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Huang G, Wu KK, Li XN, Kuai JH, Zhang AJ. Intestinal tuberculosis with small bowel stricture and hemorrhage as the predominant manifestation: Three case reports. World J Gastrointest Surg 2024; 16:248-256. [PMID: 38328313 PMCID: PMC10845280 DOI: 10.4240/wjgs.v16.i1.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Intestinal tuberculosis is a chronic disease caused by Mycobacterium tuberculosis that mainly affects the ileum and cecum. Small bowel tuberculosis, characterized by predominant involvement of the small intestine, is an extremely rare condition with highly atypical clinical presentations, making diagnosis even more challenging. CASE SUMMARY We report three cases of small intestinal tuberculosis, two of the patients presented primarily with abdominal pain, and one presented with gastrointestinal bleeding. All patients underwent blood tests and imaging examinations. Small bowel endoscopy (SBE) revealed that the main lesions in these patients were intestinal stenosis or gastrointestinal bleeding caused by small intestinal ulcers. One patient ultimately underwent surgical treatment. Following a complex diagnostic process and comprehensive analysis, all patients were confirmed to have small intestinal tuberculosis and received standard antituberculosis treatment, leading to an improvement in their condition. CONCLUSION Patients with SBTs present with nonspecific symptoms such as abdominal pain, weight loss, and occasional gastrointestinal bleeding. Accurate diagnosis requires a thorough evaluation of clinical symptoms and various tests to avoid misdiagnosis and complications.
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Affiliation(s)
- Gang Huang
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Kang-Kang Wu
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Xiao-Na Li
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Jing-Hua Kuai
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Ai-Jun Zhang
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
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2
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Tanoglu A, Erdem H, Friedland JS, Ankaralı H, Garcia-Goez JF, Albayrak A, El-Kholy A, Ceviker SA, Amer F, Erol S, Darazam IA, Rabiei MM, Sarwar MZ, Zeb M, Nawaz H, Ceylan MR, Cernat R, Tasbakan M, Ayoade F, Ruch Y, Tigen ET, Angioni G, Rajani DP, Akhtar N, Surme S, Sengoz G, Karlıdag GE, Marino A, Ripon RK, Çağ Y, Aydın Ö, Akkoyunlu Y, Seyman D, Angamuthu K, Cascio A, Popescu CP, Sirmatel F, Eren E, Dar RE, Munu FU, Tanoglu EG, Echeverry E, Velez JD, Artuk C, Balin SO, Pandya N, Erdem A, Demiray EKD, Aypak A. Clinicopathological profile of peritoneal tuberculosis and a new scoring model for predicting mortality: an international ID-IRI study. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04630-9. [PMID: 37318601 DOI: 10.1007/s10096-023-04630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/03/2023] [Indexed: 06/16/2023]
Abstract
Existing literature about peritoneal tuberculosis (TBP) is relatively insufficient. The majority of reports are from a single center and do not assess predictive factors for mortality. In this international study, we investigated the clinicopathological characteristics of a large series of patients with TBP and determined the key features associated with mortality. TBP patients detected between 2010 and 2022 in 38 medical centers in 13 countries were included in this retrospective cohort. Participating physicians filled out an online questionnaire to report study data. In this study, 208 patients with TBP were included. Mean age of TBP cases was 41.4 ± 17.5 years. One hundred six patients (50.9%) were females. Nineteen patients (9.1%) had HIV infection, 45 (21.6%) had diabetes mellitus, 30 (14.4%) had chronic renal failure, 12 (5.7%) had cirrhosis, 7 (3.3%) had malignancy, and 21 (10.1%) had a history of immunosuppressive medication use. A total of 34 (16.3%) patients died and death was attributable to TBP in all cases. A pioneer mortality predicting model was established and HIV positivity, cirrhosis, abdominal pain, weakness, nausea and vomiting, ascites, isolation of Mycobacterium tuberculosis in peritoneal biopsy samples, TB relapse, advanced age, high serum creatinine and ALT levels, and decreased duration of isoniazid use were significantly related with mortality (p < 0.05). This is the first international study on TBP and is the largest case series to date. We suggest that using the mortality predicting model will allow early identification of high-risk patients likely to die of TBP.
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Affiliation(s)
- Alpaslan Tanoglu
- Department of Internal Medicine and Gastroenterology, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, University of Health Sciences, 34785, Istanbul, Turkey.
| | - Hakan Erdem
- Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
- MKCC Cardiac Centre, Awali, Bahrain
| | | | - Handan Ankaralı
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Jose Fernando Garcia-Goez
- Infectious Disease Service Hospital Universitario Fundacion Valle del Lili Colombia, Facultad de Medicina Universidad Icesi, Cali, Colombia
| | - Ayse Albayrak
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sevil Alkan Ceviker
- Department of Infectious Diseases, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Fatma Amer
- Department of Medical Microbiology and Immunology, Zagazig Faculty of Medicine, Zagazig, Egypt
| | - Serpil Erol
- Department of Infectious Diseases, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | | | | | - Misbah Zeb
- Department of Infectious Diseases, Mayo Hospital, Lahore, Pakistan
| | - Hassan Nawaz
- Department of Infectious Diseases, Mayo Hospital, Lahore, Pakistan
| | | | - Roxana Cernat
- Department of Infectious Diseases, Clinical Hospital for Infectious Diseases, Constanta, Romania
| | - Meltem Tasbakan
- Department of Infectious Diseases, Ege University, Izmir, Turkey
| | - Folusakin Ayoade
- Department of Infectious Diseases, University of Miami, Miami, FL, USA
| | - Yvon Ruch
- Department of Infectious Diseases, Strasbourg University, Strasbourg, France
| | - Elif Tükenmez Tigen
- Department of Infectious Diseases, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Goffredo Angioni
- Department of Infectious Diseases, Hospital SS Trinità, Borgomanero, Italy
| | - Dhanji P Rajani
- Microcare Laboratory & Tuberculosis Research Centre, Surat, Gujarat, India
| | - Nasim Akhtar
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Serkan Surme
- Department of Infectious Diseases, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gonul Sengoz
- Department of Infectious Diseases, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gulden Eser Karlıdag
- Department of Infectious Diseases, Elazig Fethi Sekin City Hospital, University of Health Sciences, Elazig, Turkey
| | - Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Rezaul Karim Ripon
- Department of Public Health and Informatics, Jahangirnagar University, Savar Union, Bangladesh
| | - Yasemin Çağ
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Özlem Aydın
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Akkoyunlu
- Department of Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Derya Seyman
- Department of Infectious Diseases, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Kumar Angamuthu
- Department of Infectious Diseases, Almana General Hospitals, Dammam, Saudi Arabia
| | - Antonio Cascio
- Infectious Disease Unit, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | - Corneliu Petru Popescu
- Department of Infectious Diseases, Dr. Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Fatma Sirmatel
- Department of Infectious Diseases, Bolu Abant Izzet Baysal University Medical Faculty, Bolu, Turkey
| | - Esma Eren
- Department of Infectious Diseases, Kayseri City Hospital, Kayseri, Turkey
| | - Razi Even Dar
- Department of Infectious Diseases, Caemal, Haifa, Israel
| | - Foday Usman Munu
- Department of Infectious Diseases, Lakka Government Hospital, Freetown, Sierra Leone
| | - Esra Guzel Tanoglu
- Department of Molecular Biology and Genetics, University of Health Sciences, Istanbul, Turkey
| | - Esteban Echeverry
- Infectious Disease Service Hospital Universitario Fundacion Valle del Lili Colombia, Facultad de Medicina Universidad Icesi, Cali, Colombia
| | - Juan Diego Velez
- Infectious Disease Service Hospital Universitario Fundacion Valle del Lili Colombia, Facultad de Medicina Universidad Icesi, Cali, Colombia
| | - Cumhur Artuk
- Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Safak Ozer Balin
- Department of Infectious Diseases, Fırat University Medical Faculty, Elazig, Turkey
| | - Nirav Pandya
- Department of Infectious Diseases, Bhailal Amin General Hospital, Vadodara, India
| | - Aysegul Erdem
- Department of Pathology, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | | | - Adalet Aypak
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Training and Research Hospital, Ankara, Turkey
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Mantilla JC, Chaves JJ, Africano-Lopez F, Blanco-Barrera N, Mantilla MJ. Gastrointestinal tuberculosis: An autopsy-based study. INFECTIOUS MEDICINE 2023; 2:122-127. [PMID: 38077832 PMCID: PMC10699657 DOI: 10.1016/j.imj.2023.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 06/29/2024]
Abstract
BACKGROUND Tuberculosis is a disease of great relevance since it is one of the leading causes of morbidity and mortality worldwide. Gastrointestinal tuberculosis is an unusual presentation. It is defined as the involvement of any segment of the digestive tract, associated viscera, and peritoneum. The study's main objective is to collect information from autopsies of patients diagnosed with gastrointestinal tuberculosis in a Pathology reference center in Colombia. METHODS This is a retrospective and descriptive study of autopsy reports. A total of 4,500 autopsies were performed between January 2004 and December 2020. The inclusion criteria were authorization of a family member following local law regulations and a final autopsy diagnosis of gastrointestinal tuberculosis using microscopic visualization. RESULTS Forty-eight patients with gastrointestinal tuberculosis autopsies were included in our study. Most of the patients were male (n = 35, 72.9%) with a median age of 40.5 years old. Human immunodeficiency virus infection history was reported in 28 cases (58.33%). The most affected gastrointestinal tract site was the terminal ileum. Ulcers and thickened epithelium were common autopsies macroscopic findings. Tuberculosis multiorgan compromise was a relevant finding in patients with gastrointestinal tuberculosis. CONCLUSIONS Gastrointestinal tuberculosis is a disease of great importance, being its diagnosis a clinical challenge. Underdiagnosis can be reported in a high percentage of cases, so autopsy diagnosis can help reveal more accurate data about this condition.
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Affiliation(s)
- Julio Cesar Mantilla
- Department of Pathology, Universidad Industrial de Santander, Bucaramanga 680002, Colombia
- Department of Pathology, Hospital Universitario de Santander, Bucaramanga 680002, Colombia
| | - Juan José Chaves
- Department of Pathology, Fundación Universitaria de Ciencias de la Salud, Bogotá 111411, Colombia
- Department of Gastroenterology, Gastrocenter and Medical Specialities, Ipiales 524061, Colombia
| | - Ferney Africano-Lopez
- Department of Gastroenterology, Universidad Militar Nueva Granada, Bogotá 250240, Colombia
| | - Néstor Blanco-Barrera
- Department of Gastroenterology, Universidad Militar Nueva Granada, Bogotá 250240, Colombia
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Maulahela H, Simadibrata M, Nelwan EJ, Rahadiani N, Renesteen E, Suwarti SWT, Anggraini YW. Recent advances in the diagnosis of intestinal tuberculosis. BMC Gastroenterol 2022; 22:89. [PMID: 35227196 PMCID: PMC8885312 DOI: 10.1186/s12876-022-02171-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/29/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intestinal tuberculosis still has a high incidence, especially in developing countries. The biggest challenge of this disease is the establishment of the diagnosis because the clinical features are not typical. Investigations such as culture, acid-fast bacilli (AFB) staining, and histopathology have low sensitivity, so other investigations are needed. Latest molecular-based diagnostic modalities such as GeneXpert, interferon-gamma (IFN-γ) release assays (IGRA), polymerase chain reaction (PCR), multiplex-PCR, and immunological markers are expected to help diagnose intestinal tuberculosis. This article review will examine the latest diagnostic modalities that can be used as a tool in establishing the diagnosis of intestinal tuberculosis. RESULTS Through a literature search, we were able to review the diagnostic values of various available diagnostic modalities as the appropriate additional test in intestinal tuberculosis. Culture as a gold standard has a sensitivity and specificity value of 9.3% and 100% with the MGIT BACTEC system as the most recommended medium. The sensitivity values of AFB staining, histopathology examination, GeneXpert, IGRA, PCR, multiplex-PCR and, immunological markers were ranged between 17.3 and 31%; 68%; 81-95.7%; 74-88%; 21.6-65%; 75.7-93.1%; and 52-87%, respectively. Meanwhile the specificity values were 100%; 77.1%; 91-100%; 74-87%; 93-100%; 96.4-100%; and 70-95%, respectively. CONCLUSION The combination of clinical examination, conventional examination, and the latest molecular-based examination is the best choice for establishing the diagnosis of intestinal tuberculosis. Most recent modalities such as multiplex PCR and immunological marker examinations are diagnostic tools that deserve to be used in diagnosing intestinal tuberculosis as their sensitivity and specificity values are quite high and more evidences are expected to support the application of these examinations shortly soon.
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Affiliation(s)
- Hasan Maulahela
- Division of Gastroenterology, Internal Medicine Department, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National Central General Hospital, Infectious Diseases and Immunology Research Center, Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia.
| | - Marcellus Simadibrata
- Division of Gastroenterology, Internal Medicine Department, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National Central General Hospital, Infectious Diseases and Immunology Research Center, Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Erni Juwita Nelwan
- Division of Tropical Medicine and Infectious Diseases, Internal Medicine Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Infectious Diseases and Immunology Research Center, Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Nur Rahadiani
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Editha Renesteen
- Infectious Diseases and Immunology Research Center, Faculty of Medicine Universitas Indonesia, Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - S W T Suwarti
- Infectious Diseases and Immunology Research Center, Faculty of Medicine Universitas Indonesia, Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
| | - Yunita Windi Anggraini
- Infectious Diseases and Immunology Research Center, Faculty of Medicine Universitas Indonesia, Indonesian Medical Education and Research Institute (IMERI), Jakarta, Indonesia
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Kővári B, Pai RK. Upper Gastrointestinal Tract Involvement in Inflammatory Bowel Diseases: Histologic Clues and Pitfalls. Adv Anat Pathol 2022; 29:2-14. [PMID: 34310370 PMCID: PMC8663524 DOI: 10.1097/pap.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The upper gastrointestinal (UGI) manifestations of inflammatory bowel diseases (IBDs) are frequently obscured by classic ileal and colonic symptoms and are reported to involve only 0.5% to 4% of adult patients. However, because of the improvement of endoscopic techniques and the growing use of esophagogastroduodenososcopy with biopsy, both asymptomatic and clinically significant esophageal, gastric, and duodenal manifestations are increasingly recognized. The UGI involvement in IBD was historically synonymous with Crohn's disease (CD), but the doctrine of ulcerative colitis (UC) being limited to the colon has been challenged, and UC-related gastroduodenal lesions have been reported. The diagnosis of UGI IBD should ideally rely on a combination of the clinical history, endoscopic picture, and histologic features. Although endoscopic changes such as aphthoid or longitudinal ulcers and bamboo-joint-like pattern are suggestive of CD, histologic evaluation increases the sensitivity of the IBD diagnosis since histologic alterations may be present in endoscopically unremarkable mucosa. Conversely, in many cases, the histologic findings are nonspecific, and the knowledge of clinical history is vital for reaching an accurate diagnosis. The presence of epithelioid granuloma is highly suggestive of CD but is present in a minority of CD cases; thus, pathologists should be aware of how to diagnose UGI IBD in the absence of granulomata. This article reviews the most important clinical, endoscopic, and histologic features of IBD-associated esophagitis, gastritis, and duodenitis, as well as the IBD-related manifestations in the biliary tract and the postcolectomy setting.
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Affiliation(s)
- Bence Kővári
- Department of Pathology, Henry Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Pathology, University of Szeged and Albert Szent-Györgyi Health Center, Szeged, Hungary
| | - Rish K. Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ
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