Clinical Status and Research Progress of Tuberculous Peritonitis / 中国医学科学院学报

Tuberculous peritonitis(TBP)is currently one of the common manifestations of extrapulmonary tuberculosis.Due to the atypical clinical features,diverse types of diseases to be distinguished,and limited detection methods,TBP is difficult to be diagnosed and the fatality caused by delayed diagnosis increases significantly.We studied the current research status of TBP and found that T cells spot test,abdominal CT,and laparoscopic biopsy were of high diagnostic value for TBP.However,the application of ascites Xpert-MTB/RIF-ultra assay,ascites ADA,and whole-body positron emission tomography/computed tomography remained to be studied.Serum CA125 helps to judge the efficacy of anti-tuberculosis treatment.

Tuberculosis peritoneal. Una forma de presentación poco frecuente de una enfermedad emergente en pediatría / Peritoneal tuberculosis. A rare form of presentation of an emerging disease in pediatrics

La tuberculosis constituye un importante problema sanitario, que afecta a un tercio de la población mundial. La localización pulmonar es la más frecuente, y es rara la presentación perito-neal. Las manifestaciones clínicas son inespecíficas, por lo que el diagnóstico requiere de un alto nivel de sospecha.Se comunica el caso de una adolescente de 13 años hospitali-zada por tuberculosis peritoneal. El objetivo es describir una forma poco frecuente de manifestación extrapulmonar de la infección por M. tuberculosis en la edad pediátrica y concien-tizar a la comunidad médica, en el contexto epidemiológico actual, sobre la reemergencia de esta enfermedad y la impor-tancia del diagnóstico y tratamiento oportunos, así como de reforzar las medidas de control y prevención.

Tuberculosis constitutes an important health problem, affect-ing one third of the world's population. The pulmonary lo-calization is the most frequent one, being rare the peritoneal presentation. Clinical manifestations are non-specific so the diagnosis requires a high level of suspicion.The case of a 13-year-old teenager hospitalized for peritoneal tuberculosis is reported. The objective is to describe a rare form of extra-pulmonary manifestation of M. tuberculosis infection in the pediatric age and to sensitize the medical community, in the current epidemiological context, to the reemergence of this disease and the importance of timely diagnosis and treat-ment as well as strengthening control and prevention measures.

Peritonitis tuberculosa en un niño / Pediatric tuberculous peritonitis: case report

Resumen La peritonitis tuberculosa es una entidad infrecuente en la población pediátrica. Es una forma poco común de tuberculosis extrapulmonar y representa un muy bajo porcentaje de todos los casos de tuberculosis. Sus síntomas son inespecíficos, manifestándose usualmente con ascitis, dolor abdominal, fiebre y baja de peso. El retraso en su diagnóstico y tratamiento, dada su forma de presentación, puede incrementar su morbimortalidad. Se comunica el caso de una adolescente de 14 años, previamente sana, quien se presentó con fiebre y ascitis. La laparoscopia demostró múltiples nódulos en la cavidad abdominal compatibles con una tuberculosis peritoneal, la cual fue posteriormente confirmada por cultivo y biología molecular. La paciente completó su tratamiento antituberculoso recuperándose en forma satisfactoria.

Tuberculous peritonitis is an uncommon entity in the infant population. It is an uncommon form of extrapulmonary tuberculosis and represents a very low percentage of all cases of tuberculosis. Its symptoms are nonspecific and usually manifesting with ascites, abdominal pain, fever and low weight. The delay in its diagnosis and treatment, originated by its form of presentation, can cause an increase in its morbidity and mortality. We report the case of a 14-year-old patient without concomitant disease or pulmonary tuberculosis, who presented with ascites and fever. Laparoscopy showed multiple nodules in the abdominal cavity compatible with peritoneal tuberculosis, which was subsequently confirmed by culture and molecular test. The patient completed her antituberculosis treatment recovering satisfactorily.

Tuberculosis abdominal: patología infrecuente en un paciente joven: reporte de un caso / Abdominal tuberculosis: an unusual disease in a young patient: a case report

Resumen Introducción: La tuberculosis abdominal es un problema reemergente, y es una de las enfermedades transmisibles más importante en todo el mundo. A pesar de las expectativas acerca de su erradicación en países en desarrollo, ha sido recientemente declarada de nuevo como una patología de emergencia mundial. Con el aumento de su incidencia y prevalencia, su forma abdominal es una de las presentaciones de afectación extrapulmonar más comunes. Objetivo: Dado que la tuberculosis puede afectar diversos órganos, tiene una amplia gama y gran espectro de signos y síntomas que dificultan su diagnóstico y retrasan el tratamiento. Por esto, se realiza esta revisión de tema, concentrándonos en que el alto índice de sospecha debe ser un factor importante en el diagnóstico precoz, para que una vez establecido, se pueda iniciar el tratamiento ayudando a prevenir y disminuir las altas tasas de morbilidad y mortalidad evidenciadas en la actualidad. Caso Clínico: Paciente joven con presencia de ascitis secundaria a tuberculosis abdominal confirmada por una biopsia y el aumento de la adenosin deaminasa en el líquido peritoneal. Se describen los principales hallazgos clínicos, paraclínicos, estudios imagenológicos y tratamiento.

Introduction: Abdominal tuberculosis is a reemerging problem and is one of the most important communicable diseases in the world. Despite expectations about the eradication in developing countries, it has recently been re-declared as a global emergency pathology. The increased incidence and prevalence shows an abdominal shape as one of the most common extrapulmonary involvement presentations. Objective: Since tuberculosis can affect various organs, it has a wide range and spectrum of signs and symptoms that make diagnosis difficult and delay treatment. Therefore, this review of the topic is done, concentrating on the fact that the high suspicion index should be an important factor in the early diagnosis. Treatment can be initiated helping to prevent and reduce high morbidity and mortality rates. Case Report: We present a case of a young patient with ascites secondary to abdominal tuberculosis confirmed by biopsy and increased adenosine deaminase in the peritoneal fluid. The main clinical findings, paraclinic, imaging studies and treatment are described.

Case report of myeloperoxidase deficiency associated with disseminated paracoccidioidomycosis and peritoneal tuberculosis

Abstract Myeloperoxidase (MOP) is present in monocyte and neutrophil lysosomes, catalyzing hydrogen peroxide and chloride ion conversion to hypochlorous acid. MOP seems to destroy pathogens during phagocytosis by neutrophils and is considered an important defense against innumerous bacteria. We present a patient who had MOP deficiency, who presented with a subacute form of paracoccidioidomycosis and later with peritoneal tuberculosis. MOP deficiency leads to the diminished destruction of phagocytized pathogens. This case gives important evidence of an association between MOP deficiency and increased susceptibility to infection by Paracoccidioides brasiliensis and Mycobacterium tuberculosis.

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)

Tuberculosis peritoneal con presentación clínica como cáncer ovárico avanzado: revisión de la literatura / Peritoneal tuberculosis with clinical presentation as advanced ovarian cancer

Se presenta el caso de paciente con ascitis, masa pelviana y CA 125 elevado, sugerentes de cáncer ovárico avanzado. Se realizó laparoscopía que demostró lesiones compatibles con tuberculosis peritoneal. La biopsia laparoscópica de las lesiones demostró granulomas, por lo que no se realizó más cirugía y se inició tratamiento antituberculoso específico con buena respuesta clínica. Se revisa en la literatura tuberculosis peritoneal y su dificultad con el diagnóstico diferencial con cáncer de ovario avanzado.

It is presented the case of a patient with ascites, pelvic mass and elevated CA 125, all suggested of advanced ovarian cancer. It was made a laparoscopy that evidenced lesions of peritoneal tuberculosis. The laparoscopic biopsy of the lesions demostrated granulomas, for that there was no more surgery made and antituberculosis specific treatment was started, with good clinical response. It is revisited in the literature peritoneal tuberculosis and its difficult differential diagnoses with advanced ovarian cancer.

Tuberculose peritoneal: um diagnóstico diferencial no abdômen agudo: relato de caso / Peritoneal tuberculosis: a differential diagnosis in acute abdomen: case report

JUSTIFICATIVA E OBJETIVOS: O Amazonas é o estado com maior taxa de incidência de tuberculose (TB) no Brasil, com 82,7casos por 100.000 habitantes. O acometimento peritoneal é raro, com alta morbimortalidade, representando 0,1 a 0,7% de todos os casos. O objetivo deste estudo foi relatar um caso de abdômen agudo inflamatório secundário a TB peritoneal em paciente jovem imunocompetente. RELATO DO CASO: Paciente do sexo masculino, 33 anos, procedentede Manaus-AM, etilista, com história de TB familiar. Evoluindo há um mês com ascite, astenia, cefaleia, febre vespertina, sudorese noturna, perda ponderal de 10%. Deu entrada no pronto-socorro com dor abdominal suprapúbica e sinais clínicos de irritação peritoneal. Foi submetido à laparotomia exploradora, sendo encontradas diversas lesões nodulares, que foram biopsiadas. O estudo histopatológico revelou formações granulomatosas, necrose caseosa e bacilos álcool-ácidos resistentes, compatíveis com TB peritoneal. As sorologias para vírus da imunodeficiência humana e hepatites B e C foram negativas. CONCLUSÃO: A TB peritoneal é de difícil diagnóstico, devendo ser lembrada como um diagnóstico diferencial em paciente jovem, imunocompetente, com quadro de abdômen agudo inflamatório procedente de área epidemiológica de alta prevalência para TB.

BACKGROUND AND OBJECTIVES: The Amazon is the state with the highest incidence rate of tuberculosis (TB) in Brazil with 82.7 cases per 100,000 inhabitants. Peritoneal involvement is rare with high morbidity and mortality, accounting for 0.1% to 0.7% of all cases. The aim of this study was to report a case of acute abdomen secondary to inflammatory peritoneal TB in an immunocompetent young patient. CASE REPORT: Male patient, 33 years old, coming from Manaus, state of Amazonas, alcoholic, with family history of TB. One-month progression with ascites, asthenia, headache, afternoon fever, night sweats, weight loss of 10%. The patient was admitted to the ER with suprapubic abdominal pain and clinical signs of peritoneal irritation. He underwent exploratory laparotomy and several nodular lesions were found which were biopsied. Histopathological examination revealed granulomatous formation, caseous necrosis and acid-alcohol resistant bacilli consistent with peritoneal TB. Serology for human immunodeficiency virus and hepatitis B and C was negative. CONCLUSION: Peritoneal TB is difficult to diagnose and should be included as a differential diagnosis in young, immunocompetent patients coming from epidemiological area of high prevalence of TB with acute abdomen with signs of inflammation.

A Case of Chlamydia trachomatis Peritonitis Mimicking Tuberculous Peritonitis / 대한소화기학회지

Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination.

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.

Multifocal idiopathic fibrosclerosis mimicking tuberculosis of the abdomen.

We present a 13 year old girl from Assam who had been treated as abdominal tuberculosis for 2 years due to the presence of refractory lymphocyte-predominant ascites and multiple small bowel strictures associated with significant anorexia and weight loss. On evaluation she was found to have retroperitoneal fibrosis with hydroureteronephrosis, mediastinal fibrosis and a retro-orbital pseudotumour. Based on these findings the diagnosis of Multifocal Idiopathic Fibrosclerosis (MIFS) was made. Ascites and multiple bowel strictures have been only rarely been described in association with MIFS. The other unique features in this patient were the early age of presentation, the presence of mediastinal fibrosis in association with retroperitoneal fibrosis, extensive soft tissue fibrosis of the neck, axillae and the presence of trismus. In a country like ours where Tuberculosis is commonplace, one would not think twice about treating such a case with antituberculous therapy. However, with a constellation of findings suggestive of a diffuse fibrotic process, MIFS should be an important consideration.©

Ectopic decidual reaction mimicking peritoneal tubercles: a report of three cases.

Ectopic decidual reaction is commonly seen in the ovary and cervix; however, peritoneal localization is rare. Peritoneal deciduosis is usually an incidental histological finding. It may present a diagnostic dilemma by mimicking grossly peritoneal carcinomatosis or tubercles and deciduoid mesothelioma, microscopically. We report three cases of ectopic decidual reaction discovered incidentally during caesarian sections, as whitish yellow nodules resembling tubercles. Histology revealed extensive decidualisation. To the best of our knowledge, this is the first report of ectopic decidua mimicking peritoneal tubercles.

frequency and management of intestinal Tuberculosis; a hospital based study

To determine the frequency of clinical manifestation of intestinal tuberculosis and outcome of different treatment modalities. This descriptive study was conducted at Lady Reading Hospital Peshawar from July 2005 to June 2006. Fifty cases having radiological evidence of tuberculosis in the intestines were included in the study. Various parameters like age, sex, presentation, investigation and various treatment modalities were studied. Twenty three [46%] patients presented with subacute and 13 [26%] with acute intestinal obstruction and 12 [24%] with signs of peritonism. Presenting symptoms were: pain abdomen and anorexia in 47[94%] patients, nausea / vomiting in 30 [60%] patients and constipation in 28 [56%] patients. Tenderness was present in 48 [96%] patients and distension of abdomen in 35 [70%]. Two [4%] patients were treated conservatively and 48 patients [96%] were managed by surgery [emergency surgery 34 cases, semi-elective surgery 14 cases]. In 47 [94%] patients, diagnosis was confirmed by characteristic caseating granuloma. Resection of the small bowel with ileo-ileal anastamosis was done in 16 cases and limited right hemicolectomy with ileo-colic anastamosis in 14 cases. Two staged procedures were performed in 8 cases. Only three [6%] cases needed re-admission for complications, two [4%] for sub-acute obstruction and one [2%] for ileostomy prolapse. Abdominal tuberculosis presents with pain abdomen, anorexia, vomiting and with signs of intestinal obstruction. The surgical procedures like resection with primary anastomosis have satisfactory outcome. Two stage surgical procedures are advisable if the risk of anastamotic leakage and faecal fistula formation is high

unusual presentation of pelvic tuberculosis

Tuberculosis is highly prevalent in developing countries like Pakistan and should be considered in the differential diagnosis of patients with pelvic mass, ascites and raised serum CA 125 levels. A case of pelvic tuberculosis with markedly raised serum CA 125 levels and initial diagnosis of ovarian tumour was made

Tuberculose peritoneal: como diagnosticar / Peritoneal tuberculosis: how to obtain a confident diagnosis

O peritônio é sítio freqüente de envolvimento abdominal pela tuberculose. Geralmente, a suspeitaé feita a partir de um exame de imagem e, mais freqüentemente, pela tomografia computadorizada. Alguns sinais tomográficos são bastante indicativos de tuberculose peritoneal e permitem pressupor o seu diagnóstico, que é confirmado por exames laboratoriais e laparoscopia. A carcinomatose peritoneal é o seu principal diagnóstico diferencial. Apresentamos uma revisão dos principais sinais diagnósticos de tuberculose peritoneal e como diferenciá-la da carcinomatose peritoneal.

The peritoneum is a frequent site of involvement by peritoneal tuberculosis. Generally, computed tomography appears to be the imaging modality of choice in the detection and assessment of abdominal tuberculosis. The computed tomography findings can help in the diagnosis of peritoneal tuberculosis, that is confirmed by a positive culture or hystologic analysis of biopsy obtainedthrough laparoscopic examination. Peritoneal carcinomatosis is the main differential diagnosis. In this article we present the spectrum of tomographic manifestation of peritoneal tuberculosis and how we can differentiate it from peritoneal carcinomatosis.

[Peritoneal tuberculosis in children about a 42 cases]

Peritoneal tuberculosis is a common affection in the developing countries. Its frequency in the industrial countries is substantially increasing mainly due to AIDS pandemiy. In Morocco it occupies the third position after pulmonary tuberculosis and gangional tuberculosis. It represents 75%of abdominal localisations. In this study, we report 42 cases that were hospitalized at the pediatrics department at the Hassan II University Hospital of Fez, Morocco, Our patients, 22 boys and 20 girls, were aged between 1.5 and 14 years old with an average age of 7.7 years. They were vaccinated with BCG in 97%of cases. Twelve cases were due to contagion. The clinical profile was dominated by ascitis, abdominal pain sometimes with resemblance to surgical pathologies and acute fever. Association with other tuberculosis affections, mainly pleural tuberculosis, was observed in 17 cases. In 26 kids diagnosis was confirmed with histology. The scheme and the duration of anti-bacilli treatment varied depending on cases and the coarse was good in general. Based on these observations we can con that the incidence of peritoneal tuberculosis is still very high in Morocco, since the frequency of contagion is very important the screening remains obligatory, the delay of diagnosis is due to the clinical polymorphism and to the lack of bacteriological evidence

Etiologic and Laboratory Analyses of Ascites in Patients who Underwent Diagnostic Paracentesis / 대한간학회지

BACKGROUND/AIMS: Liver cirrhosis and malignant tumors are two major causes of ascites according to the reports from Western countries, 80% and 10% respectively. Assuming that there might be regional differences in etiologies and changes in their frequency over time, we investigated causes of ascites and the diagnostic usefulness of various laboratory tests. METHODS: Medical records of 366 patients, who underwent diagnostic paracentesis in the mid-1990s (1996 and 1997) and early 2000s (2001 and 2002), were retrospectively reviewed. The etiology was confirmed by histology, imaging studies, and ascites analyses. RESULTS: The frequency of cirrhotic ascites was 59.6%, cancer-related 25.7%, tuberculous peritonitis 6.6%, and others 8.1%. Among cirrhotics, the frequency of cases related to hepatitis B decreased significantly from 72% to 55% over time, and alcoholic cirrhosis increased from 18% to 34%. Among cancer-related ascites, peritoneal carcinomatosis type was 75.5% (primary sites: stomach 24.5%, pancreas 15.9%, colon 15.9%, lung 7.4%, etc), metastatic liver cancers 8.5%, hepatocellular carcinoma without cirrhosis 6.4%, etc. The sensitivity of serum-ascites albumin gradient for the diagnosis of cirrhotic ascites was 91.4%, and total protein in ascites also revealed a comparable diagnostic sensitivity, 90%. The diagnostic sensitivity of adenosine deaminase for tuberculous peritonitis was 94.2%, and its positive predictive value was 75%. CONCLUSIONS: Liver cirrhosis is the leading cause of ascites, especially alcoholic cirrhosis has significantly increased. The next common etiology is cancer-related, and its frequency in Korea is higher than in western countries. Tuberculous peritonitis is still prevalent, and adenosine deaminase could precisely differentiate it from other causes.

Tuberculose peritoneal: relato de caso / Peritoneal tuberculosis: case report

A tuberculose peritoneal consiste num processo inflamatório crônico causado pelo Mycobacterium tuberculosis. Sua sintomatologia é inespecífica, com comprometimento sistêmico. É aqui descrito o caso de um paciente de 35 anos de idade, alcoólatra, portador de cirrose hepática. Seu diagnóstico foi definido após realização de biópsia peritoneal feita durante a laparotomia exploradora. Iniciou-se o tratamento preconizado e o paciente recebeu alta em boas condições clínicas.

Medicina basada en evidencias en hepatología III-A:evaluación de test diagnóstico: utilidad de adenosin deaminasa (ADA) en el diagnóstico de peritonitis tuberculosa / Evidence based medicine in hepatology III-A: critical analysis of diagnostic test: effectiveness of ADA for diagnosing tuberculous peritonitis

El siguiente estudio continúa la serie de publicaciones sobre decisiones clínicas en Hepatología, usando los pasos de la Medicina basada en Evidencia. Se analizó la utilidad de la adenosin deaminasa (ADA) en el diagnóstico de tuberculosis peritoneal (TBP) en un paciente con ascitis. Usando un modelo de búsqueda basado en una pregunta clínica, se identificaron 17 artículos relacionados. Uno de ellos fue extensa y críticamente analizado, incluyendo una revisión de su validez (comparación con gold standard, espectro de pacientes analizados, y reproducibilidad del trabajo), análisis de sus resultados, y discusión de su aplicabilidad. El artículo seleccionado fue prospectivo, incluía a pacientes consecutivos, confirmó el diagnóstico de tuberculosis con una biopsia laparoscópica en todos los pacientes, y realizó la determinación de ADA utilizando el método de Giusti. Los Resultados mostraron que ADA es un test discriminativo para el diagnóstico de TBP, con un punto de corte óptimo de 32 UI/L. Concluimos que la medición de niveles de ADA en líquido ascítico, es una forma efectiva de diagnosticar TBP.

Abdominal tuberculosis in adolescents. Difficulties in diagnosis

Since the nature of abdominal tuberculosis is mimicking a number of diseases, this may cause delayed diagnosis resulting in evident increased morbidity and mortality. Most of the time, serologic and bacteriologic tools are not enough. We report 3 adolescents with distinct presentations, one mimicking Crohn's disease, one with hepatitis, and the last one with ascites. Terminal ileitis and mesenteric lymphadenitis were found in laparotomy of the first case mimicking Crohn disease. Granulomatous hepatitis was found in the liver biopsy of the second patient, and peritonitis was found by laparoscopy of the third patient. Tuberculosis could be diagnosed merely by histopathologic investigation. All were treated successfully without complication