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Tuberculous peritonitis in 11 children: clinical features and diagnostic approach
1Department of Pediatrics, Dicle University Medical School, Diyarbakir, Turkey. fuatgurkan@hotmail.com
Insights
Diagnosing tuberculous peritonitis (TBP) in children requires a high suspicion. Clinical symptoms, imaging, and skin tests aid diagnosis when invasive methods are unavailable.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Radiology
Background:
- Tuberculous peritonitis (TBP) is a rare, challenging manifestation of childhood tuberculosis.
- It presents with prolonged abdominal symptoms, ascites, and lymphocytic exudate.
- Diagnosis often requires a high index of suspicion due to its rarity.
Purpose of the Study:
- To retrospectively evaluate the diagnostic features of childhood tuberculous peritonitis.
- To identify key clinical, microbiological, and radiological indicators for TBP diagnosis.
Main Methods:
- Retrospective analysis of 11 pediatric cases diagnosed with TBP.
- Evaluation of clinical presentation, diagnostic test results (tuberculin skin tests, PCR, cultures), and imaging findings (ultrasonography, CT).
- Review of histopathological findings from peritoneoscopy/laparoscopy where performed.
Main Results:
- The study included 11 children (7 males, ages 1-11 years) with TBP.
- Common symptoms included abdominal distention and ascites (100%), fever (27%), and weight loss (18%).
- Mycobacterium tuberculosis was detected by PCR in one sample; imaging and skin tests were valuable, with histopathology confirming diagnosis in two cases.
Conclusions:
- Clinical symptoms, positive tuberculin skin tests, and a history of tuberculosis exposure are crucial for diagnosing TBP.
- Radiological techniques (ultrasonography, CT) significantly aid in diagnosis.
- In resource-limited settings, these non-invasive methods are vital, especially when invasive procedures like peritoneoscopy are not feasible.
Background:
Tuberculous peritonitis (TBP) is a rare manifestation of childhood tuberculosis characterized by long-lasting abdominal symptoms and exudate and lymphocytes in the ascitic fluid. The diagnosis of TBP is rarely established unless a high index of suspicion is maintained.
Methods:
The diagnostic features of 11 cases who were hospitalized with TBP in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Turkey, were evaluated retrospectively.
Results:
Seven cases were male and the ages of all cases ranged between 1 and 11 years. The onset of symptoms was 1-12 months (mean +/- SD 3.1 +/- 2.7 months) prior to the admission time. Nine patients gave a history of familial tuberculosis. Three cases had Bacillus Calmette-Guérin (BCG) scars and the results of five tuberculin unit (TU) tests in cases without and with BCG were over 10 and 15 mm, respectively. The most common presenting clinical symptoms and signs at admission were abdominal distention and ascites (100%), fever (27%) and loss of weight (18%). One case had accompanying tuberculous meningitis and two cases had concomitant pulmonary tuberculosis. Only one of 11 samples of ascitic fluid yielded Mycobacterium tuberculosis by the polymerase chain reaction method and no other microbiologic evidence was obtained in culture specimens. Ultrasonographic and computed tomographic imagings revealed high-density ascites that contributed well to the diagnosis. The diagnosis in two patients was proven histopathologically via peritoneoscopy and laparoscopy. All cases were treated with isoniazide, rifampisin for 9 months and pyrazinamide for the first 2 months.
Conclusions:
Radiologic diagnostic techniques, positive skin tests and a history of exposure to tuberculosis may contribute to the diagnosis of TBP, helped by clinical symptoms and findings, particularly when invasive diagnostic methods via peritoneoscopy and laparoscopy are not available in developing countries.