Objective: To describe the clinical, biochemical, microbiologic, radiologic and histological features and outcome of intestinal TB. Methods: Medical records of patients diagnosed with intestinal TB were reviewed. Cases were considered bacteriologically-confirmed if intestinal tissue was positive on smear culture or polymerase chain reaction (PCR); and clinically-diagnosed if with clinical, histologic, and radiologic evidence of extra-pulmonary TB. Results: Fifteen patients [Mean (SD) age: 13 (4) years; 53% females] were included. One was bacteriologically-confirmed; and fourteen were clinically-diagnosed. Fever (87%) and abdominal pain (73%) were commonly seen. Seven (47%) had anemia, 5 (33%) leukocytosis and 10 (71%) hypoalbuminemia. Eleven (73%) were positive on smear or TB PCR of various specimens. Nine of 10 (90%) patients with an abdominal CT scan had thickening of bowel loops. Three with intestinal biopsy demonstrated caseation granuloma. Fourteen patients were given quadruple anti-TB medications. Six had surgery, 8 had no disease-related complications, 4 died of sepsis and 3 were lost to follow up. Conclusion Intestinal TB presents with non-specific clinical and laboratory features. Radiologic findings may provide a clue to the diagnosis. Histologic confirmation in intestinal tissue was only seen in a few cases. The prognosis was favorable for patients who completed the anti-TB treatment.
Tuberculosis, Extrapulmonary ; Mycobacterium tuberculosis

BACKGROUND: Hepatic or liver tuberculosis is an uncommon form of extra-pulmonary tuberculosis which accounts for less than 1% of all tuberculous infections. Furthermore, tuberculous liver abscess (TLA), a subset of hepatic tuberculosis is extremely rare with a prevalence of 0.34% and is usually associated with foci of infection either in the lung, gastrointestinal tract, or an immunocompromised state. CASE PRESENTATION: A case of a 63-year-old immunocompetent male, with no history of prior pulmonary tuberculosis, was initially diagnosed with pyogenic liver abscess and treated with empiric two-week therapy of Metronidazole 500mg/tab 1 tablet TID and Ciprofloxacin 500mg/tab 1 tablet BID. However, there was the persistence of right upper quadrant pain and jaundice despite compliance to therapy, hence admission. Initial antibiotics were re-initiated and subsequently underwent ultrasound-guided liver aspiration draining a thick, light brown abscess. Microbiologic cultures of the abscess turned out negative but AFB smear revealed 1+ on the AFB national TB program scale signifying 10-99 AFB seen/ 100 visual fields in at least 50 fields. Currently, there are no local treatment recommendations specific for isolated tuberculous liver abscess, thus was empirically started on 2HRZE/4HR for six months. On follow-up, the patient had no recurrence of liver abscess via a repeat ultrasound of the whole abdomen. CONCLUSION This is an uncommon presentation of extra-pulmonary tuberculosis, an isolated tuberculous liver abscess in an immunocompetent male presenting with persistent right upper abdominal quadrant pain and jaundice. Despite the endemicity of tuberculosis in the Philippines, an isolated tuberculous liver abscess is uncommon or often overlooked. The excellent clinical prognosis of these patients with appropriate therapy necessitates timely diagnosis of this infrequent clinical entity and will prevent further unnecessary surgical interventions.
Tuberculosis ; Tuberculosis, Extrapulmonary ; Liver Abscess

Humans ; Tuberculosis, Extrapulmonary ; Retrospective Studies ; Paraffin Embedding ; Tuberculosis/diagnosis* ; Mycobacterium tuberculosis/genetics* ; Formaldehyde ; Sensitivity and Specificity ; Sputum

BACKGROUND AND OBJECTIVES

Hepatobiliarypancreatic tuberculosis (HBPTB) is a less common form of tuberculosis that often presents as malignancy or lithiasis. Advances in diagnostics and minimally invasive procedures have led to the detection of more patients with milder forms of TB requiring surgical management. Due to the low incidence rates and lack of standardized approaches, additional studies are needed to improve patient outcomes. This study examined the risk factors, diagnostic methods, and treatments for HBPTB patients at the University of the Philippines – Philippine General Hospital (UP-PGH) from January 1, 2014 to December 31, 2021.

METHODS

This retrospective descriptive study utilized our institutional database to identify patients who underwent a surgical procedure for HBPTB and their associated risk factors. Inclusion criteria required biopsy or microbiologic proof of tuberculous involvement of the biliary tract or nearby structures.

RESULTS

Among a total of 45 patients, the most common admitting diagnosis were HBP tuberculosis (37.8%) and malignancy (35.6%). 47.6% of patients had a previous or concurrent TB exposure. Sixty percent had subclinical malnutrition indicated by normal weight and low albumin. The liver (37.8%) and the bile ducts (33.3%) were the most common organs involved. The most common surgical procedures done were ultrasound-guided liver biopsy, biliary enteric anastomosis, percutaneous transhepatic biliary drainage (PTBD), and endoscopic retrograde cholangiopancreatography with or without stenting (ERCP).

CONCLUSIONS

This study provides additional data for clinicians to tailor diagnostic and treatment plans accordingly. Striking a balance between surgical procedures and appropriate anti-tuberculous therapy (ATT) is essential for successful treatment. Local data can be useful to help identify tuberculosis patterns unique to Filipinos and highlight socio-economic factors contributing to this rare presentation of TB.

Human ; Tuberculosis, Extrapulmonary ; Biliary Tract Diseases ; General Surgery ; Acute Care Surgery ; Liver Diseases ; Pancreas