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Acute tuberculous perforation of the small bowel during antituberculosis therapy.

An acute, free perforation of a tuberculous ileal lesion occurred in a 25-year-old man during antituberculous therapy. The increasing incidence of extrapulmonary tuberculosis and the rarity of some of the related symptoms and complications, as presented by this patient, emphasize the importance of an early diagnosis. This case report also points out the importance of obtaining endoscopic biopsy material for bacterial culture, even if an apparently normal mucosa is seen, for the diagnosis of tuberculous intestinal disease.

Acute Disease↗

Impact of human immunodeficiency virus infection on abdominal tuberculosis in western India.

We studied the seroprevalence of human immunodeficiency virus infection in patients with pulmonary tuberculosis and abdominal tuberculosis. We also assessed the clinical characteristics, risk factors, tuberculin status, site, and response to therapy of abdominal tuberculosis in human immunodeficiency virus (HIV)-seropositive and HIV-seronegative patients. Volunteer blood donors (n = 8,395), patients with pulmonary tuberculosis (n = 387), and patients with abdominal tuberculosis (n = 108) were screened for HIV 1 and/or HIV 2 by enzyme-linked immunosorbent assay (ELISA; Torrent, India) and positivity reconfirmed by a repeat ELISA and Western blot test. The HIV seroprevalence in the abdominal tuberculosis patients (16.6%) was significantly higher compared with those with pulmonary tuberculosis (6.9%, p < 0.05) and volunteer blood donors (1.4%, p < 0.01). Absolute lymphocyte counts did not differ between the HIV-seropositive and HIV-seronegative patients (2,044.94 +/- 830 vs 2,261.34 +/- 805/mm3, p = NS). The Mantoux reaction was larger in the HIV-seronegative group as compared with the HIV-seropositive group (14.8 mm vs. 9.5 mm, p < 0.05). Tuberculosis patients responded well to conventional antituberculosis drugs in standard doses regardless of their HIV status.

AIDS-Related Opportunistic Infections↗

Inflammatory bowel disease in Saudi Arabia: presentation and initial management.

Non-specific Inflammatory Bowel disease (IBD) is infrequently seen in the Arabs of the Arabian Peninsula. This paper documents the presentation and initial management of 101 such Arabs treated for inflammatory bowel disease between 1976 and 1994. Medical records were examined and patients were classified according to the Organisation Mondiale de Gastroenterologie diagnostic scoring system. Sixty-seven patients had mucosal ulcerative colitis, 28 Crohn's disease (CD) and six indeterminate colitis; age range 2-71 years. Three patients had a family history of (IBD). The diagnosis was made by a combination of the patients' history, physical, radiological, endoscopic and histological examination; however, eight patients were not examined endoscopically and one in four patients was not biopsied at presentation. Thirty-nine patients did not receive any treatment prior to referral. One in three patients was first treated as inpatients. Giardia, Amoeba, Salmonella, Shigella or Schistosoma were detected in the stools of 36 patients at presentation. Following appropriate treatment, these infections were eliminated but the patients' symptoms persisted. Six patients who were thought to have gastrointestinal tuberculosis were subsequently diagnosed with CD. Ten patients had extraintestinal manifestations of their IBD and 11 had side effects (osteoporosis, Cushingoid features and growth retardation) from steroid treatment at other hospitals. Diagnosis was often delayed because infectious diarrhoea was common and awareness was low. Patients were referred late and some had developed complications of therapy.

Adolescent↗

Tuberculous peritonitis developing during chemotherapy for pulmonary and intestinal tuberculosis: a case report.

This report is of a case of tuberculous peritonitis that developed during antituberculous chemotherapy. A 54-year-old man had been diagnosed as all-drug susceptible pulmonary and intestinal tuberculosis, and treatment with isoniazid, ethambutol and rifampicin had been initiated. About 5 months later, while still undergoing therapy, a large amount of ascites developed. A diagnostic laparoscopy was performed but due to the adhesion between the greater omentum and the parietal peritoneum, intestinal perforation occurred. An emergency operation was performed and the diagnosis of tuberculous peritonitis was confirmed. There are few reports of abdominal tuberculosis developing during antituberculous chemotherapy. In this case a paradoxical response may have been involved in the pathogenesis.

Antibiotics, Antitubercular↗

Laparoscopic diagnosis of abdominal tuberculosis.

Abdominal tuberculosis (TB) is an uncommon condition in Western societies although Europe and America have noted an increase of this condition in immigrants and AIDS patients. This report documents three diagnosed cases of abdominal TB over a 12-month period in a Melbourne western suburbs teaching hospital which services a large migrant population. We also review the literature on this condition. If migrants present with diffuse abdominal symptoms, the diagnosis of abdominal tuberculosis should always be considered. Laparoscopy should replace diagnostic laparotomy as the definitive diagnostic tool.

Adult↗

[A child case of Down's syndrome with intestinal tuberculosis and tuberculous pleuritis].

A 13 year-old girl with Down's syndrome was admitted to our hospital with a very positive reaction to PPD 5TU, abnormal shadow on the chest X-ray films and diarrhea. She suffered from acute enterocolitis one year ago, and then has been complaining of abdominal pain, appetite loss, and weight loss for a year. After admission, she was diagnosed as tuberculous pleuritis and suspected intestinal tuberculosis by laboratory examination. She recovered without sequelae by the combination therapy of SM, INH, and RFP, and was discharged after 5 months. The diagnosis of intestinal tuberculosis was confirmed by Colon Fiberscopy showing ulceration at the ileocecal region and simultaneous biopsy showing granuloma. Surgical treatment was not reserved, because she had no complications namely perforation and fistulization. We estimated that the onset of intestinal tuberculosis coincided with the acute enterocolitis which she had about one year ago. We realized the importance of paying attention to intestinal tuberculosis in the differential diagnosis of enterocolitis, especially regional enteritis. Furthermore, in the therapy of the immunocompromised host including Down's syndrome, we must pay attention to extra-pulmonary tuberculosis. Efficiency of SM for intestinal tuberculosis with complications was confirmed.

Adolescent↗

Humoral immune response in human tuberculosis: immunoglobulins G, A, and M directed against the purified P32 protein antigen of Mycobacterium bovis bacillus Calmette-Guérin.

The P32 protein antigen of Mycobacterium bovis BCG, identified as antigen 85A in the BCG reference system, was used to investigate the humoral immune response in human tuberculosis (TB). Immunoglobulin G (IgG), IgA, and IgM directed against P32 were measured by an enzyme-linked immunosorbent assay. Mean IgG and IgA antibody levels differed significantly (P less than 0.001) between active-TB patients (50 untreated and 52 treated) and healthy control subjects (111 unvaccinated tuberculin negative, 38 unvaccinated tuberculin positive, and 72 recently BCG vaccinated). Mean IgG antibody levels, but not mean IgA antibody levels, were higher (P less than 0.05) in patients with positive microscopic examination for acid-fast bacilli than in patients with negative microscopic examination. A positive relation was found between mean levels and the extent of disease. There was no difference in mean IgM antibody levels between patients and controls. By setting the upper normal limit at the 95th percentile of the 221 healthy subjects, the sensitivities were 46% in untreated and 63% in treated patients for IgG and 30 and 50%, respectively, for IgA. Of the untreated patients, 56% were positive for either IgG or IgA antibodies. Among the untreated patients with negative direct smear, 35% were positive for IgG and 24% were positive for IgA. When both immunoglobulin classes were combined, the serological test was positive in 47% of those patients. Neither naturally acquired tuberculin hypersensitivity nor BCG vaccination affected positivity frequencies in healthy subjects. Only active TB seemed to induce significant anti-P32 antibody levels and to be associated with positivity. A serological test with P32 as the antigen might therefore be helpful for the rapid diagnosis of TB.

Adolescent↗

PCR amplification of the IS6110 insertion element of Mycobacterium tuberculosis in fecal samples from patients with intestinal tuberculosis.

PCR amplification of insertion element IS6110 of Mycobacterium tuberculosis in fecal samples was evaluated in the diagnosis of intestinal tuberculosis (ITB). The numbers of samples that tested positive by PCR with SalI digestion were 16/18 untreated-ITB samples, 0/8 treated-ITB samples, 12/14 smear-positive pulmonary tuberculosis samples, and 0/30 control samples. The sensitivity, specificity, positive predictive value, and negative predictive value of fecal PCR were 88.8%, 100%, 100%, and 93.7%, respectively.

Base Sequence↗

Malabsorption and subtotal villous atrophy secondary to pulmonary and intestinal tuberculosis.

A case of malabsorption and subtotal villous atrophy secondary to pulmonary and intestinal tuberculosis is reported. The patient was a 21-year-old Chinese girl who had active pulmonary tuberculosis, malabsorption, subtotal villous atrophy, atrophic gastritis with hypochlorhydria, ileal stricture, and a severe non-specific anaemia. There was also evidence to suggest protein-losing enteropathy. The association of subtotal villous atrophy and atrophic gastritis with tuberculosis is discussed. When antituberuclous therapy was instituted, improvement was marked not only clinically but also in the tests for intestinal absorption and in the jejunal mucosa.

Adult↗

Tuberculous ileo-colitis in Ibadan: a clinicoradiological review.

Twenty cases of tuberculous ileo-colitis with radiographic changes seen in the University College Hospital, Ibadan, Nigeria, are reviewed and the clinical features and radiographic patterns examined. The intestinal lesions in all cases were secondary to healed and active pulmonary tuberculosis. Although the ileo-caecal region is the commonest site of involvement, lesions also occurred in the distal part of the colon and the entire colon was sometimes involved. Rare occurrences, such as the diverticular type, enterolithiasis, tuberculosis presenting as intussusception and as an appendicular mass, are also reported. Four principal radiological types of colonic change emerged from the study, namely, the hyperplastic, the ulcerative, the mixed ulcero-hyperplastic, and the carcinoma-like types. The salient features in the differential diagnosis of ileo-colonic lesions in a tropical setting are discussed.

Adolescent↗