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Tuberculous Peritonitis

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  • Authors: Urvashi Vaid1, Gregory C. Kane2
  • Editor: David Schlossberg3
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Department of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA 19107; 2: Department of Medicine, Sidney Kimmel Medical College, The Korman Lung Center, Thomas Jefferson University, Philadelphia, PA 19107; 3: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0006-2016
  • Received 12 September 2016 Accepted 03 October 2016 Published 10 February 2017
  • Urvashi Vaid, urvashi.vaid@jeffersonhospital.org
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  • Abstract:

    Tuberculous peritonitis is rare in the United States but continues to be reported to occur in certain high-risk populations, which include patients with AIDS or cirrhosis, patients on continuous ambulatory peritoneal dialysis, recent immigrants from areas of high endemicity, and those who are immunosuppressed. The diagnosis of this disease requires a high clinical index of suspicion and should be considered in the differential of ascites with a lymphocyte predominance and serum-ascitic albumin gradient of <1.1 mg/dl. Microbiological or pathological confirmation remains the gold standard for diagnosis. Ascitic fluid cultures have low yield, but peritoneoscopy with biopsy or cultures frequently confirms the diagnosis. Newer techniques with future application include determination of adenosine deaminase and interferon gamma levels in ascitic fluid. Ultrasound and computed tomography are frequently used to guide fluid aspiration and biopsies. Six months of treatment with antituberculosis therapy is adequate except in cases of drug-resistant tuberculosis. The role of steroids remains controversial. Surgical approaches may be required to deal with complications including bowel perforation, intestinal obstruction from adhesions, fistula formation, or bleeding.

  • Citation: Vaid U, Kane G. 2017. Tuberculous Peritonitis. Microbiol Spectrum 5(1):TNMI7-0006-2016. doi:10.1128/microbiolspec.TNMI7-0006-2016.

Key Concept Ranking

Peyer's Patches
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Interferon gamma
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References

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2017-02-10
2017-09-22

Abstract:

Tuberculous peritonitis is rare in the United States but continues to be reported to occur in certain high-risk populations, which include patients with AIDS or cirrhosis, patients on continuous ambulatory peritoneal dialysis, recent immigrants from areas of high endemicity, and those who are immunosuppressed. The diagnosis of this disease requires a high clinical index of suspicion and should be considered in the differential of ascites with a lymphocyte predominance and serum-ascitic albumin gradient of <1.1 mg/dl. Microbiological or pathological confirmation remains the gold standard for diagnosis. Ascitic fluid cultures have low yield, but peritoneoscopy with biopsy or cultures frequently confirms the diagnosis. Newer techniques with future application include determination of adenosine deaminase and interferon gamma levels in ascitic fluid. Ultrasound and computed tomography are frequently used to guide fluid aspiration and biopsies. Six months of treatment with antituberculosis therapy is adequate except in cases of drug-resistant tuberculosis. The role of steroids remains controversial. Surgical approaches may be required to deal with complications including bowel perforation, intestinal obstruction from adhesions, fistula formation, or bleeding.

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Figures

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FIGURE 1

Miliary seedlings on peritoneum and serosal surface of bowel with dense adhesions. Reproduced from reference 64, per CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/).

Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0006-2016
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TABLE 1

Clinical and laboratory features of tuberculous peritonitis

Source: microbiolspec February 2017 vol. 5 no. 1 doi:10.1128/microbiolspec.TNMI7-0006-2016

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