Revista Médica del Hospital General de México (Apr 2015)

Peritoneal tuberculosis: A persistent diagnostic dilemma, use complete diagnostic methods

  • L. Salgado Flores,
  • A. Hernández Solís,
  • A. Escobar Gutiérrez,
  • L. Criales Cortés José,
  • I. Cortés Ortiz,
  • H. González González,
  • E. Luis Martínez,
  • R. Cicero Sabido

DOI
https://doi.org/10.1016/j.hgmx.2015.03.009
Journal volume & issue
Vol. 78, no. 2
pp. 55 – 61

Abstract

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Introduction: Tuberculosis (TB) is a global public health issue. Peritoneal tuberculosis amounts to 2% of all the extrapulmonary forms. It has a difficult clinical and bacterial diagnosis. Objective: To establish the usefulness of different methods for the diagnosis of peritoneal TB in Mexican adult patients with abdominal pathology. Methodology: A total of 44 patients with chronic abdominal pathology, clinically suspected of having peritoneal tuberculosis, were studied. All patients with peritoneum laparoscopic biopsy and ascites were studied. Studies were performed using Ziehl–Neelsen stain, cultures for microbacteria by Löwestein–Jensen (L–J) and tube of the growing indicator of Mycobacterium BACTEC (MGIT-960), real-time polymerase chain reaction (RT-PCR) with the 1S6110 insertion sequence for the Myocobacterium tuberculosis complex. Antibodies were determined by immunoenzymatic assay (ELISA) and Western blot (WB) in peripheral blood. Results: Tuberculosis was confirmed in 22 (50%) patients through histology. In peritoneum biopsy, Ziehl–Neelsen stain was positive for AAFB (acid–alcohol-fast bacilli) in three cases (13%), in Löwestein–Jensen's cultures in five cases (22%) and in MGIT-960 in ten cases (45%). The RT-PCR was positive in twelve cases (54%). In ascites, the Ziehl–Neelsen stain was positive in one case (4%), the Löwestein–Jensen culture in nine cases (40%), in MGIT-960 culture in eight cases (36%), and in RT-PCR was positive in eleven cases (50%). The immunological methods recorded a low positivity. Conclusions: The bacterial and RT-PCR methods had low performance, probably due to the low bacillary load of lesions. The histopathological study with characteristic tuberculosis lesions turned out to be the most useful, and it must be jointly performed with bacteriological and molecular studies in suspected cases of tuberculosis with unknown cause ascites.

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