Gastrointestinal Tuberculosis Research Articles

Artificial intelligence-aided colonoscopic differential diagnosis between Crohn's disease and gastrointestinal tuberculosis.

Differentiating between Crohn's disease (CD) and gastrointestinal tuberculosis (GITB) is challenging. We aimed to evaluate the clinical applicability of an artificial intelligence (AI) model for this purpose. The AI model was developed and assessed using an internal dataset comprising 1,132 colonoscopy images of CD and 1,045 colonoscopy images of GITB at a tertiary referral center. Its stand-alone performance was further evaluated in an external dataset comprising 67 colonoscopy images of 17 CD patients and 63 colonoscopy images of 14 GITB patients from other institutions. Additionally, a crossover trial involving three expert endoscopists and three trainee endoscopists compared AI-assisted and unassisted human interpretations. In the internal dataset, the sensitivity, specificity, and accuracy of the AI model in distinguishing between CD and GITB were 95.3%, 100.0%, and 97.7%, respectively, with an area under the ROC curve of 0.997. In the external dataset, the AI model exhibited a sensitivity, specificity, and accuracy of 77.8%, 85.1%, and 81.5%, respectively, with an area under the ROC curve of 0.877. In the human endoscopist trial, AI assistance increased the pooled accuracy of the six endoscopists from 86.2% to 88.8% (P=0.010). While AI did not significantly enhance diagnostic accuracy for the experts (96.7% with AI vs 95.6% without, P=0.360), it significantly improved accuracy for the trainees (81.0% vs 76.7%, P=0.002). This AI model shows potential in aiding the accurate differential diagnosis between CD and GITB, particularly benefiting less experienced endoscopists.

039. Obstructive Ileus Caused by Colitis Tuberculosa: A Case Report

Background: Gastrointestinal TB (GTB) constituting approximately 1% to 3% of all TB globally and characterized including of any part of digestive system and its related organs. Results: A 61 years old man was admitted to emergency departement with abdominal pain and abdominal distention since 6 months and getting worse in 1 day. He also complained dispneu. On examination, the abdomen was rigid, distended, and tender and the lung has wheezing. The radiographs of abdomen revelved dilated loops of the small intestine with multiple air-fluid levels suggestive of small intestine obstruction. A chest radiograph showed active TB with opacity of the right lung. The patient was planned for exploratory laparotomy and founded anastomosis, peritoneal deposits, matted bowel, and a perforation of ileus. Intraoperative biopsy was taken from the ileus perforation and revelved tuberkulosa infected. Postoperatively, he was started antituberculous theraphy (ATT) of Rifampicin, isoniazid, and ethambutol (RHE). Conclusion: Obstructive Ileus is a complication of gastrointestinal tuberculosis in patients with a history of untreated latent tuberculosis.

S2775 Diagnostic Challenges and Effective Treatment of Gastrointestinal TB: Insights From a Clinical Case

S2775 Diagnostic Challenges and Effective Treatment of Gastrointestinal TB: Insights From a Clinical Case

Anal tuberculosis presented as chronic perianal abscess in an immunocompetent adult: A rare case report

ABSTRACT There are reported 7.5 million cases of extra pulmonary tuberculosis (TB) (EPTB) worldwide and 19% in the South-East Asia region. Anal TB represents an exceedingly uncommon extra pulmonary manifestation of TB), occurring in fewer than 1% of individuals who acquire TB. The occurrence of perianal illness is extremely rare, accounting for 1% of the gastrointestinal (GI) tract, while GI TB makes up less than 1% of all TB cases. The most prevalent manifestation is the development of a fistula in the anus, while the presentation as a perianal abscess is uncommon. We present a case of isolated perianal TB with no associated GI or pulmonary dissemination in the immunocompetent.

Colonic Tuberculosis Mimicking Colonic Cancer: A Multidisciplinary Diagnosis and Case Report

Gastrointestinal tuberculosis accounts for 1% to 3 % of all TB cases worldwide. Colonic tuberculosis is rare and can be mistaken for malignancy. It commonly presents as chronic abdominal pain along with night sweats, diarrhea, and fatigue and can resemble variety of other diseases making the diagnosis difficult. It presents with vague clinical and radiological picture making the diagnosis challenging for the clinicians. Its diagnosis is usually made by combining clinical features, radiological, tissue AFP staining and histopathologal examinations. The typical histopathologic findings include confluent large granulomas and langhans giant cells with caseating necrosis. Gastrointestinal tuberculosis responds well to standard antituberculous drugs and surgery is done for patients that have complications like strictures or obstruction which does not respond to medical therapy. This case illustrates a 40 year old man who presented with crampy lower abdominal pain and diagnosed as a colonic cancer both on imaging and clinically which later found to have colonic tuberculosis on a colectomy histopathologic sample. He was treated with anti-TB and respond well to his treatment. This case will give an insight for treating physicians to have a high index of suspicion for colonic TB in a patient who presented with lower abdominal pain and having colonic mass.

New diagnostic strategies to distinguish Crohn's disease and gastrointestinal tuberculosis.

Despite advances in our radiological, histological and microbiological armamentarium, distinguishing between Crohn's disease (CD) and intestinal tuberculosis (ITB), especially in a TB endemic country, continues to be a challenging exercise in a significant number of patients. This review aims to summarize current available evidence on novel diagnostic techniques which have a potential to fill the gap in our knowledge of differentiating between ITB and CD. Both ITB and CD are associated with altered host immune responses, and detection of these altered innate and adaptive immune cells has potential to distinguish ITB from CD. ITB and CD have different epigenetic, proteomic and metabolomic signatures, and recent research has focused on detecting these differences. In addition, the gut microbiome, which is involved in mucosal immunity and inflammatory responses, is considerably altered in both ITB and CD, and is another potential frontier, which can be tapped to discriminate between the two diseases. With technological advancements, we have newer radiological modalities including perfusion CT and dual-layer spectral detector CT enterography and evidence is emerging of their role in differentiating ITB from CD. Finally, time will tell whether the advent of artificial intelligence, with rapidly accumulating data in this field, will be the gamechanger in solving this puzzle of diagnostic dilemma between ITB and Crohn's disease. Recent advances need to be clinically validated before they can be used as novel diagnostic measures to differentiate Intestinal TB from CD.

Imaging in Abdominal Tuberculosis

AbstractDiagnosis of abdominal tuberculosis is challenging due to its variable imaging appearance, which can mimic several other conditions. This review covers the imaging spectrum of tubercular involvement of abdominal lymph nodes, peritoneum, solid abdominal viscera, and the gastrointestinal tract. Tubercular lymphadenitis is the most frequent manifestation of abdominal tuberculosis and may show necrosis. Peritoneal tuberculosis is the next most commonly involved site in the abdomen and can be of wet, fibrotic, and dry forms. The ileocecal region is the most common site of involvement in gastrointestinal tuberculosis. Solid visceral involvement mostly affects the liver and spleen causing hepatosplenomegaly with a micronodular or macronodular imaging pattern. Awareness of the spectrum of imaging manifestations and a high index of suspicion is required to reach the correct diagnosis.

Discrimination of pediatric cryptogenic multifocal ulcerous stenosing enteritis from small bowel Crohn's disease and gastrointestinal tuberculosis: A retrospective study (with videos).

Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare entity that mimics various inflammatory strictures of the small intestine. Pediatric literature is scarce. We analyzed the clinical, radiological, endoscopic and histopathological features of children with CMUSE that differentiate it from small bowel Crohn's disease (SBCD) and gastrointestinal tuberculosis (GITB). CMUSE was diagnosed by the following criteria: (1) unexplained small bowel strictures with superficial ulcers, (2) chronic/relapsing ulcers of small bowel after resection, (3) no signs of systemic inflammation, (4) absence of other known etiologies of small bowel ulcers. SBCD and GITB were diagnosed based on standard criteria. The clinical features, laboratory parameters, radioimaging, endoscopy (including video capsule endoscopy [VCE], intra-operative endoscopy), histopathological features and treatment outcome were noted. Out of 48,CMUSE was diagnosed in 13 (27%) isolated small bowel and ileocecal strictures, while GITB and SBCD accounted for 41% and 21% cases, respectively. Common presentations were sub-acute obstruction (46%), obscure gastrointestinal bleeding (38%) and protein-losing enteropathy (38%). CMUSE patients had significantly longer disease duration compared to SBCD and GITB (p < 0.001). SBCD (90.0%) and GITB (85%) cases had elevated C-reactive protein (CRP), none with CMUSE had elevated CRP (p < 0.001). The disease was localized in jejunum (100%) and proximal ileum (56%) in CMUSE, ileocecal region (85%) in GITB, but evenly distributed in small intestine in SBCD. Endoscopy showed evenly placed, superficial, circumferential ulcers with strictures in CMUSE, deep linear ulcers in SBCD and circumferential ulcers in GITB. Upfront immunosuppression was given in four; three (75%) of them relapsed. Only surgery was done in three with one (25%) having relapse. Upfront surgery followed by immunosuppression was used in six, but all relapsed and two required repeat surgery. CMUSE is important but underdiagnosed in children. Lack of constitutional symptoms, normal inflammatory parameters and characteristic ulcers with strictures helped in differentiating CMUSE from GITB and SBCD.

Intestinal tuberculosis revealed by stercoral peritonitis in a patient at D3 postpartum: A case report

Digestive tuberculosis is uncommon compared to pulmonary tuberculosis. Gastrointestinal tuberculosis accounts for 2.5% of cases of extra-pulmonary tuberculosis. Early diagnosis is not easy because of the non-specific clinical picture. We report a case of intestinal tuberculosis revealed by stercoral peritonitis in a 29- year-old patient whose CT scan showed a large pneumoperitoneum. The procedure consisted of a bowel resection, removing both perforations and performing a Bouilly volkman ileostomy. Anatomopathological examination of the operative specimen revealed ulcerated and perforated ileitis with epithelio-giganto-cellular and necrotizing granulomatous lesions suggestive of tuberculosis.

Direct peritoneal resuscitation in a patient with gastrointestinal tuberculosis with an open abdomen

Rationale/objectivesThis case report aims to illustrate the methodology involved in the management of a patient with gastrointestinal tuberculosis with an open abdomen with direct peritoneal resuscitation. We present a 49-year-old malnourished male, in septic shock, who presented with mechanical intestinal obstruction from gastrointestinal tuberculosis (GITB) and required delayed abdominal closure. Direct peritoneal resuscitation (DPR) was employed as an adjunct to shorten the interval to closure by reducing organ edema and inflammatory cytokine levels. MethodsThis is a case report describing the procedure of direct peritoneal resuscitation and its use in non-trauma related surgeries requiring delayed abdominal closure. ResultsThe patient recovered well from the surgery with the abdomen closed after nine days from the first procedure. ConclusionDirect peritoneal resuscitation is a viable adjunct in patients requiring delayed abdominal closure.

Artificial intelligence for discrimination of Crohn's disease and gastrointestinal tuberculosis: A systematic review.

Discrimination of gastrointestinal tuberculosis (GITB) and Crohn's disease (CD) is difficult. Use of artificial intelligence (AI)-based technologies may help in discriminating these two entities. We conducted a systematic review on the use of AI for discrimination of GITB and CD. Electronic databases (PubMed and Embase) were searched on June 6, 2022, to identify relevant studies. We included any study reporting the use of clinical, endoscopic, and radiological information (textual or images) to discriminate GITB and CD using any AI technique. Quality of studies was assessed with MI-CLAIM checklist. Out of 27 identified results, a total of 9 studies were included. All studies used retrospective databases. There were five studies of only endoscopy-based AI, one of radiology-based AI, and three of multiparameter-based AI. The AI models performed fairly well with high accuracy ranging from 69.6-100%. Text-based convolutional neural network was used in three studies and Classification and regression tree analysis used in two studies. Interestingly, irrespective of the AI method used, the performance of discriminating GITB and CD did not match in discriminating from other diseases (in studies where a third disease was also considered). The use of AI in differentiating GITB and CD seem to have acceptable accuracy but there were no direct comparisons with traditional multiparameter models. The use of multiple parameter-based AI models have the potential for further exploration in search of an ideal tool and improve on the accuracy of traditional models.

Diagnostic Efficacy of New Xpert Ultra for Extrapulmonary Tuberculosis Using Culture and Composite Reference Standard.

Xpert Ultra (Cepheid, USA) is recently introduced with an extra category of trace-positive results and higher sensitivity for tuberculosis (TB) diagnosis. The objective of the study was to assess the diagnostic accuracy of Xpert Ultra for extrapulmonary samples using culture and composite reference standard (CRS) as the gold standard. In a 1-year (March 2021-22) prospective observational study, samples of suspected extrapulmonary TB (EPTB) patients were subjected to Ziehl-Neelsen staining, culture, and Xpert Ultra (Cepheid, Sunnyvale, CA) tests. Relevant clinical and treatment information was noted. The diagnostic accuracy of Xpert Ultra compared with culture and CRS was calculated. Out of 1720 suspected patients of EPTB, 223 (13%), predominantly males 135 (60%), with a mean age of 41.46 ± 19.81 years, were diagnosed as TB positive following CRS criteria. The maximum cases were of pleural TB (35.4%), followed by central nervous system TB (17.9%), gastrointestinal TB (17.5%), and lymph node TB (12.1%). Of all samples, 150 (8.7%) were microbiologically confirmed, including 141 detected by Xpert ultra, 67 culture positive, and only 16 smear positive. Among the Xpert Ultra-positive samples, 35 showed trace results, including six false-positive results. Considering culture and CRS as the gold standard, the sensitivity (86.57%, 59.64%) and specificity (94.98%, 99.47%) of Xpert Ultra were calculated, respectively. Rifampicin resistance was detected in 1 (0.70%) sample. Diagnosis of EPTB is a challenge and Xpert Ultra may detect TB at a very early stage. However, it is essential to rule out false-positive results. Additional studies are needed on Xpert Ultra to interpret trace results better.

S2712 Poor Consumption: A Case of Gastrointestinal Tuberculosis Mimicking Malignancy in an Immunocompromised Patient

S2712 Poor Consumption: A Case of Gastrointestinal Tuberculosis Mimicking Malignancy in an Immunocompromised Patient

Computed tomography versus ultrasonography in the evaluation of periumbilical abdominal pain

Background: The objective of this study was to study, assess, and make early diagnosis of periumbilical pain abdomen accurately. Aims and Objectives: To study, assess, and diagnose causes of periumbilical abdominal pain accurately so as to minimize the unnecessary exploratory laparotomy and operations and consequently improved patient care and to compare the role of ultrasonography (USG) and computed tomography (CT) in the evaluation of various causes of periumbilical abdominal pain. Materials and Methods: This prospective study (CTRI/2023/01/048809) was done on 315 patients with periumbilical pain at M.L.B. Medical College Jhansi, Uttar Pradesh on PHILIPS 16 Slice multi-detector CT SCAN machine and GE Vivid T8 ultrasound machine. These patients were blindly and randomly divided by chit system into two groups irrespective of their age and gender. The first group of patients which included 160 patients undergoes ultrasonographic evaluation and the other group of patients which includes 155 patients undergoes contrast-enhanced computed tomographic evaluation. Results: Among 315 patients, the most common cause of periumbilical pain was found to be appendicitis followed by bowel pathologies which include gastrointestinal tuberculosis. Conclusion: USG is the initial modality and modality of choice in female and young (3rd and 4thdecade) patients presenting with periumbilical pain as it is diagnostic in gynecological causes of periumbilical pain and also minimizes unnecessary radiation exposure to female and young patients. Contrast-enhanced CT is the modality of choice in male and old age patients (5th and 6th decade) as it is diagnostic in vascular causes. Overall plain CT has limited role.

The diagnostic challenge of gastrointestinal tuberculosis mimicking colon cancer: A case report

Gastrointestinal tuberculosis (TB) accounts for 3.5% of extrapulmonary TB cases and is associated with active or inactive pulmonary TB in 76% of cases. A 53-year-old lady with no prior history of morbidity visited our hospital's department with weakness, an inability to eat, a 39°C fever, no chills, and night sweats that had been present for about six months. Additionally, a colonoscopy revealed a mamelonated mass of a stenotic character in the ascending colon, along with minor mesenteric adenitis, on computed tomography scans of the abdomen and pelvis. The obtained specimen's histological analysis revealed histiocytes and a few large cells producing granulomas without neoplastic features. The colonic biopsy's Löwenstein-Jensen medium culture revealed development of the Mycobacterium TB complex. After receiving therapy for two months with rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by four months with rifampicin and isoniazid, the patient had significantly improved. The current case serves as an example of the difficulty in diagnosing GI TB. The lack of symptoms and occasionally false-positive imaging results reinforce the necessity for increased clinical suspicion.

Intraspinal and Intracranial Neurotuberculosis, Clinical and Imaging Characteristics and Outcomes in Hospitalized Patients: A Cohort Study (2000-2022).

Neurotuberculosis (neuroTB) is a devastating disease, and is difficult to diagnose. The aim of this study was to analyze the clinical and imaging characteristics, and outcomes of a retrospective cohort (2000-2022) of hospitalized patients diagnosed with intraspinal and intracranial neuroTB. This work was designed through clinical, laboratory and imaging findings. Variables included: demographic data, history of tuberculosis, neurological complications, comorbidities and outcomes. Morbi-mortality risk factors were identified by univariate analysis. The cohort included: 103 patients with intraspinal and 82 with intracranial neuroTB. During the study period, in-hospital mortality of 3% for intraspinal and 29.6% for intracranial neuroTB was estimated. Motor deficit was found in all patients with intraspinal neuroTB. Risk factors for the unfavorable outcome of patients with intraspinal neuroTB were: age ≥ 40 years, diabetes mellitus (DM), diagnostic delay, kyphosis and spondylodiscitis ≥ 3 levels of involvement. Among the patients with intracranial neuroTB, 79/82 (96.3%) had meningitis and 22 patients had HIV infection (10 of them died). Risk factors for mortality from intracranial neuroTB were: HIV infection, hydrocephalus, stroke, lymphopenia and disseminated and gastrointestinal TB. Patients with intraspinal neuroTB had a significant number of destroyed vertebrae that determined their neurological deficit status. The mortality burden in intracranial neuroTB was conditioned by HIV infection and renal transplantation patients.

Physical Medicine and Rehabilitation Management in Patient with Loculated Empyema, Pleural Effusion et causa Chylothorax on WSD, Gastrointestinal Tuberculosis and History of Drop-Out Pulmonary Tuberculosis: A Case Report

Introduction: Tuberculosis (TB) is a lung disease caused by Mycobacterium tuberculosis (MTB), known for its high morbidity and mortality rate. When it infects organs outside the lungs, the condition is called extrapulmonary TB.&#x0D; Case report: A 52-year-old man who came to dr. Cipto Mangunkusumo hospital with worsening abdominal pain since a month ago. During the physical examination, tenderness in the right lower quadrant of the abdomen was felt. Furthermore, blood work showed leukocytosis and thrombocytosis. An X-ray examination revealed loculated pleural effusions. A WSD was placed, and pleural fluid analysis resulted in chylus. Sputum smears were negative. An abdominal CT scan revealed irregular thickening of the caecum wall extending to part of the large intestine and multiple surrounding lymphadenopathies. The patient was diagnosed with gastrointestinal TB and received category 1 anti-TB drugs.&#x0D; Conclusion: The patient also underwent pulmonary rehabilitation and had improvements at the end of the hospitalization period.&#x0D; Keywords: Extrapulmonary TB, Gastrointestinal TB, Loculated empyema, Pulmonary rehabilitation.

Tuberculosis revisted: classic imaging findings in childhood

Tuberculosis (TB) remains one of the major public health threats worldwide, despite improved diagnostic and therapeutic methods. Tuberculosis is one of the main causes of infectious disease in the chest and is associated with substantial morbidity and mortality in paediatric populations, particularly in low- and middle-income countries. Due to the difficulty in obtaining microbiological confirmation of pulmonary TB in children, diagnosis often relies on a combination of clinical and radiological findings. The early diagnosis of central nervous system TB is challenging with presumptive diagnosis heavily reliant on imaging. Brain infection can present as a diffuse exudative basal leptomeningitis or as localised disease (tuberculoma, abscess, cerebritis). Spinal TB may present as radiculomyelitis, spinal tuberculoma or abscess or epidural phlegmon. Musculoskeletal manifestation accounts for 10% of extrapulmonary presentations but is easily overlooked with its insidious clinical course and non-specific imaging findings. Common musculoskeletal manifestations of TB include spondylitis, arthritis and osteomyelitis, while tenosynovitis and bursitis are less common. Abdominal TB presents with a triad of pain, fever and weight loss. Abdominal TB may occur in various forms, as tuberculous lymphadenopathy or peritoneal, gastrointestinal or visceral TB. Chest radiographs should be performed, as approximately 15% to 25% of children with abdominal TB have concomitant pulmonary infection. Urogenital TB is rare in children. This article will review the classic radiological findings in childhood TB in each of the major systems in order of clinical prevalence, namely chest, central nervous system, spine, musculoskeletal, abdomen and genitourinary system.Graphical

Gastrointestinal tuberculosis: An autopsy-based study

BackgroundTuberculosis is a disease of great relevance since it is one of the leading causes of morbidity and mortality worldwide. Gastrointestinal tuberculosis is an unusual presentation. It is defined as the involvement of any segment of the digestive tract, associated viscera, and peritoneum. The study's main objective is to collect information from autopsies of patients diagnosed with gastrointestinal tuberculosis in a Pathology reference center in Colombia. MethodsThis is a retrospective and descriptive study of autopsy reports. A total of 4,500 autopsies were performed between January 2004 and December 2020. The inclusion criteria were authorization of a family member following local law regulations and a final autopsy diagnosis of gastrointestinal tuberculosis using microscopic visualization. ResultsForty-eight patients with gastrointestinal tuberculosis autopsies were included in our study. Most of the patients were male (n = 35, 72.9%) with a median age of 40.5 years old. Human immunodeficiency virus infection history was reported in 28 cases (58.33%). The most affected gastrointestinal tract site was the terminal ileum. Ulcers and thickened epithelium were common autopsies macroscopic findings. Tuberculosis multiorgan compromise was a relevant finding in patients with gastrointestinal tuberculosis. ConclusionsGastrointestinal tuberculosis is a disease of great importance, being its diagnosis a clinical challenge. Underdiagnosis can be reported in a high percentage of cases, so autopsy diagnosis can help reveal more accurate data about this condition.

Perfusion Computed Tomography May Help in Discriminating Gastrointestinal Tuberculosis and Crohn’s Disease

Gastrointestinal tuberculosis (GITB) and Crohn's disease (CD) are close mimics. This prospective study aimed to evaluate the diagnostic performance of perfusion computed tomography (CT) in differentiating GITB from CD. Consecutive patients with ileocaecal thickening underwent perfusion CT of the ileocaecal region between January 2019 and July 2020. Two radiologists (blinded to the final diagnosis) independently assessed blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability at perfusion CT. These parameters were compared among the patients with GITB as well as active and inactive CD. Receiver operating characteristic curves were utilized for determining the diagnostic performance of perfusion CT. Interclass correlation coefficient and Bland-Altman analysis were performed to compare the observations of the two radiologists. During the study period, 34 patients underwent perfusion CT. Eight patients had diagnoses other than intestinal tuberculosis or CD. Thus, 26 patients (mean age 36 ± 14 years, 18 males) with GITB (n = 11), active CD (n = 6), and inactive CD (n = 9) were evaluated. BF, MTT, and permeability showed significant differences among the groups, while BV did not differ significantly among the groups. BF and permeability had 100% sensitivity and 100% specificity, while MTT had 61.5-100% sensitivity and 70-100% specificity for differentiating GITB from active CD and active from inactive CD. The interclass correlation coefficient for perfusion CT parameters was 0.88-1. Perfusion CT is a novel imaging technique that can improve the diagnostic performance of differentiating tuberculosis from CD.