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IBD vs Intestinal Tuberculosis: The Role of the Infectious Disease Specialist

Intestinal Tuberculosis (TB) and Inflammatory Bowel Disease (IBD) are two conditions that can appear strikingly similar in clinical presentations, making diagnosis a challenging process. Differentiating between these two is crucial, as their treatments are entirely different—and a wrong diagnosis can lead to harmful outcomes.

Similar Symptoms, Different Causes

IBD, which includes Crohn’s disease and ulcerative colitis, is an autoimmune condition where the body attacks its own gut lining. Intestinal TB, on the other hand, is a bacterial infection caused by Mycobacterium tuberculosis affecting the gastrointestinal tract.

Common symptoms of both include:

  • Chronic abdominal pain
  • Diarrhea or altered bowel habits
  • Weight loss
  • Low-grade fever
  • GI bleeding

Despite these similarities, the underlying pathology is very different, which is why the expertise of an Infectious Disease (ID) Specialist is essential.

Why Infectious Disease Evaluation is Key

An ID specialist is trained to detect signs of chronic infections like TB that may mimic autoimmune diseases. They conduct targeted investigations including:

  • PCR testing or GeneXpert for TB DNA
  • Histopathology from biopsies
  • Mantoux (Tuberculin) tests and IGRA (Interferon Gamma Release Assays)
  • Radiological imaging (e.g., CT, MRI)

A thorough infectious workup can prevent the dangerous consequence of misdiagnosing intestinal TB as IBD and wrongly starting immunosuppressants, which can allow TB to disseminate.

  • Treatment: A Delicate Balance
  • Intestinal TB is treated with a full course of Anti-Tubercular Therapy (ATT) for 6–9 months.

IBD often requires long-term immunosuppression (steroids, biologics, etc.).

Starting immunosuppressive treatment in a patient with undiagnosed TB can be fatal. Hence, ruling out TB thoroughly before initiating IBD treatment is a standard recommendation, especially in endemic countries like India.

Clinical Clues That Favor TB Over IBD:

  • History of TB exposure or past TB
  • Presence of lung lesions on chest X-ray
  • Shorter duration of illness
  • Involvement of the ileocecal region
  • Presence of caseating granulomas on biopsy

When to Consult an Infectious Disease Specialist

  • When dealing with unexplained chronic GI symptoms
  • When biopsy shows granulomas or features that are not classic for IBD
  • Before starting immunosuppressive treatment in suspected IBD
  • If there is a lack of response to standard IBD therapies

Remember: Not all granulomatous colitis is IBD—some are TB.

Consult an infectious disease expert to avoid misdiagnosis and ensure safe, effective treatment.
👩‍⚕️ Dr. Chhavi GuptaMBBS, MD, DM (AIIMS, New Delhi)Senior Consultant – Infectious Diseases📍 Yashoda Super Speciality Hospital, Kaushambi📞 For Appointments: +91 8851 346 424🌐 drchhavigupta.com

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ATT-Induced Liver Dysfunction: A Serious Concern in TB Management

Understanding ATT and Its Role

Anti-tuberculosis therapy (ATT) is the standard treatment for tuberculosis, typically involving a combination of drugs like isoniazid, rifampicin, pyrazinamide, and ethambutol. While these drugs are effective, some of them carry a known risk of liver toxicity.

What Is ATT-Induced Liver Dysfunction?

ATT-induced liver dysfunction refers to liver damage that occurs as a side effect of TB medications. It often presents as elevated liver enzymes (transaminases), and in some cases, may progress to jaundice or even acute liver failure if left unmonitored.

Symptoms to Watch For

  • Nausea and vomiting
  • Abdominal pain (especially in the right upper quadrant)
  • Jaundice (yellowing of eyes and skin)
  • Fatigue or general weakness
  • Dark-colored urine

Who Is at Risk?

Patients at higher risk for liver toxicity from ATT include:

  • Those with pre-existing liver disease (e.g., hepatitis B or C)
  • People with poor nutritional status
  • Elderly individuals
  • Those who consume alcohol regularly
  • HIV-positive individuals
  • Monitoring and Management
  • Baseline Liver Function Tests (LFTs) should be done before starting ATT
  • Routine monitoring is important, especially during the first two months
  • If significant liver injury occurs, drugs may need to be paused and reintroduced gradually under expert guidance
  • Modified regimens or hepatoprotective agents may be considered

Why Early Detection Matters

Delays in recognizing liver dysfunction can lead to serious complications and jeopardize TB treatment. Timely action can prevent permanent damage and allow patients to safely complete their course of therapy.

If you or someone you know is undergoing TB treatment and experiencing symptoms of liver dysfunction, consult an infectious disease specialist immediately.

Dr. Chhavi Gupta
MBBS, MD, DM (AIIMS, New Delhi)
Senior Consultant – Infectious Diseases
Yashoda Super Speciality Hospital, Kaushambi
📞 For Appointments: +91 8851 346 424
🌐 drchhavigupta.com

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Granulomatous Inflammation: It’s Not Always Tuberculosis

Granulomatous inflammation is a common finding in biopsy samples, particularly in regions where tuberculosis (TB) is prevalent. While TB is a major cause, not every granulomatous reaction is due to tuberculosis. Mistaking every granulomatous lesion as TB can lead to misdiagnosis, unnecessary treatment, and delay in identifying more serious conditions such as malignancies or systemic fungal infections.

What Is Granulomatous Inflammation?

Granulomas are small nodules of immune cells that form in response to chronic inflammation. They act as the body’s defense mechanism to isolate harmful substances or infections it cannot eliminate easily. While TB is a leading cause, other infections and even non-infectious diseases can trigger granuloma formation.

Causes Other Than Tuberculosis

  • Fungal Infections: Diseases like histoplasmosis, blastomycosis, and cryptococcosis can all present with granulomas on histopathology.
  • Malignancies: Certain cancers, especially lymphomas, can mimic granulomatous inflammation.
  • Autoimmune Diseases: Sarcoidosis and granulomatosis with polyangiitis are examples of immune-mediated granulomatous diseases.
  • Foreign Body Reactions: Materials such as talc, sutures, or even inhaled particles can provoke granulomatous responses.

Why Correct Diagnosis Matters

In TB-endemic countries like India, clinicians often begin anti-TB treatment based solely on histopathology. However, starting TB treatment without confirming the diagnosis can be dangerous:

  • Delays appropriate care if the cause is fungal, malignant, or autoimmune.
  • Leads to unnecessary side effects and drug resistance.
  • Causes emotional and financial burden on patients and families.

What Should Be Done?

A thorough clinical evaluation, imaging studies, and additional lab tests (like fungal cultures, molecular diagnostics, or special stains) are crucial before initiating any therapy. Multidisciplinary input, including from infectious disease specialists, is often necessary.

When in Doubt, Consult an Expert

If your biopsy shows granulomatous inflammation, but the clinical picture doesn’t match TB, don’t rush into treatment. Consult a specialist to avoid misdiagnosis.

Dr. Chhavi Gupta
MBBS, MD, DM (AIIMS, New Delhi)
Senior Consultant – Infectious Diseases
Yashoda Super Speciality Hospital, Kaushambi

📞 For Appointments: +91 8851 346 424
🌐 More Info: drchhavigupta.com

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Understanding Multidrug-Resistant Tuberculosis (MDR-TB): Causes, Symptoms, and Treatment

Tuberculosis (TB) remains a significant global health challenge, but an even greater concern is Multidrug-Resistant Tuberculosis (MDR-TB). MDR-TB is a form of TB that does not respond to at least isoniazid (INH) and rifampicin (RIF), the two most potent first-line anti-TB drugs. This makes treatment more complex, expensive, and prolonged, increasing the risk of complications and transmission.

Causes of MDR-TB
MDR-TB primarily develops due to:

  • Incomplete or improper TB treatment – When patients fail to complete their full course of TB medication, the bacteria may develop resistance.
  • Incorrect prescription of TB drugs – Using the wrong drug combinations, incorrect dosages, or poor-quality medications can contribute to resistance.
  • Person-to-person transmission – MDR-TB can spread through the air from an infected person to others, making early detection and treatment critical.

Symptoms of MDR-TB
The symptoms of MDR-TB are similar to drug-sensitive TB but may persist despite standard treatment. Common symptoms include:

  • Persistent cough lasting more than three weeks, often with mucus or blood
  • Fever and night sweats
  • Unexplained weight loss
  • Fatigue and weakness
  • Chest pain and difficulty breathing

MDR-TB Can Develop at Any Site of Infection
While TB commonly affects the lungs, MDR-TB can also develop in other parts of the body, including the lymph nodes, spine, brain, kidneys, and joints . Extrapulmonary MDR-TB may cause symptoms depending on the infected site, such as severe back pain in spinal TB or swelling in lymph node TB.

Diagnosis of MDR-TB
To confirm MDR-TB, specialized laboratory tests such as *GeneXpert, Line Probe Assay (LPA), or Culture and Drug Sensitivity Testing (DST) – are performed to detect drug resistance. These tests help in selecting the appropriate treatment regimen.

Treatment of MDR-TB
MDR-TB treatment is longer and involves second-line antibiotics. The regimen includes:

  • Bedaquiline, Delamanid, Levofloxacin, Moxifloxacin, or Linezolid, depending on drug susceptibility testing.
  • Treatment duration ranges between 6 to 24 months.
  • Strict adherence – to treatment is essential to prevent further resistance.
  • Nutritional support and overall health management – play a crucial role in recovery.

Prevention of MDR-TB
Preventing MDR-TB involves:

  • Completing the full course of TB treatment – as prescribed.
  • Early diagnosis and prompt treatment – of drug-resistant cases.
  • Infection control measures – like wearing masks, improving ventilation, and avoiding crowded places.
  • BCG vaccination – in children to prevent severe forms of TB.

Conclusion
MDR-TB is a serious public health threat, but early diagnosis and proper treatment can help control its spread. Awareness, adherence to medication, and preventive measures are key in the fight against MDR-TB.

For expert consultation on TB and infectious diseases, visit Dr. Chhavi Gupta, MBBS, MD, DM (AIIMS, New Delhi), Senior Consultant in Infectious Diseases at Yashoda Super Speciality Hospital, Kaushambi.

TB admin

Do you Know Tuberculosis can cause infertility in females and males?

Dr. Chhavi Gupta
DM (Infectious disease), AIIMS, New Delhi
Senior Consultant, Yashoda Superpseciality Hospital, Kaushambi

 The association between infection and infertility has been long known. The infections that manifest symptomatically are identified easily and timely and can be managed. However, infections that lead to asymptomatic infections or remain dormant are more damaging as lack of symptoms prevents a patient from seeking timely medical intervention and consequently chronic damage to reproductive organs.

It is always believed by the common man that TB can affect only the lungs, but TB can affect any body part beyond the lung known as extrapulmonary TB (EPTB). TB affecting reproductive organs, also known as Genitourinary TB is responsible for 27.1 per cent cases of EPTB. The exact incidence of female genitourinary TB is not known because of vague symptomatology or asymptomatic cases, lack of sensitive diagnostic tests, and cases are not underreported.  Genital TB mostly spreads from the lungs or other organs via blood or sometimes directly spreads from adjacent organs like abdominal TB or may be sexually transmitted from active genitourinary TB in the partner.

Female Genitourinary TB and Infertility

TB causes both functional and physiological damage to the reproductive system. Genital TB in females affect most commonly fallopian tubes (90% of cases) leading to tubal blockage, and the uterus in 70% of cases resulting in decreased endometrial receptivity for implantation of a fertilized egg; ovaries are affected in 20-25 % of cases resulting in poor egg formation. Apart from affecting organs, Genital Tb also causes disturbance in the immune system, which may interfere with the implantation of fertilized eggs in the uterus. Thus, genital TB in females not only affect conception but also the ability to carry pregnancy. Further, it is important to note that not only genital TB causes infertility but TB affecting any other organ in the body causes malnutrition, immune disturbances, and impaired hormone production which can lead to poor egg formation or secondary amenorrhoea resulting in infertility.

Infertility treatment and risk of TB

As we learned TB is one of the main reasons for infertility but vice versa is there. Reactivation of TB can occur after surgical manipulation, high steroid levels, immune system perturbations, and increased vascularity during ovarian stimulation are thought to be the triggering factors for TB reactivation.

Male Genitourinary TB and Infertility

Genital TB in males predominantly causes structural damage to the male reproductive system. About 10% of patients with male genital TB may present with infertility, and around 4.0–9.1% of such men may have poor semen quality. Sometimes, scarring and fibrosis may persist even after successful treatment of TB. Similar to females, males may also remain asymptomatic or they may present as an unexplained, gradually progressing decline in semen quality or sometimes TB is picked incidentally during diagnostic workup. Sometimes, TB of any other part of the body apart from genital TB can affect the overall health of males leading to malnutrition and oligospermia.

Genital TB is a paucibacillary disease, i.e. number of tuberculosis bacteria that can be detected is very scanty, hence the diagnosis is very difficult. The diagnostic work requires complete investigations like blood test, radiology test, endometrial biopsies or aspirate followed by pathological or microbiological conformation. Sometimes in absence of appropriate diagnostic test, patients end up in taking tuberculosis treatment based on suspicious or misleading diagnostic test, this may be equally harmful as unnecessary tuberculosis treatment may promote drug resistant tuberculosis.

Genital TB is a complex and chronic infection that can affect reproductive system of both males or females resulting in infertility. Early detection and treatment can prevent irreversible damage but being paucibacillary disease, diagnosis remains difficult. With recent advancement in diagnostic test, detailed history and meticulous examination and diagnostic work up is key to success. Couple must seek specialist opinion before starting tuberculosis treatment for infertility.

TB admin

How Does Tuberculosis (TB) Affect Pregnancy?

Tuberculosis (TB) is a serious infectious disease that primarily affects the lungs but can spread to other parts of the body. For pregnant women, TB poses unique challenges and risks that need to be carefully managed to ensure the health and well-being of both the mother and the baby. In this blog post, we’ll explore how TB affects pregnancy, the potential risks involved, and the importance of proper diagnosis and treatment.

Understanding Tuberculosis in Pregnancy

TB is caused by the bacteria Mycobacterium tuberculosis. It spreads through the air when an infected person coughs, sneezes, or speaks. When TB occurs during pregnancy, it can lead to complications if not properly managed. Pregnant women are at risk of both pulmonary TB (affecting the lungs) and extrapulmonary TB (affecting other organs).

Risks to the Mother

1. Increased Fatigue:
Pregnancy naturally comes with increased fatigue, and TB can exacerbate this condition, making it more difficult for the expectant mother to manage daily activities.

2. Nutritional Deficiencies:
TB can affect the body’s ability to absorb nutrients, which can lead to nutritional deficiencies. Proper nutrition is critical during pregnancy to support the health of both the mother and the developing baby.

3. Complications:
Women with TB may face a higher risk of complications during pregnancy and delivery. This can include a higher likelihood of developing anemia, experiencing preterm labor, and needing medical interventions during childbirth.

Risks to the Baby

1. Low Birth Weight:
Babies born to mothers with TB are at a higher risk of being born with low birth weight, which can lead to additional health challenges in the early stages of life.

2. Preterm Birth:
There is an increased risk of preterm birth (delivery before 37 weeks of gestation) among pregnant women with TB. Preterm babies often require special care in neonatal intensive care units (NICUs).

3. Congenital TB:
Although rare, TB can be transmitted from the mother to the baby during pregnancy or delivery. Congenital TB is a serious condition that requires prompt medical attention.

Key Points for Managing TB During Pregnancy

1. Early Diagnosis:
Early diagnosis of TB is crucial for effective management. Pregnant women who exhibit symptoms of TB, such as persistent cough, weight loss, night sweats, or fever, should seek medical evaluation promptly.

2. Proper Treatment:
Safe and effective TB treatment options are available for pregnant women. It’s essential to follow the treatment regimen prescribed by healthcare professionals to control the infection and reduce the risk of complications.

3. Regular Monitoring:
Pregnant women with TB require close monitoring by healthcare providers to ensure both maternal and fetal health. This includes regular prenatal visits, TB treatment adherence, and nutritional support.

4. Nutritional Support:
Maintaining proper nutrition is vital for pregnant women with TB. A balanced diet that meets the increased nutritional demands of pregnancy can help improve overall health and outcomes.

5. Avoiding Exposure:
Pregnant women should avoid close contact with individuals known to have active TB to reduce the risk of transmission.

Conclusion

Tuberculosis during pregnancy is a serious condition that requires careful management and monitoring. By understanding the risks and following appropriate medical guidance, pregnant women with TB can achieve better health outcomes for themselves and their babies. Early diagnosis, proper treatment, and regular prenatal care are key components in managing TB effectively during pregnancy.

For expert guidance on managing TB during pregnancy, consult Dr. Chhavi Gupta, an infectious diseases specialist from AIIMS, New Delhi. Dr. Gupta’s expertise and comprehensive care approach ensure the best possible outcomes for both mother and baby.

Contact Details:

  • Name: Dr. Chhavi Gupta, MBBS, MD, DM (AIIMS, New Delhi)
  • Specialty: Infectious Diseases Specialist
  • Phone: +91 8851 346 424

 

TB admin

TB prevention therapy – game changer in END TB STRATEGY

Tuberculosis has been one of the deadliest diseases worldwide for centuries. According to Global TB Report 2023, an estimated 10.6 million people fell ill with TB globally and 1.3 million people suffering from TB died globally in 2022. India carries a high burden of TB, with an estimated 27% of the global TB cases and 31% of global deaths due to TB cases. This causes substantial economic loss in terms of loss of lives, workdays and income. United Nations Sustainable Developmental Goals (UN SDG) aimed at ending the TB epidemic by 2030. India is one of the signatories of the UN SDG and has committed to End TB by 2025, five years ahead of the SDG timeline. To accomplish the goal, Pradhan Mantri TB Mukht Bharat Abhiyan was launched and the national TB program has made significant strides in recent years in terms of advanced and effective interventions for TB diagnosis, treatment, and care by scaling up diagnostic capacity, intensified active case finding, launching Nikshay Poshan Yojna (TB Nutritional support program). Till now the focus of the National TB control program is active case detection and treatment, however, targeted treatment of persons at risk of developing active TB disease is a crucial component of the End TB Strategy. Hence, the TB Preventive Treatment (TPT) program has been launched to decrease the latent TB reservoir, preventing the development of active TB and its spread in the community. Every year World TB Day is celebrated on 24th March and this year’s theme is “Yes We Can End TB”. In this article, we will highlight some facts about latent TB and TB preventive therapy.

What is latent TB and Tuberculosis infection?

Latent TB or Tuberculosis infection is scientifically defined as a state of persistent immune response to prior-acquired Mycobacterium tuberculosis antigens without evidence of clinically manifested active TB. People who have been exposed to TB bacteria inhale them, the immune system prevents these bacteria from growing, and bacteria remain dormant in the lungs of an individual for a long time. People with latent TB do not exhibit symptoms, the load of TB bacteria is very low, and hence it does not spread in the community. However, they can be carriers of TB bacteria. However, at any point in life especially in people with weakened immune systems like diabetes, or immunocompromised patients, TB bacteria may become active, resulting in Tuberculosis disease. Now this active TB bacteria load is very high and can easily spread from one person to another. The transition phase from LTBI to active TB infection can linger long and even during the initial period of active TB, the patient may be unaware of the illness; during this period there is a high chance of spread of active TB bacteria.

What is the current burden of Latent TB?

According to estimates, almost 33% of people worldwide have latent tuberculosis, while in India; the estimated prevalence is 31%.

What is Tuberculosis Preventive Therapy (TPT)?

TB Preventive therapy consists of one or two anti-tubercular drugs given to persons with a history of exposure to TB or those who are infected with TB (latent TB or TBI) and are at higher risk of developing active TB than the general population to prevent the development of active TB disease.

How does TPT work?

According to available data, 51% of people having latent TB will gradually develop TB disease throughout their lives depending upon their immune status. TPT eliminates the dormant TB bacteria inside the body before it can develop into active TB and damage the organs. However, it will work only if active TB is ruled out in the concerned person. The goal is to reduce TB transmission in the community to have a significant impact on human health

Who should take TPT?

All household contacts of active pulmonary (lung) TB, immunosuppressed patients and patients on dialysis are eligible for TPT after ruling out active TB.

How TPT should be taken?

TPT should be taken only after being prescribed by the medical practitioner. It consists of one or two pills to be taken daily for the defined duration as recommended by the medical practitioner. It does not involve major side effects.

How does TPT help in TB elimination?

The available studies have shown that TPT reduces the risk of TBI converting to active TB by 60-70%. Hence it will help in reducing the burden of TB and also halts the transmission of TB in the community.

TB admin

Understanding Tuberculosis: Causes, Symptoms, and Treatment

Tuberculosis (TB) remains a significant global health challenge, affecting millions of people each year. Despite advances in medical science, TB continues to be a leading cause of morbidity and mortality worldwide. In this blog post, we delve into the intricacies of TB, exploring its causes, symptoms, and available treatment options.

What is Tuberculosis?

Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs but can also affect other parts of the body, such as the kidneys, spine, and brain. TB spreads through the air when an infected person coughs or sneezes, releasing bacteria-containing droplets that can be inhaled by others.

Symptoms of Tuberculosis

The symptoms of TB can vary depending on the type and severity of the infection. Common symptoms include:

  1. Persistent cough that lasts for more than three weeks
  2. Chest pain
  3. Coughing up blood or phlegm
  4. Fatigue
  5. Fever and chills
  6. Night sweats
  7. Loss of appetite
  8. Unintended weight loss

Diagnosis of Tuberculosis

Diagnosing TB typically involves a combination of medical history, physical examination, and diagnostic tests. These tests may include:

  1. Tuberculin skin test (TST): A small amount of tuberculin protein is injected under the skin, and the area is checked for a reaction after a few days.
  2. Chest X-ray: This can reveal abnormalities in the lungs that may indicate TB.
  3. Sputum test: A sample of sputum (phlegm) is examined under a microscope to check for the presence of TB bacteria.
  4. Blood tests: These tests can detect antibodies produced by the body in response to TB infection.
  5. Molecular tests: These tests detect TB DNA in sputum samples and provide rapid diagnosis.

Treatment of Tuberculosis

TB is treatable and curable with appropriate medication. The standard treatment for TB involves a combination of antibiotics taken for a specified duration. The most commonly used antibiotics for TB treatment include isoniazid, rifampicin, ethambutol, and pyrazinamide. Treatment typically lasts for six to nine months, depending on the type and severity of the infection.

Prevention of Tuberculosis

Preventing TB involves a combination of strategies, including:

  1. Vaccination: The Bacille Calmette-Guérin (BCG) vaccine can help prevent severe forms of TB in children.
  2. Infection control measures: These include identifying and treating active TB cases promptly, promoting good respiratory hygiene, and ensuring adequate ventilation in indoor spaces.
  3. Screening and early detection: High-risk individuals, such as healthcare workers and those living in densely populated areas, should undergo regular screening for TB.

Dr. Chhavi Gupta: Your TB Specialist

Dr. Chhavi Gupta, an experienced infectious disease specialist with qualifications including MBBS, MD, and DM from AIIMS, New Delhi, is dedicated to combating TB and providing quality care to her patients. With her expertise and compassionate approach, Dr. Gupta offers comprehensive TB diagnosis and treatment services.

Book Your Appointment Today!

Don’t delay in seeking medical attention if you suspect you may have TB. Book your appointment with Dr. Chhavi Gupta today:

📞 Call Now: +91 8851 346 424

Together, let’s work towards a TB-free world.

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