Recently, faecal-TB PCR test targeting IS6110 has also been documented by Balamurugan et al. (2010) in differentiating these two diseases. However, clinical utility of this PCR test is not validated in large number of patients. One major drawback of conventional PCR is that it requires tissue destruction and nucleic acid extraction making impossible HDAC inhibitors in clinical trials correlation with histological characteristics (Almadi et al., 2009). An in situ PCR has been developed where IS6110 target was amplified within the intact cells and that combined the ability to localize specific DNA within tissues (Pulimood
et al., 2008). This method could also differentiate intestinal TB from Crohn’s disease in archival mucosal biopsy specimens. However, the sensitivity of in situ PCR needs to be improved and studies should be carried out on large number of patients with Crohn’s disease and intestinal TB before its usefulness is confirmed (Pulimood et al., 2008; Almadi et al., 2009). Cutaneous TB constitutes about 1.5% of all EPTB
cases (Singal & Sonthalia, 2010). However, this disease has re-emerged during the last two decades together with high incidence of PTB and multiple-drug resistant TB (MDR-TB; Abdalla et al., 2009). Differentiation of cutaneous TB from other infectious granulomas of the skin (sarcoidosis, leprosy, fungal 5-Fluoracil chemical structure or NTM infections) is difficult because of insufficient AFB in the tissue biopsies (Bravo & Gotuzzo, 2007). Of all the clinical types, scrofuloderma is the most commonly encountered variant followed by lupus vulgaris, TB verrucosa cutis and lichen scrofulosorum (Singal & Sonthalia, 2010). Tangeritin These clinical types
of cutaneous TB have been confirmed by PCR, while smear microscopy and culture test completely failed (Padmavathy et al., 2003). Interestingly, Okazaki et al. (2005) reported first case of M. bovis BCG-derived cutaneous TB (localized at different area from the vaccination site) without immune deficiency by multiplex PCR assay based on region of difference (RD)1, complement sequence of RD1, RD2, RD8, RD14 and SenX3-RegX3 regions originating from M. bovis BCG Tokyo 172. TB cutis orificialis, a rare manifestation of cutaneous TB (caused by auto-inoculation of M. tuberculosis in patients with advanced internal TB), has been confirmed by PCR (Choi et al., 2009). Using culture/histopathology as the gold standard, IS6110-based conventional PCR/nested PCR has been well documented in diagnosing cutaneous TB and that showed superiority over 16S rRNA gene-based PCR (Ogusku et al., 2003; Obieta et al., 2010). A highly sensitive and specific PCR assay targeting 65 kDa protein gene has also been developed for the diagnosis of cutaneous TB, considering culture/response to ATT as the gold standard (Negi et al., 2005a; Abdalla et al., 2009). Ocular TB represents a rare form of EPTB, which accounts for 0.