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- Original Article Interferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn’s disease in tuberculosis endemic areas
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Karan Sachdeva
, Peeyush Kumar, Bhaskar Kante, Sudheer K. Vuyyuru, Srikant Mohta, Mukesh K. Ranjan, Mukesh K. Singh, Mahak Verma, Govind Makharia, Saurabh Kedia, Vineet Ahuja -
Intestinal Research 2023;21(2):226-234.
DOI: https://doi.org/10.5217/ir.2022.00010
Published online: June 13, 2022
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- Correspondence to Vineet Ahuja, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, 3093, Third Floor, Teaching Block, New Delhi110029, India. Tel: +91-11-26588500, Fax: +91-11-26588641, E-mail: Vineet.aiims@gmail.com
- Co-Correspondence to Saurabh Kedia, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Third Floor, Teaching Block, New Delhi 110029, India. Tel: +91-11-26546575, Fax: +91-11-26588643, E-mail: dr.saurabhkedia@yahoo.com
• Received: January 18, 2022 • Revised: March 11, 2022 • Accepted: March 27, 2022
© Copyright 2023. Korean Association for the Study of Intestinal Diseases.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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XML DownloadInterferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn’s disease in tuberculosis endemic areas
Fig. 1. Selection of patients according to inclusion and exclusion criteria. IGRA, interferon-gamma release assay; ITB, intestinal tuberculosis.
Fig. 2. Receiver operating characteristic (ROC) curve for interferon-gamma release assay in diagnosing intestinal tuberculosis. Area under the curve=0.66 (95% confidence interval, 0.55–0.75).
Fig. 3. Concordance between interferon-gamma release assay (IGRA) and tuberculin skin test (TST). Both tests were positive in 12 patients and negative in 26 patients. IGRA positivity along with TST negative was seen in 8 patients; TST positive with IGRA negative was seen in 18 patients. Cohen’s kappa coefficient, κ=0.17.
Fig. 1.
Fig. 2.
Fig. 3.
Interferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn’s disease in tuberculosis endemic areas
| Characteristics | Crohn’s disease (n = 49) | Intestinal tuberculosis (n = 59) |
P-value |
|---|---|---|---|
| Sex | 0.800 | ||
| Male (n = 65) | 30 (61.2) | 35 (59.3) | |
| Female (n = 43) | 19 (38.8) | 24 (40.7) | |
| Age (yr), mean ± SD | 37.8 ± 14.0 | 32.6 ± 13.1 | 0.050 |
| Duration of illness (yr) | < 0.001 |
||
| Mean | 5.1 | 2.1 | |
| Median (range) | 4 yr (3 mo–25 yr) | 1 yr (4 wk–20 yr) | |
| Clinical features | |||
| Diarrhea | 18 (36.7) | 15 (25.4) | 0.200 |
| Blood in stool | 18 (36.7) | 8 (13.6) | 0.005 |
| Abdominal pain | 38 (77.6) | 58 (98.3) | 0.001 |
| Intestinal obstruction | 11 (22.4) | 27 (45.8) | 0.012 |
| Weight loss | 32 (65.3) | 49 (83.0) | 0.030 |
| Hemoglobin (g/dL), mean ± SD | 10.1 ± 2.5 | 11.3 ± 2.5 | 0.010 |
| Perianal lesions | 7 (14.3) | 1 (1.6) | 0.020 |
| Endoscopy site |
|||
| Left colon | 13 (26.6) | 4 (8.5) | 0.020 |
| Transverse colon | 7 (14.3) | 6 (12.8) | 0.800 |
| Ascending colon | 11 (22.4) | 11 (23.4) | 0.911 |
| Cecum | 10 (20.4) | 9 (19.1) | 0.876 |
| Terminal ileum | 19 (38.8) | 16 (34.0) | 0.630 |
| Endoscopy features |
|||
| Aphthous or serpiginous ulcers | 5 (10.2) | 0 | 0.010 |
| Transverse ulcers | 6 (12.2) | 9 (19.1) | 0.351 |
| Longitudinal ulcers | 7 (14.3) | 0 | 0.003 |
| Nodularity | 8 (16.3) | 4 (8.5) | 0.247 |
| Stricture | 8 (16.3) | 13 (27.6) | 0.179 |
| CT site |
|||
| Left colon | 8 (16.3) | 1 (1.6) | 0.006 |
| Transverse colon | 5 (10.2) | 4 (6.8) | 0.520 |
| Ascending colon | 3 (6.1) | 8 (13.6) | 0.200 |
| Cecum | 6 (12.2) | 15 (25.4) | 0.080 |
| Terminal ileum | 26 (53.0) | 29 (49.1) | 0.670 |
| CT features |
|||
| Circumferential wall thickening | 25 (51.0) | 32 (54.2) | 0.670 |
| Long segment involvement | 9 (18.3) | 7 (11.9) | 0.340 |
| Asymmetric thickening | 10 (20.4) | 19 (32.2) | 0.170 |
| Stricture | 6 (12.2) | 6 (10.2) | 0.730 |
| Crohn’s disease (n = 49) |
Intestinal tuberculosis (n = 59) |
||||||
|---|---|---|---|---|---|---|---|
| IGRA+ (n=12) | IGRA– (n=37) | P-value | IGRA+ (n = 24) |
IGRA– (n = 35) |
P-value | ||
| Past history of TB | 6 (50.0) | 13 (35.1) | 0.50 | 4 (16.7) | 13 (37.1) | 0.14 | |
| TST (n = 64) | 4/6 (66.7) | 4/24 (16.7) | 0.03 |
8/14 (57.1) | 14/20 (70.0) | 0.48 | |
| Clinical features | |||||||
| Diarrhea | 3 (25.0) | 15 (40.5) | 0.50 | 7 (29.2) | 8 (22.9) | 0.76 | |
| Blood in stool | 4 (33.3) | 14 (37.8) | 0.99 | 2 (8.3) | 6 (17.1) | 0.45 | |
| Abdominal pain | 9 (75.0) | 29 (78.4) | 0.99 | 24 (100) | 34 (97.1) | 0.99 | |
| Intestinal obstruction | 6 (50.0) | 5 (13.5) | 0.02 |
7 (29.2) | 20 (57.2) | 0.06 | |
| Weight loss | 6 (50.0) | 26 (70.3) | 0.30 | 19 (79.2) | 30 (85.7) | 0.75 | |
| Hemoglobin (g/dL) | 10.74 ± 2.66 | 9.77 ± 2.39 | 0.24 | 11.29 ± 2.53 | 11.24 ± 2.56 | 0.94 | |
| Lymphocytes (%) | 26.04 ± 9.19 | 23.92 ± 12.85 | 0.50 | 25.82 ± 8.26 | 24.27 ± 8.17 | 0.65 | |
| Lymphocytes (absolute) | 1,858.27 ± 817.20 | 1,961.16 ± 1,239.40 | 0.80 | 1,837.62 ± 529.50 | 1,794.22 ± 585.60 | 0.79 | |
| Endoscopy site |
|||||||
| Left colon | 1 (8.3) | 12 (32.4) | 0.14 | 1 (6.6) | 3 (9.3) | 0.76 | |
| Transverse colon | 1 (8.3) | 6 (16.3) | 0.66 | 2 (13.3) | 4 (12.5) | 0.94 | |
| Ascending colon | 1 (8.3) | 10 (27.0) | 0.25 | 3 (20.0) | 8 (25.0) | 0.71 | |
| Cecum | 1 (8.3) | 9 (24.3) | 0.41 | 4 (26.6) | 5 (15.6) | 0.37 | |
| Terminal ileum | 8 (66.7) | 11 (29.7) | 0.04 |
7 (46.6) | 9 (28.1) | 0.21 | |
| Endoscopy features |
|||||||
| Aphthous or serpiginous ulcers | 0 | 5 (13.5) | 0.31 | 0 | 0 | ||
| Transverse ulcers | 1 (8.3) | 5 (13.5) | 0.99 | 3 (20.0) | 6 (18.7) | 0.92 | |
| Longitudinal ulcers | 2 (16.7) | 5 (13.5) | 0.99 | 0 | 0 | ||
| Nodularity | 2 (16.7) | 6 (16.2) | 0.99 | 2 (13.3) | 2 (6.2) | 0.42 | |
| Stricture | 2 (16.7) | 6 (16.2) | 0.99 | 3 (20.0) | 10 (31.2) | 0.42 | |
| CT site |
|||||||
| Left colon | 0 | 8 (21.6) | 0.17 | 0 | 1 (2.8) | 0.99 | |
| Transverse colon | 0 | 5 (13.5) | 0.31 | 1 (4.2) | 3 (8.5) | 0.63 | |
| Ascending colon | 1 (8.3) | 2 (5.4) | 0.99 | 2 (8.3) | 6 (17.1) | 0.45 | |
| Cecum | 1 (8.3) | 5 (13.5) | 0.99 | 6 (25.0) | 9 (25.7) | 0.99 | |
| Terminal ileum | 10 (83.3) | 16 (43.2) | 0.02 | 11 (45.8) | 18 (51.4) | 0.79 | |
| CT features |
|||||||
| Circumferential wall thickening | 3 (25.0) | 22 (59.5) | 0.05 | 11 (45.8) | 21 (60.0) | 0.28 | |
| Long segment involvement | 1 (8.3) | 8 (21.6) | 0.42 | 0 | 7 (20.0) | 0.03 | |
| Asymmetric thickening | 4 (33.3) | 6 (16.2) | 0.23 | 9 (37.5) | 10 (28.6) | 0.57 | |
| Stricture | 3 (25.0) | 3 (8.1) | 0.15 | 1 (4.16) | 5 (14.3) | 0.38 | |
| IGRA | Intestinal tuberculosis (n = 59) | Crohn’s disease (n = 49) | Total |
|---|---|---|---|
| Positive | 24 | 12 | 36 |
| Negative | 35 | 37 | 72 |
| Total | 59 | 49 | 108 |
| TST | Intestinal tuberculosis (n = 59) | Crohn’s disease (n = 49) | Total |
|---|---|---|---|
| Positive | 22 | 8 | 30 |
| Negative | 12 | 22 | 34 |
| Total | 34 | 30 | 64 |
| IGRA | Tuberculosis infection history | No history of tuberculosis | Total |
|---|---|---|---|
| Positive | 10 | 26 | 36 |
| Negative | 26 | 46 | 72 |
| Total | 36 | 72 | 108 |
| TST | IGRA positive | IGRA negative | Total |
|---|---|---|---|
| Positive | 12 | 18 | 30 |
| Negative | 8 | 26 | 34 |
| Total | 20 | 44 | 64 |
Table 1. Basic Demographic Features, Exposure History and Clinical Features at Presentation in Patients with Crohn’s Disease and Intestinal Tuberculosis (n=108)
Values are presented as number (%) unless otherwise indicated. The frequencies for Endoscopy and CT findings do not add up due to few patients having normal findings and few having overlapping site/features. n=47 for the endoscopy site and features in the intestinal tuberculosis cohort. Statistically significant difference, SD, standard deviation; CT, computed tomography.
Table 2. Features of IGRA Positive and Negative Subgroups in Patients with Crohn’s Disease and Intestinal Tuberculosis
Values are presented as number (%) or mean±standard deviation. The frequencies for Endoscopy and CT findings do not add up due to few patients having normal findings and few having overlapping site/features. n=47 for the endoscopy site and features in the intestinal tuberculosis cohort. The IGRA+ cohort included 15 patients and the IGRA- cohort had 32 patients respectively for endoscopy site/features. Statistically significant difference, IGRA, interferon-gamma release assay; TB, tuberculosis; TST, tuberculin skin test; CT, computed tomography.
Table 3. Results of IGRA in Patients with Intestinal Tuberculosis and Crohn’s Disease
IGRA, interferon-gamma release assay.
Table 4. Results of TST in Patients with Intestinal Tuberculosis and Crohn’s Disease
TST, tuberculin skin test.
Table 5. Past History of Tuberculosis Infection with Respect to IGRA Results
IGRA, interferon-gamma release assay.
Table 6. Concordance between IGRA and TST Test
IGRA, interferon-gamma release assay; TST, tuberculin skin test.
