Tuberculosis peritoneal, un diagnóstico diferencial para ascitis en cirrosis / Peritoneal tuberculosis, a differential diagnosis for ascites in cirrhosis

Resumen Se presenta el caso de un paciente con antecedente de consumo crónico de alcohol, que consultó por dolor abdominal inespecífico, fiebre intermitente no cuantificada y pérdida de peso, con posterior aumento del perímetro abdominal. Se encontró ascitis y hallazgos en imágenes que sugerían cirrosis. El estudio del líquido ascítico fue no hipertensivo con predominio de linfocitos y niveles de adenosina-desaminasa (ADA) elevados. La ecografía y tomografía de abdomen mostraron el engrosamiento del peritoneo y la biopsia peritoneal por laparoscopia fue compatible con enfermedad granulomatosa, con reacción en cadena de la polimerasa (PCR) positiva para Mycobacterium tuberculosis en un paciente sin otras causas de inmunosupresión. Este caso muestra la necesidad de mantener una alta sospecha clínica de TB en patologías abdominales con clínica inespecífica, aun en pacientes sin inmunocompromiso claro.

Abstract This is the case of a patient with a history of chronic alcohol consumption, who consulted for nonspecific abdominal pain, intermittent fever, and weight loss, with subsequent increase in the abdominal perimeter. Ascites and imaging findings suggestive of cirrhosis were found. The study of ascitic fluid was non-hypertensive with a predominance of lymphocytes and elevated adenosine deaminase (ADA) levels. Ultrasound and abdominal tomography showed peritoneal thickening. Laparoscopic peritoneal biopsy was compatible with granulomatous disease, with positive PCR for Mycobacterium tuberculosis in a patient with no other causes of immunosuppression. This report shows the importance of keeping a high index of suspicion for TB in patients with abdominal pathology, even in those without evident inmunocompromise.

Tuberculosis infantil sistémica

Introducción: La tuberculosis infantil, definida como la enfermedad infectocontagiosa producida por el bacilo de Koch en pacientes menores de 15 años, continúa siendo un problema de salud pública debido a la cantidad de casos que anualmente se informan, además de ser un desafío para el pediatra en el diagnóstico y tratamiento de esta enfermedad. Objetivo: Describir el caso de un paciente varón con un cuadro de tuberculosis multisistémica. Presentación de caso: Paciente varón de 13 años con un cuadro progresivo de pérdida de peso de 20 kilos en 3 meses, dolor abdominal de localización difusa, tos seca e hiporexia. En los exámenes realizados, se encontraron lesiones cavitarias pulmonares, múltiples adenopatías enteroperitoneales y baciloscopia positiva en heces y orina; con lo que se llegó al diagnóstico de tuberculosis sistémica infantil y se inició esquema antituberculoso. El paciente evolucionó favorablemente y se encuentra estable. Conclusiones: Ante un paciente pediátrico con síndrome consuntivo, procedente de una zona endémica, la tuberculosis debe ser una de las primeras opciones en el diagnóstico diferencial.

Introduction: Childhood tuberculosis, defined as the infectious-contagious disease caused by the Koch bacillus in patients under 15 years of age, continues to be a public health problem due to the number of cases that are reported annually; in addition to represent a challenge for the pediatrician in the diagnosis and treatment of this disease. Objective: Describe the case of a male patient with a picture of multisystem tuberculosis. Case presentation: A 13-year-old male patient with a progressive weight loss of 20 kg in 3 months, abdominal pain of diffuse location, dry cough and hyporexia. In the examinations carried out, pulmonary cavitary lesions, multiple enteroperitoneal adenopathies and positive smears in feces and urine were found; with which the diagnosis of systemic tuberculosis in children was reached and an antituberculous scheme was initiated. The patient progressed favorably and he is stable. Conclusions: In the case of a pediatric patient with a wasting syndrome, and coming from an endemic area, tuberculosis should be one of the first options in the differential diagnosis.

Diagnostic challenge between Crohn's disease and intestinal tuberculosis in chronic diarrhea with ulcerated jejunal stenosis: a case report / Desafío diagnóstico entre la enfermedad de Crohn y la tuberculosis intestinal en la diarrea crónica con estenosis yeyunal ulcerada: reporte de un caso

ABSTRACT Intestinal tuberculosis and Crohn's disease are a diagnostic challenge because of the clinical, radiological and endoscopic similarity. The histological and microbiological findings are positive in less than 50%, which delays the correct treatment, putting the patient at risk. We reported a 34-year-old immunocompetent patient with 4 years of malabsorptive diarrhea, weight loss, nocturnal diaphoresis, abdominal pain and an ulcer with stenosis in the jejunum was found; she received empirical anti- tuberculosis treatment with clinical improvement. Later the culture was positive for M. tuberculosis.

RESUMEN La tuberculosis intestinal y la enfermedad de Crohn son un desafío diagnóstico debido a la similitud clínica, radiológica y endoscópica. Los hallazgos histológicos y microbiológicos son positivos en menos del 50%, lo que retrasa el correcto tratamiento, poniendo en riesgo al paciente. Reportamos un paciente de 34 años inmunocompetente con 4 años de diarrea malabsortiva, pérdida de peso, diaforesis nocturna, dolor abdominal y se encontró una úlcera con estenosis en yeyuno; recibió tratamiento empírico antituberculoso con mejoría clínica. Posteriormente el cultivo fue positivo para M. tuberculosis.

Linfoma de células T/NK extranasal primario en íleon / Natural Killer/T cell primary extranasal ileum lymphoma

RESUMEN El linfoma extranodal de células T/NK extranasal (NKTL) primario del tracto gastrointestinal es poco frecuente y tiene carácter agresivo. Presentamos el caso de un paciente inmunocompetente de 51 años que ingresa por dolor abdominal de dos meses de evolución. En la colonoscopía, se hallaron ulceraciones ileales, por lo que se le realizaron estudios para descartar enfermedad de Crohn y tuberculosis intestinal, posteriormente presentó obstrucción intestinal. En la laparotomía exploratoria, se encontró un conglomerado ganglionar en mesenterio. La anatomía patológica confirmó el diagnóstico de NKTL primario en íleon. Se inició quimioterapia y el paciente pidió alta voluntaria dada su precaria condición. Dos meses después del alta el paciente fallece. Este linfoma ha sido reportado principalmente en Asia y posiblemente sea el primer caso reportado en Perú. Tiene un pronóstico funesto con una supervivencia global de ocho meses. Por ello, es necesario un diagnóstico precoz e iniciar la terapia oportunamente.

ABSTRACT Primary extranodal Natural Killer / T cell lymphoma (NKTL) on gastrointestinal tract is an uncommon and aggressive neoplasm. We present the case of a 51-year-old immunocompetent patient with a 2-month history of abdominal pain. Colonoscopy findings showed ileal ulcerations, so studies were carried out to rule out Crohn's disease and intestinal tuberculosis. Later, he developed intestinal obstruction. Exploratory laparotomy found a nodal conglomerate in the mesentery. Anatomical pathology confirmed the diagnosis of primary NKTL on the ileum. Chemotherapy was initiated but the patient asked for voluntary discharge because of his precarious condition. Two months after discharge the patient died. This lymphoma has been reported mainly in Asia and is possibly the first case in Peru. It has a dismal prognosis with overall survival of 8 months. Therefore, it is necessary to get an early diagnosis and begin therapy in a timely manner.

Tuberculosis abdominal en niños de un hospital público de tercer nivel en México / Abdominal tuberculosis in children of a public tertiary hospital in Mexico

INTRODUCCIÓN. A nivel mundial la tuberculosis es una de las diez causas de muerte, con una incidencia de 7 920 pacientes entre 0 ­ 14 años en la región de América; siendo el abdomen el sitio extrapulmonar más común. OBJETIVOS. Describir las características etarias, clínicas, microbio-lógicas, complicaciones y comorbilidades asociadas en los pacientes pediátricos con tuberculosis abdominal. MATERIALES Y MÉTODOS. Estudio retrospectivo, base de datos de 23 pacientes y edades de 0 meses a 17 años 11 meses y 29 días de edad con evidencia confirmatoria de la presencia del microorganismo; de los servicios de Gastroenterología y Epidemiología en el Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca ", período 2007 a 2018. RESULTADOS. Se informaron 47,8% (11; 23) de sexo masculino y 52,2% (12; 23) de sexo femenino; 26,1% (6; 23) con antecedente de ingesta de lácteos no pasteurizados. Los tres datos clínicos más frecuentes fueron dolor abdominal, fiebre y pérdida de peso. El 8,7% (2;23) tuvieron convivencia con personas con tuberculosis activa positivo; 30,4% (7; 23) registraron prueba cutánea de derivado proteico pu-rificado positiva; 30,4% (7; 23) identificación de bacterias ácido-alcohol resistentes positivo; 43,5% (10; 23) estudios de imagen compatibles; 8,7% (2; 23) proteína C reactiva de mucosa intestinal po-sitivo; 4,3% (1; 36) cultivo positivo y 8,7% (2; 23) pacientes con inmunodeficiencia. CONCLUSIÓN. La tuberculosis abdominal, se presentó en menores de edad con síntomas inespecíficos de dolor abdominal, fiebre y pérdida de peso, expuestos a ingesta de productos lácteos no pasteurizados, combe positivo e inmunodeficiencia.

INTRODUCTION. Worldwide, tuberculosis is one of the ten causes of death, with an incidence of 7 920 patients between 0 - 14 years in the Americas region; the abdomen being the most common extrapulmonary site. OBJECTIVES. Describe the age, clinical, microbiological, complications and associated comorbidities in pediatric patients with abdominal tuberculosis. MATERIALS AND ME-THODS. Retrospective study, database of 23 patients and ages from 0 months of age to 17 years 11 months and 29 days of age with confirmatory evidence of the presence of the microorganism; of the Gastroenterology and Epidemiology services at the New Civil Hospital of Guadalajara "Dr. Juan I. Menchaca ", period 2 007 to 2 018. RESULTS. 47,8% (11; 23) men and 52,2% (12; 23) women were reported; 26,1% (6; 23) with a history of unpasteurized dairy intake. The three most frequent clinical data were abdominal pain, fever and weight loss. 8,7% (2; 23) lived together with people with positive active tuberculosis; 30,4% (7; 23) recorded a positive purified protein derivative skin test; 30,4% (7; 23) positive acid-alcohol resistant bacteria identification; 43,5% (10; 23) compatible imaging studies; 8,7% (2; 23) positive intestinal mucosal C-reactive protein; 4,3% (1; 36) positive culture and 8,7% (2; 23) patients with immunodeficiency. CONCLUSION. Abdominal tuberculosis occurred in minors with nonspecific symptoms of abdominal pain, fever and weight loss, exposed to intake of unpasteurized dairy products, positive combe and immunodeficiency

La tuberculosis intestinal: un desafío diagnóstico / Intestinal tuberculosis: a challenge diagnosis

RESUMEN Fundamento: la tuberculosis es un problema de salud pública a escala mundial. Es una enfermedad sistémica que en raras ocasiones puede afectar el tracto gastrointestinal, es poco frecuente en pediatría. Constituye su diagnóstico un gran desafío. Objetivo: presentar el caso de un adolescente con manifestaciones digestivas como síntomas iniciales de la tuberculosis intestinal. Presentación del caso: paciente de 15 años de edad, masculino, con historia de dolor abdominal, diarreas crónicas, pérdida de peso y fiebre con escalofríos. Por estos síntomas es remitido a consulta de Gastroenterología. Conclusiones: se debe sospechar la tuberculosis intestinal en pacientes pediátricos con síntomas de malabsorción intestinal. Se observó mejoría clínica de las manifestaciones digestivas luego de comenzar con el tratamiento antituberculoso.

ABSTRACT Background: tuberculosis is a public health problem to a world scale. It is a systemic illness that can rarely affect the gastrointestinal tract and it is not very frequent in pediatrics. Its diagnosis constitutes a great challenge. Objective: to present the case of an adolescent with digestive issues as first symptoms of intestinal tuberculosis. Presentation of the case: 15 year-old patient, masculine, with history of abdominal pain, chronic diarrheas, loss of weight and fever with chills. For this symptomatology he was remitted to our gastroenterology consultation. Conclusions: the intestinal tuberculosis should be suspected in pediatric patients with symptoms of intestinal malabsorption. Clinical improvement of the digestive issues was observed after beginning with the antituberculous treatment.

Perfil clínico-epidemiológico da tuberculose intestinal em pacientes de um hospital universitário / Clinical and epidemiological profile of intestinal tuberculosis in patients of a university hospital

OBJETIVO: Estabelecer o perfil clínico-epidemiológico da tuberculose intestinal em pacientes assistidos em um ambulatório específico. MÉTODOS: Estudo descritivo e retrospectivo, no qual foram avaliadas as principais características da população com diagnóstico de tuberculose intestinal atendida em um hospital universitário e notificada de janeiro 2009 a junho de 2017. RESULTADOS: A população foi constituída na maioria por mulheres, com média de 47,7 anos, negativas para o anti-HIV e residentes na região metropolitana. Ao diagnóstico, 27,3% apresentavam alteração de hábito intestinal e 45,4% doença fistulizante/ estenosante. Quase todos os resultados do PPD foram positivos, e 100% das radiografias de tórax não possuíam anormalidades. No histopatológico do segmento intestinal, o achado mais prevalente foi o granuloma caseoso. CONCLUSÃO: A tuberculose deve ser investigada em pacientes com doença intestinal no nosso país. (AU)

epidemiological profile of intestinal tuberculosis in patients assisted in a specific outpatient clinic. METHODS: This was a descriptive and retrospective study evaluating the main characteristics of the population with diagnosis of Intestinal tuberculosis treated at a University Hospital, and notified from January 2009 to June 2017. RESULTS: The population consisted mostly of women, with a mean age of 47.7 years, negative for anti-HIV, and livingin the metropolitan region of the city. At diagnosis, 27.3% presented changed bowel habits, and 45.4% fistulizing/stenosing disease. Almost all PPD results were positive and 100% of chest radiographs had no abnormalities. In the histopathology of the intestinal segment, the most prevalent finding was caseous granuloma. CONCLUSION: Tuberculosis should be investigated in patients with intestinal disease in our country. (AU)

Tuberculosis extrapulmonar en paciente inmunocompetente / Extrapulmonary tuberculosis in immunocompetent patient

La tuberculosis extrapulmonar se define como la infección ocasionada por Mycobacterium tuberculosis a tejidos y órganos fuera del parénquima pulmonar, aproximadamente el 1-3 % del total de los casos de TB son extrapulmonares y de estos el 11-16 % afectan al abdomen; 10 al 15 % en los no infectados por el VIH y hasta en 70 % en los infectados. El presente reporte es acerca de una paciente de 34 años, sexo femenino, heterosexual, que no refirió conductas sexuales de riesgo, misma que solicitó valoración por emergencias del hospital general del norte de Guayaquil Los Ceibos (HGNG-C), refiriendo manifestaciones clínicas de 1 semana de evolución aproximadamente, tales como: náusea, vómitos, deposiciones líquidas en varias ocasiones, sin mejoría a pesar de tratamiento médico previo, que se complica con la aparición de dolor abdominal severo, por el cual se decidió efectuar apendicetomía de emergencia; en los resultados anatomopatológicos se detectaron estructuras granulomatosas, estableciéndose el diagnóstico de tuberculosis extrapulmonar.

Extrapulmonary tuberculosis is defined as the infection caused by Mycobacterium tuberculosis to tissues and organs outside the lung parenchyma, approximately 1-3 % of the total TB cases are extrapulmonary and of these 11-16 % affect the abdomen; 10 to 15 % in those not infected by HIV and up to 70 % in those infected. The present report is about a 34-year-old female,heterosexual, who did not report risky sexual behavior, who requested emergency assessment from the general hospital in the north of Guayaquil Los Ceibos (HGNG-C), referring to manifestations clinics of 1 week of evolution, such as: nausea, vomiting, liquid stools on several occasions, without improvement despite previous medical treatment, which is complicated by the appearance of severe abdominal pain, for which it was decided to perform emergency appendectomy ; In the anatomopathological results, granulomatous structures were detected, establishing the diagnosis of extrapulmonary tuberculosis.

Solitary Jejunal Tuberculosis with Intestinal Obstruction in an Immunocompetent Patient / 대한내과학회지

Intestinal tuberculosis is an infection of the gastrointestinal tract by the Mycobacterium tuberculosis complex. To the best of our knowledge, solitary intestinal tuberculosis accompanied by intestinal obstruction, particularly in the middle of the small intestine, is extremely rare. We report a case of solitary jejunal tuberculosis in a 49-year-old man with no underlying disease. He was admitted a few days after the onset of diffuse abdominal discomfort. Upon evaluation, we initially considered a malignancy of the distal jejunum with ileus due to the presence of a mass. Therefore, he underwent laparoscopic resection of the small bowel. Unexpectedly, the histologic specimen showed a chronic caseating granulomatous lesion with acid-fast bacilli. Ultimately, he was diagnosed with solitary jejunal tuberculosis. He was successfully treated with anti-tuberculosis drugs without any complications.

Tuberculosis gastrointestinal como causa de hemorragia digestiva masiva en un paciente con infección por VIH / Gastrointestinal tuberculosis as a cause of massive gastrointestinal bleeding in a patient with HIV infection

Resumen La tuberculosis (TBC) gastrointestinal es una complicación infrecuente y fatal en pacientes con infección por VIH. Se presenta en 3-16% de las formas extrapulmonares y su principal localización es la válvula ileocecal y colon. La hemorragia digestiva baja con presencia de una o múltiples úlceras en colon es una presentación muy inusual de TBC intestinal. El diagnóstico se confirma por biopsia y cultivo del tejido intestinal. La cirugía en caso de perforación intestinal sigue siendo el tratamiento de elección. Se presenta el caso de un paciente con infección por VIH, sin tratamiento anti-retroviral, quien desarrolló una TBC diseminada con perforación intestinal y hemorragia digestiva masiva de curso fatal.

Gastrointestinal tuberculosis is a rare and fatal complication in patients with HIV infection. It occurs in 3%-16% of extra pulmonary forms. The main location in 90% of cases is the ileocecal valve and colon. The most unusual presentation of gastrointestinal tuberculosis is massive bleeding with the presence of one or multiple ulcers in the colon. The diagnosis can be confirmed by biopsy and by culture of intestinal tissue. Surgical resection is the treatment of choice. We report a case of a HIV-infected patient, who did not receive antiretrovirals, and who developed disseminated tuberculosis with intestinal perforation, presenting a fatal massive intestinal bleeding.

Penetrating gastric ulcer as a manifestation of multisystemic tuberculosis / Úlcera gástrica penetrante como manifestación de tuberculosis multisistémica

We present the case of a 30-year old female with a history of abdominal pain, fever, poor oral tolerance and weight loss for 6 months. An abdominal CT scan showed marked gastric dilatation due to extrinsic compression from lymphadenopathies around the second portion of the duodenum. The upper endoscopy revealed the presence of a penetrating gastric ulcer in the greater curvature. Biopsies of the lesions showed hystiocytes with granulomatous features and Acid Fast Bacilli (AFB) positive, and the cultures grew Mycobacterium tuberculosis sensitive to Isonazid and Rifampin. Subsequently anti-TB regimen was initiated achieving great clinical and endoscopic improvement.

Se presenta un caso de una mujer de 30 años de edad con historia de dolor abdominal, fiebre, poca tolerancia oral y pérdida de peso por 6 meses. Un CT scan abdominal muestra dilatación marcada gástrica debido a una compresión extrínseca por adenopatías alrededor de la segunda porción del duodeno. Una endoscopía alta revela la presencia de una úlcera gástrica penetrante en la curvatura mayor. Las biopsias mostraron histiocitos con granulomatosis y bacilos acid fast positivos y en los cultivos crecieron micobacterium tuberculosis sensibles a isoniacidad y rifampicina. Subsecuentemente se inició el régimen anti TBC lográndose una mejoría clínica y endoscópica evidente.

Peritonitis tuberculosa con perforación intestinal en población pediátrica en un hospital de tercer nivel de Bogotá, Colombia / Tuberculous peritonitis with intestinal perforation in the pediatric population at a third level of care hospital in Bogotá, Colombia

Introducción. La peritonitis tuberculosa es un tipo de presentación poco frecuente de la tuberculosis en población pediátrica, con enfermedades concomitantes que favorecen una inmunosupresión crónica. En el presente artículo, se presenta un caso de peritonitis tuberculosa manejado en nuestra institución y se hace una revisión crítica de la literatura científica. Materiales y métodos. Se llevó a cabo un estudio observacional y descriptivo de los pacientes que fueron sometidos a cirugía con hallazgo intraoperatorio de peritonitis generalizada, y con diagnóstico confirmado de peritonitis tuberculosa, desde el 1° de junio del 2004 hasta el 30 de junio del 2015. Resultados. Se revisaron 486 pacientes con peritonitis generalizada, de los cuales solo a un paciente masculino de cuatro años, con síndrome nefrótico y tuberculosis pulmonar, se le hizo diagnóstico de peritonitis tuberculosa, con perforación intestinal y necesidad de cirugía de urgencia. Falleció el día 51 de hospitalización en la unidad de cuidados intensivos. Discusión y conclusiones. La tuberculosis peritoneal es una entidad poco frecuente en la población pediátrica, pero debe considerarse en pacientes con factores de riesgo para inmunosupresión, nexo de contagio para tuberculosis y ascitis, acompañados de dolor abdominal y fiebre. El diagnóstico temprano mejora el pronóstico del paciente y la biopsia peritoneal es la prueba estándar para confirmar esta entidad. Su incidencia en nuestra institución es de 0,2 %

Introduction: Tuberculous peritonitis is a rare type of presentation of tuberculosis in pediatric patients with comorbidities associated with chronic immunosuppression. In this article, we present a case of tuberculous peritonitis managed at our institution and a critical review of the literature. Materials and methods: Descriptive observational study of patients who underwent surgery with the intraoperative finding of generalized peritonitis in the period June 1, 2004 to June 30, 2015. Only one patient was confirmed with tuberculous peritonitis. Results: 486 patients with generalized peritonitis were studied. The diagnosis of tuberculous peritonitis was confirmed only in a 4 year old male patient with nephrotic syndrome and pulmonary tuberculosis. The patient had intestinal perforation and required an emergency surgical intervention. He died on day 51 of hospitalization in the ICU. Discussion and conclusions: Peritoneal tuberculosis is a rare entity in the pediatric population, but it should be considered in patients with risk factors for immunosuppression, nexus of tuberculosis infection and ascites, accompanied by abdominal pain and fever. Early diagnosis improves the patient´s prognosis, and peritoneal biopsy is the gold standard to confirm this entity, whose incidence is 0.2% at our institution.

Tuberculosis intestinal, un reto diagnóstico: a propósito de un caso / Intestinal tuberculosis, a diagnostic challenge: report of a case

La tuberculosis gastrointestinal es una patología rara y difícil de diagnosticar, que está asociada con diversos factores sociales y económicos, así como con el estado de salud de la víctima. Este relato de caso se realizó sobre la tuberculosis intestinal en el Departamento de Boyac, en el que se describen los principales aspectos clínicos, paraclínicos, el proceso de diagnóstico y el plan de manejo en el paciente. La afectación gastrointestinal de la tuberculosis tiene una baja incidencia, siendo el sexto lugar de compromiso. Los signos y síntomas manifestados por el paciente no son específicos ya menudo el personal de salud sospecha y primero se centra en otras enfermedades que son más frecuentes. A partir de este caso médico, se ponen de relieve las diversas sospechas diagnósticas que se plantearon en el curso de la enfermedad con el fin de lograr un diagnóstico de la tuberculosis intestinal, lo que proporciona una mayor orientación para que los médicos tengan en cuenta esta enfermedad en su práctica clínica.

Gastrointestinal tuberculosis is a rare and difficult pathology to diagnose, which is associated with various social and economic factors as well as the state of health of the sufferer. This case report was made about intestinal tuberculosis in the Department of Boyac , in which the main clinical, paraclinical, the process of diagnosis and management plan in place in the patient are described. Gastrointestinal involvement of tuberculosis has a low incidence, being the sixth place of commitment. Signs and symptoms manifested by the patient are not specific and often the health staff suspect and first focuses on other diseases that are more prevalent. From this medical case, the various diagnostic suspicions that were raised in the course of the disease are emphasized in order achieve a diagnosis of the intestinal tuberculosis, which provides a higher guidance for doctors to take this disease into account in their clinical practice.

Research progress in differential diagnosis of Crohn's disease and intestinal tuberculosis / 中国医师杂志

Crohn's disease and intestinal tuberculosis are intestinal chronic granuloma.The mis-diagnosing rate is high.It is a great challenge to distinguish Crohn's disease from intestinal tuberculosis.The prognosis is quite different between Crohn's disease and intestinal tuberculosis.So,it's very important to correctly identify Crohn's disease and intestinal tuberculosis.

A Meta-analysis of the accuracy of interferon-γrelease assays in differentiating intestinal tuberculosis from Crohn's disease in Asia / 中华内科杂志

Objective This meta-analysis assessed the value of interferon-γ release assays (IGRAs) in the differential diagnosis of intestinal tuberculosis (ITB) from Crohn's disease (CD).Methods Systematic search without language restriction was conducted in the main computerized databases until June 2015.Studies that have evaluated the performance of IGRAs (QuantiFERON-TB Gold or T-SPOT.TB) in distinguishing ITB from CD were eligible.Main outcome measures included sensitivity and specificity.Area under the curve (AUC) of the summary receiver operating characteristic (sROC) curve was used to evaluate the accuracy of IGRAs.Results Twelve studies (all from Asia) were finally included.The pooled sensitivity and specificity of IGRAs for the differential diagnosis of ITB from CD were 82.8％ (95％CI 78.4％-86.6％) and 86.7％ (95％ CI 83.2％-89.6％) respectively.The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 6.870 (95％ CI 5.345-8.830) and 0.171 (95％ CI 0.105-0.279).The diagnostic odds ratio was 44.030 (95％ CI 27.964-69.325).And the AUC of sROC was 0.939.Conclusions IGRAs have a high sensitivity and specificity for the diagnosis of ITB,and specificity is consistent from study to study.IGRAs may be considered as a supplementary method in the differential diagnosis of ITB from CD.

Tuberculosis pulmonar, esofágica y laríngea / Pulmonary, esophageal and laryngeal tuberculosis

Resumen La tuberculosis es una de las enfermedades que más ha impactado en la sociedad a nivel mundial siendo influenciada por la pandemia del VIH, los patrones migratorios y el uso de la medicación antituberculosa. La forma extrapulmonar es rara siendo más característica en los pacientes inmunocomprometidos, cuyas manifestaciones clínicas son inespecíficas, por lo que constituye un reto diagnósticopara los clínicos, en la mayoría de los casos retardando su detección y tratamiento. Se presenta el caso clínico de un paciente aparentemente inmunocompetente que consulta por cuadro de seis años de evolución de disfagia progresiva, pérdida de peso inexplicada, en quien se encontró compromiso por tuberculosis a nivel esofágico y laríngeo que explicaban los síntomas de ingreso, así como compromiso pulmonar sin clara sintomatología. Cuadro llamativo y de relevancia por su forma de presentación de alto riesgo de diseminación de la infección en un paciente sin inmunocompromiso. (Acta Med Colomb 2014; 39: 85-89).

Abstract Tuberculosis is one of the diseases that has more impacted the global society, being influenced by the HIV pandemic, migration patterns and the use of anti-TB drugs. Extrapulmonary tuberculosis is rare, being more characteristic in immunocompromised patients, whose clinical manifestations are nonspecific, thus constituting a diagnostic challenge for clinicians and in most cases delaying its detection and treatment. The case of a patient apparently immunocompetent consulting for a six years history of progressive dysphagia and unexplained weight loss, in whom involvement of esophagus and larynx by tuberculosis was found explaining the symptoms of admission, as well as the pulmonary involvement with no clear symptoms, is presented. It is a striking and relevant clinical picture by its presentation with high risk of dissemination of the infection in a patient without immunocompromise. (Acta Med Colomb 2014; 39: 85-89).

The clinical, endoscopic and pathologic features of Crohn's disease in the differentiation from intestinal tuberculosis / 中华内科杂志

Objective To investigate the clinical,endoscopic and pathologic features in the differential diagnosis between Crohn' s disease (CD) and intestinal tuberculosis (ITB).Methods The complete clinical data of 107 patients with CD and 69 patients with ITB in our hospital from January 2011 to January 2012 were retrospectively analyzed.The diagnostic value of the clinical and endoscopic scoring system was evaluated.Results CD occurred mainly in male.The salient features of CD included long duration of disease high incidence of colectomy.Comparing with patients with ITB,patients with CD have more cases of diarrhea,hematochezia,abdominal mass,intestinal obstruction,intestinal hemorrhage,perianal lesions,and extraintestinal manifestations (all P ＜ 0.05).It's more frequent to have positive results of anti-Saccharomyces cerevisiae antibody (ASCA),perinuclear antineutrophil cytoplasmic antibody (pANCA) and fecal occult blood in CD patients,as well as low albumin,high C-reactive protein (CRP),elevated platelet count and hematocrit (P ＜ 0.05 or P ＜ 0.01).The salient features of ITB included low fever,night sweats,active parenteral tuberculosis,increased erythrocyte sedimentation rate (ESR),chest X-ray abnormalities,the positive PPD (purified protein derivatives tuberculin) and T-SPOT (P ＜ 0.05 or P ＜0.01).Based on the imaging,CD often involved the small intestine,such as the intestinal stricture and abdominal abscess (P ＜ 0.05),while mesenteric lymphadenopathy was more common in ITB (P ＜ 0.05).The endoscopic examination showed that some patterns of disease involvement such as fissure-shape ulcer [41.12％ (44/107) vs 5.80％ (4/69)],cobblestone sign [15.89％ (17/107) vs 4.35％ (3/69)],lesions over four segment [24.30％ (26/107) vs 7.25％ (5/69)],rectum involvement [17.76％ (19/107) vs 5.80％ (4/69)],ileocecal valve stenosis [21.50％ (23/107) vs 8.70％ (6/69)] and mucosal bridge [5.61％ (6/107) vs 0(0/69)] were more frequent in CD patients than those in ITB patients(P ＜ 0.01 or P ＜0.05).However circular ulcers[37.68％ (26/69) vs 9.35％ (10/107)],rat-bite-like ulcers[24.64％ (17/69) vs 12.15％ (13/107)],persistent open ileocecal valves [39.13％ (27/69) vs 19.63％ (21/107)],tuberous and polypoid lesions [36.23％ (25/69) vs 20.56％ (22/107),37.68％ (26/69) vs 22.43％ (24/107)] were more common in ITB (P ＜ 0.01 or P ＜ 0.05).In terms of pathological findings,certain characteristic features such as transmural inflammation [5.61％ (6/107) vs 0 (0/69)],fissure-liked ulcers [14.02％ (15/107) vs 4.35％ (3/69)],non-caseous granulomas [5.61％ (6/107) vs 0(0/69)],lymphoid hyperplasia [16.82％ (18/107) vs 5.80％ (4/69)] and crypt abscess [9.35％ (10/107) vs 1.45％ (1/69)] were more common in CD than those in ITB(P ＜ 0.05).According to the clinical and endoscopic scoring system,the positive diagnostic rate of CD was 50.47 ％ (54/107)and of ITB was 66.67 ％ (46/69) (P ＜ 0.05).Conclusions The differential diagnosis between CD and ITB should be considered carefully based on clinical,endoscopic,pathological characteristics.The clinical and endoscopic scoring system may contribute to distinguish CD and ITB.

Differential Diagnosis between Crohn's disease, intestinal tuberculosis and primary small intestinal lymphoma based on clinical features, endoscopic and CT fingings / 中华普通外科杂志

Objective To investigate clinical,endoscopic and CT characteristics in Crohn's disease (CD),intestinal tuberculosis(ITB) and primary small intestinal lymphoma (PSIL).Methods In this study,39 cases of CD,24 cases of ITB and 23 cases of PSIL were retrospectively analyzed.Clinical and CT data were collected in all patients,23 CD cases,20 ITB cases and 20 PSIL cases underwent endoscopic exam.Chi-square tests or analysis of variance were used to evaluate and differentiate characteristics.Results Diarrhea,perianal disease,intestinal obstruction occurred significantly more in CD than in ITB and PSIL (x2 =10.134,6.769,8.000,P ＜ 0.05).Febrility,night sweating,pulmonary tuberculosis and ascites occurred more in ITB than in CD and PSIL (x2 =25.696,19.194,35.133,P ＜0.05).Abdominal mass,hematochezia and enterobrosis occurred more in PSIL than in CD and ITB (x2 =19.562,17.708,12.647,P＜0.05).Longitudinal ulcer,cobblestone sign were found more in CD than in ITB and PSIL(x2 =6.283,11.592,P ＜ 0.05).Transverse ulcer and rodent ulcer were found more in ITB than in CD and PSIL(x2 =15.633,19.686,P ＜ 0.05),but lump eminentia were found more in PSIL than in CD and ITB(x2 =26.120,P ＜0.05).Layering thickening,mural gas,fat,edema,enteric cavity stenosis,abscess were discovered more in CD than in ITB and PSIL (x2 =17.472,10.346,7.773,6.867,16.325,10.994,P＜0.05),single layer thickening and hollow lymph nodes were discovered more in ITB than in CD and PSIL(x2 =17.997,12.475,P ＜ 0.05).Multi segmental lesions was discovered more in CD and ITB than in PSIL (x2 =28.460,P ＜ 0.05),while single segmental lesions,mural single eccentric layer thickening and intussusceptions were discovered more in PSIL than in CD and PSIL (x2 =28.460,P ＜0.05).The intestinal wall thickening and lymph nodes enlargement in ITB and PSIL were higher than the CD (F =8.661,7.166,P ＜ 0.05),while the intestinal wall enhancement at CT imaging in PSIL was lower than CD and ITB (F =10.179,P ＜ 0.05).Conclusions Comprehensive analysis made on clinical,endoscopic and CT features of CD,ITB and PSIL may facilitate correct diagnosis.