Published online Apr 27, 2021. doi: 10.4240/wjgs.v13.i4.355
Peer-review started: January 12, 2021
First decision: February 11, 2021
Revised: February 11, 2021
Accepted: April 14, 2021
Article in press: April 14, 2021
Published online: April 27, 2021
Processing time: 97 Days and 23.9 Hours
The management of anal fistulas is quite complicated. The association of tuberculosis (TB) with anal fistulas can make its treatment even more difficult. The main challenge is timely detection of TB in anal fistulas and its proper management.
There is little data available on diagnosis and management of TB in anal fistulas.
To test the detection rate of TB by commonly used tests like histopathology, polymerase chain-reaction (PCR) and GeneXpert.
Three most commonly utilized tests, PCR, GeneXpert and histopathology were performed to detect TB in pus and tissue (fistula tract wall or lining) samples in anal fistula patients. The results were then compared and analyzed.
In 1336 tissue and pus samples tested in 776 anal fistula patients, it was found that PCR was significantly more sensitive than histopathology and GeneXpert to detect TB. Pus was significantly more sensitive than tissue samples to detect TB. TB fistula had a significantly higher proportion of complex fistulas.
PCR is the most sensitive method to detect TB in anal fistulas. Though TB is associated with complex fistulas but timely diagnosis and treatment led to a high success rate in these fistulas.
More tests need to be developed which can detect TB rapidly with high sensitivity as well as specificity.