Intestinal tuberculosis is the most common inflammation of the intestine worldwide. It is caused by mycobacteria and is associated with severe abdominal pain and diarrhea.
What is intestinal tuberculosis?
Intestinal tuberculosis is an infectious disease caused by mycobacteria. Worldwide, intestinal tuberculosis is widespread. However, it is now very rare in Germany and other central European countries. This is mainly due to improved food hygiene. In the past, milk was sold directly after milking and was often contaminated with mycobacteria. Today, the milk is pasteurized before sale. This kills the pathogens. More effective methods of veterinary medicine have also helped to reduce cases of bovine tuberculosis and, consequently, intestinal tuberculosis infections in humans. Intestinal tuberculosis can affect the entire gastrointestinal tract. However, the preferred localizations are the scrotum and the appendix.
Causes
Causes can be divided into primary and secondary intestinal tuberculosis. Primary intestinal tuberculosis is the result of bovine tuberculosis. The causative agent, Mycobacterium bovis, passes into the milk of infected cattle and is transmitted to humans when the contaminated milk is consumed. This form of transmission has become rare in Western countries due to pasteurization of milk. Nowadays, infection usually occurs by ingestion of mycobacteria coughed up in pulmonary tuberculosis. Pulmonary tuberculosis is most commonly caused by the pathogen Mycobacterium tuberculosis. According to worldwide statistics, it is the deadliest infectious disease. If inflammation of the intestine occurs in this way, it is a secondary intestinal tuberculosis. Infection via the bloodstream is also possible. After infection, the pathogens infiltrate the so-called Peyer’s plaques of the intestine. These initially cause caseation there and later intestinal ulcers.
Symptoms, complaints, and signs
The main symptoms of intestinal tuberculosis are severe abdominal pain and violent diarrhea. The diarrhea is accompanied by large losses of sodium, protein, and potassium. Blood is often found in the stool. This may be deposited or mixed with the feces. Furthermore, those affected suffer from fever and night sweats. Weight loss occurs. The pain and bleeding are caused by ulceration of the intestinal wall. These ulcers can also cause constipation and even intestinal obstruction. In the case of intestinal obstruction, stool and diapers can no longer pass. Affected patients may vomit feces. The ulcers may also form fistulas. These tube-like connections then lead from the intestine into the abdominal cavity, where they cause inflammation with abdominal dropsy (ascites). If intestinal tuberculosis has also developed in the area of the rectum, anal fistulas can develop. In this case, the inflammatory cavities emerge in the anal region. A secretion from the openings of the fistulas is typical. Patients with anal fistulas constantly have stool- or blood-stained underwear. Anal fistulas can also be very painful. As a general rule, if there is unexplained pain in the abdomen, fever, and abdominal dropsy, tuberculous peritonitis should always be investigated.
Diagnosis
If intestinal tuberculosis is suspected, a stool examination is first performed. However, this is only suitable to a limited extent for establishing the diagnosis. A colonoscopy with biopsy and subsequent microscopy is more target-oriented. Furthermore, an ultrasound examination of the intestine is performed. Hyperplastic forms of intestinal tuberculosis can feign colorectal cancer. As a differential diagnosis, chronic inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis must always be excluded. Appendicitis may also be considered as a differential diagnosis. Further information in making the diagnosis is provided by a computed tomography scan of the abdomen.
Complications
In intestinal tuberculosis, the patient suffers from severe discomfort in the abdomen and stomach. This involves diarrhea and severe abdominal pain. Usually, the affected person is confined to bed rest during the disease and is unable to perform physical activities. The severe diarrhea causes weight loss and dehydration.Therefore, especially high fluid intake is important in case of intestinal tuberculosis. Likewise, the stool may be bloody. For many people, blood in the stool causes panic. If ulcers develop, in the worst case, intestinal obstruction may also occur. In this case, the patient may vomit feces and usually also suffers from severe inflammation in the abdominal cavity. In addition to pain, there is also fever. Treatment is carried out with the help of antibiotics and other medications. If the treatment is started early, there are usually no complications. However, the treatment itself can last for half a year, during which time the patient suffers from the symptoms. Taking the antibiotics can cause disturbances in the intestinal flora. Similarly, antibiotics can cause discomfort to the eyes or ears.
When should you go to the doctor?
Diarrhea and persistent, severe abdominal pain associated with fever and night sweats raise the suspicion of intestinal tuberculosis. Medical help is necessary if the symptoms have not subsided after three to four days at the latest. In particular, the subsequent weight loss, constipation and diarrhea must be clarified quickly. Affected persons should pay attention to the body’s signals and observe the course of the disease. If the symptoms subside after a few days, it is probably a relatively harmless gastrointestinal disorder that will resolve itself. However, if intestinal obstruction occurs in the course of the disease, an emergency doctor must be consulted immediately. Quick action is also required in the event of anal fistula or signs of abdominal dropsy. Both indicate advanced intestinal tuberculosis, which can be fatal if left untreated. Basically, the following applies: unclear pain in the abdomen, fever and symptoms of ascites should always be clarified. If complications occur during treatment, a call to the responsible physician is recommended in any case.
Treatment and therapy
Intestinal tuberculosis is treated in exactly the same way as pulmonary tuberculosis. The mycobacteria divide very slowly and can also remain dormant in granulomas for a very long time. Therefore, the risk of resistance development is particularly high here. If a diagnosis is confirmed or if intestinal tuberculosis is highly suspected, patients must be treated with several antibiotics simultaneously. These antibiotics, which act specifically against Mycobacterium, are also called antituberculotics. According to the guidelines for tuberculosis treatment, therapy is with a four-drug combination of rifampicin, ethambutol, pyrazinamide and isoniazid. These antibiotics are administered over a period of two months. After that, therapy with rifampicin and isoniazid is continued for another four months. Thus, tuberculosis treatment lasts at least six months. In milder cases and in children, the antibiotic ethambutol is usually omitted. If intolerances occur, streptomycin is available as a reserve antibiotic. Side effects may occur during treatment. Patients suffer from polyneuropathies. Liver damage may also occur. Streptomycin can damage the kidneys and inner ear. Optic nerves may become inflamed when ethambutol is taken. Supportive substances used in the treatment of intestinal tuberculosis are L-arginine, high-dose vitamin D, PDE-4 inhibitors, and lactoferrin.
Outlook and prognosis
Intestinal tuberculosis has a good prognosis outlook if treated medically. The disease, which is very rare in Germany today, is treated with prolonged therapy. Over six months to two years, the patient is administered drugs so that a complete recovery can occur. The administration of chemotherapeutic agents kills the pathogens and the inflammation heals. In people with a weakened immune system, healing may take a longer time. The body’s immune system must be supported in order to prevail against the pathogen Mycobacterium tuberculosis. In people with a healthy diet, a normal weight and no other illnesses, intestinal tuberculosis heals completely within six months. Without treatment, the symptoms may increase in intensity or persist for several years. The risk of further diseases increases in this case, as the immune system is severely weakened.In the worst case, without treatment, the patient is at risk of intestinal obstruction or intestinal perforation. Emergency situations are thus present and there is a danger to life. Intestinal tuberculosis can develop again at any time after recovery, as soon as the affected person comes into contact with the germ that causes the disease. In the case of a renewed treatment, the healing path for the patient is normally prolonged.
Prevention
Primary intestinal tuberculosis can be prevented by treating the milk. The pathogens are present only in raw milk and are killed by pasteurization. Controlling bovine tuberculosis is also effective prevention. Due to these preventive measures, primary intestinal tuberculosis has become very rare in Germany. Secondary intestinal tuberculosis can only be prevented by controlling pulmonary tuberculosis. Currently, there is no effective vaccine protection against tuberculosis. The most important preventive measure is to detect and treat infected persons as soon as possible. For this reason, tuberculosis is one of the notifiable infectious diseases under Section 6 of the Infection Protection Act.
Follow-up
In most cases, the measures of an aftercare for intestinal tuberculosis strongly depend on the time of diagnosis, so that usually no general prediction can be made about it. The earlier the disease is detected and treated, the better is usually the further course, although self-healing cannot occur. Therefore, the affected person should see a doctor at the first symptoms and signs of the disease in order to prevent further complications and discomfort. In most cases, treatment is carried out by taking antibiotics. The affected person should always pay attention to a correct dosage and also to a regular intake in order to alleviate the symptoms properly. If there are any uncertainties or questions, a doctor should always be consulted first to avoid further complications. Likewise, a balanced and, above all, healthy diet can alleviate the discomfort of the diseases. Patients are often dependent on the help and support of their own family and friends. This can also alleviate psychological upsets or depression. Whether the diseases result in a reduced life expectancy of the affected person cannot be universally predicted in this context.
What you can do yourself
Intestinal tuberculosis is treated with the help of medicines. Some measures support recovery and prevent serious complications. Since diarrhea may occur more frequently in the course of intestinal tuberculosis, you should drink enough fluids. A gentle diet soothes the gastrointestinal tract and prevents the often colicky pain. If fever and night sweats occur, the ambient temperature should be adjusted. The doctor will also recommend relaxation and bed rest. In advanced stages, treatment must be provided in a hospital. A patient diary provides an overview of the symptoms and the course of intestinal tuberculosis. This makes it possible to optimize treatment measures, especially in the case of chronic disease. If stomach cramps and vomiting of stool occur, there may be an emergency such as constipation or intestinal obstruction. An emergency physician should provide the affected person with medical care and clarify possible causes. After a hospital stay, rest is also advised. If a serious underlying disease such as Crohn’s disease or ulcerative colitis has been diagnosed, further measures such as the purchase of inserts or adult diapers may be advisable. Which steps are necessary in detail should be discussed with the responsible physician.
