Tuberculosis, Intestinal

Key Features

• Common in developing nations; rare in the United States, except in immigrant groups or in patients with untreated AIDS

• Caused by Mycobacterium tuberculosis and Mycobacterium bovis

Clinical Findings

• Active pulmonary tuberculosis in < 50%

• Most common involvement is ileocecal

• Chronic abdominal pain, obstructive symptoms, weight loss, diarrhea

• Abdominal mass palpable

• Complications include

  • Intestinal obstruction

  • Hemorrhage

  • Fistula formation

• Differential diagnosis

  • Crohn disease

  • Carcinoma

  • Lymphoma

  • Intestinal amebiasis

Diagnosis

• PPD skin test may be negative, especially in weight loss or AIDS

• Abdominal CT

• Colonoscopy

• Definitive diagnosis by either endoscopic or surgical biopsy revealing acid-fast bacilli and caseating granuloma or by positive cultures

• Detection of tubercle bacilli in biopsy specimens by polymerase chain reaction

Treatment

• Tuberculosis, initial treatment (Table 9–15)

• Antituberculous drugs characteristics (Table 9–14)