A prospective study on tubercular fistula in ano and its management

Abstract

Objective Tuberculosis fistula in ano, though less encountered, is an important clinical entity in developing countries like India. Diagnosis of TB fistula is a challenge despite of advances in diagnostic modalities and it depends upon both local and systemic clinical presentation. This prospective study aimed at to substantiate the importance of clinical diagnosis as well as medical management of tubercular fistula by antitubercular drugs. Methods and results 25 patients of fistula in ano suspected to be of tubercular origin underwent histopathology of fistulous tracks and an 8 week therapeutic trial of antitubercular treatment after getting an informed consent. Though biopsy showed positive evidence of tubercular pathology only in 52% cases, therapeutic trial showed improvement in local and systemic features in 23 (92%) cases. Of these 23 cases, 3 were cured after 18 months of anti tubercular treatment and 18 showed cure after 24 months of anti tubercular treatment while 2 cases withdrew from the study at 12 and 14 months respectively due to adverse drug reactions though their fistulous symptoms were relieved. Conclusion Meticulous clinical evaluation plays a vital role in diagnosis of tubercular fistula in addition to other diagnostic methods. Anti tubercular treatment is the mainstay of treatment in tubercular fistula with a minimum duration of 18–24 months owing to the recurrent and relapsing nature of disease.

Anal mycobacterial infections†

“…5 Moreover, several studies report that the number of men affected is significantly higher than women, and may reach a ratio of 4:1. 2,7,9 In our small sample, both patients were male and under 40 years old. Physical examination may contribute significantly to the hypothesis of anal mycobacterial infection.…”

“…9 Constitutional symptoms, such as anorexia, weight loss and night fever, should reinforce the hypothesis of mycobacterial infection. 9 Simultaneous occurrence of respiratory symptoms, such as chronic cough accompanied by poor discharge or sputum, may indicate concomitant pulmonary disease. 7 Such condition was reported in approximately 75% of patients in a historical series of anal tuberculosis, where individuals also had active or previously treated lung disease.…”

“…The development of anal fistula seems to be the most common presentation of mycobacterial infection of the anorectoperineal region. 3,6,7,9 However, there is a low specificity of symptoms reported by patients to characterize the infection as associated with mycobacteria, contrary to the much more frequent complication of a crypto-glandular infectious process. 9 Constitutional symptoms, such as anorexia, weight loss and night fever, should reinforce the hypothesis of mycobacterial infection.…”

“…3,6,7,9 However, there is a low specificity of symptoms reported by patients to characterize the infection as associated with mycobacteria, contrary to the much more frequent complication of a crypto-glandular infectious process. 9 Constitutional symptoms, such as anorexia, weight loss and night fever, should reinforce the hypothesis of mycobacterial infection. 9 Simultaneous occurrence of respiratory symptoms, such as chronic cough accompanied by poor discharge or sputum, may indicate concomitant pulmonary disease.…”

“…The mainstay of treatment for perianal mycobacterial infection is prolonged antibiotic therapy with multiple combined drugs, following the same principle of infections caused by these agents in other organs and systems. 2,6,9,10 The recommended treatment regimen involves 6 months of treatment, the first two with rifampicin, isoniazid, pyrazinamide, and ethambutol and the remaining four with only rifampicin and pyrazinamide. 9,10 Some authors, however, have reported a possible need for prolongation of this treatment based on the slow response and tendency to recurrence.…”