Abdominal TB exists

SIHLE (not real name) is a young 26-year-old university student in Bulawayo who battled an unknown health condition for months, with no clue what was consuming her weight and she could not explain the diarrhoea she was experiencing.

She suffered loss of appetite, stomach pain and would spend a lot of time sleeping at home. Sihle even visited a traditional healer in a bid to find out what the mystery disease was but she found no joy.

Months later her stomach started swelling up and she assumed she was pregnant but that was not the case. The swelling prompted her to visit a hospital in the city where she was told she had abdominal tuberculosis (TB).

Although TB most commonly affects the lungs (pulmonary), any organ or tissue can be involved (extra pulmonary).

TB in general is re-emerging as a global emergency which is further complicated by HIV/Aids and the use of immunosuppressant drugs. TB may involve any body system and in the abdomen it can mimic many conditions, like inflammatory bowel disease, malignancy and other infectious diseases. Untreated or delayed treatment can result in life-long complications. It is therefore necessary to recognise the disease early and initiate treatment for this curable disease.

Abdominal TB may present varying imaging features depending upon the organs involved. A CT scan offers the unique ability to image the entire abdominal structures in a single examination and pick out any abnormalities.

The Ministry of Health and Child Care Aids and TB unit, however, said this type of TB is rare in Zimbabwe.

“The type of TB in question is a very rare one and in our implementation they are collectively recorded as Extrapulmonary TB so data for disaggregated by type of Extrapulmonary TB. Understanding on the common type of TB is still limited,” said advocacy communication and social mobilisation officer in the ministry, Mr Andrew Nyambo.

He said the other emerging types of Multiple Drug Resistant TB were much more common.

TB is caused by bacteria (Mycobacterium tuberculosis) that most often affects the lungs. Tuberculosis is curable and preventable too.

TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.

Less commonly, TB infections develop in areas outside the lungs, such as the lymph nodes (small glands that form part of the immune system), the bones and joints, the digestive system, the bladder and reproductive system, and the nervous system (brain and nerves).

Research says Abdominal TB can result from direct seeding of the abdominal cavity or by blood spread from the lungs. Sometimes, the bacteria can enter the food pipe and can get to the intestines. TB bacteria can cause infection of any part of the abdomen and pelvis, including the intestines, liver, kidney, spleen, urinary system and the uterus and its associated structures.

Each form of abdominal tuberculosis has its own specific set of symptoms and signs. Diagnosis of each of these requires different modalities.

Some other signs and symptoms of abdominal TB include pain in the abdomen, nausea, loss of weight, diarrhoea, fever, vomiting and constipation.

Directly observed treatment is one of the core elements in the treatment strategy. This requires a supervisor to watch a patient taking the tablets. This ensures that the patient takes right drugs, in the right doses and completes the treatment. The best supervisors are health workers and community health workers.

Tuberculosis mostly affects adults in their most productive years. However, all age groups are at risk. Over 95 percent of cases and deaths are in developing countries. According to the World Health Organisation (WHO) people who are infected with HIV are 20 to 30 times more likely to develop active TB. The risk of active TB is also greater in persons suffering from other conditions that impair the immune system like HIV.

Once a diagnosis of TB is made it is the responsibility of the health care worker to ensure that the patient is notified and registered, and completes the full course of TB treatment.

Patients with other forms of TB like that of the abdomen are given the standardised treatment regimen for six months except for those with TB of the meninges, bone, joint, pericardium, disseminated or spinal disease with neurological complications who should have a prolonged continuation phase of six months.

Zimbabwe falls within the list of 22 countries in the world that are most burdened by TB.

The WHO End TB Strategy, adopted by the World Health Assembly in May 2014, is a blueprint for countries to end the TB epidemic by driving down TB deaths, incidence and eliminating catastrophic costs. It outlines global impact targets to reduce TB deaths by 90 percent and to cut new cases by 80 percent between 2015 and 2030, and to ensure that no family is burdened with catastrophic costs due to TB.

Ending the TB epidemic by 2030 is among the health targets of the newly adopted Sustainable Development Goals. WHO has gone one step further and set a 2035 target of 95 percent reduction in deaths and a 90 percent decline in TB incidence.

Medical doctors noted that people who experience symptoms like that of Sihle should seek medical assistance and get treatment as soon as they can so that abdominal TB is treated.