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Clinicopathological profile of gastrointestinal tuberculosis: a multinational ID-IRI study

  • Alpaslan Tanoglu
  • Hakan ErdemEmail author
  • Jon S. Friedland
  • Fahad M. Almajid
  • Ayse Batirel
  • Sholpan Kulzhanova
  • Maiya Konkayeva
  • Zauresh Smagulova
  • Filiz Pehlivanoglu
  • Sophia de Saram
  • Serda Gulsun
  • Fatma Amer
  • Ilker Inanc Balkan
  • Recep Tekin
  • Antonio Cascio
  • Nicolas Dauby
  • Fatma Sirmatel
  • Meltem Tasbakan
  • Aysegul Erdem
  • Ahmed Ashraf Wegdan
  • Ozlem Aydin
  • Salih Cesur
  • Secil Deniz
  • Seniha Senbayrak
  • Affan Denk
  • Tolga Duzenli
  • Soline Siméon
  • Ahsen Oncul
  • Burak Ozseker
  • Tolga Yakar
  • Necati Ormeci
Original Article

Abstract

Data are relatively scarce on gastro-intestinal tuberculosis (GITB). Most studies are old and from single centers, or did not include immunosuppressed patients. Thus, we aimed to determine the clinical, radiological, and laboratory profiles of GITB. We included adults with proven GITB treated between 2000 and 2018. Patients were enrolled from 21 referral centers in 8 countries (Belgium, Egypt, France, Italy, Kazakhstan, Saudi Arabia, UK, and Turkey). One hundred four patients were included. Terminal ileum (n = 46, 44.2%), small intestines except terminal ileum (n = 36, 34.6%), colon (n = 29, 27.8%), stomach (n = 6, 5.7%), and perianal (one patient) were the sites of GITB. One-third of all patients were immunosuppressed. Sixteen patients had diabetes, 8 had chronic renal failure, 5 were HIV positive, 4 had liver cirrhosis, and 3 had malignancies. Intestinal biopsy samples were cultured in 75 cases (78.1%) and TB was isolated in 65 patients (86.6%). PCR were performed to 37 (35.6%) biopsy samples and of these, 35 (94.6%) were positive. Ascites samples were cultured in 19 patients and M. tuberculosis was isolated in 11 (57.9%). Upper gastrointestinal endoscopy was performed to 40 patients (38.5%) and colonoscopy in 74 (71.1%). Surgical interventions were frequently the source of diagnostic samples (25 laparoscopy/20 laparotomy, n = 45, 43.3%). Patients were treated with standard and second-line anti-TB medications. Ultimately, 4 (3.8%) patients died and 2 (1.9%) cases relapsed. There was a high incidence of underlying immunosuppression in GITB patients. A high degree of clinical suspicion is necessary to initiate appropriate and timely diagnostic procedures; many patients are first diagnosed at surgery.

Keywords

Tuberculosis Immune-suppression Gastro-intestinal Endoscopy Treatment 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Turkish Health Sciences University None-interventional Studies Ethical Counsel in Istanbul approved the study (06/07/2018; 18/19).

Informed consent

Not applicable.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Alpaslan Tanoglu
    • 1
  • Hakan Erdem
    • 2
    Email author
  • Jon S. Friedland
    • 3
  • Fahad M. Almajid
    • 4
  • Ayse Batirel
    • 5
  • Sholpan Kulzhanova
    • 6
  • Maiya Konkayeva
    • 6
  • Zauresh Smagulova
    • 6
  • Filiz Pehlivanoglu
    • 7
  • Sophia de Saram
    • 8
  • Serda Gulsun
    • 9
  • Fatma Amer
    • 10
  • Ilker Inanc Balkan
    • 11
  • Recep Tekin
    • 12
  • Antonio Cascio
    • 13
  • Nicolas Dauby
    • 14
  • Fatma Sirmatel
    • 15
  • Meltem Tasbakan
    • 16
  • Aysegul Erdem
    • 17
  • Ahmed Ashraf Wegdan
    • 18
  • Ozlem Aydin
    • 19
  • Salih Cesur
    • 20
  • Secil Deniz
    • 21
  • Seniha Senbayrak
    • 22
  • Affan Denk
    • 23
  • Tolga Duzenli
    • 1
  • Soline Siméon
    • 24
  • Ahsen Oncul
    • 25
  • Burak Ozseker
    • 26
  • Tolga Yakar
    • 27
  • Necati Ormeci
    • 28
  1. 1.Department of GastroenterologySultan Abdülhamid Han Training and Research HospitalIstanbulTurkey
  2. 2.ID-IRIAnkaraTurkey
  3. 3.St. George’s University of LondonLondonUK
  4. 4.Department of Medicine, Infectious Diseases DivisionKing Saud UniversityRiyadhSaudi Arabia
  5. 5.Department of Infectious Diseases and Clinical MicrobiologyUniversity of Health Sciences, Dr. Lutfi Kirdar Training and Research HospitalIstanbulTurkey
  6. 6.Department of Infectious DiseasesAstana Medical UniversityAstanaKazakhstan
  7. 7.Department of Infectious Diseases and Clinical MicrobiologyHaseki Training and Research HospitalIstanbulTurkey
  8. 8.North Middlesex University Hospital NHS TrustLondonUK
  9. 9.Department of Infectious Diseases and Clinical MicrobiologyDiyarbakir Training and Research HospitalDiyarbakirTurkey
  10. 10.Department of Medical Microbiology and Immunology, Faculty of MedicineZagazig UniversityZagazigEgypt
  11. 11.Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of MedicineIstanbul University-CerrahpasaIstanbulTurkey
  12. 12.Department of Infectious Diseases and Clinical MicrobiologyDicle University Faculty of MedicineDiyarbakirTurkey
  13. 13.Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) - Infectious Disease Unit, Policlinico “P. Giaccone”University of PalermoPalermoItaly
  14. 14.Department of Infectious DiseasesCentre Hospitalier Universitaire Saint-Pierre, Université libre de Bruxelles (ULB)BrusselsBelgium
  15. 15.Department of Infectious Disease and Clinical MicrobiologyIzzet Baysal University School of MedicineBoluTurkey
  16. 16.Department of Infectious Disease and Clinical MicrobiologyEge University School of MedicineIzmirTurkey
  17. 17.Department of PathologyKecioren Training and Research HospitalAnkaraTurkey
  18. 18.Department of Medical Microbiology and Immunology, Faculty of MedicineFayoum UniversityFayoumEgypt
  19. 19.Department of Infectious Diseases and Clinical MicrobiologyGoztepe Training and Research HospitalIstanbulTurkey
  20. 20.Department of Infectious Diseases and Clinical MicrobiologyAnkara Training and Research HospitalAnkaraTurkey
  21. 21.Department of Infectious Diseases and Clinical MicrobiologyPamukkale University School of MedicineDenizliTurkey
  22. 22.Department of Infectious Diseases and Clinical MicrobiologyHealth Sciences University, Haydarpasa Numune Training and Research HospitalIstanbulTurkey
  23. 23.Department of Infectious Diseases and Clinical MicrobiologyFirat University School of MedicineElazigTurkey
  24. 24.Department of Infectious and Tropical DiseasesUniversity Hospital of Pointe-à-PitreGuadeloupeFrance
  25. 25.Department of Infectious Diseases and Clinical MicrobiologySisli Hamidiye Etfal Training and Research HospitalIstanbulTurkey
  26. 26.Department of Internal Medicine, Division of GastroenterologyMugla Sitki Kocman University Faculty of MedicineMuglaTurkey
  27. 27.Department of GastroenterologyMedical Park HospitalMersinTurkey
  28. 28.Department of GastroenterologyAnkara University School of MedicineAnkaraTurkey

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