Abdominal Tuberculosis is common and under-diagnosed in HIV positive Adults in Zambia

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Sinkala, Edford
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Abdominal tuberculosis is a common form of extra- pulmonary tuberculosis especially in HIV/AIDS patients. A high index of suspicion is required for diagnosis of abdominal tuberculosis in these patients. A study was done at the University Teaching Hospital, Lusaka, Zambia to ascertain whether abdominal tuberculosis is common in HIV/AIDS patients, and whether under diagnosed. The inclusion criteria were fever and weight loss, with one or more of the following: diarrhoea persisting for >1 month, ascites, abdominal lymphadenopathy based on ultrasound, mesenteric masses based on ultrasound, hepatomegaly or splenomegaly, pancreatic enlargement, or unexplained focal or generalised pain/tenderness persisting over 7 days. The exclusion criteria included: HIV negative, solely pelvic and renal abnormalities, on antituberculous treatment for more than 1 week or too sick to undergo laparoscopy or colonoscopy. 31 subjects completed the algorithm and all the subjects had abdominal ultrasound scanning of which some had laparoscopy/laparotomy while others underwent colonoscopy. In order to determine if abdominal lymphadenopathy was attributable to HIV an equivalent number to those who met the criteria was recruited as controls and had abdominal ultrasound scanning. These subjects were HIV positive and had no features of tuberculosis. In this study 22 subjects had evidence of abdominal tuberculosis while 9 had no evidence of abdominal tuberculosis representing 71% and 29% respectively. Non of the controls had abdominal lymphadenopathy or any appreciable mass on abdominal ultrasound implying that abdominal lymphadenopathy indicate pathology. Good history and physical examination proved to be useful in diagnosing abdominal tuberculosis. Among the physical findings, abdominal tenderness was the commonest (86%) in subjects with evidence of abdominal tuberculosis. This study also revealed that abdominal ultrasound is an important tool in helping to make diagnosis of abdominal tuberculosis especially in poor resource set up where CT and MRI scans are not readily available. This study showed that 73% of those with evidence of abdominal tuberculosis had ascites and 54% of subjects with abdominal tuberculosis had ascites with fibrous strands. While laparoscopic studies plus biopsy will confirm abdominal tuberculosis, this study noted that it is possible for normal looking mucosa on colonoscopy to be colonised by Mycobacteria tuberculosis (this was found in 1 out of 5 subjects). No Mycobacterium was cultured from any of the blood samples drawn from the study subjects and positive culture of the ascitic fluid was low (13.6%). Many subjects with abdominal tuberculosis had low CD4 count (mean= 92 cell/ul). 20 subjects (HIV positive) who died of suspected pulmonary or abdominal tuberculosis had autopsy done on them. Disseminated tuberculosis was more frequent than either pulmonary or abdominal tuberculosis. Abdominal tuberculosis in quite common in HIV positive patients. Therefore it is important to take a detailed history and elicit signs pertaining to abdominal TB.
Bacteriology-zambia , Tuberculosis-zambia , Public Health-Zambia