Gastrointestinal Tuberculosis

Gastrointestinal Tuberculosis

    * Introduction
    * Esophageal Tuberculosis
    * Tuberculosis gastric and duodenal
    * Intestinal Tuberculosis
    * TB colony
    * Treatment
A third of the world population is infected with the tuberculosis bacillus, but not all infected persons have clinical disease. The bacteria cause disease when the immune system is weakened, such as the elderly and HIV-positive. Intestinal tuberculosis is a major health problem in underdeveloped countries. A significant increase was recorded recently in developed countries, especially in association with HIV infection. Autopsies of patients with pulmonary tuberculosis before effective treatment period demonstrated intestinal involvement in 55-90% of fatal cases. Approximately 20-25% of patients with intestinal tuberculosis have pulmonary and tubreculoza.
Intestinal Tuberculosis can involve any part of the intestine, although the ileum and colon are the favorite places. Nonspecific symptoms such as weight loss and abdominal pain are present in 80-90% of patients with intestinal tuberculosis. Nausea and vomiting may occur in patients with intestinal obstruction. Approximately one third of patients reported constipation. In patients infected with HIV tubreculoza tends to occur earlier compared to HIV-related opportunistic infections when the CD 4 cell count is 150-350/μL. Laboratory tests may show anemia and a normal blood count. Tuberculin skin test is negative in most patients with primary intestinal tuberculosis. A positive test does not indicate active disease.
Empirical therapy of tubrculozei initially start with a therapy of four drugs: isoniazid, rifampin, pyrazinamide and ethambutol or streptomycin. After two months piranzinamida therapy may be interrupted. Isoniazid and rifampin are continued for four months.
Pathogenesis of gastrointestinal tuberculosis
Tuberculosis pathogen Mycobacterium tuberculosis. Other mycobacterial species are Mycobacterium bovis which simulates tuberculosis, M. avium, M. intracellulare.
Pathways of intestinal infection include: -Ingestion of infected sputum in patients with active pulmonary tuberculosis and mai8 particularly in patients with pulmonary cavitation and positive sputum tests Marrow-seeking the spread by means of pulmonary tuberculosis outbreaks in submucous ganglia Local-seeking the spread of adjacent organs involved in primary tuberculous infection (kidney that determine the duodenum fistula with mediastinal lymphadenopathy and tuberculosis of the esophagus.
Tuberculosis intestinal disease is characterized by inflammation and fibrosis of the bowel wall and regional lymph nodes. Mucosal ulceration Payer plaques result from necrosis, lymph follicles and vascular thrombosis. At this stage of the disease changes are reversible and healing without scarring is possible. As the disease progresses, ulceration becoming confluent, and extensive fibrosis leads to bowel wall thickening, fibrosis and damage pseudotumoral. Strictures and fistulas may form.
Serosal surface of the tubers may nodular masses. The mucosa is inflamed with redness and swelling similar to that seen in Crohn's disease. In some cases, mouth ulcers can be seen in the colon. Cazeificarea can not be observed in granulomas, especially in the mucosa but is seen in regional lymph nodes.
On histological examination of intestinal tuberculosis can be classified into three categories: -Ulcerative form of tuberculosis seen in approximately 60% of patients. Multiple superficial ulcers on the epithelial surface. It is considered an active form of the disease, ulcers of the longitudinal axis perpendicular to the axis of the intestine Hypertrophic-form seen in 10% of patients with bowel wall thickening is to scarring, fibrosis and a table layout that mimics carcinoma rigid Ulcerohipertrofica-shape is a subtype seen in 30% of patients, they have a combination of characters that shape ulcerative and hypertrophic.
Signs and symptoms of gastrointestinal tuberculosis

 
Tuberculosis can occur in people of any age, although it is more common in children and the elderly whose immune system is weakened. Can be found at any age group which is immunosuppressed. Intestinal tuberculosis may involve any site on the gastrointestinal tract, but is more commonly found in the ileum and colon. Nonspecific symptoms such as weight loss and abdominal pain are present in 80-90% of patients with intestinal tuberculosis. Nausea and vomiting may occur in patients with intestinal obstruction. Approximately one third of patients reported constipation. Patients infected with HIV tend to present early tuberculosis from other opportunistic infections associated with AIDS.