Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Intestinal tuberculosis [keywords]
- Screening for Imported Diseases in an Immigrant Population: Experience from a Teaching Hospital in Barcelona, Spain. [JOURNAL ARTICLE]
- Am J Trop Med Hyg 2014 Oct 20.
The objective of this study was to describe the screening for imported diseases among an immigrant population. This retrospective observational study was of all of adult immigrants attended at the Tropical Medicine Unit of the Vall d'Hebron Teaching Hospital from September of 2007 to March of 2010. The screening strategy was adjusted by symptoms, country of origin, and length of residence in Europe. Overall, 927 patients were included. The median age was 34.5 years, and 42.1% of patients were male. A diagnosis was made in 419 (45.2%) patients. The most frequent diagnoses were Chagas disease, anemia, latent tuberculosis infection, intestinal parasitosis, hepatitis B virus (HBV) infection, and human immunodeficiency virus (HIV) infection. After screening, more diseases were identified in immigrants from sub-Saharan Africa (new diagnoses in 56.6% of patients) than patients from other geographic areas. The geographic origin and length of residence in a developed country determine the prevalence of diseases; hence, screening protocols must be based on this information.
- Carboxymefloquine, the major metabolite of antimalarial drug mefloquine, induces drug metabolizing enzyme and transporter expression by activation of pregnane X receptor. [JOURNAL ARTICLE]
- Antimicrob Agents Chemother 2014 Oct 13.
Malaria patients are frequently co-infected with HIV and mycobacteria causing tuberculosis, which increases the co-administration of drugs and thereby enhances the risk of pharmacokinetic drug-drug interactions. Activation of pregnane X receptor (PXR) by xenobiotics, including many drugs, induces drug metabolism and transport, thereby possibly resulting in attenuation or loss of the therapeutic response of drugs being co-administered. While several artemisinin-type antimalarial drugs have been shown to activate PXR, data on non-artemisinin-type antimalarials are still missing. Therefore this study aims to elucidate the potential of non-artemisinin antimalarial drugs and drug metabolites to activate PXR. The screening of 16 clinically used antimalarial drugs and six major drug metabolites for binding to PXR, using the two-hybrid PXR ligand binding domain assembly assay, identified carboxymefloquine, the major and pharmacological inactive metabolite of the antimalarial drug mefloquine, as a potential PXR ligand. Two-hybrid PXR-coactivator and -corepressor interaction assays, as well as PXR-dependent promoter reporter gene assays, confirmed carboxymefloquine as a novel PXR agonist, which specifically activated the human receptor. In the PXR-expressing intestinal LS174T cells and in primary human hepatocytes, carboxymefloquine induced the expression of drug metabolizing enzymes and transporters on the mRNA and protein level. The crucial role of PXR for carboxymefloquine-dependent induction of gene expression was confirmed by siRNA-mediated knock-down of the receptor. Thus, the clinical use of mefloquine may result in pharmacokinetic drug-drug interactions by means of its metabolite carboxymefloquine. Whether these in vitro finding are of in vivo relevance has to be addressed in future clinical drug-drug interaction studies.
- Confluent Granulomas and Ulcers Lined by Epithelioid Histiocytes: New Ideal Method for Differentiation of ITB and CD? A Meta Analysis. [Journal Article]
- PLoS One 2014; 9(10):e103303.
There are few widely accepted criteria other than caseation, which has low sensitivity, for differentiating intestinal tuberculosis (ITB) and Crohn's disease (CD).We performed a meta-analysis to evaluate the use of confluent granulomas and ulcers lined by epithelioid histiocytes as histological methods for differentiating ITB and CD, compared with that of caseation.We searched PubMed, Medline, Embase, Web of Science, the Cochrane Library and Chinese Biomedicine Database for all relevant studies on the histological differentiation of ITB and CD. Sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each study. Study quality and heterogeneity were assessed. Meta-regression analysis and sensitivity analyses were performed.Ten randomized trials involving 316 ITB and 376 CD patients were included. The results showed that analysis of caseation showed an overall weighted area under the curve (AUC) of 0.9966, overall sensitivity and specificity were 0.21 and 1.00, respectively, with a positive likelihood ratio (+LR) of 10.79, negative likelihood ratio(-LR) of 0.82 and DOR of 13.74. Confluent granulomas had a lower overall weighted AUC of 0.9381, sensitivity and specificity were 0.38 and 0.99, respectively, with a +LR of 16.29, -LR of 0.65 and DOR of 26.52. Overall weighted AUC for ulcers lined by epithelioid histiocytes was 0.9017, sensitivity and specificity were 0.41 and 0.94, respectively, with a +LR of 6.46, -LR of 0.54 and DOR of 13.17. Significant heterogeneity was noted for the studies. Meta-regression analysis showed that study source, publication year, size, design and quality did not affect heterogeneity.Confluent granulomas and ulcers lined by epithelioid histiocytes are helpful in distinguishing ITB from CD, which may provide a new method, other than caseating granulomas and acid-fast bacilli, to differentiate ITB and CD in mucosal biopsies.
- [A case of esophageal and intestinal tuberculosis that occurred during treatment of rheumatoid arthritis with etanercept]. [English Abstract, Journal Article]
- Kekkaku 2014 Aug; 89(8):711-6.
An 88-year-old woman with rheumatoid arthritis who had started etanercept treatment in July 2011 was referred to our hospital in February 2012 for right-sided pleural effusion. Chest computed tomography showed right pleural effusion, partial swelling of a calcified mediastinal lymph node, and mid-esophageal thickening of the mucosal wall. Gastroendoscopy showed mid-esophageal ulceration. Histological examination of biopsy specimens from this ulceration revealed noncaseating granulomas with Langhans giant cells. Ziehl-Neelsen staining of this section was positive for acid-fast bacilli. Polymerase chain reaction analysis of gastric juice was positive for Mycobacterium tuberculosis; we therefore diagnosed the patient with esophageal tuberculosis. However, since abdominal computed tomography showed swelling of mesenteric lymph nodes, we also suspected intestinal tuberculosis. Colonoscopy showed multiple ileal erosions; histological analyses of biopsied specimens revealed granulomas with Langhans giant cells, similar to the esophageal findings. We finally diagnosed the patient with both esophageal and intestinal tuberculosis. After anti-tuberculosis treatment, the right pleural effusion disappeared and the abdominal lesions improved. Although mycobacterial involvement of both the esophagus and intestine is rare in immunocompromised and immunocompetent hosts, differential diagnosis of these diseases is likely to become more important.
- Differential diagnosis of Crohn's disease versus ileal tuberculosis. [Journal Article]
- Curr Gastroenterol Rep 2014 Nov; 16(11):418.
Both intestinal tuberculosis and Crohn's disease are chronic granulomatous inflammatory diseases of the bowel having overlap of clinical, endoscopic, radiological, and histological features. Differentiating between the two disorders is relevant not only in Asian countries but also in the West. In spite of diagnostic criteria for both diseases being available, still the dilemma of segregating the two diseases remains. Nearly one third of the patients with Crohn's disease may receive anti-tuberculosis treatment also. Diagnosis should be based on the combination of all disease-specific and corroborative evidences.
- Abdominal cocoon in a young man. [Journal Article]
- World J Emerg Med 2014; 5(3):234-6.
Intestinal obstruction remains a common problem encountered in the surgical emergency, and usually occurs secondary to adhesions, obstructed herniae or tubercular strictures. However, at times, rare causes of obstruction can also be encountered.A 24-year-old male patient presented with recurrent episodes of intestinal obstruction that was found to be secondary to an abdominal cocoon on laparotomy.The patient underwent adhesiolysis of the cocoon, and remains well on a follow-up. Histopathological report of the cocoon wall revealed fibrocollagenic tissues with a mixed inflammatory infiltrate, without any evidence of tuberculosis.Abdominal cocoon can be a rare cause of intestinal obstruction in male patients. Adhesiolysis of the cocoon membrane releases the obstruction and gives good results.
- Efficacy and safety of Stephania glabra: an alkaloid-rich traditional medicinal plant. [JOURNAL ARTICLE]
- Nat Prod Res 2014 Sep 4.:1-15.
Stephania glabra (Roxb.) Miers (Menispermaceae) has long been used for the treatment of asthma, tuberculosis, dysentery, hyperglycaemia, cancer, fever, intestinal complaints, sleep disturbances and inflammation in many Asian countries. It mainly contains alkaloids and, until now, over 30 alkaloids such as bisbenzylisoquinolines, hasubanalactams, berberines and aporphines have been isolated from its tuber. Most of its traditional medicinal activities are scientifically approved by various in vitro and in vivo studies. It shows remarkable anti-psychotic, anti-diabetic, antipyretic, analgesic, antimicrobial and anti-hypertensive activities. This work includes comprehensive information on the ethnobotany, chemistry and pharmacology of S. glabra. This review also focuses on the future perspectives with main emphasis on the establishment of therapeutic index and safety index of the plant. This review concludes that S. glabra has a great potential to treat various diseases, and could be used as a source for novel healthcare products in the near future, which needs further studies.
- Abdominal tuberculosis with an acute abdomen: our clinical experience. [Journal Article]
- J Clin Diagn Res 2014 Jul; 8(7):NC07-9.
Tuberculosis is an important cause of morbidity in India. Abdominal Tuberculosis is a great mimicker and is difficult to diagnose. This prospective observational study is based on those patients who were diagnosed to be suffering from Abdominal Tuberculosis only after they presented with an acute abdomen. This study aims to document the nature of different types of acute presentation in Abdominal Tuberculosis according to involved sites and surgical pathology. The study also discusses the indications and extent of surgical intervention.Seventy new cases of Abdominal Tuberculosis (out of 718 cases of acute abdomen) were diagnosed and treated over a period of three years in the surgical ward of Calcutta National Medical College. Macroscopic appearance of abdominal tissues during surgery suggested the diagnosis of tuberculosis. The diagnosis was confirmed by histopathology and tissue culture. All patients were subsequently treated with a full course of antitubercular drugs (ATD).The clinical presentations of acute abdomen included acute intestinal obstruction, perforative peritonitis and acute appendicitis etc. Terminal ileum and ileocaecal region were predominantly involved. The most common pathology was intestinal stricture with or without perforation. Most of the patients (approx 78.5%) required emergency surgery as a therapeutic intervention. A two-stage procedure was preferred in peritonitis and sepsis. Most of the remaining patients (12.8%) required surgery after initial conservative treatment for the first few days. Undiagnosed Abdominal Tuberculosis represents a notable percentage (10%) of patients who present with an acute abdomen as a surgical emergency.Abdominal Tuberculosis is very difficult to diagnose and diagnosis is often delayed till an acute abdomen is presented with. Almost all patients needed surgical intervention. Irrespective of surgery, all patients of abdominal tuberculosis require a full ATD.
- [Crohn's disease or intestinal tuberculosis: A diagnostic challenge.] [JOURNAL ARTICLE]
- Arch Pediatr 2014 Aug 25.
Distinguishing intestinal tuberculosis from Crohn disease is difficult and can result in misdiagnosis, especially when active pulmonary infection is absent. A 13-year-old girl was admitted to our hospital with a 2-month history of watery diarrhea, abdominal pain, and 12-kg weight loss. Based on clinical, radiological, endoscopic, and histological findings, she was initially misdiagnosed as having Crohn disease and treated with glucocorticosteroids, with a poor response after 4 weeks. Intestinal tuberculosis was then suspected. Improvement was observed during the 1st week of antituberculous treatment. The differentiation of intestinal tuberculosis from Crohn disease may be very difficult in some patients. A positive response to antituberculous treatment associated with clinical, endoscopic, and histological features argue in favor of the diagnosis of intestinal tuberculosis.
- Infectious diseases in Poland in 2012. [Journal Article]
- Przegl Epidemiol 2014; 68(2):177-85.
The aim of the study is to assess the epidemiological situation for infectious and parasitic diseases in Poland in 2012.The main source of data for this study are statistical overviews contained in the annual bulletins "Infectious Diseases in Poland in 2012" and "Immunizations in Poland in 2012" (NIPH-NIH, Warsaw 2013) and data contained in the articles presented in this issue of Przegląd Epidemiologiczny. Information on deaths due to infectious and parasitic diseases registered in Poland in 2012 and earlier years is based on the data of the Department for Demographic Research of Central Statistical Office.Upper respiratory tract infection classified as "influenza and influenza-like illness" were reported in 2012 in a total number of 1 460 037 cases. In comparison with 2011, it was an 26.2% increase of incidence, and as compared to the median of 2006-2010 of 286.1%. In 2012, with still the clear predominance of salmonellosis among intestinal bacterial infections, downward trend in the incidence of intestinal infections of this etiology persisted. In 2012 reported number of intestinal infections caused by Salmonella was, 8 267 (21.5/100 000), which represents incidence decrease of 4.5%. Foodborne infections of viral etiology were reported in 39462 cases (102.4/100 000). Most frequent were caused by rotaviruses - 23 692 (61.5/100 000). In 2012, there were 4 684 reported cases of pertussis (12.2/100 000), which means an increased incidence compared with the previous year by 180%. In 2012, there was an increase in the number of cases of mumps by 7.5% (from 2 585 to 2 779 cases), and of rubella by 46.0%, but compared to the median of the years 2006 to 2010 it was a decrease of 52.9%. In 2012, there was not any case of congenital rubella. Number of measles cases was 70 (0.18/100 000). In 2012, there was an increase in the number of cases of invasive disease caused by H. influenzae from 31 in 2011 to 36 in 2012. Number of infections caused by Streptococcus pneumoniae remained in 2012 as compared to 2011, on almost the same level: 436 in 2012 and 430 in 2011. However, there was a 36% increase in the number of sepsis cases caused by this organism. The incidence of tuberculosis in total (all forms of TB) in 2012 decreased compared to the previous year from 22.0 to 19.6 /100000, and pulmonary tuberculosis from 20.5 to 18.2. In 2012, were reported 1 093 cases of HIV infections (2.84/100 000), compared with the previous year, it was a fall in incidence of 2.4%. 21 cases of malaria occurred in people, who infection acquired abroad in malaria endemic areas. In 2012, there were no cases of diphtheria, poliomyelitis, rabies and viral haemorrhagic fevers outside of dengue, of which 5 cases of infections acquired in endemic areas were reported to National Sanitary Inspection. Total number of people who died in Poland in 2012 due to infectious and parasitic diseases, was 2 774. The share of deaths from these causes in the total number of deaths was 0.72%, and the mortality rate - 7.2/100 000. Out of all those deaths 41.1% were due to sepsis.