Gastrointestinal Tuberculosis in Golestan province- northeast of Iran: A 5-year reportCorrespondence Address :
Sima Besharat, Address: Moosavi Blindalley, 21st Edalat, Vali-e-Asr St, Gorgan city,Golestan Province, Iran. Postal code: 49177-44563, Tel: 098171-2240835, E-mail: firstname.lastname@example.org
Extra pulmonary tuberculosis (EPTB) is an important clinical problem (15-20% of TB cases). Patients may complain from general symptoms such as fever, anorexia, weight loss, weakness and fatigue and other non- specific signs and symptoms (1), (2), (3). One important part of EPTB is gastrointestinal TB (GI TB). Clinicians often use clinical manifestations, radiological and endoscopic evidence and non-specific measures to diagnose gastrointestinal TB (1).
We collected all new data about TB cases reported between 1999 and 2003 in Golestan province, Northeast Iran. During this period, 1924 new cases of TB were registered, 740 (38.46%) had EPTB, and 39 cases (5.27% of EPTB) were treated for gastrointestinal TB. This percentage of EPTB and GITB is higher than other studies (4), (5), (6). Among 30 remaining patients treated for gastrointestinal TB, most were females (2.75 times higher than males). The female predominance had been reported in other studies (7), (8), (9), (10), (11), (12). It is documented that TB is due to a defect in cellular immunity, and sexual hormones have some effects on human immunity.
The mean age of the patients was 32.03Â±13.73 years (median=27 years). Most of the cases (70%) were younger than 40-years-old. This is similar to other studies (1), (7), (8).But in the developed countries the EP TB often occurs in old age patients (2). Only 7 patients (23.3%) expressed previous contact with pulmonary TB cases. None of them had a past history of pulmonary TB. Some studies suggested that most of the GI TB patients (or generally EP TB) had a past history of active pulmonary TB (1), (13). Most of our patients had low socioeconomic levels and resided in rural areas. Other studies also reported that most of these patients live in poor or low economic areas (11), (14). The site of involvement in 18 cases (60%) had been reported as gastrointestinal tract, there was no specific site of involvement reported in them. In 10 cases (33.3%), peritoneal TB and in remaining 2 patients (6.7%) oropharyngeal TB were reported.
The most frequent symptoms (except for generalized presentations like fatigue, weight loss, anorexia and fever) were abdominal pain and abnormal distension, concordant with other studies (7), (8), (11), (12). We could not find clear scar of BCG vaccine in more than half of the patients (55.2%). It seems that cases without apparent BCG scar are at the higher risk for TB in the future. Patients were diagnosed as following: 1-Pathologic (18 cases, 66.7%); 2-Clinical and Para clinical (7 cases, 25.5%); and 3-Clinical suspicious to TB and therapeutic response (2 cases, 7.4%). Pathological methods are the most reliable policy for diagnosis of GI TB (13). The lag time between the onset of symptoms and the definite diagnosis was longer than one month (1.54Â±0.51 months). In other countries, this lag time was about 50 days (15), (13), (2), (7).
We strongly suggest that in every young patient (especially women) with general symptoms of chronic disease and nonspecific gastrointestinal symptoms-specially in TB endemic area- a careful work-up would be made. Extra pulmonary TB can be an important curable differential di
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