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Vargas Rodríguez AE, Godinez Vidal AR, Alcántara Gordillo R, Duarte Regalado CS, Soto Llanes JO. A Case Report and Literature Review of Intestinal Perforation Due to Tuberculosis. Cureus 2023; 15:e43241. [PMID: 37692608 PMCID: PMC10491503 DOI: 10.7759/cureus.43241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Intestinal tuberculosis (ITB) is challenging due to its nonspecific clinical presentation, sometimes manifesting with acute complications such as intestinal perforation or obstruction. We present the case of a 39-year-old male presented with continuous fever, abdominal pain, and peritoneal irritation. A contrast-enhanced thoracoabdominopelvic computed tomography revealed free air and fluid, suggestive of intestinal perforation. Urgent surgical treatment was performed via exploratory laparotomy, including right hemicolectomy and construction of a Brooke ileostomy. Histopathological analysis confirmed intestinal miliary tuberculosis. The most commonly affected areas in ITB are the ileocecal region and ileum. Symptoms include abdominal pain, weight loss, changes in bowel habits, and fever. Contrast-enhanced computed tomography is crucial for diagnosis. The first-line treatment is medical with antituberculosis drugs. Due to its delayed diagnosis, ITB should be considered in patients with nonspecific and progressive symptoms. Early medical management is crucial to prevent acute complications associated with high morbidity and mortality.
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2
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Zhou R, Qiu X, Ying J, Yue Y, Ruan T, Yu L, Liu Q, Sun X, Wang S, Qu Y, Li X, Mu D. Diagnostic performance of adenosine deaminase for abdominal tuberculosis: A systematic review and meta-analysis. Front Public Health 2022; 10:938544. [PMID: 36211645 PMCID: PMC9533650 DOI: 10.3389/fpubh.2022.938544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023] Open
Abstract
Background and aim Abdominal tuberculosis (TB) is a common type of extrapulmonary TB with an insidious onset and non-specific symptoms. Adenosine deaminase (ADA) levels increase rapidly in the early stages of abdominal TB. However, it remains unclear whether ADA serves as a diagnostic marker for abdominal TB. Methods We performed a systematic literature search for relevant articles published in PubMed, Web of Science, Cochrane Library, and Embase up to April 2022. First, we used the Quality Assessment of Diagnostic Accuracy Studies tool-2 (QUADAS-2), to evaluate the quality of the included articles. Bivariate and hierarchical summary receiver operating characteristic (HSROC) models were then utilized to analyze pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC). In addition, we explored a subgroup analysis for potential heterogeneity and publication bias among the included literature. Results Twenty-four articles (3,044 participants, 3,044 samples) which met the eligibility criteria were included in this study. The pooled sensitivity and specificity of ADA for abdominal TB detection were 93% [95% confidence interval (CI): 0.89-0.95] and 95% (95% CI: 0.93-0.96), respectively. PLR and NLR were 18.6 (95% CI: 14.0-24.6) and 0.08 (95% CI: 0.05-0.12), respectively. DOR and AUROC were 236 (95% CI: 134-415) and 0.98 (95% CI: 0.96-0.99), respectively. Furthermore, no heterogeneity or publication bias was found. Conclusions Our meta-analysis found ADA to be of excellent diagnostic value for abdominal TB and could be used as an auxiliary diagnostic tool. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022297931.
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Affiliation(s)
- Ruixi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xia Qiu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Junjie Ying
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China,*Correspondence: Junjie Ying
| | - Yan Yue
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Tiechao Ruan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Luting Yu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Qian Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xuemei Sun
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Shaopu Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xihong Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China,Dezhi Mu
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3
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Mehershahi S, Haider A, Fortuzi K, Shaikh DH, Patel H. Abdominal Ascites of Unknown Origin: Diagnostic Accuracy of Adenosine Deaminase for Tuberculous Peritonitis. Case Rep Gastroenterol 2021; 15:418-423. [PMID: 33976620 PMCID: PMC8077663 DOI: 10.1159/000514892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
The occurrence of tuberculosis (TB) is exceedingly rare in the United States (US), and incidence has steadily declined since 1993, but the pace of decline has slowed in recent years. The US TB rate during 2019 declined to 2.7 cases per 100,000 persons, the lowest level on record. The abdominal form is the sixth leading cause of extrapulmonary TB, after lymphatic, genitourinary, osteoarticular, miliary, and meningeal. Abdominal TB can infect any part of the gastrointestinal tract, including the peritoneum and the pancreaticobiliary system. We present a case of persistently elevated adenosine deaminase in peritoneal ascites of a young, healthy female with new-onset ascites. An extended diagnostic evaluation was performed to reach the diagnosis.
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Affiliation(s)
- Shehriyar Mehershahi
- Gastroenterology, BronxCare Health System, Bronx, New York, USA.,Internal Medicine, BronxCare Health System, Bronx, New York, USA
| | - Asim Haider
- Internal Medicine, BronxCare Health System, Bronx, New York, USA
| | - Ked Fortuzi
- Internal Medicine, BronxCare Health System, Bronx, New York, USA
| | - Danial H Shaikh
- Gastroenterology, BronxCare Health System, Bronx, New York, USA.,Internal Medicine, BronxCare Health System, Bronx, New York, USA
| | - Harish Patel
- Gastroenterology, BronxCare Health System, Bronx, New York, USA.,Internal Medicine, BronxCare Health System, Bronx, New York, USA
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4
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Ladumor H, Al-Mohannadi S, Ameerudeen FS, Ladumor S, Fadl S. TB or not TB: A comprehensive review of imaging manifestations of abdominal tuberculosis and its mimics. Clin Imaging 2021; 76:130-143. [PMID: 33596517 DOI: 10.1016/j.clinimag.2021.02.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
The ever-growing prevalence of tuberculosis is a cause for concern among both developing and developed countries. Abdominal tuberculosis is the most common site of extrapulmonary tuberculosis and involves almost all of the visceral organs. Clinical presentation of abdominal tuberculosis is often non-specific. Thus, having a high index of clinical suspicion is necessary to aide early diagnosis and guide prompt initiation of appropriate treatment. In this review, we focus on the entire spectrum of abdominal tuberculosis and other diseases mimicking it with an emphasis on their imaging findings.
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Affiliation(s)
- Heta Ladumor
- Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar.
| | - Salma Al-Mohannadi
- Weill Cornell Medicine - Qatar, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar
| | | | - Sushila Ladumor
- Department of Radiology, Hamad General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Shaimaa Fadl
- Department of Radiology, Virginia Commonwealth University, West Hospital, 1200 East Broad Street, Room 2-013, Box 984070, Richmond, VA, 23298, United States of America
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5
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Abstract
Diagnosing intestinal tuberculosis (TB) with uncommon clinical manifestations is often challenging. Here, we report a case of an alcoholic patient who presented with vague symptoms and was later diagnosed with intestinal TB. This patient experienced multiorgan failure causing hemodynamic instability requiring ionotropic support; acute hypoxic respiratory failure managed with non-invasive positive pressure ventilation, hepatic failure, transudative peritoneal effusion, and transudative pleural effusion. These conditions clouded our judgment to pursue colonoscopy for a definite diagnosis and delayed the anti-tuberculosis treatment. When intestinal tuberculosis TB is suspected, the differential diagnosis must be established with other gastrointestinal involving diseases, including mycobacterium avium complex (MAC) and Crohn's disease (CD). MAC can show overlapping features with intestinal TB or coexist with it; Acid-fast stain and tissue culture are the key tests to differentiate these two. In the presence of diagnostic uncertainty between intestinal TB and CD, a therapeutic trial with anti-tuberculous therapy may be warranted.
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Affiliation(s)
- Hansang Park
- Internal Medicine, New York City Health and Hospitals Corporation (NYC HHC) Metropolitan, New York, USA
| | - Tikal Kansara
- Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | - Ana M Victoria
- Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | - Noella Boma
- Internal Medicine, Metropolitan Hospital, New York, USA
| | - Jungrak Hong
- Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
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6
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Dhali A, Das K, Dhali G, Ghosh R, Sarkar A, Misra D. Abdominal tuberculosis: Clinical profile and outcome. Int J Mycobacteriol 2021; 10:414-420. [PMID: 34916461 DOI: 10.4103/ijmy.ijmy_195_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Gopal Sharma R. Sharma's Parachute Sign in abdomino-pelvic TB. Indian J Tuberc 2019; 68:400. [PMID: 34099208 DOI: 10.1016/j.ijtb.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Ram Gopal Sharma
- Department of Surgery, Maharishi Markandeshwar(Deemed to Be University), Mullana, Ambala, Haryana, India.
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8
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Wu DC, Averbukh LD, Wu GY. Diagnostic and Therapeutic Strategies for Peritoneal Tuberculosis: A Review. J Clin Transl Hepatol 2019; 7:140-148. [PMID: 31293914 PMCID: PMC6609850 DOI: 10.14218/jcth.2018.00062] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023] Open
Abstract
Peritoneal tuberculosis (PTB), although rarer than its pulmonary counterpart, is a serious health concern in regions of the world with high tuberculosis prevalence. Individuals with baseline immunocompromise condition, whether acquired or medically induced, are at greatest risk for experiencing PTB. While medical treatment of the condition is similar to that of the pulmonary disease, the generally immunocompromised state of those infected with PTB, along with a lack of highly sensitive and specific testing methods make early diagnosis difficult. This review discusses the risks factors, clinical features, diagnostic methods, and treatment options for PTB.
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Affiliation(s)
| | - Leon D. Averbukh
- *Correspondence to: Leon D. Averbukh, Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, 236 Farmington Ave., Farmington, CT 06030, USA. Tel: +1-347-306-4752, Fax: +1-860-679-4613, E-mail:
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9
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Gong Y, Li S, Rong R, Chen X, Jiang L. Isolated gastric varices secondary to abdominal tuberculosis mimicking lymphoma: a case report. BMC Gastroenterol 2019; 19:78. [PMID: 31138138 PMCID: PMC6540571 DOI: 10.1186/s12876-019-0998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Abdominal tuberculosis (TB) rarely presents with abdominal masses and rarely causes isolated gastric varices. Case presentation We report a case of isolated gastric varices secondary to abdominal TB mimicking lymphoma. A 42-year-old woman without any history of liver disease presented with melena and mild abdominal pain. Upon admission to the hospital, laboratory investigations revealed a hemoglobin level of 76 g/L. Gastroduodenoscopic examination showed isolated gastric fundal varices with red color signs. Abdominal contrast-enhanced computed tomography (CECT) revealed non-enhanced masses of soft-tissue density in the lesser omental and the retropancreatic areas, multiple para-aortic lymph nodes, and multiple small hypodense splenic lesions. Positron emission tomography-CT showed hypermetabolic [F-18]2-fluoro-2-deoxyglucose activity involving multiple regional lymph nodes and the bone marrow, suggestive of lymphoma. Bone marrow biopsy revealed no abnormality. Histopathological examination of a CT-guided biopsy specimen showed granulomatous inflammation with necrosis and microorganisms that stained positive with acid-fast stains. Abdominal CECT showed a decrease in the size of the lesser omental and peripancreatic masses, as well as the para-aortic lymph nodes after 4-month anti-TB therapy. Conclusions TB should be considered among the differential diagnoses in patients with abdominal masses, isolated gastric varices, and regional lymphadenopathy. Prompt and definitive diagnosis of abdominal TB requires a coordinated approach involving laboratory tests, radiological examination, and invasive procedures for optimal decision making and management.
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Affiliation(s)
- Yaoyao Gong
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
| | - Shuo Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
| | - Rong Rong
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
| | - Xiaoxing Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China.
| | - Liuqin Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
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10
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Mandavdhare HS, Singh H, Dutta U, Sharma V. A real-world experience with 6 months of antitubercular therapy in abdominal tuberculosis. JGH OPEN 2019; 3:201-205. [PMID: 31276036 PMCID: PMC6586575 DOI: 10.1002/jgh3.12136] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 12/21/2022]
Abstract
Background and Aim Abdominal tuberculosis is an important form of extrapulmonary tuberculosis. Evidence from clinical trials suggests that 6 months of antitubercular therapy (ATT) is sufficient for abdominal tuberculosis. Methods We report real-world experience with 6 months of ATT based on a retrospective analysis of patients with abdominal tuberculosis seen at a large tertiary care hospital in India. Results Of 101 patients, 93 with complete records were included. The mean age was 35.90 ± 14.06 years, and 53 were males (56.98%). A total of 42 patients (45.16%) had intestinal involvement, 24 (25.08%) had peritoneal, 22 (23.65%) had combined involvement, and 5 patients (5.37%) had isolated lymph nodal involvement. Six patients received prolonged ATT. Six patients developed ATT-induced hepatitis. Of 64 patients with intestinal involvement, 45 had stricturing disease (70.3%), of whom 7 (15.5%) required surgery due to refractory symptoms. Overall, there was one death, and eight patients (including one with massive gastrointestinal bleeding) needed surgery. Conclusion Six months of ATT is associated with objective clinical response in most of the patients of abdominal tuberculosis.
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Affiliation(s)
- Harshal S Mandavdhare
- Department of Gastroenterology and General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Harjeet Singh
- Department of Gastroenterology and General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Usha Dutta
- Department of Gastroenterology and General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Vishal Sharma
- Department of Gastroenterology and General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
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11
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Cho JK, Choi YM, Lee SS, Park HK, Cha RR, Kim WS, Kim JJ, Lee JM, Kim HJ, Ha CY, Kim HJ, Kim TH, Jung WT, Lee OJ. Clinical features and outcomes of abdominal tuberculosis in southeastern Korea: 12 years of experience. BMC Infect Dis 2018; 18:699. [PMID: 30587154 PMCID: PMC6307147 DOI: 10.1186/s12879-018-3635-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 12/18/2018] [Indexed: 12/30/2022] Open
Abstract
Background Abdominal tuberculosis (TB) is an uncommon form of infection with Mycobacterium tuberculosis in Korea. In this study, we aimed to highlight the clinical features, diagnostic methods, and outcomes of abdominal TB over 12 years in Southeastern Korea. Methods A total of 139 patients diagnosed as having abdominal TB who received anti-TB medication from January 2005 to June 2016 were reviewed. Among them, 69 patients (49.6%) had luminal TB, 28 (20.1%) had peritoneal TB, 7 (5.0%) had nodal TB, 23 (16.5%) had visceral TB, and 12 (8.6%) had mixed TB. Results The most frequent symptoms were abdominal pain (34.5%) and abdominal distension (21.0%). Diagnosis of abdominal TB was confirmed using microbiologic and/or histologic methods in 76 patients (confirmed diagnosis), while the remaining 63 patients were diagnosed based on clinical presentation and radiologic imaging (clinical diagnosis). According to diagnostic method, frequency of clinical diagnosis was highest in patients with luminal (50.7%) or peritoneal (64.3%) TB, while frequency of microscopic diagnosis was highest in patients with visceral TB (68.2%), and frequency of histologic diagnosis was highest in patients with nodal TB (85.2%). Interestingly, most patients, except those with nodal TB, showed a good response to anti-TB agents, with 84.2% showing a complete response. The mortality rate was only 1.4% in the present study. Conclusions Most patients responded very well to anti-TB therapy, and surgery was required in only a minority of cases of suspected abdominal TB.
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Affiliation(s)
- Jin-Kyu Cho
- Department of Surgery, Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, 52727, Gyeongnam, Republic of Korea
| | - Young Min Choi
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea
| | - Sang Soo Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea. .,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea. .,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
| | - Hye Kyong Park
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ra Ri Cha
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Wan Soo Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jin Joo Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae Min Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hong Jun Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Chang Yoon Ha
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Tae Hyo Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Woon Tae Jung
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Ok Jae Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
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12
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Singh H, Krishnamurthy G, Rajendran J, Sharma V, Mandavdhare H, Kumar H, Deen Yadav T, Vasishta RK, Singh R. Surgery for Abdominal Tuberculosis in the Present Era: Experience from a Tertiary-Care Center. Surg Infect (Larchmt) 2018; 19:640-645. [PMID: 30044168 DOI: 10.1089/sur.2018.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The role of surgery in abdominal tuberculosis is being redefined, as many patients will be candidates for endoscopic dilatation rather than open surgery. METHODS A retrospective analysis was done of the surgical procedures performed in patients with abdominal tuberculosis in a large tertiary-care center in North India. Details such as clinical presentations, previous history of tuberculosis, any anti-tubercular therapy (ATT), Mantoux skin test results, and the surgical procedures and findings were recorded. Short-term outcomes also were analyzed. RESULTS Thirty-five patients (26 male) were included, and the median age at presentation was 24 years (range 12-80 years). Sixteen patients had received prior ATT for abdominal tuberculosis. The indication for surgery was intestinal obstruction, perforation, and bleeding in 23 (66%), 10 (29%), and 2 (6%) respectively. Twenty-eight patients had intestinal strictures, with the ileum being the most common site (n = 21). Perforation was present in 10 patients, of which six had multiple perforations. Cocoon abdomen was present in four patients, two of whom had associated small-bowel stricture. Among 33 patients who underwent bowel resection, 14 had ileo-cecal resection/right hemicolectomy. The rest had small-bowel resection. Primary anastomosis and stoma creation was performed in 12 (36%) and 21 (64%), respectively. Post-operative intra-abdominal collections (p = 0.02) and incision dehiscence (p = 0.05) were more common in patients having stoma creation. CONCLUSION Surgical intervention is warranted in a subset of patients with abdominal tuberculosis and may be required in patients with recurrent intestinal obstruction or pain, intestinal perforation, or gastrointestinal bleeding.
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Affiliation(s)
- Harjeet Singh
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Gautham Krishnamurthy
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Jayapal Rajendran
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Vishal Sharma
- 2 Department of Gastroenterology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Harshal Mandavdhare
- 2 Department of Gastroenterology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Hemanth Kumar
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Thakur Deen Yadav
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Rakesh Kumar Vasishta
- 3 Department of Histopathology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Rajinder Singh
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
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13
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Aggarwal P, Kedia S, Sharma R, Bopanna S, Madhusudhan KS, Yadav DP, Goyal S, Jain S, Mouli VP, Das P, Dattagupta S, Makharia G, Ahuja V. Tubercular Intestinal Strictures Show a Poor Response to Anti-Tuberculous Therapy. Dig Dis Sci 2017; 62:2847-2856. [PMID: 28856488 DOI: 10.1007/s10620-017-4727-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/18/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The literature on resolution of intestinal strictures in patients with intestinal tuberculosis (ITB) after anti-tuberculous therapy (ATT) is sparse and ambivalent. We aimed to assess the frequency of stricture resolution after ATT and its predictors. METHODS This ambispective cohort study included consecutive ITB patients with strictures who received ATT for ≥6 months and were on regular follow-up between January 2004 and December 2015. Resolution of stricture was assessed at the end of ATT by endoscopy/radiology. RESULTS Of 286 patients, 128 had strictures, and 106 were finally included (63 males, median age 35 years). The stricture location was distal ileum/ileocecal in 52 (49.1%), colon in 37 (34.9%), ileocolonic in 4 (3.8%), proximal small bowel in 10 (9.4%), and gastroduodenal in 4 (3.8%) patients. Although all patients demonstrated mucosal healing (indicating resolution of active infection), stricture resolution occurred only in 25/106 (23.6%) patients. Symptoms pertaining to stricture (pain abdomen/recurrent SAIO) were present in 104/106 (98%) patients, and after a median of 6 (6-9) months of ATT, these symptoms resolved only in half, 88% (22/25) in patients with stricture resolution and 38% (30/79) in patients with persistent strictures. Colonic strictures had the least resolution (5.4%) followed by proximal small intestinal (20%) and distal ileal/ileocecal (36.5%). Although not statistically significant, stricture resolution was less frequent in patients with multiple strictures, longer strictures (>3 cm), and strictures in which scope was not negotiable prior to ATT. CONCLUSION Only one-fourth of ITB patients with strictures show resolution of stricture following ATT. The resolution of strictures is dependent on disease location, and majority of them exhibit symptoms pertaining to stricture even after ATT.
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Affiliation(s)
- Piyush Aggarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, Room No 3111, Third Floor, Teaching Block, New Delhi, 110070, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, Room No 3111, Third Floor, Teaching Block, New Delhi, 110070, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Room No 66, New Delhi, 110070, India
| | - Sawan Bopanna
- Department of Gastroenterology, All India Institute of Medical Sciences, Room No 3111, Third Floor, Teaching Block, New Delhi, 110070, India
| | | | - Dawesh P Yadav
- Department of Gastroenterology, All India Institute of Medical Sciences, Room No 3111, Third Floor, Teaching Block, New Delhi, 110070, India
| | - Sandeep Goyal
- Department of Gastroenterology, All India Institute of Medical Sciences, Room No 3111, Third Floor, Teaching Block, New Delhi, 110070, India
| | - Saransh Jain
- Department of Gastroenterology, All India Institute of Medical Sciences, Room No 3111, Third Floor, Teaching Block, New Delhi, 110070, India
| | - Venigalla Pratap Mouli
- Department of Gastroenterology, All India Institute of Medical Sciences, Room No 3111, Third Floor, Teaching Block, New Delhi, 110070, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110070, India
| | - Siddhartha Dattagupta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110070, India
| | - Govind Makharia
- All India Institute of Medical Sciences, Room No 3065, Third Floor, Teaching Block, New Delhi, 110070, India
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, Room No 3093, Third Floor, Teaching Block, New Delhi, 110070, India.
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14
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What remains to surgeons in the management of abdominal tuberculosis? A 10 years experience in an endemic area. Indian J Tuberc 2017; 64:167-172. [PMID: 28709483 DOI: 10.1016/j.ijtb.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/28/2016] [Accepted: 01/09/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tuberculosis (TB) is a common endemic disease in Tunisia. Abdominal location is rare. Early diagnosis of abdominal TB remains difficult due to its non-specific clinical presentations. The aim of our study is to highlight the characteristics of the different presentations, to characterize tools contributing to a positive preoperative diagnosis, and finally to assess the role of surgery in the management of this entity. MATERIALS AND METHODS A retrospective review from 2005 to 2015 identified 90 cases of confirmed abdominal TB managed in the Department of General Surgery of the Habib Thameur Hospital. The diagnosis was established by histopathology examination for all cases. This study was approved by the ethical committee. RESULTS The mean age of the patient was 44.13 years with a sex ratio (M/F) of 0.34. We collected 56 cases of peritoneal TB, 12 cases of abdominal lymph node TB, 10 cases of intestinal TB, four cases of hepatic TB, and two cases of gallbladder's TB. For six patients, an association of many localizations was noted. The diagnosis was suspected on clinical, biological, and morphological arguments, but the confirmation was always made by surgical exploration and pathological examination of removed specimens. Surgical management was urgent in complicated cases (13.3%). Laparoscopy was performed in 71 cases (78.9%). Laparoscopic features of peritoneal TB were specific and always confirmed by histological examination. CONCLUSION Despite the wide range of examination available for the preoperative exploration of abdominal TB, diagnosis is usually late and difficult. TB is a medical condition. However, surgical exploration is frequently needed in the management.
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15
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Kentley J, Ooi JL, Potter J, Tiberi S, O'Shaughnessy T, Langmead L, Chin Aleong J, Thaha MA, Kunst H. Intestinal tuberculosis: a diagnostic challenge. Trop Med Int Health 2017; 22:994-999. [PMID: 28609809 DOI: 10.1111/tmi.12908] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe characteristics, presentation, time to diagnosis and diagnostic findings of patients with intestinal tuberculosis (ITB) in a low-burden country. METHOD Retrospective study of 61 consecutive ITB patients diagnosed between 2008 and 2014 at a large East London hospital. RESULTS Forty of sixty-one patients were male. Mean age was 34.6 years. 93% of patients were born abroad, mostly from TB-endemic areas (Indian subcontinent: 88%, Africa: 9%). 25% had concomitant pulmonary TB. Median time from symptom onset to ITB diagnosis was 13 weeks (IQR 3-26 weeks). Ten patients were initially treated for IBD, although patients had ITB. The main sites of ITB involvement were the ileocaecum (44%) or small bowel (34%). Five patients had isolated perianal disease. Colonoscopy confirmed a diagnosis of ITB in 77% of those performed. 42 of 61 patients had a diagnosis of ITB confirmed on positive histology and/or microbiology. CONCLUSION Diagnosis of ITB is often delayed, which may result in significant morbidity. ITB should be excluded in patients with abdominal complaints who come from TB-endemic areas to establish prompt diagnosis and treatment. Diagnosis is challenging but aided by axial imaging, colonoscopy and tissue biopsy for TB culture and histology.
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Affiliation(s)
- J Kentley
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - J L Ooi
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - J Potter
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Tiberi
- Department of Infectious Diseases, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T O'Shaughnessy
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - L Langmead
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Chin Aleong
- Department of Pathology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M A Thaha
- Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - H Kunst
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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16
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Abstract
BACKGROUND Tuberculosis (TB) of the gastrointestinal tract and any other organ within the abdominal cavity is abdominal TB, and most guidelines recommend the same six-month regimen used for pulmonary TB for people with this diagnosis. However, some physicians are concerned whether a six-month treatment regimen is long enough to prevent relapse of the disease, particularly in people with gastrointestinal TB, which may sometimes cause antituberculous drugs to be poorly absorbed. On the other hand, longer regimens are associated with poor adherence, which could increase relapse, contribute to drug resistance developing, and increase costs to patients and health providers. OBJECTIVES To compare six-month versus longer drug regimens to treat people that have abdominal TB. SEARCH METHODS We searched the following electronic databases up to 2 September 2016: the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase (accessed via OvidSP), LILACS, INDMED, and the South Asian Database of Controlled Clinical Trials. We searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for ongoing trials. We also checked article reference lists. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared six-month regimens versus longer regimens that consisted of isoniazid, rifampicin, pyrazinamide, and ethambutol to treat adults and children that had abdominal TB. The primary outcomes were relapse, with a minimum of six-month follow-up after completion of antituberculous treatment (ATT), and clinical cure at the end of ATT. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and assessed the risk of bias in the included trials. For analysis of dichotomous outcomes, we used risk ratios (RR) with 95% confidence intervals (CIs). Where appropriate, we pooled data from the included trials in meta-analyses. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included three RCTs, with 328 participants, that compared six-month regimens with nine-month regimens to treat adults with intestinal and peritoneal TB. All trials were conducted in Asia, and excluded people with HIV, those with co-morbidities and those who had received ATT in the previous five years. Antituberculous regimens were based on isoniazid, rifampicin, pyrazinamide, and ethambutol, and these drugs were administered daily or thrice weekly under a directly observed therapy programme. The median duration of follow-up after completion of treatment was between 12 and 39 months.Relapse was uncommon, with two cases among 140 participants treated for six months, and no events among 129 participants treated for nine months. The small number of participants means we do not know whether or not there is a difference in risk of relapse between the two regimens (very low quality evidence). At the end of therapy, there was probably no difference in the proportion of participants that achieved clinical cure between six-month and nine-month regimens (RR 1.02, 95% CI 0.97 to 1.08; 294 participants, 3 trials, moderate quality evidence). For death, there were 2/150 (1.3%) in the six-month group and 4/144 (2.8%) in the nine-month group. All deaths occurred in the first four months of treatment, so was not linked to the duration of treatment in the included trials. Similarly, the number of participants that defaulted from treatment was small in both groups, and there may be no difference between them (RR 0.50, 95% CI 0.10 to 2.59; 294 participants, 3 trials, low quality evidence). Only one trial reported on adherence to treatment, with only one participant allocated to the nine-month regimen presenting poor adherence to treatment. We do not know whether six-month regimens are associated with fewer people experiencing adverse events that lead to treatment interruption (RR 0.53, 95% CI 0.18 to 1.55; 318 participants, 3 trials, very low quality evidence). AUTHORS' CONCLUSIONS We found no evidence to suggest that six-month treatment regimens are inadequate for treating people that have intestinal and peritoneal TB, but numbers are small. We did not find any incremental benefits of nine-month regimens regarding relapse at the end of follow-up, or clinical cure at the end of therapy, but our confidence in the relapse estimate is very low because of size of the trials. Further research is required to make confident conclusions regarding the safety of six-month treatment for people with abdominal TB. Larger studies that include HIV-positive people, with long follow-up for detecting relapse with reliability, would help improve our knowledge around this therapeutic question.
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Affiliation(s)
- Sophie Jullien
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUK
| | - Siddharth Jain
- All India Institute of Medical SciencesDepartment of Internal MedicineNew DelhiIndia
| | - Hannah Ryan
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUK
| | - Vineet Ahuja
- All India Institute of Medical SciencesDepartment of GastroenterologyAnsari NagarNew DelhiIndia110029
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17
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Bourgain G, Sbai W, Luciano L, Massoure MP, Brardjanian S, Goin G, De Biasi C, Wolf A, Al Shukry A, Coton T. Hepato-peritoneal tuberculosis with negative interferon gamma assay (Quantiferon™) in an immunocompetent patient: A case report. Clin Res Hepatol Gastroenterol 2016; 40:e44-5. [PMID: 26774362 DOI: 10.1016/j.clinre.2015.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 02/04/2023]
Affiliation(s)
- G Bourgain
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France
| | - W Sbai
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France
| | - L Luciano
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France
| | - M P Massoure
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France
| | - S Brardjanian
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France
| | - G Goin
- Service de chirurgie viscérale, hôpital d'instruction des armées, CS 50004, 13384 Marseille cedex 13, France
| | - C De Biasi
- Laboratoire d'anatomo-pathologie, hôpital d'instruction des armées, CS 50004, 13384 Marseille cedex 13, France
| | - A Wolf
- Laboratoire de biologie, hôpital d'instruction des armées, CS 50004, 13384 Marseille cedex 13, France
| | - A Al Shukry
- Service d'ORL, hôpital d'instruction des armées, CS 50004, 13384 Marseille cedex 13, France
| | - T Coton
- Service de pathologie digestive, hôpital d'instruction des armées Laveran, CS 50004, 13384 Marseille cedex 13, France.
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Sharma JB, Singh N, Dharmendra S, Singh UB, P V, Kumar S, Roy KK, Hari S, Iyer V, Sharma SK. Six months versus nine months anti-tuberculous therapy for female genital tuberculosis: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2016; 203:264-73. [PMID: 27391900 DOI: 10.1016/j.ejogrb.2016.05.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/19/2016] [Accepted: 05/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare six months versus nine months anti-tuberculous therapy in patients of female genital tuberculosis. STUDY DESIGN It was a randomized controlled trial in a tertiary referral center teaching institute on 175 women presenting with infertility and found to have female genital tuberculosis on clinical examination and investigations. Group I women (86 women) were given 9 months of intermitted anti-tuberculous therapy under directly observed treatment short course (DOTS) strategy while Group II (89 women) were given 6 months of anti-tuberculous therapy under DOTS. Patients were evaluated for primary end points (complete cure, partial response, no response) and secondary end points (recurrence rate, pregnancy rate) during treatment. All patients were followed up further for one year after completion of therapy to assess recurrence of disease and further pregnancies. RESULTS Baseline characteristics were similar between two randomized groups. There was no difference in the complete clinical response rate (95.3% vs 97.7%, p=0.441) between 9-months and 6-months groups. Four patients in 9-months group and two patients in 6-months group had recurrence of disease and required category II anti tuberculous therapy (p=0.441). Pregnancy rate during treatment and up to one year follow up was also similar in the two groups (23.2% vs 21.3%, p=0.762). Side effects occurred in 27(31.4%) and 29(32.6%) in 9-months and 6-months of therapy and were similar (p=0.866). CONCLUSIONS There was no difference in complete cure rate, recurrent rate and pregnancy rate for either 6-months or 9-months of intermittent directly observed treatment short course anti-tuberculous therapy in female genital tuberculosis. CLINICAL TRIAL REGISTRATION The trial was registered in clinicaltrials.gov with registration no: CTRI/2009/091/001088.
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Affiliation(s)
- Jai B Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Neeta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sona Dharmendra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Urvashi B Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanamail P
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - K K Roy
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Hari
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - V Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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19
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Jullien S, Jain S, Ryan H, Ahuja V. Six months therapy for abdominal tuberculosis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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