understanding-and-managing-intestinal-tuberculosis-a-comprehensive-guide

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Overview

Understanding and Managing Intestinal Tuberculosis: A Comprehensive Guide

Overview

Intestinal tuberculosis (TB) is a chronic, specific infection caused by Mycobacterium tuberculosis, which invades the intestinal tract. It often follows pulmonary TB and has seen an increase in incidence among individuals with weakened immune systems in recent years. This article delves into the causes, symptoms, diagnosis, and treatment options for intestinal TB, providing a comprehensive guide for both healthcare professionals and patients.

Causes and Incidence

Intestinal TB typically originates from Mycobacterium tuberculosis, the same bacterium responsible for pulmonary TB. The infection usually spreads from open pulmonary or laryngeal TB when a patient swallows saliva containing the bacteria. Other modes of transmission include sharing utensils with an open TB patient and consuming contaminated, unsterilized milk or dairy products. The disease primarily affects the ileocecal region but can also involve the colon and rectum.

Types of Intestinal TB

There are three main types of intestinal TB based on pathological characteristics:

1. Ulcerative intestinal TB
2. Hypertrophic intestinal TB
3. Mixed intestinal TB

The disease predominantly affects young and middle-aged adults, with a higher incidence in females (male-to-female ratio of approximately 1:1.85).

Diagnosis

The onset of intestinal TB is typically slow and may last for a long time. Common symptoms include:

• Abdominal pain, usually located in the lower right quadrant or around the umbilicus, characterized by intermittent, dull pain that may worsen with eating.
• Diarrhea in ulcerative intestinal TB, with stools resembling paste and usually without mucus or blood.
• Constipation in hypertrophic intestinal TB.
• General symptoms such as long-term, irregular low fever, night sweats, weight loss, pale complexion, anemia, and fatigue.
• A firm, fixed mass in the lower right abdomen with mild to moderate tenderness.

Diagnostic tests include:

• Blood tests, such as an elevated erythrocyte sedimentation rate (ESR) and the presence of a few pus cells and red blood cells in stool.
• Tuberculin skin test or T-cell spot test (T-SPOT) for TB infection.
• Colonoscopy with biopsy to identify granulomas, caseous necrosis, or acid-fast bacilli.

Additional tests may include CT scans, ultrasounds, and X-rays.

Treatment

Treatment for intestinal TB involves a combination of general, symptomatic, and antitubercular therapy:

1. General Treatment: Adequate rest, high-protein, high-calorie, and high-vitamin diet, and avoiding raw or spicy foods. In some cases, regular injections of albumin may be necessary.
2. Symptomatic Treatment: Medications for abdominal pain, correction of water and electrolyte imbalances, and nutritional support for malnutrition or severe diarrhea.
3. Antitubercular Treatment: A combination of three to four antitubercular drugs, often in the form of a fixed-dose combination (FDC) for convenience and compliance.
4. Chinese Medicine: Certain herbal remedies may be used as adjunctive therapy, such as garlic and gecko extracts.
5. Surgical Treatment: In cases of complete or partial intestinal obstruction, acute or chronic intestinal perforation, massive intestinal bleeding, or when diagnostic difficulties necessitate exploratory laparotomy.
6. Corticosteroid Treatment: For patients with severe blood dissemination or toxic symptoms, corticosteroids may be added to the antitubercular regimen to alleviate symptoms and prevent complications like adhesions and obstruction.

Early diagnosis and timely treatment can lead to a favorable prognosis for most patients with intestinal TB.