Perfil clínico, teste padrão da resistência à droga e resultados do tratamento de pacientes com tuberculose abdominal da Índia ocidental
| Autor: | Qais Contractor, Pravin Rathi, Sunil V Pawar, Samit S Jain, Sanjay Chandnani, Suhas Udgirkar |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Abdominal pain medicine.medical_specialty Tuberculosis Adolescent Antitubercular Agents Drug Resistance Colonoscopy Constrição patológica India Drug resistance Asymptomatic Endoscopy Gastrointestinal 03 medical and health sciences Young Adult 0302 clinical medicine Pathologic constriction Internal medicine medicine Tuberculose Humans Prospective Studies lcsh:RC799-869 Child Resistência a medicamentos Aged GeneXpert MTB/RIF Granuloma medicine.diagnostic_test business.industry Multi-drug-resistant tuberculosis Gastroenterology Middle Aged medicine.disease Symptomatic relief Treatment Outcome 030228 respiratory system Socioeconomic Factors Tuberculosis Gastrointestinal 030211 gastroenterology & hepatology lcsh:Diseases of the digestive system. Gastroenterology Female medicine.symptom Abdome business Follow-Up Studies |
| Zdroj: | Arquivos de Gastroenterologia v.56 n.2 2019 Arquivos de gastroenterologia Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia instacron:IBEPEGE Arquivos de Gastroenterologia, Vol 56, Iss 2, Pp 178-183 Arquivos de Gastroenterologia, Volume: 56, Issue: 2, Pages: 178-183, Published: 26 AUG 2019 |
| Popis: | BACKGROUND: Abdominal tuberculosis is an increasing problem in developing world. OBJECTIVE: The objective of the study was to describe the clinical presentations, drug resistance pattern and treatment outcomes of abdominal tuberculosis in Western India. METHODS: All the cases of abdominal tuberculosis from May 2014 to April 2017, diagnosed on the basis of clinical profile and gross morphological findings at endoscopy, imaging, followed by histology and/or GeneXpert and MGIT culture were included. All patients received antitubercular drug (AKT) therapy according to national protocol. Patients were followed from diagnoses till completion of treatment and various parameters were studied. RESULTS: Out of the 176 patients, 48% were males. Abdominal pain was most common complaint in 83.5%. On colonoscopy terminal ileum and ileocaecal valve were most commonly involved segments. Upper gastrointestinal tract was involved in four patients. Overall ulceronodular lesions were most common followed by ulcerative/nodular lesion. Strictures in bowel were seen in 28 (15.9%) patients with ileocaecal valve being most commonly involved, of which 23 had symptomatic relief with AKT and only three required dilatation. Histopathology showed granuloma in 80.8% cases. MGIT was positive in 43 (35.80%) cases and GeneXpert was positive in 35 (26.1%) cases. Eight patients had multi drug resistant tuberculosis. Only two patients required surgical management. CONCLUSION: Abdominal tuberculosis with wide spectrum of presentation, can still be managed with early diagnosis and treatment even in patients with sub acute intestinal obstruction. Weight gain or resolving symptoms were considered early markers of treatment response. Patients with stricture can become asymptomatic with medical treatment alone. RESUMO CONTEXTO: A tuberculose abdominal é um problema crescente no mundo em desenvolvimento. OBJETIVO: O objetivo do estudo foi descrever as apresentações clínicas, o padrão de resistência a fármacos e os desfechos de tratamento da tuberculose abdominal na Índia ocidental. MÉTODOS: Foram incluídos todos os casos de tuberculose abdominal de maio de 2014 a abril de 2017, diagnosticados com base no perfil clínico e nos resultados morfológicos brutos na endoscopia, imagem latente, seguido pela histologia e/ou pela cultura de GeneXpert e de MGIT. Todos os pacientes receberam a terapia antitubercular da droga (AKT) de acordo com o protocolo nacional. Os pacientes foram acompanhados de diagnósticos até a conclusão do tratamento e vários parâmetros foram estudados. RESULTADOS: Dos 176 pacientes, 48% eram do sexo masculino. A dor abdominal foi a queixa mais comum em 83,5%. Na colonoscopia, o íleo terminal e a válvula íleo-cecal foram os segmentos mais comumente envolvidos. O trato gastrointestinal superior foi envolvido em quatro pacientes. As lesões ulceronodulares totais foram as mais comuns seguidas pela lesão ulcerosa/nodular. As estenoses foram observadas em 28 (15,9%) pacientes priciplamente com a válvula íleo-cecal envolvida, dos quais 23 tiveram alívio sintomático com AKT e somente três necessitaram de dilatação. A histopatologia mostrou o granuloma em 80,8% casos. O MGIT foi positivo em 43 (35,80%) e GeneXpert foi positivo em 35 (26,1%) casos. Oito pacientes tiveram tuberculose resistente a múltiplas drogas. Apenas dois pacientes necessitaram de manejo cirúrgico. CONCLUSÃO: A tuberculose abdominal com amplo espectro de apresentação, ainda pode ser manuseada com diagnóstico precoce e tratamento mesmo em pacientes com obstrução intestinal sub-aguda. Ganho de peso ou sintomas resolvidos foram considerados marcadores precoces de resposta ao tratamento. Pacientes com estenose podem se tornar assintomáticos com tratamento médico isoladamente. |
| Databáze: | OpenAIRE |
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