Systematic review: tuberculous peritonitis – presenting features, diagnostic strategies and treatment
- 30 September 2005
- journal article
- review article
- Published by Wiley in Alimentary Pharmacology & Therapeutics
- Vol. 22 (8), 685-700
- https://doi.org/10.1111/j.1365-2036.2005.02645.x
Abstract
The peritoneum is one of the most common extrapulmonary sites of tuberculous infection. Peritoneal tuberculosis remains a significant problem in parts of the world where tuberculosis is prevalent. Increasing population migration, usage of more potent immunosuppressant therapy and the acquired immunodeficiency syndrome epidemic has contributed to a resurgence of this disease in regions where it had previously been largely controlled. Tuberculous peritonitis frequently complicates patients with underlying end-stage renal or liver disease that further adds to the diagnostic difficulty. The diagnosis of this disease, however, remains a challenge because of its insidious nature, the variability of its presentation and the limitations of available diagnostic tests. A high index of suspicion is needed whenever confronted with unexplained ascites, particularly in high-risk patients. Based on a systematic review of the literature, we recommend: tuberculous peritonitis should be considered in the differential diagnosis of all patients presenting with unexplained lymphocytic ascites and those with a serum-ascites albumin gradient (SAAG) of <11 g/L; culture growth of Mycobacterium of the ascitic fluid or peritoneal biopsy as the gold standard test; further studies to determine the role of polymerase chain reaction, ascitic adenosine deaminase and the BACTEC radiometric system for acceleration of mycobacterial identification as means of improving the diagnostic yield; increasing utilization of ultrasound and computerized tomographic scan for the diagnosis and as a guidance to obtain peritoneal biopsies; low threshold for diagnostic laparoscopy; treatment for 6 months with the first-line antituberculous drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) in uncomplicated cases.Keywords
This publication has 97 references indexed in Scilit:
- Cancer Antigen 125 in Patients With Chronic Liver DiseaseMayo Clinic Proceedings, 2002
- Imaging of abdominal tuberculosisEuropean Radiology, 2001
- Diagnosis of abdominal tuberculosis: sonographic findings in patients with early disease.American Journal of Roentgenology, 1995
- Diagnostic value of ascites gamma interferon levels in tuberculous peritonitis. Comparison with adenosine deaminase activityTubercle, 1991
- Tuberculous peritonitis: laparoscopic diagnosis of an uncommon disease in the United StatesGastrointestinal Endoscopy, 1988
- Tuberculous peritonitis in LesothoTubercle, 1986
- Tuberculous peritonitis: CT appearanceAmerican Journal of Roentgenology, 1985
- Tuberculous peritonitis: Diagnostic value of the ascitic/blood glucose ratioTubercle, 1984
- CT of abdominal tuberculosisAmerican Journal of Roentgenology, 1982
- INDICATIONS, CONTRAINDICATIONS AND COMPLICATIONS OF LAPAROSCOPYObstetrical & Gynecological Survey, 1975