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Calin R, Belkacem A, Caraux-Paz P, Wagner M, Guillot H, Veziris N, Jaureguiberry S, Caumes E, Patey O, Pourcher V. Abdominal Tuberculosis: Experience from Two Tertiary-Care Hospitals in the Paris Region. Am J Trop Med Hyg 2021; 104:223-228. [PMID: 33205739 DOI: 10.4269/ajtmh.20-0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abdominal tuberculosis (ATB) is uncommon and not very well known by clinicians. We describe the characteristics, evolution, and treatment of patients with ATB in two large hospitals in the Paris region. We reviewed all records of patients treated for ATB, from January 01, 2010 to December 01, 2016, diagnosed by bacteriological and/or histological methods or highly suspected because of clinical/radiological features. We included 80 patients, with a median (IQR) age of 39 (29-50) years, with 56.2% being males. Among them, 63.7% had African origins, 15% Asian, and 11.2% European. Twenty-nine had a cause of immunosuppression (n = 21 HIV infection). The main abdominal localizations were lymph nodes (72.5%), peritoneum (62.5%), and solid organs (25%). Extra-abdominal localizations were recorded in 65 (81.2%) patients. Tuberculosis was proven bacteriologically in 71%, histologically in 50%, and solely clinical/radiological in 10% of cases. Patients received standard therapy for a median duration of 9 months, with a favorable outcome. Corticosteroid therapy was used in 15 cases, either for paradoxical reaction or to prevent complications. Abdominal TB was mainly represented by lymphatic and peritoneal localizations, proven bacteriologically, and associated with extra-abdominal localizations in most cases. The use of steroids remains controversial, but it does not seem systematically needed in case of abdominal involvement.
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Affiliation(s)
- Ruxandra Calin
- 1Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.,2Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Tenon, Paris, France
| | - Anna Belkacem
- 3Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Intercommunal Lucie et Raymond Aubrac, Villeneuve Saint Georges, France
| | - Pauline Caraux-Paz
- 3Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Intercommunal Lucie et Raymond Aubrac, Villeneuve Saint Georges, France
| | - Mathilde Wagner
- 4Service de Radiologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Héène Guillot
- 1Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Nicolas Veziris
- 5Service de Bactériologie, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Stéphane Jaureguiberry
- 1Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.,6Service des Maladies Infectieuses et Médecine Tropicale, AP-HP, INSERM 1018 CESP Centre de Recherche en Epidémiologie et Santé des Populations, Hôpital Universitaire de Bicêtre, Le Kremlin-Bicêtre, France
| | - Eric Caumes
- 1Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.,7INSERM U1136, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris, France
| | - Olivier Patey
- 3Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Intercommunal Lucie et Raymond Aubrac, Villeneuve Saint Georges, France
| | - Valérie Pourcher
- 1Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.,7INSERM U1136, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris, France
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Abstract
Patient: Female, 47-year-old Final Diagnosis: Intraperitoneal tuberculosis Symptoms: Abdominal pain • decreased appetite Medication: — Clinical Procedure: — Specialty: Infectious Diseases • Medicine, General and Internal
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Affiliation(s)
- Binita Bhandari
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
| | - Samantha A Snyder
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
| | - John D Goldman
- Department of Infectious Disease, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA
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Sen D, Brunton J, Melchior L, Klein D, Levy GH, Wainscoat B, Chuang L. Peritoneal tuberculosis: A case report on a rare cause of tumor marker elevation. Case Rep Womens Health 2020; 28:e00264. [PMID: 33145180 PMCID: PMC7591737 DOI: 10.1016/j.crwh.2020.e00264] [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: 09/03/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022] Open
Abstract
Peritoneal tuberculosis (TB) is a rare extrapulmonary manifestation of TB with non-specific clinical characteristics which can produce test results mimicking malignancy and granulomatous peritonitis. This case describes a Filipino 59-year-old, nulliparous woman who was admitted with abdominal pain, ascites, and an elevated CA-125 level. Radiographically, peritoneal nodules were visualized and initial suspicion was high for malignancy. Following a bilateral salpingo-oophorectomy and peritoneal biopsy, histology was negative for malignancy but revealed non-caseating granulomas. She was discharged then readmitted with progressive abdominal pain, and a repeat laparoscopic biopsy yielded specimens with growth of acid-fast bacilli (AFB). A delay in diagnosis and treatment of tuberculous peritonitis increases mortality rates, making early diagnosis with laparoscopic biopsy of paramount importance in prompt diagnosis and initiation of therapy. This patient was initiated on standard anti-TB therapy and experienced no complications.
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Affiliation(s)
- Dilek Sen
- Ross University School of Medicine, Miramar, Florida, USA
| | - Joshua Brunton
- Department of Obstetrics and Gynecology, Danbury Hospital, Danbury, Connecticut, USA
| | - Landon Melchior
- Department of Radiology, Norwalk Hospital, Norwalk, Connecticut, USA
| | - David Klein
- Department of Radiology, Norwalk Hospital, Norwalk, Connecticut, USA
| | - Gillian H Levy
- Department of Pathology, Norwalk Hospital, Norwalk, Connecticut, USA
| | - Booth Wainscoat
- Department of Infectious Disease, Norwalk Hospital, Norwalk, Connecticut, USA
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Danbury Hospital, Danbury, Connecticut, USA
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Mekaiel A, Al-Tkrit A, Aneeb M, Saeed M, Doshi K. Tuberculosis in an Immunocompetent Immigrant Patient. Cureus 2020; 12:e10225. [PMID: 33042668 PMCID: PMC7535870 DOI: 10.7759/cureus.10225] [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: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
Peritoneal tuberculosis (TB) is a rare medical condition in developed nations like the United States, and it is uncommon to observe this condition in patients without underlying immunosuppression. This report describes a patient who developed abdominal pain, constipation, and ascites. And later on, he was diagnosed with peritoneal TB following laparoscopy with peritoneal biopsy. The patient was an immigrant from a high TB burden country but had no other common risk factors for the development of peritoneal TB. Treatment with anti-TB therapy resulted in significant clinical improvement.
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Affiliation(s)
- Andrew Mekaiel
- Internal Medicine, Jamaica Hospital Medical Center, Jamaica, USA
| | - Amna Al-Tkrit
- Internal Medicine, Jamaica Hospital Medical Center, Jamaica, USA
| | - Mohammad Aneeb
- Internal Medicine, Jamaica Hospital Medical Center, Jamaica, USA
| | - Meena Saeed
- Internal Medicine, Jamaica Hospital Medical Center, Jamaica, USA
| | - Kaushik Doshi
- Internal Medicine, Jamaica Hospital Medical Center, Jamaica, USA
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Abstract
PURPOSE OF REVIEW The elevator mechanism of the duodenoscope was the focus of endoscopically transmitted infections prior to the COVID-19 pandemic. Since that time, the 'suspicious suspects' in the endoscopy unit have grown in number in the eyes of both patients and endoscopists. RECENT FINDINGS This review summarizes the existing guidelines related to infection control in the endoscopy unit and emerging technologies to address gaps, identifies recommendations proposed during the COVID-19 pandemic, and reminds the reader that infection prevention has not changed since the emergence of COVID-19, only the importance of infection prevention has increased in visibility. SUMMARY Infection prevention has been and will always be necessary in the gastrointestinal endoscopy unit. Although outbreaks of antibiotic-resistant organisms and infectious diseases like COVID-19 raise the profile of infection control, there have been no major changes to infection control practice recommendations because of the global pandemic. The history of lapses in infection control, persistent contamination of reprocessed endoscopes, and failure of many endoscopy units to identify certain endoscopic procedures as aerosol-generating procedures prior to the pandemic emphasize the need for better knowledge and implementation of infection control practices within endoscopy units.
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