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The epidemic of acquired immunodeficiency syndrome has caused a worldwide resurgence of tuberculosis. A case of acute tuberculosis with anorectal involvement presenting at an urban American hospital is discussed. Although anorectal involvement by tuberculosis is not uncommon, the diagnosis is usually initially missed.
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The recent literature on abdominal tuberculosis is comprehensively reviewed, and seven cases of abdominal tuberculosis are reported, including four belonging to three generations of the same family. Possible explanations for this familial incidence are discussed. Abdominal tuberculosis is not so rare; 135 cases have recently been reported from the United States and Canada. This review dissipates four common misconceptions: abdominal tuberculosis is rare, tuberculosis is a stigmata of the poor, abdominal tuberculosis is always associated with active pulmonary tuberculosis, and chronic abdominal pathology is synonymous with regional enteritis. Since the description of regional enteritis, more and more cases of chronic intestinal pathology have been labeled "regional enteritis." The fact that intestinal tuberculosis is rather uncommon should not automatically lead to the diagnosis of regional enteritis. The possibility that many cases of so-called regional enteritis may, in fact, be a stage or a variant of abdominal tuberculosis, is worth considering. Abdominal tuberculosis is not a relic of the past. It remains a real challenge to the diagnostic acumen and therapeutic skills of both the internist and the surgeon.
The advent of CT and MRI imaging in the last two decades has redefined the approach and analysis of various diseases including tuberculosis. Tuberculosis afflicts hollow and solid viscera. Genitourinary, hepatobiliary and adrenal tuberculosis is uncommon in children. CT and MRI have however shown several advantages over conventional radiology and other imaging modalities in early diagnosis and follow-up of tuberculosis in different parts of the body.
Twenty-seven cases of patients with intestinal tuberculosis were reported. Seventeen cases showed good response to antituberculosis chemotherapy. The numbers and size of ulceration, pseudopolyp and deformity of intestinal tract were checked by endoscopic and X-ray studies on comparative evaluation between prechemotherapeutic and postchemotherapeutic stage. In these cases, subjective symptoms were disappeared parallel with the marked improvement on X-ray and endoscopic findings. These data suggest that with current well planned antituberculosis chemotherapy program, tuberculous colitis is controlled fairly while tuberculous enteritis in controlled inadequately. Therefore, surgical procedures are commly indicated to the treatment of tuberculous enteritis.
BACKGROUND: Gut tuberculosis appears to be a rare diagnosis in Central Europe. The main diagnostic method is endoscopy with biopsy in order to win histology and a culture. By means of endoscopy the differential diagnosis to Crohn's disease is sometimes difficult. Computertomography and/or ultrasound can facilitate the diagnosis of gut tuberculosis. CASE REPORT: A 64-year-old woman presented in our hospital with cervical lymph nodes and ulcerations in the cecum and near the ileocecal valve. Major symptoms were abdominal pain, loss of weight, diarrhea and febrile temperature. Histology and culture revealed tuberculosis. The common antituberculotic therapy had to be stopped due to severe allergic reaction. After desensitization the patient could be treated successfully with a triple antituberculotic therapy without further complication. CONCLUSION: Beside the early treatment with tuberculotic drugs it is very important to consider the differentiation of a gut tuberculosis.
BACKGROUND: The last decade has seen a resurgence in the incidence and clinical presentation of tuberculosis (TB). Little data exist in the paediatric age group regarding abdominal tuberculosis (ATB) and limited reports of its CT features have been published. PURPOSE: To elucidate the CT features of ATB in children. MATERIALS AND METHODS: The medical records of 22 patients with ATB were reviewed. Data were extracted regarding the methods of diagnosis and HIV status. The plain chest films were examined and the CT scans were assessed for adenopathy, solid organ involvement, ascites, bowel wall and omental thickening and inflammatory masses. RESULTS: Ten patients had biopsy-proven ATB, 11 had extra-abdominal TB with clinical suspicion of ATB and 1 had a positive trial of therapy. Five patients were tested for HIV and one tested positive. Thirteen patients had abnormal chest radiographs. The commonest CT finding was lymphadenopathy ( n=17), followed by solid organ involvement ( n=12), ascites ( n=5), bowel wall thickening ( n=5), inflammatory masses ( n=2) and omental thickening ( n=1). CONCLUSIONS: The clinical features of ATB are protean. This usually results in a delay in diagnosis and impacts negatively on patient morbidity and mortality. On CT, the constellation of findings is highly suggestive of the diagnosis of ATB and, used in conjunction with clinical and laboratory data, should narrow the differential considerably. Unique findings include histologically proven active TB in calcified lymph nodes and a pancreatic TB granuloma.
BACKGROUND: The present study was done to emphasize the importance of ultrasound (US) and US-guided fine-needle aspiration biopsy (FNAB) in the diagnosis of abdominal tuberculosis. METHODS: Sixty-six proven cases of abdominal tuberculosis were selected for this study. The diagnosis was based on clinical features, US observations, FNAB, operative findings, and responses to appropriate antitubercular treatment. The US findings were interpreted with regard to the involvement of lymph nodes, intestine, peritoneum, solid viscera, and abdominal abscesses. Patients with disease limited to the musculoskeletal and genitourinary systems were not included in the study. RESULTS: Peritoneal tuberculosis was the most common form, of the "wet" ascitic type. Ascites was clear in 19 patients and complex in 17. Tuberculous lymphadenopathy was seen in 37 patients. There was a predilection of periportal, peripancreatic, and mesenteric locations compared with the degree of retroperitoneal involvement. Calcification and heterogeneous echotexture were seen in seven cases. FNAB confirmed the diagnosis of tubercular lymphadenopathy in 19 patients. Intestinal disease was seen in 14 patients. Hepatic or splenic involvement was seen as diffuse organomegaly; less commonly, focal lesions were seen. CONCLUSION: This combination of US findings in proper clinical settings are diagnostic of tuberculosis. FNAB confirms the diagnosis in lymphadenopathy, abscesses, and focal lesions of the viscera.
BACKGROUND: We evaluated the efficacy of abdominal ultrasound (US) and fine-needle aspiration biopsy (FNAB) in the diagnosis of disseminated mycobacteriosis (DM) in acquired immunodeficiency syndrome (AIDS). METHODS: Twelve AIDS patients (nine male, three female; age range, 22-43 years) with DM underwent abdominal US within 2 days after admission with 3.5- to 5-MHz convex probes and a 7.5-MHz linear probe. All patients underwent FNAB of one or two enlarged abdominal lymph nodes. Eight patients underwent FNAB of the spleen. The aspirated specimens were stained with acid fast for quick examination and cultured for isolation of mycobacteria. RESULTS: Abdominal US showed enlarged, hypoechoic, round or oval, abdominal lymph nodes (diameter, 10-35 mm; mean, 18 mm) in all patients; splenomegaly (spleen diameter, 14-22 cm; mean, 16.8 mm) in all patients; numerous splenic abscesses (diameter, 3-20 mm) in nine patients; hepatomegaly (right hepatic lobe thickness, 14.5-17 cm) in all patients; small intestinal wall thickening in five patients (maximum bowel wall thickness, 7-15 mm); mild to moderate ascites in six patients; pleural effusion in four patients; bilateral enlargement of the kidneys with hyperechogenicity of the cortex in three patients; and a retroperitoneal tubercular abscess in one patient. No complication occurred after FNAB of lymph nodes and spleens. Fast-acid stain of spleen and/or lymph node FNAB specimens allowed early diagnosis of mycobacteriosis in 12 of 12 cases (100%). Cultures of lymph node aspirates grew mycobacteria in six of 12 patients (50%). Spleen aspirates grew mycobacteria in nine of nine patients (100%). Blood cultures were positive in four of 12 patients (33%). Mycobacterium tuberculosis was diagnosed in six patients and M. avium in five. CONCLUSION: Abdominal US features can suggest DM in AIDS patients. Spleen and/or lymph node FNAB indicated the specific diagnosis in 100% of patients.
CASE REPORT: We report on the clinical course of a 40-year-old patient with an oral manifestation of miliary tuberculosis. In addition to oral mucosa and lung, the colon and ileum were also infested. The oral lesions may resemble malignant tumors and are difficult to diagnose, especially because tuberculosis has become a rare disease in industrialized countries. DISCUSSION: Oral lesions and concomitant pulmonary complaints can be a sign for existing tuberculosis. Patients with these problems should undergo a chest X-ray and a biopsy from the oral mucosa. In addition, tests should be conducted to determine if mycobacteria are present in the sputum, gastric fluid, and urine and cultures grown. In cases with negative results PCR may detect DNA of Mycobacterium tuberculosis.
A 69-year-old female was admitted to our hospital because of asthenia, anorexia and 20 kg weight loss. An ultrasound study and computerized tomography (CT) imaging revealed a mesenteric mass and laparotomy was performed. The diagnosis was mesenteric tuberculosis with jejunal involvement. This represents an atypical onset of tuberculosis in a non-immunosuppressed patient.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Concentrations of isoniazid and rifampicin were determined in time-matched samples of saliva and serum from 30 tuberculous patients (18 with pulmonary tuberculosis and 12 with intestinal tuberculosis), comprising 18 slow and 12 rapid acetylators of isoniazid, following administration of isoniazid 300 mg and rifampicin 12 mg/kg. The diffusion of isoniazid into saliva was quite rapid and the salivary concentrations were similar to those in serum, suggesting that saliva could be used in place of serum for all pharmacokinetic studies with isoniazid. The salivary concentrations of rifampicin were much lower than those in serum, the mean peak concentrations being 0.9 and 8.5 microgram/ml, respectively. Further, there was evidence of a significant delay in the diffusion of rifampicin from serum to saliva.
LEARNING OBJECTIVES: Radiological findings of abdominal tuberculosis can mimic those of many different diseases. A high level of suspicion is required, especially in high-risk population. In this article, we will describe barium studies, ultrasound (US) and computed tomography (CT) findings of abdominal tuberculosis (TB), with emphasis in the latest. We will illustrate CT findings that can help in the diagnosis of abdominal tuberculosis and describe imaging features that differentiate it from other inflammatory and neoplastic diseases, particularly lymphoma and Crohn's disease. As tuberculosis can affect any organ in the abdomen, emphasis is placed to ileocecal involvement, lymphadenopathy, peritonitis and solid organ disease (liver, spleen and pancreas). A positive culture or hystologic analysis of biopsy is still required in many patients for definitive diagnosis.
A review of the discharge diagnoses and mycobacterial cultures of patients admitted to a major New York City hospital over an 18-month period revealed 21 patients with abdominal mycobacterial infections (17 male, 4 female) with an average age of 36 years. Acquired immunodeficiency syndrome (AIDS) or an identifiable AIDS risk was present in 14. The disease was manifest by peritoneal (eight patients), ileocecal (seven), and hepatic involvement (three), and psoas abscess (three). Diffuse abdominal pain was the most frequent presenting symptom. However, absence of pain (19 percent) and lack of abdominal findings (28 percent) were not uncommon. The erythrocyte sedimentation rate was significantly elevated (mean 72 mm/hour), whereas the white blood cell count was normal in 18 patients. Computed tomography findings were abnormal in all patients studied and suggested mycobacterial infection in 67 percent. Ten patients (48 percent) required surgery. Although there were no individual differences in clinical or laboratory presentation between the operative and nonoperative patient groups, more patients with pain and higher fever were operated upon. There was one postoperative death. The overall mortality rate was 24 percent, and the mean survival and follow-up 10.2 months and 12.2 months, respectively.