Difference between Intestinal Tuberculosis and Intestinal Amoebiasis
Difference between Intestinal Tuberculosis and Intestinal Amoebiasis
Tuberculosis is a chronic illness caused by Mycobacterium Tuberculosis and it is abbreviated as T.B. it can occur in any part of gastrointestinal disease starting from oral cavity to anal canal. It required immediate and long term treatment otherwise results in multiple complications e.g. rupture of intestines which then need surgical procedure. Amoebiasis is also an intestinal infection. The organism causing it is known as ‘Entamoeba histolytica’. Its treatment is easy and short term as compared to intestinal T.B. But early investigations and diagnosis is necessary for total cure. Both the diseases are irritating for patients as they produce symptoms early.
Intestinal T.B
Tuberculosis (TB) kills 3 million people worldwide every year. An estimated 1 billion people will be infected in 2000-2020, 200 million will become ill and 35 million will die from TB if control is not strengthened. Radiological characteristics and clinical association with the history of tuberculous infection in the GI tract. The bacteria cause the disease when the immune system is weakened, as in older patients and in patients who are HIV positive. The control of TB has been challenging because of the natural history of the disease and the varying pattern in which it manifests in different groups. Tuberculosis bacteria enter the gastrointestinal tract by haematogenous dissemination, ingestion of contaminated sputum, or direct dissemination from contaminated contiguous lymph nodes and fallopian tubes.The most commonly involved sites are ileum, proximal colon and peritoneum. There are two types of intestinal T.B. First one is ulcerative tuberculosis, it occurs after tuberculous infection of lungs caused by swallowing of tubercle bacilli. It produces ulcers in the ileum. Second type is hyperplastic T.B which is caused by ingestion of mycobacterium tuberculosis by persons who have high resistance against the organism.
Intestinal Amoebiasis
Amoebiasis is caused by entamoeba histolytica which is mainly found in impure food and drinks. Amoebiasis is common in tropical countries with underdeveloped sanitation. It is most prevalent in the Indian subcontinent, sections of Central and South America, and countries in Africa. It infects human beings in the form of cysts which reach the intestine through infected food and water. In the small intestine it is converted into adult form called trophozite which are then transferred to colon and produce ulcers in colon and upper part of rectum. In the cecum it can cause perforation. Diagnosis is mainly based on laboratory investigations.
Intestinal T.B VS Intestinal Amoebiasis
Causative factor
Intestinal T.B is caused by mycobacterium tuberculosis.
Intestinal amoebiasis is caused by entamoeba histolytica.
Sign and Symptoms
The most common -symptoms seen are fever with night sweats , weight loss , anemia , abdominal pain relieved on diarrhea. Hyperplastic TB causes enlargement of lymph nodes and there may be a mass in the right lower part of belly. Symptom of this disease may resemble that of cancer, appendicitis, fungal infection and female reproductive parts tumor
Usually the symptoms of Intestinal Amebiasis appear after 1 to 4 weeks of ingestion of cyst.Sometime patient is asymptomatic too. If the parasite decides to invade the lining of your intestine, it may cause amebic dysentery. Amebic dysentery is a more aggressive type of amebiasis with regular watery, bloody stools and sometimes liquid whitish discharge in the stools can be seen too with extreme stomach cramping.
Duration of disease
Intestinal T.B is a chronic disease.
Intestinal amoebiasis may be acute or chronic.
Ulcers
Intestinal T.B produces ulcers with undermined margins of ulcerated area.
Intestinal amoebiasis produces ulcer which are flask shaped.
Perforation
Intestinal T.B can result in perforation of part of gut.
Intestinal amoebiasis does not cause perforation.
Complication
Intestinal tuberculosis complications include perforation It is a hole in GI tract ), peritonitis( Inflammation of peritoneum), and hypertrophy, gastrointestinal bleeding, scarring, or tuberculoma ( is a clinical manifestation of tuberculosis that clustered tubercles into a firm lump) and obstruction.
In the complication of intestinal amebiasis if once trophozites have broken through the intestinal walls, they could even enter the bloodstream and travel to multiple internal organs. They may end up in your liver, heart, lungs, brain, or other organs. If trophozites infect the internal organ, they may possibly cause: Liver Abscess, infection, ulceration,loss of blood could cause anemia , severe illness and death .
Stricture
Intestinal T.B can cause constrictions in the intestine.
Intestinal amoebiasis does not cause constrictions.
Diagnosis
Intestinal tuberculosis is diagnosed through barium meal and diagnostic laparoscopy.
Intestinal amoebiasis has been given a diagnosis from your medical and travel history through stools examination, PCR, serology (ELISA) and endoscopic examination.
Treatment
Intestinal T.B is treated through Anti-Tuberculous Drugs for 9 months (initial two months of therapy with rifampicin, isoniazid, pyrazinamide and ethambutol thrice weekly.
Intestinal amoebiasis is treated through metronidazole and diloxanide furoate ( It can be used in children >2 years of age ) which kill amoebas in blood , in intestine and in liver abscess .
Differential Diagnosis
Intestinal T.B can be confused with appendix mass, crohn’s disease, lymphoma, round worm infestation, cancer and fungal infection.
Intestinal ameobiasis can be confused with Tuberculosis , cancer and it should be differentiate from infectious condition that contain occult blood in diarrhea like (campylobacter, shigella, salmonella , E-coli ) and non-infectious cause include inflammatory bowel disease
Conclusion
Intestines are subject to various acute and chronic infections resulting in complications among them intestinal tuberculosis and intestinal amebiasis are one of them. Intestinal Tuberculosis is chronic disease and is more lethal than intestinal amebiasis . However, both the diseases need early diagnosis and prompt treatment . Which one is more lethal in your opinion?
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