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

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

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

Ultrasonography for diagnosis of abdominal tuberculosis in HIV infected people.

Background & objectives: There is an increasing incidence of abdominal tuberculosis with the advent of HIV infection. This study was aimed at determining the pattern of presentation of abdominal tuberculosis on ultrasonography (USG) in HIV positive patients. Methods: This retrospective study was carried at the ART Centre, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, between March 2005 to July 2007. HIV positive patients (n=2453) with prolonged fever, abdominal pain/distension, altered bowel habits and diarrhoea underwent ultrasonography for tuberculosis of abdomen. The different ultrasonological findings in abdominal tuberculosis were noted. CD4 counts of these patients were also recorded. Results: Of the total 2453 patients, 244 showed findings suggestive of abdominal tuberculosis. Lymphadenopathy with predominantly hypoechoic/necrotic echotexture was seen in 158/244 (64.8%) patients. Splenomegaly was seen in 68 patients with 61 of them (89.7%) showing multiple hypoechoic lesions in the parenchyma. 53 of 244 (21.7%) showed extensive abdominal involvement. Liver enlargement was seen as a part of extensive abdominal involvement. A total of 203 patients completed antitubercular treatment, of which 198 (97.5%) showed resolution of lesions in USG. CD4 counts in patients with extensive abdominal involvement were lowest compared to CD4 count in patients with others USG findings. Interpretation & conclusion: Ultrasonological findings like lymphadenopathy (≥1.5 cm) with hypoechoeic/necrotic echotexture, hypoechoic splenic lesions and extensive abdominal involvement in HIV infected patients may be suggestive of abdominal tuberculosis.

Enterolithiasis: An uncommon finding in abdominal tuberculosis.

Enterolithiasis, the formation of intestinal calculi due to stasis, is known to occur with abdominal tuberculosis. It has uncommonly been reported from India and only rarely in older children.

Apresentação de tuberculose com hemorragia digestiva alta: relato de caso / Tuberculosis presenting as upper gastrointestinal bleeding: case report

Tuberculose pode envolver qualquer parte do trato gastrointestinal, entretanto a localização gástrica é extremamente rara. Tuberculose gástrica pode mimetizar úlcera péptica ou neoplasia gástrica maligna, porém hemorragia digestiva alta é manifestação extremamente incomum da tuberculose gástrica. Nós relatamos um caso de tuberculose disseminada, em uma paciente com SIDA com repetidos episódios de melena e hematêmese. A biópsia realizada evidenciou micobacteriose antral, com presença de bacilos álcool-ácido resistentes na área ulcerada (AU)

Tuberculosis may involve any part of the gastrointestinal (GI) tract. However gastric involvement is extremely rare. Gastric tuberculosis may simulate peptic ulcer or gastric malignancy, but upper GI bleeding is an extremely uncommon manifestation. We report a case of disseminated tuberculosis in a patient with AIDS, with repeated episodes of melena and hematemesis. A biopsy revealed antral mycobacteriosis with the presence of acidfast bacilli in the ulcerated area (AU)

Clinicicopathologic profile of patients presenting with abdominal tuberculosis in a tertiary care hospital

To evaluate pattern of presentation of patients with abdominal tuberculosis [TB] in a tertiary care hospital. This was a hospital based non-interventional descriptive case series study. It included patients of both sexes, more than 12 years of age, with clinically suspected abdominal tuberculosis. The study was carried out in medical wards of Lady Reading Hospital, Peshawar from January to December 2003. Patients were selected by non-probability convenient sampling method after obtaining an informed consent. Out of 100 patients with abdominal TB, there were 62 [62%] patients with intestinal TB, 30 [30%] with peritoneal TB and 08 [08%] patients with nodal TB. The mean age of patients was 36.4+9.64 years. Fever was observed in 74 [74%] patients, weight loss in 42 [42%], abdominal pain in 72 [72%] diarrhoea in 53 [53%], vomiting in 49 [49%], abdominal mass in 34 [34%], and ascites in 36 [36%] patients. Montoux test was positive in 67 [67%], immuno-chromatographic testing [ICT] for Tuberculosis., was positive in 62 [62%] patients. Chest radiograph was abnormal in 24 [24%] patients, Abdominal Ultrasonography showed abnormalities in 72 [72%] patients.. Barium contrast studies showed abnormalities in 77 [77%] patients. Computerized tomography [CT] of the abdomen was abnormal in 84 [84%]. Intestinal tuberculosis was the most common entity in patients with TB abdomen. The most frequent presenting features of abdominal TB were fever and abdominal pain. CT abdomen had the highest diagnostic yield

Abdominal tuberculosis on-going challenge to gastroenterologists

The aim of this study is to record the observations and experience on the diagnosis and management of abdominal tuberculosis [TB] and to highlight the difficulties in the diagnosis and management of this condition. Two hundred consecutive patients attending the Gastroenterology Department of the King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia between May 1991 and May 2001, suspected with abdominal TB were investigated. A detailed clinical history and physical examination were obtained. Data of 75 confirmed cases of abdominal TB were analyzed. The most common presenting symptoms were anorexia [84%], abdominal pain [84%] and weight loss [72%]. Abdominal tenderness was the most common clinical finding, followed by ascites and abdominal mass [42%]. The chest radiograph suggestive of pulmonary TB was diagnosed in 24 patients [32%]. Computed tomographic [CT] scanning revealed abnormalities in all 51 patients who underwent the procedure, while positive findings were observed by abdominal ultrasound in 66% of the tested patients. Histopathological examination of patients showed tuberculous granuloma, while acid fast bacilli were seen in 34%. Mycobacterium tuberculosis was identified by microbiological methods in 60% of patients. The most common presenting symptoms were anorexia [84%], abdominal pain [84%] and weight loss [72%]. Abdominal tenderness was the most common clinical finding, followed by ascites and abdominal mass [42%]. The chest radiograph suggestive of pulmonary TB was diagnosed in 24 patients [32%]. Computed tomographic [CT] scanning revealed abnormalities in all 51 patients who underwent the procedure, while positive findings were observed by abdominal ultrasound in 66% of the tested patients. Histopathological examination of patients showed tuberculous granuloma, while acid fast bacilli were seen in 34%. Mycobacterium tuberculosis was identified by microbiological methods in 60% of patients. A high index of clinical suspicion is required to make an early diagnosis of abdominal TB. Suspicion should be aroused, particularly in patients having a combination of anorexia, abdominal pain, weight loss and ascites. Diagnosis requires the utilization of a combination of various diagnostic procedures especially abdominal ultrasound, CT scan and endoscopy, which provides a high diagnostic yield in this disease. A normal chest radiograph does not exclude the presence of abdominal TB. A timely use of laparoscopy are often required to prevent surgical intervention

Duodenal tuberculosis: radiological features on barium studies and their clinical correlation in 28 cases.

BACKGROUND: A retrospective analysis of 28 cases of duodenal tuberculosis (TB) was done to evaluate radiological findings and their value in the diagnosis of the disease. SUBJECTS AND METHODS: Upper gastrointestinal and small bowel series of 28 patients with duodenal tuberculosis were analysed for radiological findings. The diagnosis of duodenal TB was confirmed by surgery and biopsy in 18, on the basis of radiological findings and response to treatment in 9, and on the basis of findings on upper gastrointestinal scopy and biopsy in 1 patient. RESULTS: The study included 28 patients (14 males, 14 females). The mean age was 32.1 (range 5-65). Twenty-three (82.2%) patients presented with obstructive symptoms while five manifested with dyspeptic symptoms. Of the latter, 4 had ulcerations in the third and fourth parts of the duodenum. In the remaining patient, the mucosa of the duodenum could not be clearly visualised. Two patients had extrinsic impression at the D2-D3 and D3-D4 segments. In 23 patients with obstructive symptoms, 18 demonstrated luminal narrowing of varying degrees and 5 had a sharp band-like cut-off at the third part of the duodenum. Of the 18 patients with luminal narrowing, 13 had extrinsic compression, 12 had proximal dilatation and 14 had ulcerations mainly in the second and third parts of the duodenum. Biliary involvement was seen in 3 patients without any signs or symptoms directly referable to the biliary involvement. CONCLUSION: Though duodenal TB lacks specific radiological features, barium studies help to localise and define the area of narrowing and ulcerations and help to confirm the presence of lymph nodes causing compression of the duodenum.

Laparoscopy assisted hemi-colectomy for ileo-caecal tuberculosis.

Laparoscopy assisted hemicolectomy for ileo-caecal tuberculosis is being evaluated the world over. Several procedures are performed laparoscopically, including the laparoscopic hemicolectomy, for benign and malignant diseases. Abdominal tuberculosis is one of the commonest causes of intestinal obstruction in India. We have evaluated the role of laparoscopic resection of ileocaecal tuberculosis and successfully performed the procedure in five patients. The clinical profiles of patients and operative procedure are discussed in this article with a brief review of the literature.

[Gastro-intestinal tuberculosis [21 cases]]

21 cases of gastrointestinal tuberculosis were diagnosed within 4 years ileocaecal [10], colic [7], small bowel [4] and gastroduodenal [2]. More than one localisation was encountered in 7 patients. In 10 cases, the presence of fistulas whether blind or communicating was noticed. The diagnostic criterious were either a positive histological examination, or the association of suggestive radiological aspects and a pulmonary or peritoneal tuberculosis, or a positive tuberculous test treatment. The clinical, biological, pathological and the radiological aspects of the gastrointestinal tuberculosis as well as the problems of the differential diagnosis, are discussed