Tuberculous anal fistulas - prevalence and clinical features in an endemic area.
AbstractABSTRACT Introduction The aim of this study was to determine the prevalence of tuberculosis (TB) in anal fistulae at a referral hospital in Cape Town, and to document the clinical features and course of patients with tuberculous anal fistulae. Patients and methods This is a prospective study of all patients who underwent surgery for anal fistulae at the Colorectal Surgery Unit at Groote Schuur Hospital in Cape Town from 2004 to 2006. Tissue was submitted for histopathological examination, Ziehl- Neelson staining and TB culture. The patients with proven TB were followed up until January 2008. Results 117 operations were performed on 96 patients. TB was diagnosed in 7of the 96 patients (7.3%). In 5 of these 7 cases, the diagnosis of TB could be proven on histological examination and Ziehl- Neelson staining, while in 2 cases the diagnosis could only be made on TB culture. None of the 7 patients had systemic features suggestive of TB, and only one had evidence of TB on chest x-ray. Five patients were HIV negative, and 2 declined testing. After a median follow of 2 years, 5/7 patients had evidence of recurrent or persistent fistulae, despite having completed 6 months of TB treatment. Conclusion At a referral hospital in an endemic area, TB was present in 7.3% of anal fistulae. Histopathological examination including Ziehl- Neelson staining was inadequate to make the diagnosis in a third of these patients. Tissue from anal fistulae should therefore routinely be sent for TB culture as well as histopathological examination and Ziehl- Neelson staining in areas where TB is prevalent.
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