Since ancient times, mankind has been fighting intestinal tuberculosis. This is a serious and dangerous disease that, if left untreated, can lead to death. Everyone should know how this disease manifests itself. So, what is intestinal tuberculosis? What are its symptoms?
Essence of intestinal tuberculosis
Tuberculosis is a disease known to all people. By this term, specialists understand a chronic infectious disease. Many people think that this disease is associated only with damage to the respiratory system. In fact, this is not so. There are also extrapulmonary varieties of the disease. One of them is intestinal tuberculosis. The disease is caused by mycobacteria. One of the sources of infection are patients who do not follow the rules of personal hygiene.
Such people shed Mycobacterium tuberculosis (MBT) and infect several people a year. Cattle are also sources of infection. Mycobacterium tuberculosis is very resistant to the influence of environmental factors. Under various influencesmicroorganisms can become ultrafine filterable particles or giant branching structures. Under favorable conditions, MBTs take on typical forms.
Forms of intestinal tuberculosis
The named disease is divided into primary and secondary. How is intestinal tuberculosis transmitted, what causes it? The answer to this question is worth giving. So, primary tuberculosis occurs for several reasons:
- Due to the unboiled milk of tuberculosis cows.
- When hematogenous dissemination of Mycobacterium tuberculosis from the primary focus in the lungs, lymph nodes.
- Due to the consumption of food from dishes that are infected with Mycobacterium tuberculosis, or a container that belongs to people with this disease.
The secondary form of the disease occurs in sick people with affected lungs due to ingestion of sputum and saliva. Mycobacterium tuberculosis in this way enters the intestine and infects its wall (mostly affects the ileum). As a result, fistulas and ulcerations occur. Is intestinal tuberculosis dangerous to others? Statistics show that usually the disease is a secondary process that occurs during the progress of the pulmonary form. Much less often, intestinal tuberculosis turns out to be primary, developed due to alimentary infection.
Symptoms of disease
With intestinal tuberculosis, people notice the following suspicioussigns:
- Symptoms of intoxication. Because of the disease, appetite is lost, body weight begins to decrease. Patients complain of night sweats, fever. Women may not have periods.
- Intestinal symptoms. At the onset of the disease, some people experience constipation. It is followed, as a rule, by prolonged and exhausting diarrhoea. Patients who see specialists also complain of abdominal pain.
- Having an education. On palpation of the abdomen, a mildly painful tumor can be felt.
With ulcerative-destructive lesions of the intestine, symptoms of peritoneal irritation occur. Patients have a fever. In the feces, blood is visible or there are its components (erythrocytes, leukocytes), which are detected by specialists when conducting a study using a microscope. The ulcerative-destructive process may be characterized by complications. Often there are bleeding, intestinal obstruction, violation of the integrity of its wall.
Tuberculosis Diagnosis
The diagnosis of "intestinal tuberculosis" can be made by specialists after a comprehensive examination. It includes:
- tuberculin tests;
- radiography;
- colonoscopy;
- irrigoscopy;
- laparoscopy with biopsy.
Quite informative methods are computed tomography and laparoscopy. During the use of these diagnostic methods, specialists often find calcified mesentericlymph nodes, tuberculous tubercles. Informative and x-ray examination. Thanks to him, specialists detect signs of intestinal tuberculosis (for example, a retention of barium in the caecum when other departments are released).
Quantiferon test is a modern laboratory method for detecting infection. Covering the diagnosis of tuberculosis, it is worth considering it. So, the essence of the test is to examine the patient's blood. It is given in the morning on an empty stomach from a vein and placed in a special kit consisting of three test tubes. After blood sampling, specialists conduct a study. The quantiferon test can give a positive, negative and questionable result:
- A positive result indicates MBT infection.
- Negative results are obtained by he althy people. However, it should be noted that with it one should not exclude infection with Mycobacterium tuberculosis. The result may be false negative. This happens in the early stages of infection, with immunodeficiency states.
- Dubious result is possible with individual characteristics of immunity, as well as in case of violation of preanalytical requirements. For more information, doctors decide whether to take new blood or order additional examinations.
Differential diagnosis
Those signs that are identified by specialists during the examination of people with suspected intestinal tuberculosis may be characteristic of other inflammatory diseases. Lotthe named ailment has in common with ulcerative colitis, Crohn's disease, amoebic dysentery, intestinal neoplasms. To make a correct diagnosis, differential diagnosis is necessary:
- To ensure the absence of amoebic dysentery and neoplasms, a histological examination should be performed.
- Thanks to endoscopic biopsy, sarcoid-like granulomas consisting of lymphocytes with large Pirogov-Langhans type cells can be detected. Such structures are characteristic of intestinal tuberculosis and Crohn's disease. These diseases can be distinguished from each other by the foci of caseous necrosis. They occur together with granulomas only in intestinal tuberculosis.
Treatment of disease
When diagnosed with intestinal tuberculosis, treatment begins in specialized hospitals. Its goal is the persistent healing of foci of infection, the elimination of symptoms of the disease. Treatment of tuberculosis is quite long. Recovery usually occurs within a year. In some cases, it takes much longer to heal.
Complex treatment is necessary for intestinal tuberculosis. Its main component is chemotherapy. Doctors choose specific drugs, determine their combinations, doses. In the beginning, intensive chemotherapy is carried out. It inhibits the reproduction of mycobacteria, helps to reduce their number. Regarding treatment regimens, it is worth noting that every day can be used:
- Isoniazid and Rifampicin;
- Isoniazid and Ethambutol.
First drug combinationis prescribed for a period of 9 to 12 months, and the second - for 18. Such a long treatment is necessary due to the fact that mycobacteria multiply slowly and can remain in an inactive state for a long time.
If tuberculosis of the intestine is diagnosed, then conservative treatment will not necessarily be prescribed. It may not give the expected result in all cases. Sometimes doctors prescribe surgical treatment. It is indicated in the development of complications. For example, surgery may be indicated if there is a large amount of fluid in the abdominal cavity. Mechanical intestinal obstruction also requires surgical intervention. The reasons for its occurrence may lie in the scars left after the cure and adhesions between the intestinal loops.
Treatment related problems
The main problem associated with the treatment of intestinal tuberculosis is the indiscipline of sick people. Many patients do not follow the recommendations of specialists and stop taking tuberculostatic drugs. Due to the premature termination of chemotherapy, the process is exacerbated. Another problem is that after taking the prescribed drugs, side effects may appear. The serious consequences of drug toxicity are:
- Hepatitis is an inflammatory disease of the liver.
- Thrombocytopenia is a condition characterized by a decrease in the number of platelets.
- Neuritis is an inflammatory disease of the nerves.
- Renal failure is a pathological condition characterized byviolation of all kidney functions.
Side effects are rare. They are encountered by 3-5% of people receiving Rifampicin and Isoniazid, and 1-2% of patients treated with Isoniazid and Ethambutol. When side effects appear, the treatment program is changed.
Consequences of intestinal tuberculosis
The prognosis for the disease depends on how timely the specialists diagnosed the disease and prescribed the therapy. In advanced cases and with destructive lesions of the small intestine, the prognosis is unfavorable due to recurrence of intestinal obstruction and impaired absorption of nutrients. A less pessimistic prognosis is given with damage to the colon.
Disease prevention
In order to prevent the development of intestinal tuberculosis, preventive treatment is carried out. In order to determine whether a particular person needs it, a preliminary setting of tuberculin samples is performed. If the result is positive, then preventive treatment is prescribed. It consists in carrying out chemoprophylaxis with Isoniazid for 1 year. Prevention is carried out not only with a positive tuberculin test to avoid a disease such as intestinal tuberculosis. The reasons for her appointment may be as follows:
- Person has frequent contact with people who have active TB.
- The patient is taking corticosteroid and immunosuppressive drugs.
- A person suffers from various immunodeficienciesorigin.
In conclusion, it is worth noting that if you have suspicious symptoms characteristic of intestinal tuberculosis, you should immediately contact a general practitioner at the clinic. If the specialist suspects the named disease, the patient will be referred to one of the specialized anti-tuberculosis institutions.
