TROPICAL DISEASE 19

6.3 GASTROINTESTINAL TUBERCULOSIS

Gastrointestinal tuberculosis constitute nearly 1 percent of  all hospital   admission  

and  11  percent   of   small   intestinal obstruction.

These figures are low if compared with the clinical experience of

Surgeons.

The   explanation   is  that  establishing   the   diagnosis   of

tuberculosis  by  histopathology or demonstration of  bacilli  is

difficult.

6.3.1 PATHOLOGY

The abdominal cavity may be affected with tuberculosis through;   

   *  Primary  infection  due to direct ingestion  of  tubercular

      bacillus

   *  Spread from tuberculosis from other parts of the body

   *  Spread from female genital tract

There are three types of lesions seen:

   *  Ulcerative

   *  Fibrotic

   *  Hyperplastic

On  histology  a  typical granuloma  is  seen  however  caseation

necrosis is not always present.

Identification of tubercle bacilli is rare.

A  granuloma may show central caseation surronded  by  epitheloid

and  Langhans giant cells there are also areas  with  lymphocytes

and plasma cells.

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TROPICAL DISEASE 18

TRANSMISSION 2

- The risk of transmission is increased when susceptible contacts

share the air for prolonged periods of time with a person who has

untreated pulmonary TB and who is coughing freely.

-  In individuals who become infected, infectious  particles  are

inhaled through the nose and mouth, are carried down the  airways

of  the  lungs,  and eventually reach the  small  air  sacs  (the

alveoli).

It is in the alveoli that infection usually begins and where  the

tubercle bacilli are initially able to multiply.

-  During the first few weeks after infection,  tubercle  bacilli

spread  unchallanged from the initial location in the  lungs,to  the

lymph  nodes, in the center of the chest, and then to other  parts

of the body by way of the bloodstream.

-  Tubercle  bacilli  can  reach  all  areas  of  the  body,  but

frequently   travel  to  certain  areas  that  are   particularly

susceptible to developing disease, such as the upper portions  of

the lungs,the kidneys, the brain, and bone.

-  Within 2 to 10 weeks, the body's immunologic response to  the

tubercle  bacilli  is  usually  sufficient  to  prevent   further

bacterial multiplication and spread. 

-  At this point an infected person will usually have a  positive

tuberculin skin test.

- For those who develop active TB, the lungs are the most  common

site of disease (in approximately 85 percent of all cases). 

- But disease may occur at any site in the body.

- Extrapulmonary disease may occur in the;

lymph nodes,

brain(causing TB meningitis),

kidney,

bones, or any other site.

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TROPICAL DESEASE 16

6. TUBERCULOSIS


- Tuberculosis is a bacterial infection with many manifestations
and wide distribution in the world.
- The lungs are most commonly affected, but lesions may also
occur in the kidney, bones, lymph nodes, or disseminated
throughout the body.

- The causative organism is Mycobacterium tuberculosis, a rod 2
to 4 um in length and 0.3 um in thickness, it " is acid fast".

- Tubercle bacilli are aerobes thus the organs affected are
vascular and relatively high in oxygen tension; two species of
tubercle bacilli cause the disorder M.tuberculosis and M.bovis.

6.1 TRANSMISSION

This communicable disease caused by Mycobacterium tuberculosis,
often called tubercle bacilli.
- Is spread person to person.
- Airborne infectious particles are produced when a person with
infectious TB of the lung or larynx forcefully exhales such as
when coughing, sneezing, speaking,or singing.

- These particles are dispersed in the local environment, remain
airborne, and can be inhaled by someone sharing the same air
space.

- TB is more easily transmitted in closed air spaces where
ventilation is poor.

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TROPICAL DISEASE 15

4.2 VISCERAL LEISHMANIASIS (KALA-AZAR)

The causitive organism is L Donovani also transmitted by a

sandfly.

The prasite is transported by lymphatic to lymph nodes

and viscera.

Some control of the disease has occured through DDT

and antimalaria programmes.

It still persists in Assam, Bihar,West Bengal, Nepal and Sikkim.

4.2.1 Clinical

In the early stage the patient suffers from intermittant fever

and anaemia.

In later stages there is hepatosplenomegaly.

Bone marrow smears slow L. Donovani.

The patients respond to pentavalant antimony therapy.

TREATMENT

The disorder can be treated with stibogluconate.

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