Systematic review: tuberculous peritonitis--presenting features, diagnostic strategies and treatment.

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.

• Authors: F M Sanai, K I Bzeizi
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 22 Issue 8 Pg. 685-700 (Oct 15 2005) ISSN: 0269-2813 [Print] England
• PMID: 16197489 (Publication Type: Journal Article, Review, Systematic Review)

Chemical References

• Antitubercular Agents

Topics

• Adolescent
• Adult
• Algorithms
• Antitubercular Agents (therapeutic use)
• Female
• Humans
• Laparoscopy
• Male
• Peritonitis, Tuberculous (diagnosis, drug therapy, epidemiology)
• Tomography, X-Ray Computed