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A Ten-year Review of Peritoneal Tuberculosis in Children at a Government Tertiary Hospital
Juan Miguel L Murillo1, Germana Emerita V Gregorio1
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila.
Insights
Pediatric peritoneal tuberculosis (TB) often presents with vague symptoms. Early diagnosis using imaging and histology, followed by anti-TB treatment, leads to a favorable prognosis in children.
Area of Science:
- Pediatric infectious diseases
- Gastroenterology
- Medical microbiology
Background:
- Peritoneal tuberculosis (TB) is a rare manifestation of TB in children, accounting for 5% of all pediatric TB cases.
- Limited case reports exist on pediatric peritoneal TB, highlighting the need for further clinical characterization.
Purpose of the Study:
- To comprehensively evaluate the clinical, biochemical, radiological, histological, and microbiological characteristics of pediatric patients diagnosed with peritoneal TB.
- To determine the treatment outcomes and prognosis for children with peritoneal tuberculosis.
Main Methods:
- A retrospective review of medical records (2011-2020) for pediatric patients meeting diagnostic criteria for peritoneal TB.
- Patients were classified as bacteriologically-confirmed (positive AFB smear, culture, or PCR) or clinically-diagnosed (clinical findings plus histological/radiological evidence).
- Data analysis included descriptive statistics (mean, SD, n, %) for patient demographics, clinical presentation, laboratory findings, imaging results, and treatment outcomes.
Main Results:
- Eighteen pediatric patients (mean age 14.27 years) with disseminated TB and peritoneal involvement were analyzed.
- Abdominal distention (83%) and pain (61%) were common presentations; abdominal distention (83%) and tenderness (44%) were frequent physical findings.
- Radiological (ascites, lymphadenopathy) and histological (granulomatous inflammation) findings were crucial for diagnosis in most clinically-diagnosed cases. Fifteen patients improved with anti-TB treatment, while three died.
Conclusions:
- Pediatric peritoneal TB exhibits non-specific clinical and laboratory features, often necessitating a combination of radiological and histological evidence for diagnosis.
- Prompt diagnosis and appropriate quadruple anti-TB drug therapy, sometimes combined with surgery, result in a favorable prognosis for affected children.
Background:
Peritoneal tuberculosis comprises 5% of all forms of tuberculosis in children. There are limited reports of peritoneal TB in children.
Objective:
To determine the clinical, biochemical, radiologic, histologic, and microbiologic features and outcome of pediatric patients diagnosed with peritoneal tuberculosis.
Methods:
Review of medical records from 2011-2020 of patients fulfilling diagnostic criteria of peritoneal TB. Patient was considered as bacteriologically-confirmed if with positive AFB smear, culture, or PCR on peritoneal or omental tissue; and clinically-diagnosed if with clinical findings AND presence of histologic and/or radiologic evidence of extra-pulmonary TB. Data was presented as mean (SD) or n (%), as appropriate.
Results:
Eighteen patients [Mean (SD) age: 14.27 (± 4.1) years old, 56% males] were included. All had disseminated TB with peritoneal involvement. One case was bacteriologically-confirmed (TB PCR positive omental tissue); 17 were clinically-diagnosed. Most common presentation was abdominal distention (83%) and abdominal pain (61%). Most common physical finding was abdominal distention (83%) and abdominal tenderness (44%). Seven patients (39%) had anemia, 11 (61%) had leukocytosis, and three (17%) had thrombocytosis. Thirteen (72%) had hypoalbuminemia. Ten (56%) were positive on AFB smear, TB culture, and PCR of various specimens. Fourteen of sixteen (88%) with abdominal CT scan had ascites and intrabdominal lymphadenopathy. Nine of 12 tissue samples from seven patients demonstrated chronic granulomatous inflammation. Seventeen were given quadruple anti-TB. Six also had surgery. Overall, 15 were discharge improved after mean of 4.2 weeks of hospital stay, while three died of sepsis. Eleven of the 15 were well one month after discharge.
Conclusion:
Peritoneal TB presents with non-specific clinical and laboratory features. Radiologic and histologic findings increase the likelihood of diagnosis. The prognosis is favorable for patients who are diagnosed and treated with anti-TB drugs.
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