A 14-year-old girl presenting with tuberculous intestinal perforation while in a temporary shelter after the 2015 earthquake in Nepal

Abstract

A 14-year-old Nepalese girl presented with fever, abdominal pain and vomiting. She was living with her family in a temporary settlement camp following the earthquake in Nepal in 2015. She had had abdominal pain for 2 months and fever for 1 month. Abdominal examination suggested acute peritonitis. At laparotomy, three ileal perforations were detected and histopathology demonstrated caseous granulomas. Her father had sputum-positive pulmonary tuberculosis. She was diagnosed with abdominal tuberculosis and responded well to anti-tuberculosis chemotherapy. Intestinal perforation is a rare complication of tuberculosis in children.

Abdominal tuberculosis masquerading as carcinomatosis: Not difficult to miss!

“…Abdominal TB poses even more of a diagnostic challenge in the pediatrics population due to the varied presentation ranging from non-specific symptoms to those that mimic common abdominal conditions [6]. The most common presentations in children include fever, abdominal pain±discomfort, weight loss, and ascites [1, 3,7,12,17,18].…”

“…Tuberculosis infects the abdomen and peritoneum through several mechanisms such as ingestion of contaminated products, hematogenous spread, direct spread, and by lymphatic spread from a primary source [3,6,7,9,17,18].…”

“…Tuberculosis is caused by Mycobacterium tuberculosis and typically affects the lungs but can also affect other sites [1,4]. Abdominal tuberculosis (ATB) accounts for 5% cases of extrapulmonary TB and refers to infection of the gastrointestinal tract (GIT), the mesentery, and its nodes, omentum, peritoneum, and related solid organs [3,5,6]. It usually presents in a clinical spectrum that ranges from non-specific symptoms to those that mimic Crohn's disease or abdominal carcinomatosis [5,[7][8][9].…”

“…Risk factors for extrapulmonary TB include HIV, cirrhosis, diabetes mellitus, female gender, extremes of age, Asian/African ethnicity, malignancy, and peritoneal dialysis treatment [3,7,9,10]. The incidence of ATB tends to be higher among school children and adolescents than in children under 5 years old [6,11].…”

The Impact of Earthquakes on Public Health: A Narrative Review of Infectious Diseases in the Post-Disaster Period Aiming to Disaster Risk Reduction

“…Upper respiratory tract infections were observed quite frequently in the short-term period after disasters induced by earthquakes generated in several continents, including North America (the 1994 Northridge [ 68 , 69 ], 2001 El Salvador [ 70 , 71 ], and 2010 Haiti earthquakes [ 72 , 73 , 74 , 75 , 76 , 77 ], Europe (the 2009 L’Aquila earthquake [ 78 ] and 2014 Cephalonia Island earthquakes [ 79 ]), and Asia (the 1995 Kobe [ 80 ], 1999 Chi-Chi [ 81 , 82 ], 2003 Bam [ 83 , 84 ], 2004 Sumatra-Andaman [ 85 ], 2005 Kashmir [ 86 , 87 ], 2009 Sumatra [ 88 ], 2009 Samoa [ 85 ], 2011 Tōhoku [ 85 , 89 ], 2013 Lushan [ 90 , 91 ], 2013 Bohol [ 92 , 93 ], 2015 Gorkha [ 94 , 95 , 96 , 97 , 98 , 99 ] and 2016 Kumamoto earthquakes [ 100 ]) ( Figure 2 ). Most of the earthquake-affected people lived in overcrowded evacuation shelters, with inadequate air ventilation, unsafe drinking water, and poor personal hygiene being among the possible predisposing factors of contracting respiratory infectious diseases [ 70 , 71 , 72 , 80 , 81 , 82 ,…”