Jan 01, 2014 tuberculous peritonitis is a serious condition with rising prevalence in recent years. Peritoneal tuberculosis pt is a form of abdominal tuberculosis that accounts for 1%3% of all cases of tuberculous disease and often manifests with nonspecific symptoms. Pdf peritoneal tuberculosis tb remains a public health problem especially in. Peritoneal tuberculosis tb is an extrapulmonary form of presentation of tuberculosis. Tuberculosis is usually confined to the respiratory system but may involve any organ system 1. A delay in the diagnosis and treatment of peritoneal tuberculosis may lead to worse clinical outcomes. Peritoneal tuberculosis presents with signs and symptoms that mimic an advancedstage gynecologic or gastrointestinal cancer. Risk factors include hiv infection, diabetes mellitus, treatment with antitumor necrosis factor tnf agents, ongoing peritoneal dialysis and hepatic cirrhosis. Polymerase biopsy chain reaction abstract introduction. It can occur most commonly following reactivation of a latent focus of tuberculosis. Tuberculosis by site of disease south dakota 2015 pulmonary 71% both 17% nonpulmonary 12%.
It is an uncommon variant of tuberculosis with an estimated incidence of 0. The quantiferontb gold qftg is the first igra approved by the fda as an aid for diagnosing m. Diagnosis of abdominal tuberculosis world journal of emergency. Other signs and symptoms compatible with tuberculosis, such as abnormal chest xray, abnormal chest ct scan or other chest imaging study, or. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. The variability in patient presentation and the indolent nature of the in. Peritoneal tuberculosis tb remains a public health problem especially in the developing countries, even in the developed countries, where the disease had been mostly controlled. In our case, the peritoneal tuberculosis developed in patient who tested. Peritoneal tuberculosis most often presents as abdominal pain and ascites.
Abdominal tuberculosis tb is a rare extrapulmonary presentation of tb representing about 5% of all cases of extrapulmonary tb. Peritoneal tuberculosis tbp, an uncommon peritoneal infection, is commonly diagnosed in immigrants from developing countries and represents a substantial proportion of cases of extra pulmonary tuberculosis. Tuberculous peritonitis an overview sciencedirect topics. Tuberculosis is a speciality journal focusing on basic experimental research on tuberculosis, notably on bacteriological, immunological and pathogenesis aspects of the disease. Peritoneal tuberculosis demonstrates calcifications or enlargement of the spleen on ct scan more often than does ovarian cancer, but neither of these findings were present in our. Peritoneal tuberculosis is rare with increased incidence rates in recent years. Among 6 of the 8 cases in which death was caused by peritoneal tuberculosis, treatment was delayed for 6 weeks. Haddad,1 lina menassamoussa,2 carole kesrouani,3 stephanie daccache,4 fady g.
Peritoneal tuberculosis is a rare disease, often associated with a primary site of tuberculosis. Peritoneal tuberculosis demonstrates calcifications or enlargement of the spleen on ct scan more often than does ovarian cancer, but neither of these findings were present in our case. Tuberculosis cases and case rates per 100,000 population. Clinical features and outcomes of abdominal tuberculosis in. Both the incidence and severity of abdominal tuberculosis at are expected to increase with increasing incidence of hiv infection. Abdominal tuberculosis tb is a type of tb that affects the gut, the peritoneum the lining of the abdominal cavity, abdominal lymph nodes, and, more rarely, the solid organs in the abdomen liver, pancreas, and spleen. Corticosteroid treatment of peritoneal tuberculosis pdf.
Prevalance of tuberculosis in patients on hemodialys. Extrapulmonary manifestations may affect up to 15% of patients with tuberculosis. Tuberculous peritonitis radiology reference article. Tuberculosis tb is an infectious disease usually caused by mycobacterium tuberculosis mtb bacteria. In this study, we aimed to highlight the clinical features, diagnostic methods, and outcomes of abdominal tb over 12 years in southeastern korea. Peritoneal tuberculosis amounts to 2% of all the extrapulmonary forms. The lower prevalence of tuberculosis in pd population may be related with different demographic and socioeconomic factors as well as the modality of dialysis. It is especially common in those patients with risk factors such as an immunocompromised state, chronic kidney disease, or cirrhosisliver disease. Peritoneal tuberculosis pt, a form of at, occurs in three forms. Peritoneal tuberculosis as a cause of ascites in a patient with cirrhosis bmj case rep.
Because the disease can spread through the air to infect both humans and other animals, it is a public health concern affecting circuses and zoos. Introduction the risk of tuberculosis tb is higher 6. Pulmonary and peritoneal tuberculosis associated with tumor. Positive tuberculosis skin test or positive interferon gamma release assay for m. United states and the district of columbia, 2015 and 2014 pdf pdf icon 293k. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those affected. Hemodialysis, peritoneal dialysis, tuberculosis, prevalence. He came from cambodia but had no history of tuberculosis tb vaccination, tb, or known contact. Diagnosing peritoneal tuberculosis bmj case reports. The diagnosis in gastrointestinal tuberculosis and dry peritonitis can be reached by. It is usually secondary to reactivation of latent tb or ingestion of contaminated food.
They were evaluated for latent tuberculosis with qftgit, tst and an assessment by an expert pulmonologist using patients medical history and xrays. Received 3rd september, 2015, accepted 29th september, 2015, published 30th september, 2015 1. After a 6month course of tuberculostatics, the ascites resolved. Fluid and tissue procurement by paracentesis and image or laparoscopicguided biopsy for pathology and microbiology laboratory assessment is key. Hemoperitoneum, peritoneal dialysis, peritoneal tuberculosis, refractory. Siegel division of infectious diseases, george washington university medical center, 2150 nw pennsylvania avenue, washington, dc 20037, usa.
Exacerbation of mycobacterium tuberculosis enteritis masquerading as crohns disease after treatment with a tumor necrosis factoralpha inhibitor. A case of peritoneal tuberculosis developed after infliximab. The third pathway of peritoneal infection involves the direct spread to the peritoneum from an infected adjacent focus, such as the fallopian tubes pictured or a psoas abscess74 depicted in 3. The most commonly used classification divides peritoneal tuberculosis into wetascitic type, dryplastic type and. Siegel division of infectious diseases, george washington university medical center. Dec 27, 2018 background abdominal tuberculosis tb is an uncommon form of infection with mycobacterium tuberculosis in korea. Diagnostic and therapeutic strategies for peritoneal. Issues related to tb involving the intestinal tract, peritoneum, and. Peritoneal tuberculosis accounts for 34% of all presentations of tuberculosis. We found biological inflammatory syndrome c reactive protein,141 mgl, lymphopaenia 1.
Tuberculous peritonitis in patients undergoing continuous. Tuberculous peritonitis is one of the possible forms of abdominal tuberculosis. Volume 3, issue 9, pp 766767, september, 2015 issn. Peritoneal tuberculosis a rare diagnosis pulmonology. Peritoneal tuberculosis occurs in approximately 1% of all of tuberculosis cases. It can either occur in isolation or along with a primary focus such as the lungs in patients with disseminated tuberculosis. Confirmation is obtained by combining radiological and microbiological findings with the study of peritoneal fluid or of a sample collected by means of percutaneous biopsy. Tuberculosis generally affects the lungs, but can also affect other parts of the body. The observed mortality rate of 15% is greater than the. It is ranked sixth in incidence after lymphatic, pleural, osteoarticular, genitourinary and meningeal.
The most common form of peritoneal tuberculosis causes an accumulation of fluid, called ascites, in the cavity between the peritoneums two layers, the parietal peritoneum and the visceral peritoneum. Igra detects sensitization to mycobacterium tuberculosis by measuring interferon gamma release in response to antigens representing m. Guidelines on the management of latent tuberculosis infection. Due to the persistent suspicion of tuberculosis, a laparoscopy was performed showing multiple small white tubercles scattered over the peritoneum. These are called wet type infections, in contrast with dry. A forsaken yet misleading diagnosis joseph kattan,1 fady gh. Primary pulmonary tuberculosis is the commonest form though extrapulmonary tuberculosis is not rare. Peritoneal tuberculosis as a cause of ascites in a patient. Risk factors for peritoneal involvement include concomitant hiv infection, patients who undergo peritoneal dialysis, and patients with cirrhosis 9. A case of tuberculous peritonitis in childhood core. The incidence of tuberculous peritonitis is low in western countries and immunocompetent patients, although in developing countries it may account for 30% of all nonpulmonary tb and for at least 20% of all cases of ascites. Peritoneal tuberculosis ptb, although rarer than its pulmonary. Furthermore, we report our diagnostic algorithm for abdominal tuberculosis.
Get a printable copy pdf file of the complete article 557k. Pulmonary and peritoneal tuberculosis associated with. Peritoneal biopsies showed the presence of necrotising granulomas and cultures were positive for mycobacterium tuberculosis complex. These guidelines have been superseded by latent tuberculosis infection. Adenosine deaminase activity in the diagnosis of tuberculous. Evaluation of xpert mtbrif assay performance in the diagnosis of abdominal tuberculosis. Peritoneal tuberculosis is the most common presenta. Abdominal tuberculosis is a type of extrapulmonary tuberculosis which involves the abdominal organs such as intestines, peritoneum and abdominal lymph nodes. Refractory peritonitis with hemoperitoneum due to tuberculosis. In conclusion, a diagnosis of peritoneal tuberculosis must be considered in patients with ascites, peritoneal thickening of unknown origin, and increased ca125 levels. Detection of latent tuberculosis inf ection in peritoneal dialysis patients. Pulmonary and peritoneal tuberculosis associated with tumor necrosis factoralpha inhibitor use.
Methods a total of 9 patients diagnosed as having abdominal tb who received antitb medication from january 2005 to june 2016 were. Peritoneal tuberculosis presenting with portal vein thrombosis and transudative ascites a diagnostic dilemma. Pdf neutrophils play a protective nonphagocytic role in. A 54yearold man presented with a 2month history of weight loss, fever, sweats, swelling and abdominal pain. Detection of latent tuberculosis infection in peritoneal. The nonspecific features of this disease can lead to diagnostic delays and the development of complications. Her initial abdominal paracentesis does not rule out malignancy, given the 20%30% falsenegative rate of peritoneal fluid sampling in the setting of ovarian cancer with malignant ascites1 laparoscopic.
Peritoneal tuberculosis tb is one of the most challenging forms of extrapulmonary tuberculosis to diagnose. Tuberculosis of the intestine can affect multiple areas of the bowel simultaneously. Peritoneal tuberculosis tb is considered a rare form of extra pulmonary disease and. Definitive diagnosis requires tissue sampling, and. Sixmonth therapy for people with abdominal tuberculosis. Peritoneal tuberculosis suny downstate medical center. Haddad,4 and david atallah5 1hematology and oncology department, faculty of medicine, saint joseph university, beirut, lebanon 2radiology department, faculty of medicine, saint joseph university, beirut, lebanon. Nine patients were treated with steroids plus antituberculosis agents cases, and 26 received antituberculosis treatment only controls. Tuberculosis tb can involve any part of the gastrointestinal tract and is the sixth most frequent site of extrapulmonary involvement. The most common presentation of this disease is the respiratory type, the extra pulmonary manifestations are difficult to recognize and diagnose.
Peritoneal tuberculosis presenting with portal vein. Peritoneal tuberculosis presenting as chronic ascites with. Peritoneal tuberculosis is a common type of abdominal tuberculosis. Feb 26, 2021 peritoneal tuberculosis may cause a buildup of fluids in the abdomen called ascites. In a 2015 metaanalysis, investigators found that the diagnostic. Diagnostic and therapeutic strategies for peritoneal tuberculosis. Tuberculosis remains as an important public health problem. Updated and consolidated guidelines for programmatic management, 2018. Tuberculosis cases and case rates per 100,000 population, ranked and grouped by number of cases. Jul 01, 2000 the shortterm attributable mortality associated with peritoneal tuberculosis in patients undergoing capd was 15%. A study of cases at groote schuur hospital 19621971. Clinical and pathological features of three types of.
Pdf abdominal tuberculosis and other mycobacterial infections. Hiv infection is a primary risk factor for this condition. Most infections show no symptoms, in which case it is known as latent tuberculosis. Signs and symptoms cough dryproductive sputum 7580% weight loss 4575% fatigue 6070% fever 5060% night. Peritoneal tuberculosis mimicking advanced ovarian cancer. This challenge can be compounded in low incidence regions, and in patients with cirrhosis in whom the presence of ascites alone may not prompt further investigation. Abstract full text pdf pdf plus supplemental material. It is believed that the animals originally acquired the disease from humans, a process called reverse zoonosis.
Pdf corticosteroid treatment of peritoneal tuberculosis. Demographical features and relative extra peritoneal tuberculosis distribution in different types of peritoneal tuberculosis. In women presenting with an abdominal mass and ascites, the first diagnosis to consider is ovarian cancer. In patients with peritoneal tuberculosis, an abnormal chest radiograph is found in 21%83% of cases, with active pulmonary tuberculosis present in about 14% of cases. Abdominal tuberculosis tb includes involvement of the gastrointestinal. Peritoneal tuberculosis is an important problem inregions of the world where tuberculosis is still prevalent chest 1991. As of 2015, tuberculosis appears to be widespread among captive elephants in the us. Peritoneal tuberculosis presenting as persistent ascites. The absence of characteristic clinical features of the disease often makes its diagnosis difficult and elusive. Fibroadhesive peritoneal tuberculosis mimicking inflammatory acute.
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