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Saad MK, Ghandour F, Saikaly E. Adalimumab-Induced Isolated Peritoneal Tuberculosis. International Journal of Recent Surgical and Medical Sciences 2023. [DOI: 10.1055/s-0043-1761477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
AbstractThe therapeutic approach to immune-mediated diseases including Crohn's disease has dramatically improved with the introduction of immunomodulators such as anti-tumor necrosis factor (TNF). However, its use is not complication-free, and since its introduction, a growing number of opportunistic infections is being reported in patients under treatment despite all preventive measures taken. Herein, we report a case of adalimumab-induced isolated peritoneal tuberculosis.
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Affiliation(s)
- Melissa Kyriakos Saad
- General Surgery Department, Saint George Hospital University Medical Center, Beirut, Lebanon
- University of Balamand, Faculty of Medicine and Medical Sciences, Lebanon
| | - Fatme Ghandour
- University of Balamand, Faculty of Medicine and Medical Sciences, Lebanon
- Pathology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Elias Saikaly
- University of Balamand, Faculty of Medicine and Medical Sciences, Lebanon
- General Surgery, Colorectal Surgery, Saint George Hospital University Medical Center, Beirut, Lebanon
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Jena A, Mohindra R, Rana K, Neelam PB, Thakur DC, Singh H, Gupta P, Suri V, Sharma V. Frequency, outcomes, and need for intervention in stricturing gastrointestinal tuberculosis: a systematic review and meta-analysis. BMC Gastroenterol 2023; 23:46. [PMID: 36814249 PMCID: PMC9948355 DOI: 10.1186/s12876-023-02682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Gastrointestinal strictures impact clinical presentation in abdominal tuberculosis and are associated with significant morbidity. AIM To conduct a systematic review of the prevalence of stricturing disease in abdominal and gastrointestinal tuberculosis and response to antitubercular therapy (ATT). METHODS We searched Pubmed and Embase on 13th January 2022, for papers reporting on the frequency and outcomes of stricturing gastrointestinal tuberculosis. The data were extracted, and pooled prevalence of stricturing disease was estimated in abdominal tuberculosis and gastrointestinal (intestinal) tuberculosis. The pooled clinical response and stricture resolution (endoscopic or radiologic) rates were also estimated. Publication bias was assessed using the Funnel plot and Egger test. The risk of bias assessment was done using a modified Newcastle Ottawa Scale. RESULTS Thirty-three studies reporting about 1969 patients were included. The pooled prevalence of intestinal strictures in abdominal tuberculosis and gastrointestinal TB was 0.12 (95%CI 0.07-0.20, I2 = 89%) and 0.27 (95% CI 0.21-0.33, I2 = 85%), respectively. The pooled clinical response of stricturing gastrointestinal tuberculosis to antitubercular therapy was 0.77 (95%CI 0.65-0.86, I2 = 74%). The pooled stricture response rate (endoscopic or radiological) was 0.66 (95%CI 0.40-0.85, I2 = 91%). The pooled rate of need for surgical intervention was 0.21 (95%CI 0.13-0.32, I2 = 70%), while endoscopic dilatation was 0.14 (95%CI 0.09-0.21, I2 = 0%). CONCLUSION Stricturing gastrointestinal tuberculosis occurs in around a quarter of patients with gastrointestinal tuberculosis, and around two-thirds of patients have a clinical response with antitubercular therapy. A subset of patients may need endoscopic or surgical intervention. The estimates for the pooled prevalence of stricturing disease and response to ATT had significant heterogeneity.
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Affiliation(s)
- Anuraag Jena
- grid.415131.30000 0004 1767 2903Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Ritin Mohindra
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Kirtan Rana
- grid.415131.30000 0004 1767 2903Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pardhu B. Neelam
- grid.415131.30000 0004 1767 2903Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Dhuni Chand Thakur
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Harjeet Singh
- grid.415131.30000 0004 1767 2903Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pankaj Gupta
- grid.415131.30000 0004 1767 2903Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vikas Suri
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Sharma K, Sharma M, Sharma V, Sharma M, Parmar UPS, Samanta J, Sharma A, Kochhar R, Sinha SK. MTBDRplus and MTBDRsl for simultaneous diagnosis of gastrointestinal tuberculosis and detection of first-line and second-line drug resistance. J Gastroenterol Hepatol 2023; 38:619-624. [PMID: 36652396 DOI: 10.1111/jgh.16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/24/2022] [Accepted: 01/17/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIM Emergence of drug resistance, especially to second-line drugs, hampers tuberculosis elimination efforts. The present study aimed to evaluate MTBDRplus and MTBDRsl assays for detecting first-line and second-line drug resistance, respectively, in gastrointestinal tuberculosis (GITB). METHODS Thirty ileocecal biopsy specimens, processed in the Department of Microbiology between 2012 and 2022, that showed growth of Mycobacterium tuberculosis on culture were included in the study. DNA, extracted from culture, was subjected to MTBDRplus and MTBDRsl (Hain Lifescience GmbH, Nehren, Germany), following manufacturer's instructions. Their performance was compared against phenotypic drug susceptibility testing (pDST) and gene sequencing. RESULTS Out of the 30 specimens, 4 (13.33%) were mono-isoniazid resistant, 4 (13.33%) were multidrug resistant (MDR), 2 (6.67%) were pre-extensively drug resistant (pre-XDR), and 2 (6.67%) were mono-fluoroquinolone resistant. The results were 100% concordant with pDST and gene sequencing. CONCLUSIONS In the wake of growing drug resistance in all forms of extrapulmonary tuberculosis, including GITB, MTBDRplus and MTBDRsl are reliable tools for screening of resistance to both first-line and second-line drugs.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sharma K, Sharma M, Sharma V, Sharma M, Samanta J, Sharma A, Kochhar R, Sinha SK. Evaluating diagnostic performance of Truenat MTB Plus for gastrointestinal tuberculosis. J Gastroenterol Hepatol 2022; 37:1571-1578. [PMID: 35501293 DOI: 10.1111/jgh.15878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/24/2022] [Accepted: 04/28/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Prompt and accurate diagnosis of gastrointestinal tuberculosis (GITB) along with simultaneous detection of drug resistance is inevitable for tuberculosis elimination. Truenat MTB Plus (TruPlus), a chip-based real-time polymerase chain reaction assay, was evaluated for the first time for diagnosing GITB and detecting rifampicin resistance. METHODS Fifty ileocecal biopsy specimens (5 microbiologically confirmed GITB [culture-positive], 25 clinically confirmed GITB [culture-negative], and 20 control patients) processed in the Department of Microbiology between 2011 and 2021 were subjected to TruPlus assay, Xpert MTB RIF assay multiplex polymerase chain reaction. Their performance was evaluated against both culture and composite reference standard. RESULTS The overall sensitivity and specificity of TruPlus in diagnosing GITB was 70% (21/30) and 100%, respectively. The sensitivity was 60% (3/5) for microbiologically confirmed cases and 72% (18/25) for clinically confirmed cases. Performance of TruPlus was superior to Xpert (sensitivity = 30%; P = 0.001) and comparable with MPCR (sensitivity = 83.33%; P = 0.13). Both TruPlus and MPCR had moderate agreement with reference standards, and MPCR detected additional three cases. Both TruPlus and Xpert correctly reported Rifampicin resistance in three cases. CONCLUSIONS TruPlus, with its greater portability and higher sensitivity than Xpert, could serve as an important tool for diagnosing GITB and rifampicin resistance at outreach endemic areas.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ahmed HA, Babiker HO. Intestinal tuberculosis—the challenging mimicker—in a young Sudanese patient: A case report. Clin Case Rep 2022; 10:e6210. [PMID: 35957772 PMCID: PMC9361794 DOI: 10.1002/ccr3.6210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/28/2022] [Accepted: 07/25/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hayat A. Ahmed
- Faculty of Medicine University of Khartoum Khartoum Sudan
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Baleguli V, Rizvi S, Varghese M, Ilyas J. A Rare Cause of Esophageal Dysphagia – Secondary Esophageal Tuberculosis. Cureus 2022; 14:e21019. [PMID: 35154989 PMCID: PMC8820495 DOI: 10.7759/cureus.21019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. It continues to be one of the most common causes of death in adults across all countries. It is found to be relatively lower in North America. When aerosol droplets that contain Mycobacteriumtuberculosis are inhaled, it can deposit in the respiratory tract, particularly in the patient’s lungs. Following this deposition, one of the four outcomes can take place. These include clearance of the organism immediately, primary disease, latent infection, and reactivation disease. Unhindered bacterial growth after primary infection can lead to a hematogenous spread of bacilli to produce disseminated TB. Esophageal involvement causing esophageal TB can be primary or secondary esophageal TB. We present a unique case of secondary esophageal TB with symptoms of dysphagia and odynophagia with primary TB focus on the lung. Computed tomography (CT) of the chest noted diffuse bilateral miliary lung disease. TB QuantiFERON gold and sputum culture were positive for TB. Mycobacterial culture for identification with high-performance liquid chromatography showed isoniazid-resistant TB. The patient was started on antitubercular therapy with rifampin, ethambutol, moxifloxacin, and pyrazinamide for a total of nine months. Esophagogastroduodenoscopy (EGD) reported severe ulcerations of the oropharynx and focal ulceration in the proximal to the mid esophagus. Histopathology revealed active ulcerative and granulomatous esophagitis with mycobacterial organisms. After EGD she was started on a full liquid diet and advanced as tolerated. After discharge, she followed with the Health Department and had three negative sputum cultures after the completion of therapy.
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Wenting J, Yuyan M, Qingfeng S, Yao Z, Yumeng Y, Yi S, Yingnan H, Qing M, Qingqing W, Mengran W, Bing L, Yu L, Sishi C, Na L, Rong B, Xiaodong G, Jue P, Bijie H. Clinical features of and diagnostic approaches for abdominal tuberculosis: 5-year experience from a non-tuberculosis-designated hospital in China. Rev Esp Enferm Dig 2021; 114:461-467. [PMID: 34886676 DOI: 10.17235/reed.2021.8022/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Abdominal tuberculosis (TB) is a common form of extrapulmonary TB but is still a diagnostic dilemma in clinical practice. We are aimed to highlight the clinical features of and diagnostic approaches for abdominal TB. METHODS Seventy cases of diagnosed abdominal TB were retrospectively collected at Zhongshan Hospital, Fudan University in Shanghai, China, between 1 August 2015 and 30 June 2020. They were classified as peritoneal TB, lymph node TB, gastrointestinal TB, visceral TB, or mixed TB. RESULTS Eighteen patients were diagnosed with peritoneal TB, 9 with lymph node TB, 5 with gastrointestinal TB, 2 with visceral TB, and 36 with mixed TB. Twenty-four patients had only abdominal TB, while 7 had abdominal TB combined with pulmonary TB (PTB), 19 had abdominal TB combined with extrapulmonary TB (EPTB) in one or more sites, and 20 had abdominal TB combined with both PTB and EPTB in other sites. The median diagnosis time was 60 days. Ascites(58.6%), abdominal distension(48.6%), weight loss(44.3%) and fever(42.9%) were the most common symptoms. The overall microbiological and histological confirmation rates were 70.0% and 38.6% respectively. The non-ascites samples yielded a higher microbiological confirmation rate (63.6%) than the total samples (40.8%). Diagnosis was confirmed histologically in 18 patients (69.2%). Forty-five cases (64.3%) were clinically diagnosed. Invasive procedures such as surgery (6/7), percutaneous biopsy (7/7) and endoscopy in lymph node TB (4/5) had high confirmation rates. CONCLUSIONS The diagnosis of abdominal TB should be reached by a combination of clinical, laboratorial, radiographic, microbiological and pathological findings.
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Affiliation(s)
- Jin Wenting
- Infectious Diseases, Zhongshan Hospital. Fudan University, China
| | - Ma Yuyan
- Infectious Diseases, Zhongshan Hospital. Fudan University, China
| | - Shi Qingfeng
- Hospital Infection Management, Zhongshan Hospital. Fudan University,
| | - Zhang Yao
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Yao Yumeng
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Su Yi
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Huang Yingnan
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Miao Qing
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Wang Qingqing
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Wang Mengran
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Li Bing
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Luo Yu
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Cai Sishi
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Li Na
- Infectious Diseases, Zhongshan Hospital. Fudan University, China
| | - Bao Rong
- Microbiology, Zhongshan Hospital. Fudan University,
| | - Gao Xiaodong
- Hospital Infection Control, Zhongshan Hospital. Fudan University,
| | - Pan Jue
- Infectious Diseases, Zhongshan Hospital. Fudan University,
| | - Hu Bijie
- Infectious Diseases, Zhongshan Hospital. Fudan University, China
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Maamatou W, Jabloun A, Daib A, Jarray L, Ben Abdallah R, Hellal Y, Trabelsi F, Gharbi Y, Kaabar N. Place of Laparoscopy in Peritoneal Tuberculosis. J Laparoendosc Adv Surg Tech A 2021; 31:1480-1484. [PMID: 34748433 DOI: 10.1089/lap.2021.0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Peritoneal tuberculosis (PT) is a rare form of extrapulmonary tuberculosis in children. The diagnosis is difficult because of its clinical polymorphism. Laparoscopy is the gold standard to make the diagnosis by exploring and performing peritoneal biopsies. Our aim was to show the place of laparoscopy in the diagnosis of PT, to compare the anatomopathological results of peritoneal biopsies with a macroscopic appearance to quick start antituberculosis treatment. Case Reports: We reported 4 patients with PT, 3 girls and 1 boy. The middle age was 9 years old. The revealing symptomatology was ascites in all cases. Radiological exploration was not contributing. Laparoscopy was performed for all patients. The exploration revealed an agglutination of the intestinal loops with the presence of whitish micronodules scattered over the entire abdominal cavity. Peritoneal biopsies were done in all cases. Histological examination confirmed the diagnosis of PT in all patients and antituberculosis treatment was introduced. There was a good clinical evolution with a follow-up of 30 months. Conclusion: PT is a public health problem due to its clinical and biological polymorphism. Laparoscopy with peritoneal biopsies remains the essential means for the diagnosis of this pathology in children.
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Affiliation(s)
- Wafa Maamatou
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Asma Jabloun
- Department of Surgery "A", Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Aida Daib
- Department of Surgery "A", Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Leila Jarray
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | | | - Youssef Hellal
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Fatma Trabelsi
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Youssef Gharbi
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia
| | - Nejib Kaabar
- Department of Pediatric Surgery, Habib Thameur Hospital, Tunis, Tunisia.,Department of Surgery "A", Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
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Abstract
Tuberculosis (TB) once considered a disease of the developing world is infrequent in the developing world too. Its worldwide prevalence with a huge impact on the healthcare system both in economic and health terms has prompted the World Health Organization to make it a top priority infectious disease. Tuberculous infection of the pulmonary system is the most common form of this disease, however, extrapulmonary TB is being increasingly recognized and more often seen in immunocompromised situations. Gastrointestinal TB is a leading extrapulmonary TB manifestation that can defy diagnosis. Overlap of symptoms with other gastrointestinal diseases and limited accuracy of diagnostic tests demands more awareness of this disease. Untreated gastrointestinal TB can cause significant morbidity leading to prolonged hospitalization and surgery. Prompt diagnosis with early initiation of therapy can avoid this. This timely review discusses the epidemiology, risk factors, pathogenesis, clinical presentation, current diagnostic tools and therapy.
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Affiliation(s)
- Adnan B. Al-Zanbagi
- Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - M. K. Shariff
- Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia,Address for correspondence: Dr. M. K. Shariff, King Abdullah Medical City, PO Box 57657, Makkah Al Mukaramah - 21955, Kingdom of Saudi Arabia. E-mail:
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Mousa H, Abdel-Kader S, Abu-Zidan FM. Management of abdominal tuberculosis in a community-based hospital in a high-income developing country. World J Emerg Surg 2021; 16:25. [PMID: 34039395 PMCID: PMC8153524 DOI: 10.1186/s13017-021-00370-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background The delayed diagnosis and management of abdominal tuberculosis increases its mortality. We aimed to study the clinical presentation, management, and outcome of patients who had abdominal tuberculosis and were treated at Al-Ain Hospital, Al-Ain City, United Arab Emirates. Methods All patients who had abdominal tuberculosis and were treated at Al-Ain Hospital between January 2011 and December 2018 were studied. Data were collected retrospectively using a structured protocol including demography, clinical presentation, diagnostic methods, management, and outcome. Results Twenty-four patients having a median age of 30 years were studied with an incidence of 0.6/100,000 population. The most common symptoms were abdominal pain (95.8%) and malaise (79.2%). Fever was present only in nine patients (37.5%). Laboratory investigations, except for polymerase chain reaction immunoassay, were not helpful. Chest X-ray was abnormal in three patients (12.5%). Ultrasound and abdominal CT scan were non-specific. Thirteen patients needed surgical intervention for diagnosis or therapy. Diagnosis was confirmed by histopathology in 15 patients (62.5%), immunological assays in 7 patients (29.2%), microbiological culture in 1 patient (4%), and therapeutic trial in 1 patient (4%). The most common type of abdominal tuberculosis was gastrointestinal in 13 patients (54.2%) followed by free wet peritonitis in 5 patients (20.8%). All patients had quadruple anti-tuberculous therapy for a minimum of 6 months. The median hospital stay was 6.5 days. None of our patients died. Conclusions Diagnosis of abdominal tuberculosis remains challenging despite advances in medical technology and diagnostic tools. The limited need for diagnostic therapy in our study supports the benefit of PCR assay. Surgery was mainly indicated as the last option to reach the diagnosis or to treat complications.
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Affiliation(s)
| | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE.
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Mehershahi S, Haider A, Fortuzi K, Shaikh DH, Patel H. Abdominal Ascites of Unknown Origin: Diagnostic Accuracy of Adenosine Deaminase for Tuberculous Peritonitis. Case Rep Gastroenterol 2021; 15:418-423. [PMID: 33976620 PMCID: PMC8077663 DOI: 10.1159/000514892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
The occurrence of tuberculosis (TB) is exceedingly rare in the United States (US), and incidence has steadily declined since 1993, but the pace of decline has slowed in recent years. The US TB rate during 2019 declined to 2.7 cases per 100,000 persons, the lowest level on record. The abdominal form is the sixth leading cause of extrapulmonary TB, after lymphatic, genitourinary, osteoarticular, miliary, and meningeal. Abdominal TB can infect any part of the gastrointestinal tract, including the peritoneum and the pancreaticobiliary system. We present a case of persistently elevated adenosine deaminase in peritoneal ascites of a young, healthy female with new-onset ascites. An extended diagnostic evaluation was performed to reach the diagnosis.
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Affiliation(s)
- Shehriyar Mehershahi
- Gastroenterology, BronxCare Health System, Bronx, New York, USA.,Internal Medicine, BronxCare Health System, Bronx, New York, USA
| | - Asim Haider
- Internal Medicine, BronxCare Health System, Bronx, New York, USA
| | - Ked Fortuzi
- Internal Medicine, BronxCare Health System, Bronx, New York, USA
| | - Danial H Shaikh
- Gastroenterology, BronxCare Health System, Bronx, New York, USA.,Internal Medicine, BronxCare Health System, Bronx, New York, USA
| | - Harish Patel
- Gastroenterology, BronxCare Health System, Bronx, New York, USA.,Internal Medicine, BronxCare Health System, Bronx, New York, USA
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13
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Sharma M, Sinha SK, Sharma M, Singh AK, Samanta J, Sharma A, Kochhar R, Sharma K. Challenging diagnosis of gastrointestinal tuberculosis made simpler with multi-targeted loop-mediated isothermal amplification assay. Eur J Gastroenterol Hepatol 2020; 32:971-5. [PMID: 32433424 DOI: 10.1097/MEG.0000000000001765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prompt and accurate diagnosis of gastrointestinal tuberculosis (GITB) is highly challenging. Current conventional techniques lack sensitivity and are time-consuming. Multi targeted loop-mediated isothermal amplification (LAMP) using two targets (IS6110 and MPB64) is a promising technique for rapid diagnosis of TB. METHODS LAMP test using IS6110 and MPB64 targets for M. tuberculosis complex was performed on ileocecal biopsy samples of 35 clinically suspected patients of GITB and 30 ileocecal biopsy samples of non-tuberculosis control subjects. Results of IS6110 LAMP and MPB64 LAMP were compared with IS6110 PCR and culture INFERENCE: Overall LAMP test (using any of the two targets) had a sensitivity and specificity of 100 and 100%, respectively, for confirmed GITB (five culture positive) cases and 85.71 and 100%, respectively, for clinically suspected 30 ileocecal biopsy samples of GITB. Sensitivity of IS6110 LAMP, MPB64 LAMP and IS6110 PCR for clinically suspected cases was 22 (73.33%), 24 (80%) and 21 (70%), respectively. In total 35 GITB patients, the overall sensitivity of microscopy, culture, IS6110 PCR, IS6110 LAMP, MPB64 LAMP and the multi-targeted LAMP assay (if any of the two targets were used) were 5.71, 14.28, 68.57, 74.28, 82.85 and 85.71%, respectively. Specificity of all the tests was 100%. There were three cases which were missed by IS6110 LAMP and two cases by MPB64 LAMP. CONCLUSION Multi-targeted LAMP is a promising technique for rapid and accurate diagnosis of GITB.
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Lu S, Fu J, Guo Y, Huang J. Clinical diagnosis and endoscopic analysis of 10 cases of intestinal tuberculosis. Medicine (Baltimore) 2020; 99:e21175. [PMID: 32664157 PMCID: PMC7360195 DOI: 10.1097/md.0000000000021175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/05/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022] Open
Abstract
To analyze the clinical characteristics of intestinal tuberculosis (ITB), pay attention to the diagnostic value of endoscopy and mucosal biopsy, improve the recognition of atypical manifestations of ITB under endoscopy, and reduce misdiagnosis and missed diagnosis.The clinical data of 10 patients who were hospitalized in Changzhou second people's Hospital and finally diagnosed as ITB from January 1, 2015 to present were analyzed retrospectively. The basic information, medical history, clinical manifestations and computed tomography (CT), endoscopy of the patients was analyzed retrospectively. The results of pathological examination were analyzed and sorted out.Among the 10 patients, the ratio of male to female was 7:3, 10 (100%) had abdominal pain, 3 (30%) had diarrhea and 2 (20%) had bloody stool. The positive rate of tuberculosis T cell test was 75% (6/8), the diagnostic rate of chest high resolution CT was 60%, and the abnormal rate of abdominal high-resolution CT was 66.7% (6/9). Colonoscopy showed that the lesions mainly involved ileocecum (70%) and ascending colon (60%). Most of the lesions were intestinal stenosis (60%) and circular ulcer (50%). In a few cases, cold abscess (20%) and scar diverticulum (10%). Most of the pathological manifestations were granuloma formation and multinucleated giant cells (60%). The detection rate of caseous granuloma was 20%.The general condition and clinical manifestations of patients with ITB are not specific. Endoscopy and mucosal biopsy are of great significance for its diagnosis. The clinical manifestations and endoscopy of some patients showed atypical signs. Therefore, the combination of multi-disciplinary team models and the enhancement of clinician's recognition of the characteristics of endoscopic examination of ITB can improve us the diagnosis level of ITB.
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Affiliation(s)
- Shuangshuang Lu
- School of Medical, Dalian Medical University, Dalian
- Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jinjin Fu
- Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yongxin Guo
- School of Medical, Dalian Medical University, Dalian
- Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jin Huang
- Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
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15
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Rojas CL, Polanco EC, Vivar MC, Aguayo WG, Molina GA, Gutierrez BM, Cobo MM. Abdominal tuberculosis in Ecuador, a problem that is still not solved. J Clin Tuberc Other Mycobact Dis 2020; 20:100172. [PMID: 32637658 PMCID: PMC7330150 DOI: 10.1016/j.jctube.2020.100172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) in the gastrointestinal tract or peritoneum is an uncommon condition in clinical practice. Its rarity, combined with its nonspecific presentations, makes this kind of extrapulmonary tuberculosis difficult to diagnose as it can mimic other inflammatory or malignant conditions. Delays in treatment and frequent misdiagnosis can lead to hazardous complications. In countries like Ecuador where the disease is endemic, TB should always be considered in the differential diagnosis of a patients who present with nonspecific abdominal symptoms. In these scenarios, laparoscopy can be an invaluable tool when used with sufficiently high clinical awareness and adequate training. Case presentation We present the case of a 37-year-old female patient from Ecuador with a 1-year history of abdominal pain, nausea, intermittent vomits, night sweats, and weight loss. After clinical evaluation and a laparoscopic intervention, abdominal TB was detected and promptly treated. Antituberculosis chemotherapy was initiated, and the patient successfully recovered. Conclusions High clinical awareness is imperative when approaching abdominal TB due to its wide spectrum of clinical symptoms and its rarity. Early detection and prompt treatment are critical to minimize the possibility of hazardous complications.
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Affiliation(s)
| | | | - Maria Cecilia Vivar
- Department of Pathology, Hospital General San Francisco de Quito, Quito, Ecuador
| | | | | | - Bernardo M Gutierrez
- Universidad San Francisco de Quito, USFQ, College of Biological and Environmental Sciences, Quito, Ecuador
| | - Maria M Cobo
- Universidad San Francisco de Quito, USFQ, College of Biological and Environmental Sciences, Quito, Ecuador
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16
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Tan J, Porter D, Guo J, Pan L, Yang G, Zhang Z. A Neglected Case of Colonic Tuberculosis With Thoracolumbar Enterocutaneous Fecal Fistulae. J Med Cases 2020; 11:111-114. [PMID: 34434378 PMCID: PMC8383560 DOI: 10.14740/jmc3463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 11/11/2022] Open
Abstract
Although intestinal tuberculosis (ITB) typically affects ileocecal segments, the complication of tubercular enterocutaneous fistula is very rare. As an isolated phenomenon, primary intestinal manifestation without extraintestinal tuberculosis (TB) is exceptional and rarely reported. We present a patient with isolated ITB with six spontaneous thoracolumbar tubercular enterocutaneous fistulae. A 37-year-old Chinese woman was admitted to our institution complaining of escape of fecal matter through several openings in her back over the previous 20 years. She had nonspecific abdominal symptoms (occasional abdominal pain and alteration in bowel habit). External physical examination confirmed the presence of external thoracolumbar fecal fistulae in association with a scoliosis. Abdominal examination was unremarkable. Diagnostic colonoscopy with biopsy did not definitively confirm a diagnosis of TB. Microscopic examination in both microbiology and histopathology labs failed to identify acid-fast bacilli; however, gastrointestinal TB (GITB) was considered high on the differential diagnosis list. It was elected to perform open laparotomy with resection of the left hemi-colon. Postoperatively, she was treated with standard anti-tuberculous treatment for 6 months. The patient had an uneventful postoperative course, during which the fistulae gradually closed over the next year. This case with several low-output fistulas exiting the patient’s back was successfully treated by a combination of surgery and antimicrobial therapy. The aim of this rare case report is to raise the awareness of atypical presentation of tubercular colonic enterocutaneous fistula so that timely diagnosis and intervention can salvage patient quality of life.
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Affiliation(s)
- Jie Tan
- School of Clinical Medicine, Tsinghua University, Beijing 100084, China
| | - Daniel Porter
- Department of Orthopaedics, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing 100016, China
| | - Jinxing Guo
- Department of General Surgery, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing 100016, China
| | - Lijie Pan
- Department of General Surgery, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing 100016, China
| | - Guoshan Yang
- Department of General Surgery, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing 100016, China
| | - Zichao Zhang
- Department of General Surgery, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing 100016, China
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17
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Benzerga S, Michaux C, Calvo Lasso De Lavega E, Staub T. La tuberculose le grand mime. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Abu-Zidan FM, Sheek-Hussein M. Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay. World J Emerg Surg 2019; 14:33. [PMID: 31338118 PMCID: PMC6626328 DOI: 10.1186/s13017-019-0252-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
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%.
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Affiliation(s)
- Fikri M Abu-Zidan
- 1Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates
| | - Mohamud Sheek-Hussein
- 2Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates
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19
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UDGIRKAR S, JAIN S, PAWAR S, CHANDNANI S, CONTRACTOR Q, RATHI P. CLINICAL PROFILE, DRUG RESISTANCE PATTERN AND TREATMENT OUTCOMES OF ABDOMINAL TUBERCULOSIS PATIENTS IN WESTERN INDIA. Arq Gastroenterol 2019; 56:178-183. [DOI: 10.1590/s0004-2803.201900000-35] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/28/2019] [Indexed: 12/22/2022]
Abstract
ABSTRACT BACKGROUND: Abdominal tuberculosis is an increasing problem in developing world. OBJECTIVE: The objective of the study was to describe the clinical presentations, drug resistance pattern and treatment outcomes of abdominal tuberculosis in Western India. METHODS: All the cases of abdominal tuberculosis from May 2014 to April 2017, diagnosed on the basis of clinical profile and gross morphological findings at endoscopy, imaging, followed by histology and/or GeneXpert and MGIT culture were included. All patients received antitubercular drug (AKT) therapy according to national protocol. Patients were followed from diagnoses till completion of treatment and various parameters were studied. RESULTS: Out of the 176 patients, 48% were males. Abdominal pain was most common complaint in 83.5%. On colonoscopy terminal ileum and ileocaecal valve were most commonly involved segments. Upper gastrointestinal tract was involved in four patients. Overall ulceronodular lesions were most common followed by ulcerative/nodular lesion. Strictures in bowel were seen in 28 (15.9%) patients with ileocaecal valve being most commonly involved, of which 23 had symptomatic relief with AKT and only three required dilatation. Histopathology showed granuloma in 80.8% cases. MGIT was positive in 43 (35.80%) cases and GeneXpert was positive in 35 (26.1%) cases. Eight patients had multi drug resistant tuberculosis. Only two patients required surgical management. CONCLUSION: Abdominal tuberculosis with wide spectrum of presentation, can still be managed with early diagnosis and treatment even in patients with sub acute intestinal obstruction. Weight gain or resolving symptoms were considered early markers of treatment response. Patients with stricture can become asymptomatic with medical treatment alone.
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Affiliation(s)
| | - Samit JAIN
- Topiwala National Medical College, India
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20
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Gong Y, Li S, Rong R, Chen X, Jiang L. Isolated gastric varices secondary to abdominal tuberculosis mimicking lymphoma: a case report. BMC Gastroenterol 2019; 19:78. [PMID: 31138138 PMCID: PMC6540571 DOI: 10.1186/s12876-019-0998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Abdominal tuberculosis (TB) rarely presents with abdominal masses and rarely causes isolated gastric varices. Case presentation We report a case of isolated gastric varices secondary to abdominal TB mimicking lymphoma. A 42-year-old woman without any history of liver disease presented with melena and mild abdominal pain. Upon admission to the hospital, laboratory investigations revealed a hemoglobin level of 76 g/L. Gastroduodenoscopic examination showed isolated gastric fundal varices with red color signs. Abdominal contrast-enhanced computed tomography (CECT) revealed non-enhanced masses of soft-tissue density in the lesser omental and the retropancreatic areas, multiple para-aortic lymph nodes, and multiple small hypodense splenic lesions. Positron emission tomography-CT showed hypermetabolic [F-18]2-fluoro-2-deoxyglucose activity involving multiple regional lymph nodes and the bone marrow, suggestive of lymphoma. Bone marrow biopsy revealed no abnormality. Histopathological examination of a CT-guided biopsy specimen showed granulomatous inflammation with necrosis and microorganisms that stained positive with acid-fast stains. Abdominal CECT showed a decrease in the size of the lesser omental and peripancreatic masses, as well as the para-aortic lymph nodes after 4-month anti-TB therapy. Conclusions TB should be considered among the differential diagnoses in patients with abdominal masses, isolated gastric varices, and regional lymphadenopathy. Prompt and definitive diagnosis of abdominal TB requires a coordinated approach involving laboratory tests, radiological examination, and invasive procedures for optimal decision making and management.
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Affiliation(s)
- Yaoyao Gong
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
| | - Shuo Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
| | - Rong Rong
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
| | - Xiaoxing Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China.
| | - Liuqin Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No.300 of Guangzhou Road, Nanjing, 210029, China
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21
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Konstantara F, Stamopoulou S, Gkegkes ID, Kotrogiannis I, Fotiou E, Papazacharias C, Paraskevopoulos IA, Filippou D, Skandalakis P. Intra-abdominal lymphatic tuberculosis as a rare case of small intestine volvulus. SAGE Open Med Case Rep 2019; 7:2050313X19844379. [PMID: 31065355 PMCID: PMC6488773 DOI: 10.1177/2050313x19844379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/22/2019] [Indexed: 01/25/2023] Open
Abstract
Tuberculosis used to be uncommon in the developed countries but seems to be still
on rampant in developing countries. However, there seems to be an increasing
occurrence in the developed countries too mainly due to low living conditions,
increased migration, HIV immune-compromisation and inappropriate use of
antitubercular drugs. Lymphatic tuberculosis is the second commonest
extrapulmonary location of tuberculosis followed by genitourinary, bone and
joint, miliary, meningeal and abdominal. Abdominal tuberculosis represents
nearly 11%–16% of all extrapulmonary tuberculosis locations. Furthermore,
abdominal tuberculosis co-exists with pulmonary tuberculosis in 10%–30% of
patients. Abdominal tuberculosis remains difficult to diagnose due to
non-specific symptoms, variable anatomical locations and lack of specific
sensitive diagnostic tools. Diagnosis can be rarely suspected, especially in
cases of isolated abdominal tuberculosis without clinical or radiological
findings. We present a rare case of a patient with pulmonary tuberculosis
combined with intra-abdominal lymphatic tuberculosis causing small intestine
volvulus.
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Affiliation(s)
- Filitsa Konstantara
- First Department of Surgery, General Hospital of Attica "KAT," Athens, Greece.,Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotiria Stamopoulou
- First Department of Surgery, General Hospital of Attica "KAT," Athens, Greece
| | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT," Athens, Greece
| | | | - Eleftherios Fotiou
- First Department of Surgery, General Hospital of Attica "KAT," Athens, Greece
| | | | | | - Dimitrios Filippou
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Skandalakis
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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22
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Singh A, Sahu MK, Panigrahi M, Behera MK, UthanSingh K, Kar C, Narayan J. Abdominal tuberculosis in Indians: Still very pertinent. J Clin Tuberc Other Mycobact Dis 2019; 15:100097. [PMID: 31720424 DOI: 10.1016/j.jctube.2019.100097] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Tuberculosis is a disease that has been affecting mankind since time immemorial and it still continues to be a global health concern. Objective of the study was to evaluate the burden, clinical profile, diagnosis and diagnostic difficulties and outcome of abdominal tuberculosis (AbT) in non human immunodeficiency virus (HIV) infected adults in the department of gastroenterology at a tertiary care hospital over a period of two years. Material & methods It was an observational study and the study period was from January 2016 till January 2018. The patients who were sero positive for HIV virus were excluded from the study. Results The number of patients hospitalized during the period of 2016-2018 with abdominal tuberculosis was 58. The burden of tuberculosis of indoor patients was 1.3 cases per every 100 patients admitted. Presenting complaint of most of these patients [61%] was abdominal pain. Constitutional symptoms like fever; weight loss and loss of appetite were present in only 40% of the patients. Ascites was the presenting sign in around 45% of the patients. Peritoneum was the most common site of involvement [27 out of 58]. Almost all of these patients [25 out of 27] presented with abdominal pain and abdominal distension. Intestine was the second most common site. Ileocaecal involvement was present in fourteen patients, while other areas of colon were involved in five patients. All the 58 patients were given anti tubercular therapy. There was complete resolution of tuberculosis in 91% of cases [53 out of 58 patients]. Six patients developed drug induced liver injury. Death occurred in two patients who had disseminated tuberculosis. Conclusion Although the burden of the disease remains the same, availability of newer investigations has aided in its early diagnosis and availability of good drugs has reduced the mortality and morbidity.
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23
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Cho JK, Choi YM, Lee SS, Park HK, Cha RR, Kim WS, Kim JJ, Lee JM, Kim HJ, Ha CY, Kim HJ, Kim TH, Jung WT, Lee OJ. Clinical features and outcomes of abdominal tuberculosis in southeastern Korea: 12 years of experience. BMC Infect Dis 2018; 18:699. [PMID: 30587154 PMCID: PMC6307147 DOI: 10.1186/s12879-018-3635-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 12/18/2018] [Indexed: 12/30/2022] Open
Abstract
Background Abdominal tuberculosis (TB) is an uncommon form of infection with Mycobacterium tuberculosis in Korea. In this study, we aimed to highlight the clinical features, diagnostic methods, and outcomes of abdominal TB over 12 years in Southeastern Korea. Methods A total of 139 patients diagnosed as having abdominal TB who received anti-TB medication from January 2005 to June 2016 were reviewed. Among them, 69 patients (49.6%) had luminal TB, 28 (20.1%) had peritoneal TB, 7 (5.0%) had nodal TB, 23 (16.5%) had visceral TB, and 12 (8.6%) had mixed TB. Results The most frequent symptoms were abdominal pain (34.5%) and abdominal distension (21.0%). Diagnosis of abdominal TB was confirmed using microbiologic and/or histologic methods in 76 patients (confirmed diagnosis), while the remaining 63 patients were diagnosed based on clinical presentation and radiologic imaging (clinical diagnosis). According to diagnostic method, frequency of clinical diagnosis was highest in patients with luminal (50.7%) or peritoneal (64.3%) TB, while frequency of microscopic diagnosis was highest in patients with visceral TB (68.2%), and frequency of histologic diagnosis was highest in patients with nodal TB (85.2%). Interestingly, most patients, except those with nodal TB, showed a good response to anti-TB agents, with 84.2% showing a complete response. The mortality rate was only 1.4% in the present study. Conclusions Most patients responded very well to anti-TB therapy, and surgery was required in only a minority of cases of suspected abdominal TB.
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Affiliation(s)
- Jin-Kyu Cho
- Department of Surgery, Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, 52727, Gyeongnam, Republic of Korea
| | - Young Min Choi
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea
| | - Sang Soo Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea. .,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea. .,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
| | - Hye Kyong Park
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ra Ri Cha
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Wan Soo Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jin Joo Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae Min Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hong Jun Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Chang Yoon Ha
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Tae Hyo Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Woon Tae Jung
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Ok Jae Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
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24
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Cheng W, Zhang S, Li Y, Wang J, Li J. Intestinal tuberculosis: clinico-pathological profile and the importance of a high degree of suspicion. Trop Med Int Health 2018; 24:81-90. [PMID: 30338607 DOI: 10.1111/tmi.13169] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wei Cheng
- Department of General Surgery; Jinling Hospital; Medical School of Nanjing University; Nanjing China
| | - Shaoyi Zhang
- Department of General Surgery; Shanghai Ninth People's Hospital; Shanghai JiaoTong University School of Medicine; Shanghai China
| | - Yousheng Li
- Department of General Surgery; Shanghai Ninth People's Hospital; Shanghai JiaoTong University School of Medicine; Shanghai China
| | - Jian Wang
- Department of General Surgery; Jinling Hospital; Medical School of Nanjing University; Nanjing China
| | - Jieshou Li
- Department of General Surgery; Jinling Hospital; Medical School of Nanjing University; Nanjing China
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25
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Krylov NN, Pyatenko EA, Alekberzade AV, Kupriyanov IE. [Pancreatic tuberculosis]. Khirurgiia (Mosk) 2018:122-125. [PMID: 30560858 DOI: 10.17116/hirurgia2018121122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prevalence, risk factors of primary pancreatic tuberculosis, clinical symptoms and data of instrumental and laboratory diagnosis are reviewed in the article. The authors emphasized the peculiarities of differential diagnosis with pancreatic malignancies and advisability of the most informative methods - endoscopy and fine-needle aspiration procedure.
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Affiliation(s)
- N N Krylov
- Sechenov First Moscow State Medical University, Moscow, Russia, Moscow, Russia
| | - E A Pyatenko
- Sechenov First Moscow State Medical University, Moscow, Russia, Moscow, Russia
| | - A V Alekberzade
- Sechenov First Moscow State Medical University, Moscow, Russia, Moscow, Russia
| | - I E Kupriyanov
- Department of human anatomy of Sechenov First Moscow State Medical University, Moscow, Russia
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Abstract
It is important that surgeons are familiar with the various manifestations of tuberculosis (TB). Although TB has been declining in incidence in the developed world, it remains an important problem in endemic areas of the developing world. The aim of the review was to elucidate the natural history and characteristics of abdominal TB and ascertain the indications for surgery. TB can affect the intestine as well as the peritoneum and the most important aspect of abdominal TB is to bear in mind the diagnosis and obtain histological evidence. Abdominal TB is generally responsive to medical treatment, and early diagnosis and management can prevent unnecessary surgical intervention. Due to the challenges of early diagnosis, patients should be managed in collaboration with a physician familiar with anti-tuberculous therapy. An international expert consensus should determine an algorithm for the diagnosis and multidisciplinary management of abdominal TB.
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Affiliation(s)
- Elroy Patrick Weledji
- Department of Surgery, Faculty of Health Sciences, University of Buea, PO Box 63, Buea, Cameroon
| | - Benjamin Thumamo Pokam
- Department of Biomedical Sciences, Faculty of Health Sciences, University of Buea, PO Box 63, Buea, Cameroon
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Kentley J, Ooi JL, Potter J, Tiberi S, O'Shaughnessy T, Langmead L, Chin Aleong J, Thaha MA, Kunst H. Intestinal tuberculosis: a diagnostic challenge. Trop Med Int Health 2017; 22:994-999. [PMID: 28609809 DOI: 10.1111/tmi.12908] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe characteristics, presentation, time to diagnosis and diagnostic findings of patients with intestinal tuberculosis (ITB) in a low-burden country. METHOD Retrospective study of 61 consecutive ITB patients diagnosed between 2008 and 2014 at a large East London hospital. RESULTS Forty of sixty-one patients were male. Mean age was 34.6 years. 93% of patients were born abroad, mostly from TB-endemic areas (Indian subcontinent: 88%, Africa: 9%). 25% had concomitant pulmonary TB. Median time from symptom onset to ITB diagnosis was 13 weeks (IQR 3-26 weeks). Ten patients were initially treated for IBD, although patients had ITB. The main sites of ITB involvement were the ileocaecum (44%) or small bowel (34%). Five patients had isolated perianal disease. Colonoscopy confirmed a diagnosis of ITB in 77% of those performed. 42 of 61 patients had a diagnosis of ITB confirmed on positive histology and/or microbiology. CONCLUSION Diagnosis of ITB is often delayed, which may result in significant morbidity. ITB should be excluded in patients with abdominal complaints who come from TB-endemic areas to establish prompt diagnosis and treatment. Diagnosis is challenging but aided by axial imaging, colonoscopy and tissue biopsy for TB culture and histology.
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Affiliation(s)
- J Kentley
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - J L Ooi
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - J Potter
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Tiberi
- Department of Infectious Diseases, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T O'Shaughnessy
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - L Langmead
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Chin Aleong
- Department of Pathology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M A Thaha
- Blizard Institute, National Center for Bowel Research, Queen Mary University of London, London, UK
| | - H Kunst
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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González-Ferrer PC, Romero-Amaro ZR, Rivas-Castillo MV, Reyes-Duran PA, Arismendi-Morillo GJ. Fibroadhesive peritoneal tuberculosis mimicking inflammatory acute abdomen due to appendiceal adhesions. Rev Gastroenterol Mex 2017; 82:261-263. [PMID: 27198198 DOI: 10.1016/j.rgmx.2016.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/15/2015] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Affiliation(s)
- P C González-Ferrer
- Servicio y Posgrado de Anatomía Patológica, Hospital General del Sur «Dr. Pedro Iturbe», Maracaibo, Zulia, Venezuela
| | - Z R Romero-Amaro
- Servicio y Posgrado de Anatomía Patológica, Hospital General del Sur «Dr. Pedro Iturbe», Maracaibo, Zulia, Venezuela; Cátedra de Citopatología, Facultad de Medicina-Universidad del Zulia, Maracaibo, Zulia, Venezuela
| | - M V Rivas-Castillo
- Servicio y Posgrado de Anatomía Patológica, Hospital General del Sur «Dr. Pedro Iturbe», Maracaibo, Zulia, Venezuela
| | - P A Reyes-Duran
- Servicio y Posgrado de Anatomía Patológica, Hospital General del Sur «Dr. Pedro Iturbe», Maracaibo, Zulia, Venezuela
| | - G J Arismendi-Morillo
- Servicio y Posgrado de Anatomía Patológica, Hospital General del Sur «Dr. Pedro Iturbe», Maracaibo, Zulia, Venezuela; Instituto de Investigaciones Biológicas, Facultad de Medicina-Universidad del Zulia, Maracaibo, Zulia, Venezuela.
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González-ferrer P, Romero-amaro Z, Rivas-castillo M, Reyes-duran P, Arismendi-morillo G. Fibroadhesive peritoneal tuberculosis mimicking inflammatory acute abdomen due to appendiceal adhesions. Revista de Gastroenterología de México (English Edition) 2017; 82:261-263. [DOI: 10.1016/j.rgmxen.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Usta M, Urganci N, Dalgic N, Uslu Kızılkan N, Kurtaraner T, Ali Karadag C. Clinical Presentation in a Series of Eight Children with Abdominal Tuberculosis: Experience of a Single-Center in Turkey. Iran J Pediatr 2017; 27. [DOI: 10.5812/ijp.9766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
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Kalpande S, Pandya JS, Tiwari A, Adhikari D. Gastric outlet obstruction: an unusual case of primary duodenal tuberculosis. BMJ Case Rep 2017; 2017:bcr-2016-217966. [PMID: 28343151 DOI: 10.1136/bcr-2016-217966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Tuberculosis is a major health problem worldwide. Gastrointestinal tuberculosis presenting as isolated involvement of the duodenum is a rare case. CASE PRESENTATION A 13 year male, presented with features of gastric outlet obstruction. CT enterography scan showed circumferential mural thickening in first and second part of duodenal junction causing luminal narrowing. Upper GI endoscopy confirmed the narrowing of D1-D2 junction. Duodenal biopsy showed duodenitis with negative result for AFB stain, Helicobacter Pylori. Patient underwent roux-en-y gastro-jejunostomy. Histo-pathological findings were consistent with tuberculosis. Patient was started on AKT and discharged. At 3 months follow up; patient asymptomatic. CONCLUSION The unusual location of gastrointestinal tuberculosis, lack of specific signs and symptoms, radiological studies and endoscopy findings makes diagnosis a challenge. The treatment of duodenal tuberculosis is still medical and surgery should be reserved for emergency like gastric outlet obstruction causing nutritional compromise.
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Affiliation(s)
- Sanket Kalpande
- Department of General Surgery, BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | | | - Ajeet Tiwari
- Department of General Surgery, BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Devbrata Adhikari
- Department of General Surgery, BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
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Abstract
BACKGROUND Diagnosis of abdominal tuberculosis (TB) from ascitic fluid samples using routinely available diagnostic methods is challenging due to its paucibacillary nature. Although performance of Xpert MTB/RIF assay has been evaluated extensively on pulmonary samples, its performance on extrapulmonary samples is still under evaluation. OBJECTIVES The objective of this study was to find out the performance of Xpert MTB/RIF on ascitic fluid samples obtained from suspected cases of abdominal TB. Performance was compared with Mycobacterium growth indicator tube-960 (MGIT-960) culture and in-house multiplex polymerase chain reaction (PCR). The latter detects and differentiates Mycobacterium tuberculosis and nontuberculous mycobacteria simultaneously. MATERIALS AND METHODS Sixty-seven patients suspected of probable/possible abdominal TB were included in this observational, prospective study. All samples were tested by Ziehl-Neelsen staining, MGIT-960 culture, in-house multiplex PCR, and Xpert MTB/RIF assay. RESULTS All 67 samples were smear negative. Seventeen (25.4%) were MGIT-960 culture positive while 12 (17.9%) were detected positive by the Xpert MTB/RIF assay and 9 (13.4%) by in-house multiplex PCR. Sensitivity and specificity of the Xpert MTB/RIF assay compared with the MGIT-960 culture were 70.6% (95%, confidence interval [CI]: 44.1-89.7) and 100% (95%, CI: 92.8-100) and that of in-house multiplex PCR were 52.9% (95%, CI: 30.9-73.8) and 100% (95%, CI: 92.8-100), respectively. CONCLUSIONS Diagnostic yield of Xpert MTB/RIF assay on ascitic fluid samples was lower than MGIT-960 culture. We thus emphasize on the need for urgent discovery of new biomarkers for paucibacillary TB.
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Affiliation(s)
- Syed Beenish Rufai
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
- Address for correspondence: Prof. Sarman Singh, E-mail:
| | - Amit Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parveen Kumar
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jitendra Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Vishal
- Department of Medicine, Dr. Ram Manohar Lohia Hospital, PGIMER, New Delhi, India
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Abstract
Abdominal tuberculosis is defined as infection of the peritoneum, hollow or solid abdominal organs with Mycobacterium tuberculosis. The peritoneum and the ileocaecal region are the most likely sites of infection and are involved in the majority of the cases by haematogenous spread or through swallowing of infected sputum from primary pulmonary tuberculosis. Pulmonary tuberculosis is apparent in less than half of the patients. Patients usually present with abdominal pain, and the cause is usually identified through a combination of radiologic, endoscopic, microbiologic, histologic and molecular techniques. Anti-microbial treatment is the same as for pulmonary tuberculosis. Surgery is occasionally required.
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Affiliation(s)
- Suruchi Shreshtha
- Assistant Professor, General Surgery, Dr Baba Saheb Ambedkar Medical College & Hospital, Delhi, India.
| | - Deepak Ghuliani
- Associate Professor, General Surgery, Maulana Azad Medfical College, Delhi, India.
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Abstract
BACKGROUND Tuberculosis (TB) of the gastrointestinal tract and any other organ within the abdominal cavity is abdominal TB, and most guidelines recommend the same six-month regimen used for pulmonary TB for people with this diagnosis. However, some physicians are concerned whether a six-month treatment regimen is long enough to prevent relapse of the disease, particularly in people with gastrointestinal TB, which may sometimes cause antituberculous drugs to be poorly absorbed. On the other hand, longer regimens are associated with poor adherence, which could increase relapse, contribute to drug resistance developing, and increase costs to patients and health providers. OBJECTIVES To compare six-month versus longer drug regimens to treat people that have abdominal TB. SEARCH METHODS We searched the following electronic databases up to 2 September 2016: the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase (accessed via OvidSP), LILACS, INDMED, and the South Asian Database of Controlled Clinical Trials. We searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for ongoing trials. We also checked article reference lists. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared six-month regimens versus longer regimens that consisted of isoniazid, rifampicin, pyrazinamide, and ethambutol to treat adults and children that had abdominal TB. The primary outcomes were relapse, with a minimum of six-month follow-up after completion of antituberculous treatment (ATT), and clinical cure at the end of ATT. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and assessed the risk of bias in the included trials. For analysis of dichotomous outcomes, we used risk ratios (RR) with 95% confidence intervals (CIs). Where appropriate, we pooled data from the included trials in meta-analyses. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included three RCTs, with 328 participants, that compared six-month regimens with nine-month regimens to treat adults with intestinal and peritoneal TB. All trials were conducted in Asia, and excluded people with HIV, those with co-morbidities and those who had received ATT in the previous five years. Antituberculous regimens were based on isoniazid, rifampicin, pyrazinamide, and ethambutol, and these drugs were administered daily or thrice weekly under a directly observed therapy programme. The median duration of follow-up after completion of treatment was between 12 and 39 months.Relapse was uncommon, with two cases among 140 participants treated for six months, and no events among 129 participants treated for nine months. The small number of participants means we do not know whether or not there is a difference in risk of relapse between the two regimens (very low quality evidence). At the end of therapy, there was probably no difference in the proportion of participants that achieved clinical cure between six-month and nine-month regimens (RR 1.02, 95% CI 0.97 to 1.08; 294 participants, 3 trials, moderate quality evidence). For death, there were 2/150 (1.3%) in the six-month group and 4/144 (2.8%) in the nine-month group. All deaths occurred in the first four months of treatment, so was not linked to the duration of treatment in the included trials. Similarly, the number of participants that defaulted from treatment was small in both groups, and there may be no difference between them (RR 0.50, 95% CI 0.10 to 2.59; 294 participants, 3 trials, low quality evidence). Only one trial reported on adherence to treatment, with only one participant allocated to the nine-month regimen presenting poor adherence to treatment. We do not know whether six-month regimens are associated with fewer people experiencing adverse events that lead to treatment interruption (RR 0.53, 95% CI 0.18 to 1.55; 318 participants, 3 trials, very low quality evidence). AUTHORS' CONCLUSIONS We found no evidence to suggest that six-month treatment regimens are inadequate for treating people that have intestinal and peritoneal TB, but numbers are small. We did not find any incremental benefits of nine-month regimens regarding relapse at the end of follow-up, or clinical cure at the end of therapy, but our confidence in the relapse estimate is very low because of size of the trials. Further research is required to make confident conclusions regarding the safety of six-month treatment for people with abdominal TB. Larger studies that include HIV-positive people, with long follow-up for detecting relapse with reliability, would help improve our knowledge around this therapeutic question.
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Affiliation(s)
- Sophie Jullien
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUK
| | - Siddharth Jain
- All India Institute of Medical SciencesDepartment of Internal MedicineNew DelhiIndia
| | - Hannah Ryan
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUK
| | - Vineet Ahuja
- All India Institute of Medical SciencesDepartment of GastroenterologyAnsari NagarNew DelhiIndia110029
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Krishna S, Kalra N, Singh P, Kochhar R, Gupta R, Singh R, Khandelwal N. Small-Bowel Tuberculosis: A Comparative Study of MR Enterography and Small-Bowel Follow-Through. AJR Am J Roentgenol 2016; 207:571-7. [DOI: 10.2214/ajr.15.15580] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Jain BK, Garg PK, Sharma N, Mishra K. Diagnosis of Abdominal Tuberculosis Needs Attention. Indian J Surg 2016; 78:336-7. [PMID: 27574359 DOI: 10.1007/s12262-016-1466-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/04/2016] [Indexed: 10/22/2022] Open
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Taşkıran E, Yıldırım M, Soyaltın U, Gülle S, Dereli M, Akar H. Tuberculosis infection with hepatic involvement mimicking liver metastasis in an elderly patient. Eur Geriatr Med 2016; 7:369-371. [DOI: 10.1016/j.eurger.2016.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Anikhindi SA, Ranjan P, Sachdeva M, Kumar M. Self-expanding plastic stent for esophageal leaks and fistulae. Indian J Gastroenterol 2016; 35:287-93. [PMID: 27488703 DOI: 10.1007/s12664-016-0679-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/10/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Self-expanding plastic stents (SEPS) have emerged as a good alternative to surgery in esophageal leaks and fistulae. There is scarce published literature regarding its efficacy in these conditions. We present our experience with SEPS in treatment of esophageal leaks and fistulae. METHODS Consecutive patients admitted in a tertiary referral center who underwent SEPS placement for esophageal leak or fistula between February 2012 and February 2015 were retrospectively evaluated. Patients underwent prior assessment with upper gastrointestinal endoscopic and thoracic contrast-enhanced computed tomography assessment. SEPS (25-mm flares, 21-mm diameter) were placed under fluoroscopic guidance. A silk thread tied to upper end was routed through nostril and fixed to prevent stent migration. Nasojejunal tube was inserted in all patients. Intercostal drain was inserted in the case of hydro/pyopneumothorax. RESULTS Twelve patients [eight male, median age 45.3 years (19 to 65 years)] were included. Etiologies were spontaneous leaks due to Boerhaave syndrome (n = 2), corrosive fistulae (n = 2), tubercular fistulae (n = 4), invasive Candida esophagitis-induced fistula (n = 1), iatrogenic leaks (n = 2; one achalasia dilatation, one obesity surgery), and pancreaticoesophageal fistula due to ruptured pancreatic pseudocyst (n = 1). Stent placement was successful in all patients with no immediate postprocedure complications. Successful healing was seen in nine patients (75 %). Stents were removed after a median time of 83.5 days (13-190 days). Stent migration was seen in four patients (33.3 %), and in two of them, it was retrieved and redeployed; none had early migration (<72 h). Reasons for SEPS failure in our cohort were failure of effective sepsis control in two patients and poor wound healing seen in one patient having multiple tubercular fistulae. CONCLUSION SEPS is a safe, well-tolerated treatment with good success rate (75 %) in treatment of esophageal leaks and fistulae.
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Abstract
GOALS The aim of this study was to retrospectively analyze the clinical, endoscopic, and pathologic features of intestinal tuberculosis (TB). BACKGROUND The prevalence of intestinal TB has been increasing in China. STUDY The clinical, imaging and laboratory examination, endoscopic, and pathologic data of 81 cases of intestinal TB patients were retrospectively analyzed. RESULTS There were 48 male and 33 female cases whose age ranged from 17 to 76 years (mean, 32.4±1.6 y). Fifty-five cases were diagnosed by endoscopic biopsy, and 26 cases by postoperative pathologic examination. 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%). Purified protein derivative test (51.9%), TB antibody (34.6%), and TB protein chip (40.7%) had lower sensitivity. T-spot test sensitivity was 86.4%. Endoscopic types included ulcerative (52.7%), ulcero-proliferative (27.3%), and proliferative (20.0%) with mucosal hyperemia and edema (87.2%), mucosal erosion (76.4%), patulous ileocecal valve (65.5%), polypoid hyperplasia (58.2%), annular ulcer (52.7%), nodular hyperplasia (45.5%), and luminal stenosis (29.1%). Histopathologic findings were chronic mucosal inflammation (87.3%), ulceration (74.5%), lymphocytic aggregation (69.1%), and granulomatous fusion (58.2%). The presence of caseating granulomas (74.5%) and necrosis (25.5%) was helpful, but not common. CONCLUSIONS The clinical symptoms of intestinal TB are nonspecific. The most common anatomic locations for intestinal TB are the ileocecal valve and cecum. The T-spot test has high sensitivity, and it can be used to support the diagnosis of intestinal TB. The typical endoscopic features are circumscribed intestinal ulcers, and histopathologic findings of biopsy specimens can be also useful in making the diagnosis.
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Dong P, Chen JJ, Wang XZ. Evaluation of a tuberculous abscess on the right side of the diaphragm with contrast-enhanced computed tomography: A case report. Mol Clin Oncol 2016; 5:210-212. [PMID: 27330800 DOI: 10.3892/mco.2016.863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/22/2016] [Indexed: 12/17/2022] Open
Abstract
We herein investigate the case of a patient with a tuberculous diaphragmatic abscess confirmed by pathology. The patient underwent plain computed tomography (CT) examination of the chest and contrast-enhanced abdominal CT examination. The abscess appeared as hypodense mass with thick and irregular wall, which was enhanced on the contrast-enhanced CT images. The shape of the mass resembled an irregular double convex lens. No enlarged lymph nodes were detected on the CT images. The presence of a tuberculous diaphragmatic abscess should be suspected in patients with a diaphragmatic hypodense mass with enhanced thick walls, even when there is absence of enlarged lymph nodes on the CT images.
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Affiliation(s)
- Peng Dong
- Medical Imaging Center, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
| | - Jing-Jing Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University School of Medicine, Qingdao, Shandong 266000, P.R. China
| | - Xi-Zhen Wang
- Medical Imaging Center, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong 261031, P.R. China
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Fillion A, Ortega-Deballon P, Al-Samman S, Briault A, Brigand C, Deguelte S, Germain A, Hansmann Y, Pelascini E, Rabaud C, Chavanet P, Piroth L. Abdominal tuberculosis in a low prevalence country. Med Mal Infect 2016; 46:140-5. [PMID: 26995289 DOI: 10.1016/j.medmal.2016.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/12/2016] [Accepted: 02/16/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Abdominal tuberculosis is a rare disease. The clinical and radiological manifestations are non-specific and the diagnosis is difficult. Our objective was to describe the characteristics and treatment of patients presenting with abdominal tuberculosis in a low-incidence country. PATIENTS AND METHODS We reviewed the clinical, diagnostic, treatment, and outcome features of patients presenting with abdominal tuberculosis diagnosed by bacteriological and/or histological results and managed in five French university hospitals from January 2000 to December 2009. RESULTS We included 21 patients. The mean diagnostic delay was 13 months. Twelve patients (57%) came from a low-incidence area and only two had a known immunosuppressed condition. Eighteen patients (86%) presented with abdominal symptoms. The main organs involved were the peritoneum (n=14, 66%), the mesenteric lymph nodes (n=13, 62%), and the bowel (n=7, 33%). Sixteen patients (76%) underwent surgery, including two in an emergency setting. Seventeen patients (81%) received six months or more of anti-tuberculosis treatment. Finally, 16 patients (76%) had a positive outcome. CONCLUSION New diagnostic procedures, and especially molecular biology, may help diagnose unusual clinical presentations of tuberculosis. Invasive procedures are frequently necessary to obtain samples but also for the treatment of digestive involvement.
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Affiliation(s)
- A Fillion
- Infectious Diseases Department, University Hospital of Dijon, BP 97908, 21000 Dijon, France.
| | - P Ortega-Deballon
- Digestive and Surgical Oncology Department, University Hospital of Dijon, BP 97908, 21000 Dijon, France
| | - S Al-Samman
- Digestive and Surgical Oncology Department, University Hospital of Dijon, BP 97908, 21000 Dijon, France
| | - A Briault
- Department of Pneumology, University Hospital of Grenoble, CS 10217, 38043 Grenoble cedex 09, France
| | - C Brigand
- Department of Digestive Surgery, University Hospital of Strasbourg, 67098 Strasbourg, France
| | - S Deguelte
- Department of Digestive Surgery, University Hospital of Reims, Robert-Debré Hospital, avenue General-Koening, 51092 Reims cedex, France
| | - A Germain
- Department of Digestive, Hepatobiliary, and Endocrine Surgery, University Hospital of Nancy, Hôpitaux de Brabois, bâtiment Philippe-Canton, allée du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France
| | - Y Hansmann
- Infectious Disease Department, University Hospital of Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - E Pelascini
- Department of Digestive Surgery, University Hospital of Lyon, Hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - C Rabaud
- Infectious Diseases Department, University Hospital of Nancy, Hôpitaux de Brabois, bâtiment Philippe-Canton, allée du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France
| | - P Chavanet
- Infectious Diseases Department, University Hospital of Dijon, BP 97908, 21000 Dijon, France
| | - L Piroth
- Infectious Diseases Department, University Hospital of Dijon, BP 97908, 21000 Dijon, France
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Abumossalam A, Shebl A. The right get with the proper git: Precision of diagnosing pulmonary tuberculous cavities by means of various biopsies. Egyptian Journal of Chest Diseases and Tuberculosis 2015. [DOI: 10.1016/j.ejcdt.2015.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Dong P, Chen JJ, Wang XZ, Wang YQ. Intraperitoneal tuberculous abscess: Computed tomography features. World J Radiol 2015; 7:286-293. [PMID: 26435779 PMCID: PMC4585952 DOI: 10.4329/wjr.v7.i9.286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/12/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the computed tomography (CT) features of intraperitoneal tuberculous abscess (IPTA).
METHODS: Eight patients with IPTA confirmed by pathology were analyzed retrospectively. The clinical symptoms, medical images, and surgical findings were evaluated. Involvement of the intestine, peritoneum, viscera, and lymph nodes was also assessed.
RESULTS: All 8 patients had a history of abdominal discomfort for 1 to 6 mo. Physical examination revealed a palpable abdominal mass in 6 patients. Three patients had no evidence of pulmonary tuberculosis (TB). All IPTAs (11 abscesses) were seen as a multiseptated, peripherally enhanced, hypodense mass with enlarged, rim-enhanced lymph nodes. The largest abscess diameter ranged from 4.5 cm to 12.2 cm. CT showed 2 types of IPTA: Lymph node fusion and encapsulation. Of the 8 patients, one had liver tuberculosis and one had splenic and ovarian tuberculosis. Two cases showed involvement of the terminal ileum and ileocecal junction. Ascites were found in 4 cases. Three patients had peritonitis and mesenteritis. Three patients showed involvement of the omentum. Three patients had histological evidence of caseating granuloma, and 5 had histological evidence of acid-fast bacilli.
CONCLUSION: CT is crucial in the detection and characterization of IPTA. Certain CT findings are necessary for correct diagnosis.
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Chaparro JMO, Reyes-Ortiz CA, Soto R, Reynolds JW. Abdominal tuberculosis presenting as ascites in an older indigenous woman: a case report. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- José Mauricio Ocampo Chaparro
- Jefe del Servicio de Hospitalización Geriátrica programa ‘Siéntete como en Casa’ Corporación Comfenalco-Universidad Libre; Profesor Asociado, Departamento de Medicina Familiar, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Carlos A Reyes-Ortiz
- Division of Geriatric and Palliative Medicine, University of Texas Medical School at Houston, Houston, TX, USA
- Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | - Ramiro Soto
- Especialista Medicina Familiar, Universidad del Cauca, Popayán, Colombia
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Muroni M, Rouet A, Brocheriou I, Houry S. Abdominal tuberculosis: utility of laparoscopy in the correct diagnosis. J Gastrointest Surg 2015; 19:981-3. [PMID: 25650164 DOI: 10.1007/s11605-015-2753-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/14/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Abdominal tuberculosis is one of the most prevalent form of extra-pulmonary disease, and the diagnosis is difficult because of non-specific clinical features. METHOD We presented a case of a Tunisian woman with cough, nausea, decreased appetite and pelvic-abdominal pain. CT scan showed peritoneal thickening, peritoneal tiny nodules and enlarged mesenteric lymph nodes ascitic fluid. Sputum analysis was negative. Abdominal paracentesis was performed, and no malignant cell was detected. The Ziehl staining revealed a negativity for acid-fast bacilli. RESULTS Diagnostic laparoscopy was performed. Biopsy specimens of peritoneum, liver, omentum and diaphragm showed omental epithelioid granulomas with a centrale caseous necrosis and Langhans giant cells. The patient received anti-tubercular treatment. CONCLUSIONS In case of suspicion of tuberculosis, when bacteriologic and cytologic analysis is negative, laparoscopy with biopsies is helpful for correct diagnosis and appropriate management.
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Sabooni K, Khosravi MH, Pirmohammad H, Afrasiabian S, Moghbel N, Shahverdi E, Konjedi MA, Shahverdi A. Tuberculosis peritonitis with features of acute abdomen in HIV infection. Int J Mycobacteriol 2015; 4:151-3. [PMID: 26972884 DOI: 10.1016/j.ijmyco.2015.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 02/21/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022] Open
Abstract
This case report introduces a 26-year-old male IV drug abuser with fever, abdominal pain and distension referred to the emergency ward. According to these findings, abdominal tenderness and involuntary guarding, an explorative laparotomy was performed. Multiple biopsies of omentum, peritoneum and liver were taken. Pathologic assessment of multiple biopsies confirmed intra-abdominal TB infection.
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Affiliation(s)
- Keivan Sabooni
- Kordestan University of Medical Sciences, Kordestan, Iran
| | | | - Hossein Pirmohammad
- Students' Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | | | - Ehsan Shahverdi
- Students' Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Mohammad Amin Konjedi
- Students' Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ashkan Shahverdi
- Students' Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Joyati Tarafder A, Mahtab MA, Ranjan Das S, Karim R, Rahaman H, Rahman S. Abdominal Tuberculosis: A Diagnostic Dilemma. Euroasian J Hepatogastroenterol 2015; 5:57-59. [PMID: 29201690 PMCID: PMC5578524 DOI: 10.5005/jp-journals-10018-1133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/08/2014] [Indexed: 11/23/2022] Open
Abstract
According to the World Health Organization, more than 2 billion people are estimated to be infected with tuberculosis (TB) and approximately 95% of tuberculosis cases occur in developing countries. Extrapulmonary forms of tuberculosis constitute approximately one-sixth of all cases and the prevalence of extrapulmonary tuberculosis (TB) seems to be rising, particularly due to increasing prevalence of acquired immunodeficiency syndrome (AIDS). In patients with extrapulmonary TB, abdomen is involved in 12% of patients. Gastrointestinal involvement is found in 66 to 75% of abdominal cases, with the terminal ileum and the ileocecal region being the most common sites of involvement. Here, we report a case of abdominal TB.
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Affiliation(s)
| | - Mamun-Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Sisir Ranjan Das
- Department of Neonatology, Dhaka Medical College, Dhaka, Bangladesh
| | - Rezaul Karim
- Upazila Health Complex, Dhamrai, Dhaka, Bangladesh
| | | | - Salimur Rahman
- Department of Hepatology, Mymensingh Medical College, Mymensingh, Bangladesh
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Papis D, Branchi V, Gomez L, Herrerias F, Vilardell F, Gonzalez M, Olsina JJ. Abdominal tuberculosis mimicking Crohn's disease's exacerbation: A clinical, diagnostic and surgical dilemma. A case report. Int J Surg Case Rep 2014; 6C:122-5. [PMID: 25528041 PMCID: PMC4337931 DOI: 10.1016/j.ijscr.2014.11.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/27/2014] [Accepted: 11/28/2014] [Indexed: 12/04/2022] Open
Abstract
Tuberculosis is a health public problem, which has increased over the last 20 years. The diagnosis of extrapulmonary tuberculosis can be challenging, and in particular clinical manifestations of gastrointestinal tuberculosis are unspecific and can mimic other pathologies. Medical therapy is the treatment of choice and surgery is not required if it is diagnosed at an early stage, anyway diagnosis of abdominal tuberculosis still remains a challenge for both internists and surgeons. Before starting a therapy with adalimumab, every patient should be tested for latent tuberculosis infection.
Introduction Tuberculosis in Europe is a health public problem, which has increased constantly over the last few decades. The most common clinical manifestation of tuberculosis is pulmonary. The diagnosis of extrapulmonary tuberculosis can be challenging and clinical manifestations of gastrointestinal tuberculosis are unspecific and can mimic other pathologies. Presentation of case A young Chinese man, who had recently been diagnosed with Crohn’s disease, was admitted to the emergency room of our hospital with a one-month history of diffuse abdominal pain and weight loss. The patient initially presented with epigastric pain, which had been constantly increasing over the last 48 h. Other symptoms included diarrhea, nausea, and fever. The patient was then admitted with the diagnosis of Crohn’s disease exacerbation, and a treatment with corticosteroids, azathioprine, mesalazine, adalimumab, and antibiotic therapy was started. The symptoms were due to an initially misdiagnosed case of abdominal tuberculosis. Discussion Intestinal tuberculosis is mainly localized at the ileocecal level in 85% of patients. Medical therapy is the treatment of choice and surgery is not required if it is diagnosed at an early stage.
Conclusion The diagnosis of abdominal tuberculosis still remains a challenge for both internists and surgeons. Before starting a therapy with adalimumab, every patient should be tested for latent tuberculosis infection.
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Affiliation(s)
- Davide Papis
- Colorectal Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
| | - Vittorio Branchi
- Department of Surgery, Bonn University Hospital, Sigmund-Freud-Strasse 25, Bonn 53127, Germany.
| | - Luis Gomez
- Colorectal Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
| | - Fernando Herrerias
- Colorectal Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
| | - Felip Vilardell
- Anatomical Pathology Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
| | - Marta Gonzalez
- Hepatobilyopanctratic Unit, General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
| | - Jorge J Olsina
- General Surgery Division, University Hospital Arnau de Vilanova, University of Lleida, Avinguda Alcalde Rovira Roure, 80 25198 Lleida, Spain.
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