Alimentary Tract| Volume 50, ISSUE 6, P559-562, June 2018

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Serial C-reactive protein measurements in patients treated for suspected abdominal tuberculosis

Published:December 19, 2017DOI:



      Response to treatment is often used as a criterion for the diagnosis of abdominal tuberculosis.


      To determine utility of serum C reactive protein (CRP) in assessment of response to anti-tubercular therapy (ATT) in abdominal tuberculosis (ATB).


      We retrospectively analysed the database of patients with suspected ATB (intestinal and/or peritoneal). Response to ATT was assessed using subjective and objective (ulcer healing or ascites resolution) parameters. Serum CRP levels were estimated at baseline and then at 2 months and 6 months of ATT.


      One hundred and twelve patients were included in the analysis. The mean age was 36.57 ± 15.04 years and 54.46% (61/112) were males. Sixty-six patients (58.92%) had intestinal, 28 (25%) had peritoneal and 18 (16.07%) had both. Eleven patients had a normal CRP at baseline while 101 had elevated levels. The CRP levels declined in 94 patients at 6 months. One patient with increased levels at 2 months had multi-drug resistant TB. Seven patients showed elevated or plateaued CRP levels on follow-up. These patients had underlying Crohn’s disease (3 patients), peritoneal carcinomatosis (1), inter-current infection (1), lymphoma (1) and non-healing ulcers (1).


      Lack of decline in CRP may suggest alternative diagnosis or drug-resistant tuberculosis.


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        • Pratap Mouli V.
        • Munot K.
        • Ananthakrishnan A.
        • Kedia S.
        • Addagalla S.
        • Garg S.K.
        • et al.
        Endoscopic and clinical responses to anti-tubercular therapy can differentiate intestinal tuberculosis from Crohn’s disease.
        Aliment Pharmacol Ther. 2017; 45: 27-36
        • Sharma V.
        • Bhatia A.
        • Malik S.
        • Singh N.
        • Rana S.S.
        Visceral scalloping on abdominal computed tomography due to abdominal tuberculosis.
        Ther Adv Infect Dis. 2017; 4: 3-9
        • Logan V.S.
        Anorectal tuberculosis.
        Proc R Soc Med. 1969; 62: 1227-1230
        • Larsson G.
        • Shenoy K.T.
        • Ramasubramanian R.
        • Thayumanavan L.
        • Balakumaran L.K.
        • Bjune G.A.
        • et al.
        High faecal calprotectin levels in intestinal tuberculosis are associated with granulomas in intestinal biopsies.
        Infect Dis. 2015; 47: 137-143
        • Larsson G.
        • Shenoy K.T.
        • Ramasubramanian R.
        • Thayumanavan L.
        • Balakumaran L.K.
        • Bjune G.A.
        • et al.
        Faecal calprotectin levels differentiate intestinal from pulmonary tuberculosis: an observational study from Southern India.
        United European Gastroenterol J. 2014; 2: 397-405
        • Sharma V.
        • Mandavdhare H.S.
        • Kumar A.
        • Sharma R.
        • Sachdeva N.
        • Prasad K.K.
        • et al.
        Prevalence and clinical impact of vitamin D deficiency on abdominal tuberculosis.
        Ther Adv Infect Dis. 2017; 4: 83-86
        • Jullien S.
        • Jain S.
        • Ryan H.
        • Ahuja V.
        Six-month therapy for abdominal tuberculosis.
        Cochrane Database Syst Rev. 2016; 11: CD012163
        • Mendy J.
        • Togun T.
        • Owolabi O.
        • Donkor S.
        • Ota M.O.
        • Sutherland J.S.
        C-reactive protein, Neopterin and Beta2 microglobulin levels pre and post TB treatment in The Gambia.
        BMC Infect Dis. 2016; 16: 115
        • Jayakumar A.
        • Vittinghoff E.
        • Segal M.R.
        • MacKenzie W.R.
        • Johnson J.L.
        • Gitta P.
        • et al.
        Serum biomarkers of treatment response within a randomized clinical trial for pulmonary tuberculosis.
        Tuberculosis (Edinb). 2015; 95: 415-420
        • Lawn S.D.
        • Kerkhoff A.D.
        • Vogt M.
        • Wood R.
        Diagnostic and prognostic value of serum C-reactive protein for screening for HIV-associated tuberculosis.
        Int J Tuberc Lung Dis. 2013; 17: 636-643
        • Miranda P.
        • Gil-Santana L.
        • Oliveira M.G.
        • Mesquita E.D.
        • Silva E.
        • Rauwerdink A.
        • et al.
        Sustained elevated levels of C-reactive protein and ferritin in pulmonary tuberculosis patients remaining culture positive upon treatment initiation.
        PLoS One. 2017; 12e0175278
        • Alvarez G.G.
        • Sabri E.
        • Ling D.
        • Cameron D.W.
        • Maartens G.
        • Wilson D.
        A model to rule out smear-negative tuberculosis among symptomatic HIV patients using C-reactive protein.
        Int J Tuberc Lung Dis. 2012; 16: 1247-1251
        • Chierakul N.
        • Kanitsap A.
        • Chaiprasert A.
        • Viriyataveekul R.
        A simple C-reactive protein measurement for the differentiation between tuberculous and malignant pleural effusion.
        Respirology. 2004; 9: 66-69
        • Lau D.C.
        • Dhillon B.
        • Yan H.
        • Szmitko P.E.
        • Verma S.
        Adipokines: molecular links between obesity and atheroslcerosis.
        Am J Physiol Heart Circ Physiol. 2005; 288: H2031-H2041
        • Pepys M.B.
        • Hirschfield G.M.
        C-reactive protein: a critical update.
        J Clin Invest. 2003; 111: 1805-1812
        • Anand B.S.
        • Nanda R.
        • Sachdev G.K.
        Response of tuberculous stricture to antituberculous treatment.
        Gut. 1988; 29: 62-69
        • Larsson G.
        • Shenoy T.
        • Ramasubramanian R.
        • Balakumaran L.K.
        • Småstuen M.C.
        • Bjune G.A.
        • et al.
        Routine diagnosis of intestinal tuberculosis and Crohn’s disease in Southern India.
        World J Gastroenterol. 2014; 20: 5017-5024
        • Gaitonde S.
        • Samols D.
        • Kushner I.
        C-reactive protein and systemic lupus erythematosus.
        Arthritis Rheum. 2008; 59: 1814-1820