Kentley J, Ooi J L, Potter J, Tiberi S, O'Shaughnessy T, Langmead L, Chin Aleong J, Thaha M A, Kunst H
Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.
Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK.
Trop Med Int Health. 2017 Aug;22(8):994-999. doi: 10.1111/tmi.12908. Epub 2017 Jul 5.
To describe characteristics, presentation, time to diagnosis and diagnostic findings of patients with intestinal tuberculosis (ITB) in a low-burden country.
Retrospective study of 61 consecutive ITB patients diagnosed between 2008 and 2014 at a large East London hospital.
Forty of sixty-one patients were male. Mean age was 34.6 years. 93% of patients were born abroad, mostly from TB-endemic areas (Indian subcontinent: 88%, Africa: 9%). 25% had concomitant pulmonary TB. Median time from symptom onset to ITB diagnosis was 13 weeks (IQR 3-26 weeks). Ten patients were initially treated for IBD, although patients had ITB. The main sites of ITB involvement were the ileocaecum (44%) or small bowel (34%). Five patients had isolated perianal disease. Colonoscopy confirmed a diagnosis of ITB in 77% of those performed. 42 of 61 patients had a diagnosis of ITB confirmed on positive histology and/or microbiology.
Diagnosis of ITB is often delayed, which may result in significant morbidity. ITB should be excluded in patients with abdominal complaints who come from TB-endemic areas to establish prompt diagnosis and treatment. Diagnosis is challenging but aided by axial imaging, colonoscopy and tissue biopsy for TB culture and histology.
描述一个低负担国家中肠结核（ITB）患者的特征、临床表现、确诊时间及诊断结果。
对2008年至2014年期间在伦敦东部一家大型医院连续确诊的61例ITB患者进行回顾性研究。
61例患者中40例为男性。平均年龄为34.6岁。93%的患者出生在国外，大多来自结核病流行地区（印度次大陆：88%，非洲：9%）。25%的患者合并肺结核。从症状出现到确诊ITB的中位时间为13周（四分位间距3 - 26周）。10例患者最初被误诊为炎症性肠病（IBD），而实际患有ITB。ITB主要累及部位为回盲部（44%）或小肠（34%）。5例患者仅有肛周病变。77%接受结肠镜检查的患者经结肠镜检查确诊为ITB。61例患者中有42例经组织学和/或微生物学检查阳性确诊为ITB。
ITB的诊断常常延迟，这可能导致严重的发病率。对于来自结核病流行地区有腹部症状的患者，应排除ITB以实现及时诊断和治疗。诊断具有挑战性，但可借助轴向成像、结肠镜检查以及用于结核培养和组织学检查的组织活检来辅助诊断。
