Abdominal tuberculosis: An immigrant′s disease in the United States

Abstract

Background:Abdominal tuberculosis (TB) is an uncommon condition in the United States (US) except for patients with human immunodeficiency virus (HIV). An increasing number of cases have been reported in western countries amongst immigrants. It is important to be aware of the data and clinical characteristics in the immigrant population.Aims:The purpose of this study is to determine the epidemiologic characteristics of abdominal TB among immigrants in the US and to review the clinical presentations of abdominal TB with a focus particularly on unusual features.Materials and Methods:In a community teaching hospital in New Jersey, patients diagnosed with abdominal TB were examined and included in this report. All nine patients were immigrants from countries with high prevalence of TB and a majority had resided in the US for at least 5 years. None had clinical evidence of HIV and those that were tested were not found to be positive for HIV. Initial examination, diagnostic workup, and response to therapy were all pertinent to the management and diagnosis of these patients.Results:Three patients had atypical clinical presentations with normal chest X-rays and either negative or unknown tuberculin tests leading to delayed diagnosis and inappropriate therapy in at least one patient. With antituberculous therapy, all except for one patient had satisfactory outcomes. Immigrant patients with a diagnosis of abdominal TB had no evidence of HIV infection or other associated conditions in contrast to native-born individuals.Conclusion:Atypical presentations may cause diagnostic difficulties. Failure to perform appropriate tests may lead to inappropriate therapy with adverse outcomes. Although there is a decline in the number of TB cases in the US and screening for latent pulmonary infection in foreigners has been implemented effectively, the diagnosis of abdominal TB continues to be under diagnosed.

Asymptomatic Colonic Tuberculosis in an Immunocompetent Patient

“…Evidence supporting intestinal TB in our patient included clinical aspects of her case, including her immigration status. Although there has been a decrease in the total number of reported cases of tuberculosis in United States, cases of TB in foreign-born individuals continues to rise [4]. A pertinent laboratory value in our patient's case was having a positive Quantiferon Gold (QFT-G).…”

Peritoneal tuberculosis: A case report on a rare cause of tumor marker elevation

“…Abdominal TB is a rare disease that presents diagnostic challenges for clinicians due to the characteristics it shares with peritoneal malignancy and its relatively infrequent occurrence in developed countries [ 3 ]. With rapid globalization, physicians must consider TB as a potential etiology for intra-abdominal processes, especially in migrant populations from endemic regions [ 4 ]. Abdominal TB is classified by extent of tissue involvement, being peritoneal, nodal, luminal, or visceral.…”

“…Disadvantages are that AFB smears have high false negative rates and AFB cultures may take up to 8 weeks for growth [ 10 ]. Cell counts in patients with peritoneal TB typically range from 150 to 4000 cells/mm 3 with lymphocytic predominance, though neutrophilic pleocytosis is possible [ 4 ]. Further fluid analysis includes the calculation of the SAAG.…”

Tuberculosis in an Immunocompetent Immigrant Patient

“…Immunocompromised states, such as HIV infection, liver cirrhosis, systemic steroid use, advanced renal failure requiring continuous ambulatory peritoneal dialysis (CAPD), and underlying malignancy, have been associated with an increased risk for the development of peritoneal TB in most cases [2,3]. It is important to note that, in contrast to the native-born individuals in the Western countries, immigrants from TB-endemic areas mostly develop extrapulmonary TB in the absence of any identifiable immunosuppression [4].…”