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GASTROINTESTINAL MANIFESTATIONS OF MYCOBACTERIUM TUBERCULOSIS: A POPULATION-BASED STUDY IN THE CALGARY HEALTH REGION

K Novak, S Medlicott, S Bass, R Cowie, PL Beck
University of Calgary, Calgary, Alberta

BACKGROUND: Although the incidence and prevalence of Mycobacterium tuberculosis (TB) in the developed world has decreased over the last decade, it continues to be of significant import globally, as up to one third of the world's population is infected with TB resulting in 3 million deaths annually. The incidence in Canada is low among the general population (7.1 per 100,000), and little data exists regarding the incidence of TB in the province of Alberta. Recent data from the Calgary Health Region (CHR) showed 435 new cases of TB within the period of 1995-2002. Although extra-pulmonary TB makes up only 11% of new cases in Canada annually, in the CHR (1995-2002) 49% of new cases of TB were non-pulmonary. Data describing the incidence or clinical spectrum of non-pulmonary manifestations, namely gastrointestinal (GI) TB is scarce.
AIMS: Determine the incidence of biopsy proven GI TB in the CHR and report on the spectrum of clinical presentations and response to therapy.
RESULTS: The CHR serves a population of 1.2 million people and all pathology reports from all procedures are processed and recorded through a central data base (CLS data base). A search of the CLS database found 54 pathology cases of confirmed TB, the principal site was lymph nodal (21), primarily from the neck (16). 10 cases were of the GI tract (Jan 2000 to Dec 2005). Of the GI TB cases identified, 6 were female and 4 males. Two were under the age of 20 years. One patient, a 20 year old male, presented with a 3 month history of epigastric pain, nausea, vomiting, and a 13 kg weight loss. Endoscopy revealed near complete duodenal obstruction. Following a few months of TB therapy the patient was completely asymptomatic. A 16 year old girl presented with jaundice, a dilated common bile duct and an 8 kg weight loss. Biopsies of portal lymph nodes confirmed TB and treatment yielded complete resolution of her symptoms. Both of these patients were born in the Philippines. Further details on the presentations of the other patients identified are currently pending.
CONCLUSIONS: To our knowledge, this will be the first case series specifically describing GI TB in Canada. Further data on the incidence, clinical presentation, diagnosis and management of GI TB will aid in identification and treatment. Such knowledge is critical, as physicians knowledge of TB significantly impacts patient survival.

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