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Intestinal tuberculosis [keywords]
- Differential diagnosis of intestinal tuberculosis from Crohn's disease and primary intestinal lymphoma in China. [JOURNAL ARTICLE]
- Saudi J Gastroenterol 2014 July-August; 20(4):241-247.
Background/Aims: There are many similarities and overlaps in clinical, radiological, endoscopic, and histological features among intestinal tuberculosis (ITB), Crohn's disease (CD), and primary intestinal lymphoma (PIL), and the differential diagnosis of ITB can be very challenging for clinicians. Patients and Methods: The clinical, radiologic, endoscopic, and pathological data of 213 patients were analyzed retrospectively. According to the diagnostic criteria and exclusive criteria of ITB, CD, and PIL, 83 patients were recruited and divided into three groups, including 30 cases in the ITB group, 38 cases in the CD group, and 15 cases in the PIL group, and the medical data and statistical analysis were recorded. Results : Rural patients with abdominal pain as the first symptom and with transverse ulcer and caseating granulomas were more common in the ITB group than the CD group, whereas urban patients with stool change as the first symptom, moderate or severe anemia, thickening of intestinal wall, rectal involvement, skipping distribution, prominent lymphoid aggregates, and irregular glands were more common in CD group than ITB group (P < 0.05). Young patients (age < 30 years) with fever, weakness, fatigue, abdominal mass, intestinal perforation, and emergent operation were more common in ITB group than PIL group, whereas thickening of intestinal wall, malignant lymphocytes, limited distribution, and involvement of small intestine occurred more in PIL group than ITB group (P < 0.05). Conclusion : The differential diagnosis of ITB from CD and PIL can be made by a combination of clinical manifestation, endoscopy, and pathological examinations.
- Tuberculosis Infection Causing Intestinal Perforations in 2 Patients With Systemic Lupus Erythematosus. [JOURNAL ARTICLE]
- J Clin Rheumatol 2014 Jul 16.
Patients with systemic lupus erythematosus (SLE) have a higher incidence rate of tuberculosis and a more frequent extrapulmonary involvement than the general population. We present 2 SLE patients who developed gastrointestinal tuberculosis complicated with intestinal perforation, a rare but serious complication that could be confused with lupus-associated intestinal vasculitis. Opportunistic infections such as tuberculosis must be suspected in SLE patients with abdominal symptoms on immunosuppressive therapy because its early recognition could prevent catastrophic complications such as intestinal perforation and subsequent peritonitis.
- Parasitic Diseases as the Cause of Death of Prisoners of War during the Korean War (1950-1953). [Journal Article]
- Korean J Parasitol 2014 Jun; 52(3):335-7.
To determine the cause of death of prisoners of war during the Korean War (1950-1953), death certificates or medical records were analyzed. Out of 7,614 deaths, 5,013 (65.8%) were due to infectious diseases. Although dysentery and tuberculosis were the most common infectious diseases, parasitic diseases had caused 14 deaths: paragonimiasis in 5, malaria in 3, amoebiasis in 2, intestinal parasitosis in 2, ascariasis in 1, and schistosomiasis in 1. These results showed that paragonimiasis, malaria, and amoebiasis were the most fatal parasitic diseases during the early 1950s in the Korean Peninsula. Since schistosomiasis is not endemic to Korea, it is likely that the infected private soldier moved from China or Japan to Korea.
- Immune thrombocytopenic purpura induced by intestinal tuberculosis in a liver transplant recipient. [Journal Article]
- World J Gastroenterol 2014 Jul 7; 20(25):8304-8.
A variety of clinical manifestations are associated directly or indirectly with tuberculosis. Among them, haematological abnormalities can be found in both the pulmonary and extrapulmonary forms of the disease. We report a case of immune thrombocytopenic purpura (ITP) associated with intestinal tuberculosis in a liver transplant recipient. The initial management of thrombocytopenia, with steroids and intravenous immunoglobulin, was not successful, and the lack of tuberculosis symptoms hampered a proper diagnostic evaluation. After the diagnosis of intestinal tuberculosis and the initiation of specific treatment, a progressive increase in the platelet count was observed. The mechanism of ITP associated with tuberculosis has not yet been well elucidated, but this condition should be considered in cases of ITP that are unresponsive to steroids and intravenous immunoglobulin, especially in immunocompromised patients and those from endemic areas.
- Stool Microbiota and Vaccine Responses of Infants. [JOURNAL ARTICLE]
- Pediatrics 2014 Jul 7.
Oral vaccine efficacy is low in less-developed countries, perhaps due to intestinal dysbiosis. This study determined if stool microbiota composition predicted infant oral and parenteral vaccine responses.METHODS: The stool microbiota of 48 Bangladeshi infants was characterized at 6, 11, and 15 weeks of age by amplification and sequencing of the 16S ribosomal RNA gene V4 region and by Bifidobacterium-specific, quantitative polymerase chain reaction. Responses to oral polio virus (OPV), bacille Calmette-Guérin (BCG), tetanus toxoid (TT), and hepatitis B virus vaccines were measured at 15 weeks by using vaccine-specific T-cell proliferation for all vaccines, the delayed-type hypersensitivity skin-test response for BCG, and immunoglobulin G responses using the antibody in lymphocyte supernatant method for OPV, TT, and hepatitis B virus. Thymic index (TI) was measured by ultrasound.RESULTS: Actinobacteria (predominantly Bifidobacterium longum subspecies infantis) dominated the stool microbiota, with Proteobacteria and Bacteroidetes increasing by 15 weeks. Actinobacteria abundance was positively associated with T-cell responses to BCG, OPV, and TT; with the delayed-type hypersensitivity response; with immunoglobulin G responses; and with TI. B longum subspecies infantis correlated positively with TI and several vaccine responses. Bacterial diversity and abundance of Enterobacteriales, Pseudomonadales, and Clostridiales were associated with neutrophilia and lower vaccine responses.CONCLUSIONS: Bifidobacterium predominance may enhance thymic development and responses to both oral and parenteral vaccines early in infancy, whereas deviation from this pattern, resulting in greater bacterial diversity, may cause systemic inflammation (neutrophilia) and lower vaccine responses. Vaccine responsiveness may be improved by promoting intestinal bifidobacteria and minimizing dysbiosis early in infancy.
- Differential Diagnosis of Crohn's Disease and Intestinal Tuberculosis in Patients with Spontaneous Small-Bowel Perforation. [JOURNAL ARTICLE]
- Dig Surg 2014 Jun 21; 31(2):151-156.
Background/Aims: Spontaneous small-bowel perforation caused by Crohn's disease (CD) or intestinal tuberculosis (ITB) is a rare disease entity. We investigated the clinical features and radiologic findings of patients with CD or ITB who presented with a spontaneous small-bowel perforation. Methods: Between January 2001 and December 2010, sixty-two patients underwent surgery due to a spontaneous small-bowel perforation, including 21 (33.9%) CD patients and 18 (29.0%) ITB patients. Clinical and radiologic features were compared between CD and ITB patients. Results: The mean age was significantly lower in CD patients than in ITB patients (p = 0.014). Diarrhea was more common in CD. By contrast, night sweating and a previous history of tuberculosis were more common in ITB. Only 27.8% of patients with ITB had a positive QuantiFERON-TB Gold test. CT findings such as bowel wall thickening of more than 10 mm, omental thickening, and intra-abdominal lymphadenopathy larger than 10 mm were more common among perforations caused by ITB. Mesenteric fat infiltration was a more frequent finding in CD than in ITB. Conclusions: Clinical symptoms and radiologic findings may aid in the differential diagnosis between CD and ITB in patients presenting with spontaneous small-bowel perforation. © 2014 S. Karger AG, Basel.
- Formulation of novel sustained release rifampicin-loaded solid lipid microparticles based on structured lipid matrices from Moringa oleifera. [JOURNAL ARTICLE]
- Pharm Dev Technol 2014 Jun 25.:1-9.
Abstract Objectives: To formulate sustained release rifampicin-loaded solid lipid microparticles (SLMs) using structured lipid matrices based on Moringa oil (MO) and Phospholipon 90G (P90G). Methods: Rifampicin-loaded and unloaded SLMs were formulated by melt homogenization and characterized in terms of particle morphology and size, percentage drug content (PDC), pH stability, stability in simulated gastric fluid (SGF, pH 1.2), minimum inhibitory concentration (MIC) and in vitro release. In vivo release was studied in Wistar rats. Results: Rifampicin-loaded SLMs had particle size range of 32.50 ± 2.10 to 34.0 ± 8.40 μm, highest PDC of 87.6% and showed stable pH. SLMs had good sustained release properties with about 77.1% release at 12 h in phosphate buffer (pH 6.8) and 80.3% drug release at 12 h in simulated intestinal fluid (SIF, pH 7.4). SLMs exhibited 48.51% degradation of rifampicin in SGF at 3 h, while rifampicin pure sample had 95.5% degradation. Formulations exhibited MIC range of 0.781 to 1.562, 31.25 to 62.5 and 6.25 to 12.5 μg/ml against Salmonella typhi, Escherichia coli, and Bacillus subtilis respectively and had higher in vivo absorption than the reference rifampicin (p < 0.05). Conclusion: Rifampicin-loaded SLMs could be used once daily for the treatment tuberculosis.
- [A letal case of gastro-intestinal basidiobolomycosis]. [English Abstract, Journal Article]
- Ann Pathol 2014 Jun; 34(3):228-32.
We report here the case of a 55-year-old man from Mali, who presented with abdominal pain. Radiological exploration revealed an ileo-colonic mass surrounding the appendix. A biopsy was taken and on histology, transmural granulomatous inflammation of numerous eosinophils, lymphocytes, plasmocytes and giant cells was seen. Tuberculosis was suspected clinically and an antibiotic treatment was initiated. Two months later, the patient died of septic complications. Basidiobolus ranarum was identified by PCR. Pathogens were retrospectively highlighted on biopsies. These elements were between 10 and 15μm in diameter, occasionally pseudo-septated, and were surrounded by a thick eosinophilic cuff. The thick eosinophilic cuff was identified as the Splendore-Hoeppli phenomenon. Basidiobolomycosis is a well-known infection in the tropical areas. Basidiobolus sp., fungus of the order Entomophtorales are a known cause of chronic subcutaneous mycosis. Gastro-intestinal basidiobolomycosis is rare and presents considerable diagnostic difficulty. This infection needs to be diagnosed because surgical resection and prolonged antifungal treatment are curable in most cases.
- Permeability enhancing lipid-based co-solvent and SEDDS formulations of SQ641, an antimycobacterial agent. [JOURNAL ARTICLE]
- Pharm Dev Technol 2014 Jun 20.:1-10.
Abstract Context: Tuberculosis (TB) is a common and often deadly infectious disease caused by strains of Mycobacteria. Development of new anti-tubercular drugs is essential to control the emergence and severity of multidrug-resistant TB. Objective: The objective of this study was to develop an oral preclinical liquid formulation of SQ641 and to determine the permeability across rat intestinal tissue by Ussing chamber. Methods: Thermal and chemical characterization of SQ641 was performed by differential scanning calorimetric analysis, thermogravimetric analysis and high performance liquid chromatography. A high throughput solubility screening technique was utilized to determine the solubility of SQ641 in different solvents and co-solvents. Several co-solvent and self-emulsifying drug delivery system (SEDDS) formulations were selected for Ussing chamber permeability studies. Results and discussion: Calculated average apparent permeability coefficients of SEDDS formulations of SQ641 (ranging from 0.03 × 10(-6) to 0.33 × 10(-6)) were found to be higher than the permeability coefficients of co-solvent formulations (ranging from 0.00 × 10(-6) to 0.09 × 10(-6)) and those of the neat drug SQ641 in buffer (0.00 × 10(-6)). Conclusion: SEDDS formulations with superior permeability characteristics may provide a useful dosage form for oral intake of anti-tubercular drug SQ641, possibly due to the increase in solubility and immediate dispersion of drug.
- A Systematic Review with Meta-analysis: Accuracy of IGRA and ASCA in differentiating Intestinal Tuberculosis from Crohn's Disease in Asians. [JOURNAL ARTICLE]
- J Gastroenterol Hepatol 2014 Jun 9.
Distinguishing Crohn's disease (CD) from intestinal tuberculosis (ITB) is a clinical challenge. This meta-analysis assessed the clinical usefulness of Interferon-gamma releasing assay (IGRA) and anti-Saccharomyces cerevisiae antibody (ASCA) in the diagnosis of ITB and CD, respectively.Systematic search without language restriction was conducted in AMED, EBM, MEDLINE, EMBASE and Google Scholar until September 2013. Studies that have evaluated performance of IGRA (QuantiFERON-TB Gold or T-SPOT.TB) or ASCA in distinguishing ITB from CD were eligible. Main outcome measures included sensitivity and specificity. Random-effects models were used to combine estimates from studies with significant heterogeneity. Area under the curve (AUC) was used to measure accuracy of the tests.Eleven studies (5 IGRA, 3 ASCA, 3 IGRA and ASCA) involving 1,081 subjects were included. The pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of IGRA for the diagnosis of ITB was 81% (95% CI, 75%-86%), 85% (95% CI, 81%-89%), 6.02 (95% CI: 4.62-7.83), and 0.19 (95% CI: 0.10-0.36), respectively. The AUC was 0.92. The pooled sensitivity and specificity of ASCA for the diagnosis of CD was 33% (95% CI, 27%-38%) and 83% (95% CI, 77%-88%), respectively with an AUC of 0.58. T-SPOT.TB showed a higher sensitivity than QuantiFERON-TB Gold for the diagnosis of ITB.IGRA and ASCA have a high specificity for the diagnosis of ITB. Both IGRA and ASCA may have a supplementary role in the differential diagnosis between ITB and CD when conventional workup is not diagnostic.