A Study of Intestinal Tuberculosis with particular reference to risk factors.

Suresh, Shenoy (2007) A Study of Intestinal Tuberculosis with particular reference to risk factors. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : Tuberculosis (TB) remains the single largest infectious disease causing high mortality in humans, leading to 3 million deaths annually, about five deaths every minute. Approximately 8-10 million people are infected with this pathogen every year. In India, there are about 500,000 deaths occurring annually due to TB, with the incidence and prevalence being 1.5 and 3.5 millions per year. Tuberculosis continues to be a major health problem in India. Deaths due to tuberculosis accounts to around 50/100,000 population. Forty percent of the cases in India contract tuberculosis by the age of 6 years and 80% by the age of 16 years. The incidence of tuberculosis is also increasing in Western countries. Poor socio economic status, poor sanitation and recent upsurgence of HIV infection enhance the susceptibility to tuberculosis in India. The exact prevalence of intestinal tuberculosis in India is not known. Several susceptibility-associated genetic polymorphisms have been proposed to explain differential susceptibility to tuberculosis (TB) progression in different populations. Though several gene polymorphisms have been associated with susceptibility or resistance to TB in different ethnic populations, only few of these genetic associations have shown to have functional effect on the containment by the host immune system. AIMS OF THE STUDY : To perform a case control study in patients with intestinal tuberculosis and with matched healthy controls in order: 1. To identify the prevalence of specific risk factors such as diabetes mellitus, HIV infection, family history of tuberculosis, history of BCG vaccination, in patients with intestinal tuberculosis compared to age- and sex-matched control subjects. 2. To determine whether there are specific associations of intestinal tuberculosis with factors connected with childhood hygiene, as well as a history of treatment for intestinal parasitic infections. 3. To determine the frequency of interferon- gamma (IFN-γ) polymorphisms in patients with intestinal tuberculosis compared to appropriately matched healthy controls. 4. To study the clinical and investigation profile of intestinal tuberculosis in our institution from March 2004 to July 2006. CONCLUSIONS : A case-control study showed that several factors concerned with domestic hygiene during childhood were strongly associated with a diagnosis of intestinal tuberculosis. These included: a) Living in a town or city (versus a village) during childhood b) Availability of piped drinking water in childhood c) Presence of toilets in the house in childhood. These findings suggest that immune conditioning of the gastrointestinal tract during childhood by poor domestic hygiene may protect against intestinal tuberculosis. There was high level of heterozygosity for IFN-gamma polymophisms in the community, and the prevalence of these polymorphisms did not significantly differ in ITB. In this small series, the usual risk factors for intestinal tuberculosis, including HIV infection, were not detected. Male:Female ratio was 3:2 i.e., male predominance. Mean age of presentation was 35.56 years. Abdominal pain was the most common clinical presentation and abdominal mass was the most common clinical finding. Disease distribution was oesophageal (2%), gastroduodenal (2%), duodenocolonic (2%), ileal (14%), ileocolonic (including ileocecal) in 60 % and colonic in 20%. Colonoscopic ulcers and nodularity were most common findings. Yield of colonoscopic specimens in diagnosis was high. Diagnosis was confirmed in 80% of the cases using histopathological and microbiologial methods. Surgery was infrequently needed, mainly to treat complications.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Intestinal Tuberculosis ; risk factors.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 14 Jul 2017 03:11
Last Modified: 14 Jul 2017 03:11
URI: http://repository-tnmgrmu.ac.in/id/eprint/1619

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