Intestinal tuberculosis

The Intestinal tuberculosis is the most common inflammation of the bowel worldwide. It is caused by mycobacteria and is associated with severe abdominal pain and diarrhea.

What is intestinal tuberculosis?

The main symptoms of intestinal tuberculosis are severe abdominal pain and severe diarrhea. The diarrhea is accompanied by a large loss of sodium, protein and potassium.
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Intestinal tuberculosis is an infectious disease caused by mycobacteria. Intestinal tuberculosis is widespread worldwide. In Germany and other Central European countries, however, it is now very rarely found. This is mainly due to the improved food hygiene. In the past, milk was sold straight after milking and was often contaminated with mycobacteria.

Today the milk is pasteurized before it is sold. The pathogens are killed in the process. The more effective methods of veterinary medicine have also contributed to a decrease in the incidence of bovine tuberculosis, and thus also in the number of intestinal tuberculosis infections in humans. Intestinal tuberculosis can affect the entire gastrointestinal tract. The preferred locations, however, are the ileum and the appendix.

causes

In terms of causes, a distinction can be made between primary and secondary intestinal tuberculosis. Primary intestinal tuberculosis is the result of bovine tuberculosis. The pathogen, 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 the pasteurization of milk.

Nowadays, the infection usually occurs through the ingestion of mycobacteria, which are coughed up in cases of pulmonary tuberculosis. Pulmonary tuberculosis is most commonly caused by the pathogen Mycobacterium tuberculosis. According to global statistics, it is the deadliest infectious disease. If inflammation of the intestines occurs in this way, it is a question of secondary intestinal tuberculosis. Infection via the bloodstream is also possible.

Infiltration with the pathogens occurs in the so-called Peyer's plaques of the intestine after infection. These initially cause cheese formation and later intestinal ulcers.

Symptoms, ailments & signs

The main symptoms of intestinal tuberculosis are severe abdominal pain and severe diarrhea. The diarrhea is accompanied by a large loss of sodium, protein and potassium. Often there is blood in the stool. This can be deposited or mixed with the feces. In addition, those affected suffer from fever and night sweats. Weight loss occurs.

The pain and bleeding are caused by an ulcer in the intestinal wall. These ulcers can also lead to blockages or even intestinal obstruction. With an intestinal obstruction, the stool and diaper can no longer pass. Affected patients may vomit feces.The ulcers can also form fistulas. These tube-like connections then lead from the intestine into the abdominal cavity, where they cause inflammation with ascites.

If the intestinal tuberculosis has also developed in the rectum, anal fistulas can develop. The inflammatory cavities emerge in the anus region. Secretion from the openings of the fistulas is typical. Patients with anal fistulas constantly have stool or blood-smeared underwear. Anal fistulas can also be very painful. Basically, if you have unclear abdominal pain, fever and ascites, tuberculous peritonitis should always be clarified.

diagnosis

If intestinal tuberculosis is suspected, a stool examination is carried out first. However, this is only partially suitable for making a diagnosis. A colonoscopy with a biopsy and subsequent microscopy is more effective. An ultrasound examination of the intestine is also carried out. Hyperplastic forms of colon tuberculosis can simulate colon cancer.

In terms of differential diagnosis, chronic inflammatory bowel diseases such as Crohn's disease or ulcerative colitis must always be excluded. Appendicitis can also be considered as a differential diagnosis. A computed tomography of the abdominal cavity provides further information when making the diagnosis.

Complications

With intestinal tuberculosis, the patient suffers from severe discomfort in the abdomen and stomach. This leads to diarrhea and severe abdominal pain. As a rule, the person concerned is dependent on bed rest during the illness and is not able to carry out physical activities. The severe diarrhea leads to weight loss and dehydration.

Therefore, a high fluid intake is especially important in the case of intestinal tuberculosis. The stool can also be bloody. Many people panic with blood in their stool. If ulcers develop, it can, in the worst case, lead to an intestinal obstruction. The patient can vomit feces and usually suffers from severe inflammation in the abdominal cavity. In addition to the pain, there is also a fever.

Treatment is carried out with the help of antibiotics and other drugs. If treatment is started early, there are usually no complications. However, the treatment itself can last half a year, during which time the patient suffers from the symptoms. Taking antibiotics can lead to disorders of the intestinal flora. Antibiotics can also cause discomfort to the eyes or ears.

When should you go to the doctor?

With diarrhea and persistent, severe abdominal pain associated with fever and night sweats, intestinal tuberculosis is suspected. Medical help is necessary if the symptoms have not subsided after three to four days at the latest. In particular, the subsequent weight loss as well as constipation and diarrhea must be clarified quickly. Those affected should pay attention to the signals from the body and observe the course of the disease.

If symptoms subside after a few days, it is likely a relatively harmless gastrointestinal disease that will resolve on its own. However, if the intestinal obstruction occurs in the course of the disease, an emergency doctor must be consulted immediately. Quick action is also required with anal fistulas or signs of ascites. Both point to advanced intestinal tuberculosis which, if left untreated, can be fatal. Basically, the following applies: Always clarify unexplained abdominal pain, fever and symptoms of ascites. If complications arise during treatment, it is advisable to call the responsible doctor in any case.

Doctors & therapists in your area

Treatment & Therapy

Intestinal tuberculosis is treated in the same way as pulmonary tuberculosis. The mycobacteria divide very slowly and can also rest in granulomas for a very long time. Therefore, the risk of developing resistance is particularly high here. If the diagnosis is confirmed or if intestinal tuberculosis is highly suspected, patients must be treated with several antibiotics at the same time.

These antibiotics, which work specifically against the Mycobacterium, are also called antituberculotics. According to the guidelines for tuberculosis treatment, the therapy is carried out with a four-fold combination of rifampicin, ethambutol, pyrazinamide and isoniazid. These antibiotics are given over a period of two months. Thereafter, therapy with rifampicin and isoniazid is continued for another four months. So tuberculosis treatment takes at least six months.

In milder cases and in children, the antibiotic ethambutol is usually left out. If there are intolerances, streptomycin is available as a reserve antibiotic. Side effects may occur during treatment. The patients suffer from polyneuropathies. Liver damage can also occur. Streptomycin can damage the kidneys and inner ear.

The optic nerves may become inflamed when taking ethambutol. The following substances are used to support the treatment of intestinal tuberculosis: L-arginine, high-dose vitamin D, PDE-4 inhibitors and lactoferrin.

Outlook & forecast

Intestinal tuberculosis has a good prospect of prognosis with medical treatment. The disease, which occurs very rarely in Germany today, is treated in a longer therapy. Medication is given to the patient for six months to two years to allow full recovery.

The administration of chemotherapeutic agents kills the pathogens and the inflammation heals. People with weakened immune systems can take a long time to heal. The body's own defense system must be supported in order to be able to assert itself against the pathogen Mycobacterium tuberculosis. In people with a healthy diet, a normal weight and no other illnesses, intestinal tuberculosis heals completely within half a year.

Without treatment, the symptoms can increase in intensity or last for several years. The risk of further diseases increases in this case, as the immune system is severely weakened. In the worst case, the patient is threatened with an intestinal obstruction or rupture without treatment.

This is an emergency situation and there is a risk to life. Intestinal tuberculosis can develop again at any time after recovery as soon as the person concerned comes into contact with the germ that causes the disease. With renewed treatment, the healing path for the patient is usually longer.

prevention

Primary intestinal tuberculosis can be prevented by treating the milk. The pathogens are only present in raw milk and are killed by pasteurization. The fight against bovine tuberculosis is also an effective prevention. Thanks to these preventive measures, primary intestinal tuberculosis has become very rare in Germany.

Secondary intestinal tuberculosis can only be prevented by combating pulmonary tuberculosis. There is currently no effective vaccination against tuberculosis. The main preventive measure is that infected people are discovered and treated as soon as possible. According to § 6 Infection Protection Act, tuberculosis is therefore one of the notifiable infectious diseases.

Aftercare

In most cases, the follow-up measures for intestinal tuberculosis depend heavily on the time of diagnosis, so that generally no general predictions can be made. The earlier the disease is recognized and treated, the better the further course is usually, although self-healing cannot occur.

Therefore, the person affected should consult a doctor at the first symptoms and signs of the disease in order to prevent further complications and complaints. In most cases, the treatment is carried out by taking antibiotics. The person concerned should always pay attention to the correct dosage and regular intake in order to properly alleviate the symptoms.

If you have any questions or questions, you should always consult a doctor first so that there are no further complications. A balanced and above all healthy diet can also alleviate the symptoms of diseases. Patients often depend on the help and support of their own family and friends. This can also alleviate psychological upsets or depression. It cannot be universally predicted whether the disease will lead to a reduced life expectancy for the person affected.

You can do that yourself

Intestinal tuberculosis is treated with drugs. Some measures aid recovery and prevent serious complications. Since intestinal tuberculosis can lead to increased diarrhea, you should drink enough. A gentle diet calms 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.

At an advanced stage, treatment must be given in a hospital. A sick diary gives an overview of the symptoms and the course of intestinal tuberculosis. This makes it possible to optimize the therapeutic measures, especially in the case of chronic illness. If stomach cramps and stool vomiting occur, it may be an emergency such as constipation or intestinal obstruction.

An emergency doctor should provide the person affected with medical care and clarify possible causes. After a hospital stay, rest is also advisable. If a serious underlying disease such as Crohn's disease or ulcerative colitis has been diagnosed, further measures such as the purchase of insoles or adult diapers are sometimes useful. Which steps are necessary in detail should be discussed with the responsible doctor.