Abdominal Tuberculosis in Children: A Diagnostic Challenge

Department of Infectious Diseases, Ton-Yen General Hospital, Hsinchu, Taiwan.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi (Impact Factor: 2.35). 06/2010; 43(3):188-93. DOI: 10.1016/S1684-1182(10)60030-8
Source: PubMed


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.

3 Reads
  • Source
    • "Detailed family histories should be obtained for children with chronic abdominal complaints, especially those in endemic areas. One study reported that 60% of children with TBP have family histories of tuberculosis [9]. In our case, we suspected tuberculosis contact because her grandfather had a chronic lung disease, which might have been pulmonary tuberculosis, and because she had visited the hospital many times due to her grandfather's condition. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Currently, tuberculosis remains a major public health problem worldwide. Peritoneal tuberculosis occurs in approximately 1% of all of tuberculosis cases and is rarely observed in children. Diagnosis and treatment delays caused by mimicking many other intra-abdominal diseases can lead to increases in morbidity and mortality. Here, we present a case of a four-year-old child with tuberculosis peritonitis who was diagnosed by laparoscopic biopsy and histopathological examination and recovered with antituberculosis therapy. Peritoneal tuberculosis should be considered in younger patients and adults with fever, abdominal pain and weight loss in endemic areas. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.
    Full-text · Article · Apr 2015 · Journal of Infection and Public Health
  • Source
    • "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 [12] [13] [14] [15]. Moreover, there is very little information derived from postmortem studies [16]. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Dec 2012
  • Source
    • "The response to antituberculous therapy may indirectly prove the clinical diagnosis of abdominal TB when laboratory confirmation is lacking, especially in endemic areas [3]. Recent studies demonstrated the success of long-duration (12-month) antituberculous treatment without the need for adjunctive corticosteroids [3] [4]. Skeletal TB is another uncommon form of TB that is observed in 1—2% of children with TB because of hematogenous spread. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Apr 2012
Show more