A study to determine the historical pattern of non-traumatic ileo-cecal perforations and to evaluate the XPER MTB/RIF assay for rapid diagnosis of intestinal TB at the University Teaching Hospital, Lusaka

Abstract

Intestinal Perforations(IP) are a common cause of generalized peritonitis, the fecal contamination and overwhelming sepsis that result lead to high morbidity and mortality. Primary infectious causes include Typhoid and Tuberculosis. A high prevalence of Tuberculosis and annual typhoid fever outbreaks in Zambia suggest that Salmonella Typhi and Mycobacteria Tuberculosis (MTB) could be a cause of IPs seen at the UTH. Objectives: To study the histological features of ileo-cecal perforations and their correlation with the XPERT MTB/RIF ASSAY for the rapid diagnosis of intestinal TB. Material and Methods The study is a descriptive cross sectional study conducted from March 2014 - March 2015. The study population were patients aged between 1-90years who presented with peritonitis and intra-operatively were found to have ileo-cecal perforations, edges of the perforation and mesenteric lymph nodes were harvested intra-operatively. Convenience sampling was used to capture the study participants. A questionnaire was administered on the 2nd postoperative day to capture demographic and clinical data. Data collected was entered in Microsoft Excel 2007 and analysed in STATA version 11.

Results 35 patients with IP were enrolled. More than half (66%, n- 23) were males while less than half (44%, n-12) were females, with a mean age of twenty-one (21) years and a mean duration of illness of four (4) days. The Terminal Ileum was the most common site of perforation and single perforations were the most common. The histological pattern were as follows more than three quarters (94.3%) of the study participants had non specific inflammation, while 5.7% (n=2) had features consistent with Mycobacterium Tuberculosis infection. DNA PCR for MTB confirmed the 2 positive samples for MTB using the MTB/RIF assay. None of the study participants had any Gastrointestinal Malignancy or a previous history of Tuberculosis. Conclusion The histological pattern of ileo-cecal perforations at the UTH is mostly non specific inflammation and that of MTB, the terminal ileum is the most common site for IP, with single perforations being predominant. DNA-PCR is a fast & efficient diagnostic tool for Intestinal Tuberculosis.