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Kudu E, Danış F. Recognizing and addressing the challenges of gastrointestinal tuberculosis. World J Clin Cases 2024; 12:3648-3653. [PMID: 38994296 PMCID: PMC11235435 DOI: 10.12998/wjcc.v12.i19.3648] [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: 03/04/2024] [Revised: 04/19/2024] [Accepted: 05/09/2024] [Indexed: 06/29/2024] Open
Abstract
In this editorial, we comment on the article by Ali et al published in the recent issue of the World Journal of Clinical Cases. This case report shed light on a particularly rare manifestation of this disease-primary gastrointestinal tuberculosis (GTB) presenting as gastric outlet obstruction. GTB presents diagnostic challenges due to its nonspecific symptoms and lack of highly accurate diagnostic algorithms. This editorial synthesizes epidemiological data, risk factors, pathogenesis, clinical presentations, diagnostic methods, and therapies to raise awareness about GTB. GTB constitutes 1%-3% of all tuberculosis cases globally, with 6%-38% of patients also having pulmonary tuberculosis. Pathogenesis involves various modes of Mycobacterium tuberculosis complex entry into the gastrointestinal system, with the terminal ileum and ileocecal valve commonly affected. Clinical presentation varies, often resembling other intra-abdominal pathologies, necessitating a high index of suspicion. Diagnostic tools include a combination of biochemical, microbiological, radiological, and endoscopic assessments. Anti-tubercular medication remains the cornerstone of treatment, supplemented by surgical intervention in severe cases. Multidisciplinary management involving gastroenterologists, surgeons, pulmonologists, and infectious disease specialists is crucial for optimal outcomes. Despite advancements, timely diagnosis and management challenges persist, underscoring the need for continued research and collaboration in addressing primary GTB.
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Affiliation(s)
- Emre Kudu
- Emergency Medicine, Marmara University Pendik Training and Research Hospital, İstanbul 34899, Türkiye
| | - Faruk Danış
- Emergency Medicine, Bolu Abant İzzet Baysal University Medical School, Bolu 14000, Türkiye
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Kanthawang T, Pattamapaspong N, Peh WCG, Hammami N, Bouaziz MC, Ladeb MF. Imaging of infra-thoracic tuberculosis. Br J Radiol 2024; 97:492-504. [PMID: 38288505 DOI: 10.1093/bjr/tqad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024] Open
Abstract
Tuberculosis (TB) is a potentially curable disease that is a leading cause of death globally. While it typically affects the lungs, this disease may involve many extra-pulmonary sites, particularly in patients with risk factors. Extra-pulmonary TB often mimics a variety of different diseases, posing a diagnostic dilemma. Imaging aids in early diagnosis of TB, especially in patients with non-specific or atypical symptoms found at extra-pulmonary infra-thoracic locations. Imaging also helps guide appropriate laboratory investigation, monitor disease progress, and response to treatment. This review aims to highlight the imaging spectrum of TB affecting the infra-thoracic region, that is, gastrointestinal tract, abdominal lymph nodes, peritoneal cavity, intra-abdominal solid organs, and urogenital system.
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Affiliation(s)
- Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore 768828
| | - Nadia Hammami
- Department of Neuroradiology, National Institute of Neurology Mongi Ben Hamida, Tunis 1007, Tunisia
| | - Mouna Chelli Bouaziz
- Department of Radiology, Faculty of Medicine of Tunis, MT Kassab Institute of Orthopaedics, Tunis-El Manar University, Ksar Said, Tunis 2010, Tunisia
| | - Mohamed Fethi Ladeb
- Department of Radiology, Faculty of Medicine of Tunis, MT Kassab Institute of Orthopaedics, Tunis-El Manar University, Ksar Said, Tunis 2010, Tunisia
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Maliyakkal AM, Naushad VA, Shaath NM, Valiyakath HS, Farfar KL, Mohammed AM, Ahmed M. Gastroduodenal Tuberculosis Presenting as a Gastric Outlet Obstruction: A Case Report. Cureus 2023; 15:e49436. [PMID: 38149133 PMCID: PMC10750844 DOI: 10.7759/cureus.49436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/28/2023] Open
Abstract
Abdominal tuberculosis (TB) can affect any part of the gastrointestinal tract, solid organs, peritoneum, or lymph nodes. The diagnosis of abdominal TB is usually delayed due to a lack of specific clinical signs and symptoms and the mimicking of other intra-abdominal diseases. We present a case of gastroduodenal tuberculosis with peripancreatic lymph node involvement presented as a gastric outlet obstruction that was treated conservatively with anti-tuberculosis medications.
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Affiliation(s)
- Abdul Majeed Maliyakkal
- Department of Medicine, Hamad Medical Corporation, Doha, QAT
- Clinical Department, College of Medicine, QU Health, Qatar University, Doha, QAT
- Clinical Medicine, Weill Cornell Medicine, Doha, QAT
| | - Vamanjore A Naushad
- Department of Medicine, Hamad Medical Corporation, Doha, QAT
- Clinical Medicine, Weill Cornell Medicine, Doha, QAT
- Clinical Department, College of Medicine, QU Health, Qatar University, Doha, QAT
| | - Nabeel M Shaath
- Department of Gastroenterology, Hamad Medical Corporation, Doha, QAT
- Clinical Medicine, Weill Cornell Medicine, Doha, QAT
| | | | | | - Asad M Mohammed
- Department of Medicine, Hamad Medical Corporation, Doha, QAT
| | - Mustafa Ahmed
- Department of Medicine, Hamad Medical Corporation, Doha, QAT
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Bana SKR, Lakshmanan S, Rajendran V, N S, Anil AA, L N. A Case of Massive Gastrointestinal Bleeding Due to Abdominal Tuberculosis. Middle East J Dig Dis 2023; 15:207-209. [PMID: 38023460 PMCID: PMC10660318 DOI: 10.34172/mejdd.2023.346] [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: 03/31/2023] [Accepted: 06/22/2023] [Indexed: 12/01/2023] Open
Abstract
This case is about a complication of abdominal tuberculosis in the form of a massive lower gastrointestinal (GI) bleed, which was timely intervened by angioembolization. A young man in his mid-20s on empirical anti-tubercular therapy (ATT) for abdominal tuberculosis, presented with severe abdominal pain. The patient then developed frank per rectal bleeding, leading to a significant drop in hemoglobin level, requiring multiple blood transfusions. Upper GI endoscopy and colonoscopy findings were inconclusive. Contrast-enhanced computed tomography (CECT) of the abdomen was performed, which revealed a contrast extravasation into the jejunum due to a leak in the jejunal branch of the superior mesenteric artery (SMA), followed by selective SMA angiography (digital subtraction angiography), which was arrested by angioembolization. The patient had multiple abdominal lymphadenopathies with omental nodules. Histopathological examination of the omental nodules revealed epithelioid granuloma with Langerhans-type cells. The patient is currently receiving ATT and is doing well.
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Affiliation(s)
- Sai Krishna Reddy Bana
- Department of General Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Suja Lakshmanan
- Department of General Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Vaasanthi Rajendran
- Department of General Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Senthil N
- Department of General Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Archa Anna Anil
- Department of General Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Nanthakumar L
- Department of General Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, India
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Crossman L, Ronald Funk C, Kandiah S, Hemrajani R. Disseminated Peritoneal Tuberculosis Initially Misdiagnosed as Nephrogenic Ascites. Case Rep Nephrol 2023; 2023:4240423. [PMID: 37124145 PMCID: PMC10139807 DOI: 10.1155/2023/4240423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/30/2022] [Accepted: 01/27/2023] [Indexed: 05/02/2023] Open
Abstract
A middle-aged immigrant male from a region with endemic tuberculosis who had a history of end-stage kidney disease presented to the emergency room for routine hemodialysis and abdominal swelling. He was admitted to the medicine service for suggested daily dialysis to improve his volume overload, which was attributed to nephrogenic ascites. He was found to have several findings concerning for systemic illness, including fevers, night sweats, hypercalcemia, lymphadenopathy, omental thickening, ascitic fluid with a serum ascites albumin gradient of less than 1.1 gm/dL, and exudative pleural effusions. Our suspicion for hematologic malignancy versus disseminated infection was high. During admission, there were many diagnostic challenges in obtaining histologic and bacteriologic confirmation of our leading suspected diagnosis, disseminated tuberculosis. Ultimately, tuberculosis infection was confirmed with histologic evidence of granulomatous inflammation of cervical lymph node and sputum culture positive for Mycobacterium tuberculosis. This case highlights the necessity for every patient presenting with new ascites to undergo diagnostic paracentesis. Nephrogenic ascites is a rare syndrome that is possible in volume overloaded states but is a diagnosis of exclusion that should be supported by an exudative serum ascites albumin gradient and no evidence of an alternate etiology.
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Affiliation(s)
| | | | - Sheetal Kandiah
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Reena Hemrajani
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Lee WS, Arai K, Alex G, Treepongkaruna S, Kim KM, Choong CL, Mercado KC, Darma A, Srivastava A, Aw MM. Management and monitoring of pediatric inflammatory bowel disease in the Asia-Pacific region: A position paper by the Asian Pan-Pacific Society for Pediatric Gastroenterology, Hepatology, and Nutrition (APPSPGHAN) PIBD Working Group: Surgical management, disease monitoring, and special considerations. J Gastroenterol Hepatol 2022; 38:510-522. [PMID: 36508314 DOI: 10.1111/jgh.16084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/11/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023]
Abstract
Disease phenotype of pediatric inflammatory bowel disease (PIBD) in children from the Asia-Pacific region differs from that of children from the West. Many parts of Asia are endemic for tuberculosis, making diagnosis and management of pediatric Crohn's disease a challenge. Current available guidelines, mainly from Europe and North America, may not be completely applicable to clinicians caring for children with PIBD in Asia due to differences in disease characteristics and regional resource constraints. This position paper is an initiative from the Asian Pan-Pacific Society for Pediatric Gastroenterology, Hepatology and Nutrition (APPSPGHAN) that aims to provide an up-to-date, evidence-based approach to PIBD in the Asia-Pacific region. A group of pediatric gastroenterologists with a special interest in PIBD performed an extensive literature search covering epidemiology, disease characteristics and natural history, management, and monitoring. Attention was paid to publications from the region with special consideration to a resource-limited setting. This current position paper deals with surgical management, disease monitoring, immunization, bone health, and nutritional issues of PIBD in Asia. A special section on differentiating pediatric Crohn's disease from tuberculosis in children is included. This position paper provides a useful guide to clinicians in the surgical management, disease monitoring, and various health issues in children with IBD in Asia-Pacific region.
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Affiliation(s)
- Way Seah Lee
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.,Department of Population Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, 59100, Kajang, Selangor, Malaysia
| | - Katsuhiro Arai
- Center for Pediatric Inflammatory Bowel Disease, National Center for Child Health and Development, Tokyo, Japan
| | - George Alex
- Department of Gastroenterology and Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Suporn Treepongkaruna
- Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kyung Mo Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chee Liang Choong
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Karen Calixto Mercado
- Makati Medical Center and The Medical City, Philippine Society for Pediatric Gastroenterology, Hepatology and Nutrition, Manila, Philippines
| | - Andy Darma
- Department of Child Health, Dr. Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Anshu Srivastava
- Department of Paediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Marion M Aw
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Rare manifestation of a large stenosing gastrointestinal tumor caused by Mycobacterium tuberculosis in a previously healthy man from Austria. Wien Med Wochenschr 2021; 172:268-273. [PMID: 34613520 PMCID: PMC9463224 DOI: 10.1007/s10354-021-00887-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal tuberculosis (TB) is a rare manifestation in low TB-incidence countries such as Austria. It is usually seen in immunocompromised patients or in migrants being more susceptible for extrapulmonary disease manifestations. CASE DESCRIPTION We report a very rare manifestation of severe gastrointestinal TB in a 49-year-old previously healthy man from Upper Austria. Endoscopy showed a large tumor mass obstructing about 2/3 of the lumen of the cecum. Positron emission tomography/computed tomography scan revealed not only a high metabolic activity in the tumor mass, but also active pulmonary lesions in both upper lung lobes. Bronchial secretion showed acid-fast bacilli in the microscopy and polymerase chain reaction was positive for M. tuberculosis complex. Phenotypic resistance testing showed no resistance for first-line anti-TB drugs. Treatment with isoniazid, rifampicin, pyrazinamide and ethambutol was initiated. Based on therapeutic drug monitoring, the standard treatment regime was adapted to rifampicin high dose. TB treatment was well tolerated and the patient achieved relapse-free cure one year after the end of treatment. CONCLUSION Gastrointestinal involvement mimicking an intestinal tumor is a very rare TB manifestation in previously healthy Austrians. However, it should be kept in mind due to increasing migration from countries with higher rates of extrapulmonary TB and due to an increasing number of immunocompromised patients. TB telephone consultations can support medical professionals in the diagnosis and the management of complex TB patients. TB management is currently at a transitional stage from a programmatic to personalized management concept including therapeutic drug monitoring or biomarker-guided treatment duration to achieve relapse-free cure.
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Son IW, Kim S, Hong SB, Lee NK, Jeong MR, Han SY, Woo HY. Puncture needle with a hard plastic sheath and plastic wings minimizes repuncture attempts in ultrasound-guided paracentesis. Yeungnam Univ J Med 2021; 39:18-23. [PMID: 34247458 PMCID: PMC8895958 DOI: 10.12701/yujm.2021.01109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/16/2021] [Indexed: 11/09/2022] Open
Abstract
Background This study was performed to evaluate periprocedural factors, complications, and repuncture rate of the newly developed puncture needle and compare it with the routinely used puncture needle for ultrasound (US)-guided paracentesis. Methods We retrospectively identified 137 patients who underwent US-guided paracentesis between July 2018 and March 2019. Among them, 82 patients underwent US-guided paracentesis with a newly developed puncture needle. The other 55 patients underwent US-guided paracentesis with a routinely used puncture needle. The periprocedural factors, complications, and repuncture rate were compared between the two groups using the Mann-Whitney U test and Fisher exact test. The repuncture-associated factors were assessed using logistic regression analysis. Results There were no major or minor complications in either group. The rate of repuncture was significantly lower in the group using the newly developed puncture needle compared with the group using the routinely used puncture needle (p=0.01). The duration of the procedure was significantly shorter with the newly developed puncture needle compared with the routinely used puncture needle (p=0.01). In univariate analysis, the thickness of the abdominal wall (p=0.04) and the use of the newly developed puncture needle (p=0.01) were significantly associated with the rate of repuncture. In multivariate analysis, only the use of the newly developed puncture needle was significantly associated with the rate of repuncture. Conclusion Using this novel puncture needle with a hard plastic sheath and plastic wings, the rate of repuncture and the duration of the procedure were decreased without complications of US-guided paracentesis.
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Affiliation(s)
- Il Wan Son
- Department of Radiology, Dongnam Institution of Radiological & Medical Sciences, Busan, Korea
| | - Suk Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seung Baek Hong
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Mi Ri Jeong
- Department of Radiology, Busan Medical Center, Busan, Korea
| | - Sung Yong Han
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyun Young Woo
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Yan F, Yu X, Lei H, Chen Y, Wang J, Li J. A rare case of gastric fundus tuberculosis with nonspecific abdominal pain. J Int Med Res 2021; 49:3000605211033189. [PMID: 34311596 PMCID: PMC8320578 DOI: 10.1177/03000605211033189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
A 53-year-old patient who experienced recurring upper abdominal pain and discomfort for 4 years was admitted to our hospital. Gastroscopy was performed to identify the location of the pain and evaluate the characteristics of a mass in the abdomen. Endoscopic ultrasonography (EUS) and abdominal computed tomography (CT) revealed a space-occupying lesion in the gastric fundus, suggestive of a submucosal tumor and highly likely of stromal origin. Surgical resection of the lesion was performed for identification; however, postoperative histopathological examination of the lesion revealed gastric fundus tuberculosis (TB). Gastric TB is relatively rare; therefore, clinicians should be highly suspicious of patients with abdominal symptoms from regions with a high incidence of TB to prevent treatment delay caused by misdiagnosis.
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Affiliation(s)
- Feiyu Yan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
| | - Xianzhe Yu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
| | - Hongjun Lei
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
| | - Yi Chen
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
| | - Jiwei Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
| | - Jianguo Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi, People’s Republic of China
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Ahamed Z R, Shah J, Agarwala R, Kumar-M P, Mandavdhare HS, Gupta P, Singh H, Sharma A, Dutta U, Sharma V. Controversies in classification of peritoneal tuberculosis and a proposal for clinico-radiological classification. Expert Rev Anti Infect Ther 2019; 17:547-555. [PMID: 31293195 DOI: 10.1080/14787210.2019.1642746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Rizwan Ahamed Z
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Roshan Agarwala
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ma L, Zhu Q, Li Y, Li W, Wang X, Liu W, Li J, Jiang Y. The potential role of CT enterography and gastrointestinal ultrasound in the evaluation of anti-tubercular therapy response of intestinal tuberculosis: a retrospective study. BMC Gastroenterol 2019; 19:106. [PMID: 31242849 PMCID: PMC6595613 DOI: 10.1186/s12876-019-1030-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/20/2019] [Indexed: 12/28/2022] Open
Abstract
Background Accurate evaluation of anti-tubercular therapy (ATT) responses is crucial for both diagnosis and treatment of intestinal tuberculosis (ITB). Little is known about the role of cross-sectional imaging techniques in ITB follow-up assessment. We aimed to investigate the accuracy of cross-sectional imaging modalities, CT enterography (CTE) and gastrointestinal ultrasound (GIUS), in the evaluation of ATT responses in ITB patients. Methods Patients diagnosed with ITB and followed up by CTE and/or GIUS were retrospectively searched in the databases. Clinical, imaging, laboratory and endoscopic data were collected at baseline and the first follow-up visit. Responses were graded as good, partial and no response based on protocols described in the literature and by our institution. CTE evaluation was based on changes in the lesion area, mural thickness, enhancement patterns and lymph nodes, while GIUS evaluation was based on changes in bowel wall morphology and the Limberg score. Clinical evaluation was used as the gold-standard evaluation method, which was determined by a comprehensive impression of endoscopic changes along with symptomatic improvement and laboratory tests, with imaging results masked. Results Twenty patients with ITB were enrolled in our study. The first follow-up time was from 2 to 12 months (average 6 months). According to the gold standard evaluation, 11 patients were evaluated as having a good ATT response, while 9 had a partial response. A total of 18 patients were followed up by CTE, while 7 were followed up by GIUS, depending on medical and/or financial considerations. The accuracy of CTE and GIUS was 83% (15/18) and 85.7% (6/7), respectively. The sensitivity, specificity, PPV and NPV of CTE were 88.9, 77.8, 80 and 87.5%, respectively. Moreover, the sensitivity, specificity, PPV and NPV of GIUS were 100, 50, 83.3 and 100%, respectively. By combining the results of CTE and GIUS results, the overall accuracy was 90%, with sensitivity and specificity of 91.7 and 87.5%, respectively. Conclusion To our knowledge, this is the first study exploring the accuracy of the cross-sectional imaging modalities CTE/GIUS in the evaluation of ATT responses. Our results indicated their promising application prospect in clinical practice as a non-invasive and cost-effective approach. Electronic supplementary material The online version of this article (10.1186/s12876-019-1030-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Li Ma
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yue Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenbo Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuan Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Abstract
Gastrointestinal tuberculosis (TB) is a fascinating disease which can be observed both in the clinical context of active pulmonary disease and as a primary infection with no pulmonary involvement. It represents a significant clinical challenge because of the resurgence of TB as well as the diagnostic challenges it poses. A high clinical suspicion remains the most powerful tool in an era of medicine when reliance on diagnostic technology increases. Antimicrobial therapy is the mainstay of therapy, but surgical and endoscopic interventions are frequently required for intestinal TB. Gastrointestinal TB is truly the "great mimic" and continues to require the astute clinical acumen of skillful clinicians to diagnose and treat.
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Abstract
Tuberculous peritonitis is rare in the United States but continues to be reported to occur in certain high-risk populations, which include patients with AIDS or cirrhosis, patients on continuous ambulatory peritoneal dialysis, recent immigrants from areas of high endemicity, and those who are immunosuppressed. The diagnosis of this disease requires a high clinical index of suspicion and should be considered in the differential of ascites with a lymphocyte predominance and serum-ascitic albumin gradient of <1.1 mg/dl. Microbiological or pathological confirmation remains the gold standard for diagnosis. Ascitic fluid cultures have low yield, but peritoneoscopy with biopsy or cultures frequently confirms the diagnosis. Newer techniques with future application include determination of adenosine deaminase and interferon gamma levels in ascitic fluid. Ultrasound and computed tomography are frequently used to guide fluid aspiration and biopsies. Six months of treatment with antituberculosis therapy is adequate except in cases of drug-resistant tuberculosis. The role of steroids remains controversial. Surgical approaches may be required to deal with complications including bowel perforation, intestinal obstruction from adhesions, fistula formation, or bleeding.
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Abstract
Tuberculosis of the liver, biliary tract, and pancreas is discussed. In addition, tuberculosis in the setting of HIV-AIDS and liver transplantation is explored. Drug-induced liver injury secondary to antituberculosis medication and monitoring and prophylactic treatment for such injury is also considered.
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Clinical and laboratory presentation of abdominal tuberculosis in Shillong, Meghalaya: Experience from Northeast India. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2017. [DOI: 10.1016/j.injms.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Jehangir W, Khan R, Gil C, Baruiz-Creel M, Bandel G, Middleton JR, Sen P. Abdominal Tuberculosis: An Immigrant's Disease in the United States. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015. [PMID: 26199920 PMCID: PMC4488990 DOI: 10.4103/1947-2714.157484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Abdominal tuberculosis (TB) is an uncommon condition in the United States (US) except for patients with human immunodeficiency virus (HIV). An increasing number of cases have been reported in western countries amongst immigrants. It is important to be aware of the data and clinical characteristics in the immigrant population. Aims: The purpose of this study is to determine the epidemiologic characteristics of abdominal TB among immigrants in the US and to review the clinical presentations of abdominal TB with a focus particularly on unusual features. Materials and Methods: In a community teaching hospital in New Jersey, patients diagnosed with abdominal TB were examined and included in this report. All nine patients were immigrants from countries with high prevalence of TB and a majority had resided in the US for at least 5 years. None had clinical evidence of HIV and those that were tested were not found to be positive for HIV. Initial examination, diagnostic workup, and response to therapy were all pertinent to the management and diagnosis of these patients. Results: Three patients had atypical clinical presentations with normal chest X-rays and either negative or unknown tuberculin tests leading to delayed diagnosis and inappropriate therapy in at least one patient. With antituberculous therapy, all except for one patient had satisfactory outcomes. Immigrant patients with a diagnosis of abdominal TB had no evidence of HIV infection or other associated conditions in contrast to native-born individuals. Conclusion: Atypical presentations may cause diagnostic difficulties. Failure to perform appropriate tests may lead to inappropriate therapy with adverse outcomes. Although there is a decline in the number of TB cases in the US and screening for latent pulmonary infection in foreigners has been implemented effectively, the diagnosis of abdominal TB continues to be under diagnosed.
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Affiliation(s)
- Waqas Jehangir
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Rafay Khan
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Constante Gil
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Marilyn Baruiz-Creel
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Geraldo Bandel
- Palm Springs General Hospital, Hialeah, Florida, United States
| | - John R Middleton
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Purnendu Sen
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
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Varghese B, Al-Hajoj S. Mapping the epidemiology and trends of extra-pulmonary tuberculosis in Saudi Arabia. Int J Mycobacteriol 2015; 4:261-9. [PMID: 26964806 DOI: 10.1016/j.ijmyco.2015.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/28/2015] [Indexed: 11/18/2022] Open
Abstract
An extra-pulmonary tuberculosis (EPTB) infection rate of 30% in Saudi Arabia remains above the global rate. A variable rate of infection in each province has been reported and the involvement of most organs has been cited. Nationwide collective data on the current trends of infection are scarce and the factors behind the increased rate of EPTB are perplexing. This review endeavors to shed light into the epidemiology of EPTB, various types of infections sites, geographical differences in the infection rate, known risk factors, and challenges in the diagnosis and management of EPTB in Saudi Arabia.
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Affiliation(s)
- Bright Varghese
- Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sahal Al-Hajoj
- Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Salgado Flores L, Hernández Solís A, Escobar Gutiérrez A, Criales Cortés José L, Cortés Ortiz I, González González H, Luis Martínez E, Cicero Sabido R. Peritoneal tuberculosis: A persistent diagnostic dilemma, use complete diagnostic methods. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2015. [DOI: 10.1016/j.hgmx.2015.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Weng MT, Wei SC, Lin CC, Tsang YM, Shun CT, Wang JY, Shieh MJ, Wang CY, Wong JM. Seminar Report From the 2014 Taiwan Society of Inflammatory Bowel Disease (TSIBD) Spring Forum (May 24th, 2014): Crohn's Disease Versus Intestinal Tuberculosis Infection. Intest Res 2015; 13:6-10. [PMID: 25691838 PMCID: PMC4316223 DOI: 10.5217/ir.2015.13.1.6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 11/05/2022] Open
Abstract
Since Taiwan is an endemic area for tuberculosis (TB), differential diagnosis between the intestinal TB and Crohn's disease is an important issue. The steering committee of Taiwan Society of Inflammatory Bowel Disease (TSIBD) has arranged a seminar accordingly on May 24th, 2014 and the different point of views by gastroenterologist, radiologist, pathologist and infectious disease specialist were suggested to help the proper diagnosis and management of these two diseases.
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Affiliation(s)
- Meng-Tzu Weng
- Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei, Taiwan. ; Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taiwan
| | - Shu-Chen Wei
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taiwan
| | - Chun-Che Lin
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yuk-Min Tsang
- Department of Radiology, Far-Eastern Memorial Hospital, New Taipei, Taiwan
| | - Chia-Tung Shun
- Department of Pathology and Forensic Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taiwan
| | - Ming-Jium Shieh
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taiwan
| | - Cheng-Yi Wang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taiwan
| | - Jau-Min Wong
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taiwan
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20
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Hong KS, Kang SJ, Choi JK, Kim JH, Seo H, Lee S, Jung JW, Kang HR, Cho SH, Kim JS. Gastrointestinal tuberculosis is not associated with proton pump inhibitors: A retrospective cohort study. World J Gastroenterol 2013; 19:258-64. [PMID: 23345949 PMCID: PMC3547571 DOI: 10.3748/wjg.v19.i2.258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/28/2012] [Accepted: 10/22/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effect of proton pump inhibitors (PPIs) on the development of gastrointestinal tuberculosis.
METHODS: All patients who were more than 20 years old and who had received a prescription for PPIs among those who visited Seoul National University Hospital from January 1, 2005 to December 31, 2009 were identified. Due to the low sensitivity of the microbiologic test and the nonspecific pathologic findings, the diagnosis of gastrointestinal tuberculosis was confirmed through the presence of active ulcerations and the responses to anti-tuberculosis medications. The patients were divided into two groups according to treatment duration (group 1: ≤ 3 mo; group 2: > 3 mo) and were followed up from the time they took the first prescription of PPIs until their last visit. Logistic regression analysis was used to calculate the relative risks (RR) and 95%CI, adjusting for covariates.
RESULTS: Among the 61 834 patients exposed to PPIs (50 534 in group 1; 11 300 in group 2), 21 patients were diagnosed with PPI-associated gastrointestinal tuberculosis during 124 274 person-years of follow-up. Of 21 patients, the 12 who revealed only scar changes in the colonoscopy were excluded from the statistical analyses. Of those who remained, 2 were excluded because they underwent gastrointestinal endoscopy within 4 wk of the first prescription for PPIs. Longer exposure to PPI was associated with a higher mean age (55.0 ± 14.5 in group 1 vs 58.2 ± 13.3 in group 2, P < 0.001) and a higher Charlson co-morbidity index (0.50 ± 0.93 in group 1 vs 0.77 ± 1.14 in group 2, P < 0.001). The true incidence of active gastrointestinal tuberculosis was 0.65 per 1000 person-years in group 1 and 0.03 per 1 000 person-years in group 2. Like the less-than-three-month PPI treatment period in group 1, the over-three-month PPI therapy period in group 2 was not associated with increased risk of acquiring gastrointestinal tuberculosis, after adjusting for age and co-morbidities, whereas the Charlson co-morbidity index was associated with increased risk of acquiring gastrointestinal tuberculosis based on the score [RR: (reference 1) in group 1 vs 1.518 in group 2; 95% CI: 1.040-2.216, P = 0.03].
CONCLUSION: Long-term PPI therapy does not seem to be associated with increased risk of acquiring gastrointestinal tuberculosis, but a higher Charlson co-morbidity index is associated with such.
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Yu SM, Park JH, Kim MD, Lee HR, Jung P, Ryu TH, Choi SH, Lee IS. A case of sigmoid colon tuberculosis mimicking colon cancer. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2012. [PMID: 23185709 PMCID: PMC3499430 DOI: 10.3393/jksc.2012.28.5.275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Tuberculosis of the sigmoid colon is a rare disorder. An 80-year-old man visited Bongseng Memorial Hospital for medical examination. A colonoscopy was performed, and a lesion in the sigmoid colon that was suspected to be colon cancer was found. A biopsy was performed, and tuberculous enteritis with chronic granulomatous inflammation was diagnosed. Intestinal tuberculosis is most frequent in the ileocecal area, followed by the ascending colon, transverse colon, duodenum, stomach, and sigmoid colon, in descending order. Hence, we report a case of intestinal tuberculosis in the sigmoid colon, which is rare and almost indistinguishable from colon cancer.
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Affiliation(s)
- Seong-Min Yu
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
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22
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Allah MH, Salama ZA, El-Hindawy A, Al Kady N. Role of peritoneal ultrasonography and ultrasound-guided fine needle aspiration cytology/biopsy of extravisceral masses in the diagnosis of ascites of undetermined origin. Arab J Gastroenterol 2012; 13:116-24. [PMID: 23122452 DOI: 10.1016/j.ajg.2012.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 07/03/2012] [Accepted: 08/05/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Ascites may be of undetermined origin despite comprehensive study. This study aimed to assess the accuracy and safety of conventional and interventional high-frequency peritoneal ultrasound in the diagnosis of patients with ascites of unclear origin. PATIENTS AND METHODS A total of 62 patients were prospectively enrolled; they underwent conventional (3.5-5MHz) and high-frequency (6-8MHz) transabdominal peritoneal ultrasound to suggest the nature of ascites supplemented by fine needle aspiration cytology (FNAC) of ascites and/or core biopsy of the omentum or other extra-visceral masses for final histopathologic diagnosis. Laparoscopy or laparotomy was needed if biopsy was inconclusive. RESULTS Ultrasound-guided procedures were diagnostic in 55 (87.7%) patients. Thirty-six (58.1%) were benign, of whom 86% had tuberculous peritonitis, 26 (41.9%) were malignant, of whom 76.9% had peritoneal metastasis. High-frequency ultrasound was able to propose ultrasonographic criteria in a trial to diagnose the nature of ascites. Our proposed ultrasonographic criteria were based on the amount and texture of ascites in addition to the omental and mesenteric features. These were able to suggest the diagnosis with 80.7% sensitivity for malignant ascites and 75% specificity for benign ascites. Moreover, histopathological examination of tissues obtained by ultrasound-guided procedures increased the sensitivity to 88.5% and the specificity to 88.9% in diagnosing malignant and benign disease, respectively, with an overall diagnostic accuracy of 88.6%. These procedures were considered to be safe as only one major (haemoperitoneum) and two minor complications (temporary ascitic fistula) were reported. CONCLUSION High-frequency peritoneal ultrasound together with the minimally invasive ultrasound-guided FNAC/biopsy of extra-visceral lesions may be considered an effective and safe tool in the diagnosis of ascites of undetermined origin.
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Affiliation(s)
- Maha Hasab Allah
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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23
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Intestinal obstruction secondary to primary ileocecal tuberculosis: A case report. Int J Mycobacteriol 2012; 1:96-8. [DOI: 10.1016/j.ijmyco.2012.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/01/2012] [Accepted: 05/02/2012] [Indexed: 11/19/2022] Open
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Jain M, Baijal R, Kumar P, Gupta D. Profile of patients with gastrointestinal TB at a tertiary care centre in western India. Trop Doct 2011; 41:242-3. [DOI: 10.1258/td.2011.110128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Gastrointestinal TB is a common problem. We report a series of 32 cases diagnosed at our centre in 2009. Peritoneal and ileocaecal TB are the most common manifestations and diagnosis was confirmed in 87.5% patients. The response to treatment was favourable
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Affiliation(s)
- Mayank Jain
- Jagjivan Ram Western Railway Hospital, Maratha Mandir Marg, Mumbai Central, Mumbai – 14, India
| | - Rajiv Baijal
- Jagjivan Ram Western Railway Hospital, Maratha Mandir Marg, Mumbai Central, Mumbai – 14, India
| | - Praveen Kumar
- Jagjivan Ram Western Railway Hospital, Maratha Mandir Marg, Mumbai Central, Mumbai – 14, India
| | - Deepak Gupta
- Jagjivan Ram Western Railway Hospital, Maratha Mandir Marg, Mumbai Central, Mumbai – 14, India
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Abstract
Tuberculosis (TB) poses a serious threat to public health throughout the world but disproportionately afflicts low-income nations. Persons in close contact with a patient with active pulmonary TB and those from endemic regions of the world are at highest risk of primary infection, whereas patients with compromised immune systems are at highest risk of reactivation of latent TB infection (LTBI). Tuberculosis can affect any organ system. Clinical manifestations vary accordingly but often include fever, night sweats, and weight loss. Positive results on either a tuberculin skin test or an interferon-γ release assay in the absence of active TB establish a diagnosis of LTBI. A combination of epidemiological, clinical, radiographic, microbiological, and histopathologic features is used to establish the diagnosis of active TB. Patients with suspected active pulmonary TB should submit 3 sputum specimens for acid-fast bacilli smears and culture, with nucleic acid amplification testing performed on at least 1 specimen. For patients with LTBI, treatment with isoniazid for 9 months is preferred. Patients with active TB should be treated with multiple agents to achieve bacterial clearance, to reduce the risk of transmission, and to prevent the emergence of drug resistance. Directly observed therapy is recommended for the treatment of active TB. Health care professionals should collaborate, when possible, with local and state public health departments to care for patients with TB. Patients with drug-resistant TB or coinfection with human immunodeficiency virus should be treated in collaboration with TB specialists. Public health measures to prevent the spread of TB include appropriate respiratory isolation of patients with active pulmonary TB, contact investigation, and reduction of the LTBI burden.
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MESH Headings
- Antitubercular Agents
- Comorbidity
- Drug Resistance, Multiple, Bacterial
- HIV Infections/epidemiology
- Humans
- Interferon-gamma/metabolism
- Nucleic Acid Amplification Techniques
- Pericarditis/microbiology
- Public Health
- Tuberculin Test
- Tuberculosis/diagnosis
- Tuberculosis/drug therapy
- Tuberculosis/epidemiology
- Tuberculosis, Lymph Node/diagnosis
- Tuberculosis, Multidrug-Resistant/diagnosis
- Tuberculosis, Multidrug-Resistant/drug therapy
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/prevention & control
- Tuberculosis, Pulmonary/therapy
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Affiliation(s)
- Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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Cecal obstruction due to primary intestinal tuberculosis: a case series. J Med Case Rep 2011; 5:128. [PMID: 21450062 PMCID: PMC3073921 DOI: 10.1186/1752-1947-5-128] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 03/30/2011] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Primary intestinal tuberculosis is a rare variant of tuberculosis. The preferred treatment is usually pharmaceutical, but surgery may be required for complicated cases. CASE PRESENTATION We report two cases of primary intestinal tuberculosis where the initial diagnosis was wrong, with colonic cancer suggested in the first case and a Crohn's disease complication in the second. Both of our patients were Caucasians of Greek nationality. In the first case (a 60-year-old man), a right hemicolectomy was performed. In the second case (a 26-year-old man), excision was impossible due to the local conditions and peritoneal implantations. Histopathology revealed an inflammatory mass of tuberculous origin in the first case. In the second, cell culture and polymerase chain reaction tests revealed Mycobacterium tuberculosis. Both patients were given anti-tuberculosis therapy and their post-operative follow-up was uneventful. CONCLUSIONS Gastrointestinal tuberculosis still appears sporadically and should be considered in the differential diagnosis along with other conditions of the bowel. The use of immunosuppressants and new pharmaceutical agents can change the prevalence of tuberculosis.
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Guirat A, Koubaa M, Mzali R, Abid B, Ellouz S, Affes N, Ben Jemaa M, Frikha F, Ben Amar M, Beyrouti MI. Peritoneal tuberculosis. Clin Res Hepatol Gastroenterol 2011; 35:60-9. [PMID: 21215540 DOI: 10.1016/j.gcb.2010.07.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 05/27/2010] [Accepted: 07/19/2010] [Indexed: 02/04/2023]
Abstract
The peritoneum is one of the locations outside the most common pulmonary tuberculosis. Peritoneal tuberculosis poses a public health problem in endemic regions of the world. The phenomenon of migration, the increased use of immunosuppressive therapy and the epidemic of AIDS have contributed to a resurgence of this disease in regions where it was previously controlled. The aim of this review is to expose the clinical, biologic end radiologic futures of the peritoneal tuberculosis and to present the methods of diagnosis and treatment. The diagnosis of this disease is difficult and still remains a challenge because of its insidious nature, the variability of presentation and limitations of available diagnostic tests. The disease usually presents a picture of lymphocytic exudative ascites. There are many complementary tests with variable sensitivities and specificities to confirm the diagnosis of peritoneal tuberculosis. Isolation of mycobacteria by culture of ascitic fluid or histological examination of peritoneal biopsy ideally performed by laparoscopy remains the investigation of choice. The role of PCR, ascitic adenosine deaminase, interferon gamma and the radiometric BACTEC system can improve the diagnostic yield. An antituberculous treatment with group 1 of the WHO for 6 months is sufficient in most cases.
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Affiliation(s)
- A Guirat
- Service de chirurgie générale, CHU Habib Bourguiba, 3029 Sfax, Tunisia.
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Choi CH, Kim CJ, Lee YY, Kim JS, Song T, Park HS, Kim MK, Kim TJ, Lee JW, Lee JH, Bae DS, Kim BG. Peritoneal tuberculosis: a retrospective review of 20 cases and comparison with primary peritoneal carcinoma. Int J Gynecol Cancer 2010; 20:798-803. [PMID: 20973271 DOI: 10.1111/igc.0b013e3181e23c8f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION To evaluate the clinical features of peritoneal tuberculosis (TB) and to compare them with those of primary peritoneal carcinoma (PPC). METHODS We conducted a retrospective review of women with peritoneal TB who were managed at Samsung Medical Center from January 1996 to October 2006. As a control sample, patients with a diagnosis of PPC during the same period were also selected for comparison. RESULTS During the study period, we identified 20 female patients with peritoneal TB. The median age was 39 years (range, 23-69 years), and the median cancer antigen 125 (CA-125) level was 448 U/mL (range, 32-1725 U/mL). Seventeen patients with PPC whom we examined were older, with a median age of 63 years (range, 50-73 years); their median CA-125 level was higher at 1848 U/mL (range, 42-14,380 U/mL). Compared with those of PPC, the radiologic findings of peritoneal TB indicated less severe involvement of the omentum and the mesentery (P = 0.03). Among the 20 patients who underwent operations, 6 (30%) underwent exploratory laparotomy; 12 (60%), diagnostic laparoscopy; and 2 (10%), laparoscopy converted to laparotomy because of severe adhesion. Frozen tissue sections revealed chronic granulomatous tissue reaction in 15 (83.3%) of 18 women with peritoneal TB. CONCLUSIONS Maintaining a high index of suspicion is very important for the successful treatment of peritoneal TB, especially in developing countries. Age, CA-125 level, and omental involvement as identified by computed tomography may be helpful for the differential diagnosis of peritoneal TB and PPC.
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Affiliation(s)
- Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kela M, Agrawal A, Sharma R, Agarwal R, Agarwal VB. Ileal tuberculosis presenting as a case of massive rectal bleeding. Clin Exp Gastroenterol 2009; 2:129-31. [PMID: 21694836 PMCID: PMC3108638 DOI: 10.2147/ceg.s8009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Indexed: 11/23/2022] Open
Abstract
Massive rectal bleeding is an uncommon presentation of ileal tuberculosis. Fewer than 12 cases are reported in the literature. We report a case of ileal tuberculosis presenting at the emergency department with subacute intestinal obstruction and severe rectal bleeding. The case of the massive bleeding could be identified only after an exploratory laparotomy.
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Affiliation(s)
- Manoj Kela
- Department of Surgery, S.A.I.M.S., Medical College, Indore, Madhya Pradesh, India
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30
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Lower gastrointestinal tract tuberculosis: an important but neglected disease. Int J Colorectal Dis 2009; 24:1175-80. [PMID: 19421759 DOI: 10.1007/s00384-009-0721-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2009] [Indexed: 02/04/2023]
Abstract
PURPOSE Difficulties in early and accurate diagnosis of intestinal tuberculosis lead to frequent misdiagnosis even in endemic areas. This study aimed to investigate clinical and laboratory characteristics of patients with lower gastrointestinal tract tuberculosis (LGITB). MATERIALS AND METHODS Patients who met the criteria for LGITB in a medical center from 1997 to 2006 were identified and their medical records reviewed. RESULTS A number of 4,567 patients with culture or histology-proven tuberculosis were identified, and 30 (0.66%) were diagnosed with LGITB. Principal co-morbidities were type II diabetes mellitus (23%) and alcoholism (23%). Twenty-two (73%) had radiographic findings suggestive of pulmonary tuberculosis, which was culture-proven in 13. Mycobacterial cultures from stool or sputum had diagnostic yields of about 50%, comparable to that of histological studies of colonoscopic or surgical biopsies. Multidrug-resistant tuberculosis (MDRTB) was identified in four patients, including two alcoholics. Fourteen underwent surgery; two (14%) received right hemicolectomy under the diagnosis of colon cancer without pre- or intraoperative histological study. The 1-year mortality was 20% but was 50% in patients with MDRTB. CONCLUSIONS A high rate of alcoholism and diabetes mellitus and a high percentage of MDRTB among alcoholics were observed in our patients with LGITB. The diagnostic yields of stool or sputum mycobacterial culture (50%) were similar to that of intestinal histological study. Pre- or intraoperative histological examination could prevent unnecessarily extensive surgery.
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Abstract
With the changing epidemiology of Crohn's disease (CD) and intestinal tuberculosis (ITB), we are in an era where the difficulty facing physicians in discriminating between the two diseases has increased, and the morbidity and mortality resulting from a delayed diagnosis or misdiagnosis is considerably high. In this article, we examine the changing trends in the epidemiology of CD and ITB, in addition to clinical features that aid in the differentiation of both diseases. The value of various laboratory, serological, and the tuberculin skin tests are reviewed as well. The use of an interferon-gamma-release assay, QuantiFERON-TB Gold, in the workup of these patients and its value in populations where the bacillus Calmette-Guérin vaccine is still administered is discussed. Different radiological, endoscopic, and pathological similarities and features that can aid the clinician in reaching a rapid diagnosis are reviewed as well. The association between mycobacteria and CD, the concerns with the practice of antituberculosis medication trials in areas where tuberculosis (TB) is endemic, as well as extrapulmonary TB induced by the use of antitumor necrosis factor-alpha agents are delineated in this article. Furthermore, we propose an algorithm for the investigation of patients in whom the differential diagnosis encompasses CD and ITB.
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Park YS, Jun DW, Kim SH, Lee HH, Jo YJ, Song MH, Kim NI, Lee JS. Colonoscopy evaluation after short-term anti-tuberculosis treatment in nonspecific ulcers on the ileocecal area. World J Gastroenterol 2008; 14:5051-8. [PMID: 18763289 PMCID: PMC2742934 DOI: 10.3748/wjg.14.5051] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of colonoscopy follow-up after short-term anti-tuberculosis treatment in patients with nonspecific ulcers on ileocecal areas being suspicious of tuberculous colitis.
METHODS: We prospectively analyzed the colonoscopic findings before and after short term anti-tuberculosis treatment in 18 patients with nonspecific ulcers on the ileocecal area and compared them with 7 patients of confirmed tuberculous colitis by acid-fast bacilli or caseating granuloma on colonic biopsy.
RESULTS: Mean duration for short-term follow-up was 107.3 d with combined chemotherapy containing isoniazid, rifampicin, ethambutol and pyrazinamide. Seven patients with tuberculous colitis showed complete healing of active ulcers after short-term medication. After short-term anti-tuberculosis treatment, follow-up colonoscopy findings divided 18 patients with nonspecific ulcers into two groups by ulcer state. One is the “suspicious tuberculous colitis group” showing healing of ulcers and erosions and another is the “suspicious inflammatory bowel disease group” showing active ulcers with or without aggravation of the lesion. Finally, all 9 of the “suspicious tuberculous colitis group” were diagnosed as tuberculous colitis showing no recurrence of ulcers after termination of 9 mo of anti-tuberculosis medication. Patients of the “suspicious inflammatory bowel disease group” were finally diagnosed as Crohn’s disease or nonspecific colonic ulcers during long-term follow up.
CONCLUSION: Follow-up colonoscopy shows a healing stage ulcer or scarring change without an active ulcer with just 2 mo to 3 mo of medication in patients with tuberculous colitis. Colonoscopy follow-up after short term anti-tuberculosis trial in patients with nonspecific ulcers on the ileocecal area is valuable in making early differential diagnosis of tuberculous colitis.
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Jung AD, Seo YH, Park SH, Park JS, Cho SC, Lee NH, Lee BK, Ju SY, Ko JS, Ko HM, Park CJ. A Case of Secondary Gastric Tuberculosis Mimicking Submucosal Tumor. Chonnam Med J 2008. [DOI: 10.4068/cmj.2008.44.1.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- An Doc Jung
- Department of Internal Medicine, Gwangju Veterans Hospital, Korea
| | - Young Ho Seo
- Department of Internal Medicine, Gwangju Veterans Hospital, Korea
| | - Sang Hyun Park
- Department of Internal Medicine, Gwangju Veterans Hospital, Korea
| | - Jung Su Park
- Department of Internal Medicine, Gwangju Veterans Hospital, Korea
| | - Sang Cheol Cho
- Department of Internal Medicine, Gwangju Veterans Hospital, Korea
| | - Nam Hun Lee
- Department of Internal Medicine, Gwangju Veterans Hospital, Korea
| | - Bong Kyu Lee
- Department of Internal Medicine, Gwangju Veterans Hospital, Korea
| | - So Young Ju
- Department of Internal Medicine, Gwangju Veterans Hospital, Korea
| | - Jun Seok Ko
- Department of Radiology, Gwangju Veterans Hospital, Korea
| | - Hyang Mi Ko
- Department of Pathology, Gwangju Veterans Hospital, Korea
| | - Cheol Ju Park
- Department of Internal Medicine, Sangmu Hospital, Gwangju, Korea
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34
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Abstract
OBJECTIVE Reports suggest that the rates of tuberculosis (TB) continue to rise in the UK and throughout the world. The spread of the disease is aided by poverty, overcrowding, co-infection with human immunodeficiency virus and drug resistance. Consistent with the overall trend, intra-abdominal and gastrointestinal (GI) TB rates are rising. Tuberculosis is a treatable disease, whether occurring in the lungs or at extra-pulmonary sites but the nonspecific features of the disease result in difficulty in establishing a diagnosis. In this report, we have concentrated on the benefits and potential pitfalls of diagnostic methods. METHOD A literature review was performed using the National Library of Medicine's Pubmed Database using the keywords diagnosis, management, abdominal and GI TB. RESULTS Abdominal TB presents a particular challenge, as the diverse features of the disease do not readily suggest a particular diagnosis and diagnostic delays lead to significant morbidity and mortality. A number of investigative methods have been used to aid in the diagnosis of abdominal and GI TB. CONCLUSION The nonspecific presentation of abdominal and GI TB present challenges in the diagnosis of this increasingly common disease. A high index of suspicion is an important factor in early diagnosis. After a diagnosis has been established, prompt initiation of treatment helps prevent morbidity and mortality.
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Affiliation(s)
- S Rasheed
- St Mark's Hospital, Harrow, Middlesex, UK
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35
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Sibartie V, Kirwan WO, O'Mahony S, Stack W, Shanahan F. Intestinal tuberculosis mimicking Crohn's disease: lessons relearned in a new era. Eur J Gastroenterol Hepatol 2007; 19:347-9. [PMID: 17353702 DOI: 10.1097/meg.0b013e328012122b] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Over 400 000 cases of tuberculosis existed in Europe in 2002, 1% of which were intestinal tuberculosis. With population migrations on the increase, physicians may have to face an increase in intestinal tuberculosis. One of the attributes of intestinal tuberculosis is its ability to present in nonspecific ways and to mimic other disorders, in particular inflammatory bowel disease. We present a case series of intestinal tuberculosis presenting as inflammatory bowel disease and referred for management to a specialized clinic in inflammatory bowel disease, followed by a discussion of the difficulties encountered with this condition. We highlight the consequences that misdiagnosis can have, in an era where population demographics are changing in Europe and where immunomodulators and biological agents have the potential to do more harm than good.
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Affiliation(s)
- Vikrant Sibartie
- Department of Medicine, University College Cork, National University of Ireland, Ireland
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36
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Affiliation(s)
- Bruce K Adams
- Department of Nuclear Medicine, Mafraq Hospital, Abu Dhabi, United Arab Emirates.
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37
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Rautou PE, Corcos O, Hammel P, Cazals-Hatem D, Slama JL, Morin AS, Réza K, Lévy P, Ruszniewski P. [Pseudo Zollinger-Ellison syndrome in a patient with duodenal stenosis caused by tuberculosis]. ACTA ACUST UNITED AC 2006; 29:1164-8. [PMID: 16505764 DOI: 10.1016/s0399-8320(05)82183-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report the case of a 32-year-old Indian man with symptoms suggesting Zollinger-Ellison syndrome including abdominal pain, esaphagitis, duodenal stenosis that did not improve with antisecretory medication, elevated fasting gastrin serum levels that increased after intravenous secretin injections, elevated chromogranin A serum levels and tumoral aspect of pancreatic uncus on CT scan examination. A pancreaticoduodenectomy was performed. Histological examination of the resected specimen showed that there was no endocrine tumour of the pancreas or the duodenum, but identified marked lesions of follicular and caseous tuberculosis. The final diagnosis retained pseudo Zollinger-Ellison syndrome due to gastric outlet obstruction caused by duodenal stenosis of a tuberculosis origin.
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Affiliation(s)
- Pierre-Emmanuel Rautou
- Fédération Médico-Chirurgicale d'Hepato-Gastroentérologie, Centre Hospitalier Intercommunal Robert Ballanger, Aulnay-sous-Bois
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38
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Abstract
To evaluate the values of clinical findings in differential diagnosis between Crohn's disease (CD) and intestinal tuberculosis (ITb), so that better diagnosis strategies could be found, we analysed the records of 30 patients with ITb and 30 patients with CD retrospectively. We reviewed the cardinal symptomatic and physical, radiological, colonoscopic, pathological findings in the patients. Some cardinal symptomatic and physical, radiographic and colonscopic features of CD and ITb were positive correlation. Its Pearson correlation coefficients were 0.976, 0.953 and 0.961, respectively (p = 0.000, 0.003 and 0.000). Some histological features of CD and ITb had no correlation. Its Pearson correlation coefficient was 0.140 (p = 0.765). It is difficult to differentiate CD from ITb in clinical practice. The differential diagnosis depends largely upon colonoscopy and histopathology.
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Affiliation(s)
- Z Y Zhou
- Department of Internal Medicine, Renmin Hospital of Wuhan University, HuBei, China.
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39
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Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis--presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther 2005; 22:685-700. [PMID: 16197489 DOI: 10.1111/j.1365-2036.2005.02645.x] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The peritoneum is one of the most common extrapulmonary sites of tuberculous infection. Peritoneal tuberculosis remains a significant problem in parts of the world where tuberculosis is prevalent. Increasing population migration, usage of more potent immunosuppressant therapy and the acquired immunodeficiency syndrome epidemic has contributed to a resurgence of this disease in regions where it had previously been largely controlled. Tuberculous peritonitis frequently complicates patients with underlying end-stage renal or liver disease that further adds to the diagnostic difficulty. The diagnosis of this disease, however, remains a challenge because of its insidious nature, the variability of its presentation and the limitations of available diagnostic tests. A high index of suspicion is needed whenever confronted with unexplained ascites, particularly in high-risk patients. Based on a systematic review of the literature, we recommend: tuberculous peritonitis should be considered in the differential diagnosis of all patients presenting with unexplained lymphocytic ascites and those with a serum-ascites albumin gradient (SAAG) of <11 g/L; culture growth of Mycobacterium of the ascitic fluid or peritoneal biopsy as the gold standard test; further studies to determine the role of polymerase chain reaction, ascitic adenosine deaminase and the BACTEC radiometric system for acceleration of mycobacterial identification as means of improving the diagnostic yield; increasing utilization of ultrasound and computerized tomographic scan for the diagnosis and as a guidance to obtain peritoneal biopsies; low threshold for diagnostic laparoscopy; treatment for 6 months with the first-line antituberculous drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) in uncomplicated cases.
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Affiliation(s)
- F M Sanai
- Division of Hepatology, Department of Internal Medicine, Riyadh, Saudi Arabia.
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40
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Abstract
INTRODUCTION Bradford, in West Yorkshire, United Kingdom, has a population of 486 340 of which 17.3% originate from South Asia. We describe our experience of abdominal tuberculosis over a 10 year period. METHODS Fifty-nine cases of abdominal tuberculosis were identified between 1992 and 2002 from the Tuberculosis Registry, Bradford hospitals. Fifty case records were available for retrospective review. RESULTS Median age of the patients was 38 years (range, 14-81) and 35 (59.3%) were females. Fifty-four (91.5%) patients were of South Asian origin, four (6.8%) were Caucasians and one patient was an Arab. The mean standardized incidence of abdominal tuberculosis in the South Asian population during the study period was 9.32 cases/10(5)/year whereas in the local white population it was 0.1/10(5)/year (relative risk=93). Fever (90%), abdominal pain (88%) and weight loss (82%) were the commonest presenting features. Ileocaecal region in 20 (40%) patients and tubercular peritonitis in 16 (32%) cases were the common sites involved. Active pulmonary tuberculosis was present in 18 (36%) patients. Diagnosis of tuberculosis was confirmed by isolating acid-fast bacilli or by demonstrating caseating granulomas on biopsy in 36 (72%) cases. Acid-fast bacilli isolated in all the 29 (58%) cases were Mycobacterium tuberculosis and were sensitive to all standard anti-tubercular drugs except one patient who was resistant to isoniazid. CONCLUSION Abdominal tuberculosis remains a common problem in a multicultural community in the United Kingdom with a varied presentation. High index of suspicion is required for early diagnosis. Most of the patients respond very well to standard anti-tubercular therapy and surgery is required only in a minority of cases. Drug resistant abdominal tuberculosis has not been a problem in this series.
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Affiliation(s)
- Amit Singhal
- Integrated Department of Gastroenterology, Bradford Teaching Hospitals NHS Trust, UK.
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41
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Collado C, Stirnemann J, Ganne N, Trinchet JC, Cruaud P, Barrat C, Benichou J, Lhote F, Malbec D, Martin A, Prevot S, Fain O. Gastrointestinal tuberculosis: 17 cases collected in 4 hospitals in the northeastern suburb of Paris. ACTA ACUST UNITED AC 2005; 29:419-24. [PMID: 15864206 DOI: 10.1016/s0399-8320(05)80796-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED Gastrointestinal tuberculosis is a rare form of extrapulmonary tuberculosis and its diagnosis can be difficult. AIMS To analyze the diagnostic and therapeutic characteristics of gastrointestinal tuberculosis. METHODS Retrospective study from 17 cases collected in 4 hospitals in Seine Saint-Denis between 1987 and 2002. RESULTS Seventeen cases and 19 localizations were collected: small intestine (N = 7), ileocecum (N = 6), colon (N = 4) and gastroduodenum (N = 2). Two patients had two localizations. Mean age was 43.9 years. Subjects from immigrant populations (76.5%) were preferentially affected. Twenty-three percent of patients (13 tested) were infected by human immunodeficiency virus. Weight-loss and general weakness (88%), abdominal pain (88%), fever (59%), nausea/vomiting (53%) were the predominant symptoms. The delay in diagnosis was 82 days (range: 7-180) and time before specific treatment 31.6 days (range: 7-90). Histological evidence of caseating granuloma was found in six patients. Mycobacterium tuberculosis was detected in six. Digestive imaging was abnormal in 15 patients. Mesenteric lymph nodes were the most common associated site of tuberculosis (N = 8, 47%). Mean duration of treatment was 8.2 months (range: 6-12). Thirteen patients were cured, three died and one was lost to follow up. CONCLUSION Gastrointestinal tuberculosis is not an uncommon diagnosis in the north-eastern Parisian area, especially among immigrant populations and immunodeficient patients. The most frequent localizations are the small intestine and ileocecum. Diagnosis can be made by pathology and/or bacteriology on endoscopic and/or surgical biopsy samples.
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Affiliation(s)
- Caroline Collado
- Service de Médecine Interne, Faculté de Médecine, Université Paris XIII, Bondy, France
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42
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Kim YS, Moon JS, Lee JW, Kim I, Ryu SH, Paik IW. Solitary intra-abdominal tuberculous lymphadenopathy mimicking duodenal GIST. Korean J Intern Med 2005; 20:72-5. [PMID: 15906957 PMCID: PMC3891416 DOI: 10.3904/kjim.2005.20.1.72] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Tuberculosis remains prevalent in developing countries and has recently re-emerged in the Western world. Intra-abdominal tuberculosis can mimic a variety of other abdominal disorders, and here we describe a patient with solitary tuberculous mesenteric lymphadenopathy mimicking duodenal gastrointestinal stromal tumor (GIST). A 22-year-old woman complained of epigastric discomfort and was presumed to have a duodenal GIST after an endoscopic examination and abdominal CT scan. However, exploratory laparotomy revealed an enlarged node penetrating the duodenal bulb, which was diagnosed histopathologically as tuberculous lymphadenitis. This case suggests that in regions with a high prevalence of tuberculosis, intra-abdominal tuberculosis is often mistaken as a malignant neoplasm. A high index of suspicion and the accurate nonsurgical diagnosis of intra-abdominal tuberculosis continues to be a challenge.
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Affiliation(s)
- You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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43
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Imaging of Gastrointestinal Tuberculosis. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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44
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Abstract
Gastrointestinal tuberculosis is defined as infection of the peritoneum, hollow or solid abdominal organs, and abdominal lymphatics with Mycobacterium tuberculosis organisms. Gastrointestinal tuberculosis is relatively rare in the United States and is the sixth most common extrapulmonary location. Populations at risk include immigrants to the United States, the homeless, prisoners, residents of long-term care facilities, and the immunocompromised. The peritoneum and the ileocecal region are the most likely sites of infection and are involved in the majority of cases by hematogenous spread or through swallowing of infected sputum from primary pulmonary tuberculosis. Pulmonary tuberculosis is apparent in less than half of patients. Patients usually present with abdominal pain, weight loss, fever, anorexia, change in bowel habits, nausea, and vomiting. The diagnosis is often delayed and is usually made through a combination of radiologic, endoscopic, microbiologic, histologic, and molecular techniques. Antimicrobial treatment is the same as for pulmonary tuberculosis. Surgery is occasionally required.
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Affiliation(s)
- Todd A Sheer
- Department of Gastroenterology, Naval Medical Center San Diego, San Diego, CA 92134, USA.
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45
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Kim SG, Kim JS, Jung HC, Song IS. Is a 9-month treatment sufficient in tuberculous enterocolitis? A prospective, randomized, single-centre study. Aliment Pharmacol Ther 2003; 18:85-91. [PMID: 12848629 DOI: 10.1046/j.1365-2036.2003.01599.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Tuberculosis has increased in parallel with the acquired immunodeficiency syndrome epidemic and the use of immunosuppressive therapy, and the growing incidence of extra-pulmonary tuberculosis, especially with intestinal involvement, reflects this trend. However, the duration of anti-tuberculous therapy has not been clarified in intestinal tuberculosis. AIM To compare the efficacy of different treatment durations in tuberculous enterocolitis in terms of response and recurrence rates. METHODS Forty patients with tuberculous enterocolitis were randomized prospectively: 22 patients into a 9-month and 18 into a 15-month group. Diagnosis was made either by colonoscopic findings of discrete ulcers and histopathological findings of caseating granuloma and/or acid-fast bacilli, or by clinical improvement after therapeutic trial. Patients were followed up with colonoscopy every other month until complete response or treatment completion, and then every 6 months for 1 year and annually. Complete response was defined as a resolution of symptoms and active tuberculosis by colonoscopy. RESULTS Complete response was obtained in all patients in both groups. Two patients in the 9-month group and one in the 15-month group underwent operation due to intestinal obstruction and perianal fistula, respectively. No recurrence of active intestinal tuberculosis occurred during the follow-up period in either group. CONCLUSIONS Tuberculous enterocolitis can be managed by 9-month chemotherapy without disease recurrence. Further investigations are needed in immunocompromised patients.
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Affiliation(s)
- S G Kim
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea
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46
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Affiliation(s)
- Nuria Maroto Arce
- Servicio de Medicina Digestiva. Hospital Universitario La Fe. Valencia. España.
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47
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Chatzicostas C, Koutroubakis IE, Tzardi M, Roussomoustakaki M, Prassopoulos P, Kouroumalis EA. Colonic tuberculosis mimicking Crohn's disease: case report. BMC Gastroenterol 2002; 2:10. [PMID: 12019037 PMCID: PMC115203 DOI: 10.1186/1471-230x-2-10] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2002] [Accepted: 05/13/2002] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Intestinal tuberculosis is a rare disease in western countries, affecting mainly immigrants and immunocompromised patients. Intestinal tuberculosis is a diagnostic challenge, especially when active pulmonary infection is absent. It may mimic many other abdominal diseases. CASE PRESENTATION Here, we report a case of isolated colonic tuberculosis where the initial diagnostic workup was suggestive of Crohn's disease. Computed tomography findings however, raised the possibility of colonic tuberculosis and the detection of acid-fast bacilli in biopsy specimens confirmed the diagnosis. CONCLUSIONS In conclusion, this case highlights the need for awareness of intestinal tuberculosis in the differential diagnosis of chronic intestinal disease
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Affiliation(s)
| | | | - Maria Tzardi
- Pathology, University Hospital Heraklion, Crete, Greece
| | | | | | - Elias A Kouroumalis
- Department of Gastroenterology, University Hospital Heraklion, Crete, Greece
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48
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Koh DM, Bell JR, Burkill GJ, Padley SP, Healy JC. Mycobacterial infections: still a millennium bug--the imaging features of mycobacterial infections. Clin Radiol 2001; 56:535-44. [PMID: 11446750 DOI: 10.1053/crad.2001.0755] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mycobacterial infection is re-emerging as a major health care concern. Although Mycobacterium tuberculosis(MTB) is still the most important pathogen, atypical mycobacterium (AMB) infections are becoming increasingly common. We present a pictorial review of the imaging features of these infections in the chest, abdomen, brain and musculoskeletal system. Imaging similarities and differences between the normal and the immunocompromised host will be highlighted.
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Affiliation(s)
- D M Koh
- Department of Radiology, Chelsea and Westminster Hospital, London, UK
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49
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Abstract
The diagnosis of gastrointestinal tuberculosis (GITB) is often delayed, increasing the morbidity associated with this treatable condition. In this case series, the clinical presentations and outcomes of 18 patients with GITB are reviewed. Our aim was to elucidate the presenting signs and symptoms of GITB so as to help physicians improve their ability to make this diagnosis. Cases were gathered retrospectively over an 8-year period from Santa Clara Valley Medical Center, San Jose, California. Sources of information included patient records from our TB clinic and our hospital from 1989 to 1997. Of the 18 patients, 16 had a definitive diagnosis of GITB made from histology and/or culture from an abdominal source. In the remaining two patients, a presumptive diagnosis of GITB was made based on the co-occurrence of abdominal signs and symptoms, response to antituberculous therapy, and Mycobacterium tuberculosis identified at a nonabdominal site. The most common clinical presentation was a triad of abdominal pain, fever, and weight loss. This triad was present in 8 of 18 patients. Seven patients presented with two of these signs and symptoms, two had abdominal pain alone, and one presented with other symptomatology. Time to diagnosis ranged from 2 days to 11 months, with a mean time to diagnosis of 50 days. These findings suggest that the diagnosis of GI and hepatic TB is often delayed. Possible reasons for delay include nonspecific signs and symptoms and failure to consider TB in the initial differential diagnosis. Once diagnosed, the outcome of GITB in this series was favorable.
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Affiliation(s)
- J S Bernhard
- Department of Medicine, Santa Clara Valley Medical Center, San Jose, California 95128, USA
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50
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Datta S, Vincent PJ, Singh Y, Bhalla VP, Mani NS. TUBERCULOUS PERITONITIS IN A HERNIAL SAC. Med J Armed Forces India 2000; 56:163-164. [PMID: 28790686 DOI: 10.1016/s0377-1237(17)30139-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Sgs Datta
- Clinical Tutor, Armed Forces Medical College, Pune 411 040
| | - P J Vincent
- Associate Professor, Armed Forces Medical College, Pune 411 040
| | - Y Singh
- Professor and Head, Armed Forces Medical College, Pune 411 040
| | - V P Bhalla
- Reader and Surgical Gastroenterologist, Department of Surgery, Armed Forces Medical College, Pune 411 040
| | - N S Mani
- Reader, Department of Pathology, Armed Forces Medical College, Pune 411 040
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