MyMedR

Cookson JS

Malayan Medical Journal, 1937;12:84-7.

Matched MeSH terms: Tuberculosis, Gastrointestinal

A case of concurrent gastrointestinal, peritoneal and urinary bladder tuberculosis

Ahmad MF, Mohamad N, Sapiai NA, Razali NA, Anuar AH

Indian J Tuberc, 2022 Oct;69(4):706-709.

PMID: 36460413 DOI: 10.1016/j.ijtb.2021.09.004

Tuberculosis is a top 10 leading cause of death worldwide. Lungs are primarily involved organs in tuberculosis. The rest of cases are extrapulmonary tuberculosis (14% reported in 2017). Extrapulmonary tuberculosis always presents with non-specific symptoms, thus at risk of delay diagnosis and management. In genitourinary tuberculosis, kidney alone and kidney with urinary bladder or ureter is affected in more than 70% of cases. The ureter and urinary bladder infections are almost always secondary to tuberculous involvement of the kidney. Bacilli haematogenic spreading is a known transmission pathway to the kidney. In this case, we diagnosed isolated urinary bladder tuberculosis caused by direct gastrointestinal tuberculosis infiltration, a rare occurrence of extrapulmonary tuberculosis. We illustrate the multiorgan involvement in tuberculosis infection including pulmonary, gastrointestinal, peritoneal and urinary bladder.

Matched MeSH terms: Tuberculosis, Gastrointestinal*

Perforation of tuberculous enteritis: report of a case

Bahari HM

Med J Malaysia, 1978 Jun;32(4):282-4.

PMID: 732621

Matched MeSH terms: Tuberculosis, Gastrointestinal/diagnosis*

Fulltext The TB--Crohn's affair--a never ending dilemma

Praveen S, Razman J

Med J Malaysia, 2008 Aug;63(3):259-60.

PMID: 19248705

An 80 year old lady presented with signs and symptoms of sub-acute intestinal obstruction which failed conservative management. CT scan abdomen revealed circumferential ileum thickening with proximal bowel dilatation. Laparotomy and segmental resection was done. Pathological findings were suggestive of chronic granulomatous ileits with differential of Crohn's disease and gastrointestinal tuberculosis. The patient was presumed to have gastrointestinal tuberculosis and commenced on anti tuberculosis treatment despite inconclusive evidence for confirmation and showed marked clinical improvement.

Matched MeSH terms: Tuberculosis, Gastrointestinal/complications*; Tuberculosis, Gastrointestinal/diagnosis*; Tuberculosis, Gastrointestinal/therapy

Inflammatory diseases of the bowel: a Malaysian experience

Ti TK

Aust N Z J Surg, 1979 Aug;49(4):428-31.

PMID: 115452

A 10-year experience in the diagnosis and treatment of 92 patients with inflammatory bowel diseases in Kuala Lumpur is described. Tuberculosis (34 cases) was the most common inflammatory bowel disease of surgical importance. The clinical presentation of tuberculous enteritis and Crohn's disease is similar, though tuberculosis is strongly suggested by associated pulmonary disease and radiological evidence of caecal involvement. The finding of 10 cases each of Crohn's disease and ulcerative colitis is in keeping with an increased awareness of these conditions in a developing urban society where facilities exist for thorough investigation of diarrhoeal diseases. Amoebiasis sometimes causes a granulomatous lesion simulating carcinoma. Diverticular disease of the colon as known in the West is of very rare occurrence.

Matched MeSH terms: Tuberculosis, Gastrointestinal/diagnosis; Tuberculosis, Gastrointestinal/pathology; Tuberculosis, Gastrointestinal/therapy

Fulltext Abdominal tuberculosis: a presumptive diagnosis

Ramanathan M, Wahinuddin S, Safari E, Sellaiah SP

Singapore Med J, 1997 Sep;38(9):364-8.

PMID: 9407759

Abdominal tuberculosis (TB) is common. But the diagnosis of abdominal TB is fraught with difficulties as it is often not possible to get a microbiological confirmation of the infection. We therefore undertook this study to highlight those pertinent clinical and laboratory features which would enable one to make a provisional diagnosis of abdominal TB early, to pave way for a trial of anti-tuberculosis chemotherapy.

Matched MeSH terms: Tuberculosis, Gastrointestinal/complications; Tuberculosis, Gastrointestinal/diagnosis*; Tuberculosis, Gastrointestinal/drug therapy

Fulltext How can gastro-intestinal tuberculosis diagnosis be improved? A prospective cohort study

Lowbridge C, Fadhil SAM, Krishnan GD, Schimann E, Karuppan RM, Sriram N, et al.

BMC Infect Dis, 2020 Mar 30;20(1):255.

PMID: 32228479 DOI: 10.1186/s12879-020-04983-y

BACKGROUND: Gastrointestinal tuberculosis (TB) is diagnostically challenging; therefore, many cases are treated presumptively. We aimed to describe features and outcomes of gastrointestinal TB, determine whether a clinical algorithm could distinguish TB from non-TB diagnoses, and calculate accuracy of diagnostic tests.

METHODS: We conducted a prospective cohort study of hospitalized patients in Kota Kinabalu, Malaysia, with suspected gastrointestinal TB. We recorded clinical and laboratory characteristics and outcomes. Tissue samples were submitted for histology, microscopy, culture and GeneXpert MTB/RIF®. Patients were followed for up to 2 years.

RESULTS: Among 88 patients with suspected gastrointestinal TB, 69 were included in analyses; 52 (75%) had a final diagnosis of gastrointestinal TB; 17 had a non-TB diagnosis. People with TB were younger (42.7 versus 61.5 years, p = 0.01) and more likely to have weight loss (91% versus 64%, p = 0.03). An algorithm using age 26 g/L, platelets > 340 × 109/L and immunocompromise had good specificity (96.2%) in predicting TB, but very poor sensitivity (16.0%). GeneXpert® performed very well on gastrointestinal biopsies (sensitivity 95.7% versus 35.0% for culture against a gold standard composite case definition of confirmed TB). Most patients (79%) successfully completed treatment and no treatment failure occurred, however adverse events (21%) and mortality (13%) among TB cases were high. We found no evidence that 6 months of treatment was inferior to longer courses.

CONCLUSIONS: The prospective design provides important insights for clinicians managing gastrointestinal TB. We recommend wider implementation of high-performing diagnostic tests such as GeneXpert® on extra-pulmonary samples.

Matched MeSH terms: Tuberculosis, Gastrointestinal/diagnosis*; Tuberculosis, Gastrointestinal/drug therapy; Tuberculosis, Gastrointestinal/microbiology; Tuberculosis, Gastrointestinal/pathology

Fulltext Differences in patient profiles of abdominal and pulmonary tuberculosis: a comparative study

Chong VH

Med J Malaysia, 2011 Oct;66(4):318-21.

PMID: 22299550

Objectives: Tuberculosis remains a common infection and is often associated with non-specific constitutional symptoms or laboratory investigations regardless of site of manifestations. This study compares the profiles of abdominal tuberculosis (ATB) and pulmonary tuberculosis (PTB).
Methods: Patients with ATB (n=34, male-21, mean age 43.3 ± 16.0 years) diagnosed over a nine year period were identified from the National Tuberculosis registry and retrospectively reviewed. Comparisons were made with patients treated for PTB (n=163).
Results: The most commonly affected sites were the ileocecal regions, peritoneum and hepatobiliary system. Common clinical presentations were abdominal pain (61.8%), anorexia (44.1%), weight loss (55.9%), fever (41.1%) and abdominal distension (29.4%). Four patients had concomitant active PTB. Compared to PTB, patients with ATB had significantly lower serum haemoglobin (11.6 ± 2.4 vs. 12.6 ± 2.0 gm/dL, p=0.036) and higher rate of adverse events of antituberculous treatment (50% vs. 15.4%, p<0.001). There were no difference in prevalence of constitutional symptoms (fever, weight loss and anorexia), platelet level, albumin, total protein and erythrocyte sedimentation rate. Importantly, there was no difference in the treatment
response. More patients with ATB and concomitant active PTB had reported weight loss (100% vs. 36.7%, p=0.017).
Conclusion: There are differences in the profiles of ATB and PTB. Awareness of such differences can help to improve the understanding and management of this infection.

Matched MeSH terms: Tuberculosis, Gastrointestinal/complications*; Tuberculosis, Gastrointestinal/drug therapy

Fulltext Protean manifestations of gastrointestinal tuberculosis

Ismail Y, Muhamad A

Med J Malaysia, 2003 Aug;58(3):345-9.

PMID: 14750373

We present 11 cases to illustrate the protean presentations of gastrointestinal tuberculosis. The patients presented with perianal fistula, appendicitis, ascites, rectal, intestinal or gastric 'growth', "ulcerative colitis", or recurrent anemia. In some of these cases there was no conclusive proof of infection with Mycobacterium tuberculosis but they responded well to empirical treatment with anti-tuberculous therapy. These cases illustrate that because signs and symptoms of intestinal tuberculosis are non-specific and even histology can be misleading, the diagnosis of gastrointestinal tuberculosis requires a high index of suspicion. A therapeutic trial of antituberculous drugs should be considered for patients with a high clinical suspicion of tuberculosis.

Matched MeSH terms: Tuberculosis, Gastrointestinal/diagnosis*; Tuberculosis, Gastrointestinal/etiology

Diagnostic challenge of gastrointestinal tuberculosis: a report of 34 cases and an overview of the literature

Radzi M, Rihan N, Vijayalakshmi N, Pani SP

Southeast Asian J. Trop. Med. Public Health, 2009 May;40(3):505-10.

PMID: 19842436

We report 34 cases of gastrointestinal TB from Malaysia and present an overview of the diagnostic challenges. A concerted effort is necessary to improve the existing diagnostic methods, and develop and evaluate newer diagnostic tools through well designed multi-center studies.

Matched MeSH terms: Tuberculosis, Gastrointestinal/diagnosis*

Meta-analysis: the association between HIV infection and extrapulmonary tuberculosis

Naing C, Mak JW, Maung M, Wong SF, Kassim AI

Lung, 2013 Feb;191(1):27-34.

PMID: 23180033 DOI: 10.1007/s00408-012-9440-6

BACKGROUND: Extrapulmonary tuberculosis has been an AIDS-defining condition. Individual studies that highlight the association between HIV and extrapulmonary TB are available. Our objectives were to synthesis evidence on the association between extrapulmonary tuberculosis and HIV and to explore the effective preventive measures of these two diseases.

METHODS: This is a meta-analysis of observational studies reporting effect estimates on how HIV is associated with extrapulmonary tuberculosis. We searched for the eligible studies in the electronic databases using search terms related to HIV and extrapulmonary tuberculosis. Where possible, we estimated the summary odds ratios using random effects meta-analysis. We stratified analysis by the type of study design. We assessed heterogeneity of effect estimates within each group of studies was assessed using I (2) test.

RESULTS: Nineteen studies (7 case control studies and 12 cohort studies) were identified for the present study. The pooled analysis shows a significant association between HIV and extrapulmonary tuberculosis (summary odds ratio: 1.3; 95 % confidence interval (CI) 1.05-1.6; I (2): 0 %). In a subgroup analysis with two studies, a significant association was found between CD4+ count less than 100 and the incidence of extrapulmonary tuberculosis (summary OR: 1.31; 95 % CI 1.02-1.68; I (2): 0 %).

CONCLUSIONS: Findings show evidence on the association between extrapulmonary tuberculosis and HIV, based on case control studies. Further studies to understand the mechanisms of interaction of the two pathogens are recommended.

Matched MeSH terms: Tuberculosis, Gastrointestinal/epidemiology*

Fulltext Oesophageal tuberculosis: rare but not to be forgotten

Momin RN, Chong VH

Singapore Med J, 2012 Sep;53(9):e192-4.

PMID: 23023913

Tuberculosis remains an important cause of morbidity and mortality, especially in underdeveloped and developing nations. Manifestations could be nonspecific and may mimic many other conditions, including malignancies. Oesophageal involvement is surprisingly rare despite the high prevalence of pulmonary tuberculosis and the close proximity of these two structures. We report two cases of oesophageal tuberculosis; a 73-year-old man with simultaneous oesophageal, stomach and duodenal involvement, and a 45-year-old man with isolated oesophageal involvement. Underlying malignancies were initially suspected in both cases, but they were eventually diagnosed as tuberculosis.

Matched MeSH terms: Tuberculosis, Gastrointestinal/diagnosis*

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology practice recommendations for medical management and monitoring of inflammatory bowel disease in Asia

Ran Z, Wu K, Matsuoka K, Jeen YT, Wei SC, Ahuja V, et al.

J Gastroenterol Hepatol, 2021 Mar;36(3):637-645.

PMID: 32672839 DOI: 10.1111/jgh.15185

Inflammatory bowel disease (IBD) has increased in incidence and prevalence in Asian countries since the end of the 20th century. Moreover, differences in the cause, phenotypes, and natural history of IBD between the East and West have been recognized. Therefore, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have established recommendations on medical management of IBD in Asia. Initially, the committee members drafted 40 recommendations, which were then assessed according to Grading of Recommendations Assessment, Development and Evaluation. Eight statements were rejected as this indicated that consensus had not been reached. The recommendations encompass pretreatment evaluation; medical management of active IBD; medical management of IBD in remission; management of IBD during the periconception period and pregnancy; surveillance strategies for colitis-associated cancer; monitoring side effects of thiopurines and methotrexate; and infections in IBD.

Matched MeSH terms: Tuberculosis, Gastrointestinal

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