Tuberculous Peritonitis–Associated Mortality Is High among Patients Waiting for the Results of Mycobacterial Cultures of Ascitic Fluid Samples

Abstract

We identified 60 cases of tuberculous peritonitis during the past 12 years at our health care center. Most of the patients had severe underlying medical conditions, such as cirrhosis, renal failure, diabetes mellitus, and malignancy. Abnormal chest radiograph findings, ascitic fluid lymphocytosis, and biochemical findings for exudates could only identify 33%, 37%, and 53% of the cases, respectively. On the other hand, peritoneal biopsy allowed early definitive diagnosis for 9 patients. Thirty-one patients died, 26 of whom died < or =6 weeks after their initial presentation, often before the result of mycobacterial culture was available. Only 8 patients died of advanced disease after antituberculous therapy was started. Univariate analysis showed that advanced age, underlying diagnosis, and delayed initiation of therapy were associated with higher mortality rates. Standard antituberculous chemotherapy is highly effective. However, conventional microbiologic diagnostic methods are slow and not sensitive enough for establishing a diagnosis of tuberculous peritonitis.

A prospective audit of the use of diagnostic laparoscopy to establish the diagnosis of abdominal tuberculosis

“…67 The mortality of tuberculosis peritonitis is 47-49% if untreated, although it can be less than 5% with treatment, several studies report a mortality of up to 60% mainly because of delayed or missed diagnosis. 29,66 To avoid any delay or missed diagnosis we wished to look at the utility of diagnostic …”

“…28 Mortality rate can be as high as 60% if anti tuberculosis treatment is not started within 30 days of symptom onset. 29 There has been a trend to make use of empirical trials of anti-tuberculosis therapy to establish the diagnosis. This is problematic as the definition of clinical recovery is vague and there are different diagnoses such as lymphoma or malignancy that can mimic abdominal tuberculosis.…”

Use of adenosine deaminase measurements and QuantiFERON in the rapid diagnosis of tuberculous peritonitis

“…Peritoneal TB is manifested clinically as ascites of insidious onset, abdominal pain and fever (Chow et al, 2002). Although an uncommon disease, the non-specific symptoms associated with TB peritonitis and its challenging clinical course can interfere with a definitive diagnosis, and TB peritonitis is often confused with other intraabdominal diseases.…”

Role of laparoscopy in the diagnosis and management of abdominal tuberculosis

“…Abdominal TB is one such complex presentation. 7,8 Abdominal tuberculosis poses a complex diagnostic challenge for clinicians as presentation is often subtle. Symptoms may even be absent in some patients.…”

“…Therefore it can be easily overlooked with an often delay in early diagnosis. 4,7,29 Recently laparoscopy have been increasingly recognized as a procedure that offers precise visual assessment of intra-abdominal condition, collection of specimen for biochemical, microbiological, histopathological analysis and prompt intervention. Against this background, this study was conducted to evaluate the role of laparoscopy in patients with suspected abdominal tuberculosis.…”