Intestinal tuberculosis is a rare infectious disease of extrapulmonary form. Primary symptoms of the disease do not make it possible to diagnose the disease in the early stages. Tuberculosis begins to develop under the signs of other diseases and is often detected in severe form.
This diagnosis is determined by phthisiatricians and gastroenterologists.
According to statistics, this disease is most often accompanied by pulmonary tuberculosis.
Intestinal tuberculosis and its symptoms rarely manifest themselves at an early stage, so treatment generally begins at the second stage. Therapy is carried out in specialized tuberculosis medical institutions.
Causes of infection
There is only one cause of intestinal tuberculosis, infection of the body with the Koch bacterium. This microbe is common in the environment, especially in cattle. Therefore, hygiene instructions should not be neglected and heat treatment of milk and animal meat should be carried out.
Transmitted infection can be airborne and droplet, and the source of infection is persons with tuberculosis. In tuberculosis patients, the disease develops as a result of ingestion of saliva and the spread of bacteria through the lymph and blood.
Transmitted microbes in saliva and blood infect the intestines. But the mere presence of a microorganism is not enough. Favorable conditions will be weakened immunity, inflammatory processes and diseases of the intestinal system.
Causes of tuberculosis intestinal infection
Intestinal tuberculosis can affect the body following a specific pattern, and there are several routes of transmission.
There are three options for the development of this pathology:
- The tuberculosis bacteria gets into the sputum, and the person swallows the sputum, allowing the pathogen to enter deeper into the body. The infection penetrates the intestines through the digestive system and settles on the intestinal mucosa, beginning to develop. Adapting in the intestines, tuberculosis causes slow and imperceptible destruction of the body, as well as acute inflammation, which is rarely associated with tuberculosis infection and is confused with other diseases.
- Tuberculosis can be transmitted by infection of the lymph nodes.
- The infection develops in another human organ, but it also reaches the digestive system. The tuberculosis bacterium enters the intestines through the blood or lymph.
The disease can easily enter the human body and develop to a state that causes serious health problems.
Cases of intestinal tuberculosis can be classified:
- infection of the intestines directly with tuberculosis infection;
- an infection that has spread to the intestines after infection with pulmonary tuberculosis;
- the formation of many foci of tuberculosis infection throughout the body.
For the disease to begin its development in the human intestine, the Koch bacterium must not only somehow enter the body, but also overcome the resistance of the immune system. It is not always the case that a bacterium, once inside a person, adapts there and begins the slow destruction of the affected organ. The risk of infection with intestinal tuberculosis increases if a person suffers from diseases of the intestinal mucosa, rectum, anus, has inflammation localized on the intestinal walls, or HIV.
Symptoms of the disease
The first signs may appear after infection within a year, but it may take longer. The disease at this time occurs without any specific symptoms. At the initial stage, granulomas form under the intestinal mucosa.
Symptoms of intestinal tuberculosis can be mistaken for a disorder of the food system. There is mild pain in the abdominal area and intoxication.
In the second stage, there are more manifestations such as weight loss and lack of appetite. Diarrhea replaces constipation, stomach pain. Sweating increases, fever, nausea, gag reflex, flatulence appear, and blood changes. The pain syndrome becomes more pronounced and constant.
The severe stage is characterized by bleeding, inflammation of the peritoneum, rectal obstruction, peptic ulcer, weakness, blood and pus in the stool. There are periodic phases of exacerbation. There may be a dull pain in the navel area, which intensifies with movement or exercise. Signs of intoxication are growing.
Symptoms and clinical picture
Intestinal tuberculosis in primary or secondary form is usually detected by one sign that predominates over all others, namely, diarrhea.
Diarrhea begins suddenly, for no apparent reason, and becomes severe immediately. Patients experience 12-15 relaxations during the day: first, semi-solid masses are released, mixed with grayish or whitish flakes, and then completely watery. If blood is mixed in due to ulceration, the gray color turns black. Sometimes flaps of dead and foul-smelling mucous membrane are found in the night vessel (diphtheria and dysenteric form).
Histological examination of the eruptions reveals the presence of granular fat cells, altered blood cells, Charcot-Leyden crystals and purulent bodies. Finally, they contain Koch's mycobacteria, as well as many other microorganisms.
Colic precedes or accompanies bowel movements. Quite often, enteralgic attacks are observed earlier. The pain renews under the influence of food and compression of the abdomen.
Constipation can be combined with diarrhea or completely replace it. If constipation is accompanied by flatulence and painful tympanitis, then it is a sign of intestinal narrowing.
Intestinal disorders are accompanied by stomach disorders: lack of appetite, nausea and vomiting. Urine is secreted in scanty quantities, contains a lot of sediment and often protein; Indican is sometimes found.
Hectic fever and night sweats appear. The latter sometimes alternates with diarrhea.
A tumor in the ileum is observed exclusively with tuberculosis of the cecum or Bauginian valve. This tumor can be painful. In such cases, a swelling is found, the size of a turkey egg or more. The boundaries of the tumor are more or less sharp; it is dense, produces a dull tone when tapped and has little mobility. In other places, only diffuse infiltration is found.
The existence of abdominal dropsy indicates the participation of the peritoneum in the process.
Forms of tuberculosis
How the disease is transmitted: as a result of the entry of bacteria from the lungs into the gastrointestinal system, new formations are formed in the large or small intestine in the form of ulcerative nodes and micro cavities. Depending on the location of development, tuberculosis of the abdominal cavity, intestines and lymph nodes is distinguished.
The course of the disease divides tuberculosis into:
- ulcerative with a large number of neoplasms;
- ulcerative-hypertrophied with ulcers and gradual loss of intestinal material;
- hypertrophied is a complete loss of intestinal material;
- stenosing, when the lesions are on the walls of the lymphatic vessels.
Koch's bacillus chooses the ileum or the first section of the colon as its habitat. In the ileum, the disease forms formations of ulcers, hypertrophied lumps and stenosis of the spaces. In the first section of the colon, the intestinal lymphatic system is affected with the formation of ulcers along the diameter.
Next, the inflammatory process begins in the lymph nodes, and tuberculous lumps form in the upper shell of the ulcer. This all leads to inflammation of the abdominal cavity.
The disease exists in three forms. The first form is initial tuberculosis. Endemic enters the intestinal system with food or through household contact. The lymph nodes of the abdominal cavity begin to grow, in which fluid accumulates and intestinal loops stick. Pain and obstruction of the rectum appear, neoplasms are palpated.
The second form of primary intestinal tuberculosis is formed as a result of ingestion of sputum during tuberculous lung disease. Voids and ulcerative wounds form on the intestinal walls, accumulation of fluid in the abdominal cavity, and inflammation of the walls of the ileum.
The third form, hyperplastic ileocecal tuberculosis, is extremely rare and is a disease of mixed first and second forms.
If intestinal tuberculosis is not diagnosed and treated in a timely manner, there will be deterioration in patency, narrowing of the intestinal passage, rupture and entry of decomposition products into the abdominal cavity, blood in bowel movements, peritonitis, and disruption of the intestinal system.
Flow
The course is usually slow, although the duration of intestinal tuberculosis cannot be determined even approximately. It all depends on the extent of the changes and the malignancy of the bacteria. If enteritis joins pulmonary tuberculosis, then one cannot count on the improvement of the latter, since it is always a dangerous complication.
Sometimes remissions and temporary stops of the process are observed. Usually, however, emaciation and loss of strength progress; patients bear the special mark of tuberculous cachexia with characteristic facial pigmentation and bedsores in the last period. In some cases, death occurs from miliary tuberculosis.
Among the complications that can shorten the course of the disease, mention should be made of bleeding and perforation.
Minor bleeding is common, but heavy bleeding is also not uncommon.
Intestinal perforation is detected in some patients with sudden pain, vomiting, chills and flatulence. Since peritonitis quite often remains limited, the perforation is not recognized.
Diagnostics
Consultation with a gastroenterologist suggests an inflammatory process. Intestinal tuberculosis has signs of similar diseases of amoebic dysentery and tumors. The surest way to identify Koch's bacillus is to get a Mantoux vaccination, which shows the body's reaction to the administered tuberculin.
After 2 days, the condition of the injection site is checked. If the papule is larger than 10 mm, then infection with tuberculosis is possible.
However, the Mantoux test gives a positive result in half of the studies. At the onset of the disease, making a diagnosis is difficult because there are no specific tests and not enough symptoms. This leads to the fact that patients are referred already at the stage of caseous necrosis.
Examination of feces, urine, blood, and gastric cavity is not enough for diagnosis.
Analyzes provide a general description of the disease, but do not indicate the phases of development. Intestinal tuberculosis and its diagnosis involves radiography and endoscopy with biopsy, ultrasound, tuberculin tests and computed tomography.
Fluoroscopy allows you to detect changes in the intestinal walls and lack of activity for a long time, as well as obtain the location of the lesion and types of infection. Irregularities, compactions, and deformations form in the lesion, which are visible in the image.
Endoscopy provides a picture of the intestinal walls and allows tissue sampling for histological and microbiological examination.
Ultrasound and computed tomography also reveal degenerative changes in the intestine. But such methods have no independent meaning.
A definitive diagnosis can be made by a phthisiatrician based on blood tests, feces and scrapings of the inner intestinal wall.
How to prevent intestinal tuberculosis
Although intestinal tuberculosis can be cured, it is a long and exhausting task - it will be much easier to prevent the disease from developing.
Certain preventive measures will help with this matter:
- The state is obliged to control the situation with infectious diseases. Those sick with tuberculosis should be provided with the necessary medications and procedures, and healthy people should have less risk of becoming infected.
- Regular tuberculosis testing allows you to control the disease. If the syndrome is detected at an early stage, it can be cured faster, and the risks of it being transmitted to other people will be minimized.
- Immediately after birth, the child must undergo vaccination. During the first month, children are given a vaccine, the role of which cannot be underestimated.
- Since animals also suffer from tuberculosis, people should be careful when coming into contact with them. In this regard, people working on farms or other places with large concentrations of animals are required to undergo regular checks.
- Infectious patients are kept in medical institutions. Such places provide the necessary qualified assistance for the treatment of intestinal tuberculosis.
Intestinal tuberculosis has no age restrictions, so prevention is useful for both adults and children.
Treatment of tuberculosis
Intestinal extrapulmonary tuberculosis is treated in two ways: medication and surgery. Drug therapy consists of using the drugs Streptomycin, Ftivazid, PAS, Isoniazid.
If there are no results, drugs of the second group are prescribed: Ethambutol, Ethionamide, Cycloserine, as well as chemotherapy procedures. Treatment with drugs lasts 1.5 - 2 years.
The surgical method is used when drug therapy has no effect or the disease is in an advanced form, and consists of removing ulcers, fistulas and intestinal stenosis. All therapeutic and surgical procedures are carried out in special medical institutions.
Antibiotics are used in therapy and it is very important to follow a diet with foods high in carbohydrates, proteins and fats. The diet should include: soups, fish and cottage cheese dishes, a variety of cereals, meat cutlets from chicken or veal, fresh squeezed juices.
Excluded from the diet: legumes and fatty meats, smoked foods and preservatives, carbonated drinks.
