What Causes Abdominal TB Other Than HIV

tuberculosis

Brief overview

  • Description: notifiable bacterial infectious disease. Mainly affects the lungs, but also bones, intestines and other organs
  • Infection: mostly via droplet infection via the lungs, but also via the digestive tract or skin injuries. Only one in ten infected people develops symptoms.
  • Symptoms:Fever, cough, night sweats, weight loss, exhaustion, later bloody expectoration
  • particularly at risk: People with a weak immune system, e.g. HIV patients, people who take immunosuppressants, homeless, malnourished, children, addicts
  • Diagnosis: Antibody test on the skin, blood tests, x-rays, direct detection of bacteria
  • treatment: Antibiotics (treatment is difficult if the bacterial strain is resistant)
  • Forecast: Otherwise healthy patients have a good chance of recovery if the disease is detected early.

Tuberculosis: description

Tuberculosis (Tbc, TB) is caused by rod-shaped bacteria, so-called Mycobacteria, caused. They mainly affect the lungs, but sometimes other organs as well.

  • "Treat tuberculosis consistently!"

    Three questions to

    Dr. med. Markus Frühwein,
    Specialist in General Medicine
  • How common is tuberculosis?

    A quarter of all people worldwide are infected with the tuberculosis pathogen. However, only about one in ten actually get sick with symptoms. However, an estimated 1.4 million die from it each year. While tuberculosis is common in Eastern Europe, the western industrial nations are little affected. Around 5,500 people fell ill in Germany in 2017. The incidence rate has thus been at a similar level for years.

  • Who is particularly at risk?

    Since tuberculosis is much more common in other regions, especially in Africa, Southeast Asia and the Western Pacific, people who were born there are particularly affected in Germany. People who have close contact with patients with infectious tuberculosis are also at risk. As well as people infected with HIV and people with a weak immune system. Other risk factors are drug addiction, homelessness and poverty.

  • How long does recovery take?

    Tuberculosis can be treated with different combinations of drugs. On average, you should expect six months for standard therapy. However, should complications arise, such as resistant bacterial strains, therapy can take significantly longer. Timely treatment and regular use of the medication is crucial for success, even if it is for a longer period of time.

  • Dr. med. Markus Frühwein,
    Specialist in General Medicine

    Dr. med. Markus Frühwein is a specialist in general medicine, tropical medicine, travel medicine and nutritional medicine and owner of the Dr. Frühwein & Partner in Munich.

In most cases, the body succeeds in fighting the pathogens or in encapsulating them to render them harmless at an early stage. This is how tuberculosis breaks only in around five to ten percent of those infected actually off. Symptoms are fever, tiredness, night sweats and weight loss. Later, there is a bloody cough and shortness of breath, which is a "open" tuberculosis suggests. "Open" tuberculosis means that the foci of infection in the lungs are not encapsulated, but open to the bronchi.

In the past, tuberculosis was also known as Consumption referred to because the sick physically degrade very quickly without effective treatment.

Tuberculosis: incidence

Around ten million people are newly diagnosed with tuberculosis around the world every year. In 2019 alone, 1.4 million patients died directly from TB or as a result of the disease.

Tuberculosis has become rare in Germany. Last year the Robert Koch Institute registered 4,127 cases of illness. That is 14.2 percent less than the year before.

Reporting requirement

Doctors must report every patient suffering from tuberculosis and who needs treatment to the responsible health department by name. There is also an obligation to notify patients who suffer from pulmonary tuberculosis that requires treatment but who refuse or discontinue therapy.

Tuberculosis - it really is that dangerous

  • More tuberculosis cases in Germany

    Tuberculosis (TB) is on the rise again in Germany: 5865 cases of tuberculosis were reported to the Robert Koch Institute in 2015 - 30 percent more than in the previous year. How do the increasing numbers come about? And how dangerous is the disease for the population? The most important answers about TBC.
  • What is tuberculosis?

    TB is caused by a bacterium (Mycobacterium tuberculosis). It mainly affects the lungs, but can also implant itself in the skin, bones, kidneys and intestines. Typical symptoms in the later stages are chronic cough with (bloody) sputum, night sweats and weight loss. The disease can usually be contained well with antibiotics. If left untreated, however, it can be fatal. Therefore, around 1.5 million people worldwide still die from TB each year. And here too, the situation could worsen again.
  • How great is the danger in Germany?

    Because not only when the drugs are missing, but also when a person becomes infected with pathogens against which the common antibiotics are not effective, it becomes dangerous. It was believed that TBC had almost been defeated: While hundreds of thousands died of "consumption", as the disease was also called, in the 19th century in Germany alone, it had lost its horror by the middle of the 20th century thanks to effective antibiotics. But now the tide seems to be turning again.
  • The problem with the multi-resistant germs

    In the meantime, TB strains that are resistant to several important antibiotics are spreading worldwide. It is such multi-resistant germs that are of great concern to the experts. Treating them is tedious, difficult, and has serious side effects. The therapy does not work in about half of the patients. There are still only a few cases of multi-resistant TBC in Germany. In 2015 there were 89 - that's around three percent. But that could change.
  • Are there any danger from sick refugees?

    The probability of contracting TB in Germany is currently extremely low. Experts attribute the current rising numbers to the fact that more refugees are arriving from countries where tuberculosis is much more common. In fact, asylum seekers accounted for more than a quarter of new diagnoses in 2015. Thanks to comprehensive controls, the infected are quickly identified and treated accordingly. The refugees do not pose a threat to the population.
  • How quickly do you get infected?

    In any case, the risk of contracting TB from an infected person is low, at least after brief contact - much lower than with the flu, for example. Like this, TBC is mainly transmitted via droplet infection - but this only works if it is what is known as open pulmonary tuberculosis. The pathogens get from the lungs into the air. This is not the case with "closed" tuberculosis.
  • Only ten percent get sick

    TBC is a very common infectious disease worldwide. According to estimates by the World Health Organization, every third person carries the pathogen. However, the body usually copes well with the bacteria: the disease actually breaks out in only about ten percent. The other patients - with a so-called latent tubercular infection - cannot be infected.
  • Are there any new drugs coming soon?

    So it is not the refugees that are the problem, but the dwindling power of the drugs. Here the impending danger has been ignored for far too long. In the meantime, however, intensive research is being carried out on new drugs around the world. The most promising candidates against multi-resistant germs are currently the active ingredients bedaquiline and delamanid. For decades, they have been the first anti-TB agents to hit the market - albeit under strict conditions.

Tuberculosis - this is how you get infected

For a long time, tuberculosis was considered to be almost eradicated in the western industrialized countries. In recent years the disease has become more common again due to immigration of sick people, for example from Eastern European countries.

How do the bacteria get into the body?

The transmission of tuberculosis occurs in different ways:

  • Breathing air infection: The vast majority of patients become infected because they have been coughed or sneezed on by patients with "open" tuberculosis. The patients expel tiny droplets of secretion containing bacteria, which healthy people can inhale and then fall ill themselves.
  • Digestive tract infection: The bacteria can also enter the body through the digestive tract. The causative agent of bovine tuberculosis, Mycobacterium bovis, can be transmitted to humans through raw milk from sick cows, for example.
  • Infection through the skin: Another way of transmission is skin injuries. The tuberculosis pathogen can enter the body through them.

How contagious is tuberculosis?

Compared to other infectious diseases such as flu, TBC is not very contagious. The disease actually breaks out in only one in ten infected people. Whether you fall ill after contact with an infected person depends primarily on two factors:

  • how much pathogen the sick person has secreted
  • how powerful your own immune system is

The Tuberculosis incubation period - i.e. the time between infection and the outbreak of the disease - can be weeks to months.

Tuberculosis: symptoms

There are different signs of tuberculosis: Depending on the stage of the disease a patient is and which organs have been infected by the bacteria, different symptoms appear.

Latent tuberculosis

In many cases there are no symptoms of tuberculosis: the person's body manages to keep the bacteria in check so that there are no symptoms. Doctors refer to this as latent tuberculosis.

Closed tuberculosis

In people with good physical defenses, the immune cells form a kind of capsule around the foci of inflammation caused by the tuberculosis bacteria. Nodular structures, so-called granulomas or tubercles, develop. The pathogens can still be active in these tubercles, but do not cause any damage in the body. Later the tubercles increasingly scarred and calcified. You can often see them on x-rays years later. Doctors refer to this form of progression as closed tuberculosis.

Primary tuberculosis

In around five to ten percent of patients, the body's immune system fails to successfully encapsulate the pathogen. Then foci of inflammation form in the lungs and the nearby lymph nodes, which enlarge. This condition is known as primary tuberculosis. However, the process is slow: this stage usually begins within two years of infection.

Often the sufferers do not notice this form of tuberculosis either. However, various complaints can also occur, such as:

  • fever
  • to cough
  • night sweats
  • Loss of appetite
  • Weight loss
  • fatigue
  • exhaustion

Open tuberculosis

If the infection spreads in the body, cavities, so-called caverns, form in the lung tissue. They are filled with dead cells and active tuberculosis bacteria (necrosis, cheese formation). If these cavities break through to the bronchi, it is called open tuberculosis.

Then typical tuberculosis symptoms appear: the patient coughs up mucus, which can also be bloody. The pathogens then often find their way into the air in large numbers.

Patients with open tuberculosis are highly contagious!

Post-primary tuberculosis

Tuberculosis pathogens can persist in the body for a long time without causing symptoms. However, the disease can break out for the first time or again many years after the initial infection. Then one speaks of post-primary tuberculosis.

In around 80 percent of cases, this affects the lungs. Sometimes the pathogens are also distributed via the bloodstream. The smallest inflammations develop in other organs, so-called "minimal lesions". It usually affects the pleura, lymph nodes, bones and joints. But the digestive tract, skin and genital organs can also be affected.

Tuberculosis outside of the lung tissue

Even if they are mostly located in the lungs - tuberculosis pathogens can also infect organs and tissues in the rest of the body. There are very different symptoms.

Lung root: There are a particularly large number of lymph nodes where the bronchi enter the lungs (pulmonary root, pulmonary hilus). If they are attacked by tuberculosis bacteria, they swell and compress the adjacent airways. The lung tissue behind it is cut off from the air supply and collapses. If the lung area that is no longer ventilated is large, the patient will noticeably suffer from shortness of breath.

Pleura: With tuberculosis of the pleura (pleurisy tuberculosa), those affected usually have pain when breathing. With "wet" pleurisy, fluid collects around the lungs, which can compress the lungs so hard that it causes shortness of breath.

Miliary tuberculosis: Miliary tuberculosis is a TB infection that affects not only the lungs but also the meninges, liver, spleen, kidneys and eyes. In the process, small, granule-sized foci of inflammation are formed throughout the entire organ. They are reminiscent of millet grains, in Latin milium. This form of TB is rare in Germany. It is more likely to affect children or people with a weakened immune system.

The symptoms of tuberculosis in this form of the disease are non-specific. This means that they can also occur in many other diseases and are not typical of tuberculosis. These include fever, headache, a stiff neck and visual disturbances.

Intestinal tuberculosis: Patients contract intestinal tuberculosis mainly through the consumption of infected raw cow's milk. In addition to flu-like symptoms, there are symptoms that are reminiscent of a chronic inflammatory bowel disease: diarrhea, abdominal pain and weight loss. Often there is also blood in the stool. As the disease progresses, peritonitis or a dangerous intestinal obstruction can develop.

Skin tuberculosis: An infection of the skin with tuberculosis pathogens can manifest itself in different ways. Flat, red-brown skin changes occur most frequently. These are often hardened and clearly palpable. However, the patient is in no pain. Doctors also speak of this disease picture Lupus vulgaris.

Urinary tract tuberculosis: If the urinary tract is infected with tuberculosis, inflamed nodules form in the kidneys, ureters and bladder, which can scar and calcify. Sufferers experience pain when urinating and in the flanks. You may find blood or pus in the urine. The nodules can also block the urinary tract, causing the urine to back up. The urinary organs can suffer permanent damage as a result.

Tuberculosis of the genital organs: In women, a tuberculosis infection of the genital organs usually migrates from the fallopian tubes to the uterus. Then the menstrual period often stops and the woman can become sterile.

In men, the epididymis can be attacked by tuberculosis bacteria. These then swell painfully and are reddened. The disease can lead to infertility.

Bone and joint tuberculosis (spondylitis tuberculosa): Bone and joint TB manifests itself in swelling and pain in the joints, but especially in the thoracic and lumbar spine. The patients feel very sick.

If the inflammatory process of this tuberculosis continues untreated, abscesses form. Nerve failures with symptoms of paralysis occur in the affected areas. Often a hunched back is formed. In extreme cases, the spine kinks backwards. However, thanks to good treatment options, these severe TB symptoms have now become very rare.

Tuberculosis: causes and risk factors

With a share of over 95 percent Mycobacterium tuberculosis the most common causative agent of tuberculosis in humans (the rest is attributable to others Myobacterium-Species). The disease mainly breaks out in people with a weakened immune system. This includes:

  • HIV-infected people, AIDS patients
  • chronically ill (e.g. diabetics)
  • Patients in whom the immune system is suppressed by drugs (e.g. after a transplant)
  • Drug addicts, smokers and alcoholics
  • elderly
  • Patients with kidney failure
  • homeless people
  • Malnourished
  • Infants and children under four years of age

Migrants from countries with poor health care are comparatively likely to suffer from tuberculosis. The risk of infection is particularly high in the confined spaces of refugee accommodation. TB is also more common among prison inmates than the rest of the population.In both groups, therefore, the medical side pays special attention to the possible spread of TB.

Tuberculosis: diagnosis and examination

The signs of TB are not very characteristic (unspecific). About 15 percent of the time, there are no symptoms at all. The infection is therefore usually discovered by chance, for example during a check-up at the family doctor or specialist in internal medicine.

Medical history

Taking the medical history (anamnesis) is the first step in the event of a suspected TB. The doctor asks the patient about any symptoms, for example:

  • Do you have a low temperature?
  • Do you sweat profusely at night?
  • Have you lost a lot of weight lately?

Other circumstances that make tuberculosis more likely and should therefore be discussed in the anamnesis include:

  • previous tuberculosis infection (in this case dormant TB bacteria may have been reactivated)
  • known TB cases in the immediate vicinity, i.e. among relatives and friends or at work (especially in the medical field)
  • Travel to countries with a higher prevalence of tuberculosis
  • Pre-existing illnesses or the use of drugs that weaken the immune system and thereby promote tuberculosis infection

Physical examination

Since tuberculosis occurs in the lungs in most cases, the doctor will examine it by listening and tapping it. Signs of consumption can also be found in other parts of the body, such as skin changes or pounding pain over the side ribs or kidneys.

If a doctor suspects a tuberculosis infection based on the medical history and physical examination, there are a number of other examination options available for clarification.

Tuberculosis: test method

There are special tests that help diagnose tuberculosis.

Tuberculin skin test (THT)

In the Mendel-Mantoux tuberculin test, the doctor injects a small amount of the pathogen's protein (tuberculin) under the patient's skin. Since the immune system of infected people usually produces special antibodies against the pathogen after a few weeks, a reddened hardening forms at the injection site in people infected with tuberculosis.

However, the test does not provide proof for or against an infection. If it occurs too early (less than six weeks) after the infection or if the immune system is weakened, not enough antibodies are (yet) available. The tuberculosis skin test is negative despite the infection. Even in older people or people with weakened immune systems, the tuberculin skin test can be negative despite infection.

IGRA (interferon gamma release assay)

This test examines the patient's blood. If the person is infected with tuberculosis, special immune cells produce interferon gamma, which can be detected during this examination.

The test is more accurate than the skin test. At the moment, however, doctors are primarily using it in addition to the tuberculin skin test (THT), especially in the case of a positive skin test or people with weakened immune systems. If both the skin test and the IGRA test are negative, consumption is very unlikely.

You can read more about the tuberculin skin test and IGRA as well as rapid tests for tuberculosis diagnostics in the article Tuberculosis Test.

Direct pathogen detection

If, for example, shadows appear in the lung tissue in the X-ray image (see below) and the above-mentioned TB tests are positive, the tuberculosis bacteria must be detected directly. Sputum, gastric juice, urine, menstrual blood and cerebral fluid are examined. In some cases, doctors also take tissue samples from the lungs or lymph nodes (biopsies). If tuberculosis pathogens are actually found in the samples, a test is carried out at the same time to determine whether the bacterial strain concerned is resistant to certain antibiotics.

The direct pathogen detection is meaningful, but complex and time-consuming. It can take up to twelve weeks to get results.

roentgen

A chest x-ray (chest x-ray) can reveal possible foci of inflammation. With primary tuberculosis, these appear as round shadows. When the hilar lymph nodes are infected, the shadow resembles a chimney. With miliar TB, however, the doctor can recognize many small dots.