Abdominal Tuberculosis Research Articles

Generalized tuberculosis with intestinal lesion in an adolescent. Case report

In the two recent decades a decrease in tuberculosis (TB) incidence has been observed worldwide, according to the World Health Organization, while the incidence of extrapulmonary TB, including TB of the intestine, is growing. Generally, diagnosis of TB in children and adolescents is difficult due to its subclinical course in a significant part of patients. A special diagnostic challenge is extrapulmonary TB, including abdominal TB. Abdominal TB has entered the top five most frequent manifestations of extrapulmonary TB along with TB of the peripheral lymph nodes, urogenital TB, bone and joint TB, and TB of the central nervous system. Lack of specific clinical signs of the disease results in late diagnosis of abdominal TB. We described a case of generalized TB with intestinal lesion in an adolescent. We detected mistakes in the follow-up of the female patient with double exposure to household TB, which resulted in late diagnosis of the disease. We demonstrated the challenges in diagnosing intestinal TB under the guise of appendicitis, which led to the development of complications – spilled peritonitis and abdominal abscess. The tactics of management of the female patient at high risk for developing bowel obstruction was represented. Interdisciplinary interactions with extrapulmonary TB specialists were accented for cases of generalized TB.

A rare case of peritoneal tuberculosis mimicking peritoneal carcinomatosis: the ongoing challenge

Tuberculosis (TB) is a serious infection that can involve any organ system and present in various forms. About one-third of the world’s population are carriers of latent TB. Although most cases are from a pulmonary origin, there is a rising prevalence of abdominal TB. Patients with pulmonary or extrapulmonary TB are treated similarly through the use of pharmacological therapy. Nonspecific clinical manifestations of TB have made it difficult for clinicians to diagnose. Peritoneal tuberculosis (PTB) is a serious concern as its symptoms overlap with that of many other chronic conditions, especially in those who are immunocompromised. The lack of highly sensitive and specific testing methods has made early intervention difficult, therefore a high index of suspicion is crucial in the progression of the disease. Here, we present a case of a 71-year-old female with a history of abdominal pain, fever, and weakness. Initial investigation with computed tomography (CT) imaging revealed omental fat stranding that pointed towards peritoneal carcinomatosis (PC) from possible recurrence of her ovarian cancer. Further investigation with a peritoneal biopsy was remarkable for caseating granulomas with fat necrosis confirming extrapulmonary TB. This report highlights a rare case of PTB mimicking PC in an elderly patient who is immunocompromised from the use of long-term corticosteroids who continued to decline after pharmacological treatment of the disease.

Abdominal Tuberculosis in India: A Comprehensive Review Article

Abdominal Tuberculosis in India: A Comprehensive Review Article

Tuberculous calcific constrictive pericarditis in an adult female with a past history of abdominal tuberculosis.

Tuberculous pericarditis, one of the rarer extrapulmonary manifestations of tuberculosis, remains a challenge in endemic countries such as India. As the clinical presentation of tuberculous pericarditis is highly variable, the diagnosis is often missed, delayed, or incorrectly diagnosed. Constrictive pericarditis (CP) is one of tuberculous pericarditis's most serious and advanced sequelae. Several invasive and non-invasive diagnostic modalities are crucial to address the challenges of confirming the diagnosis of CP in suspected cases. This study reports the case of an Indian adult female with a past history of previously treated abdominal tuberculosis diagnosed anew with tuberculous calcific constrictive pericarditis.

S3913 A Diagnostic Dilemma: Abdominal Tuberculosis Mimicking Suspected Crohn’s Disease or Latent Tuberculosis Activated by Biologic Therapy

S3913 A Diagnostic Dilemma: Abdominal Tuberculosis Mimicking Suspected Crohn’s Disease or Latent Tuberculosis Activated by Biologic Therapy

Atypical tuberculous peritonitis presenting as a peritoneal pseudocyst in an immunocompetent adult: insights from a case and literature review

BackgroundTuberculous peritonitis often presents with nonspecific symptoms that can lead to diagnostic challenges, particularly when manifesting as peritoneal pseudocysts. This study highlights the clinical complexity and diagnostic approach of tuberculous peritonitis presented as a pseudocyst in an immunocompetent adult, an atypical scenario that is rarely documented.Case presentationWe report a detailed case of a 41-year-old man presenting with abdominal distension, pain, and significant weight loss over four months. Abdominal CT showed a peritoneal pseudocyst, initially misdiagnosed due to its resemblance to more common abdominal pathologies. The diagnosis of tuberculous peritonitis was confirmed through histopathological analysis. Additionally, a systematic literature review was conducted to identify and analyse similar cases, focusing on clinical presentations, diagnostic methods, and patient outcomes. Our patient exhibited classic symptoms of abdominal TB but was unique due to the absence of prior ventriculoperitoneal shunting, a common factor in similar cases. Our literature review found that such presentations typically result in diagnostic delays averaging five months, complicating patient management and outcomes. This review also underscores the importance of considering tuberculosis in the differential diagnosis of peritoneal pseudocysts, particularly in TB-endemic regions.ConclusionThis case and review emphasize the need for high clinical suspicion and prompt investigation of tuberculosis in patients presenting with atypical abdominal symptoms and pseudocysts. Improved diagnostic strategies, including early use of imaging and pathological evaluations, are essential for timely diagnosis and management, thereby improving patient outcomes in suspected cases of extrapulmonary tuberculosis.

Targeting ADA and HIV-1 Nef Protein with Protease Inhibitors: A Repurposing Strategy through Molecular Networking and an In silico Approach for Integrated Management of HIV Co-infected with Abdominal Tuberculosis

Background: Background: The co-infection of HIV and abdominal TB poses a worldwide danger to humanity. This is because there are more strains of bacteria that are resistant to many classes of currently available medications. According to current findings, repurposing existing available medications will result in more effective functioning than using newly designed medications. Objective: Based on this fact, we hypothesised that the PI could be repurposed; we used Food and Drug Administration (FDA)-approved PI drugs to treat HIV co-infected patients with abdominal TB, and a computational study has been conducted. Methods: This comprises network analysis models to find their protein drug interaction (PDI) through a search tool for interacting chemicals (STICH) module of Cytoscape network analysis model followed by the screening of these drugs for their ADMET prediction and binding affinity with adenosine deaminase (ADA), a protein responsible for abdominal TB, and the HIV-1 Nef protein, responsible for the regulation of immune function (CD4+). Results: The network analysis showed 13 nearest binding drugs of these proteins of interest. The ADMET study result showed the pharmacologically relevant parameters that have a significant effect on the binding affinity, bioavailability, and toxicity of PI. The top three scores achieved by PI against adenosine deaminase enzyme activity (PDB ID: 1A4M) are viz., -23.7919, -23.3529, and -22.6773 for Ritonavir, Tipranavir, and Atazanavir, respectively. The top three scores achieved by PI against HIV-1 Nef protein activity (PDB ID: 6URI) are viz., -28.7321, -28.4987, and -28.3155 for Atazanavir, Tipranavir, and Simeprevir, respectively. The active site of ADA and HIV-1 Nef proteins comprises amino acid residues such as for Tipranavir: Arene-Cation interaction (Phenyl and Pyridine)- Arg B1081, and Lys B1033 (1A4M) and Arene-Cation interaction (Pyridine and Phenyl)- Lys D11 and Arg D33; Sidechain acceptor Thr B40; Sidechain donor- Asp D30; Backbone donor- Ala B37 (6URI). Atazanavir: Arene-Cation interaction (Phenyl)- Lys A254 and Lys B1033; Sidechain acceptor - Arg A251 (1A4M). Conclusion: Thus, from the computational studies carried out, we could obtain hints for optimising the molecular selectivity of the PI to provide help in the design of new compounds via the repurposing strategy of the FDA-approved PI for effective treatment of co-morbidity with HIV and abdominal TB. However, further pharmacokinetics, pharmacodynamics, preclinical, and clinical studies permit the design of the new agents without undesirable interactions.

Diagnostic Approach of Mesenteric Cyst in Children: A Case Report

Background: Mesenteric cysts are intra-abdominal masses that arise from obstructed lymphatic drainage within the mesentery. Early diagnosis can be challenging, as it is often difficult to recognize based solely on clinical findings. The diagnosis is frequently made following imaging studies or during surgery. Despite their generally benign nature, delayed diagnosis can lead to serious complications. This case report aims to share our experience on the diagnostic approach for mesenteric cysts in children. Case: A 2-year-old boy presented with a 14-month history of slowly progressive abdominal distension and signs of bowel obstruction, including weight loss. Abdominal ultrasound revealed thin-walled, well-demarcated, septated fluid sacs consistent with a cyst. Abdominal CT-Scan showed massive ascites filling the intraperitoneal cavity and pushing the intestine upward along the thickened mesentery, causing bowel obstruction. Histopathological examination confirmed the diagnosis of cyst lymphangioma derived from mesentery. The cyst was successfully excised via laparotomy, and histological examination confirmed it as a cystic lymphangioma. Discussion: Our diagnostic approach focused on exclusion of differential diagnosis for abdominal distention in children, including ascites, abdominal tuberculosis, mesenteric cysts, and intra-abdominal masses. The absence of constitutional symptoms and lack of response to anti-tuberculosis therapy made it an unlikely diagnosis. While the CT-scan suggested ascites, the ultrasound results suggested a mesenteric cyst. Despite its large size, a complete excision of the cyst was successfully performed via laparotomy. Conclusion: The nonspecific nature of mesenteric cysts often delays diagnosis, making abdominal ultrasound an essential initial imaging modality for patients suspected of having this condition.

Surgical Management of Complicated Abdominal Tuberculosis: The First Systematic Review-New Treatments for an Ancient Disease and the State of the Art.

Background: Abdominal tuberculosis comprises all forms of tuberculosis that involve the gastrointestinal tract. Controversies exist regarding the surgical approach and timing and type of intervention for complicated forms of abdominal tuberculosis. The aim of this systematic review is to define the rate of surgical treatment, the type of surgical procedures performed and the role of minimally invasive surgery in the management of abdominal tuberculosis. Methods: The literature in MEDLINE, Scopus and Google Scholar and forward and backward citations for studies published between database inception and July 2022 were searched without language restrictions. All prospective and retrospective studies were included. The electronic database search yielded 2440 records. Additionally, eight records were identified through snowball searching. Following duplicate removal (45 duplicates found), 2403 records were screened for titles and abstracts. After screening for titles and abstracts and exclusion criteria, 38 reports were included for systematic review, 27 retrospective studies and 11 prospective studies. Data extracted included the general and demographic characteristics of the studies, diagnostic methods used, clinical presentation, site of involvement and details on surgical treatment. Results: In total, 2870 patients with a diagnosis of abdominal tuberculosis were included, and 1803 (63%) underwent a surgical procedure. The majority of patients underwent an open surgical procedure (95%). The most commonly performed procedures were adhesiolysis (21%) and small bowel resection with primary anastomosis (21%). Conclusions: The results of this review suggest that whenever surgery is required, there is a tendency to perform open surgical procedures in patients with complicated abdominal tuberculosis, both in emergency and elective settings, despite advances in minimally invasive surgery. The study protocol was registered on PROSPERO (CRD42022354322).

Imaging in Abdominal Tuberculosis

AbstractDiagnosis of abdominal tuberculosis is challenging due to its variable imaging appearance, which can mimic several other conditions. This review covers the imaging spectrum of tubercular involvement of abdominal lymph nodes, peritoneum, solid abdominal viscera, and the gastrointestinal tract. Tubercular lymphadenitis is the most frequent manifestation of abdominal tuberculosis and may show necrosis. Peritoneal tuberculosis is the next most commonly involved site in the abdomen and can be of wet, fibrotic, and dry forms. The ileocecal region is the most common site of involvement in gastrointestinal tuberculosis. Solid visceral involvement mostly affects the liver and spleen causing hepatosplenomegaly with a micronodular or macronodular imaging pattern. Awareness of the spectrum of imaging manifestations and a high index of suspicion is required to reach the correct diagnosis.

A Case Report on Peritoneal Tuberculosis in an Immunocompromised Patient

Background: Peritoneal tuberculosis (PTB) is one of the most challenging forms of extra pulmonary tuberculosis. Abdominal TB cases make up above 3% of all extra pulmonary TB as per the Index TB Guidelines. PTB is commonly due to reactivation of latent tuberculosis in the peritoneum. Numerous cases were still misdiagnosed due to nonspecific presentation. The golden standard for diagnosis is laparoscopic biopsy. Presenting signs and symptoms of PTB are unspecific such as ascites, abdominal pain and distension, fever, weight loss, diarrhea/constipation. Peritoneal tuberculosis is a significant cause of ascites in developing countries. The causative agent of peritoneal tuberculosis is Mycobacterium tuberculosis. Case Presentation: In this case study, a 52 year old male had complaints of progressive abdominal distension and fever for 2 weeks. Patient underwent diagnostic paracentesis, upper and lower GI endoscopy, biopsy and gene xpert to confirm peritoneal tuberculosis. Patient with peritoneal TB have gradually progressive abdominal swelling due to ascites and abdominal pain. Conclusion: Peritoneal tuberculosis should be considered in differential diagnosis. Differential diagnosis, especially in the developing countries or under developed countries. This case highlights the easy diagnosis of the condition other than the other case reports.

Tubercular abdominal cocoon: a rare cause of subacute small bowel obstruction

BackgroundEncapsulating peritoneal sclerosis (EPS) or abdominal cocoon is a very rare cause of subacute intestinal obstruction. We hereby report an elderly male presenting with recent-onset subacute intestinal obstruction with characteristic imaging findings of this entity in a background of abdominal tuberculosis on computed tomography (CT) scan that enabled timely diagnosis and appropriate clinical management. The report aims to highlight the typical radiological findings of this rare entity that may otherwise go undetected on imaging investigations, thereby causing a delay in diagnosis with adverse clinical outcomes.Case presentationA 57-year-old male patient presented to the hospital with complaints of diffuse abdominal pain with obstipation and recurrent episodes of vomiting since last three days. Clinical evaluation also revealed an ill-defined lump in right lower abdomen. An urgent contrast-enhanced CT scan after oral contrast administration was performed that revealed dilated, clumped up small bowel loops in a ‘whorl-like’ pattern in right iliac fossa region. These obstructed loops were encased by a thick peritoneal membrane giving a ‘cocoon-like’ appearance. Also appreciated were scattered punctate calcific foci in jejunal walls and adjacent peritoneum along with mild ascites. On the basis of typical imaging findings, provisional diagnosis of tubercular cocoon abdomen was given that was later confirmed by laboratory investigations and diagnostic laparoscopy.ConclusionEncapsulating peritoneal sclerosis or cocoon abdomen is an extremely rare cause of subacute intestinal obstruction. Further, cocoon abdomen in a background of abdominal tuberculosis is even rarer. However, this case report highlights the characteristic imaging findings for broader audience that enabled prompt diagnosis and appropriate clinical management in this case, achieving optimal clinical outcome.

Outcome of Abdominal Tuberculosis Complicated by Portal Hypertension, Pulmonary Tuberculosis, and Severe Acute Malnutrition

Background: Abdominal tuberculosis (TB) is a form of extrapulmonary TB that can present with or without involvement of the lungs. The diagnosis is difficult to establish, which may lead to diagnostic delays. Effective management of adolescent TB requires a holistic approach from various medical disciplines and interventions. This case presented a rare case 13-year-old girl diagnosed with abdominal TB Case: A 13-year-old girl presented with seven-months history of subfebrile fever, lymph node enlargement, abdominal distention, pallor, and severe weight loss. She was diagnosed with abdominal TB. The diagnosis was further complicated by portal hypertension, pulmonary TB, and severe acute malnutrition. To address these challenges, a multidisciplinary treatment plan was implemented and closely monitored for a period of 12 months Discussion: Multiple factors are significantly contributing to the successful outcome of the treatment for abdominal tuberculosis, including good adherence to the prescribed anti-tuberculous medications, absence of side effects from the drugs, the patient's positive knowledge, attitude and health behaviours, and housing and environmental health. Conclusion: This case highlights the importance of factors influencing disease outcomes of abdominal TB. Proper management of the factors would lead to significant clinical and nutritional status improvement, reduce TB transmission, and improved the overall quality of life.

Anemic retinopathy in a patient with abdominal tuberculosis: A case report

Retinal hypoxia caused by anemia can be a cause of retinal nerve fiber infarction and increased transmural pressure. This results in superficial and deep hemorrhages, cotton wool spots, retinal edema, Roth spots, and vessel dilatations. Tuberculosis (TB) may cause anemia due to malabsorption, reduced intake, or due to chronic diseased state. Here, we report a patient of abdominal TB with anemic retinopathy, which was improved after taking proper treatment for anemia.

Patterns and Outcomes in Pediatric Abdominal Tuberculosis: A Single Centre Cohort Study

IntroductionAbdominal tuberculosis presents in a variety of ways. Different testing modalities must be applied in addition to having a high clinical suspicion to diagnose and initiate therapy. Medications have a good response; however, morbidity has been seen following surgical management of complicated presentations like intestinal obstruction and perforation. There is a paucity of studies in the pediatric age group which evaluate response to the different treatment regimen and identify factors associated with poorer outcomes in children with abdominal tuberculosis. MethodsPatient records of 75 children with abdominal tuberculosis at a single center were evaluated using a questionnaire, covering a 14-year period from 2007 to 2021. Demographic features, presenting signs and symptoms, investigations and treatment details were studied. In- person or telephonic follow-up was conducted to identify treatment outcomes. ResultsIncidence of abdominal TB was 7%, of all TB children with a mean age of 10.1 years. Mesenteric lymph nodes were involved in 67% and small intestine in 33% cases. Surgery was required in 22 children. 85% children completed treatment. Small intestine involvement had higher probability of undergoing surgery. Of the 70 children with complete follow up, 64 were well and 6 children succumbed to the disease. Older age, small intestine involvement and surgery were independently associated with higher mortality. ConclusionIntestinal involvement is associated with greater need for surgical intervention and greater mortality. Adolescents have poorer outcomes. Further studies are required focusing on these individual subgroups to understand the patterns of presentation, causes for mortality and prevention. Level of EvidenceLevel 5.

Stercoral Peritonitis Revealing Abdominal Tuberculosis in an Infant: A Case Report

While relatively uncommon in children, abdominal tuberculosis should be considered in the presence of an insidious symptomatology marked by prolonged fever and gastrointestinal disturbances. Ultrasound or CT imaging can assist in guiding diagnosis and prelevements. histopathological confirmation is usually required to establish a definitive diagnosis.

Haemorrhagic ascites: An atypical presentation of endometriosis

Abstract Haemorrhagic ascites is primarily associated with perforated abdominal viscera, malignancies and tuberculosis or hepatic pathologies. However, its presentation due to ovarian endometriosis is a rare finding. We report the rare occurrence of haemorrhagic ascites due to ovarian endometriosis in a 26-year-old multiparous female presentingwith severe abdominal pain. The other probable causes of ascites were excluded and computed tomography of abdomen and pelvis revealed moderate ascites with bulky left ovarian cyst. Abdominal paracentesis revealed haemorrhagic ascitic fluid which on cytopathology did not reveal evidence of malignancy. Diagnostic work-up including magnetic resonance imaging and diagnostic laparoscopy confirmed the diagnosis. She was treated with oral dienogest which caused regression of the mass and pain. This case highlights that endometriosis may be included in the differential diagnosis while treating haemorrhagic ascites in women in reproductive age.

Clinical profiles and causes of ascites in children at a tertiary care hospital, Bangladesh

Background: Ascites is an accumulation of serous fluid within the peritoneal cavity. Combined analysis of laboratory data and clinical and pathological details are essential for establishing a differential diagnosis. In children of Bangladesh our context, etiologies behind ascites are not yet studied well. The aim of our study was to evaluate the causes of ascites in the basis of clinical feature and laboratory investigation in children. Methods: This was a cross-sectional retrospective descriptive hospital-based record review of a tertiary center of hospital, Bangladesh. All children aged between 6 months to 17 years with ascites, irrespective of their primary cause admitted in pediatric ward were included in this study. The study was conducted during September 2019 to September 2020. During this period, 50 children presented with ascites were enrolled in the study. Result: The mean age was 8.174. The age range of the patients was from 6 months to 17 years. Twenty-eight (56.0%) of them were males and 44% of the participants were female. Maximum 54% have duration more than 7 days. The most common previous symptoms were fever (68%) and jaundice (38%) followed by bleeding manifestation (30%). The most common etiology of ascites was Chronic liver disease with portal HTN (48%), followed by abdominal tuberculosis (14%). Conclusion: This study found that CLD with Portal HTN is the most common cause of ascites in pediatric age group and second most common cause is infectious cause e.g. abdominal tuberculosis. This also highlighted that the presenting symptoms and laboratory parameter that guided to find out the causes of ascites.

Diagnosis of abdominal tuberculosis: Detection of mycobacterial CFP-10 and HspX proteins by gold nanoparticle-PCR amplified immunoassay

Attempts were made to improve the efficacy of PCR amplified immunoassay (I-PCR) for diagnosing abdominal TB cases by utilizing the gold nanoparticle (AuNP)-based I-PCR, where AuNPs were functionalized with detection antibodies/oligonucleotides that exhibited 84.3% sensitivity and 95.1% specificity. This assay would improve the ongoing algorithms used in abdominal TB diagnosis.

Rifampicin-induced thrombocytopenia in a patient with abdominal tuberculosis

Most anti-tubercular drugs are relatively safe, but adverse reactions are not uncommon. Rifampicin is one of the most effective and widely used anti-tuberculosis drugs. Adverse effects due to rifampicin are not uncommon and the patients usually have skin rash, gastrointestinal disturbances, and hepatotoxicity. Rarely, the patients may also have allergic and autoimmune manifestations, which may include life-threatening thrombocytopenia. A high index of suspicion and careful evaluation for temporal association with the suspected drug are required to diagnose drug-induced immune thrombocytopenia. We present a case of rifampicin-induced thrombocytopenia; though relatively rare, it needs attention.