Diagnosis and Antimicrobial Susceptibility of Mycobacterium Tuberculosis in a Tertiary Care Hospital in Bangladesh

Background: Tuberculosis (TB) is a common condition all over the world but more common in developing countries like Bangladesh38. This is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. In 2013, 9 million people fell ill with TB and 1.5 million died from the disease globally. Approximately 15-20 % of total TB cases are extrapulmonary in non-HIV patients. Among extrapulmonary TB, abdominal tuberculosis (ATB) accounts for 11%-16%. Abdominal TB is difficult to diagnose because of its lack of specific symptoms, low yield of acid-fast bacilli (AFB) on smear and culture due to paucibacillary lesion; and variable manifestations depending upon anatomical localization of the disease. The diagnosis of abdominal TB classically requires histopathological, microbiological and culture confirmation of Mycobacterium tuberculosis. Investigations like Imaging (Ultrasound, Barium X-Rays, and CT scan) and the Mantoux test have only supportive value. Aim of the study: The aim of the study was to diagnose modalities and antimicrobial susceptibility in abdominal tuberculosis patients.Material & Methods:This cross-sectional hospital-based observational study was carried out among 73 adult patients with the diagnosis of abdominal TB who met the selection criteria and attended in Gastroenterology department of DMCH through either admission or referral from May 2015 to April 2016.Results:The most frequent symptoms were weight loss (96.9%), abdominal pain (75%), and fever (75%). The most frequent signs were anaemia (34.4%), followed by ascites (27.9%). Basis of diagnosis in abdominal tuberculosis was histolopathogy in 37.5%, Gene Xpert in 28.1%, Positive AFB on culture in 9.4%, ADA value in ascitic fluid (Cutoff >40 IU/L) in 25%, and good clinical response (Based on weight gain and general improvement in wellbeing) to a therapeutic trial of anti-TB treatment in 18.7% patients. Drug sensitivity pattern was analyzed in all three AFB culture-positive patients; resistance was detected in one which showed multidrug resistance (MDR TB).Conclusions:The result of this study highlighted the diagnostic yield of various investigation modalities, particularly newer modalities (Gene Xpert, culture sensitivity in Bactec MGIT 960) and basis of diagnosis in abdominal TB. This study also determined the MTB culture positivity from tissue biopsies in patients with abdominal TB and demonstrated drug-resistant MTB in culture-confirmed abdominal TB.

Tuberculosis abdominal como causa de abdomen agudo / Abdominal tuberculosis as a cause of acute abdomen

La tuberculosis abdominal es una patología infrecuente, cursa con un cuadro clínico inespecífico y múltiples diagnósticos diferenciales. Debe considerarse como posibilidad diagnóstica en lugares con alta prevalencia de tuberculosis pulmonar de lo contrario puede ser diferido en el tiempo condicionando un diagnósco y tratamiento tardíos. Los estudios de imagen, en manos experimentados, pueden orientar hacia el diagnostico. El artículo descrito presenta un cuadro infrecuente e inespecífico de tuberculosis abdominal como causa de abdomen agudo.

Abdominal tuberculosis is an infrequent pathology, it presents with a nonspecific clinical picture and multiple differential diagnoses. It should be considered as a diagnostic possibility in places with a high prevalence of pulmonary tuberculosis; otherwise, it may be delayed in time, conditioning a late diagnosis and treatment. Imaging studies in experienced hands can guide the diagnosis. The described article presents an infrequent and nonspecific picture of abdominal tuberculosis as a cause of acute abdomen

A clinicopathological study and management of abdominal tuberculosis

 Background: Tuberculosis is a major health problem in developing countries. Inspite of considerable advances, abdominal tuberculosis still continues to be of paramount health issue in India, owing to its vague and non-specific presentation challenging the therapeutic skills of present day surgeon. Surgical intervention was frequently used in the past for diagnosis is not necessary and is reserved for complications like obstruction, perforation, fistula, or a mass which does not resolve with medical therapy.Methods: 30 patients admitted in Department of Surgery satisfying the inclusion criteria from November 2015 to October 2017. Patients were selected on a prospective basis.Results: In this study out of 30 patients, 16 patients were treated conservatively with anti- tubercular therapy (ATT) alone and 14 patients underwent surgical treatment. Out of 14 patients, 5 patients were operated on emergency basis and 9 were operated electively. Of the 5 emergency cases, 2 patients underwent resection anastomosis of small bowel, 1 patient underwent adhesiolysis, and 3 patients with hollow viscus perforation underwent perforation closure with peritoneal drainage.Conclusions: Tuberculosis has become a resurgent global problem with increasing numbers of extrapulmonary manifestations, non-specific features of abdominal tuberculosis result in difficulty in establishing a diagnosis, hence prompt initiation of treatment that can be either medical management or a surgical procedure is important to prevent morbidity and mortality associated with it.

A study on the surgical management of abdominal tuberculosis in patients attending a tertiary hospital

Background: Tuberculosis is seen due to various factors such as overcrowding and unhygienic conditions. In order to diagnose a case of abdominal tuberculosis, a detailed history and a thorough clinical examination must be done. The objective of this article was to determine the number of patients who presented to a tertiary hospital with abdominal tuberculosis and in which of these patients management in the surgical department was required.Methods: A total of 50 patients who had abdominal tuberculosis were studied. The study was carried out at SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu, India. The study was carried out from February 2017 to January 2020. A detailed history was obtained and a thorough clinical examination was done. Investigations such as CBC, chest X-ray, abdomen X-ray, ultrasound scan and CT scan of the abdomen were done. When required, patients underwent surgery and the results obtained were analyzed and tabulated. In our study, out of a total of 50 patients, 32 patients were found to have required surgery. The statistics were analyzed using SPSS package 16.0.Results: It was seen that in this study, male patients were more commonly affected with abdominal tuberculosis, and resection and anastomosis was the most common surgical procedure done when required. The findings obtained were compared with other studies.Conclusions: In patients with abdominal tuberculosis, a detailed history and a thorough clinical examination are required in order to diagnose the condition as early as possible.

A retrospective observational study of clinical profile, diagnosis, management and outcome of abdominal tuberculosis in 30 patients

Background: Abdominal tuberculosis is found worldwide although prevalence rates are still highest in the developing countries. The sites of involvement of abdominal tuberculosis are peritoneum, lymph nodes, intestine and solid viscera. The objectives of this study were to describe the clinical profile of patients with abdominal tuberculosis, to review the use of diagnostic modalities, both non-invasive and invasive and to study the outcome of management of abdominal tuberculosis.Methods: This is an observational retrospective study of 30 patients with diagnosis of abdominal tuberculosis treated at university linked teaching hospital of South Gujarat from August 2015 to November 2017.Results: In our study, disease was found almost equally prevalent in both rural and urban areas affecting mostly lower socio-economical class. The mean age was 34 years (range from 13 to 62); male and female ratio was 2.33:1; the mean hospital stay was 09 days (range from 5 to 48 days). Abdominal pain was present in almost all cases, having chronic pain in 21 patients and acute in 9 patients. There were 05 (16.7%) patients found to be HIV positive in this study. There was mortality of 02 patients post operatively due to sepsis in those patients operated in emergency with peritonitis.Conclusions: Abdominal tuberculosis is prevalent in lower socioeconomic class patients and affects younger male patients more commonly. Most commonly intestinal and mesenteric disease presented with chronic abdominal pain and constitutional symptoms of tuberculosis.

Role of polymerase chain reaction of ascitic fluid and its correlation with adenosine deaminase levels in the diagnosis of abdominal tuberculosis

Background: It is still difficult to diagnose tuberculosis as a source of abdominal pain. Due to the lack of non-invasive diagnostic testing, the diagnosis remains a problem. Determining the role of polymerase chain reaction (PCR) in ascitic fluid in the diagnosis of abdominal tuberculosis, we can conclude whether it is sensitive/specific or not and further its use in the diagnosis of abdominal tuberculosis. Objective: The objective of the study was to determine the role of PCR in ascitic fluid in the diagnosis of abdominal tuberculosis and also to correlate the ADA levels of ascitic fluid with the PCR report. Materials and Methods: This prospective comparative study includes 41 clinically suspected abdominal tuberculosis patients (age range 15–65 years) over a period of 2 years. A detailed history, clinical evaluation, and relevant investigations, including radiology, were done in all patients. Bacteriological or histological approaches had to support the diagnosis of abdominal tuberculosis, and PCR was also tested for Mycobacterium tuberculosis in ascitic fluid. Results: The mean age of patients was 31.71±12.32 years with male:female ratio was 1.4:1. PCR was positive in 24 (58.8%) cases. A receiver operating characteristic curve showed that a cutoff value of 35.3 IU/L (AUC 0.998, P < 0.001) for the ADA level produced the best results as a diagnostic test for abdominal tuberculosis, yielding the following parameter values: Sensitivity 100%, specificity 94.1%, positive predictive value 96%, negative predictive value 100%, and diagnostic accuracy 97.56%. ADA values were significantly elevated during abdominal tuberculosis, indicating that ADA can still be a valuable diagnostic tool. Conclusion: Our findings indicate that ascitic fluid PCR is a safe tool for diagnosing it and should be tried at least before surgical intervention.

Surgical management and post-operative complications in abdominal tuberculosis patients

Background: Abdominal tuberculosis is a diagnostic and therapeutic challenge in resource limited countries. The vague clinical presentation is a barrier to early diagnosis. Aim of the study was to highlight the role of operative procedures and post-operative complications in patients suffering from abdominal tuberculosis.Methods: This is a descriptive study of abdominal tuberculosis cases, which were operated in the Department of Surgery, Lal Lajpath Rai hospital Kanpur, Uttar Pradesh, India, and associated hospitals. Informed and written consent was obtained from each patient prior to commencement of the study. Detailed data of each patient was entered on a Microsoft excel. Data were presented in number and percentages.Results: Most of the patient’s lumps were present in right ileac fosa, 70.37% followed by lymph node mass. Rolled omentum and appendicular showed minimum percentage of cases. In operative finding on exploratory laparotomy, the most common site of involvement was ileocaecal, and less commonly involved site in abdomen tuberculosis are duodenum and appendix. Surgical procedures, intestinal resection in the form of right hemicolectomy (21 cases), small bowel resection (58 cases). Appendicectomies were done only in 3 cases. Post-operative complications were found in 64 cases. Most of the complication developed in patients those were operated in emergency.Conclusions: Most of the surgeons were preferred conservative surgery rather than extensive resection of the active lesion. Commonest post-operative complication was broncho pulmonary complication.

Consideraciones diagnósticas y terapéuticas de la tuberculosis intestinal / Diagnostic and Therapeutic Considerations about Abdominal Tuberculosis

Introducción: La tuberculosis es una enfermedad reemergente, importante como causa mayor de incapacidad y muerte en muchas zonas del mundo. La tuberculosis intestinal representa 11 por ciento de todas las formas extrapulmonares; 0,5 por ciento de todos los casos nuevos de y el 10 al 15 por ciento en los no infectados por el VIH. En el municipio Tunas se notificó el caso de un adolescente de 17 años, masculino, al que se le diagnostica esta enfermedad luego de haber presentado síntomas de dolor abdominal recurrente durante de varios meses antes del diagnóstico. Objetivo: Actualizar la información sobre el diagnóstico y tratamiento de la tuberculosis intestinal. Métodos: Se realizó una revisión bibliográfica sobre tuberculosis intestinal con la literatura encontrada en bases de datos disponibles en la red Infomed: PubMed, Hinari, The Cochrane Library, SciELO, MEDLINE y MedicLatina; con un enfoque histórico-lógico y de análisis-síntesis. Conclusiones: El diagnóstico precoz de la tuberculosis intestinal sin tuberculosis pulmonar activa continúa siendo un problema de salud, ya que los parámetros clínicos, bioquímicos, imagenológicos y endoscópicos aún carecen de especificidad, y en algunos casos se ha mostrado resistencia al tratamiento habitual(AU)

Introduction: Tuberculosis is a reemerging disease, also important as a major cause of disability and death in many regions of the world. Abdominal tuberculosis represents 11 percent of all extrapulmonary forms; 0.5 percent of all new cases of HIV infection and 10-15 percent of those not infected with HIV. In Las Tunas Municipality, the case of a 17-year-old male adolescent who was diagnosed with this disease was reported after the patient presented symptoms of recurrent abdominal pain for several months before diagnosis. Objective: To update information on the diagnosis and treatment of abdominal tuberculosis. Methods: A literature review on intestinal tuberculosis was carried out with the literature found in databases available on the Infomed network, such as PubMed, Hinari, The Cochrane Library, SciELO, MEDLINE, and MedicLatina, with a historical-logical and analysis-synthesis approach. Conclusions: The early diagnosis of intestinal tuberculosis without active pulmonary tuberculosis continues to be a health concern, since clinical, biochemical, imaging, and endoscopic parameters still lack specificity, and, in some cases, resistance to usual treatment has been shown(AU)

A Study of 25 Diagnosed Cases of Abdominal Tuberculosis – A Review Article

Background: The objective of this study is to evaluate diagnosed cases of abdominal tuberculosis (TB) in terms of incidence,manifestation in different age groups, clinical presentations, treatment received (conservative or surgical), lesions foundintraoperatively, and its outcome on follow-ups.Methods: It is a retrospective study with 25 cases of abdominal TB treated at Guru Gobind Singh Hospital, Jamnagar, duringthe period of 2005–2007. Detailed history, physical examination, necessary investigations such as complete blood counts, ESR,urine examination, sputum examination, and radiological investigations were prescribed in all cases. Barium study, Mantouxtest, ascitic fluid examination, and computed tomography scan abdomen were carried out when indicated. Tissue or biopsymaterials were histologically examined. Results were analyzed with patient’s health status.Results: In 25 case series of abdominal TB, the average age of presentation was between 10 and 40 years with definitemale predominance (male:female = 3:2). Most of the patients belonged to low socioeconomic class which, in turn, reflectsovercrowding, undernourishment, bad sanitation, and poor hygiene in living conditions. In our study, ESR was raised in morethan 90% of patients. Abdominal pain was the most common presenting symptom followed by anorexia, fever, and vomiting.About 25% of patients were having TB foci in lung either active or healed lesion. Uncorrected anemia, malnutrition, andpulmonary TB were all contributory to poor prognosis and prolonged morbidity. Anti-TB drugs gave most satisfactory resultsin our patients.Conclusions: Koch’s abdomen is a clinical entity with varied clinical presentation. It is very common in tropics and maypresent with complications. Most of the patients are cured with conservative treatment and anti-TB drugs. Surgery is requiredin case of complications only. No drug-resistant cases have been found in this study. Investigations have played major role inconfirmation of disease.

A Retrospective Analysis of Clinical Profile of Abdominal Tuberculosis

Objective: Analysis of the clinical profile of patient presentedwith abdominal tuberculosis.Study Design: Retrospective study.Materials and Methods: The study was conducted at SIMSHapur & Govt. Medical College Saharanpur between January2016 to Dec’ 2017. A total of 56 patients were enrolled. Alldemographic data and clinical profile were collected.Results: A total of 56 patient were found, out of which maleand Female were 33(58.92%) and 23 (41.08%) respectively.Most common age affected by abdominal tuberculosis was 21to 40 Years. Regarding symptoms abdominal pain, vomiting,loss of appetite and weight loss were the presenting symptomsin 44 (78.57%), 42 (75%), 38 (67.86%) and 29 (51.79%)respectively. Regarding clinical sign at the time of presentation,pallor, abdominal tenderness and abdominal distension werepresent in 41(73.21%), 29(51.79%) and 22(39.29%)respectively. Regarding diagnosis, biopsy is the gold standardfor diagnosis of tuberculosis, so biopsies were taken by variousmeans. The endoscopic, laparoscopic, laparotomy biopsieswere taken in 13(23.21%), 17(30.36%), 10(17.86%) of patientsrespectively. Image guided Biopsy and Ascitic fluid analysiswas done in 6(10.71%) and 10(17.86%) of patients.Conclusion: Abdominal TB constitutes a major health problemin developing & poor countries. Abdominal TB is very difficult todiagnosis. A high index of suspicion picks the patient early, ifdiagnostic delayed present as acute abdomen

Abdominal tuberculosis: a surgical perplexity

Abdominal tuberculosis is one of the most challenging forms of extra pulmonary tuberculosis. The diagnosis of the disease itself poses the greatest challenge due to the variability of presentation. Clinical presentations in various forms with conflicting results on a multitude of haematological, immunological and radiological tests causes a lot of confusion in interpreting and correlating the symptoms to arrive at a diagnosis. This adds to the perplexity in surgical management of this complex disease especially in an era where AIDS has added to the problems. Having arrived at a diagnosis, chemotherapy is the mainstay of treatment. Surgery is indicated when the response to medical therapy is poor or complications supervene. Deciding the optimum procedure is again a major issue. Understanding the pathophysiology therefore is pivotal in making a value decision. The article briefly outlines the approach to this surgical perplexity.

A Clinico Pathological Study of Abdominal Tuberculosis

Background: The main type of tuberculosis of interest to any hospital- based surgeon is intestinal, the clinical presentation of which varies from one of an acute abdomen to one of a protracted cause of ill health and morbidity with a notorious reputation for poor response to therapy, both conservative as well as surgical. Low socio- economic status and malnutrition in our country are very important causes of the high prevalence of pulmonary tuberculosis, and with superadded problems of overcrowding and poor access to good sanitation and neglect for medical attention, extra pulmonary forms of tuberculosis also form a sizeable proportion of the case load of tuberculosis. The major source of infection is the open untreated case of pulmonary tuberculosis. Methods: Presented here is a brief account of hospital- based study of the presentation of 50 cases of abdominal tuberculosis and its management in both the acute as well as chronic setting, carried out at the S.C.B Medical College, Cuttack, Odisha. Results: In our study 40% patients presented with signs of intestinal obstruction, 6% with perforative peritonitis, 34% with diffuse or well defined lump and 54% with ascites. All these patients underwent biochemical, radiological and endoscopic investigations. 26 patients underwent surgical treatment, Out of these 26 patients, 14 were operated in emergency and 12 were operated electively, Emergency surgeries were performed after correction of fluid electrolyte imbalance. Of the 14 emergency cases, 3 patients underwent resection anastomosis of small bowel. 6 patients underwent right hemicolectomy for iieocaecal tuberculosis. Conclusion: In this study 60% patients had an acute and subacute presentation and 40% patients had a chronic presentation.

High CA 125 in a Case of Abdominal Tuberculosis mimicking Ovarian Malignancy.

A 45-year-old patient was admitted with history of abdominal pain and distension. Clinically diagnosis was pointing toward a case of right-sided ovarian mass with ascites. Computed tomography (CT) scan of the abdomen was suggestive of mucinous cystadenoma of right ovary with moderate ascites. Ascitic fluid tap was exudative in nature and negative for malignant cells. Blood investigations were within normal limits except for raised CA 125 (more than 1000 mIU/L) and raised erythrocyte sedimentation rate (ESR) (112 mm/h). Our provisional diagnosis was serous cystadenocarcinoma right ovary or pelvic tuberculosis (TB) involving right adnexa and pelvic peritoneum. Ascitic fluid findings were more in favor of pelvic TB, therefore the patient was started on antitubercular treatment (ATT) on trial basis. The patient responded considerably well to ATT.

Clinical Study of Abdominal Tuberculosis in Children.

Background: Abdominal TB is well described in adults, but is relatively rare in children in the modern era. Abdominal involvement is uncommon in children, occurring with an incidence of approximately 10% under the age of 10 years. Due to multiple manifestations a high index of suspicion accompanied by the appropriate investigations help in diagnosis. The diagnosis of gastrointestinal tuberculosis is challenging as it presents with a variety of symptoms. A high index of suspicion is essential. Medical treatment is the mainstay of therapy. The role of surgery is principally in diagnosis and the management of complications. Methods: This hospital based observational study was conducted prospectively for two years in a tertiary care hospital. Data including presenting symptoms(distension of abdomen, pain abdomen, lump abdomen),Signs (Loculated ascites, perforation & peritonitis) history of Bacille Calmette- Guerin vaccination, lesion sites, laboratory data, image findings, diagnosis, tuberculin skin test, risk factors, treatment, and outcome were collected and analyzed. Results: The present study conducted over a period of two years in a tertiary care hospital, a total number of 15 cases were presented by M: F 6:9 ratio. Preponderance (10 patients) was found in the age group of 10-15 years. Adenosine deaminase levels >32 IU/lt taken as significant. 6 cases presented as ascitic form of abdominal tuberculosis in this series and all cases had significant ADA levels. 8 cases were confirmed with histopathological examination. Conclusion: Abdominal Tuberculosis in children is uncommon and present with protean manifestations. Ascitic fluid adenosine deaminase level more than 32 IU/L has significant clinical correlation in ascitic form of abdominal tuberculosis. The commonest complication of gastrointestinal tuberculosis is intestinal obstruction. Diagnostic laparoscopy is useful in cases presented with chronic pain abdomen with nonspecific clinicoradiological findings mainly in peritoneal tuberculosis. Surgical intervention has tremendous role in treating the complications.

Surgical treatment of abdominal tuberculosis and intestinal obstruction: A report of 152 cases / 解放军医学杂志

Objective To summarize the experiences in surgical treatment of abdominal tuberculosis and intestinal obstruction. Methods The clinical data were retrospectively analyzed of surgically treated 112 cases of abdominal tuberculosis and intestinal obstruction from Jan. 2010 to Dec. 2015. Results Of the 112 cases, 96 were diagnosed with complete intestinal obstruction, including 29 cases of ileocecal tuberculosis (12 cases of ileum perforation), 39 cases of severe adhesions, and 28 cases of strangulated ileus caused by adhesive band; 16 cases were incomplete ileus, including 6 cases of ileocecal tuberculosis, 6 cases of part adhesions caused by mesenteric lymph node tuberculosis, and 4 cases of angulation adhesion. A hundred and six cases were cured surgically. Six cases were obstructed again and cured after antituberculotic treatment. Five cases were with intestinal fistula after surgery, of whom 2 cases died of MODS induced by aggravation of infection, and 3 cases were cured and recovered after antituberculotic and nutritional support treatment through thorough drainage. Conclusions The surgical treatment as early as possible is recommended for the patients with abdominal tuberculosis and intestinal obstruction. Preoperative formulation through full multidisciplinary team (MDT) consultation of reasonable anti-tuberculosis treatment and nutritional support scheme is the key to complete recovery and reduce of postoperative complications.

Ultrasound findings in abdominal tuberculosis: usual and unusual appearances.

Introduction: Tuberculosis is a major health problem in developing countries. Abdominal tuberculosis is not an uncommon manifestation of extra pulmonary tuberculosis. Recognition of its usual and unusual findings is important for diagnosis of the disease. Material and Methods: This retrospective study involved 150 abdominal tuberculosis patients over a period of 5 years in rural & urban population of Nashik district in Maharashtra. Abdominal ultrasound using Siemens (Accuson X500) and Philips HD 11 with convex & linear probes was done to find out the intestinal and extraintestinal disease involvement and appearances. Results: Abdominal tuberculosis was found to be more common in rural population and had a slight female predominance. In extraintestinal involvement; ascites was found in 44% cases, peritoneal thickening was found in 15 % cases, tubercles were found in 5% cases and thick swollen mesentery in 7% cases. Lymphadenopathy was seen in 47% cases. In intestinal involvement, isolated bowel wall thickening (30%), bowel ulceration (3%), bowel lump with pseudo kidney appearance (11%), matting and clumping of bowel loops (16.5%) and complex bowel mass (8.5%) were seen. Some of the unusual patterns like “club sandwich appearance” (11%) and “multilayered sandwich appearance”(2%) were also seen. Conclusion: Because of nonspecific symptoms abdominal Tuberculosis is mostly under diagnosed or misdiagnosed for chronic acidity, gastritis /colitis or chronic appendicitis. Knowledge of both usual and unusual findings is essential to diagnose abdominal tuberculosis. Hence abdominal ultrasound should be used as a primary cost effective screening modality for diagnosis which helps in management of abdominal tuberculosis.

Tuberculosis extrapulmonar en el niño / Extrapulmonary tuberculosis in children

Pulmonary tuberculosis (TB) is the most common type of TB in children. Extrapulmonary tuberculosis is also prevalent (about 30-40 percent of cases) and it can occur in a variety of anatomical sites. This study presents a review of the literature on the main clinical manifestations of extrapulmonary tuberculosis in children, its diagnosis and treatment. At the end, some reflections on the importance of BCG for prevention are presented.

La tuberculosis (TB) pulmonar es el tipo más común de TB en niños. La tuberculosis extrapulmonar también es frecuente (alrededor de 30-40 por ciento de los casos) y se puede presentar en una gran variedad de sitios anatómicos. Se hace una revisión de la literatura sobre las principales manifestaciones clínicas extrapulmonares de la tuberculosis en niños, su diagnóstico y su tratamiento. Al final se hacen algunas reflexiones sobre la importancia de la BCG para su prevención.

Tuberculosis infantil: un caso clínico de presentación típica / Childhood tuberculosis: a clinical case of atypical presentation

La tuberculosis (TBC) infantil, según la Organización Mundial de la Salud (OMS), es la que se presenta en menores de 15 años. Es responsable de aproximadamente 11% de todos los casos de TBC en el mundo. En Uruguay en los últimos años se ha observado un aumento de la incidencia de la enfermedad en niños. El diagnóstico de TBC infantil representa un desafío, ya que en el niño la infección suele cursar con manifestaciones clínicas inespecíficas y muchas veces en forma asintomática, lo que retrasa el diagnóstico. Se describe el caso de una escolar a la que se le diagnosticó TBC pulmonar y abdominal. La niña no tenía noción de contacto epidemiológico. Se presentó inicialmente con una clínica sugestiva de neumonía adquirida en la comunidad de probable etiología inespecífica. Su evolución no fue la esperada, por lo que se buscaron otros agentes etiológicos. La prueba tuberculínica fue positiva. La tomografía computada evidenció múltiples adenopatías torácicas y abdominales, hallazgos que sugirieron el diagnóstico de TBC, a forma pulmonar y abdómino-ganglionar. Ante la sospecha se comenzó el tratamiento antituberculoso, con buena evolución. Posteriormente se confirmó la infección por M tuberculosis. Se destaca la importancia de mantener un alto índice de sospecha de la enfermedad, en vista a un diagnóstico y tratamiento oportuno y eficaz.

According to the World Health Organization (WHO), childhood tuberculosis (TB) affects children under 15 years of age. It is accounts for approximately 11% of all cases of TB in the world. In Uruguay, the incidence of TB in children has increased in the recent years. The diagnosis of childhood TB is a challenge because clinical presentation is nonspecific in children, it is often asymptomatic, what delays diagnosis. The study presents the case of a girl with pulmonary and abdominal tuberculosis. She had no epidemiological contact and community acquired pneumonia was the initial clinical presentation. Clinical signs and symptoms failed to improve with treatment, so investigation of other etiologic agents was ruled out. Tuberculin test was positive. Computerized tomography revealed multiple thoracic and abdominal lymph nodes. Diagnosis of pulmonary and abdominal-nodal tuberculosis was suspected, tuberculosis treatment was started. M. tuberculosis infection was confirmed by sputum culture. High suspicion rates of the disease are necessary to provide a timely diagnosis and treatment.

Study to evaluate the role of laparoscopy in chronic abdominal pain.

Background: Patients with chronic abdominal pain can undergo numerous diagnostic tests with little change in their pain. This study was under taken to assess the efficacy of performing diagnostic and therapeutic laparoscopy in patients with chronic abdominal pain for longer than 12 weeks. Methods: All patients undergoing laparoscopy for chronic abdominal pain were included in the study for a period of 1 year from Nov. 2011 to Oct. 2012. The patient’s demographic data, length of time with pain, diagnostic studies, intraoperative findings, interventions and follow-up were determined. Results: A total of 25 patients (19 women and 6 men) with an average age of 34.64 years underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The average length of time with pain was 32.96 weeks (range 12-96). 2 cases required conversion to an open procedure and no complications occurred. Findings included abdominal Koch's in 9, appendicitis in 8, cholecystitis in 1, cirrhosis in 1; ovarian cyst in 1, bilateral fimbrial cyst in 1 and 4 patients had no obvious pathology. 82.6% of patients had pain relief at the time of follow up. Conclusion: Laparoscopy has a diagnostic and therapeutic role in patients with chronic pain abdomen.