Tuberculous Ascites Research Articles

Frequency and Diagnostic Criteria of Tuberculous Ascites in Port Sudan

Background: Tuberculosis is an infectious caseating granulomatous disease that cause by mycobacterium mainly mycobacterium tuberculosis and mycobacterium bovis, it is a systemic disease that effect any body organ, but mainly affect the lung.

CLINICAL PROFILE OF ASCTES BASED ON PRESENTATION AND LABORATORY FINDINGS:AN INSTITUTIONAL EXPERIENCE FROM MAHARASHTRA,INDIA

Introduction: Ascites is the fluid collection in the potential space of the peritoneal cavity. Alcoholic liver disease and intra-abdominal malignancy are two major etiologies behind it. Also, diagnosis of tuberculous ascites should be thought of due to endemicity. Cirrhotic patients at any time during the course of disease, invariably present with ascites which is one of the marker of decompensation. In our context, etiology behind ascites and its correlation with symptoms and clinical findings not yet studied, so present study is conceptualised. Aim: To study clinical profile of ascites based on presentation and laboratory findings Methods: This is a cross-sectional retrospective descriptive hospital based record review of patients presented with ascites in a tertiary center of Maharashtra . One hundred fourteen patients with ascites under regular follow up of SMBT Hospital were reviewed. Data regarding presenting complaints, examination findings, relevant investigations during first visit and final diagnosis were retrieved from our own record keeping and recorded information were then evaluated. Results: Patients having ascites have myriad of symptoms and signs, commonest clinical feature being icterus (74, 64.9%). Most of them were anemic at presentation. Forty-two (36.8%) had high blood urea and 36 (31.5%) with high creatinine suggesting approximately 30-40% cases presented with deranged renal function test. Ninety-three (81.5%) had raised total serum bilirubin. Similarly, PT/INR derangements were in 74 (64.9%) and 57 (50%) suggesting deranged liver function. Serum albumin was less than 3.5 gram/decilitre in 83(72.8%) cases. Among the patients studied, 80 (70.1%) had high Serum-Ascites Albumin Gradient (SAAG) suggesting transudative type of ascites and rest 34 had low SAAG suggesting exudative type of ascites. Overall assessment revealed, majority of patients (71.05%) had Chronic liver disease (CLD) as the cause of ascites. Conclusions: Ascites due to chronic liver disease was the main finding with etiology supported by laboratory findings. Significant numbers of the patients had deranged renal function on top of liver function derangement, so these parameters need to be properly taken care of.

Feasibility and Safety of Transgastric Natural Orifice Transluminal Endoscopic Surgery in the Diagnosis of Ascites of Unknown Origin.

Objective: The purpose of this study was to evaluate the feasibility and safety of transgastric natural orifice transluminal endoscopic surgery (TG-NOTES) combined with biopsy in the diagnosis of unknown ascites. Method: This retrospective study used data from the first affiliated hospital of Nanchang university on 51 patients who were diagnosed with ascites of unknown origin between January 2013 and May 2019 and experienced peritoneal biopsy through TG-NOTES. The outcome measures included diagnostic accuracy and procedure-related adverse events. Results: TG-NOTES was performed successfully in 46 of 51 patients, tuberculous ascites in 38 cases, carcinomatous ascites in 4 cases, cirrhotic ascites in 1 case, and 3 cases showed no obvious abnormalities in pathological result. Five cases failed to be diagnosed because of abdominal adhesions. The diagnostic rate of TG-NOTES was 84.3%. There were no severe procedure-related adverse events and no mortality. All patients had good wound healing and no complaint of discomfort on follow-up. Conclusion: The majority of ascites of unknown origin can be expounded through TG-NOTES combined with biopsy without severe complication, therefore, it is a feasible and safe method to detect the cause of unexplained ascites.

Diagnosis of malignant versus tuberculous ascites using tumor markers and globulin ratios in serum and ascites: A Fisher discriminant model

Background and study aimsThis study was conducted to investigate the significance of tumor and biochemical markers in serum and ascitic fluid in the differential diagnosis of tuberculous and malignant ascites. Patients and methodsBased on findings from natural orifice transluminal endoscopic surgery and postoperative pathology or cytology of 63 patients, they were divided into the malignant group (31 patients) and the tuberculous group (32 patients). Levels of tumor markers, albumin, globulin, and lactate dehydrogenase were measured simultaneously. Data were statistically analyzed, and a Fisher discriminant model was established. The receiver operating characteristic curve was constructed to confirm the discriminant value. ResultsThe levels of carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 19-9 (CA 19-9), and globulin in serum and ascitic fluid were different between the tuberculous and malignant ascites groups (P < .05). The ratios of ascites-to-serum levels of CEA, CA125, and CA 19-9, as well as the ratio of serum-to-ascites of globulin levels, were different between the two groups (P < .05). The Fisher discriminant model was established based on the ascites-to-serum ratios of CEA, CA125, and CA 19-9 levels and the serum-to-ascites ratio of globulin levels. The area under the curve was 0.908, the sensitivity was 0.838 (26/31), and the specificity was 0.875 (28/32). ConclusionA Fisher discriminant model can be established using serum and ascites tumor markers and globulin ratios, which is valuable in the differential diagnosis of tuberculous versus malignant ascites.

Using Ascitic Fluid Adenosine Deaminase Assay in the Diagnosis of Tuberculous Ascites

Aims: This study aimed to analyze the diagnostic values of the Adenosine Deaminase (ADA) test for detecting Tuberculosis (TB) ascites in Vietnam. Materials and Methods: A cross-sectional study was conducted on 43 patients with ascites. ADA, acid-fast bacilli (AFB) smear microscopy and culture as well as histological tests were performed. Diagnostic values including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated. Results : The area under the curve (AUC) of ascitic fluid ADA in diagnosis of TB ascites was 0.937 with p <0.001. The optimal cut-off value was 30.2 U/L with high sensitivity (100%) and specificity (88.5%), 85% PPV and 100% NPV. Conclusions : Ascitic fluid ADA assay is a useful diagnostic tool to detect TB ascites.

Pediatric abdominal chylolymphatic cysts: Sneaky abdominal masqueraders.

Chylolymphatic mesenteric cysts of the abdomen is a rare differential for cystic tumors, more so in the pediatric age group, and they have various clinical presentations. There have been very few cases reported worldwide. To the best of our knowledge, a multicystic chylolymphatic cyst of the abdomen as demonstrated below is the first reported occurrence worldwide in the pediatric age group. We herein report the case of a 1-year-old who presented to us with gradual distension of the abdomen for 4 months with occasional episodes of vomiting and a lobulated cystic abdominal mass on palpation. He was mistakenly treated with anti-tuberculous treatment for suspected loculated ascites. The imaging revealed a multiloculated mass in the abdomen in close relation to the small bowel. He was also worked up for tuberculosis, and the findings were negative. Laparotomy revealed multiple cysts closely applied to the jejunum, starting at 4 cm from the duodenojejunal flexure, which was resected and anastomosed. To the best of our knowledge, this is the first reported case of an abdominal chylolymphatic cyst occurring as a chain of multiple cysts in the pediatric age group, and we want to emphasize the importance of further imaging in a case of suspected loculated tuberculous ascites as this is a differential diagnosis with a treatable surgical option. Surgical excision of these cysts should be done in toto as an individual excision of each of these cysts in an attempt to preserve the bowel length may end up jeopardizing the blood supply of the affected bowel.

Study of role of amniotic fluid total protein (AFTP) assessment in the diagnosis of tubercular ascites

Background: It is not economically feasible to estimate the serum and ascitic albumin level for calculating Serum Ascites Albumin Gradient (SAAG) in every suspected tubercular ascites patient. Ascites fluid total protein (AFTP) seems a cheaper and viable alternative. Authors attempted to compare the efficacy of Amniotic Fluid Total Protein (AFTP) against Serum Ascites Albumin Gradient (SAAG) in the diagnosis of Tubercular Ascites.Methods: Patients who were admitted to Medicine Wards, with the complaints of distension of abdomen, proved by ultrasound to have ascites, were included in the study. Total 102 Patients of ascites were included. The incidence of Tuberculous ascites was observed and special features regarding their clinical presentation, ascitic fluid values and imaging studies were noted.Results: Tubercular ascites was seen in 18 (17.6%) patients out of the 102 subjects studied. In the group of patients having raised ascitic fluid ADA, authors found that the number of patients having raised AFTP (16 cases, 88.88%) was significantly more than the patients having lower SAAG (13 cases, 71.22%) (p=0.007).Conclusions: In the setting where calculating SAAG may prove to be quite expensive, AFTP is a reasonable predictor of Tubercular infection in ascitic fluid.

Clinical Profile of Ascites Based on Presentation and Laboratory Findings: An institutional experience from Kathmandu, Nepal

Introduction: Ascites is the fluid collection in the potential space of the peritoneal cavity. Alcoholic liver disease and intra-abdominal malignancy are two major etiologies behind it. Also, diagnosis of tuberculous ascites should be thought of due to endemicity. Cirrhotic patients at any time during the course of disease, invariably present with ascites which is one of the marker of decompensation. In our context, etiology behind ascites and its correlation with symptoms and clinical findings not yet studied, so present study is conceptualized.&#x0D; Methods:This is a cross-sectional retrospective descriptive hospital based record review of patients presented with ascites in a tertiary center of Kathmandu. One hundred fourteen patients with ascites under regular follow up of Shree Birendra Hospital (SBH) were reviewed. Data regarding presenting complaints, examination findings, relevant investigations during first visit and final diagnosis were retrieved from our own record keeping and recorded information were then evaluated.&#x0D; Results: Patients having ascites have myriad of symptoms and signs, commonest clinical feature being icterus (74, 64.9%). Most of them were anemic at presentation. Forty-two (36.8%) had high blood urea and 36 (31.5%) with high creatinine suggesting approximately 30-40% cases presented with deranged renal function test. Ninety-three (81.5%) had raised total serum bilirubin. Similarly, PT/INR derangements were in 74 (64.9%) and 57 (50%) suggesting deranged liver function. Serum albumin was less than 3.5 gram/deciliter in 83(72.8%) cases. Among the patients studied, 80 (70.1%) had high Serum-Ascites Abumin Gradient (SAAG) suggesting transudative type of ascites and rest 34 had low SAAG suggesting exudative type of ascites. Overall assessment revealed, majority of patients (71.05%) had Chronic liver disease (CLD) as the cause of ascites.&#x0D; Conclusions: Ascites due to chronic liver disease was the main finding with etiology supported by laboratory findings. Significant numbers of the patients had deranged renal function on top of liver function derangement, so these parameters need to be properly taken care of.&#x0D; Key Words: Ascites, liver cirrhosis, serum ascetic albumin gradient.

Case of Chylous Ascites: A Diagnostic Dilemma

We present a case of an 83 year-old male who is status post orthotopic liver transplant in November 2005 for alcoholic cirrhosis, presenting to Henry Ford Hospital with increasing abdominal girth. His symptoms began 2 months prior to presentation following cardiac pacemaker placement for heart block. He was hospitalized shortly after his procedure for shortness of breath and was found to have a pericardial effusion, which was thought to be inflammatory in nature and resolved with steroids. He had been following in the transplant clinic on a regular basis without issues, and was maintained on a stable immunosuppression regimen of mycophenolate and Sirolimus for several years. As part of the work up for his new-onset ascites, a paracentesis was performed. Fluid analysis demonstrated 702 WBCs with 77% lymphocytes, serum-albumin ascites gradient (SAAG) < 1.1 g/dL, total protein < 2.5 g/dL and triglycerides of 2360 mg/dL; consistent with chylous ascites. Lipase and amylase levels were within normal limits. Fungal cultures, acid-fast bacilli stains and cytology were all negative. Echocardiogram showed normal right-sided pressures with preserved ejection fraction and stable pericardial effusion. CT abdomen was unremarkable with no evidence of cirrhosis or portal hypertension. Lymphoscintigraphy study was unremarkable. Liver biopsy was performed without evidence of cirrhosis or rejection. Cardiology was consulted to determine whether the ascites was secondary to venous/lymphatic obstruction as a complication of pacemaker placement or heart failure; this was felt unlikely given preserved cardiac function and normal positioning of pacemaker leads on x-ray. Ultimately, Sirolimus was felt to be the culprit of his chylous ascites. Sirolimus was subsequently discontinued and cyclosporine was initiated with resolution of his ascites. Chylous ascites is a rare finding. It most commonly occurs in the setting of malignancy, lymphatic/vascular obstruction or cirrhosis. Less common etiologies include mycobacterial infection, congenital, inflammatory, post-operative, traumatic and medications such as calcium channel blockers and Sirolimus. Few cases of chylous ascites secondary to Sirolimus have been reported, particularly in renal transplant patients. There are no reported cases of Sirolimus-induced chylous ascites in liver transplant patients. The diagnosis is established by abdominal paracentesis, with fluid studies demonstrating a triglyceride level >200 mg/dL. SAAG and protein levels may vary. Acid-fast bacilli stain and ADA should be performed as well to rule out tuberculous ascites in those at high risk, along with amylase, lipase and standard fluid studies. Abdominal CT should be obtained to rule out pathologic lymph nodes and masses, and lymphoscintigraphy or lymphangiography can aid in detecting leakage from lymphatics and patency of the thoracic duct. Failure to identify a clear etiology following this workup should prompt an investigation into drug etiologies. Treatment is aimed at correction of the underlying etiology (or withholding the offending agent) along with therapeutic paracenteses as needed. A high protein and low fat diet with medium chain triglycerides is recommended. Occasionally, surgery may be performed for obstructive etiologies such as malignancy. Transjugular intrahepatic shunts may be performed for cirrhotic patients. There is also limited evidence for the use of orlistat, somatostatin and octreotride in the mitigation of chylous ascites.

Diagnostic Significance of Serum Ascites cholesterol to Differentiate Malignant and non Malignant Ascites

Background: Ascitic fluid usually forms slowly as a result of obstruction of proximal vascular systems (Venous, lymphatic). It may also form directly in response to disease involving the peritoneum. Differentiation between malignancy related and non-malignantascites is a challenge that is not always met satisfactorily. Both malignant and tuberculous ascites are exudative in nature with lymphocytic predominance and low Serum Ascitic Fluid Albumin Gradient values can not be differentiated easily form each other. Studies have shown that parameters like ascitic fluid cholesterol have been superior to the conventional method of ascitic fluid analysis in discriminating ascites caused by malignancy from others. Method: This study was conducted in the Department of Pathology, Shyam Shah Medical College, Rewa during the period from May 2009 to October 2011. The study comprised of 100 patients with different causes of ascites admitted to wards of S.G.M.H. Rewa. Result: Cases were divided in to 3 groups. Groups I consists of patents(39 male and 31 female) with ascites due to chronic liver disease and other non tubercular and non neoplastic diseases, Group II consists of 20 patients (4 male and 16 female) with ascites due to tuberculosis, Group III consists of 10 patients (4 male and 6 female) with ascites due to malignant diseases. Ascitic fluid cholesterol level was found to be 32.9571±7.1183mg%,0.05±9.047gm%, 74.1±16.1707mg% in Group I, Group II and Group III respectively. On comparing Group III with I and II values were found to be highly significant (p 0.05). The value of ascitic fluid cholesterol level found in Group III was comparatively higher (>54.5mg%) than Group I and Group II with an exception in one case, where we found a higher level of cholesterol. Conclusion: In our study we found a significant raised cholesterol level (74.1 ±16.1707mg%) well above the cut off value (54.5mg%) and it has got a good differentiating potential for determining malignant ascites from non-malignant ascites. DOI: 10.21276/APALM.1371

English

English

Disseminated tuberculosis with varied paradoxical reactions

Paradoxical reactions are immune-mediated exacerbations of disease triggered by tuberculosis (TB) treatment. We describe a case of varied paradoxical reactions in a 9-year-old girl who was diagnosed with mediastinal TB and tuberculous ascites. The development of paradoxical reaction was gradual with pericardial effusion occurring first followed by pleural effusion and subsequently bilateral papilledema.

Value of measurement of gradient and ratio of ascites-serum tumor markers in differential diagnosis of tuberculous ascites and malignant ascites

Value of measurement of gradient and ratio of ascites-serum tumor markers in differential diagnosis of tuberculous ascites and malignant ascites

DIAGNOSIS OF TUBERCULOUS ASCITIES;

Diagnosing Tuberculous ascites is a challenge. Polymerase chain reaction (PCR) and adenosine deaminase activity(ADA) have come up as promising modalities to aid diagnosis of tuberculosis in body fluids. Objective: To find and compare theusefulness of ADA and PCR in ascitic fluid in diagnosis of peritoneal tuberculosis. Study Design: A cross-sectional study. Place of Study:Medical Unit-I, Ghulam Mohammad Mahar Medical College Hospital, Sukkur. Duration of Study: From January 2010 to July 2011.Methods: Fifty five patients of exudative ascites, were diagnosed as peritoneal tuberculosis by following criteria- clinical suspicion, PPD(Skin Tuberculin test) positive, suggestive bacteriological and/or imaging findings and ascitic fluid showing lymphocytosis withdecreased glucose and SAAG (Serum- Ascites albumin gradient) of &lt;1.1 gm/ dL. PCR and ADA were performed in the ascitic fluid andpositivity rates determined and compared. Results: Out of 55 study subjects, 50 patients (90.9%) were PCR positive and 48 (87.3%)were ADA positive; both were equiefficacious (p=0.54). High agreement between PCR and ADA tests was noted. Conclusions: ADA andPCR are comparable as diagnostic modality for tuberculous peritonitis, however ADA scores over PCR because of easy availability, lowcost, less infrastructure requirement and less-time consuming.

Expression and significance of cyclooxygenase-2 mRNA in benign and malignant ascites

To investigate the mRNA expression of cyclooxygensae-2 (COX-2) in benign and malignant ascites, and to explore the difference in COX-2 mRNA expression among different diseases. A total of 36 samples were collected from the Fifth Affiliated Hospital of Sun Yat-Sen University and divided into two experimental groups: benign ascites (n = 21) and malignant ascites (n = 15). Benign ascites included cirrhotic ascites (n = 10) and tuberculous ascites (n = 5). Malignant ascites included oophoroma (n = 7), cancer of colon (n = 5), cancer of the liver (n = 6), gastric cancer (n = 2), and bladder carcinoma (n = 1). The mRNA expression of COX-2 in ascites was examined with reverse transcriptase polymerase chain reaction (RT-PCR) technology, and the positive rate of COX-2 mRNA was compared between different diseases. The positive rate of COX-2 mRNA in malignant ascites was 42.9% (9/21), which was significantly higher than in benign ascites, 6.7% (1/15), difference being significant between these two groups (χ(2) = 4.051, P = 0.044). The proportion of the positive rate in the malignant ascites was as follows: ovarian cancers 57.1% (4/7), colon cancer 40.0% (2/5), liver cancer 33.3% (2/6), gastric cancer 50.0% (1/2), and bladder cancer 0.00% (0/1). However, there was no significant difference in COX-2 mRNA expression among various tumors with malignant ascites (χ(2) = 1.614, P = 0.806). Among the benign ascites, COX-2 mRNA levels were different between the tuberculous ascites (0/5) and cirrhotic ascites (1/10), but there was no significant difference (P = 1.000). COX-2 mRNA, detected by RT-PCR, is useful in the differential diagnosis of benign and malignant ascites, which also has potential value in the clinical diagnosis of tumors.

Usefulness of serum ascites cholesterol gradient (SACG), total protein (TP) ratio and serum ascites albumin gradient (SAAG) in differentiating tuberculous ascites and cirrhotic ascites

Background: Differential diagnosis of ascites is a common clinical problem and is usually done by Serum Ascites Albumin Gradient (SAAG).However many other markers can also be utilized for the same. Aims & Objective: This study was carried out to evaluate the diagnostic efficiency of ascitic fluid cholesterol, serum ascites albumin gradient (SAAG) , Total protein Ratio and serum ascites cholesterol gradient (Chol gradient/ SACG) in differentiating cirrhotic and tuberculous ascites. Material and Methods: The study included 48 patients admitted in St John’s Medical Hospital, Bangalore, out of which 25 patients were diagnosed with tuberculous ascites and 23 patients were diagnosed with cirrhotic ascites. Serum and ascitic fluid (AF) albumin, Total protein (TP) and Cholesterol (Chol) were estimated. The SAAG, TP ratio, Serum ascites cholesterol gradient (SACG) were calculated. Significance was assessed at 5% level of significance. Cohen’s d effect size has been computed and discrimination function analysis is done to determine the percentage of correct classification between cirrhotic and tubercular ascites. Results: SAAG showed a sensitivity and specificity of 100% and 95.6% at cut off of >1.1g/dl TP ratio at a cut off > 0.5 showed sensitivity100% and specificity98% specificity. Ascitic fluid Cholesterol is high in the tuberculous group and showed sensitivity and specificity of at a cut off value of 100% and 95.5%. Ascitic fluid TP showed a sensitivity and specificity of 100% and 96% at a cut off value of

Polymerase chain reaction and adenosine deaminase activity in tuberculous ascites

Polymerase chain reaction and adenosine deaminase activity in tuberculous ascites

Study of Adenosine Deaminase Activity As A Biochemical Marker of Cell Mediated Immunity in Tuberculous Meningitis, Tuberculous Pleural Effusion and Tuberculous Ascites

The present study conducted with the aim that ADA estimation is a simple cheaper and quicker biochemical test and could provide additional supportive evidence for the diagnosis of tuberculous meningitis, tuberculous pleural effusion, tuberculous ascites in clinically suspected cases and will therefore help in early institution of therapy to these patients. The data was collected and interpreted at department of Physiology and Department of Medicine Gandhi Medical College, Bhopal.DOI: http://dx.doi.org/10.3329/jom.v13i1.9065JOM 2012; 13(1): 32-38

Leptin levels in the differential diagnosis between benign and malignant ascites

To evaluate the role of leptin levels in the differential diagnosis of ascites. Ascitic leptin, TNFalpha and serum leptin levels were measured in 77 patients with ascites (35 with malignancies, 30 cirrhosis and 12 tuberculosis). Control serum samples were obtained from 20 healthy subjects. Leptin and TNFalpha levels were measured by ELISA. Body mass index (BMI) and percentage of body fat (BFM) by skin fold measurement were calculated for all patients and control groups. Peritoneal biopsy, ascites cytology and cultures or biochemical values were used for the diagnosis of patients. In patients with malignancies, the mean serum and ascites leptin levels and their ratios were significantly decreased compared to the other patient groups and controls. In tuberculosis peritonitis, ascitic fluid TNFalpha levels were significantly higher than malignant ascites and cirrhotic sterile ascites. BMI and BFM values did not distinguish between patients and controls. In patients with malignant ascites, levels of leptin and TNFalpha were significantly lower than in patients with tuberculous ascites.

Diagnostic Accuracy of Ascitic Fluid IFN-γ and Adenosine Deaminase Assays in the Diagnosis of Tuberculous Ascites

In this study, we evaluated the diagnostic accuracy and cost-effectiveness of ascitic fluid interferon-gamma (IFN-gamma) and adenosine deaminase (ADA) assays in the diagnosis of tuberculous ascites. Ascitic fluid from patients with proven tuberculosis (TB) (n = 31) and non-TB ascites (n = 88) was analyzed for IFN-gamma and ADA levels. Areas under the receiver operative characteristic (ROC) curves (AUCs) for the two biologic markers were compared. Levels of ascitic fluid IFN-gamma, median (range): 560 (104-1600) pg/mL vs. 4.85 (0-320) pg/mL (p < 0.001), and ADA, median (range): 58 (16-331) IU/L vs. 10 (0-59) IU/L (p = 0.001), were significantly different between TB and non-TB groups. IFN-gamma and ADA assays showed equal sensitivity (0.97) and differed marginally in specificity (0.97 vs. 0.94). Difference in AUCs was not significant (0.99 vs. 0.98, p < 0.62). For differentiating TB from non-TB ascites, optimal cutoff points were 112 pg/mL for IFN-gamma and 37 IU/L for ADA. The accuracy of the ADA assay was similar to that of the IFN-gamma assay in differentiating of TB from non-TB ascites. Because both material and human costs of the ADA assay are far less than those of the IFN-gamma assay, the former is probably the most appropriate diagnostic test for analysis of peritoneal fluid in resource- limited settings.