Title: Understanding Intestinal Tuberculosis: A Modern Family Doctor's Perspective
Overview:
Intestinal tuberculosis (TB), a chronic, specific infection caused by Mycobacterium tuberculosis, has been a significant health concern. This article, crafted from Chinese medical guidance, aims to provide a comprehensive overview of intestinal TB, its diagnosis, and treatment options.
The Basics of Intestinal Tuberculosis:
Intestinal TB typically arises from pulmonary TB and has seen an increase in incidence among individuals with weakened immunity. The causative agent is predominantly the human type of Mycobacterium tuberculosis. Common modes of transmission include inhaling sputum from open pulmonary TB patients or consuming contaminated food and utensils. In rare cases, it can be transmitted through the consumption of unsterilized milk or dairy products containing the bovine type of the bacterium.
The disease primarily affects the ileocecal region, but can also involve the colon and rectum. It is categorized into three types based on pathological features: ulcerative, granulomatous, and mixed intestinal TB. The condition is more prevalent among young and middle-aged adults, with a higher prevalence in females (ratio of 1:1.85).
Diagnosis:
The onset of intestinal TB is gradual with a prolonged course. Common symptoms include abdominal pain, typically located in the right lower quadrant or around the umbilicus, which may be intermittent and exacerbated by meals. Ulcerative TB often presents with diarrhea, while granulomatous TB is characterized by constipation. General symptoms include an irregular low-grade fever, night sweats, weight loss, pallor, anemia, and fatigue. A palpable mass in the right lower quadrant, accompanied by mild to moderate tenderness, may also be present.
Diagnostic procedures include blood tests (e.g., elevated erythrocyte sedimentation rate), stool examination for the presence of pus cells and red blood cells, tuberculin skin test, T-SPOT TB test, and colonoscopy with biopsy. Additional tests may include ESR, PPD, CT scans, ultrasounds, and X-rays.
Distinguishing intestinal TB from other conditions, such as Crohn's disease, colon cancer, amebiasis, schistosomiasis, intestinal lymphoma, typhoid fever, actinomycosis, and appendicitis, is crucial for accurate diagnosis.
Treatment:
The treatment of intestinal TB is comprehensive and includes:
General Treatment: Adequate rest, a nutritious diet, and maintaining bowel regularity are essential. Patients may require periodic injections of albumin.
Symptomatic Treatment: Medications like atropine or anticholinergic drugs may be used for abdominal pain. Correction of fluid and electrolyte imbalances, nutritional support, and gastrointestinal decompression may be necessary in cases of incomplete obstruction.
Medication: Treatment usually involves a combination of three to four antitubercular drugs, often in the form of fixed-dose combination (FDC) tablets. Common antitubercular drugs include isoniazid, rifampin, rifapentine, streptomycin, pyrazinamide, ethambutol, sodium para-aminosalicylate, ethionamide, prothionamide, amikacin, kanamycin, capreomycin, ofloxacin, levofloxacin, moxifloxacin, and ciprofloxacin.
Traditional Chinese Medicine (TCM): TCM treatments may include the use of garlic and gecko powder in specific dosages and frequencies.
Surgical Treatment: Surgery may be necessary in cases of complete obstruction, fistula formation, massive bleeding, or when a part of the intestine needs to be removed.
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.
Conclusion:
Early diagnosis and prompt treatment are crucial for the successful management of intestinal TB. With proper care and adherence to the treatment plan, most patients can achieve recovery and have a good prognosis. It is important for individuals with a history of TB or symptoms suggestive of intestinal TB to seek medical attention promptly.