scholarly journals Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease

2021 ◽  
Vol 6 (5) ◽  
pp. 196-211
Author(s):  
M. N. Reshetnikov ◽  
D. V. Plotkin ◽  
Yu. R. Zyuzya ◽  
A. A. Volkov ◽  
O. N. Zuban ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Immunosuppressive Therapy ◽  
Abdominal Cavity ◽  
Intestinal Tuberculosis ◽  
Clinical Manifestations ◽  
Granulomatous Inflammation ◽  
Diagnostic Features ◽  
Fecal Matter

The differential diagnosis of intestinal tuberculosis and Crohn’s disease is a difficult task for most specialists due to their high similarity in clinical manifestations, instrumental diagnosis and histological pattern.The aim: to consider the clinical and diagnostic features of intestinal tuberculosis and Crohn’s disease, to show the role of various methods of their diagnosis (CT of the abdominal cavity, CT-enterography, colonoscopy with biopsy).A clinical example shows a case illustrating the difficulties of diagnosing intestinal tuberculosis, initially diagnosed as Crohn’s disease. The features of the course, complex diagnosis and treatment of intestinal tuberculosis and its complications during immunosuppression are demonstrated. At the first stage of treatment, the patient’s data related to CT of the chest organs, colonoscopy and histological examination of biopsy samples were incorrectly interpreted. As a result, a wrong diagnosis of Crohn’s disease was made, and immunosuppressive therapy was prescribed that provoked a generalization of the existing tuberculosis process. Subsequently, repeated surgical interventions were performed for complications of intestinal tuberculosis – perforation of tuberculous ulcers, peritonitis. Based on the analysis of the literature data and our own observation, it is shown that granulomatous inflammation in the study of intestinal biopsies doesn’t always allow us to make a clear diagnosis, first of all, there are intestinal tuberculosis and Crohn’s disease in the differential diagnostic series. The use of histobacterioscopy according to Ziehl – Neelsen, the study of fecal matter by luminescent microscopy, as well as molecular genetic methods for detecting DNA MTB allow us to verify the diagnosis. If Crohn’s disease is misdiagnosed as intestinal tuberculosis, then the prescribed anti-tuberculosis therapy can cause harm and lead to a delay in the underlying disease treatment. The reverse misdiagnosis is potentially more dangerous: if tuberculosis is misdiagnosed as Crohn’s disease, then the appointment of immunosuppressive therapy can lead to the generalization of tuberculosis and the development of fatal complications. 

scholarly journals Ileum Histoplasmosis Mimicking Intestinal Tuberculosis and Crohn’s Disease

2018 ◽  
Vol 12 (1) ◽  
pp. 63-68
Author(s):  
Xin-Bo Ai ◽  
Zhen-Jiang Wang ◽  
Qi-Chao Dong ◽  
Xu Lin ◽  
Yu-Ping Chen ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Surgical Resection ◽  
Case Reports ◽  
Bone Marrow Involvement ◽  
Intestinal Tuberculosis ◽  
Clinical Manifestations ◽  
Antibody Test ◽  
Final Approach

Gastrointestinal histoplasmosis (GIH) without pulmonary and bone marrow involvement is very rare worldwide. It can be misdiagnosed as intestinal tuberculosis or Crohn’s disease. There are just few case reports of GIH in patients with a positive HIV antibody test. Here, we report a patient who presented to our hospital with repeated intestinal obstruction. The suspicious diagnosis was intestinal tuberculosis or Crohn’s disease due to unspecific clinical manifestations and radiologic images. Our patient’s HIV antibody test was negative. She had no medical prescriptions. Therefore, our differential diagnosis needed to include ileum histoplasmosis besides intestinal lymphoma, intestinal tuberculosis, and Crohn’s disease. Finally, the patient was diagnosed with ileum histoplasmosis due to surgical resection. It is important to be aware of potential infectious diseases, such as ileum histoplasmosis, when making a differential diagnosis. Moreover, surgical resection might be the final approach for small-intestine stricture with fibrosis.

Building a trustworthy AI differential diagnosis application for Crohn’s disease and intestinal tuberculosis (Preprint)

2021 ◽  
Author(s):  
Keming Lu ◽  
Yuanren Tong ◽  
Si Yu ◽  
Yucong Lin ◽  
Yingyun Yang ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Statistical Significance ◽  
Intestinal Tuberculosis ◽  
Language Models ◽  
Diagnostic Features ◽  
College Hospital ◽  
Medical College ◽  
Validation Set

BACKGROUND Differentiating between Crohn’s disease (CD) and intestinal tuberculosis (ITB) has long been an important and challenging problem in clinical practice. Endoscopy is an essential examination for a timely and accurate diagnosis but the results can be confusing and rely heavily on the experience of the clinician. OBJECTIVE We aim to perform more accurate endoscopic diagnosis between CD and ITB by building a trustworthy AI differential diagnosis application with high interpretability. METHODS A total of 1271 electronic health record (EHR) patients who had undergone colonoscopies at Peking Union Medical College Hospital (PUMCH) and were clinically diagnosed with CD (n=875) or ITB (n=396) were used in this study. We build a workflow to make diagnoses with EHRs and mine differential diagnosis features; this involves finetuning the pretrained language models, distilling them into a light and efficient TextCNN model, interpreting the neural network and selecting differential attribution features, and then adopting manual feature checking and carrying out debias training. RESULTS The accuracy of debiased TextCNN on differential diagnosis between CD and ITB is 0.83 (CR F1: 0.87, ITB F1: 0.77), which is the best among the baselines. On the noisy validation set, its accuracy was 0.70 (CR F1: 0.87, ITB: 0.69), which was significantly higher than that of models without debias. We also interpret all of the models and find that the debiased model more easily mines the diagnostically significant features. The debiased TextCNN unearthed 39 diagnostic features in the form of phrases, 17 of which were key diagnostic features recognized by the guidelines. CONCLUSIONS We build a trustworthy AI differential diagnosis application for differentiating between CD and ITB focusing on accuracy, interpretability and robustness. The classifiers perform well, and the features that were found to have statistical significance are in agreement with clinical guidelines.

scholarly journals Levels of TB-IGRA may help to differentiate between intestinal tuberculosis and Crohn’s disease in patients with positive results

2020 ◽  
Vol 13 ◽  
pp. 175628482092200
Author(s):  
Yujie Zhao ◽  
Meilin Xu ◽  
Liang Chen ◽  
Zhanju Liu ◽  
Xiaomin Sun
Keyword(s):  
Weight Loss ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Tuberculosis ◽  
Clinical Manifestations ◽  
Final Analysis ◽  
Interferon Gamma Release Assay ◽  
Significant Difference ◽  
History Of ◽  
Diagnosis Criteria

Aim: The aim of this study was to investigate the significance of positive tuberculosis interferon gamma release assay (TB-IGRA) in the differential diagnosis of intestinal tuberculosis (ITB) and Crohn’s disease (CD) patients, and to find a suitable threshold to help distinguishing CD from tuberculosis (TB), so as to provide better recommendations for clinical treatment. Methods: A retrospective study was performed including 484 patients who underwent TB-IGRA testing for suspected CD or ITB treated in the Shanghai Tenth People’s Hospital of Tongji University between January 2015 and May 2018. According to the diagnostic criteria, 307 patients, including 272 CD and 35 ITB patients, were recruited for the final analysis. We comprehensively and systematically collected their clinical manifestations, and analyzed the influence of TB-IGRA values referring to diagnosis criteria, and the possible causes of false positives. The receiver operator characteristic (ROC) curve and the cut-off value were applied to distinguish between ITB and CD patients. Results: Of the 56 patients with suspected CD enrolled, 23 were finally diagnosed with CD and 33 with ITB. In patients with TB-IGRA ⩾ 100 pg/ml, 4 cases were CD and 29 cases were ITB, while 19 cases were CD and 4 cases were ITB in patients with TB-IGRA < 100 pg/ml ( p < 0.05). TB-IGRA ⩾ 100 pg/ml indicated a high possibility of TB infection, with a sensitivity of 88% and a specificity of 74%. Three out of the four CD patients with TB-IGRA ⩾ 100 pg/ml had a history of tuberculosis, while only 1 of the 19 CD patients with TB-IGRA < 100 pg/ml had a history of tuberculosis ( p < 0.05). The average duration of ITB was 7 months, and that of CD was 46.8 months, thus a significant difference ( p < 0.05) was observed. Perianal lesions such as anal fistula or abscess were found in all CD patients. Among ITB patients, 8 out of 15 patients with TB-IGRA ⩾ 400 pg/ml experienced weight loss, while only 1 out of 18 patients with TB-IGRA < 400 pg/ml underwent weight loss ( p < 0.05). Conclusion: Patients with CD have longer duration of disease, and perianal lesions are more common in CD. ITB patients with TB-IGRA ⩾ 400 pg/ml experience weight loss more readily, which indicates that TB-IGRA value may be correlated positively with the severity of ITB. In patients with CD and ITB, TB-IGRA = 100 pg/ml may be a cut-off value of TB-IGRA. For patients with TB-IGRA ⩾ 100 pg/ml, it is recommended to use diagnostic anti-TB treatment first. Comprehensive analysis and judgment are required for patients with TB-IGRA from 14 pg/ml to 99 pg/ml. TB-IGRA false positivity may occur in patients with a history of TB infection.

scholarly journals Visceral Fat as a Useful Parameter in the Differential Diagnosis of Crohn's Disease and Intestinal Tuberculosis

2014 ◽  
Vol 12 (1) ◽  
pp. 42 ◽  
Author(s):  
Jun Kwon Ko ◽  
Hang Lak Lee ◽  
Jin Ok Kim ◽  
Soon Young Song ◽  
Kang Nyeong Lee ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Visceral Fat ◽  
Intestinal Tuberculosis

scholarly journals Application value of tissue tuberculosis antigen combined with Xpert MTB/RIF detection in differential diagnosis of intestinal tuberculosis and Crohn’s disease

2020 ◽  
Author(s):  
Baoying Fei ◽  
Lin Zhou ◽  
Yu Zhang ◽  
Linhe Luo ◽  
Yuanyuan Chen
Keyword(s):  
Differential Diagnosis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Tuberculosis ◽  
Surgical Excision ◽  
Endoscopic Biopsy ◽  
Detection Sensitivity ◽  
Intestinal Tissue ◽  
Tissue Samples ◽  
Tuberculosis Antigen

Abstract Background: The purpose of this study was to evaluate the value of Xpert MTB/RIF detection and tuberculosis antigen detection of Mycobacterium tuberculosis cluster (MTBC) in intestinal tissues for differentiating intestinal tuberculosis (ITB) from Crohn’s disease (CD). Methods: A total of 110 patients who were clinically diagnosed with CD or ITB were monitored. Several specimens of intestinal tissue from endoscopic biopsy or surgical excision were used for culture and Xpert MTB/RIF for detection of MTBC, respectively. Four antigens (38KDa, ESAT-6, MPT64, Ag85 complex) of MTBC in intestinal tissue were detected by immunohistochemistry. Results: A total of 42 cases of intestinal tuberculosis and 46 cases of CD were included in the experimental analysis. Perianal lesions and longitudinal ulcers were more common in CD patients (p < 0.05), while caseous granuloma and annular ulcers were more common in ITB patients (P < 0.05). The positive rate of MTBC detected by Xpert MTB/RIF in intestinal tissue samples of ITB patients was 33.33%, which was significantly higher compared to CD patients (p < 0.05) and compared to acid-fast staining smears (9.52%) (p < 0.05). The positive MPT64 expression rate in patients with intestinal tuberculosis was 40.48%, which was significantly higher than that observed in CD patients, which was 19.56% (p<0.05). Conclusions: The detection of Xpert MTB/RIF in intestinal tissue is a rapid and useful method for establishing an early diagnosis of intestinal tuberculosis. The detection of Xpert MTB/RIF and MPT64 antigen in intestinal tissues have definitive value in the differential diagnosis of intestinal tuberculosis and Crohn’s disease. The combination of these two methods could improve detection sensitivity.

scholarly journals Application value of tissue tuberculosis antigen combined with Xpert MTB/RIF detection in differential diagnosis of intestinal tuberculosis and Crohn’s disease

2019 ◽  
Author(s):  
baoying fei ◽  
lin zhou ◽  
yu zhang ◽  
Linhe Luo ◽  
Yuanyuan Chen
Keyword(s):  
Differential Diagnosis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Tuberculosis ◽  
Surgical Excision ◽  
Endoscopic Biopsy ◽  
Detection Sensitivity ◽  
Intestinal Tissue ◽  
Tissue Samples ◽  
Tuberculosis Antigen

Abstract Abstract Background: The purpose of this study was to evaluate the value of Xpert MTB/RIF detection and tuberculosis antigen detection of Mycobacterium tuberculosis (MTB) in intestinal tissues for differentiating intestinal tuberculosis (ITB) from Crohn’s disease (CD). Materials and Methods: A total of 110 patients who were clinically diagnosed with CD or ITB were monitored. Several specimens of intestinal tissue from endoscopic biopsy or surgical excision were used for MTB culture and Xpert MTB/RIF detection, respectively. Four antigens (38KDa, ESAT-6, MPT64, Ag85 complex) of MTB in intestinal tissue were detected by immunohistochemistry. Results: A total of 42 cases of intestinal tuberculosis and 46 cases of CD were included in the experimental analysis. Perianal lesions and longitudinal ulcers were more common in CD patients (p < 0.05), while caseous granuloma and annular ulcers were more common in ITB patients (P < 0.05). The positive rate of M. tuberculosis detected by Xpert MTB/RIF in intestinal tissue samples of ITB patients was 33.33%, which was significantly higher compared to CD patients (p < 0.05) and compared to acid-fast staining smears (9.52%) (p < 0.05). The positive MPT64 expression rate in patients with intestinal tuberculosis was 40.48%, which was significantly higher than that observed in CD patients, which was 19.56% (p<0.05). Conclusions: The detection of Xpert MTB/RIF in intestinal tissue was conducive to the quick and early diagnosis of intestinal tuberculosis. Xpert MTB/RIF and MPT64 antigen in intestinal tissues had certain value in the differential diagnosis of intestinal tuberculosis and Crohn’s disease. The combination of these two methods could improve detection sensitivity.

M1112 Clinical Usefulness of Visceral Fat in the Differential Diagnosis of Crohn's Disease from Intestinal Tuberculosis

2009 ◽  
Vol 136 (5) ◽  
pp. A-352
Author(s):  
Seung Chul Cho ◽  
Hang Lak Lee ◽  
Narae Ha ◽  
Sunggon Shim ◽  
Kangnyeong Lee ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Visceral Fat ◽  
Intestinal Tuberculosis ◽  
Clinical Usefulness

A case report of a patient with isolated Crohn’s disease of the stomach

2021 ◽  
Vol 19 (3) ◽  
pp. 95-101
Author(s):  
E.A. Trush ◽  
◽  
A.I. Ulyanin ◽  
A.V. Korolev ◽  
L.N. Androsova ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Symptoms ◽  
Granulomatous Inflammation ◽  
Endoscopic Finding ◽  
Disease Course ◽  
Morphological Examination ◽  
Gastric Biopsies ◽  
Upper Gastrointestinal

Crohn’s disease of the esophagus, stomach or duodenum is extremely rare and characterized by an aggressive disease course with a poor prognosis. Clinical symptoms of the upper gastrointestinal tract lesion are nonspecific, therefore esophagogastroduodenoscopy with biopsy is necessary for the differential diagnosis. Crohn’s disease of the stomach is characterized by a specific endoscopic finding – bamboo-joint-like appearance of gastric folds. Granulomatous inflammation in morphological examination of gastric biopsies in patients with Crohn’s disease is rare, therefore endoscopic finding is more pathognomonic. This article presents a clinical case of a patient with isolated Crohn’s disease of stomach, differential diagnosis and treatment approaches of the disease. Key words: Crohn’s disease, Crohn’s disease with lesions of the stomach, gastroprotective agents, proton pump inhibitors, endoscopic sonography

Sign in / Sign up

Export Citation Format

Share Document