Primary Intestinal Tuberculosis Research Articles

Spectrum of abdominal tuberculosis presenting as acute surgical emergency: Relevance in 21st century, a case series

BackgroundAbdominal tuberculosis presenting as acute surgical emergency continues to be a major issue in developing countries including India. Being an indolent disease with varied presentation, there is a need to describe the epidemiology, clinicopathological nature of the disease. Hence, this series was conducted with the aim of describing our institutional experience in the management of abdominal tuberculosis presenting as acute surgical emergency, outlining the epidemiology, management aspects and the analysis of risk factors for poor outcome in our population. MethodsThis was a descriptive series of patients operated for abdominal tuberculosis presenting as acute surgical emergency at a tertiary care hospital in Eastern India from January 2021 to January 2022. All consecutive patients presenting with intestinal obstruction or peritonitis who underwent laparotomy with intra operative and histopathological finding suggestive of tuberculosis were taken for the study. ResultsA total of 30 patients with acute abdominal tuberculosis were included in the study. 56.7% of patients were males; the mean age of presentation was 43 years with majority of patients in the younger to middle age groups. Most (80%) patients were from rural areas with limited access to healthcare. One patient had co-infection with HIV. Five patients had diabetes and six patients had hypertension as co-morbidities. 73.3% of patients had primary intestinal tuberculosis. Majority (76.7%) presented with acute intestinal obstruction. All patients had colicky abdominal pain as a consistent feature. 40% of patients were anaemic and 70% had low serum albumin levels. The most common site of affection was Ileo-cecal region (73.3%) with stricture as the pathology. Segmental resection with end to end anastomosis was the most common procedure performed (46.7%). 26.7% of patients had an adverse post operative complication, and 23.3% had surgical site infection (SSI). The mortality rate in our series was 6.7%. Although coexisting SSI, co-morbidities were associated with increased mortality, it was not found to be statistically significant (p = 0.08). 16 patients were lost to follow up. ConclusionAbdominal tuberculosis presenting as acute abdomen continues to challenge surgeons even in the 21st century. Majority in the developing countries present late with varied complications. A high index of clinical suspicion is required for timely diagnosis to reduce the mortality and morbidity of the disease.

A rare complication of the great mimicker: free tubercular ileal perforation

Primary intestinal tuberculosis is an uncommon form of extra-pulmonary tuberculosis. With non-specific manifestations, unusual presentations and no proven superior diagnostic modality, differentiation and diagnosis of abdominal tuberculosis is a difficult scenario. Undiagnosed, untreated cases may present with complications. Free perforation of small bowel due to tuberculosis is a rare complication (1-2%) because of adhesion formation and reactive peritoneal thickening; however, when it occurs is most feared for its association with high mortality. We report a case of an elderly male who presented with features of intestinal perforation, treated with emergency surgery and diversion ostomy for small bowel perforation which was diagnosed post-operatively to be of tubercular etiology. Acute care surgeons may be trapped in diagnosing such cases with its non-specific imaging findings, and hence must maintain a low threshold for surgical intervention in the emergency setting.

Diagnostic classification of endosonography for differentiating colorectal ulcerative diseases: A new statistical method.

AIMTo establish a classification method for differential diagnosis of colorectal ulcerative diseases, especially Crohn’s disease (CD), primary intestinal lymphoma (PIL) and intestinal tuberculosis (ITB).METHODSWe searched the in-patient medical record database for confirmed cases of CD, PIL and ITB from 2008 to 2015 at our center, collected data on endoscopic ultrasound (EUS) from randomly-chosen patients who formed the training set, conducted univariate logistic regression analysis to summarize EUS features of CD, PIL and ITB, and created a diagnostic classification method. All cases found to have colorectal ulcers using EUS were obtained from the endoscopy database and formed the test set. We then removed the cases which were easily diagnosed, and the remaining cases formed the perplexing test set. We re-diagnosed the cases in the three sets using the classification method, determined EUS diagnostic accuracies, and adjusted the classification accordingly. Finally, the re-diagnosing and accuracy-calculating steps were repeated.RESULTSIn total, 272 CD, 60 PIL and 39 ITB cases were diagnosed from 2008 to 2015 based on the in-patient database, and 200 CD, 30 PIL and 20 ITB cases were randomly chosen to form the training set. The EUS features were summarized as follows: CD: Thickened submucosa with a slightly high echo level and visible layer; PIL: Absent layer and diffuse hypoechoic mass; and ITB: Thickened mucosa with a high or slightly high echo level and visible layer. The test set consisted of 77 CD, 30 PIL, 23 ITB and 140 cases of other diseases obtained from the endoscopy database. Seventy-four cases were excluded to form the perplexing test set. After adjustment of the classification, EUS diagnostic accuracies for CD, PIL and ITB were 83.6% (209/250), 97.2% (243/250) and 85.6% (214/250) in the training set, were 89.3% (241/270), 97.8% (264/270) and 84.1% (227/270) in the test set, and were 86.7% (170/196), 98.0% (192/196) and 85.2% (167/196) in the perplexing set, respectively.CONCLUSIONThe EUS features of CD, PIL and ITB are different. The diagnostic classification method is reliable in the differential diagnosis of colorectal ulcerative diseases.

Free Perforation of Ileal Tubercular Ulcer- A Case Report and Literature Review

Primary intestinal tuberculosis is unusual in North American, European and Caribbean countries. Its diagnosis is often surprising and differentiation from inflammatory bowel diseases is difficult. Intestinal perforation is an uncommon but potentially fatal complication of intestinal tuberculosis. There is no reported case of ileal tubercular ulcer perforation from the Caribbean. We present a 59 year old HIV negative patient presented with peritonitis with solitary perforation of terminal ileum. Histology revealed presence of Langerhan’s cell with caseating granulomatous inflammation and culture grew acid fast bacilli. A subsequent Manteaux test was strongly positive. There was no radiological evidence of pulmonary tuberculosis. Patient was started on anti-tubercular therapy and it is now over one year, the symptoms have not recurs back again.

Opportunistic infections in a renal transplant recipient

With the present progress in transplantation procedures, there is an improvement in patient and allograft survival. However, the immunosuppression necessary to sustain the allograft predisposes these transplant recipients to infection, which is now a significant cause of morbidity and mortality. We describe a case of a 30-year-old renal transplant recipient with two opportunistic infections, namely, primary cutaneous aspergillosis and intestinal tuberculosis, with terminal enterococcal pleuritis and peritonitis. Control of the degree of immunosuppression, and prompt recognition and treatment of infection are vital for successful organ transplantation.

Opportunistic infections in a renal transplant recipient

With the present progress in transplantation procedures, there is an improvement in patient and allograft survival. However, the immunosuppression necessary to sustain the allograft predisposes these transplant recipients to infection, which is now a significant cause of morbidity and mortality. We describe a case of a 30-year-old renal transplant recipient with two opportunistic infections, namely, primary cutaneous aspergillosis and intestinal tuberculosis, with terminal enterococcal pleuritis and peritonitis. Control of the degree of immunosuppression, and prompt recognition and treatment of infection are vital for successful organ transplantation.

Intestinal/Peritoneal Tuberculosis in Children: An Analysis of Autopsy Cases

Infection by Mycobacterium bovis is not infrequently identified in Mexico. Its relation to nonpasteurized milk products ingestion is well recognized with primary infection usually in the intestinal tract. The term “abdominal tuberculosis” includes peritoneal as well as primary and secondary intestinal tuberculosis. The clinical differentiation of these conditions is difficult. In this work, we reviewed the clinical and pathological features of 24 cases of children dying with tuberculosis in whom autopsy revealed abdominal disease in a referral hospital in Mexico City. We identified 8 cases of primary intestinal tuberculosis, with documentation of M. bovis in 6 of them, and 9 cases of secondary intestinal tuberculosis (primary pulmonary disease), all negative to M. bovis. Seven patients had peritoneal tuberculosis without intestinal lesions and with active pulmonary disease in 4 of them, and of the remaining three, two had mesenteric lymph node involvement suggesting healed intestinal disease. In this approach to abdominal tuberculosis, postmortem analysis was able to differentiate primary from secondary intestinal tuberculosis and to define the nature of peritoneal involvement. This discrimination gives rise to different diagnostic approaches and epidemiological and preventive actions, particularly in countries where tuberculosis is endemic and infection by M. bovis continues to be identified.

Cecal obstruction due to primary intestinal tuberculosis: a case series

IntroductionPrimary intestinal tuberculosis is a rare variant of tuberculosis. The preferred treatment is usually pharmaceutical, but surgery may be required for complicated cases.Case presentationWe report two cases of primary intestinal tuberculosis where the initial diagnosis was wrong, with colonic cancer suggested in the first case and a Crohn's disease complication in the second. Both of our patients were Caucasians of Greek nationality. In the first case (a 60-year-old man), a right hemicolectomy was performed. In the second case (a 26-year-old man), excision was impossible due to the local conditions and peritoneal implantations. Histopathology revealed an inflammatory mass of tuberculous origin in the first case. In the second, cell culture and polymerase chain reaction tests revealed Mycobacterium tuberculosis. Both patients were given anti-tuberculosis therapy and their post-operative follow-up was uneventful.ConclusionsGastrointestinal tuberculosis still appears sporadically and should be considered in the differential diagnosis along with other conditions of the bowel. The use of immunosuppressants and new pharmaceutical agents can change the prevalence of tuberculosis.

Primary Intestinal Tuberculosis Presenting as Crohn's Disease

17 y.o. female, who had undergone a laparoscopic appendectomy two weeks prior to presenting with RLQ pain, weight loss, fevers and hematochezia. Pathology from the appendectomy was significant for multiple granulomas. Fungal and AFB stains were negative. An UGI with SBFT revealed 8 cm of abnormal terminal ileum, consistent with Crohn's disease. She was not evaluated endoscopically because of the recent appendectomy but was started on oral steroids and mesalamine. She clinically improved and underwent an EGD and colonoscopy six weeks later revealing Helicobacter pylori gastritis and mild inflammatory changes in the rectum and cecum. She was then lost to follow up for several months until she came into the ER with hematochezia, anemia, fever, and weight loss. CT scan of the abdomen and pelvis revealed thickening of the terminal ileum and cecum with some free fluid in the pelvis, her stool studies were negative. She was transfused with PRBCs and started on IV steroids, after a week without improvement she was given a dose of Infliximab with good clinical response. She was discharged home on a tapering dose of prednisone and sulfasalazine. She did well for several weeks until her return to the ER with similar symptoms. A repeat CT scan revealed mesenteric lymphadenopathy without any other new findings. She then underwent a repeat colonoscopy with gross evidence of ileitis, colitis and pseudo polyp formation. Biopsies revealed acute and chronic colitis with granuloma formation. A PPD placed prior to restarting steroids was negative. She was then started on a two week course of IV steroids and broad spectrum antibiotics without clinical improvement. A second dose of Infliximab was given without response. Her poor clinical progression led to an exploratory laparotomy for an ileocecal resection followed by an uncomplicated post operative course. The resected specimen was reviewed by our pathologist, who thought this could be an infectious process. It was also reviewed by a GI pathologist, who felt the specimen represented either Wegener's granulomatosis or Crohn's disease with post Infliximab histologic changes. After 37 days, however, Mycobacterium tuberculosis DNA was found via PCR from a lymph node, and a lymph node culture grew Mycobacterium tuberculosis. This patient had no risk factors for tuberculosis and her chest radiographs were negative at the time. She was subsequently treated with anti-Tb medications, but because of noncompliance, disease progression was noted on serial chest films. Once compliant and after completion of therapy, all of her symptoms resolved.

TUBERCULOUS PERFORATION OF THE SMALL INTESTINE

Secondary intestinal tuberculosis is considered a complication of active pulmonary tuberculosis, whereas primary intestinal tuberculosis is defined as tuberculous enteritis without pulmonary infection. The incidence of intestinal tuberculosis has sharply declined since the advent of effective chemotherapy in Japan. These cases ofactive pulmonary tuberculosis which developed acute peritonitis secondary to perforations of tuberculous enteritis. Case 1: A 56-year-old man was referred from other hospital because of laryngeal and pulmonary tuberculosis. His past history included chemotherapy for pulmonary tuberculosis. He was treated with RFP, INH and streptomycin. His hospital course was unevenful until 12th day after chemotherapy, when he developed abdominal distention associated with shock. At surgery a perforation was found 100cm proximal to the duodenojejunal flexure. He died of cancer of the rectum 2 years after the operation. Case 2: A 39-year-old man was referred from another hospital because of pulmonary and intestinal tuberculosis. He developed lower abdominal pain associated with nausea and vomiting on the 11th day after chemotherapy. At operation a perforation was found 50cm distal to the ileocecal valve. Simple repair, appendectomy and drainage were performed. An appendix showed caseating granuromas. After surgery and chemotherapy he got well.

Primary intestinal tuberculosis in the Sudan.

The pathology and bacteriology of fatal primary intestinal tuberculosis are described. The disease occurred in adults and was characterized by massive abdominal lymphadenopathy with minimal lesions in the intestines. The liver and spleen were involved in the form of nodular caseous lesions. Clinically, hepatic lesions simulated malignant disease of the liver. In advanced cases, the histological changes consisted of massive caseation without inflammatory cellular reaction. In 22 out of 23 cases where a bacteriological examination was carried out, the causative organism was Mycobacterium tuberculosis. Possible explanations for this are presented.

Ileal Chloride Secretion as a Cause of Secretory Diarrhea in a Patient with Primary Intestinal Tuberculosis

Severe secretory diarrhea resulting in dehydration and hypokalemia was observed in a patient in whom primary cecal tuberculosis was diagnosed by colonoscopy. Although the ileum appeared normal at colonoscopy and by biopsy, intestinal perfusion studies showed that the ileum was secreting water and electrolytes. Chloride secretion against a high electrical gradient suggested active anion secretion. Absorption in the colon was unimpaired. The diarrhea resolved after 4 wk of antituberculous therapy. Repeat perfusion studies after 3 mo showed normal absorption in the ileum. This case report suggests that intestinal tuberculosis can cause secretory diarrhea. The mechanism by which secretion occurs is not clear, but probably involves active anion secretion.

Ileocecal tuberculosis with target cell anemia.

A case of ileocecal tuberculosis with the presenting feature a “target cell” anemia in a young colored female is recorded. Certain observations as to the etiology are noted and since the process was reversed by bowel resection, it is assumed that the intestinal tuberculosis was responsible for the so-called target cell anemia. The lesion was of the ulcero-hyperplastic variety and in the face of the negative chest x-ray would lead one to conclude that it is a case of primary intestinal tuberculosis, yet it is possible that the pulmonary lesion is so minute it was missed on a routine chest plate and that the different lesions are variants of one fundamental process, i.e. ulcerative, ulcero-hyperplastic and hyperplastic intestinal tuberculosis.

Observations on THE BOVINE TUBERCLE BACILLUS IN HUMAN TUBERCULOSIS

It is now thirty-one years since Robert Koch, at the London Congress on Tuberculosis, announced his con clusion that infection of human beings with bovine bacilJi was so rare that it was unnecessary to take special measures to prevent it. That statement, which was strongly contested, set in train investigations in many countries into the susceptibility of human beings to bovine tuberculosis, investigations which are still being carried ?n, and, in consequence of recent findings, with re newed energy and interest. It is appropriate in this, the fiftieth anniversary of Koch's discovery of the tubercle bacillus, to review the bacteriological work of the past thirty years to see where we stand in regard to this pressing and difficult matter of bovine tuberculosis. Koch's opinion that bovine tuberculosis was a negli gible factor in human tuberculosis was based, not on experi mental work with a large amount of human material, but chiefly on the alleged extreme rarity of primary intestinal tuberculosis in Germany. He argued in the first place that one can assume with certainty that a case of tuberculosis has been caused by alimenta only in those instances where there is evidence of primary infection of the intestines, and secondly, that if man is susceptible to the bovine type primary intestinal tuberculosis should be of common occurrence, in view of the abundant oppor tunities for the transference of bovine bacilli through consumption of milk. This argument overlooked the possibility that bovine bacilli can traverse the intestinal mucosa without leaving in that tissue any trace of their passage.

Primary Intestinal Tuberculosis in a Nursing Baby

Primary Intestinal Tuberculosis in a Nursing Baby

PROPHYLAXIS OF TUBERCULOSIS IN CHILDREN.

In order that we can intelligently apply the proper treatment for the prevention of the disease, an inquiry into the method of its propagation must be made. The postmortem examinations of hundreds of cases of tuberculosis show that it is a rarity to find primary intestinal tuberculosis. Heubner's results in a series of studies were as follows: Heubner argues that, as not one single case appeared in a series of 800 nurslings during the first three months, the disease was acquired and not transmitted by inheritance. Kuss proved anatomically that primary tuberculous lesions are most frequently found in the bronchial glands. This corresponds with inhalation tuberculosis in animal experiments; hence it must be presumed that the inhalation of the Bacillus tuberculosis may cause this infection. Infants are constantly exposed to infection when in the same room with adults affected with tuberculosis. Heubner describes a case of a child with sound

Primary Intestinal Tuberculosis in Children: Perforation of Ulcers

Primary Intestinal Tuberculosis in Children: Perforation of Ulcers