Clin Microbiol. 2010;48:229–37.

    Article  CAS  PubMed  Google Scholar 

  46. Theron G, Peter J, Calligaro G, et al. Determinants of PCR performance (Xpert MTB/RIF), including bacterial load and inhibition, for TB diagnosis using specimens from different body compartments. Sci Rep. 2014;4:5658.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Denkinger CM, Schumacher SG, Boehme CC, Dendukuri N, Pai M, Steingart KR. Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2014;44:435–46.

    Article  PubMed  Google Scholar 

  48. Kedia S, Das P, Madhusudhan KS, et al. Differentiating Crohn's disease from intestinal tuberculosis. World J Gastroenterol. 2019;25:418–32.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Choi YS, Kim DS, Lee JB, et al. Clinical features of tuberculous versus Crohn's anal fistulas, in Korea. J Crohns Colitis. 2015;9:1132–7.

    Article  PubMed  Google Scholar 

  50. Garg P, Singh P, Kaur B. Magnetic resonance imaging (MRI): operative findings correlation in 229 fistula-in-Ano patients. World J Surg. 2017;41:1618–24.

    Article  PubMed  Google Scholar 

  51. Garg P. Comparison of preoperative and postoperative MRI after fistula-in-Ano surgery: lessons learnt from an audit of 1323 MRI at a single Centre. World J Surg. 2019;43:1612–22.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Garg Fistula Research Institute (GFRI), Panchkula, Haryana, India

    Pankaj Garg

  2. Indus International Hospital, Mohali, India

    Pankaj Garg

  3. Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India

    Vipul D. Yagnik

  4. SSR Medical College, Belle Rive, Mauritius

    Sushil Dawka

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  1. Pankaj Garg
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  2. Vipul D. Yagnik
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  3. Sushil Dawka
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Editors and Affiliations

  1. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Vishal Sharma

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Garg, P., Yagnik, V.D., Dawka, S. (2022). Perianal Tuberculosis. In: Sharma, V. (eds) Tuberculosis of the Gastrointestinal system. Springer, Singapore. https://doi.org/10.1007/978-981-16-9053-2_9

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  • DOI: https://doi.org/10.1007/978-981-16-9053-2_9

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