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1.
Medicine (Baltimore) ; 99(32): e21641, 2020 Aug 07.
Article in English | MEDLINE | ID: mdl-32769931

ABSTRACT

RATIONALE: Intestinal tuberculosis (TB) is rarely seen in patients with end-stage renal disease (ESRD). We report an intestinal TB case with a clinical presentation similar to that of colon cancer in a patient with ESRD on hemodialysis. PATIENT CONCERNS: A 49-year-old man presented with a 3-month history of general weakness and anorexia. He had been treated for stage 5 chronic kidney disease (CKD) due to diabetic nephropathy for the last 3 years. His blood urea nitrogen and serum creatinine levels were 96.9 and 8.1 mg/dL, respectively, at the time of admission; azotemia was accompanied by severe anemia, hypoalbuminemia, hyperkalemia, and metabolic acidosis. Hemodialysis was initiated for suspected exacerbation of uremia; however, intermittent fever, night sweats, and abdominal discomfort persisted. DIAGNOSES: Abdominal computed tomography (CT) and whole-body F-fluorodeoxyglucose positron emission tomography were indicative of ascending colon cancer with lymph node metastases. However, colonoscopy with biopsy revealed the formation of submucosal caseating granuloma and acid-fast bacillus. INTERVENTIONS: We initiated quadruple therapy with isoniazid, rifampicin, pyrazinamide, and ethambutol. The patient continued the quadruple regimen for the first 2 months before switching to dual therapy and received anti-TB medications for a total of 12 months. OUTCOMES: After 9 months of standard anti-TB chemotherapy, polypoid residual lesions were noted during follow-up colonoscopy. Laparoscopy-assisted ileocecal resection was performed. No findings suggestive of recurrence of colonic TB were observed on follow-up abdominal CT at 6 months after discontinuation of anti-TB medications. LESSONS: If non-specific uremic symptoms persist in patients with advanced CKD, the possibility of extrapulmonary TB such as intestinal TB must be considered. Also, in patients with radiologic suspicion of colon cancer, endoscopy with biopsy should be performed promptly to exclude colonic TB with similar clinical manifestations.


Subject(s)
Kidney Failure, Chronic/complications , Tuberculosis, Gastrointestinal/etiology , Anorexia/etiology , Antitubercular Agents/therapeutic use , Drug Combinations , Ethambutol/therapeutic use , Humans , Isoniazid/therapeutic use , Kidney Failure, Chronic/physiopathology , Male , Middle Aged , Muscle Weakness/etiology , Pyrazinamide/therapeutic use , Renal Dialysis/methods , Republic of Korea , Rifampin/therapeutic use , Tomography, X-Ray Computed/methods , Tuberculosis, Gastrointestinal/physiopathology
2.
Dis Colon Rectum ; 62(11): 1390-1400, 2019 11.
Article in English | MEDLINE | ID: mdl-31596764

ABSTRACT

BACKGROUND: Few data are published on perianal tuberculosis. OBJECTIVE: This study aimed to determine the best method to diagnose tuberculosis in patients with fistula-in-ano and to conduct a systematic review to determine the incidence and characteristics of tuberculosis fistula-in-ano. DATA SOURCES: The prospective study data and existing literature were derived from PubMed, Google scholar, and Scopus STUDY SELECTION:: Prospective analysis of patients with tuberculous fistula-in-ano treated between 2014 and 2018 was conducted, and a systematic review of studies describing ≥3 patients with tuberculosis fistula-in-ano was completed. INTERVENTION: Testing of tuberculosis was performed by histopathology or polymerase chain reaction of tissue or pus from the fistula tract. MAIN OUTCOME MEASURES: The primary outcomes measured were the detection rate of various tests to detect tuberculosis in fistula-in-ano and the prevalence rate of tuberculosis in simple versus complex fistulas. RESULTS: In 637 samples (410 patients) tested, tuberculosis was detected in 49 samples (43 patients). Additional samples (n = 106) sent in patients with a high index of suspicion tested positive in 14 more patients. Thus, overall, 63 samples tested positive in 57 patients (total: 743 samples in 410 patients were tested). Tuberculosis was detected in 2 of 181 patients (1.1%) in tissue (histopathology), in 28 of 341 patients (8.2%) in tissue (polymerase chain reaction), and in 19 of 115 patients (16.5%) in pus (polymerase chain reaction) samples. To detect tuberculosis, tissue (polymerase chain reaction) was significantly better than tissue (histopathology) (28/341 vs 2/181, p < 0.00001) and pus (polymerase chain reaction) was significantly better than tissue (polymerase chain reaction) (19/115 vs 28/341, p < 0.0009). Tuberculosis was significantly more common in complex fistulas than in simple fistulas (20.3% vs 7.2%, p = 0.0002). The systematic review (n = 199) highlighted that tubercular fistulas are more common in recurrent and complex fistulas and in tuberculosis endemic regions. LIMITATIONS: The true sensitivity and specificity of each testing modality could not be determined because not all patients with tuberculosis fistula-in-ano were tested by every diagnostic modality studied. CONCLUSIONS: The tuberculosis detection rate of polymerase chain reaction was significantly higher than histopathology. Among polymerase chain reaction, pus had higher detection rate than tissue. Tuberculosis was associated with more complex and recurrent fistulas.


Subject(s)
Fissure in Ano , Mycobacterium tuberculosis , Rectal Fistula , Streptomycin/administration & dosage , Tuberculosis, Gastrointestinal , Aftercare/methods , Antitubercular Agents/administration & dosage , Bacteriological Techniques/methods , Bacteriological Techniques/statistics & numerical data , Female , Fissure in Ano/diagnosis , Fissure in Ano/epidemiology , Fissure in Ano/microbiology , Fissure in Ano/therapy , Humans , Incidence , India/epidemiology , Magnetic Resonance Imaging/methods , Male , Middle Aged , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/isolation & purification , Outcome Assessment, Health Care , Polymerase Chain Reaction/methods , Polymerase Chain Reaction/statistics & numerical data , Rectal Fistula/diagnosis , Rectal Fistula/epidemiology , Rectal Fistula/microbiology , Rectal Fistula/therapy , Recurrence , Reproducibility of Results , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/statistics & numerical data , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/epidemiology , Tuberculosis, Gastrointestinal/physiopathology , Tuberculosis, Gastrointestinal/therapy
3.
BMJ Case Rep ; 12(8)2019 Aug 26.
Article in English | MEDLINE | ID: mdl-31451473

ABSTRACT

Mycobacterium tuberculosisis highly endemic in the Philippines. The diagnosis is challenging with its non-specific presentation and the organism could extend to any of the organs. Interestingly, bacterial peritonitis arising spontaneously from gastrointestinal tuberculosis (TB) in an otherwise healthy, non-cirrhotic patient is quite unusual. In this paper, we discuss the case of a 27-year-old HIV-seronegative woman with massive intraperitoneal mixed bacterial and tuberculous abscess presenting 20 months after being diagnosed with bacteriologically confirmed gastrointestinal TB. Repeated large-volume paracentesis was done to drain out the infected ascites instead of inserting a percutaneously implanted catheter. Clinical improvement was noted and she was discharged after 12 days of intravenous antibiotics. She had completed 6 months of antituberculosis therapy and been well since then. The case has demonstrated that repeated paracentesis along with appropriate antibiotic regimen, may be a viable option for patients with TB and bacterial coinfected peritonitis. And possibly, peritoneal TB may increase the risk for (spontaneous) bacterial peritonitis.


Subject(s)
Antitubercular Agents/administration & dosage , Ascites , Ileum , Mycobacterium tuberculosis/isolation & purification , Paracentesis/methods , Peritonitis, Tuberculous , Tuberculosis, Gastrointestinal , Adult , Ascites/etiology , Ascites/physiopathology , Ascites/therapy , Colonoscopy/methods , Diagnosis, Differential , Female , Humans , Ileum/diagnostic imaging , Ileum/microbiology , Ileum/pathology , Intraabdominal Infections/diagnosis , Peritonitis, Tuberculous/diagnosis , Peritonitis, Tuberculous/physiopathology , Peritonitis, Tuberculous/therapy , Tomography, X-Ray Computed/methods , Treatment Outcome , Tuberculosis, Gastrointestinal/complications , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/physiopathology , Tuberculosis, Gastrointestinal/therapy
4.
World J Emerg Surg ; 14: 33, 2019.
Article in English | MEDLINE | ID: mdl-31338118

ABSTRACT

Diagnosing abdominal tuberculosis remains a great challenge even for experienced clinicians. It is a great mimicker that has unusual presentations. A high index of suspicion is essential for reaching its diagnosis. Clinical and radiological findings of abdominal tuberculosis are non-specific. Herein, we report the lessons we have learned over the last 30 years stemming from our own mistakes in diagnosing abdominal tuberculosis supported by illustrative challenging clinical cases. Furthermore, we report our diagnostic algorithm for abdominal tuberculosis. This diagnostic algorithm will help in reaching the proper diagnosis by histopathology or microbiology. Our diagnostic workup depends on categorizing the clinical and radiological findings of abdominal tuberculosis into five different categories including (1) gastrointestinal, (2) solid organ lesions, (3) lymphadenopathy, (4) wet peritonitis, and (5) dry/fixed peritonitis. The diagnosis in gastrointestinal tuberculosis and dry peritonitis can be reached by endoscopy. The diagnosis in solid organ lesions can be reached by ultrasound-guided aspiration. The diagnosis in wet peritonitis and lymphadenopathy can be reached by ultrasound-guided aspiration followed by laparoscopy if needed. Diagnostic laparotomy should be kept as the last option for achieving a histological diagnosis. Capsule endoscopy and enteroscopy were not included in the diagnostic algorithm because of the limited data of using these modalities in abdominal tuberculosis. They need special expertise, and rarely used in low- and middle-income countries. Furthermore, capsule endoscopy may cause complete intestinal obstruction in small bowel strictures. A definite diagnosis can be reached in only 80% of the patients. Therapeutic diagnosis should be tried in the remaining 20%.


Subject(s)
Tuberculosis, Gastrointestinal/diagnosis , Adult , Algorithms , Antitubercular Agents/therapeutic use , Decision Support Techniques , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Radiography/methods , Tuberculosis, Gastrointestinal/physiopathology , Ultrasonography/methods
5.
Pol Przegl Chir ; 91(1): 35-37, 2019 Jan 03.
Article in English | MEDLINE | ID: mdl-30919818

ABSTRACT

Abdominal tuberculosis is a common problem for clinicians in the tropical world and may manifest with varying clinical scenarios. Intestinal tuberculosis could have intestinal ulcers, strictures, hypertrophic lesions like polyps and may be complicated by perforation, bleeding, and intestinal obstruction. Crohn's disease is an important differential of intestinal tuberculosis which is closely mimics intestinal tuberculosis in clinical, endoscopic, radiological and histological presentation. Crohn's disease is known to have a fistulising variant. We report the case of 23 year old lady who had disseminated tuberculosis with intestinal involvement and seemed to improve on anti-tubercular therapy (ATT) but present with intestinal obstruction in the third month of ATT. Surgical exploration revealed clumping of bowel loops with multiple ileo-ileal fistulae. The case is presented because of the presence of entero-enteric fistulae and also because it demonstrated that intestinal tuberculosis may need surgical intervention even after initial improvement because of complications like intestinal obstruction.


Subject(s)
Crohn Disease/diagnosis , Crohn Disease/physiopathology , Intestinal Fistula/complications , Intestinal Fistula/surgery , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/surgery , Adult , Diagnosis, Differential , Female , Humans , Intestinal Fistula/physiopathology , Treatment Outcome , Tuberculosis, Gastrointestinal/physiopathology , Young Adult
6.
Trop Doct ; 49(2): 143-144, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30541387

ABSTRACT

A combination of anaemia and knuckle pigmentation should always raise concern for megaloblastic anaemia. As the terminal ileum is the site of vitamin B12 absorption and also the commonest site of abdominal tuberculosis, a clinical triad of prolonged fever, knuckle pigmentation and right lower quadrant abdominal tenderness should suggest ileocaecal tuberculosis in endemic areas.


Subject(s)
Anemia, Megaloblastic/complications , Tuberculosis, Gastrointestinal/complications , Vitamin B 12 Deficiency/etiology , Adolescent , Anemia, Megaloblastic/drug therapy , Anemia, Megaloblastic/pathology , Anemia, Megaloblastic/physiopathology , Antitubercular Agents/therapeutic use , Drug Therapy, Combination , Humans , Ileum/drug effects , Ileum/pathology , Ileum/physiopathology , Male , Treatment Outcome , Tuberculin Test , Tuberculosis, Gastrointestinal/drug therapy , Tuberculosis, Gastrointestinal/pathology , Tuberculosis, Gastrointestinal/physiopathology , Vitamin B 12/blood , Vitamin B 12/therapeutic use , Vitamin B 12 Deficiency/drug therapy , Vitamin B 12 Deficiency/pathology , Vitamin B 12 Deficiency/physiopathology
8.
BMJ Case Rep ; 20182018 Apr 19.
Article in English | MEDLINE | ID: mdl-29674398

ABSTRACT

A 15-year-old girl presented with erythema nodosum and mild abdominal complaints. Her intestinal granulomatous disease was erroneously diagnosed as Crohn's disease despite the fact that the possibility of tuberculosis was considered. The final diagnosis of tuberculosis was made only when an anti-tumour necrosis factor therapy resulted in further deterioration. The patient was treated with isoniazid, rifampin, pyrazinamide and ethambutol, with slow and steady clinical improvement until complete recovery was achieved.


Subject(s)
Antitubercular Agents/administration & dosage , Crohn Disease/diagnosis , Granulomatous Disease, Chronic , Intestinal Diseases , Tuberculosis, Gastrointestinal , Adolescent , Diagnosis, Differential , Female , Granulomatous Disease, Chronic/diagnosis , Granulomatous Disease, Chronic/etiology , Granulomatous Disease, Chronic/physiopathology , Humans , Intestinal Diseases/diagnosis , Intestinal Diseases/etiology , Intestinal Diseases/physiopathology , Tomography, X-Ray Computed/methods , Treatment Outcome , Tuberculin Test/methods , Tuberculosis, Gastrointestinal/complications , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/drug therapy , Tuberculosis, Gastrointestinal/physiopathology
10.
Indian J Gastroenterol ; 34(1): 43-50, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25663290

ABSTRACT

BACKGROUND: Extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn's disease (CD), as well as intestinal tuberculosis (ITB) from Asia, are underreported. We, therefore, describe the prevalence of EIMs in Indian IBD and ITB patients and study their relationship with disease extent and severity in IBD. METHODS: This retrospective single-center study included all IBD and ITB patients evaluated from January 2005 to July 2012. Disease profile and frequencies of arthropathies (peripheral and central) and ocular (episcleritis, iritis/uveitis), oral (aphthous stomatitis), skin (erythema nodosum, pyoderma gangrenosum, psoriasis), hepatobiliary (primary sclerosing cholangitis), and thromboembolic manifestations were analyzed. RESULTS: Of 1,652 patients (1146 UC, 303 CD, 203 ITB), frequency of any EIM was 33.2 %, 38.3 %, and 14.3 % in UC, CD, and ITB patients, respectively. Thromboembolism was more common among UC patients with pancolitis than proctitis (p < 0.001) and left-sided colitis (p = 0.02). Primary sclerosing cholangitis was seen in 0.4 % UC patients. Steroid-dependent UC patients had higher frequency of any EIM, peripheral arthropathy, or thromboembolism than patients with no or infrequent steroid requirement (p < 0.05). Peripheral arthropathy (p = 0.02), erythema nodosum (p = 0.01), and aphthous stomatitis (p = 0.004) were more common with CD than with UC patients. Patients with colonic CD had higher frequency of peripheral arthropathy, any EIM, and multiple EIMs than ileal or ileocolonic disease (p < 0.05). Relative to ITB, CD patients had higher frequencies of peripheral arthropathy (p < 0.001), aphthous stomatitis (p = 0.01), any EIM (p < 0.001), and multiple EIMs (p < 0.001). CONCLUSIONS: In Indian IBD and ITB patients, EIMs appear to be related to disease severity in UC and disease location in CD and are significantly more common in CD than in ITB. Overall prevalence of EIMs in these patients is similar to that of the West.


Subject(s)
Colitis, Ulcerative , Crohn Disease , Tuberculosis, Gastrointestinal , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/epidemiology , Colitis, Ulcerative/physiopathology , Crohn Disease/diagnosis , Crohn Disease/epidemiology , Crohn Disease/physiopathology , Humans , India/epidemiology , Prevalence , Retrospective Studies , Severity of Illness Index , Time Factors , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/epidemiology , Tuberculosis, Gastrointestinal/physiopathology
11.
Infect Dis (Lond) ; 47(3): 137-43, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25522183

ABSTRACT

BACKGROUND: The diagnosis of intestinal tuberculosis (ITB) is sometimes difficult to establish and requires endoscopic investigation with biopsies for histopathological examination. This study aimed to evaluate calprotectin as a marker of inflammation in ITB. METHODS: Patients with ITB were prospectively recruited in Southern India from October 2009 until July 2012. Demographic, clinical, endoscopic and histological features were examined along with faecal calprotectin (FC), serum calprotectin (SC) and C-reactive protein (CRP). RESULTS: Thirty patients (median age 34.5 years, 19 men) were included. Clinical features were abdominal pain (97%), weight loss (83%), cachexia (75%), fatigue (63%), watery diarrhoea (62%), nausea (55%) and fever (53%). Endoscopy showed transverse ulcers (61%), nodularity of mucosa (55%), aphthous ulcers (39%), strictures (10%) and fissures (10%). The terminal ileum and right colon harboured 81% of the lesions. Histology revealed granulomas in biopsies from 10 of the patients. FC and CRP levels showed a strong positive correlation (rs = 0.70, p < 0.01). FC, SC and CRP levels were higher in the granulomatous than the non-granulomatous patients, respectively (median FC 988 µg/g, interquartile range (IQR) 940 vs 87 µg/g, IQR 704, p < 0.01; median SC 8.2 µg/ml, IQR 7.3 vs 3.8 µg/ml, IQR 8.9, p = 0.23; median CRP 38.8 mg/L, IQR 42.9 vs 2.3 mg/L, IQR 13.5, p < 0.01). Higher median calprotectin and CRP levels were detected in patients with extensive than localized disease, but the differences did not reach statistical significance. CONCLUSION: ITB patients with granulomas on histology have high levels of faecal calprotectin and CRP.


Subject(s)
Feces/chemistry , Granuloma/pathology , Leukocyte L1 Antigen Complex/analysis , Tuberculosis, Gastrointestinal/pathology , Tuberculosis, Gastrointestinal/physiopathology , Abdominal Pain , Adult , Aged , Biomarkers/analysis , Biopsy , C-Reactive Protein/analysis , Cachexia , Diarrhea/microbiology , Fatigue , Female , Fever , Humans , India , Intestines/pathology , Leukocyte L1 Antigen Complex/blood , Male , Middle Aged , Nausea , Weight Loss , Young Adult
12.
World J Gastroenterol ; 20(40): 14831-40, 2014 Oct 28.
Article in English | MEDLINE | ID: mdl-25356043

ABSTRACT

Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge, as the nonspecific features of the disease which may lead to diagnostic delays and development of complications. This condition is regarded as a great mimicker of other abdominal pathology. A high index of suspicion is an important factor in early diagnosis. Abdominal involvement may occur in the gastrointestinal tract, peritoneum, lymphnodes or solid viscera. Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis. Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality. Most of the patients respond very well to standard antitubercular therapy and surgery is required only in a minority of cases. Imaging plays an important role in diagnosis of abdominal tuberculosis because early recognition of this condition is important. We reviewed our experience with the findings on various imaging modalities for diagnosis of this potentially treatable disease.


Subject(s)
Gastrointestinal Tract , Tuberculosis, Gastrointestinal , Antitubercular Agents/therapeutic use , Bacteriological Techniques , Diagnosis, Differential , Diagnostic Imaging/methods , Digestive System Surgical Procedures , Gastrointestinal Tract/drug effects , Gastrointestinal Tract/microbiology , Gastrointestinal Tract/physiopathology , Gastrointestinal Tract/surgery , Humans , Mycobacterium tuberculosis/isolation & purification , Predictive Value of Tests , Treatment Outcome , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/microbiology , Tuberculosis, Gastrointestinal/mortality , Tuberculosis, Gastrointestinal/physiopathology , Tuberculosis, Gastrointestinal/therapy
14.
Indian J Tuberc ; 60(3): 184-5, 2013 Jul.
Article in English | MEDLINE | ID: mdl-24000498

ABSTRACT

Tuberculosis of the gastrointestinal tract (GIT) occurs as a primary lesion or secondary to a focus of tuberculosis elsewhere in the body, most commonly in the lungs. Tuberculosis can affect any part of the GIT from the oesophagus to the anal canal. Two main types are - the tuberculous ulcer and the rarer hypertrophic type which is generally found at the ileocecal junction, less commonly in the colon or rectum. Tuberculosis of bowel distal to ileocecal junction is rare and is seldom considered as a differential diagnosis of rectal stricture (2%). We report a case of rectal tuberculosis presenting with rectal prolapse and masquerading as malignancy, clinically, radiologically as well as on colonoscopy. The diagnosis was confirmed by repeated histopathological examination. The patient underwent definitive surgery along with anti-tuberculous therapy.


Subject(s)
Antitubercular Agents/administration & dosage , Dissection , Rectal Neoplasms/diagnosis , Rectal Prolapse , Rectum/pathology , Tuberculosis, Gastrointestinal , Colectomy/methods , Colonoscopy , Diagnosis, Differential , Humans , Male , Middle Aged , Rectal Prolapse/etiology , Rectal Prolapse/surgery , Treatment Outcome , Tuberculosis, Gastrointestinal/complications , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/physiopathology , Tuberculosis, Gastrointestinal/therapy
16.
J Indian Med Assoc ; 110(3): 187-8, 2012 Mar.
Article in English | MEDLINE | ID: mdl-23029952

ABSTRACT

Gastric tuberculosis is mostly secondary to pulmonary tuberculosis. Primary and isolated gastric tuberculosis is very rare. A case of primary gastric tuberculosis of stomach in a 45-year-old female, known diabetic and hypertensive who presented to the hospital with epigastric pain and vomiting is being reported. Endoscopy showed a gastric ulcerated nodular lesion and biopsy showed tuberculous granuloma. Repeat endoscopy after a course of antituberculosis treatment showed minimal gastritis and complete resolution of the ulcerated nodular lesion.


Subject(s)
Antitubercular Agents/therapeutic use , Stomach/pathology , Tuberculosis, Gastrointestinal , Abdominal Pain/etiology , Biopsy , Female , Gastroscopy/methods , Humans , Middle Aged , Rare Diseases , Treatment Outcome , Tuberculosis, Gastrointestinal/complications , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/drug therapy , Tuberculosis, Gastrointestinal/physiopathology , Vomiting/etiology
18.
Trop Doct ; 41(4): 242-3, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21914676

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.


Subject(s)
Tuberculosis, Gastrointestinal/pathology , Tuberculosis, Gastrointestinal/physiopathology , Adolescent , Adult , Age Distribution , Aged , Antitubercular Agents/therapeutic use , Female , Hospitals , Humans , Incidence , India/epidemiology , Male , Middle Aged , Peritoneum/pathology , Retrospective Studies , Risk Factors , Sex Distribution , Tomography, X-Ray Computed , Treatment Outcome , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/drug therapy , Young Adult
19.
World J Gastroenterol ; 17(4): 433-43, 2011 Jan 28.
Article in English | MEDLINE | ID: mdl-21274372

ABSTRACT

Differentiating intestinal tuberculosis from Crohn's disease (CD) is an important clinical challenge of considerable therapeutic significance. The problem is of greatest magnitude in countries where tuberculosis continues to be highly prevalent, and where the incidence of CD is increasing. The final clinical diagnosis is based on a combination of the clinical history with endoscopic studies, culture and polymerase chain reaction for Mycobacterium tuberculosis, biopsy pathology, radiological investigations and response to therapy. In a subset of patients, surgery is required and intraoperative findings with pathological study of the resected bowel provide a definitive diagnosis. Awareness of the parameters useful in distinguishing these two disorders in each of the different diagnostic modalities is crucial to accurate decision making. Newer techniques, such as capsule endoscopy, small bowel enteroscopy and immunological assays for Mycobacterium tuberculosis, have a role to play in the differentiation of intestinal tuberculosis and CD. This review presents currently available evidence regarding the usefulness and limitations of all these different modalities available for the evaluation of these two disorders.


Subject(s)
Crohn Disease/diagnosis , Tuberculosis, Gastrointestinal/diagnosis , Capsule Endoscopy , Crohn Disease/pathology , Crohn Disease/physiopathology , Crohn Disease/therapy , Humans , India , Mycobacterium tuberculosis/genetics , Radiography/methods , Tuberculosis, Gastrointestinal/pathology , Tuberculosis, Gastrointestinal/physiopathology , Tuberculosis, Gastrointestinal/therapy
20.
Klin Med (Mosk) ; 88(2): 53-7, 2010.
Article in Russian | MEDLINE | ID: mdl-21105474

ABSTRACT

The aim of this work was to study clinical manifestations of abdominal tuberculosis (AT) and its diagnosis. It included 142 patients examined in Ulyanovsk region in 1990-2006. 88.7% of them first applied to general practitioners who diagnosed AT in 69.7% of the cases (half of them postmortem). AT was found in one third (30.3%) of the patients attending tuberculosis dispensaries (86.1% during urgent laparatomy). AT manifests itself as clinical conditions requiring therapeutic, surgical, anti-infectious, and anti-tumour treatment. The most informative diagnostic tool is histological study of tissue biopsies obtained during endoscopic and videolaparoscopic procedures. Medical histories also provide materials for early diagnosis and treatment of AT by evidence-based methods; they include data on refractory gastrointestinal ulcers and infiltrates, calcinates located in mesenteric lymph nodes, liver and spleen by X-ray, hypersensitivity to tuberculin.


Subject(s)
Tuberculosis/diagnosis , Abdomen , Adult , Diagnosis, Differential , Diagnostic Techniques and Procedures , Female , General Practice , Humans , Male , Tuberculosis/pathology , Tuberculosis/physiopathology , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Gastrointestinal/pathology , Tuberculosis, Gastrointestinal/physiopathology , Tuberculosis, Lymph Node/diagnosis , Tuberculosis, Lymph Node/pathology , Tuberculosis, Lymph Node/physiopathology
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