1,931 results on '"Peritonitis, Tuberculous"'
Search Results
2. Clinico-radiological Classification of Peritoneal Tuberculosis
- Author
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Vishal Sharma, Assistant Professor
- Published
- 2020
3. IFN-gamma-releasing Assay Based Approach in Patients With Suspected Tuberculous Peritonitis
- Author
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Sung-Han Kim, Associate Professor
- Published
- 2018
4. Characterizing omental PET/CT findings for differentiating tuberculous peritonitis from peritoneal carcinomatosis.
- Author
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Duan, Hongli, Xu, Dongdong, Lu, Rencai, Wang, Siyu, Xie, Ran, and Wang, Shaobo
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COMPUTED tomography , *PERITONEAL cancer , *PERITONITIS , *POSITRON emission tomography computed tomography , *OMENTUM , *HYPERTHERMIC intraperitoneal chemotherapy , *TUBERCULOUS meningitis - Abstract
Purpose: To characterize and investigate PET/CT findings in the omentum in the differentiation of tuberculous peritonitis (TBP) and peritoneal carcinoma (PC). Methods: Thirty-nine patients with TBP and 113 patients with PC who underwent PET/CT were retrospectively enrolled. The omental uptake intensity, distribution characteristics, contracture, size and boundary of soft-tissue lesions, and CT patterns were reviewed. Results: Absent and focal FDG uptake in the lesser omentum was more common in the PC patients (P = 0.034 and P = 0.017, respectively), and diffuse FDG uptake in the lesser omentum was more common in the TBP patients (P < 0.001). An apron-like pattern in the greater omentum commonly occurred in the TBP patients (P = 0.004). Micronodules (< 5 mm) were more common in the TBP patients (P < 0.001), and masses (> 3 cm) were more common in the PC patients (P = 0.001). Smudged and nodular patterns occurred more frequently in the TBP patients than in the PC patients (P < 0.001 and P = 0.003, respectively), and the caked pattern occurred more frequently in the PC patients (P < 0.001). There was no significant difference in the FDG uptake intensity and the boundary of soft-tissue lesions between the TBP and PC patients (P = 0.191 and P = 0.061, respectively). Conclusion: Diffuse FDG uptake, an apron-like pattern, micronodules, and a smudged and nodular pattern might be significant differential features of TBP. Absent and/or focal FDG uptake, mass, and a caked pattern might be significant differential features of PC. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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5. Tuberculous peritonitis
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Hisako Kushima, Ryohei Sakamoto, Yoshiaki Kinoshita, and Hiroshi Ishii
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Antitubercular Agents ,Peritonitis, Tuberculous ,Humans ,General Medicine - Published
- 2023
6. The Clinical Utility of the Neutrophil-to-Lymphocyte Ratio as a Discriminatory Test among Bacterial, Mycobacterium Tuberculosis, and Nontuberculous Mycobacterium Peritoneal Dialysis–Related Peritonitis
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Winston Wing-Shing Fung, Kai-Ming Chow, Jack Kit-Chung Ng, Gordon Chun-Kau Chan, Philip Kam-Tao Li, and Cheuk-Chun Szeto
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Neutrophils ,Peritonitis, Tuberculous ,Humans ,Nontuberculous Mycobacteria ,Lymphocytes ,Mycobacterium tuberculosis ,General Medicine ,Peritonitis ,Tuberculosis, Lymph Node ,bacterial infections and mycoses ,Peritoneal Dialysis ,Original Investigation ,Retrospective Studies - Abstract
BACKGROUND: Distinguishing Mycobacterium tuberculosis (TB) and nontuberculous Mycobacterium (NTM) from bacterial peritoneal dialysis (PD)–related peritonitis (peritonitis) is often very challenging and can lead to a significant delay in diagnosis and treatment. The neutrophil-to-lymphocyte ratio (NLR) is readily calculable and has been shown to be useful in differentiating pulmonary TB from bacterial pneumonia. We are the first group to demonstrate the predictive efficacy of peritoneal dialysate (PDE) NLR in distinguishing TB/NTM peritonitis from bacterial causes in the PD population. METHODS: We retrospectively reviewed the clinical and laboratory characteristics of all patients with TB/NTM peritonitis, methicillin-sensitive Staphylococcus aureus (MSSA) peritonitis, and culture-negative peritonitis in our tertiary center between July 2000 and July 2020. The diagnostic ability of the blood and PDE NLR for differential diagnosis was evaluated. RESULTS: In total, 258 episodes, 38 episodes, and 27 episodes were caused by MSSA, TB, and NTM species, respectively; 364 episodes were culture negative. The PDE NLR level taken at presentation were lowest in the TB peritonitis, followed by the NTM, culture-negative, and MSSA groups, (9.44±13.01, 16.99±23.96, 36.63±32.33, 48.51±36.01; P
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- 2022
7. Crohn's disease and intestinal tuberculosis: challenging from every angle.
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Guimarães A, Gama J, Curvo-Semedo L, and Manso AC
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- Female, Humans, Abscess, Adult, Crohn Disease complications, Crohn Disease diagnosis, Crohn Disease pathology, Enteritis, Mycobacterium tuberculosis, Peritonitis, Tuberculous, Tuberculosis, Gastrointestinal complications, Tuberculosis, Gastrointestinal diagnosis, Tuberculosis, Gastrointestinal drug therapy, Tuberculosis, Lymph Node
- Abstract
A woman in her 20s with a recent diagnosis of Crohn's disease (CD) affecting the ileocaecal valve was started on adalimumab, after routine tuberculosis (TB) tests were negative. Her abdominal symptoms got worse and she started presenting respiratory distress and fever. Tomography revealed a left pleural effusion, pneumonia and peritonitis with pelvic abscess. The diagnosis of disseminated TB with digestive involvement was suggested and sputum cultures were positive for Mycobacterium tuberculosis Treatment for TB was started and immunosuppressants discontinued, leading to respiratory improvement. Abdominal imaging was repeated, showing worsening signs of multisegmental ileal wall thickening, ileocaecal valve obstruction and a persistent pelvic abscess. She was then submitted to a laparoscopic ileocaecal resection for suspicion of worsening CD. Histopathology showed chronic ileocolitis compatible with CD and ganglionic tuberculosis, revealing the diagnosis of intestinal tuberculosis superimposed in CD. Recovery was uneventful., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2023
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8. Intestinal tuberculosis presented as spindle cell pseudotumor in a HIV-positive case.
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Li C, Zhang Q, and Wen Y
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- Male, Humans, Adult, Tuberculosis, Lymph Node, Peritonitis, Tuberculous, Tuberculosis, Gastrointestinal complications, Tuberculosis, Gastrointestinal diagnosis, HIV Seropositivity, Mycobacterium tuberculosis
- Abstract
MSP is a rare and atypical form of benign granulomatous inflammation characterised by tumour-like local proliferation of spindle-shaped histiocytes containing acid-fast positive mycobacteria, which should be differentiated from neoplastic lesions. A 26-year-old Chinese man complained an intermittent and mild right lower abdominal pain for 5 months in May 2022.Histopathology of biopsy samples showed Mycobacterial spindle cell pseudotumor (MSP). The test of Mycobacterium tuberculosis detected by polymerase chain reaction using intestinal tissue slice was negative. The metagenomic next-generation sequencing (BGI-Shenzhen) using formalin-fixation and paraffin-embedded intestine samples confirmed Mycobacterium tuberculosis complex (MTBC).
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- 2023
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9. Assessment of CT perfusion indices of the clinicoradiological response to anti-tubercular therapy in patients with intestinal tuberculosis.
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Sasi A, Ahuja V, Das CJ, Arora U, Garg P, Razik A, Kedia S, Das P, Jadon RS, Soneja M, and Wig N
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- Adult, Female, Humans, Prospective Studies, Male, Peritonitis, Tuberculous, Tomography, X-Ray Computed methods
- Abstract
Aim: To explore the possibility of using a novel technique, CT perfusion imaging, to monitor the response to anti-tubercular therapy (ATT) in patients with intestinal tuberculosis., Materials and Methods: A prospective observational study was performed in adults with treatment naive-intestinal tuberculosis. Clinical, endoscopic, and conventional radiological findings of patients were compared at baseline and post-ATT. CT perfusion imaging was performed with recording of six perfusion parameters (blood flow, blood volume, mean transit time, time to peak, maximum peak intensity, and permeability/blood flow extraction)., Results: Twenty-two patients (13 women, 59%) with a median age of 25 years were recruited. The terminal ileum and ileocaecal junction were the most frequent sites of involvement (59%), with multiple segments of the intestine being involved in 16 patients (73%). Median duration of ATT was 6 months (range 6-10 months). Complete clinical response was observed in 22/22 (100%) patients, endoscopic response in 12/12 (100%) patients, and radiological response in 10/13 (76%) patients. There was a significant decrease in mean blood flow, blood volume, maximum peak intensity, and an increase in mean transit time and time to peak on follow-up CT perfusion imaging performed after 6 months of ATT., Conclusion: Significant alterations in CT perfusion parameters were demonstrated following treatment, consistent with a decline in inflammation and vascularity. CT perfusion imaging of the bowel is a novel means to assess the radiological response to ATT in intestinal tuberculosis, although at the cost of a higher dose of radiation exposure., (Copyright © 2023. Published by Elsevier Ltd.)
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- 2023
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10. Peritoneal Tuberculosis Presenting as Chronic Ascites With Scrofula: A Case Report.
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Bogoslovskaya, Galina and Zaldivar, Jose
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TUBERCULOSIS diagnosis ,ASCITES ,SCROFULA ,ANTITUBERCULAR agents ,CA 125 test - Abstract
Peritoneal tuberculosis (PTB) is a common type of extrapulmonary tuberculosis; however, due to variety of clinical presentations, diagnostic challenges do occur. The nonspecific features of this disease can lead to diagnostic delays and the development of complications. In addition, PTB can mimic a malignancy, especially in women who present with ascites and elevated cancer antigen (CA) 125 levels. A high index of suspicion is an important factor in an early diagnosis. Moreover, an early diagnosis and the initiation of antituberculous therapy are essential for preventing morbidity and mortality. Fortunately, most of these patients respond very well to standard antituberculous therapy. Here, we have reported the case of a young female patient who presented with chronic ascites, mild abdominal tenderness, and later, scrofula. Ultimately, she was diagnosed with PTB based on her test results. We expect that this case report will contribute to the existing literature on this subject. [ABSTRACT FROM AUTHOR]
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- 2019
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11. Mycobacterium tuberculosis peritonitis in peritoneal dialysis patients: A scoping review
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K A Thomson Benjamin, Momciu Bogdan, and Vaughan Stephen
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medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,Peritonitis, Tuberculous ,Peritonitis ,Peritoneal dialysis ,Mycobacterium tuberculosis ,Internal medicine ,medicine ,Humans ,In patient ,biology ,business.industry ,Multi-drug Resistant Tuberculosis ,Incidence (epidemiology) ,Multi-drug-resistant tuberculosis ,General Medicine ,medicine.disease ,biology.organism_classification ,Catheter ,Nephrology ,Kidney Failure, Chronic ,business ,Peritoneal Dialysis ,Mycobacterium Tuberculosis ,High Burden Tuberculosis Country - Abstract
Background The clinical syndrome of Mycobacterium tuberculosis (TB) peritoneal dialysis (PD) peritonitis is poorly understood. Whether local TB patterns modify the clinical syndrome, and what factors associate with poor outcomes is also unknown. Methods A scoping review identified published cases of TB PD peritonitis. Cases from low and high TB burden areas were compared, and cases that did or did not suffer a poor clinical outcome were compared. Results There were 216 cases identified. Demographics, presentation, diagnosis, treatment and outcomes were described. Significant delays in diagnosis were common (6.1 weeks) and were longer in patients from low TB burden regions (7.3 vs 3.7 weeks). In low TB burden areas, slower diagnostic methods were more commonly used like PD fluid culture (64.3 vs. 32.7%), and treatment was less likely with quinolone antibiotics (6.9 vs 34.1%). Higher national TB incidence and lower GDP per capita were found in cases that suffered PD catheter removal or death. Diagnostic delays were not longer in cases in which a patient suffered PD catheter removal or death. Cases that suffered death were older (51.9 vs 45.1 years) and less likely female (37.8 vs. 55.7%). Removal of PD catheter was more common in cases in which a patient died (62.0 vs 49.1%). Conclusions Outcomes in TB PD peritonitis are best predicted by national TB incidence, patient age and sex. Several unique features are identified to alert clinicians to use more rapid diagnostic methods that might enhance outcomes in TB PD peritonitis. This article is protected by copyright. All rights reserved.
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- 2021
12. Differential diagnosis of Crohn’s disease and intestinal tuberculosis: development and assessment of a nomogram prediction model
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Shaoxiong, Zeng, Ying, Lin, Jiaxiang, Guo, Xi, Chen, Qiong, Liang, Xiaoming, Zhai, and Jin, Tao
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Diagnosis, Differential ,Nomograms ,Crohn Disease ,Tuberculosis, Gastrointestinal ,Peritonitis, Tuberculous ,Gastroenterology ,Humans ,General Medicine ,Enteritis ,Retrospective Studies - Abstract
Background China is a region with a high incidence of tuberculosis, and the incidence of IBD has also been rising rapidly in recent years. Differentiating Crohn’s disease(CD) from intestinal tuberculosis (ITB) has become a very challenging issue. We aimed to develop and assess a diagnostic nomogram to differentiate between CD and ITB to improve the accuracy and practicability of the model. Methods A total of 133 patients (CD 90 and ITB 43) were analyzed retrospectively. Univariate and multivariate logistic regression analysis was included to determine the independent predictive factors and establish the regression equation. On this basis, the nomogram prediction model was constructed. The discrimination, calibration and clinical efficiency of the nomogram were assessed using area under the curve(AUC), C-index, calibration curve, decision curve analysis (DCA) and clinical impact curve. Results T-SPOT positive, cobblestone appearance, comb sign and granuloma were significant predictors in differentiating CD from ITB. Base on the above independent predictors, a diagnostic nomogram was successfully established. The sensitivity, specificity, accuracy of the prediction model are 94.4%, 93.0%, 94.0% respectively. The AUC and the C-index of the prediction model are both 0.988, which suggest that the model had a good discrimination power. The calibration curve indicated a high calibration degree of the prediction model. The DCA and clinical impact curve indicated a good clinical efficiency of the prediction model which could bring clinical benefits. Conclusion A nomogram prediction model for distinguishing CD from ITB was developed and assessed, with high discrimination, calibration and clinical efficiency. It can be used as an accurate and convenient diagnostic tool to distinguish CD from ITB, facilitating clinical decision-making.
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- 2022
13. A case report of systemic lupus erythematosus and intestinal tuberculosis with lower gastrointestinal bleeding: A treatment approach utilizing parenteral nutrition.
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Zhou A, Wang Y, Chen Y, Zhong H, Chen B, and Tan C
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- Humans, Female, Adult, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage therapy, Parenteral Nutrition, Lupus Erythematosus, Systemic complications, Lupus Erythematosus, Systemic therapy, Lupus Erythematosus, Systemic diagnosis, Enteritis, Peritonitis, Tuberculous, Tuberculosis, Gastrointestinal complications, Tuberculosis, Gastrointestinal diagnosis, Tuberculosis, Gastrointestinal therapy, Tuberculosis, Lymph Node
- Abstract
Rationale: Limited literatures are available on lower gastrointestinal bleeding in systemic lupus erythematosus (SLE) combined with intestinal tuberculosis. Sharing the treatment experiences of a 26-year-old female patient diagnosed with this complex condition in this report may contribute valuable insights., Patient Concerns: The patient initially presented with abdominal pain and active gastrointestinal bleeding, leading to admission to the hospital. Over a 2-week period, she experienced persistent bleeding, with daily volumes ranging from 300 mL to 800 mL., Diagnoses: Lower gastrointestinal bleeding was diagnosed in this patient with concurrent systemic lupus erythematosus and intestinal tuberculosis., Interventions: As her symptoms rapidly progressed, food and water intake had to be completely restricted. The parenteral nutrition was implemented., Outcomes: The medical team effectively controlled the bleeding, leading to a notable improvement in the patient's condition. Consequently, she was able to resume oral intake and was discharged from the hospital., Lessons: This case highlights the significance of using parenteral nutrition in the management of lower gastrointestinal bleeding in patients with concurrent systemic lupus erythematosus and intestinal tuberculosis. Close monitoring and collaborative efforts among healthcare professionals are crucial to achieve successful outcomes in similar cases., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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14. Case report: a case report and literature analysis on intestinal tuberculosis intestinal perforation complicated by umbilical intestinal fistula and bladder ileal fistula.
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Liu G, Chen T, Song X, Chen B, and Kang Q
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- Male, Humans, Infant, Urinary Bladder, Intestines, Intestinal Perforation diagnosis, Intestinal Perforation etiology, Intestinal Perforation surgery, Intestinal Fistula complications, Intestinal Fistula diagnosis, Intestinal Fistula surgery, Enteritis, Tuberculosis, Gastrointestinal complications, Tuberculosis, Gastrointestinal diagnosis, Tuberculosis, Gastrointestinal surgery, Peritonitis, Tuberculous, Tuberculosis, Lymph Node
- Abstract
Background: Intestinal tuberculosis is a chronic and specific infection caused by Mycobacterium tuberculosis invading the intestine. Due to the nonspecific clinical presentation, it is stressed that intestinal perforation complicates umbilical intestinal fistula and bladder ileal fistula is very rare and extremely difficult to be diagnosed. It is significant to identify the disease and take urgent intervene in the early stage., Case Presentation: An 18-month-old boy patient presented with abdominal pain. Abdominal CT suggested abscess formation in the right lower abdomen and pelvis. The patient underwent resection of necrotic and stenotic intestinal segments with the creation of an ileostomy, cystostomy and vesicoureteral fistula repair for the presence of intestinal perforation complicated by vesicoureteral fistula and umbilical enterocutaneous fistula. Histopathology confirmed the intestinal tuberculosis. The patient was discharged successfully after 11 days post anti-tuberculosis treatment., Conclusion: Our case report here is a rare case of umbilical intestinal fistula with bladder ileal fistula secondary to intestinal perforation from intestinal tuberculosis. The purpose of this report is to make the surgical community aware of atypical presentations of intestinal tuberculosis. If our peers encounter the similar situation, they can be prepared for corresponding diagnosis and treatment., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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15. Is MDCT an accurate tool to differentiate between benign and malignant etiology in diffuse peritoneal disease?
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Shyjumon George, Kirthi Sathyakumar, Mandeep Singh Bindra, and Anu Eapen
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Diagnosis, Differential ,Radiological and Ultrasound Technology ,Urology ,Splenomegaly ,Gastroenterology ,Peritonitis, Tuberculous ,Ascites ,Humans ,Lymphadenopathy ,Radiology, Nuclear Medicine and imaging ,Peritoneum ,Tomography, X-Ray Computed ,Retrospective Studies - Abstract
There is often considerable overlap of imaging findings in benign and malignant peritoneal diseases. We evaluated patients with diffuse peritoneal disease, to assess the diagnostic value of MDCT in predicting benign or malignant etiology in patients with unknown etiology, by analyzing the various patterns of involvement, particularly tuberculosis (TB) vs malignancy.One hundred and thirty-six patients with diffuse peritoneal disease who had abdominal CT and subsequently underwent omental biopsies were included in the study. Peritoneal, mesenteric and omental involvement by disease was evaluated on CT using specific parameters. The presence of lymphadenopathy, ascites, scalloping of organs, involvement of liver and spleen, were also compared between benign and malignant conditions using histopathology as the gold standard.In 136 patients, 72 benign and 64 malignant pathologies were classified as per histopathology. Higher age (p 0.001), increasing omental thickness (mean 25.2 mm, p = 0.004), omental caking (p 0.001), 10 mm mesenteric/peritoneal nodules (p 0.03), visceral scalloping (p = 0.001), free ascites (p = 0.003), serosal involvement (p = 0.004) and bilateral pleural effusion (p = 0.02) were associated with malignant etiology. Mesenteric thickening/stranding (p = 0.02), mesenteric adenopathy (p 0.001), necrotic nodes (p = 0.02), splenomegaly (p = 0.001) and higher attenuation ( 20HU) of ascitic fluid (p 0.001) were associated with benign etiology. The presence of mesenteric thickening or stranding (p = 0.01), splenomegaly (p = 0.02), higher ascitic fluid attenuation 20HU (p = 0.01), mesenteric adenopathy (p 0.01), necrotic nodes (p = 0.03) favored tuberculosis. CT had diagnostic accuracy (79.3, 86.7%), sensitivity (79.2, 74.6%) and specificity (79.4, 97%) for observers 1 and 2, respectively (Kappa 0.713).Contrast-enhanced MDCT has good sensitivity, specificity and accuracy in differentiating benign and malignant etiologies of diffuse peritoneal disease. Multiple common parameters can be used to differentiate between tuberculous peritonitis and peritoneal carcinomatosis.
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- 2022
16. Utility of ascitic tumor markers and adenosine deaminase for differential diagnosis of tuberculous peritonitis and peritoneal carcinomatosis
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Li Du, Xiuqi Wei, Zhuanglong Xiao, Hui Wang, and Yuhu Song
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Diagnosis, Differential ,CA-19-9 Antigen ,Adenosine Deaminase ,Gastroenterology ,Biomarkers, Tumor ,Peritonitis, Tuberculous ,Ascitic Fluid ,Humans ,General Medicine ,Peritoneal Neoplasms ,Carcinoembryonic Antigen ,Retrospective Studies - Abstract
Background Differential diagnosis between tuberculous peritonitis and peritoneal carcinomatosis remains challenging in clinical practice; thus, in-patients diagnosed with tuberculous peritonitis or peritoneal carcinomatosis were retrospectively enrolled, and diagnostic values of ascitic tumor markers and adenosine deaminase were determined. Methods Consecutive patients diagnosed with tuberculous peritonitis or peritoneal carcinomatosis were retrospectively enrolled. The pertinent data of 169 patients enrolled were collected. Results A panel of ascitic tumor makers (CEA, CA15-3, CA19-9) had high specificity (96.83%) and accuracy (94.67%) in the differentiation of peritoneal carcinomatosis from tuberculous peritonitis; and ascitic ADA was a good discriminator between these patients, with an accuracy of 91.72%. Combined use of ascitic tumor makers and ADA (ascitic ADA 3.65 ng/mL or CA15-3 > 42.70 U/mL or CA19-9 > 25.10 U/mL) performed high sensitivity (99.06%) and accuracy (94.08%) for the diagnosis of peritoneal carcinomatosis. In addition, combined ascitic ADA and tumor marker (positive ascitic tumor makers and ADA Conclusions Combined use of ascitic tumor markers and adenosine deaminase showed excellent efficiency in the differential diagnosis between tuberculous peritonitis and peritoneal carcinomatosis, thus these two simple and cost‐effective parameters should be determined when tuberculous peritonitis or peritoneal carcinomatosis was suspected in clinic practice.
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- 2022
17. Diagnostic yield and safety of percutaneous CT-guided biopsy of retroperitoneal lesions and analysis of imaging features
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Anil Kumar Singh, Prabhakar Mishra, Anshul Gupta, Zafar Neyaz, Ritu Verma, and Richa Mishra
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Image-Guided Biopsy ,medicine.medical_specialty ,Percutaneous ,Yield (engineering) ,Peritonitis, Tuberculous ,Soft Tissue Neoplasms ,Computed tomography ,030218 nuclear medicine & medical imaging ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Biopsy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Retroperitoneal Neoplasms ,Retroperitoneal Space ,Retrospective Studies ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,General Medicine ,medicine.disease ,CT guided biopsy ,030220 oncology & carcinogenesis ,Tomography ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
Background Computed tomography (CT)-guided biopsy is emerging as a preferred method for obtaining tissue samples from retroperitoneal lesions due to clear visualization of needle and vessels. Purpose To assess diagnostic yield and safety of CT-guided biopsy of retroperitoneal lesions and compare CT findings in different disease categories. Material and Methods This retrospective analytical study included 86 patients with retroperitoneal lesions who underwent CT-guided biopsy from December 2010 to March 2020. All procedures were performed with co-axial technique and multiple cores were obtained and subjected to histopathology. Additional tests like immunohistochemistry or microbiological analysis were done depending on clinical suspicion. Diagnostic yield calculation and comparison of imaging findings was done by one-way ANOVA, chi-square, and Fisher’s exact tests. Results CT-guided biopsy was technically successful in all cases with a diagnostic yield of 91.9%. Minor complications in the form of small hematomas were seen in two patients. Major disease categories on final diagnosis were lymphoma, tuberculosis, and metastases. A variety of malignant and benign soft-tissue neoplasms were also noted less commonly. With help of immunohistochemistry, lymphoma subtype was established in 88.8% of cases. Addition of microbiological tests like the GeneXpert assay helped in the diagnosis of tuberculosis in some cases. A mass-like appearance and vascular encasement was common in metastatic group and lymphoma. Conclusion Percutaneous CT-guided biopsy is a safe method for the sampling of retroperitoneal lesions with high diagnostic yield. Imaging findings are mostly overlapping; however, some features are more common in a particular disease condition.
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- 2021
18. Small-bowel ileus in peritoneal tuberculosis
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Aaron den Toom, Daniel, Engels, Kathrin, and Paulus, Niklas
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Ileus ,Peritonitis, Tuberculous ,Clinical Snapshot ,Humans ,General Medicine - Published
- 2022
19. Diagnosis of abdominal tuberculosis by mini-laparoscopy
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Thomas Theo Brehm, Stefan Schmiedel, and Ansgar W. Lohse
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Microbiology (medical) ,Diagnosis, Differential ,Infectious Diseases ,Peritonitis, Tuberculous ,Humans ,Tuberculosis ,Laparoscopy ,General Medicine - Published
- 2022
20. Peritoneal tuberculosis mimicking peritoneal carcinomatosis in a patient with gallbladder carcinoma
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Imen Ben Ismail, Marwen Sghaier, Saber Rebii, and Ayoub Zoghlami
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Microbiology (medical) ,Diagnosis, Differential ,Infectious Diseases ,Peritonitis, Tuberculous ,Humans ,Gallbladder Neoplasms ,General Medicine ,Peritoneal Neoplasms - Published
- 2022
21. Endoscopic ultrasonography-guided fine-needle aspiration for the diagnosis of retroperitoneal tuberculosis: A case report.
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Xu Z, Liu G, Ying X, and Wang J
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- Female, Humans, Middle Aged, Biopsy, Fine-Needle methods, Endosonography methods, Pancreas pathology, Lymph Nodes pathology, Abdominal Pain pathology, Tuberculosis, Lymph Node pathology, Peritonitis, Tuberculous, Pancreatic Neoplasms pathology
- Abstract
Retroperitoneal tuberculosis is a rare disease that can mimic many conditions and lacks specific clinical manifestations, which makes it difficult to diagnose. As a consequence, it can be misdiagnosed as a malignant tumour. Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) can obtain specimens of the lesion site from areas that might be inaccessible using more traditional biopsy methods. A 60-year-old female patient was admitted with a 3-month history of intermittent upper abdominal pain accompanied by nausea. Imaging found pancreatic uncinate process and retroperitoneal lymph nodes at the horizontal part of the duodenum. EUS-FNA found necrotic matter, multinucleated giant cells and epithelioid cells consistent with the signs of tuberculosis bacilli infection, although typical noncaseous granuloma and Mycobacterium tuberculosis were not observed. Retroperitoneal tuberculosis was considered as the diagnosis. After anti-tubercular therapy, the signs and symptoms quickly improved and a repeat computed tomography scan found that the space-occupying lesion had reduced in size. By using EUS-FNA, the cytological and histopathological findings can be obtained in a timely manner to facilitate an earlier diagnosis and avoid unnecessary procedures such as laparotomy or surgery.
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- 2023
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22. [Clinical Status and Research Progress of Tuberculous Peritonitis]
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Yun-Hua, Zhang and Sheng-Hua, Zhu
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Biopsy ,Peritonitis, Tuberculous ,Ascites ,Humans ,Tuberculosis ,Mycobacterium tuberculosis ,Sensitivity and Specificity - Abstract
Tuberculous peritonitis(TBP)is currently one of the common manifestations of extrapulmonary tuberculosis.Due to the atypical clinical features,diverse types of diseases to be distinguished,and limited detection methods,TBP is difficult to be diagnosed and the fatality caused by delayed diagnosis increases significantly.We studied the current research status of TBP and found that T cells spot test,abdominal CT,and laparoscopic biopsy were of high diagnostic value for TBP.However,the application of ascites Xpert-MTB/RIF-ultra assay,ascites ADA,and whole-body positron emission tomography/computed tomography remained to be studied.Serum CA125 helps to judge the efficacy of anti-tuberculosis treatment.
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- 2022
23. Expression of Adenosine Deaminase and NLRP3 Inflammasome in Tuberculous Peritonitis and Their Relationship with Clinical Efficacy
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Hongwei Su, Guorong Yan, Zijian Li, Lin Fu, and Lingdi Li
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Article Subject ,Adenosine Deaminase ,Inflammasomes ,Biochemistry (medical) ,Clinical Biochemistry ,Peritonitis, Tuberculous ,Ascites ,General Medicine ,Sensitivity and Specificity ,Treatment Outcome ,NLR Family, Pyrin Domain-Containing 3 Protein ,Genetics ,Humans ,Molecular Biology - Abstract
Objective. Tuberculous peritonitis (TP) can cause multiple infections of surrounding organs and tissues, leading to organ failure and endangering life safety. In this research, the relationship between adenosine deaminase (ADA), NLRP3 inflammasome, and TP and its clinical significance will be deeply explored, so as to provide new directions and reliable reference opinions for future clinical diagnosis and treatment. Methods. Altogether, 59 TP patients (research group, RG) and 52 non-TP patients (control group, CG) who were admitted to our hospital from May 2014 to June 2018 were regarded as research objects. Ascites samples of RG before treatment (admission) and one month after treatment and CG before treatment were obtained, and the ADA and NLRP3 levels were tested to evaluate the clinical and prognostic significance of the two in TP. Results. Before treatment, ADA and NLRP3 in RG were higher than CG ( P < 0.05 ), and the sensitivity and specificity of combined detection of the two in predicting TP occurrence were 89.83% and 73.08% ( P < 0.05 ). In addition, ADA and NLRP3 in RG patients were positively correlated with the disappearance time of abdominal pain and ascites ( P < 0.05 ) and had excellent predictive effect on the adverse reactions during treatment ( P < 0.05 ). After treatment, both in RG patients decreased, which was inversely proportional to the clinical efficacy ( P < 0.05 ). Prognostic follow-up manifested that ADA and NLRP3 in relapse patients were higher than those without recurrence after treatment ( P < 0.05 ). Conclusion. The increase of ADA and NLRP3 in TP is relevant to the adverse reactions during treatment, clinical efficacy, and prognosis recurrence after treatment. It can be used as a disease marker to confirm, intervene, and evaluate TP progression promptly.
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- 2022
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24. Clinical features and diagnostic approaches for abdominal tuberculosis: five-year experience from a non-tuberculosis-designated hospital in China
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Jin, Wenting, Ma, Yuyan, Shi, Qingfeng, Zhang, Yao, Yao, Yumeng, Su, Yi, Huang, Yingnan, Miao, Qing, Wang, Qingqing, Wang, Mengran, Li, Bing, Luo, Yu, Cai, Sishi, Li, Na, Bao, Rong, Gao, Xiaodong, Pan, Jue, and Hu, Bijie
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China ,Time Factors ,Tuberculosis, Gastrointestinal ,Abdomen ,Peritonitis, Tuberculous ,Ascites ,Humans ,Tuberculosis, Lymph Node ,Hospitals ,Retrospective Studies - Abstract
abdominal tuberculosis (TB) is a common form of extrapulmonary TB but it is still a diagnostic dilemma in clinical practice. This study aimed to highlight the clinical features and diagnostic approaches for abdominal TB.seventy cases of diagnosed abdominal TB were retrospectively collected between August 1st, 2015 and June 30th, 2020. They were classified as peritoneal TB, lymph node TB, gastrointestinal TB, visceral TB or mixed TB.eighteen patients were diagnosed with peritoneal TB, nine with lymph node TB, five with gastrointestinal TB, two with visceral TB and 36 with mixed TB. More than 65 % of the patients had tuberculosis of other sites except the abdomen. The median diagnosis time was 60 days. Ascites (58.6 %), abdominal distension (48.6 %), weight loss (44.3 %) and fever (42.9 %) were the most common symptoms. The overall microbiological and histological detection rates were 70.0 % and 38.6 %, respectively. The non-ascite samples yielded a higher microbiological confirmation rate (63.6 %) than the total samples (40.8 %). Diagnosis was confirmed histologically in 18 patients (69.2 %). Forty-five cases (64.3 %) were clinically diagnosed. Invasive procedures such as surgery (6/7), percutaneous biopsy (7/7) and endoscopy in lymph node TB (4/5) had high confirmation rates.the diagnosis of abdominal TB should be reached by a combination of clinical, laboratory, radiological, microbiological and pathological findings.
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- 2021
25. Place of Laparoscopy in Peritoneal Tuberculosis
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Fatma Trabelsi, N. Kaabar, Youssef Gharbi, Rabiaa Ben Abdallah, Wafa Maamatou, A. Daib, Y. Hellal, A. Jabloun, and Leila Jarray
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Male ,medicine.medical_specialty ,Tuberculosis ,medicine.diagnostic_test ,business.industry ,Gold standard ,Biological polymorphism ,Peritonitis, Tuberculous ,Ascites ,medicine.disease ,Middle age ,Surgery ,medicine ,Humans ,Female ,Laparoscopy ,medicine.symptom ,Peritoneum ,business ,Child ,Peritoneal tuberculosis ,Histological examination - Abstract
Introduction: Peritoneal tuberculosis (PT) is a rare form of extrapulmonary tuberculosis in children. The diagnosis is difficult because of its clinical polymorphism. Laparoscopy is the gold standard to make the diagnosis by exploring and performing peritoneal biopsies. Our aim was to show the place of laparoscopy in the diagnosis of PT, to compare the anatomopathological results of peritoneal biopsies with a macroscopic appearance to quick start antituberculosis treatment. Case Reports: We reported 4 patients with PT, 3 girls and 1 boy. The middle age was 9 years old. The revealing symptomatology was ascites in all cases. Radiological exploration was not contributing. Laparoscopy was performed for all patients. The exploration revealed an agglutination of the intestinal loops with the presence of whitish micronodules scattered over the entire abdominal cavity. Peritoneal biopsies were done in all cases. Histological examination confirmed the diagnosis of PT in all patients and antituberculosis treatment was introduced. There was a good clinical evolution with a follow-up of 30 months. Conclusion: PT is a public health problem due to its clinical and biological polymorphism. Laparoscopy with peritoneal biopsies remains the essential means for the diagnosis of this pathology in children.
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- 2021
26. Diagnosis of Peritoneal Tuberculosis from Primary Peritoneal Cancer
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I-Hui Chen, Heng-Cheng Hsu, Pao-Ling Torng, Chia-Yi Lee, Kuang-Han Lee, and Wen-Fang Cheng
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medicine.medical_specialty ,Peritoneal cancer ,Fever ,genetic structures ,Health, Toxicology and Mutagenesis ,Peritonitis, Tuberculous ,macromolecular substances ,Gastroenterology ,environment and public health ,Article ,Peritoneal Neoplasm ,White blood cell ,Internal medicine ,Tuberculous peritonitis ,peritoneal neoplasms ,medicine ,Humans ,Retrospective Studies ,symptom assessment ,integumentary system ,business.industry ,Public Health, Environmental and Occupational Health ,Wbc count ,body regions ,tuberculous peritonitis ,medicine.anatomical_structure ,Medicine ,Female ,business ,Peritoneal tuberculosis ,Body mass index ,PULMONARY INFILTRATION ,radiography - Abstract
Peritoneal tuberculosis (PTB) is an uncommon extrapulmonary infection mimickng primary peritoneal cancer (PPC). We retrospectively included 23 women with PTB and 47 women with PPC treated in a medical center to study the clinical and radiological features that differentiate PTB from PPC. Body temperature above 38 °C was a unique feature of PTB (34.7% versus 0%, p <, 0.001). Body Mass Index (BMI) was lower (21.9 ± 3.7 versus 25.2 ± 4.1, p = 0.003), white blood cell (WBC) count was lower (5179.6 ± 1502.2 versus 7716.2 ± 2741.8, p <, 0.001), and CA-125 level was lower (508.0 ± 266.1 versus 2130.1 ± 2367.2 U/mL, p <, 0.001) in PTB compared with PPC. Imaging detected more pulmonary infiltration and consolidation (52.2% versus 6.4%, p <, 0.001), and less omental/mesentery changes (52% versus 83%, p <, 0.001) in PTB compared with PPC. The operated patients received earlier treatment compared to patients without operation (7.9 ± 5.3 days versus 17.2 ± 11.0 days, p = 0.010). In conclusion, fever above 38 °C, lower BMI, lower WBC count, less elevated CA-125 level, and imaging of less omental involvement were features of PTB differentiated from PPC.
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- 2021
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27. Mycobacteria avium-related peritonitis in a patient undergoing peritoneal dialysis: case report and review of the literature
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Ling Wang, Hao Yan, Shan Mou, Zhou Jiang, and Jifang Lu
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medicine.medical_specialty ,Mycobacteria avium ,medicine.medical_treatment ,Peritonitis, Tuberculous ,Peritonitis ,Case Report ,Azithromycin ,Peritoneal dialysis ,Sepsis ,Chylous ascites ,Internal medicine ,Ascites ,medicine ,Peritoneal dialysis-related peritonitis case report ,Humans ,Ethambutol ,Nontuberculous mycobacteria ,biology ,business.industry ,Middle Aged ,biology.organism_classification ,medicine.disease ,Diseases of the genitourinary system. Urology ,Adenosine deaminase ,Nephrology ,Kidney Failure, Chronic ,Female ,RC870-923 ,medicine.symptom ,business ,Peritoneal Dialysis ,medicine.drug ,Mycobacterium avium - Abstract
Background Mycobacteria avium (M. avium) is a species of ubiquitous slowly growing nontuberculous mycobacteria. It causes opportunistic infections. However, M. avium-related peritonitis in peritoneal dialysis (PD) patients is rare. Case presentation A 51-year-old female end-stage kidney disease patient undergoing PD was admitted for a noninfectious complication. She presented catheter exit site drainage and slightly increased PD effluent white cell count (WCC) with polymorphonuclear predominance on admission. Exit site infection and PD-related peritonitis were diagnosed. Repeated cultures of effluent and drainage were negative. Initial empirical antibiotics and further adjustment were not rewarding. PD was terminated 2 weeks later, however, shortly the patient developed stupor, high fever, peritoneal irritation, and spontaneous chylous ascites, and showed elevated ascitic adenosine deaminase (ADA). The manifestations persisted and the patient’s general condition deteriorated despite intensified antibiotic therapy. Massive parallel sequencing identified M. avium in ascites on hospital day 25, and 4-drug treatment with azithromycin, amikacin, rifampin, and ethambutol was initiated. Nevertheless, the patient died from sepsis on hospital day 30. Conclusions We report a case of PD-related M. avium peritonitis. Prolonged culture-negative peritonitis, chylous ascites, and elevated ascitic ADA may hint the possibility of mycobacterial infections. Diagnostic method allowing prompt identification of the pathogen is warranted. The prognosis can be extremely poor, and the prophylaxis and treatment should be better defined.
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- 2021
28. Epidemiology of concurrent extrapulmonary tuberculosis in inpatients with extrapulmonary tuberculosis lesions in China: a large-scale observational multi-centre investigation
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Jianxiong Liu, Yongkang Dong, Xinguo Zhao, Song Yang, Chao Zheng, Qunyi Deng, Junfeng Han, Jian Du, Hongyan Chen, Dawei Chen, Qiang Song, Zaoxian Mei, Mingwu Li, Xiangyang Yao, Xiaofeng Yan, Jinshan Ma, Ertai A, Tong Ren, Yanli Zhang, Lei Tan, Shenjie Tang, Peilan Zong, Shuliang Guo, Qingyao Xie, Xinjie Li, Shengsheng Liu, ng Lia, Mei Yang, Yuanyuan Li, Dan Lei, Quanhong Wang, Yuanyuan Liu, Jian Zhang, Peijun Tang, Zhiyi Yang, Ling Chen, Wenyu Liu, Xiaohong Chen, Wanli Kang, Yan Li, Meiying Wu, Hongwei Liu, Fujian Li, Wei Shu, Kun Yan, Yingrong Du, Jianyong Zhang, Jingmin Qin, Fenglin Liu, Yi Zhang, Wenge Han, Pu Wang, Lei Wu, Xinghua Shen, Jian Zheng, Wenyu Cui, and Yan-mei Feng
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Microbiology (medical) ,Male ,medicine.medical_specialty ,China ,Tuberculosis ,Epidemiology ,Peritonitis, Tuberculous ,Disease ,Infectious and parasitic diseases ,RC109-216 ,Logistic regression ,Tuberculous meningitis ,Internal medicine ,medicine ,Humans ,Extrapulmonary tuberculosis ,Inpatients ,business.industry ,General Medicine ,Tuberculosis, Pleural ,medicine.disease ,Association rule ,Infectious Diseases ,Clinical diagnosis ,Tuberculosis, Meningeal ,Observational study ,Female ,business - Abstract
Aims: A high proportion of all tuberculosis (TB) cases present with extrapulmonary tuberculosis (EPTB), including concurrent EPTB involving more than one extrapulmonary lesion site within the body. However, previous reports only characterised lesions of single-site EPTB cases. This study aimed to investigate epidemiological characteristics and association rules of concurrent EPTB cases in China. Methods: An observational multi-centre study was carried out in China from Jan 2011 to Dec 2017 that included a total of 208,214 patients with EPTB lesions. Multivariable logistic regression analysis was used to identify associations between gender and age with concurrent EPTB. Association rules were analysed for significance using the Apriori algorithm. Results: The most prevalent form of EPTB lesion was tuberculous pleurisy (49.8%), followed by bronchial tuberculosis (14.8%) and tuberculous meningitis (7.6%). The most predominant concurrent EPTB case type was tuberculous pleurisy concurrent with tuberculous peritonitis (1.80%). Altogether 22 association rules were identified that included 20 strong association rules, among which highest confidence rates were found for tuberculous myelitis concurrent with tuberculous meningitis and sacral TB concurrent with lumbar vertebral TB. Moreover, association rules of EPTB concurrent with other EPTB types were found to vary with gender and age. The confidence rate of tuberculous myelitis concurrent with tuberculous meningitis was higher in females (83.67%) than males and highest in patients of ages 25-34 years (87.50%). Conclusions: Many types of concurrent EPTB were found. Thus, greater awareness of concurrent EPTB disease characteristics is needed to ensure timely clinical diagnosis and treatment of this disease.
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- 2021
29. Clinical characteristics and diagnosis of intestinal tuberculosis in clinical practice at Thailand's largest national tertiary referral center: An 11-year retrospective review.
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Sudcharoen A, Ruchikajorndech G, Srisajjakul S, Pongpaibul A, Ngamskulrungroj P, Tulyaprawat O, and Limsrivilai J
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- Humans, Male, Middle Aged, Female, Retrospective Studies, Tertiary Care Centers, Thailand epidemiology, Colonoscopy, Mycobacterium tuberculosis genetics, Tuberculosis, Gastrointestinal pathology, Enteritis, Peritonitis, Tuberculous, Tuberculosis, Lymph Node
- Abstract
Background: Diagnosing intestinal tuberculosis (ITB) is challenging due to the low diagnostic sensitivity of current methods. This study aimed to assess the clinical characteristics and diagnosis of ITB at our tertiary referral center, and to explore improved methods of ITB diagnosis., Methods: This retrospective study included 177 patients diagnosed with ITB at Siriraj Hospital (Bangkok, Thailand) during 2009-2020., Results: The mean age was 49 years, 55.4% were male, and 42.9% were immunocompromised. Most diagnoses (108/177) were made via colonoscopy; 12 patients required more than one colonoscopy. Among those, the sensitivity of tissue acid-fast bacilli (AFB), presence of caseous necrosis, polymerase chain reaction (PCR), and culture was 40.7%, 13.9%, 25.7%, and 53.4%, respectively. Among patients with negative tissue histopathology, 4 (3.7%) and 13 (12.0%) were ITB positive on tissue PCR and culture, respectively. The overall sensitivity when all diagnostic methods were used was 63%. Seventy-six patients had stool tests for mycobacteria. The overall sensitivity of stool tests was 75.0%. However, when analyzing the 31 patients who underwent both endoscopy and stool testing, the sensitivity of stool testing when using tissue biopsy as a reference was 45.8%. Combining stool testing and tissue biopsy did not significantly increase the sensitivity compared to tissue biopsy alone (83.9% vs. 77.4%, respectively)., Conclusion: Despite the availability of PCR and culture for TB, the overall diagnostic sensitivity was found to be low. The sensitivity increased when the tests were used in combination. Repeated colonoscopy may be beneficial. Adding stool mycobacteria tests did not significantly increase the diagnostic yield if endoscopy was performed, but it could be beneficial if endoscopy is unfeasible., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Sudcharoen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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30. A 58-Year-Old Man With Abdominal Ascites
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Vibhu Sharma, Majdi AlNabulsi, and Zeina AlMajthoub
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Peritonitis, Tuberculous ,Ascites ,Middle Aged ,Critical Care and Intensive Care Medicine ,Surgery ,Abdomen ,Humans ,Medicine ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Ultrasonography - Published
- 2021
31. 'Rollover' abdominal paracentesis versus standard technique: protocol of a crossover randomized comparative trial
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Daya Krishna Jha, Aman Sharma, Chandan Krushna Das, Pankaj Gupta, Subhas Chandra Saha, Santhosh Irrinki, Harjeet Singh, Harshal S Mandavdhare, Aashima Arora, Usha Dutta, Vishal Sharma, and Manish Rohilla
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Cancer Research ,medicine.medical_specialty ,Cytodiagnosis ,Peritonitis, Tuberculous ,03 medical and health sciences ,Peritoneal Neoplasm ,0302 clinical medicine ,Ascites ,Paracentesis ,medicine ,Humans ,Laparoscopy ,Child ,Peritoneal Neoplasms ,Randomized Controlled Trials as Topic ,Protocol (science) ,Cross-Over Studies ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Infant ,General Medicine ,Crossover study ,Standard technique ,Surgery ,Clinical trial ,Oncology ,030220 oncology & carcinogenesis ,Child, Preschool ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
The sensitivity of single abdominal paracentesis for diagnosis of peritoneal carcinomatosis in patients with malignant ascites is 40-70%. Tumor cells shed from the peritoneum settle preferentially in certain recesses of the peritoneum. We aim to compare the standard technique of abdominal paracentesis versus a rollover technique in a randomized crossover study to assess the cytological yield in patients suspected to have peritoneal carcinomatosis. Each patient will serve as their own control and the outcome assessor (cytopathologist) will be blinded to the method of paracentesis performed. The primary objective will be to compare the tumor cell positivity between the standard paracentesis group and the rollover group among enrolled patients.Lay abstract Existing methods of diagnosing cancer-related ascites are dependent on microscopic evaluation of fluid obtained from the ascites. However, this may not diagnose all such cases because the fluid may not contain many tumor cells. This may be due to the settling of tumor cells in certain inaccessible locations of the peritoneum (the lining of the abdominal cavity). This trial will look at whether rolling the patient from side to side could be helpful in increasing the chances of finding tumor cells in the ascites.
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- 2021
32. The negative impact of increasing age and underlying cirrhosis on the sensitivity of adenosine deaminase in the diagnosis of tuberculous peritonitis: a cross-sectional study in eastern China
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Lei Jin, Jian Yang, Huatang Zhang, Jun Gu, Jian Sun, Dan Ye, Jianghua Yang, Xueping Yu, and Zhiwei Song
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Microbiology (medical) ,Adult ,Liver Cirrhosis ,medicine.medical_specialty ,China ,Cirrhosis ,Cross-sectional study ,diagnosis ,Adenosine Deaminase ,Population ,Peritonitis, Tuberculous ,Infectious and parasitic diseases ,RC109-216 ,Sensitivity and Specificity ,Adenosine deaminase ,Internal medicine ,Tuberculous peritonitis ,Medicine ,Humans ,education ,education.field_of_study ,biology ,business.industry ,Eastern china ,General Medicine ,Middle Aged ,medicine.disease ,tuberculous peritonitis ,enzymes and coenzymes (carbohydrates) ,Infectious Diseases ,Cross-Sectional Studies ,Ageing ,ageing ,Cohort ,biology.protein ,business - Abstract
Background: Our study aimed to evaluate the correlation between the sensitivity of adenosine deaminase (ADA) testing for the diagnosis of tuberculous peritonitis (TBP) and patient age or cirrhosis status. Methods: Clinical data for patients clinically diagnosed with TPB (n = 132) or not (n = 147) were assessed. ADA activity was compared among three age groups (< 45 yr, 45–60 yr, and ≥ 60 yr) and among cirrhosis-related subgroups. Cut-off values for the ADA test were analyzed among three patient populations (young non-cirrhotic, n = 97; older non-cirrhotic, n = 115; cirrhotic, n = 67), and validated in a cohort of 259 participants. Results: According to the multivariate regression analyses, age < 45 yr is highly predictive of TBP risk. The young non-cirrhotic TBP patients had higher ADA activity than the middle-aged or old controls (p < 0.01). Significantly decreased activity and efficacy of ADA were observed in the cirrhotic subgroup/population, regardless of age or cohort. For the above-mentioned two non-cirrhotic populations in the validation cohort, the ADA test showed excellent performance using thresholds of 30.5 IU/L and 20.5 IU/L, with respective sensitivities of 91.1% and 92.6%. Conclusions: ADA activity is negatively associated with increasing age and underlying cirrhosis. Optimizing cut-off values for the ADA test can increase its sensitivity in non-cirrhotic individuals older than 45 years.
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- 2021
33. <scp>Tuberculosis</scp> or not <scp>tuberculosis</scp> : a case of disseminated peritoneal tuberculosis, without pulmonary involvement masking as carcinomatosis
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Julian C. Y. Ip and Lucy P. Aitchison
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medicine.medical_specialty ,Tuberculosis ,business.industry ,Carcinoma ,Peritonitis, Tuberculous ,General Medicine ,medicine.disease ,Dermatology ,Masking (Electronic Health Record) ,medicine ,Humans ,Surgery ,Peritoneum ,business ,Peritoneal tuberculosis ,Peritoneal Neoplasms - Published
- 2020
34. Inflammatory bowel disease and mycobacteria: how much can we trust isoniazid prophylaxis during antitumor necrosis factor therapy?
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Kaya Koksalan, Ozlem Mutluay Soyer, Raim Iliaz, Metin Keskin, Mine Gulluoglu, Asli Ormeci, Bilger Cavus, Cetin Karaca, Sabahattin Kaymakoglu, Kadir Demir, Filiz Akyuz, Semen Onder, Tulin Cagatay, Fatih Besisik, and Sami Evirgen
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Adult ,Male ,medicine.medical_specialty ,Tuberculosis ,Necrosis ,Antitubercular Agents ,Peritonitis, Tuberculous ,Chemoprevention ,Inflammatory bowel disease ,Mycobacterium ,03 medical and health sciences ,0302 clinical medicine ,Latent Tuberculosis ,Internal medicine ,Active tb ,Isoniazid ,medicine ,Humans ,Aged ,Retrospective Studies ,Hepatology ,Tuberculin Test ,business.industry ,Medical record ,Gastroenterology ,Retrospective cohort study ,Mycobacterium tuberculosis ,Tuberculosis, Pleural ,Inflammatory Bowel Diseases ,bacterial infections and mycoses ,medicine.disease ,Mycobacterium bovis ,030220 oncology & carcinogenesis ,Chemoprophylaxis ,Female ,Tumor Necrosis Factor Inhibitors ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Interferon-gamma Release Tests ,medicine.drug - Abstract
OBJECTIVES Isoniazid (INH) prophylaxis is recommended for the prevention of tuberculosis (TB) reactivation before or/and during initiation of treatment with tumour necrosis factor antagonists (anti-TNF agents). Nonetheless, the long-term effectiveness of chemoprophylaxis is not clear. In this study, we aimed to evaluate the characteristics of patients who developed TB reactivation in spite of INH prophylaxis associated with anti-TNF treatment. PATIENTS AND METHODS In this retrospective study, medical records of 1263 patients with inflammatory bowel disease were reviewed. Baseline TB screening tests (purified protein derivative test and/or QuantiFERON-TB Gold test) were performed on all patients before initiation of anti-TNF therapy. Patients with purified protein derivative of more than 5 mm and/or a positive result of the QuantiFERON-TB Gold test received INH prophylaxis for 9 months. We analysed the data of patients diagnosed with TB reactivation during the anti-TNF treatment despite INH chemoprophylaxis. RESULTS Overall, 175 patients underwent anti-TNF treatment. Sixty of these 175 patients had pretreatment testing showing latent TB infection and therefore were treated concomitantly with INH for 9 months in addition to their anti-TNF treatment. TB reactivation occurred in four of these 60 co-INH/anti-TNF treated patients. Active TB was diagnosed after 37.5±27 (range: 18-84) months of anti-TNF treatment. In two of the four patients that active TB was diagnosed, was also detected other Mycobacterium spp.: M. bovis in one patient and M. genavense in the other one. CONCLUSION INH chemoprophylaxis may not prevent the reactivation of TB during anti-TNF therapy in the long-term. Patients should be carefully and periodically screened for TB reactivation during anti-TNF therapy.
- Published
- 2019
35. Transvaginal natural orifice transluminal endoscopic surgery in the diagnosis of ascites of unknown origin
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Shuling Li, Wen Li, Zikai Wang, Enfeng Zhao, and Li Zhao
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Adult ,Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,Biopsy ,Operative Time ,Peritonitis, Tuberculous ,Peritonitis ,Abdominal cavity ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Pneumoperitoneum ,Peritoneoscopy ,Ascites ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Vaginitis ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Surgery ,Clinical trial ,Dyspareunia ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Vagina ,Feasibility Studies ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Gastroscopes - Abstract
Background and Aims Natural orifice transluminal endoscopic surgery (NOTES) has been established in animal models and human studies, but few clinical studies have investigated transvaginal NOTES in the diagnosis of unexplained refractory ascites. We aimed to assess the feasibility, efficacy, and safety of transvaginal NOTES for the diagnosis of unexplained ascites in female patients. Methods A prospective study was done involving 3 female patients with unexplained ascites. After general anesthesia and disinfection, a 1.0-cm incision was made in the posterior fornix of the vagina. A gastroscope was inserted into the abdominal cavity through the transvaginal incision and an artificial pneumoperitoneum was created; NOTES peritoneoscopy was performed to scrutinize the pathologic changes. Endoscopic biopsy specimens were obtained for pathologic examination. The transvaginal incision was closed by direct suturing. Results Transvaginal NOTES for diagnostic peritoneoscopy was successfully performed in 3 patients. The mean operative time was 61 minutes. The estimated blood loss was 5 to 10 mL. The pathologic diagnoses were tuberculosis for all patients, and the symptoms and ascites disappeared after antituberculosis therapy. During the 4-year follow-up, no clinically significant adverse events occurred in any patient after NOTES. No patient experienced an annex inflammation, vaginitis, dyspareunia, or sexual dysfunction. All patients were comfortable and satisfied with the nonscarring surgical procedure. Conclusions Transvaginal NOTES for the diagnosis of unexplained ascites is feasible, effective, and safe. This method had no long-term effect on female sexual function and is particularly suitable for women who have special aesthetic requirements. (Clinical trial registration number: ChiCTR-TRC-10001053.)
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- 2019
36. Common and uncommon imaging features of abdominal tuberculosis
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Usha Dutta, Suresh Kumar, Rakesh Kochhar, Narender Dhaka, Pankaj Gupta, Vishal Sharma, Saroj K. Sinha, and Harshal S Mandavdhare
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medicine.medical_specialty ,Tuberculosis ,Population ,Peritonitis, Tuberculous ,Tuberculosis, Splenic ,Tuberculosis, Lymph Node ,Abdominal tuberculosis ,Medical care ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Tuberculosis, Hepatic ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Intensive care medicine ,education ,Organ system ,education.field_of_study ,Genitourinary system ,business.industry ,Incidence (epidemiology) ,medicine.disease ,medicine.anatomical_structure ,Tuberculosis, Gastrointestinal ,Oncology ,030220 oncology & carcinogenesis ,Abdomen ,business - Abstract
Despite the advances in the medical care, tuberculosis (TB) still remains an important health problem. This is particularly relevant to the developing countries as well as the immunocompromised population in the developed world. Multidrug resistance poses another challenge and may be responsible for increasing incidence of TB, to some extent. The respiratory system is the most commonly involved, although any organ system may be affected. Abdominal involvement occurs in 11-12% of the patients with extrapulmonary TB. The clinical features of abdominal TB are nonspecific. Imaging plays an important role in the diagnosis of abdominal TB. Although a few imaging features strongly favour the possibility of TB, abdominal TB is a greater masquerader. In this review, we highlight the entire spectrum of the manifestations of abdominal tuberculosis (excluding the genitourinary involvement) with an emphasis on imaging findings.
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- 2019
37. Mycobacterial Infections in Patients With Chronic Kidney Disease and Kidney Transplantation
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Lizbeth J. Cahuayme-Zuniga and Karen B. Brust
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medicine.medical_specialty ,medicine.medical_treatment ,Antitubercular Agents ,Peritonitis, Tuberculous ,030232 urology & nephrology ,Mycobacterium Infections, Nontuberculous ,Tuberculosis, Lymph Node ,030204 cardiovascular system & hematology ,Peritoneal dialysis ,Mycobacterium tuberculosis ,03 medical and health sciences ,0302 clinical medicine ,Latent Tuberculosis ,Renal Dialysis ,Internal medicine ,medicine ,Humans ,Tuberculosis ,Renal Insufficiency, Chronic ,Kidney transplantation ,biology ,business.industry ,Retrospective cohort study ,medicine.disease ,biology.organism_classification ,Kidney Transplantation ,Nephrology ,Infectious disease (medical specialty) ,Kidney Failure, Chronic ,Nontuberculous mycobacteria ,Hemodialysis ,business ,Peritoneal Dialysis ,Interferon-gamma Release Tests ,Kidney disease - Abstract
Patients with chronic kidney disease have impaired immunity that increases their risk of infection. Increased incidence of mycobacterial infections, in particular Mycobacterium tuberculosis, is described in patients undergoing hemodialysis and peritoneal dialysis as well as after kidney transplantation in low-prevalence and high-prevalence settings. Diagnosis of this infection can be challenging because of atypical presentations that may lead to treatment delay and, consequently, increased mortality; however, recent advances in molecular testing have improved diagnostic accuracy. It is imperative to try to identify those patients at increased risk and offer adequate prophylaxis. There are controversies and insufficient data regarding treatment agents, duration, and dosages. Most studies in nontuberculous mycobacteria are based on case series and retrospective studies.
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- 2019
38. Concurrent ascending colon adenocarcinoma and ileocecal tuberculosis
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Sun Min, Park, Ji Hoon, Kim, Yosep, Chong, and Won-Kyung, Kang
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Male ,Colon, Ascending ,Tuberculosis, Gastrointestinal ,Colonic Neoplasms ,Peritonitis, Tuberculous ,Humans ,General Medicine ,Adenocarcinoma ,Middle Aged ,Tuberculosis, Lymph Node ,Enteritis - Abstract
Few cases have been reported of the coexistence of tuberculosis and adenocarcinoma of the large bowel. We report a rare case of concurrent ascending colon adenocarcinoma and ileocecal tuberculosis, which were nearly indistinguishable from one another.A 59-year-old man visited our clinic with dizziness and anorexia.Computed tomography revealed a mass in the ascending colon with ill-defined nodules in the liver. A colon biopsy showed adenocarcinoma with multinucleated giant cells. The liver nodules were confirmed to be metastatic adenocarcinomas.Ant tuberculosis medications were administered prior to surgery. Two weeks later, a laparoscopic right hemicolectomy and radiofrequency ablation of the liver were performed.The final pathology confirmed adenocarcinoma with chronic granulomatous inflammation and giant cells.In this patient, the cancer was in an advanced stage and had no history of tuberculosis infection. Thus, in this case, the malignancy seemed to create the proper environment for either reactivation of a latent tuberculosis infection or, less likely, for the acquisition of a primary mycobacterial infection. In conclusion, clinicians should be aware of the possibility of concurrent colon adenocarcinoma and intestinal tuberculosis.
- Published
- 2022
39. A challenging case of tuberculous peritonitis
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Petru Muntean and Andrada Mateutiu
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Pulmonary and Respiratory Medicine ,Peritonitis, Tuberculous ,Humans ,Mycobacterium tuberculosis ,Peritoneum - Abstract
A 24-year-old female was admitted to the hospital for recurring irregularities of menstruation and a nine day history of abdominal tenderness [...]
- Published
- 2021
40. Characterizing omental PET/CT findings for differentiating tuberculous peritonitis from peritoneal carcinomatosis
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Xu Dongdong, Duan Hongli, Lu Rencai, Wang Siyu, Shao-Bo Wang, and Ran Xie
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medicine.medical_specialty ,Urology ,Peritonitis, Tuberculous ,Gastroenterology ,Peritoneal Neoplasm ,Fluorodeoxyglucose F18 ,Internal medicine ,Positron Emission Tomography Computed Tomography ,Tuberculous peritonitis ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Peritoneal Neoplasms ,Retrospective Studies ,Lesser omentum ,PET-CT ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Hepatology ,Peritoneal carcinomatosis ,medicine.anatomical_structure ,Positron emission tomography ,Positron-Emission Tomography ,Contracture ,medicine.symptom ,Radiopharmaceuticals ,business ,Tomography, X-Ray Computed ,Omentum - Abstract
To characterize and investigate PET/CT findings in the omentum in the differentiation of tuberculous peritonitis (TBP) and peritoneal carcinoma (PC).Thirty-nine patients with TBP and 113 patients with PC who underwent PET/CT were retrospectively enrolled. The omental uptake intensity, distribution characteristics, contracture, size and boundary of soft-tissue lesions, and CT patterns were reviewed.Absent and focal FDG uptake in the lesser omentum was more common in the PC patients (P = 0.034 and P = 0.017, respectively), and diffuse FDG uptake in the lesser omentum was more common in the TBP patients (P 0.001). An apron-like pattern in the greater omentum commonly occurred in the TBP patients (P = 0.004). Micronodules ( 5 mm) were more common in the TBP patients (P 0.001), and masses ( 3 cm) were more common in the PC patients (P = 0.001). Smudged and nodular patterns occurred more frequently in the TBP patients than in the PC patients (P 0.001 and P = 0.003, respectively), and the caked pattern occurred more frequently in the PC patients (P 0.001). There was no significant difference in the FDG uptake intensity and the boundary of soft-tissue lesions between the TBP and PC patients (P = 0.191 and P = 0.061, respectively).Diffuse FDG uptake, an apron-like pattern, micronodules, and a smudged and nodular pattern might be significant differential features of TBP. Absent and/or focal FDG uptake, mass, and a caked pattern might be significant differential features of PC.
- Published
- 2021
41. Fever, abdominal pain, and lymphocytic ascites in a young immigrant from western Africa
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A, Faraone, D, Tomasi, F, Bartalesi, and A, Fortini
- Subjects
Adult ,Male ,Fever ,Italy ,Burkina Faso ,Peritonitis, Tuberculous ,Ascites ,Emigrants and Immigrants ,Humans ,Tomography, X-Ray Computed ,Abdominal Pain - Abstract
Tuberculous peritonitis is an uncommon disease in countries with low tuberculosis (TB) incidence, most often affecting non-white race, foreign-born individuals. We describe a case of TB with peritoneal involvement in a 32-year-old man immigrated to Italy from Burkina Faso, who presented with a history of fever, malaise, abdominal pain and abdominal swelling. Due to its nonspecific clinical presentation and paucibacillary nature, diagnosis of tuberculous peritonitis can be challenging, and requires a high index of suspicion. This report highlights the diagnostic challenges posed by tuberculous peritonitis and emphasizes the importance of imaging (computed tomography, CT) in identifying typical findings, and the value of histological examination of tissue specimens from peritoneum or any site of suspected TB as a tool for diagnosis confirmation.
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- 2020
42. Diagnostic accuracy of computed tomography in differentiating peritoneal tuberculosis from peritoneal carcinomatosis
- Author
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Amir H. Sohail, Muhammad S. Khan, Abin Sajan, Caroline Elizabeth Williams, Leo Amodu, Hazim Hakmi, Yousaf Bashir Hadi, Sameeha Ismail, Sachal Sohail, and Muhammad N. Ahmad
- Subjects
Adult ,Diagnosis, Differential ,Male ,Peritonitis, Tuberculous ,Humans ,Radiology, Nuclear Medicine and imaging ,Female ,Middle Aged ,Tomography, X-Ray Computed ,Omentum ,Peritoneal Neoplasms ,Retrospective Studies - Abstract
Peritoneal tuberculosis is difficult to diagnose as it may mimic peritoneal carcinomatosis, which has similar symptomatology. We sought to determine the diagnostic accuracy of computed tomography in differentiating peritoneal tuberculosis versus peritoneal carcinomatosis.The associations of radiological findings in 124 patients with peritoneal carcinomatosis (n = 55) or tuberculosis (n = 69) were determined using Chi-square test. Sensitivity, specificity, positive and negative predictive value, and total diagnostic accuracy of CT imaging, with histopathology as gold standard, was determined. Subgroup analyses to determine these parameters by age (40 years and ≤40 years) and gender (male and female) were performed.Mean age of study population was 44.1 ± 13.2 years with 61 males (49.2%) and 63 females (50.8%). The most common radiological abnormality in both peritoneal carcinomatosis (90.9%) and peritoneal tuberculosis (89.9%) was omental smudging, followed by presence of extraperitoneal mass (81.8%) in carcinomatosis and presence of micro-nodules in tuberculosis (88.4%). The findings significantly different in both the carcinomatosis and tuberculosis groups were high-density ascites, splenic calcification, splenomegaly, lymph node calcifications, micro-nodules, and macro-nodules. The diagnostic accuracy of CT in differentiating peritoneal tuberculosis from peritoneal carcinomatosis was 83.8%; sensitivity and specificity for peritoneal tuberculosis were 88.4% and 78.2%, respectively.The diagnostic accuracy of CT in differentiating peritoneal tuberculosis from peritoneal carcinomatosis revealed an overall diagnostic accuracy of 83.8%. Subgroup analysis revealed that CT may be a more specific diagnostic tool to predict peritoneal tuberculosis in female patients and in those over 40 years old.
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- 2020
43. Thinking Outside the Lungs: A Case of Disseminated Abdominal Tuberculosis
- Author
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Samantha Snyder, Binita Bhandari, and John Goldman
- Subjects
medicine.medical_specialty ,Abdominal pain ,Tuberculosis ,Pleural effusion ,Constitutional symptoms ,Antitubercular Agents ,Peritonitis, Tuberculous ,Peritonitis ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Isoniazid ,Humans ,Lung ,Ethambutol ,business.industry ,General Medicine ,Articles ,Mycobacterium tuberculosis ,Pyrazinamide ,Middle Aged ,medicine.disease ,Pneumonia ,Tuberculosis, Gastrointestinal ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,Rifampin ,business ,medicine.drug - Abstract
Patient: Female, 47-year-old Final Diagnosis: Intraperitoneal tuberculosis Symptoms: Abdominal pain • decreased appetite Medication: — Clinical Procedure: — Specialty: Infectious Diseases • Medicine, General and Internal Objective: Unusual clinical course Background: Extrapulmonary tuberculosis (TB) occurs in up to one-fifth of all cases of TB, with abdominal TB accounting for 5% of all cases. It is an uncommon diagnosis in the Western world, where it is primarily identified in immigrant and immunocompromised populations. Case Report: We review a case in which a 47-year-old Nepalese woman with a history of cognitive dysfunction secondary to epilepsy presented with decreased appetite and diffuse abdominal pain. She was hypoxic and febrile on initial exam, and imaging indicated lung consolidation, right-sided pleural effusion, and thickening and nodularity of the omentum with patchy wall thickening of the colon. After failing to improve on a standard antibiotic regimen for treatment of pneumonia and colitis, the differential was broadened to include TB. Interferon-γ release assay was subsequently found to be positive, and omental and peritoneal biopsies were obtained. The patient was started on an empiric course of rifampin, isoniazid, ethambutol, pyrazinamide, and pyridoxine. Laboratory testing revealed no immunochemical evidence of Mycobacterium species, however, Ziehl-Neelsen acid-fast stain was positive with rare acid-fast bacilli identified. Conclusions: Peritoneal TB carries significant morbidity and mortality if undiagnosed or untreated. Diagnosis is challenging in the absence of a single test that can confirm or exclude this condition. In combination with clinical suspicion, it is crucial to explore history regarding socio-epidemiology (travel, incarceration, occupation, homelessness, sick contacts) and immunological risk (drug use, chemotherapy) in patients with constitutional symptoms.
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- 2020
44. Distinguishing peritoneal tuberculosis from peritoneal carcinomatosis: a challenge
- Author
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Joshua Lansom, Nayef A. Alzahrani, David L. Morris, and Abbas El-Hajj Hussein
- Subjects
medicine.medical_specialty ,business.industry ,Carcinoma ,Peritonitis, Tuberculous ,General Medicine ,Gastroenterology ,Peritoneal carcinomatosis ,Internal medicine ,medicine ,Humans ,Surgery ,business ,Peritoneal tuberculosis ,Peritoneal Neoplasms - Published
- 2020
45. Intestinal Tuberculosis
- Author
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Luis F, Oñate-Ocaña and Lizeth, Pérez-Díaz
- Subjects
Tuberculosis, Gastrointestinal ,Peritonitis, Tuberculous ,Humans ,General Medicine ,Tuberculosis, Lymph Node - Published
- 2022
46. Value of gamma interferon enzyme-linked immunospot assay in the diagnosis of peritoneal dialysis-associated tuberculous peritonitis
- Author
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Xiaoyan Huang, Zuying Xiong, Yi'nan Sun, Qiuxia Fan, Zibo Xiong, and Jieyun Zhang
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Enzyme-Linked Immunospot Assay ,Tuberculosis ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Peritonitis, Tuberculous ,Peritonitis ,Gastroenterology ,Peripheral blood mononuclear cell ,Sensitivity and Specificity ,Peritoneal dialysis ,Mycobacterium tuberculosis ,03 medical and health sciences ,Interferon-gamma ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,biology ,business.industry ,ELISPOT ,Peritoneal fluid ,Continuous ambulatory peritoneal dialysis ,medicine.disease ,biology.organism_classification ,030104 developmental biology ,Nephrology ,Leukocytes, Mononuclear ,business ,Peritoneal Dialysis - Abstract
Background Tuberculous peritonitis is the most common form of extrapulmonary tuberculosis infection in peritoneal dialysis patients. However, diagnosing tuberculous peritonitis quickly and early has always been a challenge for nephrologists. Mycobacterium tuberculosis antigen-specific gamma interferon enzyme-linked immunospot (IFN-γ ELISPOT) assay has been widely used in the clinical diagnosis of tuberculous pleurisy and peritonitis, but its use has not been reported for uremia. Methods This study mainly verified the feasibility of using the M. tuberculosis antigen-specific IFN-γ ELISPOT assay in the diagnosis of continuous ambulatory peritoneal dialysis (CAPD) patients with tuberculous peritonitis. Taking M. tuberculosis culture as the gold standard, the IFN-γ ELISPOT assay was used to analyze peripheral blood and peritoneal dialysis fluid of patients, and the receiver operating characteristic (ROC) curves in patients with tuberculous peritonitis (TBP) or non-tuberculous peritonitis (NTBP) were analyzed. Results The area under the receiver operating characteristic curve (AUC) was 0.927 (95% CI 0.816–1.000, P = 0.001) for the ELISPOT assay with peritoneal fluid mononuclear cells (PFMC), which was higher than that for the ELISPOT assay with peripheral blood mononuclear cells (PBMC) (0.825, 95% CI 0.6490–1.000, P = 0.011). The cutoff value for the diagnosis of TBP was 40 spot-forming cells (SFCs)/2 × 105 for the ELISPOT with PBMC, with a sensitivity of 55.6%, a specificity of 92.3%, and a diagnostic efficiency of 77.3%. The cutoff value for the diagnosis of TBP was 100 SFCs/2 × 105 for the ELISPOT on PFMC, with a sensitivity, specificity, and diagnostic efficiency 77.8%, 84.6%, and 81.8%, respectively. Parallel and serial testing algorithms appeared more accurate than single ELISPOT assays with PBMC, but ELISPOT assays with PFMC. Conclusions The IFN-γ release test can be used for the early diagnosis of CAPD-related TBP; compared with peripheral blood, peritoneal fluid may be a more effective and accurate medium to diagnose CAPD complicated with tuberculous peritonitis.
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- 2020
47. Diagnostic accuracy of the Xpert MTB/RIF assay for abdominal tuberculosis: a systematic review and meta-analysis
- Author
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Shubhra Mishra, Harshal S Mandavdhare, Hariom Soni, Saurabh Dawra, Harjeet Singh, Usha Dutta, Vishal Sharma, and Praveen Kumar-M
- Subjects
0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Tuberculosis ,030106 microbiology ,Peritonitis, Tuberculous ,Diagnostic accuracy ,INTESTINAL TUBERCULOSIS ,Microbiology ,Abdominal tuberculosis ,Gastroenterology ,Polymerase Chain Reaction ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Virology ,Internal medicine ,Ascites ,medicine ,Humans ,030212 general & internal medicine ,Crohn's disease ,business.industry ,bacterial infections and mycoses ,medicine.disease ,Infectious Diseases ,Tuberculosis, Gastrointestinal ,Meta-analysis ,Diagnostic odds ratio ,medicine.symptom ,business ,Nucleic Acid Amplification Techniques - Abstract
BACKGROUND We performed a meta-analysis to determine diagnostic accuracy of Xpert MTB/RIF for diagnosis of abdominal (intestinal or peritoneal) tuberculosis (TB) in various tissues (intestinal, omental/peritoneal tissue or ascitic fluid). METHODS Electronic databases were searched for observational studies on use of Xpert MTB/RIF in ascitic fluid, peritoneal, or omental tissue for diagnosis of peritoneal and intestinal TB. We calculated the pooled sensitivity, specificity and diagnostic odds ratio of Xpert MTB/RIF for diagnosis of peritoneal TB in comparison to composite reference standard (CRS) and culture, and in comparison to CRS for intestinal TB. RESULTS Twenty-five observational studies were included. The pooled sensitivity and specificity as assessed with peritoneal culture from ascites as an Index test was 64% (95% Confidence Interval [C.I.] 49-76%) and 97% (95% C.I., 95-99%) respectively and with peritoneal CRS was 30% (95% C.I., 22-40%) and 100% (95% C.I., 98-100%) respectively. In the intestinal group, the pooled sensitivity and specificity of Xpert MTB/RIF was 23% (95% C.I., 16-32%) and 100% (95% C.I., 52-100%). The AUC of peritoneal culture and intestinal tissue was 0.935 and 0.499. CONCLUSION Xpert MTB/RIF has modest sensitivity for diagnosis of peritoneal and intestinal tuberculosis but has a good specificity. PROSPERO REGISTRATION CRD42020140545.
- Published
- 2020
48. Abdominal Tuberculosis in Children: Is It Really Uncommon?
- Author
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R, Alam, A B, Karim, and M, Rukunuzzaman
- Subjects
Fever ,Tuberculosis, Gastrointestinal ,Abdomen ,Peritonitis, Tuberculous ,Humans ,Child ,Abdominal Pain - Abstract
Now a day's tuberculosis has become a global emergency especially in children and abdomen is the sixth commonest extra-pulmonary site of involvement. Diagnosis of abdominal tuberculosis (TB) in children is still challenging. Non specific constitutional symptoms and long lasting abdominal manifestations cause unnecessary delay in diagnosis in children. Abdominal TB can be of various types like peritoneal TB, gastrointestinal TB, tubercular lymphadenopathy and visceral TB. Diagnosis can be confirmed by histopathology, culture or PCR and imaging technique also play an important role in diagnosis. Morbidity and mortality can be reduced in significant number by early recognition and effective aggressive treatment. In TB endemic areas, it could be strongly considered in children with vague complaints like chronic abdominal pain, low grade fever and weight loss. Response to anti-tubercular therapy may indirectly help the physicians to come to a diagnosis.
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- 2020
49. [Tuberculous abdominal cocoon as a rare variant of peritonitis]
- Author
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D V, Plotkin, M N, Reshetnikov, S V, Kharitonov, I A, Sokolina, A A, Pryadkin, and M, V Sinitsyn
- Subjects
Acute Disease ,Peritonitis, Tuberculous ,Humans ,Tissue Adhesions ,Peritoneum ,Fibrosis ,Intestinal Obstruction - Abstract
To study and systematize clinical symptoms of tuberculous perivisceritis, to clarify diagnostic value of laboratory and instrumental survey in these patients and to identify the features of surgical treatment.There were 8 patients with tuberculous perivisceritis. Examination included computed tomography of the abdominal cavity and chest, ultrasound, laparoscopy. All patients underwent surgical treatment with histological, cytological, microbiological and molecular genetic analysis of peritoneal exudate and biopsy of peritoneal specimens.Clinical picture of tuberculous perivisceritis is variable and non-specific. Periods of exacerbation are replaced by periods of prolonged remission. The complex of radiological survey used in verification of perivisceritis does not allow accurate determining the nature of disease. However, peritoneal tuberculosis may be suspected as a rule considering signs of thickening of the peritoneum. Objective confirmation of perivisceritis is possible only during surgical intervention. In this case, etiological factor can be established only after a thorough histological examination of resected fibrous capsule.Clinical picture of tuberculous perivisceritis does not have specific symptoms. The disease is characterized by prolonged and undulating course. Acute peritonitis and acute intestinal obstruction may be suspected during exacerbation of the pathological process. Laparotomy followed by complete excision of fibrous capsule and adhesiolysis is preferred.Изучение и систематизация клинической симптоматики туберкулезного перивисцерита, уточнение диагностической ценности использованных у данной категории больных лабораторных и инструментальных методов исследования и выявление особенностей оказания им оперативных пособий.Проанализированы результаты диагностики и лечения 8 пациентов с осумковывающим туберкулезным перивисцеритом. В комплекс обследования вошли КТ органов брюшной полости и грудной клетки, УЗИ, видеолапароскопия. Всем больным выполнено оперативное лечение с гистологическим, цитологическим, микробиологическим и молекулярно-генетическим анализом перитонеального экссудата и биоптатов брюшины.Клиническая картина туберкулезного перивисцерита вариабельна и неспецифична. Периоды обострения заболевания сменяются периодами длительной ремиссии. Используемый в верификации перивисцерита комплекс лучевых методов диагностики не может дать точного ответа о характере патологического процесса, но, как правило, позволяет заподозрить туберкулез брюшины при наличии признаков ее утолщения и слоистости. Объективно подтвердить диагноз перивисцерита удается только при проведении хирургического вмешательства. При этом этиологический фактор патологического процесса можно установить только после тщательного гистологического исследования удаленной фиброзной капсулы.В клинической картине туберкулезного перивисцерита нет специфических симптомов, заболевание имеет длительный и волнообразный характер и при обострении может соответствовать как острому распространенному перитониту, так и острой кишечной непроходимости. Операцией выбора является лапаротомия с полным иссечением фиброзной капсулы и адгезиолизисом.
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- 2020
50. Hospitalizations for tuberculous peritonitis in the United States: Results from the national inpatient sample database from 2002 to 2014
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Duncan Vos, Eric M. Sieloff, Neiberg de Alcantara Lima, Harry Boamah, Thomas Melgar, and Adam Ladzinski
- Subjects
Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,Abdominal pain ,Cirrhosis ,Tuberculosis ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,lcsh:QR1-502 ,Peritonitis, Tuberculous ,Peritonitis ,lcsh:Microbiology ,Peritoneal dialysis ,Interquartile range ,Risk Factors ,Internal medicine ,Epidemiology ,Ethnicity ,Prevalence ,Medicine ,Humans ,peritonitis ,Inpatients ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,United States ,Hospitalization ,Infectious Diseases ,tuberculosis ,epidemiology ,Female ,medicine.symptom ,business - Abstract
Background: Tuberculosis (TB) is an uncommon disease in the Western hemisphere that can present with peritoneal involvement, as tuberculous peritonitis(TBP) causing abdominal pain and fever. The healthcare and economic burden of TBP in the United States remains unknown. Methods: The National Inpatient Sample database was utilized to investigate TBP hospitalizations from 2002 to 2014. Economic expenditures, patient and hospital demographics, and associations of certain comorbidities with TBP were analyzed. Results: A total of 5878 hospitalizations for TBP occurred over the 12-year duration, with $420 million in-hospital charges. The median patient age was 45 years (interquartile range: 31.1–61.7), with the majority being Hispanic (27.15%). Hospitalizations occurred primarily in the Western (31.3%) and Southern (31.7%) United States. Patient comorbidities and the respective odds ratio associated with TBP included HIV (33.56), continuous peritoneal dialysis (10.49), malnutrition (7.38), liver cirrhosis (6.87), and liver cirrhosis sequelae (6.91). Nearly 6.37% of TBP hospitalizations also had active pulmonary TB. Conclusion: Although TBP is uncommon in the United States, it should be considered in patients presenting with abdominal pain and fever and a history of HIV, continuous peritoneal dialysis, malnutrition, liver cirrhosis, or liver cirrhosis sequelae.
- Published
- 2020
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