Health:Tuberculosis of the intestines

Tuberculosis (T.B.) is an infection caused by the microbe called mycobacterium tuberculosis. It causes an insidious illness which is usually contagious. Those staying in close contact with a patient are at high risk of acquiring the illness. Tuberculosis affects not only the lungs, but other parts of the body as well, what is known as extra pulmonary tuberculosis. Intestinal T.B. is a matter of concern as it mimics many other diseases hence becomes difficult to diagnose. Before, tuberculosis of the intestines was more prevalent in underdeveloped countries of Africa and Asia. But since the advent of HIV/AIDS, its prevalence has risen in developed western countries also. The infection can pass from the lungs to the intestines via blood stream or lymphatics. In some cases the intestines get infected directly due to infection by the bovine strain of mycobacterium tuberculosis. Drinking raw uncooked milk exposes people to the risk of infection due to the T.B. germs present in the milk. Alteration in the bowel habit is the most common manifestation of T.B. of the intestines. One may start having diarrhea or constipation which does not respond to the usual treatment given. In some persons, diarrhea may alternate with constipation. Usually this becomes chronic or recurrent. In addition one may have cramp like pain in the lower or upper abdomen depending on the site affected. After eating, a person may have a sense of bloating of the abdomen. Anorexia also develops along with other symptoms. Due to all these combined, the overall food intake of the affected person is markedly diminished. Night sweats and evening rise of temperature may or may not be present in case of T.B. of the intestines. Gradually one starts suffering from chronic deficiency of all necessary nutrients and becomes cachexic. These symptoms also occur in carcinoma of the bowels, malabsorption syndromes and also in inflammatory disease of the bowels like Crohn;s disease. But it is important to diagnose T.B. of the intestines as its treatment is different from these conditions and is curable. A high degree of suspicion is needed to diagnose intestinal T.B. In a young adult presenting with chronic diarrhea or constipation along with chronic weight loss and malnutrition, tuberculosis should be considered as one of the diagnosis. Definitive diagnosis of tuberculosis of the intestines is by biopsy of a piece of the intestine which shows the typical tubercular lesion. A sample can also be taken for culture where the causative germs can be demonstrated. Direct microscopic examination of a piece of the intestine for the causative mycobacteria may not demonstrate the mycobacteria always as happens with pulmonary T.B.Treatment involves eradication of the T.B. germs by chemotherapy. This is a difficult part as chemotherapy involves combination of drugs given over 6 to 9 months. Mostly as one starts feeling good, he or she may become irregular in taking the medicines. Moreover after some time, many persons start suffering from the adverse effects of the drugs. Burning sensation in the feet, is one of the most common side effect of anti T.B. chemotherapy and occurs due to pyridoxine (vitamin B6 deficiency) caused by isoniazid(an anti T.B. drug). Apart from this, anorexia, blurring of vision, jaundice, e.t.c., are other side effects of anti T.B. chemotherapy. Many times people stop regular treatment because of these side effects. Poor compliance on the part of the patient due to whatever reason leads to emergence of resistance in mycobacteria against the anti T.B. drugs. This results in inadequate treatment of such cases. Thus these individuals continue to suffer and also become the source of infection to others in the community. Therefore it is important on part of caregivers to see that the person suffering from T.B. of the intestines takes treatment regularly.Apart from chemotherapy, attention to the nutrition of an individual is of vital importance in helping him to get cured. As the nutritional status of a person is improved, his immune status, i.e. his body’s capability to fight germs is also increased. This also helps in eradication of the infection. rachna212002@yahoo.co.uk