Tuberculosis extrapulmonar con compromiso peritoneal. Reporte de caso clínico y revisión de literatura / Extrapulmonary tuberculosis with peritoneal compromise. Case clinical report and literature review

Extrapulmonary tuberculosis accounts for a significant proportion of tuberculosis cases worldwide (about 20-25% of the cases). Nevertheless, the diagnosis is often delayed or even missed due to insidious clinical presentation and poor performance of diagnostic tests. Peritoneal tuberculosis is due to the infection of Mycobacterium tuberculosis in the peritoneum. It represents 0.7% of total cases of tuberculosis. This disease can mimic malignancy specially in women, because of its clinical presentation with ascites, weight loss and similar radiological sings. The phenomenon of migration, the increased use of immunosuppressive therapy and the epidemic of AIDS have contributed to a resurgence of this disease. We present the clinical case of a Haitian woman who presented ascites, abdominal pain and weight loss with radiological signs that suggested peritoneal carcinomatosis, in which further studies of ascitic fluid showed elevated adenosindeaminase, a specific and sensitive finding for tuberculosis. (AU)

Clinical forms and determinants of different locations of extrapulmonary tuberculosis in an African country.

Background: Extra-pulmonary tuberculosis (EPTB) accounts for about 15% to 36% of all cases of TB and its prevalence has significantly increased with the advent of the global pandemic of human immune-deficiency virus (HIV) infection. A few studies are available on the determinants of EPTB. Aims: To determine the distribution and determinants of the main locations of EPTB in the context of high endemicity for HIV infection. Methods: This was a cross-sectional study among patients aged >15 years, receiving care in the pneumology service of the Yaounde Jamot Hospital, between October 2010 and December 2011. Logistic regressions were used to investigate potential determinants of different locations of EPTB. Results: Of the 788 eligible patients admitted during the study period, 100 (12.7%) had isolated EPTB, and 158 (20.1%) had both PTB and EPTB. Among 258 patients definitively included, 162 (62.8%) were men and the median age was 33 (25.75-44) years. Frequent extra-pulmonary locations of tuberculosis were lymph nodes (126 patients, 48.3%), pleura (121 patients, 46.4%) and peritoneum (25 patients, 9.6%). Using isolated pleural TB as a referent, independent determinants of isolated lymph node tuberculosis were HIV infection [odds ratio (95% CI), 2.58 (1.25-5.32)], duration of symptoms >6 weeks [2.41 (1.11-5.22)] and pulmonary involvement [2.39 (1.14-5.05)]. HIV infection [2.23 (1.06- 4.70)] and duration of symptoms >6 weeks [2.31 (1.08-4.96)] were also independent determinants of multifocal/disseminated tuberculosis. Conclusion: EPTB with or without concomitant PTB is frequent in this setting, with HIV infection being the main determinant.

Tuberculosis peritoneal: informe de siete casos / Peritoneal tuberculosis: report of seven cases

Introducción: La tuberculosis peritoneal es una entidad clínica con baja frecuencia de presentación y por mucho tiempo casi olvidada de la práctica clínica. Casos clínicos: Presentación y análisis de siete casos con diagnóstico de tuberculosis peritoneal, tratados en cuatro hospitales de la ciudad de Aguascalientes, en un periodo de cinco años, que presentaron las siguientes características: edad promedio de 47.5 ± 6.5 años; seis de ellos del sexo femenino y uno del masculino. Dos pacientes tenían el antecedente de tuberculosis pulmonar. Los datos clínicos más relevantes fueron dolor abdominal en seis, ascitis en cuatro y dolor abdominal en tres. El tiempo de evolución promedio de los síntomas fue de 5 ± 1.7 meses. Los hallazgos tomográficos identificados fueron tumor ovárico unilateral en cuatro y bilateral en dos, ascitis en cuatro y adenopatía retroperitoneal en uno. A los seis pacientes del sexo femenino se les encontró niveles elevados de CA125, con mediana de 419 U/ml (286 a 512 U/ml). Se sospechó neoplasia maligna en el preoperatorio en todos los casos, por lo que fueron operados en forma electiva. Se realizó laparotomía con biopsia en tres, laparotomía con salpingo-ooforectomía en dos y laparoscopia con biopsia en dos. Se sospechó tuberculosis peritoneal al momento de la cirugía en todos. El promedio de estancia hospitalaria fue de 2 ± 0.5 días. No se presentaron complicaciones ni muertes hospitalarias. Conclusiones: La tuberculosis peritoneal es una enfermedad rara que se presenta cada vez con mayor frecuencia. Debe considerarse el diagnóstico en pacientes jóvenes con tumor anexial, ascitis y elevación de CA125.

BACKGROUND: Peritoneal tuberculosis (TB) is a misdiagnosed clinical entity of low frequency. Due to its rarity, it requires a high index of suspicion in clinical practice. Its incidence has been increasing in recent years. CLINICAL CASES: We present and analyze seven cases of peritoneal TB diagnosed and treated at four hospitals in Aguascalientes, Mexico during a 5-year period. Mean age of the patients was 47.5 +/- 6.5 years. There were six females and one male. Two patients had a history of treated lung TB. The most frequent clinical data were abdominal pain (six patients), ascites (four patients), and abdominal tumor (three patients). Symptom duration prior to surgery was 5.0 +/- 1.7 months. Abdominopelvic CT examinations revealed unilateral ovarian tumor in four patients, bilateral ovarian tumor in two patients, ascites in four patients, and retroperitoneal adenopathy in one patient. All female patients had elevated serum CA-125 levels with a median of 419 U/ml (range: 286-512 U/ml). All patients had a preoperative diagnosis of malignant tumor. All surgical procedures were elective and consisted of laparotomy with biopsy in three patients, laparotomy with salpingo-oophorectomy in two patients, and laparoscopy with biopsy in two patients. Diagnosis of TB was suspected in all cases during surgery. Mean hospital stay was 2 +/- 0.5 days. There was no postoperative morbidity or mortality. CONCLUSIONS: Peritoneal TB is uncommon. Diagnoses should be considered in all patients with ascites, adnexal tumors and elevated serum CA-125 levels.

[Peritoneal tuberculosis - report of 43 cases]

Peritoneal tuberculosis represents 0, 1 to 4% of all forms of tuberculosis. The aim of our study is to describe clinical, therapeutic characteristics and the outcome of peritoneal tuberculosis. Retrospective study of all cases of peritoneal tuberculosis diagnosed in gastroenterology B department - Rabta Hospital during a 12 years period [1996 to 2007]. Forty three cases of peritoneal tuberculosis were included: 15 male and 28 female with mean age of 38years [extremes: 16 to 85years]. Five patients were cirrhotic. Clinical manifestations were dominated by ascitis [83%]. Ascitic fluid were exsudative in 97% of cases and lymphocytic in all cases. The diagnostic was based on coelioscopy with peritoneal biopsy in 26cases demonstrating caseating granulomatous lesions in 64% of cases. Extra peritoneal tuberculosis was noted in 60, 4% dominated by pleuro-pulmonary localisations. Patients were given antituberculous therapy for a mean duration of 9, 8 months and the outcome was favourable in 93%. Peritoneal tuberculosis is still a medical problem in Tunisia. It is more common in young female. Diagnosis is based on the results of peritoneal biopsies during coelioscopy. The outcome is good in most cases after antituberculous treatment

Retrospective and prospective study of ovarian tumours and tumour-like lesions.

Two hundred and thirty three cases of ovarian tumours and tumour like lesions were studied. Of these 233 cases, 96 cases were of ovarian tumours and 137 were tumour like lesions of the ovary. Of the 96 cases of ovarian tumours, 72.9% were benign, 4.1% were borderline and 22.9% were malignant. Histologically surface epithelial tumours were the commonest (48.8%) followed by germ cell tumours (23.9%), sex cord stromal tumours (8.3%) and metastatic tumours (2.0%). Ultrasound guided FNAC done in cases of ovarian tumours showed an accuracy of 100% for malignant lesions and 100% for benign and borderline lesions when compared with histopathological diagnosis. Of the non neoplastic lesions follicular cysts and corpus leuteal cysts were commonest (80.2%). Tuberculosis constituted (2.9%) cases and was the major cause of clinical diagnostic pitfalls for cases in which a clinical diagnosis of ovarian neoplasm was made.

Tuberculose peritoneal: análise de 12 casos / Peritoneal tuberculosis: analysis of 12 cases

A tuberculose peritoneal é uma situação rara com alta morbidade e mortalidade, sendo que o prognóstico depende do diagnóstico e tratamento precoces. Nos últimos anos tem havido aumento de incidência nos países desenvolvidos, principalmente em pacientes imunocomprometidos. Foram analisados retrospectivamente 12 pacientes com tuberculose peritoneal (7 homens, média de idade: 51 anos). As manifestações clínicas, comorbidades e métodos diagnósticos foram revisados. Ascite foi a manifestação mais prevalente. Tuberculose pulmonar associada estava presente em apenas 25% dos pacientes. A biópsia de peritônio foi diagnóstica em todos os casos. Deve haver alto grau de suspeita para estabelecer o diagnóstico de TBC peritoneal (AU)

Peritoneal tuberculosis is a rare condition with high morbidity and mortality, and the prognosis depends of the early diagnosis and treatment. The incidence has been growing in the last years in developed countries, mainly in immunocompromised patients. Twelve patients with peritoneal tuberculosis were retrospectively studied (7 men, mean age 51 years). Data concerning to clinical manifestations, comorbidities and diagnostic methods were obtained. Ascites was the great manifestation. Pulmonar tuberculosis was associated in 25% of patients. Peritoneal biopsy was diagnostic in all patients. To make the diagnosis of peritoneal tuberculosis a high grade of suspicion is necessary (AU)

Tuberculose peritoneal: Relato de um caso / Peritoneal tuberculosis: A case report

Os autores descrevem um caso de tuberculose peritoneal solucionado através de prova terapêutica. Tratava-se de menina de nove anos com ascite cuja punçäo mostrou líquido amarelo com elevaçäo de proteínas e predomínio de linfócitos. A evoluçäo foi favorável

Tuberculosis intestinal y peritoneal / Intestinal and peritoneal tuberculosis

Se revisaron 140 historias clínicas de pacientes mayores de 14 años con el diagnóstico de tuberculosis (TBC) intestinal y/o peritoneal según criterios diagnósticos pre establecidos, en un periodo de dieciocho años, en el Hospital Nacional Cayetano Heredia. La localización intestinal estuvo presente en el 48.5 por ciento, la peritoneal en el 33 por ciento y ambas en el 18.5 p[or ciento; siendo en conjunto el 4.5 por ciento de todas las formas de presentación de la TBC. Elgrupo de edad más comprometido fue el de 14 a 24 años, con un ligero predominio no significativo del sexo femenino sobre el masculino; la mayoría provenía de las zonas urbano marginales de Lima y regiones más pobres del país. En la mayoría el inicio fue insidioso y el curso previo a la hospitalización de uno a seis meses. No hubo un síndrome característico, sin embargo fue frecuente la disminuciónde peso, el dolor abdominal y las diarreas; entre los exámenes de laboratorio se evidenció importantemente hipoalbuminemia y anemia. El diagnóstico se realizó por estudios histopatológicos en quienes fue posible, contando con la ayuda de la radiología, ecografía y baciloscopía directa. La tuberculosis intestinal y/o peritoneal se asoció a la localización pulmonar en el 84.5 por ciento de los casos. En cuanto al tratamiento no hubo diferencia significativa en la respuesta a los diferentes esquemas empleados presentando evolución buena intrahospitalaria los dos tercios de los pacientes. La complicación más frecuente fue la obstrucción intestinal. Fallecieron en total el 14.5 por ciento. Si bien la evolución y el pronóstico ha mejorado, aún existe un elevado riesgo de muerte por esta enfermedad en países en vías de desarrollo como el Perú

Tuberculosis abdominal / Abdominal tuberculosis

Se evaluaron 20 casos de tuberculosis (TBC) abdominal; de los cuales 10

Tuberculosis peritoneal: experiencia en el Hospital Santa Clara de Bogotá

Se revisaron las historias clínicas de los pacientes con diagnóstico de Tuberculosis Peritoneal (TP) del Hospital Santa Clara entre 1983 y 1989, para evaluar sus características clínicas, métodos diagnósticos, tratamiento y evolución. La presencia de bacilos ácido-alcohol resistentes en coloración o cultivo de líquido peritoneal o de material de biopsia y/o granulomas caseificantes en tal material, fueron los criterios diagnósticos. Se encontraron 15 pacientes, 12 mujeres y 3 hombres; los síntomas más frecuentes fueron: dolor y distención abdominal, pérdida de peso y fiebre. Los signos más comunes: ascitis y dolor abdominal. Cuatro pacientes presentaron abdomen agudo. El diagnóstico se estableció mediante laparotomía en 9 pacientes, laparoscopia en 4, coloración positiva en líquido ascítico en 1 y exudado linfocítico ascítico mas TBC pleural en otro. Catorce recibieron esquema acortado; todos evolucionaron hacia la mejoría. La TP continúa siendo frecuente en nuestro medio. El cuadro clínico variable dificulta el diagnóstico. la laparoscopia con biopsia es el método diagnóstico de elección, aunque la titulación de adenosín-deaminasa en líquido ascítico resulta muy prometedora.

Abdominal tuberculosis in children.

Problems in the management of abdominal tuberculosis in children are discussed with reference to 80 surgically proven cases. The protean clinical manifestation depends on the site and the extent of the disease and its complications. The clinical diagnosis is difficult because of the vague symptoms, non-specific signs, and non-availablity of specific diagnostic tests. The most common type of pathology seen in abdominal tuberculosis in the paediatrics age were adhesive variety followed by nodal type. Strictures of the small bowel are uncommon and hyperplastic variety is rarely seen in this age group. Response to the antitubercular drugs is excellent however, the post operative complications and mortality remain high.