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Intestinal Tuberculosis

Enterocolitis Tuberculous


Presentation

  • Here we present a case of intestinal tuberculosis which initially diagnosed as Crohn's disease but after starting immunosuppressive agents he presented with disseminated tuberculosis.[ncbi.nlm.nih.gov]
  • 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[ncbi.nlm.nih.gov]
  • Intestinal tuberculosis presenting with perforation is unlikely to lead to spontaneous resolution without operative management, and patients should be brought to the operating theatre for immediate surgery.[ncbi.nlm.nih.gov]
  • We present a review of the different clinical forms of intestinal tuberculosis and the difficulties encountered in the differential diagnosis of such, emphasizing the uncommon presentation described in our patient.[ncbi.nlm.nih.gov]
  • Clinical presentation may mimic many other abdominal diseases such as intra-abdominal infections, tumors, and Crohn s disease.[ncbi.nlm.nih.gov]
Fever
  • However, the abdominal pain, fever and poor general condition persisted and so, after 11 days, the patient underwent total body computed tomography and magnetic resonance imaging of the brain.[ncbi.nlm.nih.gov]
  • Weight loss was seen in 40 (66.7%) patients, fever 36 (60%), night sweats 30 (50%), anorexia in 30 (50%) and pulmonary tuberculosis in 18 (30%) patients.[ncbi.nlm.nih.gov]
  • The possibility of tuberculosis must be taken into account when a transplant patient has fever and severe abdominal complaints with no clear evidence of another infection.[ncbi.nlm.nih.gov]
  • The patient exhibited clinical symptoms of odynophagia, bloody diarrhea, and high fever. Physical examination on admission showed a poor nutritional status.[ncbi.nlm.nih.gov]
  • Abstract A patient with a fulminant amebic colitis coexisting with intestinal tuberculosis had a sudden onset of crampy abdominal pain, mucoid diarrhea, anorexia, fever and vomiting with signs of positive peritoneal irritation.[ncbi.nlm.nih.gov]
Weight Loss
  • It also aims to raise awareness that chronic diarrhoea and weight loss are common symptoms of colonic tuberculosis.[ncbi.nlm.nih.gov]
  • CONCLUSION: Weight loss and mucosal nodularity were associated with ITB. Abdominal pain and excessive intestinal involvement were associated with CD. ITB and CD were equally common.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Blood in stool, weight loss, focally enhanced colitis, and involvement of the sigmoid colon were the most important features in differentiating CD from intestinal tuberculosis.[ncbi.nlm.nih.gov]
  • Weight loss was seen in 40 (66.7%) patients, fever 36 (60%), night sweats 30 (50%), anorexia in 30 (50%) and pulmonary tuberculosis in 18 (30%) patients.[ncbi.nlm.nih.gov]
  • We report a 19 years old boy who presented with nonbilious vomiting and weight loss. His workup showed stricture in ascending colon, multiple liver abscesses with pneumobilia on CT scan.[ncbi.nlm.nih.gov]
Malaise
  • The CD patients more frequently reported malaise (87% vs 64%, P 0.03), nausea (84% vs 56%, P 0.01), pain in the right lower abdominal quadrant on examination (90% vs 54%, P 0.01) and urban domicile (65% vs 42%, P 0.05).[ncbi.nlm.nih.gov]
  • Symptoms Constitutional localsymptoms depending upon site involved  Constitutional symptoms are: • Fever • Malaise • Anemia • Night sweats • Loss of weight • Pain abdomen: colicky if luminal compromise, dull and continuous when mesenteric lymph nodes[slideshare.net]
Inguinal Hernia
  • Abstract We report the case of a 41 year-old male who came to the emergency room with a complaint of abdominal pain, and was diagnosed to have an acute obstructive abdomen due to a right inguinal hernia incarceration.[ncbi.nlm.nih.gov]
Abdominal Pain
  • However, the abdominal pain, fever and poor general condition persisted and so, after 11 days, the patient underwent total body computed tomography and magnetic resonance imaging of the brain.[ncbi.nlm.nih.gov]
  • Majority of patients (46, 76.7%) had abdominal pain, 26 (43.3%) had vomiting; abdominal distension was seen in 22 (36.7%) cases, diarrhoea and constipation in 16 patients (26.7%) and abdominal mass in 14 patients (23.3%).[ncbi.nlm.nih.gov]
  • Abstract We report the case of a 41 year-old male who came to the emergency room with a complaint of abdominal pain, and was diagnosed to have an acute obstructive abdomen due to a right inguinal hernia incarceration.[ncbi.nlm.nih.gov]
  • Abstract A patient with a fulminant amebic colitis coexisting with intestinal tuberculosis had a sudden onset of crampy abdominal pain, mucoid diarrhea, anorexia, fever and vomiting with signs of positive peritoneal irritation.[ncbi.nlm.nih.gov]
  • He presented with abdominal pain without overt peritonitis. Initial imaging showed small locules of free air in the abdominal cavity. The patient was managed with intravenous antibiotics as upfront surgery was deemed to be high risk.[ncbi.nlm.nih.gov]
Diarrhea
  • The diarrhea resolved after 4 wk of antituberculous therapy. Repeat perfusion studies after 3 mo showed normal absorption in the ileum. This case report suggests that intestinal tuberculosis can cause secretory diarrhea.[ncbi.nlm.nih.gov]
  • The common symptoms were chronic right lower abdominal and periumbilical pain (87.7%), weight loss (80.2%), anemia (64.2%), diarrhea (46.9%), fever (43.2%), diarrhea alternating with constipation (38.3%), and night sweats (30.9%).[ncbi.nlm.nih.gov]
  • In the present study, we used the polymerase chain reaction (PCR) assay on endoscopic biopsy specimens obtained from a patient with chronic diarrhea.[ncbi.nlm.nih.gov]
  • The patient exhibited clinical symptoms of odynophagia, bloody diarrhea, and high fever. Physical examination on admission showed a poor nutritional status.[ncbi.nlm.nih.gov]
  • Abstract A renal transplant recipient with stable allograft function presented with massive hemorrhagic diarrhea and severe anemia. No microbial infection could be found in stool cultures. Early colonoscopy showed severe colitis with ulceration.[ncbi.nlm.nih.gov]
Constipation
  • The common symptoms were chronic right lower abdominal and periumbilical pain (87.7%), weight loss (80.2%), anemia (64.2%), diarrhea (46.9%), fever (43.2%), diarrhea alternating with constipation (38.3%), and night sweats (30.9%).[ncbi.nlm.nih.gov]
  • […] disease, extra-intestinal manifestations, involvement of left colon, skip lesions, aphthous ulcers, cobblestoning, longitudinal ulcers, focally enhanced colitis, and microgranulomas were significantly more common in CD, partial intestinal obstruction, constipation[ncbi.nlm.nih.gov]
  • Majority of patients (46, 76.7%) had abdominal pain, 26 (43.3%) had vomiting; abdominal distension was seen in 22 (36.7%) cases, diarrhoea and constipation in 16 patients (26.7%) and abdominal mass in 14 patients (23.3%).[ncbi.nlm.nih.gov]
  • Symptoms Of Intestinal Tuberculosis Intestinal tuberculosis is caused by mycobacterium tuberculosis, as in any other organ involvement, tuberculosis symptoms remain same except intestinal involvement may produce chronic pain in the abdomen, diarrhea, or constipation[tandurust.com]
  • Common symptoms of abdominal tuberculosis are: Fever Loss of appetite Fatigue Weight loss Constipation Diarrhea Colicky pain in the abdomen Abdominal Swelling and tenderness Night sweats Diagnosis & Treatment of Abdominal Tuberculosis Diagnosis of abdominal[medindia.net]
Intestinal Disease
  • This case points out the need for awareness of intestinal tuberculosis in the differential diagnosis of chronic intestinal disease.[ncbi.nlm.nih.gov]
  • BACKGROUND: Multi-slice computed tomography enterography (MSCTE) is now widely used to diagnose and monitor intestinal disease. Preliminary studies suggest that MSCTE may be useful in detecting intestinal tuberculosis (ITB).[ncbi.nlm.nih.gov]
  • RESULTS: Based on a high specificity of differentiating between CD and ITB, 12 features, including longitudinal ulcers, nodular hyperplasia, cobblestone-like mucosa, intestinal diseases, intestinal fistula, the target sign, the comb sign, night sweats[ncbi.nlm.nih.gov]
  • The intestinal disease showed itself perhaps eighteen months before death, with no evidence of previous infection elsewhere. The evidences of impaired nutrition with emaciation are first seen.[henriettes-herb.com]
Loss of Appetite
  • Are weight loss, low appetite and indigestion symptoms for this disease? Is it curable? A: The symptoms in the beginning of the infection can be very non-specific and vague, but continues.[doctor.ndtv.com]
  • […] of appetite, weight loss, chest pains, fever, etc.[breath.ygoy.com]
  • Poonam started to suffer from severe abdominal pain, loss of appetite and low grade fever. She complained of persistent nausea and vomiting. Regular tests and ultrasounds suggested that she was suffering from appendicitis.[parashospitals.com]
  • Common symptoms of abdominal tuberculosis are: Fever Loss of appetite Fatigue Weight loss Constipation Diarrhea Colicky pain in the abdomen Abdominal Swelling and tenderness Night sweats Diagnosis & Treatment of Abdominal Tuberculosis Diagnosis of abdominal[medindia.net]

Workup

  • His workup showed stricture in ascending colon, multiple liver abscesses with pneumobilia on CT scan. Upper GI endoscopy revealed stricture in 2nd part of duodenum distally.[ncbi.nlm.nih.gov]
  • MATERIALS AND METHODS: From January 2006 to August 2011, a total of 81 consecutive patients (64 patients with CD and 17 patients with ITB) who received CTE on the initial workup were included.[ncbi.nlm.nih.gov]
  • The subsequent diagnostic workup included colonoscopic examination of the cecal and terminal region of the ileum with multiple biopsies.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The QuantiFERON-TB Gold test may hold promise for use in intestinal inflammatory diseases when tuberculosis is suspected but conventional workup is not diagnostic.[ncbi.nlm.nih.gov]
Skin Test Positive
  • The features of night sweats, concomitant pulmonary tuberculosis, positive tuberculin skin test, positive antibody to tuberculosis, abdominal lymphadenopathy, ascites, transverse ulcers, patulous ileocecal valve, and granulomas were more common in intestinal[ncbi.nlm.nih.gov]
Granulomatous Tissue
  • Microscopic Changes - Exuberant granulomatous tissue extending onto the serosa - Esenteric fat, enlarged lymph nodes, fibrosis, and hypertrophy of the muscularis. - Granulomas in the mucosa or the Peyer's patches.[crohnsforum.com]

Treatment

  • We therefore compared the efficacy of 6-month and 9-month therapy in the treatment of intestinal TB. Ninety patients definitely diagnosed with intestinal TB were randomized into 6-month (n 45) or 9-month (n 45) treatment groups, prospectively.[ncbi.nlm.nih.gov]
  • Histology confirmed intestinal tuberculosis and she made full recover with 6 months of anti-tuberculosis treatment.[ncbi.nlm.nih.gov]
  • Combined treatment including vitamins, pancreatic enzymes substitution, antidiarrhoics and spasmolytics was administered.[ncbi.nlm.nih.gov]
  • Although a CT scan to determine the morphology of the bowel wall is a key for correct diagnosis, each case still poses challenges for diagnosis and administrating the appropriate treatment.[ncbi.nlm.nih.gov]
  • Thus tuberculostatic treatment was restarted. However, signs of an acute abdomen appeared and laparotomy was performed, thereby revealing a peritoneal spread of nodules. Resection of the ileum and ascending colon was performed.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis: —If nutrition can be sustained, these patients may live a number of years, and there is no doubt that a number of pronounced cases have recovered.[henriettes-herb.com]
  • Mitchel RS: The prognosis of bilateral symmetrical diffuse nodular pulmonary tuberculosis and its possible relation to intestinal tuberculosis . Dis Chest 1956, 29 :669–674. Google Scholar 22.[link.springer.com]
  • […] in developing countries like India where intestinal tuberculosis (ITB) is prevalent as well. [1] Distinguishing CD from ITB is often challenging as both diseases have similar radiological, endoscopic and histologic features. [2] Since treatment and prognosis[tropicalgastro.com]

Etiology

  • Fulminant amebic colitis occurring together with intestinal tuberculosis is an uncommon event and may present an interesting patho-etiological relationship. The diagnosis was proven by histopathologic examination of resected specimen.[ncbi.nlm.nih.gov]
  • He had history of an episode of pancreatitis of unknown etiology 3 years prior to this hospitalization, allergy to ceftriaxone, and a right orchiectomy for non-specified reason.[elsevier.es]
  • .  HIV coexistence has dramatically changed the etiological agents & the pattern of presentation of abdominal tuberculosis thus producing diagnostic difficulties 5.[slideshare.net]
  • […] strongyloidiasis are often considered the top priorities in the differential diagnosis. [15] Crohn's disease is uncommon in certain developing countries [16] and, therefore, in patients from those countries with the clinical picture of IBD, a tuberculous etiology[najms.org]

Epidemiology

  • 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.[ncbi.nlm.nih.gov]
  • Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology. 2004;126(6):1504-17. Linares de la Cal JA, Cantón C, Hermida C, Pérez-Miranda M, Maté-Jiménez J.[revistagastrocol.com]
  • Clinical epidemiology of inflammatory bowel disease in Lebanon . Inflamm Bowel Dis 2007; 13 :475–480. 8. Longobardi T , Jacobs P , Wu L et al .[nature.com]
  • Epidemiology of tuberculosis on the basis of nation-wide tuberculosis prevalence surveys . J Kor Med Assoc 1991; 34 : 468–476. 8. Lewis, EA , Abioye, AA . Tuberculosis of the abdomen in Ibadan: A clinicopathological review .[nature.com]
  • Epidemiological study of abdominal tuberculosis among Indian migrants and the indigenous population of Leicester, 1972-1989. Gut 1992; 33:1085-8. 7. Bernardo J. Epidemiology and pathology of extrapulmonary and miliary tuberculosis, 2014.[najms.org]
Sex distribution
Age distribution

Pathophysiology

  • Clinical appearance of intestinal tuberculosis, short bowel syndrome and of cobalamin and folate deficiency as well as pathophysiology, diagnosis and treatment of these uncommon or even rare diseases are discussed in this case report.Key words: intestinal[ncbi.nlm.nih.gov]
  • Contents Signs and Symptoms Causative Agent Mode of Transmission Diagnosis Pathogenesis/Pathophysiology Prevention Treatment Complications References Signs and Symptoms Back to Top May have none Fever Anorexia Nausea Flatulence (“gas”) Food intolerance[nursing-resource.com]
  • Radiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy (3) Department of Neonatology and Pediatrics, University of Palermo, Di Cristina Hospital, Palermo, Italy (4) Pediatric Highly Intensive Care Unit, Department of Pathophysiology[bmcresnotes.biomedcentral.com]
  • […] gastrointestinal TB have ileocecal disease Also other colorectal sites Multiple sites in 28 - 44% Ileocecum is most common site of abdominal and gastrointestinal TB Isolated colorectal involvement is uncommon - only 10.8% of abdominal gastrointestinal TB Pathophysiology[pathologyoutlines.com]
  • Pathophysiology Abdominal tuberculosis Primary Secondary  10 Abdominal TB results from ingestion of milk or food infected with Mycobacterium bovis, has become very rare these days.  Mycobacterium tuberculosis is the pathogen in most of the 20 cases[slideshare.net]

Prevention

  • Prevention Back to Top Pasteurizing of milk may help prevent infection. See TB Prevention for more information. Treatment Back to Top Anti-Tuberculosis medications in four drug combination.[nursing-resource.com]
  • Srictureplasty will relieve the mechanical bowel narrowing and thus prevent the possibility of obstruction. You should wait for having a family till after her treatment.[doctor.ndtv.com]
  • Also avoid tea, coffee , cold-drinks, alcohols etc. to prevent diarrhea. Surgery : 70% of the patients gets relief by medication. In remaining 30%, dead bacteria’s stays in intestine thus leads to interruption.[medicinalplantsanduses.com]
  • Further studies are needed to increase our confidence as to whether six-month regimens are as good as nine-month regimens for preventing relapse ; and to provide information about treating abdominal TB in children and in people with HIV.[cochrane.org]
  • Abdominal TB is generally responsive to medical treatment alone, so early diagnosis can prevent unnecessary surgical intervention [1].[sonoworld.com]

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