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Abdominal tuberculosis in children: review of 26 cases
R S Veeragandham1, F P Lynch, T G Canty
1Department of Pediatric Surgery, Children's Hospital & Health Center, San Diego, CA, USA.
Abstract:
The protean clinical manifestations and varied complications of abdominal tuberculosis continue to challenge the diagnostic acumen and therapeutic skills of all physicians. Although abdominal tuberculosis in children has not been common in the United States over the past 2 decades, the authors found 26 case reports for the period 1980-1993. Three clinical patterns were evident: intestinal (13) peritoneal (9), and asymptomatic with incidental calcifications apparent on abdominal radiographs (4). The diagnosis was suspected for only 23% of these cases, which emphasizes the nonspecific symptomatology caused by this extrapulmonary manifestation and the need for a high index of suspicion to make a prompt diagnosis. In this study, 24 of the 26 (91%) were of Hispanic origin; the other two were indo-Chinese, another high-risk group. Most patients (88%) had a positive PPD skin test result. Mycobacteria were isolated from 15 of 21 (71.4%) cultures, with M bovis in 80% and M tuberculosis in 20%. Antituberculous chemotherapy is the mainstay of treatment; surgery is reserved for tissue diagnosis in cases of peritoneal tuberculosis and for the management of complications of intestinal tuberculosis. The response to chemotherapy usually is excellent, and long-term sequelae are uncommon. It appears that steroids do not decrease the incidence or degree of fibrosis in intestinal tuberculosis.
Insights
Abdominal tuberculosis in children, though rare in the US, presents diverse symptoms, often delaying diagnosis. Prompt identification and antituberculous chemotherapy are key to successful treatment with good outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Public Health
Background:
- Abdominal tuberculosis (TB) presents varied clinical manifestations and complications, challenging diagnosis and treatment.
- While uncommon in the US, 26 pediatric cases were reported between 1980-1993, highlighting its persistence.
- High-risk populations, including Hispanic and Indo-Chinese children, were disproportionately affected.
Purpose of the Study:
- To analyze the clinical patterns, diagnostic challenges, and treatment outcomes of abdominal tuberculosis in children.
- To identify demographic and risk factors associated with pediatric abdominal TB in the US.
- To evaluate the role of chemotherapy and surgery in managing this condition.
Main Methods:
- Retrospective review of 26 pediatric abdominal TB case reports from 1980-1993.
- Analysis of clinical presentations (intestinal, peritoneal, asymptomatic), diagnostic methods, and microbiological data.
- Assessment of treatment regimens, including chemotherapy and surgical interventions, and patient outcomes.
Main Results:
- Three main patterns observed: intestinal (13 cases), peritoneal (9 cases), and asymptomatic (4 cases).
- Diagnosis was suspected in only 23% of cases due to nonspecific symptoms, necessitating a high index of suspicion.
- Mycobacteria isolated in 71.4% of cultures (80% M. bovis, 20% M. tuberculosis); 88% had positive PPD skin tests.
- Antituberculous chemotherapy was the primary treatment, with excellent response and rare sequelae; steroids showed no benefit in reducing fibrosis.
Conclusions:
- Abdominal tuberculosis in children requires a high index of suspicion due to nonspecific symptoms.
- Antituberculous chemotherapy is effective, with surgery reserved for diagnosis or complications.
- Risk factors include Hispanic and Indo-Chinese ethnicity; M. bovis is a significant causative agent.