Molecular Method as a Complementary Tool for Diagnosis Intestinal Tuberculosis

分生法用於輔助診斷腸道結核病

李兆清(Jau-Ching Lee) ； 梁憶林(Yi-Lin Liang) ； 林嘉玟(Chia-Wen Lin) ； 傅安盈(An-Ying Fu) ； 蔡維妮(Wei-Ni Tsai) ； 劉秋菁(Chiu-Ching Liu)

《Journal of Biomedical & Laboratory Sciences》 33卷2期 (2021/06) Pp. 95-99

摘要

Diagnosis of intestinal tuberculosis (TB) may be difficult because of very low positivity using the conventional methods of acid-fast bacilli microscopy and mycobacterial culture from intestinal tissue samples. Definitive diagnosis of intestinal TB can also be made from endoscopic examination on the basis of the classical histopathological demonstration of a caseating epithelioid cell granuloma. However, it is often difficult to differentiate intestinal TB from Crohn's disease due to they have similar clinical, colonoscopic, and pathological findings. Lack of suggestive computer tomography (CT) findings might also puzzle the physicians difficult to definitive diagnosis of intestinal TB. In this case report, we describe a case of a 43-year-old male patient with lower abdomen pain and tympanites documented intestinal TB in June 2020. Colonoscopy revealed hyperemia and widespread erosion. The imaging appearance of the ileocecal region on CT suspected to have intestinal TB. However, the results of acid-fast bacilli microscopy and histological examination were negative from intestinal tissue samples. According to the WHO recommendation, the GenXpert MTB/RIF system may be used as a replacement test for usual practice for testing specific non-respiratory specimens from patients presumed to have extrapulmonary TB. Finally, the positive result of the GenXpert MTB/RIF system supported the diagnosis of intestinal TB and early treatment has led to a favorable outcome in his clinical situation.

關鍵字

Intestinal tuberculosis ； the GenXpert MTB/RIF system

並列摘要

腸組織檢體利用傳統方法的抗酸菌鏡檢及分枝桿菌培養來檢驗腸道結核病，其低的陽性率可能讓診斷變得困難。腸道結核病也可藉由內視鏡檢查到俱病理組織學特徵的乾酪性肉芽腫來確診，但其與Crohn氏症在臨床病徵、結腸鏡以及病理組織等特徵相似而不易與之區別。缺乏電腦斷層典型影像亦可能困惑臨床醫師確切診斷。我們探討2020年6月一位43歲下腹部疼痛及脹氣的腸道結核病病人的案例報告，結腸鏡檢查觀察到充血及大範圍浸潤，迴盲部電腦斷層影像懷疑是腸道結核病，但腸組織檢體的抗酸菌鏡檢及病理組織檢查均呈現陰性結果。根據世界衛生組織的建議，GenXpert MTB/RIF系統可用以取代傳統試驗而對疑似有肺外結核的病人檢測其非呼吸道檢體。最後由GenXpert MTB/RIF系統得到陽性結果支持了腸道結核病的診斷且即早治療使病人狀況得到改善。

並列關鍵字

腸道結核病 ； GenXpert MTB/RIF系統