| The WHO announced on World TB Day 24th March 2005 that tuberculosis in
Africa has reached alarming proportions with a growing number of cases
linked to HIV.
The director-general of WHO Lee Jong-Wook called upon the international
community to step up efforts to tackle both diseases together HIV/AIDS and
TB. The incidence of TB in Africa as having tripled since 1990, and some of
the African states don’t have access to essential TB programs. While
addressing the G8 summit, Nelson Mandela said we can’t fight AIDS unless we
do much more to fight TB.
These alarming reports reveal tuberculosis and HIV as a co-epidemic, and as
health workers we should become more vigilent in protecting ourselves and
more aware of these conditions becoming more prevalent.
One of the rare conditions becoming more prevalent is TB related colitis. It
can occur secondary to the ingestion of tubercle bacilli which have been
expectorated from cavitary lung lesions and is then swallowed. It could also
be contracted from the ingestion of contaminated unpasteurized milk.
For the diagnosis of intestinal TB, confirmation by biopsies is highly
recommended as biopsies may reveal the typical lesions. These include
granulomas of tuberculosis, mucosal oedema, ulcerohypertrophic mucosa, and
thick nodular mucosal folds within the caecum. Ulcerations can be varied in
extent and stenotic areas are sometimesmistaken for colonic carcinoma.
Patients may present with symptoms similar to T.B. and IBS combined, which
may seem contradictory and confusing. (Abdominal pain, constipation,
diarrhea, vomiting, anorexia and mass loss with weakness and malaise, night
sweats and intermittent pyrexia with tachycardia).
Sub-mucosal inflammation, oedema, and caseating necrosis may only be evident
at surgery when colonic T.B. presents as a perforated bowel along with all
its symptoms. When tissue samples are sent for cytology the Koch’s bacilli
are present.
Chest x-rays and biopsies taken of any suspicious lesions in the colon which
reveal the Koch’s bacilli should be put on a program of T.B. treatment. The
patient needs counselling and needs to understand the importance of the
treatment which is used.
Treatment is prescribed according to body weight. The first line of
treatment is with Rifafour e-275 that is combination of four agents
Rifampicin, Isoniazide, Pyrazinamide and Ethambutol. ( 2 months). This is
followed up with Rimactazid which is a combination of two agents Rifampicin
and Isoniazide.
Last year in the Eastern Cape 41734 new TB patients were reported. It is
shocking that 9,7 per cent of all the patients did not complete their
treatment. To try and curb the defaulter rate adequate programs must be
accessed. If pulmonary T.B. can be treated and controlled adequately,
colonic T.B. can also be controlled.
In conclusion, we can only hope for global African assistance in combating
epidemics which are associated with poverty and overcrowding.
|
