Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia

Edford Sinkala,Lameck Zimba,Isaac Zulu,Sylvia Gray,Victor Mudenda,Francis Drobniewski,Paul Kelly,Sten H Vermund

doi:10.1186/1471-2334-9-44

Abstract

BackgroundThe diagnosis of abdominal tuberculosis (TB) is difficult, especially so in health care facilities in developing countries where laparoscopy and colonoscopy are rarely available. There is little information on abdominal TB in HIV infection. We estimated the prevalence and clinical features of abdominal (excluding genitourinary) TB in HIV infected adults attending the University Teaching Hospital, Zambia.MethodsWe screened 5,609 medical inpatients, and those with fever, weight loss, and clinical features suggestive of abdominal pathology were evaluated further. A clinical algorithm was used to specify definitive investigations including laparoscopy or colonoscopy, with culture of biopsies and other samples.ResultsOf 140 HIV seropositive patients with these features, 31 patients underwent full evaluation and 22 (71%) had definite or probable abdominal TB. The commonest presenting abdominal features were ascites and persistent tenderness. The commonest ultrasound findings were ascites, para-aortic lymphadenopathy (over 1 cm in size), and hepatomegaly. Abdominal TB was associated with CD4 cell counts over a wide range though 76% had CD4 counts <100 cells/μL.ConclusionThe clinical manifestations of abdominal TB in our HIV-infected patients resembled the well-established pattern in HIV-uninfected adults. Patients with fever, weight loss, abdominal tenderness, abdominal lymphadenopathy, ascites and/or hepatomegaly in Zambia have a high probability of abdominal TB, irrespective of CD4 cell count.

Highlights

The diagnosis of abdominal tuberculosis (TB) is difficult, especially so in health care facilities in developing countries where laparoscopy and colonoscopy are rarely available
The extent to which the manifestations of abdominal tuberculosis are altered by human immunodeficiency virus (HIV) infection is unknown; we are aware of only one paper which addresses this [8]
The inclusion criteria were fever and weight loss, with one or more of the following: diarrhoea persisting for >1 month, ascites, abdominal lymphadenopathy based on ultrasound, mesenteric masses based on ultrasound, hepatomegaly or splenomegaly, pancreatic enlargement based on ultrasound [18] or severe, unexplained focal or generalized abdominal tenderness persisting for 7 days or more

Summary

Introduction

The diagnosis of abdominal tuberculosis (TB) is difficult, especially so in health care facilities in developing countries where laparoscopy and colonoscopy are rarely available. There is little information on abdominal TB in HIV infection. The HIV epidemic in sub-Saharan Africa has contributed to an increased incidence of pulmonary tuberculosis (TB), but there is little information on changes in the frequency or clinical manifestations of abdominal TB. The ratio of extrapulmonary to pulmonary disease increased from 20:80 in early HIV infection to 50:50 in late HIV infection [6]. As intra-abdominal tuberculosis is difficult to diagnose [7], the contribution of abdominal infection may be higher than previous estimates suggest, but there have been few papers which address this important question. The extent to which the manifestations of abdominal tuberculosis are altered by HIV infection is unknown; we are aware of only one paper which addresses this [8]

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