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Tuberculous peritonitis: analysis of 35 cases
Abstract:
Thirty five patients with tuberculous peritonitis were studied retrospectively. Tuberculous peritonitis was defined as the isolation of Mycobacterium tuberculosis from ascites or dialysate, and/or caseating granuloma/acid-fast bacilli from peritoneal biopsy specimens from patients with pulmonary tuberculosis or a response to treatment for tuberculosis. Among the patients studied, nine with cirrhosis of the liver; seven with diabetes mellitus and six with end-stage renal disease, of whom four had undergone continuous ambulatory peritoneal dialysis. The most frequent signs of tuberculous peritonitis included ascites, fever and anemia. Ascites was found in 31 patients (89%). Abnormal findings on chest radiographs were found in 26 patients (74%), of whom 22 patients (63%) had pleural effusion and five had miliary lung lesions. Seven out of 35 patients were found to have positive culture of sputum or pleural effusion for M. tuberculosis. Two patients were found to have concomitant tuberculous peritonitis and enteritis. Multiple organ involvement was found in eight patients. Eleven patients (31%) died: eight were older than 60 years; six had cirrhosis of the liver and nine were diagnosed post-mortemly. In Taiwan, tuberculous peritonitis should be considered in patients with abnormality of chest radiography and nonresolving peritonitis.
Insights
Tuberculous peritonitis, a serious infection, often presents with ascites and fever. Early consideration in patients with chest abnormalities and persistent peritonitis is crucial for diagnosis and treatment.
Area of Science:
- Infectious Diseases
- Pulmonology
- Gastroenterology
Background:
- Tuberculous peritonitis (TBP) is a significant extrapulmonary manifestation of tuberculosis.
- Diagnosis can be challenging due to non-specific symptoms and varied presentations.
Purpose of the Study:
- To retrospectively analyze the clinical characteristics, diagnostic findings, and outcomes of tuberculous peritonitis patients.
Main Methods:
- Retrospective study of 35 patients diagnosed with TBP.
- Definition included Mycobacterium tuberculosis isolation or caseating granuloma/acid-fast bacilli on peritoneal biopsy.
- Review of clinical signs, radiological findings, and treatment responses.
Main Results:
- Ascites (89%), fever, and anemia were common signs.
- Abnormal chest radiographs (74%) with pleural effusion (63%) were frequent.
- Mortality was 31%, higher in older patients and those with cirrhosis.
Conclusions:
- TBP should be suspected in patients with abnormal chest imaging and refractory peritonitis, particularly in endemic regions like Taiwan.
- Prompt diagnosis and treatment are vital to improve patient outcomes.