Gastrointestinal tuberculosis: A systematic review of epidemiology, presentation, diagnosis and treatment

Abstract

Tuberculosis (TB) once considered a disease of the developing world is infrequent in the developing world too. Its worldwide prevalence with a huge impact on the healthcare system both in economic and health terms has prompted the World Health Organization to make it a top priority infectious disease. Tuberculous infection of the pulmonary system is the most common form of this disease, however, extrapulmonary TB is being increasingly recognized and more often seen in immunocompromised situations. Gastrointestinal TB is a leading extrapulmonary TB manifestation that can defy diagnosis. Overlap of symptoms with other gastrointestinal diseases and limited accuracy of diagnostic tests demands more awareness of this disease. Untreated gastrointestinal TB can cause significant morbidity leading to prolonged hospitalization and surgery. Prompt diagnosis with early initiation of therapy can avoid this. This timely review discusses the epidemiology, risk factors, pathogenesis, clinical presentation, current diagnostic tools and therapy.

Peritoneal and Pulmonary Tuberculosis in a Postpartum Female with Elevated Cancer Antigen 125 and Ascites

“…Peritoneal TB presents a diagnostic challenge because of its nonspecific clinical presentation, including abdominal pain and distension, fever, weight loss, nausea, and vomiting [1][2][3]. Consequently, time from the onset of infection to diagnosis can vary from weeks to months or years [6]. Routine hematologic evaluation is nonspecific for the diagnosis of peritoneal TB, and includes normochromic normocytic anemia, thrombocytosis, normal white blood cell count, elevated ESR, and hypoalbuminemia [1,2,9].…”

“…Peritoneal tuberculosis is a rare manifestation of extrapulmonary TB with an incidence of 6%, according to the CDC [ 6 , 7 ]. Risk factors for peritoneal TB are immunocompromised status, such as HIV, cirrhosis, diabetes mellitus, malignancy treated with immunosuppressive agents, corticosteroids, continuous peritoneal hemodialysis, and chronic kidney disease [ 6 , 8 ]. Additionally, as in the present case, pregnancy is also an immunocompromised state.…”

“…The sensitivity of peritoneal biopsy is 85–100% [ 9 ]. Peritoneal biopsy can reveal a thickened peritoneum with or without yellow-white tubercles, dense adhesions, and caseating granulomas [ 6 ]. Characteristic granuloma with central necrosis on biopsy, which was present in our patient, has an estimated sensitivity of 71–100% and a specificity of 100% [ 6 ].…”

“…Peritoneal biopsy can reveal a thickened peritoneum with or without yellow-white tubercles, dense adhesions, and caseating granulomas [ 6 ]. Characteristic granuloma with central necrosis on biopsy, which was present in our patient, has an estimated sensitivity of 71–100% and a specificity of 100% [ 6 ]. In our patient, the admitting diagnosis was bilateral pneumonia with presumed sepsis and ascites of unknown etiology.…”

“…Peritoneal TB is occasionally associated with involvement of the ovaries, and this can cause an elevated CA-125 [ 2 , 4 – 6 , 11 , 18 ], which is also sensitive, but nonspecific ovarian tumor marker. CA-125 also can be elevated in pulmonary and extrapulmonary tuberculosis.…”