Abdominal Tuberculosis in Children: A Diagnostic Challenge
ABSTRACT Abdominal tuberculosis (TB) is a rare manifestation of childhood TB. Abdominal TB is characterized by long-lasting abdominal symptoms, which are usually confused with other conditions, and the diagnosis is usually delayed.
During a 5-year period, we identified 10 cases of abdominal TB in a tertiary care children's hospital. Data including demographic characteristics, presenting symptoms, history of Bacille Calmette-Guérin vaccination, lesion sites, laboratory data, image findings, diagnosis, tuberculin skin test, risk factors, treatment, and outcome were collected and analyzed.
There were six female patients and four male patients, with a mean age of 14.7 years. One patient died due to the complication of disseminated TB with a pneumothorax. Household members with TB could be traced in six (60%) patients. The most common clinical presentations included fever (9/10), abdominal pain (8/10), and weight loss (8/9). The diagnosis of abdominal TB was suspected initially in only three patients; the others were not diagnosed until 7-36 days (mean=19 days) after hospitalization. The abnormal abdominal image findings, by either computed tomography or ultrasound, included lymphadenopathy (7/9), high-density ascites (6/9), thickening of the omentum or peritoneum (6/9), inflammatory mass (3/9), bowel wall thickening (1/9), and liver abscess (1/9). The chest radiography was abnormal in nine patients. Mycobacterium tuberculosis was isolated from ascites in two out of four patients, gastric aspirates in three, sputum in three, and intra-abdominal tissue specimens in two. Laparotomy was performed in three patients, laparoscopy in one, and colonoscopy in one.
In Taiwan, abdominal TB should be considered in patients with fever, abdominal pain, weight loss, and abnormal chest radiography. Characteristic computed tomography findings of abdominal TB and a history of exposure to TB contribute to the diagnosis.
- SourceAvailable from: Cecilia Ridaura-Sanz
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- "In recent years, there has been a renewed interest in extrapulmonary forms of tuberculosis as a complication of immunodeficiency in adults. In contrast, the experience in children is meager, and most reports refer to isolated cases    . Moreover, there is very little information derived from postmortem studies . "
ABSTRACT: Infection by Mycobacterium bovis is not infrequently identified in Mexico. Its relation to nonpasteurized milk products ingestion is well recognized with primary infection usually in the intestinal tract. The term “abdominal tuberculosis” includes peritoneal as well as primary and secondary intestinal tuberculosis. The clinical differentiation of these conditions is difficult. In this work, we reviewed the clinical and pathological features of 24 cases of children dying with tuberculosis in whom autopsy revealed abdominal disease in a referral hospital in Mexico City. We identified 8 cases of primary intestinal tuberculosis, with documentation of M. bovis in 6 of them, and 9 cases of secondary intestinal tuberculosis (primary pulmonary disease), all negative to M. bovis . Seven patients had peritoneal tuberculosis without intestinal lesions and with active pulmonary disease in 4 of them, and of the remaining three, two had mesenteric lymph node involvement suggesting healed intestinal disease. In this approach to abdominal tuberculosis, postmortem analysis was able to differentiate primary from secondary intestinal tuberculosis and to define the nature of peritoneal involvement. This discrimination gives rise to different diagnostic approaches and epidemiological and preventive actions, particularly in countries where tuberculosis is endemic and infection by M. bovis continues to be identified.12/2012; 2012(874):230814. DOI:10.1155/2012/230814
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- "The response to antituberculous therapy may indirectly prove the clinical diagnosis of abdominal TB when laboratory confirmation is lacking, especially in endemic areas . Recent studies demonstrated the success of long-duration (12-month) antituberculous treatment without the need for adjunctive corticosteroids  . Skeletal TB is another uncommon form of TB that is observed in 1—2% of children with TB because of hematogenous spread. "
ABSTRACT: We report the case of a 10-year-old girl who presented to the emergency department with acute abdominal pain. She was diagnosed as having extrapulmonary tuberculosis (TB) with multifocal osteomyelitis of the spine and ribs, peritonitis and intestinal involvement. We describe the clinical presentation of this unusual constellation of the disease in the absence of pulmonary involvement in a child and discuss the diagnostic challenges and treatment of these rare forms of TB.04/2012; 5(2):203-6. DOI:10.1016/j.jiph.2011.11.005
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ABSTRACT: Tuberculosis infection caused by Mycobacterium tuberculosis or other Mycobacterium species is a major communicable disease worldwide. We evaluated the epidemiology of tuberculous peritonitis to determine diagnostic features and factors related to late diagnosis. We retrospectively reviewed 211 tuberculous peritonitis cases diagnosed between January 1999 and December 2009. Clinical features, laboratory data, and diagnostic methods were analysed. Subjects included 115 males (54.5%) and 96 females (45.5%) with median age 61.0 years (range 43-72) and 29.2 days mean duration from symptoms to diagnosis. Disease histories included end-stage renal disease (20.9%), pulmonary tuberculosis (36.0%) and liver cirrhosis (23.7%). Most common symptoms were abdominal distension (80.1%), abdominal pain (68.7%) and weight loss (45.5%). Most common signs were ascites (62.6%) and fever (55.5%). One-year survival rate was 89.9%; 21 patients died during follow-up. Mortality risk was higher in patients with more concomitant diseases, including liver cirrhosis, AIDS, chronic steroid use, alcoholism, GI bleeding, haemoptysis, period from symptom presentation to treatment, secondary bacterial peritonitis requiring emergent operation. Increased duration between symptoms and definitive diagnosis increases mortality risk. Early diagnosis and prompt initiation of anti-tuberculosis therapy improve prognosis. Neutrophil-predominant ascites influences poor prognosis when correlated with secondary bacterial peritonitis.Digestive and Liver Disease 09/2011; 44(2):111-7. DOI:10.1016/j.dld.2011.08.020 · 2.96 Impact Factor