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Elgeyoushy F, Alomar TH, Alghabban MM, Alshagary RI, Alamri AM. Surprising Presentation of Intra-abdominal Tuberculosis: A Case Report. Cureus 2025; 17:e80214. [PMID: 40190942 PMCID: PMC11972610 DOI: 10.7759/cureus.80214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2025] [Indexed: 04/09/2025] Open
Abstract
Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis, posing a significant global health challenge, especially in low- and middle-income countries. While it primarily affects the lungs, it can also involve other organs, leading to varied clinical manifestations. We present the case of a 49-year-old male who experienced moderate right upper quadrant pain, nausea, and tenderness for one month. Initially diagnosed with acute cholecystitis based on clinical evaluation and imaging, intraoperative findings revealed disseminated peritoneal nodules and ascitic fluid, raising suspicion of abdominal TB. A retrograde cholecystectomy and right hemicolectomy were performed, but both acid-fast bacilli (AFB) staining and polymerase chain reaction (PCR) tests returned negative results. However, histopathological examination of the gallbladder ultimately confirmed TB, prompting the initiation of treatment. This case highlights the diagnostic challenges of abdominal TB, where clinical, radiological, and molecular tests may fail to provide conclusive results. Histopathology plays a critical role in diagnosis, and effective management often requires a combination of surgical intervention and prolonged anti-TB therapy. Early recognition of abdominal TB, particularly in atypical presentations, along with a multidisciplinary approach that includes both surgical and medical management, is vital for achieving successful outcomes. Prioritizing histopathological examination is essential when other diagnostic tests yield inconclusive results.
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Affiliation(s)
| | - Taif H Alomar
- General Surgery, King Faisal Specialist Hospital and Research Centre, Medina, SAU
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2
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Liu WJP, Wu MY, Zaborowski M, Ng E. Obstructive jaundice caused by an abdominal tuberculous mass lesion. Clin J Gastroenterol 2025; 18:202-207. [PMID: 39604756 DOI: 10.1007/s12328-024-02070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 11/15/2024] [Indexed: 11/29/2024]
Abstract
Tuberculosis is a global epidemic infection that typically presents with symptoms affecting the respiratory system. Abdominal tuberculosis is an uncommon manifestation, occurring in only 5% of tuberculosis cases globally and can present with a broad range of vague symptoms that mimic other biliary and pancreatic pathologies. We report a case of a 36-year-old woman presenting with jaundice and biliary obstruction secondary to abdominal tuberculosis. Computed tomography and magnetic resonance cholangiopancreatography revealed a loculated retroperitoneal mass abutting the pancreatic head and duodenum with associated common bile duct dilatation. Endoscopic ultrasound demonstrated an ulcerated mass in the duodenum which was biopsied. Necrotising granulomas were identified on histology and the biopsied tissue was positive on tuberculosis polymerase chain reaction testing. Thus, extrapulmonary abdominal tuberculosis was diagnosed. The patient was commenced on a 6-month course of rifampicin, isoniazid, pyrazinamide and ethambutol treatment and demonstrated complete response to medical therapy. Abdominal tuberculosis can be difficult to diagnose but should remain an important differential to be considered for patients with previous travel or residence in endemic areas presenting with gastrointestinal symptoms. Prompt diagnosis and treatment can prevent unnecessary procedures, complications and death in patients with biliary obstruction caused by abdominal tuberculosis.
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Affiliation(s)
| | - Michael Yulong Wu
- Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Matthew Zaborowski
- Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
| | - Eugene Ng
- Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, Australia
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3
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Ali AM, Mohamed YG, Mohamud AA, Mohamed AN, Ahmed MR, Abdullahi IM, Saydam T. Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction: A case report and review of literature. World J Clin Cases 2024; 12:1536-1543. [PMID: 38576818 PMCID: PMC10989457 DOI: 10.12998/wjcc.v12.i8.1536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/12/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Mycobacterium tuberculosis (TB) is the causative agent of TB, a chronic granulomatous illness. This disease is prevalent in low-income countries, posing a significant global health challenge. Gastrointestinal TB is one of the three forms. The disease can mimic other intra-abdominal conditions, leading to delayed diagnosis owing to the absence of specific symptoms. While gastric outlet obstruction (GOO) remains a frequent complication, its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy. Gastroduodenal TB can cause upper gastrointestinal hemorrhage, obstruction, and malignancy-like tumors. CASE SUMMARY A 23-year-old male presented with recurrent epigastric pain, distension, nausea, vomiting, and weight loss, prompting a referral to a gastroenterologist clinic. Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation. However, treatment was interrupted, possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes. Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall. Resection revealed gastric wall effacement with TB. CONCLUSION Primary gastric TB is rare, frequently leading to GOO. Given its rarity, suspicions should be promptly raised when encountering relevant symptoms, often requiring surgical intervention for diagnosis and treatment.
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Affiliation(s)
- Abdihamid Mohamed Ali
- Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu 2526, Somalia
| | - Yahye Garad Mohamed
- Department of Radiology, Mogadishu Somali Turkey, Training and Research Hospital, Mogadishu 2526, Somalia
| | - Abdirahman Ahmed Mohamud
- Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu 2526, Somalia
| | - Abdulkadir Nor Mohamed
- Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu 2526, Somalia
| | - Mohamed Rage Ahmed
- Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu 2526, Somalia
| | - Ismail Mohamud Abdullahi
- Department of Pathology, Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu 2526, Somalia
| | - Tuba Saydam
- Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu 2526, Somalia
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Aregawi AB, Alem AT, Girma A. A Rare Case of Intestinal Tuberculosis with Chronic Partial Small Bowel Obstruction in a 37-Year-Old Ethiopian Man. Int Med Case Rep J 2022; 15:725-733. [PMID: 36540622 PMCID: PMC9759974 DOI: 10.2147/imcrj.s388269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/03/2022] [Indexed: 01/25/2024] Open
Abstract
Tuberculosis (TB) is a chronic granulomatous inflammatory disease that affects any part of our body. TB is a significant problem in developing countries. Intestinal TB accounts for 2% of TB cases worldwide. Terminal ileum and cecum are the two commonly affected regions because of abundant lymphoid tissue, physiologic stasis, limited digestive activity and increased fluid and electrolyte absorption rate. Intestinal obstruction is the leading complication of intestinal TB, and it occurs because of intestinal luminal narrowing, multiple strictures or adhesions. The clinical presentation of patients with intestinal TB and post-TB intestinal obstruction is non-specific. It can be acute, chronic, or acute on chronic. Uncomplicated cases of intestinal TB can be managed medically. Surgery is reserved for complicated cases of intestinal TB, which includes peritonitis, intestinal obstruction and perforations. Here, we present a 37-year-old man who presented with long-standing, intermittent crampy abdominal pain and vomiting. He was diagnosed with chronic partial small bowel obstruction secondary to possibly small bowel carcinoma. We did segmental ileal resection and end-to-end ileo-ileal anastomosis. Postoperatively, the histopathology result turned out to be intestinal TB. This case report aims to make physicians aware of the rare condition of small bowel obstruction secondary to intestinal TB. Clinicians need to have a high index of suspicion in any patient with long-standing symptoms of partial obstruction and consider surgery and anti-TB once diagnosed.
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Affiliation(s)
- Alazar Berhe Aregawi
- Department of Surgery, Hawassa University Comprehensive Specialized Hospital, Hawassa University, Hawassa, Sidama, Ethiopia
| | - Alemwosen Teklehaimanot Alem
- Department of Pathology, Hawassa University Comprehensive Specialized Hospital, Hawassa University, Hawassa, Sidama, Ethiopia
| | - Abdulkerim Girma
- Department of Radiology, Yanet Internal Medicine Specialized Centre, Hawassa, Sidama, Ethiopia
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Humayun M, Chirenda J, Ye W, Mukeredzi I, Mujuru HA, Yang Z. Effect of Gender on Clinical Presentation of Tuberculosis (TB) and Age-Specific Risk of TB, and TB-Human Immunodeficiency Virus Coinfection. Open Forum Infect Dis 2022; 9:ofac512. [PMID: 36324321 PMCID: PMC9620549 DOI: 10.1093/ofid/ofac512] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Previous studies have shown gender differences in tuberculosis (TB) incidence; however, gender disparity has not been well documented across granular categorizations of anatomic sites affected by TB and in the presence of human immunodeficiency virus (HIV) coinfection, largely due to small sample size for less common TB clinical presentations and lack of detailed clinical data. METHODS The study population included TB cases aged ≥15 years (n = 41, 266) diagnosed in Harare, Zimbabwe. This cross-sectional study estimated male-to-female ratio (M/F ratio) for (1) age-specific TB incidence, (2) age-specific HIV prevalence among incident TB cases, and (3) 9 types of TB defined by affected anatomic site. RESULTS Males were at a 53% higher risk of TB compared to females (risk ratio [RR] = 1.53; 95% confidence interval [CI], 1.12-2.09). Based on adjusted odds ratios (aORs) from multinomial logistic regression model, the odds of abdominal TB (aOR = 0.51; 95% CI, .39-.68), TB bones/joints/spine (aOR = 0.63; 95% CI, .45-.90), and "other" extrapulmonary TB sites (aOR = 0.69; 95% CI = .59-.81) versus pulmonary TB were lower among males compared to females. The risk of TB-HIV coinfection among males was 17% (RR = .83; 95% CI, .74-.93) and 8% (RR = 0.92; 95% CI, .88-.95) lower in the 15- to 24-year and 25- to 44-year age groups, respectively. CONCLUSIONS This study revealed a nuanced role of gender across finer categorizations of TB, indicating the need for future research to delineate underlying mechanisms driving gender disparities in TB. The finding that women had a greater likelihood of severe forms of TB and TB-HIV coinfection compared to men has important implications for women's health in TB-HIV high-burden settings.
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Affiliation(s)
- Maheen Humayun
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Joconiah Chirenda
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Wen Ye
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Hilda Angela Mujuru
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Zhenhua Yang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Sharma K, Sharma M, Sharma V, Sharma M, Samanta J, Sharma A, Kochhar R, Sinha SK. Evaluating diagnostic performance of Truenat MTB Plus for gastrointestinal tuberculosis. J Gastroenterol Hepatol 2022; 37:1571-1578. [PMID: 35501293 DOI: 10.1111/jgh.15878] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/24/2022] [Accepted: 04/28/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Prompt and accurate diagnosis of gastrointestinal tuberculosis (GITB) along with simultaneous detection of drug resistance is inevitable for tuberculosis elimination. Truenat MTB Plus (TruPlus), a chip-based real-time polymerase chain reaction assay, was evaluated for the first time for diagnosing GITB and detecting rifampicin resistance. METHODS Fifty ileocecal biopsy specimens (5 microbiologically confirmed GITB [culture-positive], 25 clinically confirmed GITB [culture-negative], and 20 control patients) processed in the Department of Microbiology between 2011 and 2021 were subjected to TruPlus assay, Xpert MTB RIF assay multiplex polymerase chain reaction. Their performance was evaluated against both culture and composite reference standard. RESULTS The overall sensitivity and specificity of TruPlus in diagnosing GITB was 70% (21/30) and 100%, respectively. The sensitivity was 60% (3/5) for microbiologically confirmed cases and 72% (18/25) for clinically confirmed cases. Performance of TruPlus was superior to Xpert (sensitivity = 30%; P = 0.001) and comparable with MPCR (sensitivity = 83.33%; P = 0.13). Both TruPlus and MPCR had moderate agreement with reference standards, and MPCR detected additional three cases. Both TruPlus and Xpert correctly reported Rifampicin resistance in three cases. CONCLUSIONS TruPlus, with its greater portability and higher sensitivity than Xpert, could serve as an important tool for diagnosing GITB and rifampicin resistance at outreach endemic areas.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Microbiology, All India Institute of Medical Sciences, Bilaspur, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Megha Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Duan H, Xu D, Lu R, Wang S, Xie R, Wang S. Characterizing omental PET/CT findings for differentiating tuberculous peritonitis from peritoneal carcinomatosis. Abdom Radiol (NY) 2021; 46:5574-5585. [PMID: 34549331 DOI: 10.1007/s00261-021-03286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To characterize and investigate PET/CT findings in the omentum in the differentiation of tuberculous peritonitis (TBP) and peritoneal carcinoma (PC). METHODS Thirty-nine patients with TBP and 113 patients with PC who underwent PET/CT were retrospectively enrolled. The omental uptake intensity, distribution characteristics, contracture, size and boundary of soft-tissue lesions, and CT patterns were reviewed. RESULTS Absent and focal FDG uptake in the lesser omentum was more common in the PC patients (P = 0.034 and P = 0.017, respectively), and diffuse FDG uptake in the lesser omentum was more common in the TBP patients (P < 0.001). An apron-like pattern in the greater omentum commonly occurred in the TBP patients (P = 0.004). Micronodules (< 5 mm) were more common in the TBP patients (P < 0.001), and masses (> 3 cm) were more common in the PC patients (P = 0.001). Smudged and nodular patterns occurred more frequently in the TBP patients than in the PC patients (P < 0.001 and P = 0.003, respectively), and the caked pattern occurred more frequently in the PC patients (P < 0.001). There was no significant difference in the FDG uptake intensity and the boundary of soft-tissue lesions between the TBP and PC patients (P = 0.191 and P = 0.061, respectively). CONCLUSION Diffuse FDG uptake, an apron-like pattern, micronodules, and a smudged and nodular pattern might be significant differential features of TBP. Absent and/or focal FDG uptake, mass, and a caked pattern might be significant differential features of PC.
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Affiliation(s)
- Hongli Duan
- The First People's Hospital of Yunnan Province, PET/CT Center, 157 Jinbi Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China
| | - Dongdong Xu
- The First People's Hospital of Yunnan Province, PET/CT Center, 157 Jinbi Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China
| | - Rencai Lu
- The First People's Hospital of Yunnan Province, PET/CT Center, 157 Jinbi Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China
| | - Siyu Wang
- The First People's Hospital of Yunnan Province, PET/CT Center, 157 Jinbi Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China
| | - Ran Xie
- Yunnan Cancer Hospital, PET/CT Center, 519 Kunzhou Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China.
| | - Shaobo Wang
- The First People's Hospital of Yunnan Province, PET/CT Center, 157 Jinbi Road, Xishan District, Kunming, 650100, Yunnan, People's Republic of China.
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Ahmadi F, Tapper L, Al-Obudi Y, Khamar R, Khurram R. Asymptomatic peritoneal tuberculosis in a patient with a non-remitting fever and isolated pulmonary symptoms: a case report and literature review. Radiol Case Rep 2021; 16:1679-1684. [PMID: 34007383 PMCID: PMC8111435 DOI: 10.1016/j.radcr.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis (TB) remains one of the leading causes of death globally. Although abdominal or peritoneal TB is a recognised site for extrapulmonary TB to manifest, the diagnosis is often delayed due to the non-specific nature of the presenting clinical features. We present the diagnostically challenging case of a 32-year-old patient with recurrent episodes of fever and a non-productive cough that was initially treated as community-acquired pneumonia with oral antibiotics. A computed tomography scan of the thorax was unrevealing, aside from a large volume of ascites within the partially imaged upper abdomen. The patient did not report any abdominal symptoms and the abdominal examination was unremarkable. Subsequently, a transvaginal ultrasound, a contrast-enhanced computed tomography scan of the abdomen and pelvis, and magnetic resonance imaging of the abdomen and pelvis confirmed a large volume of ascites in the absence of any definite aetiology. A peritoneal biopsy was required before the diagnosis of peritoneal TB was eventually confirmed. This case highlights the importance of considering peritoneal TB in patients presenting with treatment-resistant chest symptoms and persistent pyrexia of undetermined aetiology, even in the absence of abdominal signs and symptoms.
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Affiliation(s)
- Faisal Ahmadi
- Royal Free London NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, UK
| | - Louis Tapper
- Royal Free London NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, UK
| | - Yasser Al-Obudi
- Royal Free London NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, UK
| | - Rahul Khamar
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Ruhaid Khurram
- Royal Free London NHS Foundation Trust, Pond St, Hampstead, London NW3 2QG, UK
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9
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[Right upper abdominal pain, vomiting, weight loss and icterus in a 20-year-old male refugee]. Internist (Berl) 2021; 62:203-206. [PMID: 33052456 DOI: 10.1007/s00108-020-00889-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Tuberculosis (TB) is one of the most common infectious diseases worldwide. The case of a 20-year old male refugee from Somalia, who initially presented with right-sided upper abdominal pain, vomiting, weight loss and jaundice with suspected cholecystitis is reported. In the course of further diagnostics, pyloric stenosis surprisingly appeared, which, like the cholestasis, was caused by compressing peripancreatic lymph nodes. Lymph node cytology finally showed evidence of caseating necrosis with evidence of TB pathogens.
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Talib A, Bhatty S, Mehmood K, Naim H, Haider I, Lal H, Ali G, Nashit M. GeneXpert in stool: Diagnostic yield in Intestinal Tuberculosis. J Clin Tuberc Other Mycobact Dis 2019; 17:100131. [PMID: 31788572 PMCID: PMC6880003 DOI: 10.1016/j.jctube.2019.100131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Diagnosing intestinal (Luminal) tuberculosis is challenging due to limited yield of diagnostic modalities like CT scan, colonoscopy with blind ileal biopsies. GeneXpert MTB/RIF (Xpert) assays for diagnosing tuberculosis have been performed in the body secretions with excellent results. Its yield in stool is tested in this study. Objective The study aims to evaluate the yield of GeneXpert assay in stool of suspected cases of intestinal tuberculosis. Methods Hundred patients with suspected intestinal tuberculosis underwent routine biochemical tests, radiological investigations, colonoscopy with caecal and blind ileal biopsies for histopathology. Fresh stool samples were collected, processed for DNA extraction, tested using 2:1 ratio of GeneXpert reagent to sample to give positive or negative results for Mycobacterium tuberculosis and Rifampicin resistance. Results Out of hundred participants, 52% were female. Mean age was 28.21 ± 12.13. CT scan and colonoscopy findings suggestive of TB were present in 47% and 43% participants respectively. GeneXpert in stool was positive in 20% cases. Considering mucosal biopsy with histopathology of intestinal specimens as diagnostic of abdominal Tuberculosis, sensitivity and specificity of GeneXpert was 39.1% and 85.7% respectively. Conclusion Stool GeneXpert assay offers an alternative approach to detect intestinal tuberculosis rapidly with good diagnostic accuracy. Although it cannot replace the AFB culture and histopathology but contribute for early diagnosis and management.
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Affiliation(s)
- Abu Talib
- Dow Medical College, Dow University of Health Sciences., Baba-e-Urdu Road, Karachi 74200, Pakistan
| | - Shaheen Bhatty
- Dow Medical College, Dow University of Health Sciences., Baba-e-Urdu Road, Karachi 74200, Pakistan
| | - Khalid Mehmood
- Dow Medical College, Dow University of Health Sciences., Baba-e-Urdu Road, Karachi 74200, Pakistan
| | - Huda Naim
- Dow Medical College, Dow University of Health Sciences., Baba-e-Urdu Road, Karachi 74200, Pakistan
| | - Iftikhar Haider
- Dow Medical College, Dow University of Health Sciences., Baba-e-Urdu Road, Karachi 74200, Pakistan
| | - Hari Lal
- Dow Medical College, Dow University of Health Sciences., Baba-e-Urdu Road, Karachi 74200, Pakistan
| | - Gohar Ali
- Dow Medical College, Dow University of Health Sciences., Baba-e-Urdu Road, Karachi 74200, Pakistan
| | - Muhammad Nashit
- Dow Medical College, Dow University of Health Sciences., Baba-e-Urdu Road, Karachi 74200, Pakistan
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Cho JK, Choi YM, Lee SS, Park HK, Cha RR, Kim WS, Kim JJ, Lee JM, Kim HJ, Ha CY, Kim HJ, Kim TH, Jung WT, Lee OJ. Clinical features and outcomes of abdominal tuberculosis in southeastern Korea: 12 years of experience. BMC Infect Dis 2018; 18:699. [PMID: 30587154 PMCID: PMC6307147 DOI: 10.1186/s12879-018-3635-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 12/18/2018] [Indexed: 12/30/2022] Open
Abstract
Background Abdominal tuberculosis (TB) is an uncommon form of infection with Mycobacterium tuberculosis in Korea. In this study, we aimed to highlight the clinical features, diagnostic methods, and outcomes of abdominal TB over 12 years in Southeastern Korea. Methods A total of 139 patients diagnosed as having abdominal TB who received anti-TB medication from January 2005 to June 2016 were reviewed. Among them, 69 patients (49.6%) had luminal TB, 28 (20.1%) had peritoneal TB, 7 (5.0%) had nodal TB, 23 (16.5%) had visceral TB, and 12 (8.6%) had mixed TB. Results The most frequent symptoms were abdominal pain (34.5%) and abdominal distension (21.0%). Diagnosis of abdominal TB was confirmed using microbiologic and/or histologic methods in 76 patients (confirmed diagnosis), while the remaining 63 patients were diagnosed based on clinical presentation and radiologic imaging (clinical diagnosis). According to diagnostic method, frequency of clinical diagnosis was highest in patients with luminal (50.7%) or peritoneal (64.3%) TB, while frequency of microscopic diagnosis was highest in patients with visceral TB (68.2%), and frequency of histologic diagnosis was highest in patients with nodal TB (85.2%). Interestingly, most patients, except those with nodal TB, showed a good response to anti-TB agents, with 84.2% showing a complete response. The mortality rate was only 1.4% in the present study. Conclusions Most patients responded very well to anti-TB therapy, and surgery was required in only a minority of cases of suspected abdominal TB.
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Affiliation(s)
- Jin-Kyu Cho
- Department of Surgery, Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, 52727, Gyeongnam, Republic of Korea
| | - Young Min Choi
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea
| | - Sang Soo Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea. .,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea. .,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.
| | - Hye Kyong Park
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ra Ri Cha
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Wan Soo Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jin Joo Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae Min Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Hong Jun Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Chang Yoon Ha
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Tae Hyo Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Woon Tae Jung
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Ok Jae Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongnam, 52727, Republic of Korea.,Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
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Usta M, Urganci N, Dalgic N, Uslu Kızılkan N, Kurtaraner T, Ali Karadag C. Clinical Presentation in a Series of Eight Children with Abdominal Tuberculosis: Experience of a Single-Center in Turkey. IRANIAN JOURNAL OF PEDIATRICS 2017; 27. [DOI: 10.5812/ijp.9766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
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Shi XC, Zhang LF, Zhang YQ, Liu XQ, Fei GJ. Clinical and Laboratory Diagnosis of Intestinal Tuberculosis. Chin Med J (Engl) 2017; 129:1330-3. [PMID: 27231171 PMCID: PMC4894044 DOI: 10.4103/0366-6999.182840] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Tuberculosis (TB) remains a worldwide problem. Intestinal TB (ITB) constitutes a major public health problem in developing countries and has been associated with significant morbidity and mortality. The aim of this study was to characterize the clinical, radiological, endoscopic, and pathological features of ITB and to define the strategy for establishing the diagnosis. Methods: A retrospective study (from January 2000 to June 2015) was carried out in Peking Union Medical College Hospital and all hospitalized cases were diagnosed as ITB during the study period were included. The relevant clinical information, laboratory results, microbiological, and radiological investigations were recorded. Results: Of the 85 cases, 61 cases (71.8%) were ranged from 20 to 50 years. The ileocecal region was involved in about 83.5% (71/85) of patients. About 41.2% (35/85) of patients had co-existing extra ITB, especially active pulmonary TB. Abdominal pain (82.4%) was the most common presenting symptom followed by weight loss (72.9%) and fever (64.7%). Both T-cell spot of TB test (T-SPOT.TB) and purified protein derivatives (PPD) tests were performed in 26 patients: 20 (76.9%) positive T-SPOT.TB and 13 (50.0%) positive PPD were detected, with a statistical significant difference (P = 0.046). Twenty cases (23.5%) were histopathology and/or pathogen confirmed TB; 27 cases (31.8%) were diagnosed by clinical manifestation consistent with ITB and evidence of active extra ITB; 38 cases (44.7%) were diagnosed by good response to diagnostic anti-TB therapy. Conclusions: ITB is difficult to diagnose even with modern medical techniques due to its nonspecific clinical and laboratory features. At present, combination of clinical, endoscopic, radiological, and pathological features continues to be the key to the diagnosis of ITB.
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Affiliation(s)
- Xiao-Chun Shi
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Li-Fan Zhang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yue-Qiu Zhang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Qing Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Gui-Jun Fei
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Rufai SB, Singh S, Singh A, Kumar P, Singh J, Vishal A. Performance of Xpert MTB/RIF on Ascitic Fluid Samples for Detection of Abdominal Tuberculosis. J Lab Physicians 2017; 9:47-52. [PMID: 28042217 PMCID: PMC5015498 DOI: 10.4103/0974-2727.187927] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diagnosis of abdominal tuberculosis (TB) from ascitic fluid samples using routinely available diagnostic methods is challenging due to its paucibacillary nature. Although performance of Xpert MTB/RIF assay has been evaluated extensively on pulmonary samples, its performance on extrapulmonary samples is still under evaluation. OBJECTIVES The objective of this study was to find out the performance of Xpert MTB/RIF on ascitic fluid samples obtained from suspected cases of abdominal TB. Performance was compared with Mycobacterium growth indicator tube-960 (MGIT-960) culture and in-house multiplex polymerase chain reaction (PCR). The latter detects and differentiates Mycobacterium tuberculosis and nontuberculous mycobacteria simultaneously. MATERIALS AND METHODS Sixty-seven patients suspected of probable/possible abdominal TB were included in this observational, prospective study. All samples were tested by Ziehl-Neelsen staining, MGIT-960 culture, in-house multiplex PCR, and Xpert MTB/RIF assay. RESULTS All 67 samples were smear negative. Seventeen (25.4%) were MGIT-960 culture positive while 12 (17.9%) were detected positive by the Xpert MTB/RIF assay and 9 (13.4%) by in-house multiplex PCR. Sensitivity and specificity of the Xpert MTB/RIF assay compared with the MGIT-960 culture were 70.6% (95%, confidence interval [CI]: 44.1-89.7) and 100% (95%, CI: 92.8-100) and that of in-house multiplex PCR were 52.9% (95%, CI: 30.9-73.8) and 100% (95%, CI: 92.8-100), respectively. CONCLUSIONS Diagnostic yield of Xpert MTB/RIF assay on ascitic fluid samples was lower than MGIT-960 culture. We thus emphasize on the need for urgent discovery of new biomarkers for paucibacillary TB.
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Affiliation(s)
- Syed Beenish Rufai
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parveen Kumar
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jitendra Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Vishal
- Department of Medicine, Dr. Ram Manohar Lohia Hospital, PGIMER, New Delhi, India
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