Diagnosis Of Peritoneal Tuberculosis Research Articles

PERITONEAL TUBERCULOSIS MIMIKING GASTROINTESTINAL STROMAL TUMOR

Abdominal TB is a common site of extrapulmonary tubercilosis, and peritoneal tuberculosis (PTB) is one of the most common manifestations of abdominal tuberculosis. The diagnosis of PTB can be made based on a combination of clinical, radiological, histological, and laboratory tests. The diagnosis can be easy in the presence of ascites with peritoneal granulations. some forms of PTB can make a differential diagnosis with peritoneal or digestive tract pathologies. some forms of PTB can make a differential diagnosis with peritoneal or digestive tract pathologies. We report a case of primary mesenteric tuberculosis mimicking gastrointestinal stromal tumor. The final diagnostic was performed using a combination of invasive and imaging techniques.

Wasting syndrome Ovarian cancer versus peritoneal tuberculosis: A case report

Peritoneal tuberculosis (TB) corresponds to between 1 and 3% of all tuberculosis localizations is greater in developed countries, The diagnosis of peritoneal TB can be a challenge for clinicians, due to nonspecific clinical and laboratory findings, they can present signs and symptoms similar to ovarian cancer, pelvic inflammatory disease as well as peritoneal carcinomatosis. Multiple cases of patients with ascites, pelvic masses, elevated CA-125 levels, peritoneal implants, mesenteric involvement, and paracentesis without malignant cells without being able to demonstrate the presence of mycobacteria preoperatively have been described, so they are operated on on suspicion of carcinoma of the advanced ovary diagnosing tuberculosis as A 19-year-old woman was referred by an internist and digestive surgeon with abdominal distension and weight loss. The CT scan of the abdomen showed thickening of the stomach wall with ascites. CA 125 levels raised to 2100 U/mL and the At first it was addressed as ovarian cancer, laparoscopy was performed with a biopsy sample, concluding peritoneal tuberculosis. antituberculous therapy is started, 2 weeks later patient course with (DILI), with torpid evolution which leads to his death. The objective of the clinical case is to broaden our medical outlook with differential diagnoses in the face of chronic abdominal pain in women and to remember the importance of early diagnosis, as well as clinical follow-up, for early intervention of adverse effects.

S4087 Mycobacteria in Hiding: Challenges in the Diagnosis of Peritoneal Tuberculosis

S4087 Mycobacteria in Hiding: Challenges in the Diagnosis of Peritoneal Tuberculosis

The Roth Net at 40 years: celebrating the spirit of innovation

The Roth Net at 40 years: celebrating the spirit of innovation

Diagnosis challenges of a patient with peritoneal tuberculosis masquerading as ovarian malignancy: a case report

Background: Peritoneal tuberculosis (PTB) could mimic advanced ovarian cancer cases, making its diagnosis challenging. Comprehensive and conscientious examinations for diagnosis are needed to differentiate such cases to avoid inappropriate treatment. We report a problematic diagnosis of PTB that mimic ovarian malignancy. Case Presentation: A 20-year-old female patient with history of multiple rehospitalizations, presented with complaints of abdominal pain, nausea/vomiting, low-grade fever, and weight loss in the last five months. In the first admission, patient was suspected with malignant ovarian cyst due to clinical features of malignancy with normal chest X-ray, abdominal USG suggested ovarian cyst in both ovaries, high levels of Ca125. However abdominal CT-scan showed thickening in peritoneum which suggested PTB. The patient was planned for urgent laparotomy while waiting for GenExpert result. On the second admission, patient presented with recurrent abdominal pain, GenExpert sputum and stool showed negative result, and planned for surgery but the patient refused. On the last admission, patient diagnosed with impending bowel obstruction and underwent abdominal CT-scan with contrast showed diffuse multiloculated cystic lesion in cavum pelvic and multiple prominent mesenteric lymph nodes that suggested abdominal TB with abscess in cavum pelvic. Exploratory laparotomy revealed conglomeration, pus and tubercles in the peritoneum. A TB was confirmed based on pathology and microbiology examination from tissue biopsy and pus. Conclusion: We reported patients with PTB with unspecific clinical symptoms which suspected as ovarian malignancy. This study highlights the challenges in diagnosing PTB and therefore PTB could be considered a differential diagnosis in patients suspected of ovarian malignancy in the TB endemic countries.

Diagnosis of peritoneal tuberculosis by real-time immuno-PCR assay based on detection of a cocktail of Mycobacterium tuberculosis CFP-10 and HspX proteins

ABSTRACT Background : Diagnosis of peritoneal TB is difficult owing to unusual clinical manifestations and low sensitivities obtained with most of the available diagnostic modalities. Hence, there is an urgent need to design a reliable and rapid diagnostic test followed by early therapy so as to avoid the complications associated with disease. Research design and methods : We designed a quantitative real-time immuno-PCR (RT-I-PCR) assay to detect a cocktail of Mycobacterium tuberculosis CFP-10 (Rv3874) and HspX (Rv2031c) proteins in clinical samples (ascitic fluids and peritoneal biopsies) of peritoneal TB patients and results were compared with I-PCR/ELISA. Results : A wide range of CFP-10+HspX (0.6 pg/mL to 9.9 ng/mL) was detected in clinical samples of peritoneal TB patients by RT-I-PCR, whereas ELISA exhibited a narrow range (3ng/mL to 11.5 ng/mL). Sensitivities of 81.5% and 65.7%, and specificities of 92.5% and 90%, were obtained in total 78 cases (comprising 38 peritoneal TB and 40 non-TB controls) by RT-I-PCR and I-PCR, respectively. Markedly, sensitivity obtained by RT-I-PCR was significantly higher than I-PCR (p=0.0143) and ELISA (p=0.0005). Conclusions : Our RT-I-PCR revealed good accuracy for the rapid diagnosis of peritoneal TB cases. After further improving the specificity and reducing the cost, this assay may develop into a diagnostic kit.

Evidence-Based Commentary: Ascitic Adenosine Deaminase in the Diagnosis of Peritoneal Tuberculosis

Evidence-Based Commentary: Ascitic Adenosine Deaminase in the Diagnosis of Peritoneal Tuberculosis

A Rare Case of Peritoneal Tuberculosis in a 21 Years Old Male Patient

Tuberculosis is among the top 5 causes of death from infectious disease caused by Mycobacterium tuberculosis, it most frequently affects the lungs, although it can compromise the digestive tract, genitourinary, peritoneum, pleura, bones, lymph nodes and meninges, composing the group of extrapulmonary tuberculosis. Peritoneal involvement is the most common form of abdominal type representing 0.1 to 0.7% of all tuberculosis cases. With nonspecific symptoms, without of laboratory findings that would guide the search for Mycobacteria and imaging tests that overlap common in other pathologies, the diagnosis is difficult. In Abdominal Computed Tomography, ascites, smooth peritoneal thickening, densification of the mesentery root, lymphadenomegaly with central necrosis or calcification are observed. Laparoscopy with the biopsy and collection of ascitic fluid is used as a method for diagnosis. The mortality of abdominal tuberculosis can reach 15% and perforation of intestinal loops, malnutrition, anemia, hypoalbuminemia are the main complications. We present the case of a patient presenting recurrent umbilical hernia, whose diagnosis of peritoneal tuberculosis was made during surgery.

Diagnosis of Peritoneal Tuberculosis from Primary Peritoneal Cancer.

Peritoneal tuberculosis (PTB) is an uncommon extrapulmonary infection mimickng primary peritoneal cancer (PPC). We retrospectively included 23 women with PTB and 47 women with PPC treated in a medical center to study the clinical and radiological features that differentiate PTB from PPC. Body temperature above 38 °C was a unique feature of PTB (34.7% versus 0%, p < 0.001). Body Mass Index (BMI) was lower (21.9 ± 3.7 versus 25.2 ± 4.1, p = 0.003), white blood cell (WBC) count was lower (5179.6 ± 1502.2 versus 7716.2 ± 2741.8, p < 0.001), and CA-125 level was lower (508.0 ± 266.1 versus 2130.1 ± 2367.2 U/mL, p < 0.001) in PTB compared with PPC. Imaging detected more pulmonary infiltration and consolidation (52.2% versus 6.4%, p < 0.001), and less omental/mesentery changes (52% versus 83%, p < 0.001) in PTB compared with PPC. The operated patients received earlier treatment compared to patients without operation (7.9 ± 5.3 days versus 17.2 ± 11.0 days, p = 0.010). In conclusion, fever above 38 °C, lower BMI, lower WBC count, less elevated CA-125 level, and imaging of less omental involvement were features of PTB differentiated from PPC.

Place de la laparoscopie dans le diagnostic de la tuberculose péritonéale dans une région endémique de la Tunisie

La tuberculose reste un problème de santé publique en Tunisie. Le gouvernorat de Tataouine est une zone endémique. Le péritoine est atteint dans 1 à 2% des cas. Nous rapportons une étude épidémiologique rétrospective descriptive de 32 cas de patients opérés au Service de Chirurgie de Tataouine entre 2010 et 2020, la plupart par voie laparoscopique (28 patients), pour biopsie chirurgicale et confirmation histologique de tuberculose péritonéale. Nos patients étaient répartis en 24 femmes et 8 hommes soit un sexe ratio H/F de 0,33. L´âge médian était de 43 ans avec des extrêmes de 14 à 78 ans .La laparoscopie à visée diagnostique a été pratiquée dans 28 cas (87,5%). Devant l'aspect macroscopique per opératoire, le diagnostic de tuberculose péritonéale était fortement suspecté chez 16 patients (50%). L´étude anatomopathologique des biopsies réalisées a permis de confirmer le diagnostic chez tous les patients. Le but de ce travail est de rappeler les aspects épidémiologiques, cliniques de la tuberculose péritonéale dans une région endémique de la Tunisie et de présenter la place actuelle de la laparoscopie comme moyen diagnostic rapide et efficace.

Peritoneal Tuberculosis Mimics Ovarian Cancer: A Case Report

Peritoneal tuberculosis is a form of abdominal and/or pelvic tuberculosis. This entity can sometimes imitate ovarian cancer clinically, and is accompanied by an increase of serum cancer antigen 125 (CA-125) level, which may make the differential diagnosis between the two diseases a challenge for clinicians. We report herein a case of a 49-year-old woman whose symptoms, signs, imaging and laboratory findings suggested ovarian cancer, and document the risk factors for the development of tuberculosis. Finally, the diagnosis of peritoneal tuberculosis can be obtained through further research and appropriate data analysis. The purpose of this case is to improve the medical community’s understanding of the importance of distinguishing peritoneal tuberculosis in patients with suspected ovarian cancer, so as to make accurate differential diagnosis and avoid subjecting patients to unnecessary surgery.

Diagnostic Challenge Of Peritoneal Tuberculosis In Woman With Ascites

Tuberculosis (TB) is a major health global issue including extrapulmonary tuberculosis (EPTB). The one of manifestation of EPTB is peritoneal TB that constitutes 2% from all cases of pulmonary TB around the world. The diagnosis of peritoneal TB is quite challenging because many cases have symptom that similar to other diseases and those often necessary need further specific examinations such as PCR, culture and radiologic examination. We reported a case report of peritoneal tuberculosis in woman with ascites.

Peritoneal tuberculosis mimicking carcinomatous ascites in a child living in a low prevalence country: a case report

BackgroundAscites can develop as a consequence of a number of diseases in childhood. Despite chronic liver disease is the most common cause, several conditions can lead to ascites also in the absence of liver dysfunction. As non-cirrhotic ascites shows a high degree of overlapping sign and symptoms it is still a challenge for physicians.Case presentationA 8-year-old Caucasian girl was referred for fever, vomit and diarrhea occurred over the past few weeks. Physical examination showed timpanitic distension of the abdomen with marked tenderness and increased abdominal wall rigidity. Abdominal imaging showed diffuse ascites and thickened omentum and bowel wall. Blood tests showed increased C- reactive protein levels and decreased lymphocyte count. Specific treatment for inflammatory bowel disease was started. Persisting of ascites required additional investigations. Positive tuberculin skin test and Interferon Gamma release assay (IGRA) as well as increased Ca125 serum concentrations were found. Computed tomography scan showed mediastinal and mesenteric adenopathies and diffuse smooth thickening of the omentum with significant enhancement (omental cake-like). Ascitic fluid analysis revealed high leucocytes and protein levels. Presumptive diagnosis of peritoneal tuberculosis (PTB) was made. Antituberculous treatment resulted in the resolution of ascites and normalization of lymphocyte count and Ca125 serum concentrations.ConclusionsPTB is still possible in low-prevalence countries. As it is a great mimicker of other abdominal pathology whose treatment might worsen tuberculosis progression, clinical suspicion and adequate screening are required to avoid unnecessary interventions and delayed treatment. Ca125 is a non-specific marker of peritoneal inflammation but it might be helpful in monitoring the treatment response.

Proportions of interferon-γ-producing ascites lymphocytes in response to mycobacterial antigens: A help for early diagnosis of peritoneal tuberculosis in a low TB incidence country.

BackgroundPeritoneal tuberculosis (TB) remains difficult to diagnose because of its non-specific clinical features and the lack of efficient microbiological tests. As delayed diagnosis is associated with high mortality rates, new diagnostic tools are needed.Methods and findingsWe investigated for 24 patients prospectively enrolled with a possible diagnosis of peritoneal TB, the diagnostic value of the analysis of IFN-γ production by peritoneal fluid lymphocytes in response to a short in vitro stimulation with mycobacterial antigens. The patients were classified in two groups: non-TB and confirmed or highly probable TB. Diagnosis of TB was based on microbiological and histopathological criteria and/or a favorable response to anti-TB treatment. The IFN-γ production by peritoneal CD4+ T lymphocytes was analyzed by flow cytometry after an overnight in vitro stimulation with three different mycobacterial antigens, purified protein derivative (PPD), heparin-binding haemagglutinin (HBHA) or early-secreted-antigen-target-6 (ESAT-6). The percentages of PPD-, HBHA- or ESAT-6-induced IFN-γ-producing peritoneal fluid CD4+ T lymphocytes were higher in the TB group than in the non-TB group (p = 0.0007, p = 0.0004, and p = 0.0002 respectively). Based on cut-off values determined by ROC curve analysis of the results from TB and highly probable TB compared to those of non-TB patients, the sensitivity of these three tests was 100% with a specificity of 92%.ConclusionsThe analysis of mycobacterial-induced IFN-γ production by peritoneal lymphocytes is a promising tool to reliably and rapidly diagnose peritoneal TB. Further studies should be performed on larger cohorts of patients in high-TB-incidence countries to confirm the clinical value of this new diagnostic approach for peritoneal TB.

Peritoneal Tuberculosis Mimicking Peritoneal Carcinomatosis

Tuberculosis is a serious infection that can appear in many forms and presentations. Here, we highlight a case of a 13 year old patient with a three-month history of nonspecific abdominal pain whose symptoms persisted after treating Typhoid and H. pylori infections. She had subsequent computed- tomography imaging notable for nodular thickening of the omentum and ascites concerning for possible carcinomatosis. Diagnostic laparoscopy with peritoneal biopsy revealed abdominal tuberculosis, and she had resolution of symptoms following appropriate medical therapy. We discuss the risk factors, clinical features, and work-up in the diagnosis of peritoneal tuberculosis.

Peritoneal tuberculosis mimicking peritoneal carcinomatosis

Tuberculosis is a serious infection that can appear in many forms and presentations. Here, we highlight a case of a 13 year old patient with a three-month history of nonspecific abdominal pain whose symptoms persisted after treating Typhoid and H. pylori infections. She had subsequent computedtomography imaging notable for nodular thickening of the omentum and ascites concerning for possible carcinomatosis. Diagnostic laparoscopy with peritoneal biopsy revealed abdominal tuberculosis, and she had resolution of symptoms following appropriate medical therapy. We discuss the risk factors, clinical features, and work-up in the diagnosis of peritoneal tuberculosis.

Laparoscopic Diagnosis of Peritoneal Tuberculosis

Peritoneal tuberculosis is a form of abdominal tuberculosis that involves the parietal and visceral peritoneum, the omentum, and the intestinal mesentery. The 3 types of peritoneal tuberculosis are (1) the wet type, which is noted in 90% of cases and is usually associated with ascites; (2) the dry type, which is associated with adhesions; and (3) the fixed fibrotic type, which is associated with omental thickening, loculated ascites, and matted bowel loops [1Bhargava D.K. Shriniwas N.V. Chopra P. et al.Peritoneal tuberculosis: laparoscopic pattern and its diagnostic accuracy.Am J Gastroenterol. 1992; 87: 109-112PubMed Google Scholar]. Peritoneal involvement is caused by hematogenous spread, lymphatic spread, or direct spread from tuberculous salpingitis [2Abid H. Charif I. Mellouki I. et al.Role of laparoscopy in diagnosis of peritoneal tuberculosis (about 414 cases).Open J Gastroenterol. 2013; 3: 205-207Crossref Google Scholar]. There is often a delay in diagnosis because of vague and nonspecific symptoms. The differential diagnosis for peritoneal tuberculosis is disseminated carcinomatosis, primary peritoneal serous carcinoma, and peritoneal seeding by ovarian/fallopian tubal papillary serous carcinomas. Diagnostic laparoscopy with tissue biopsy is the gold standard for the diagnosis of peritoneal tuberculosis [1Bhargava D.K. Shriniwas N.V. Chopra P. et al.Peritoneal tuberculosis: laparoscopic pattern and its diagnostic accuracy.Am J Gastroenterol. 1992; 87: 109-112PubMed Google Scholar, 2Abid H. Charif I. Mellouki I. et al.Role of laparoscopy in diagnosis of peritoneal tuberculosis (about 414 cases).Open J Gastroenterol. 2013; 3: 205-207Crossref Google Scholar]. Typical laparoscopic findings of peritoneal tuberculosis are (1) multiple yellow-white tubercles scattered all over the visceral and parietal peritoneum, (2) omental thickening with ascites, (3) fibrous bands extending from the parietal peritoneum to the visceral peritoneum, and (4) an abdominal cocoon with a matted small bowel Fig. 1, Fig. 2, Fig. 3, Fig. 4.Fig. 2Omental thickening with straw-colored ascites.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 3Fibrous bands from the parietal to visceral peritoneum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 4An abdominal cocoon with a matted small bowel.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Peritoneal tuberculosis: Advances and controversies

Peritoneal tuberculosis (TB) remains a public health problem especially in the developing countries, even in the developed countries, where the disease had been mostly controlled; it poses a new challenge for health-care facilities as a result of increased immigration from high prevalence area, the use of more potent immunosuppressive therapy and the acquired immunodeficiency syndrome epidemic. The diagnosis of peritoneal TB is often challenging and cannot be made or excluded on the basis of clinical findings, which are quite protean and nonspecific. Blood biochemistry, complete blood cell count, and radiographic studies are of limited diagnostic value. Acid-fast smear of ascitic fluid has a low yield and cultures require weeks to give results and are positive in 2%–50% of diagnosed cases. Polymerase chain reaction analysis for rapid detection of bacillus tubercles in ascitic fluid has low yield, and the role of other biomarkers such as adenosine deaminase and gamma interferon is less well described and currently being evaluated as diagnostic tools. Laparoscopy with directed biopsy provides a rapid and correct diagnosis in 76%–100% of cases and should be performed early in suspected cases. Six-month therapy with the 4-drug regimen is effective in most of the patients, while the role of adjunctive corticosteroid therapy remains controversial.

Extra-pulmonary tuberculosis in immunocompetent patients: Case series and mini review of the literature

Introduction: Tuberculosis (TB) is still one of the most frequent infectious diseases, causing 2 million deaths a year worldwide. The prevalence of TB has increased in both immunocompetent and immunocompromised and virtually, it can affect any organ. Up to 25% of tuberculosis cases present extra-pulmonary involvement. The diagnosis of extra-pulmonary TB (EPTB) is difficult, often requiring biopsy. Material and methods: We present two cases of EPTB in immunocompetent young women. The first case is about a 15-years old female who presented with persistent high fever, ascites and an increased CA-125 serum level. Biochemical analysis of ascites fluid revealed a high value of adenosine deaminase (ADA), negative Ziehl-Neelsen stain and undetectable Mycobacterium tuberculosis at PCR assay. The peritoneal biopsy confirmed the diagnosis of peritoneal TB. The second case, a 29-years old female with a seven-month history of cervical lymph nodes swelling, with drainage and excision biopsy performed, misdiagnosed as cats-scratch disease based on the histological description as granulomatous lymphadenitis, which turned out to be tuberculous lymphadenitis at the second histopathological opinion. In conclusion, these cases highlight the need for tuberculosis consideration in the differential diagnosis of extra-pulmonary involvement, even in immunocompetent individuals, in order to decrease the misdiagnoses and complications rates.

Endoscopic Ultrasound (EUS) Guided Fine Needle Aspiration: A New Modality to Diagnose Peritoneal Tuberculosis in Presence of Decompensated Cirrhosis—A Case Series and Review of Literature

The gold-standard for diagnosis is growth of Mycobacterium tuberculosis on ascitic fluid or peritoneal culture. Due to the non-specific signs and symptoms of disease, its early diagnosis is difficult, especially in patients with decompensated cirrhosis. The reported sensitivity of ascitic fluid is low and to obtain tissue for peritoneal biopsy in patients with cirrhosis is difficult. Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) is a good alternative to obtain peritoneal tissue for establishing the diagnosis of peritoneal TB. To assess the role of EUS-FNA in the diagnosis of peritoneal tuberculosis in patients with decompensated cirrhosis. Consecutive patients with peritoneal thickening, ascites and decompensated cirrhosis underwent EUS-FNA from the thickened omentum. Presence of granuloma or demonstration of acid fast bacilli was diagnostic of peritoneal tuberculosis. A total of 5 patients with CLD underwent EUS-FNA from omentum. FNA cytology revealed granuloma with multinucleated cells in all patients (100%) and AFB stain was positive in 2 of them (40%). We hereby report the use of EUS guided fine needle aspiration (FNA) of peritoneum as a newer, safe and unexplored technique for diagnosis of peritoneal TB.