GeneXpert Technique a New Diagnostic Modality for Diagnosis of Tuberculous Peritonitis in Patients on CAPD with a Review of Literature

Abstract

Tuberculous peritonitis is largely an undetected entity in developing countries among patients on CAPD. GeneXpert is a newer tool used in the diagnosis of Mycobacterial tuberculous peritonitis. This paper presents a report on the application of GeneXpert as a rapid and useful diagnostic tool in the diagnosis of Mycobacterial tuberculous peritonitis. After initiation of antituberculous therapy, the use of GeneXpert for the response to treatment is discussed. We used GeneXpert as a rapid diagnostic tool in four patients for the diagnosis or exclusion of MTB peritonitis. One diabetic male patient tested positive for GeneXpert; in other three patients, GeneXpert test was negative. After initiation of antituberculous therapy in the patient with positive GeneXpert, the dialysis effluent became clear within 3 days and repeat GeneXpert tested after 10 days was reported negative. A second patient had smear positive with refractory peritonitis due to co infection with Coagulase negative staphylococcus and budding yeast. In the other two suspected patients, GeneXpert, AFB smear, and Mycobacterial culture were negative. GeneXpert contributes to rapid diagnosis of Mycobacterium tuberculous complex and also in the identification of rifampicin resistance in two hours, whereas conventional tuberculosis culture takes 3-8weeks to show a positive result. However, Mycobacterial culture remains the gold standard for the diagnosis of mycobacterial tuberculous peritonitis as GeneXpert has not been widely applied for diagnosis of peritonitis in chronic peritoneal dialysis patients.