Abdominal Tuberculosis in Children: Challenges, Uncertainty, and Confusion

2020 ◽  
Vol 9 (2) ◽  
pp. 218-227 ◽  
Author(s):  
Giulia Sartoris ◽  
James A Seddon ◽  
Helena Rabie ◽  
Etienne D Nel ◽  
H Simon Schaaf
Keyword(s):  
Sensitivity And Specificity ◽  
Clinical Presentation ◽  
Abdominal Tuberculosis ◽  
Abdominal Ultrasound ◽  
Diagnostic Tools ◽  
Pulmonary Tb ◽  
Neglected Disease ◽  
Abdominal Symptoms ◽  
Tuberculosis In Children ◽  
Symptoms And Signs

Abstract The diagnosis of abdominal tuberculosis (TB) is challenging, and the prevalence of abdominal TB in children is likely underestimated. It may present with nonspecific abdominal symptoms and signs, but children who present with pulmonary TB may have additional abdominal subclinical involvement. Diagnosis is specifically challenging because none of the available diagnostic tools provide adequate sensitivity and specificity. In this review, we summarize the best available evidence on abdominal TB in children, covering the epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment. We propose a diagnostic approach that could be followed for symptomatic children. We believe that a combination of investigations could be useful to both aid diagnosis and define the extent of the disease, and we propose that abdominal ultrasound should be used more frequently in children with possible TB and any abdominal symptoms. This neglected disease has received little attention to date, and further research is warranted.

scholarly journals Abdominal tuberculosis in children

2001 ◽  
Vol 41 (3) ◽  
pp. 155
Author(s):  
Heda Melinda Nataprawira ◽  
Henny Komalia
Keyword(s):  
Extrapulmonary Tuberculosis ◽  
Abdominal Tuberculosis ◽  
Point Of View ◽  
Gastric Aspirate ◽  
Abdominal Symptoms ◽  
Clinical Point ◽  
Chest X Ray ◽  
Tuberculosis In Children ◽  
Positive Results ◽  
Pleural Involvement

Abdominal tuberculosis is one of the extrapulmonary tuberculosis commonly found in adolescens, however, due to its non-specific and vague abdominal symptoms, it is rarely found and reported in children. To evaluate abdominaltuberculosis in children from clinical point of view, we conducted a 5-year retrospective study on children hospitalized over a period of 1995 to 1999 in Hasan Sadikin Hospital-Bandung. Of the 15 children diagnosed as having abdominal tuberculosis, 10 (66.7%) were female and 5 (33,3%) male, age ranged from 14 – 162 months and most of them were > 10 years of age.On admission, abdominal distention was the most common complaint found (60.0%), followed by dyspnoe 3 (20.0%), abdominal pain 2 (13.3%) and generalized oedem 1 (6.7%). Most of the children (93.3%) were undernourished which half of them were severely undernourished. Seven children showed positive Mantoux testing with PPD 5 TU. There was familyhistory of adults TB discovered in 9 (60%) of the children. Eighty-percent had BCG vaccination and 6 (50%) of the showed positive scarr. Chest X-ray showed pulmonal and/or pleural involvement in 13 of the 15 children (86.7%). All ascitic fluid taken from 9 patients showed increased protein level and lymphocyte predominance. Histopathologic examinations of 5 childrensupported the diagnosis. There was no positive results of acid fast bacilli and culture done for Mycobacterium tuberculosis in gastric aspirate as well as ascitic fuid. Peritonitis tuberculosis was most commonly diagnosed (80.0%), followed by mesenterial/nodal tuberculosis (20.0%). All of the children followed (60.0%) responded well to the drugs therapy.

scholarly journals Management of Abdominal Tuberculosis in a Community-Based Hospital From a High-Income Developing Country

2021 ◽  
Author(s):  
Hussam Mousa ◽  
Saleh Abdel-Kader ◽  
Fikri Abu-Zidan
Keyword(s):  
United Arab Emirates ◽  
Clinical Presentation ◽  
Delayed Diagnosis ◽  
Abdominal Tuberculosis ◽  
Diagnostic Methods ◽  
Diagnostic Tools ◽  
Therapeutic Trial ◽  
Al Ain ◽  
Chest X Ray ◽  
Immunological Assays

Abstract Background: The delayed diagnosis and management of abdominal tuberculosis increases its mortality. We aimed to study the clinical presentation, management, and outcome of patients who had abdominal tuberculosis and treated at Al-Ain Hospital, Al-Ain City, United Arab Emirates.Methods: All patients who had abdominal tuberculosis and treated at Al-Ain Hospital between January 2011 and December 2018 were studied. Data were collected retrospectively using a structured protocol including demography, clinical presentation, diagnostic methods, management, and outcome. Results: Twenty-four patients having a median age of 30 years were studied with an incidence of 0.6/100,000 population. The most common symptoms were abdominal pain (95.8%) and malaise (79.2%). Fever was present only in nine patients (37.5%). Laboratory investigations, except the polymerase chain reaction immunoassay, were not helpful. Chest X-ray was abnormal in three patients (12.5%). Ultrasound and abdominal CT scan were nonspecific. Thirteen patients needed surgical intervention for diagnosis or therapy. Diagnosis was confirmed by histopathology in 15 patients (62.5%), immunological assays in 7 patients (29.2%), microbiological culture in one patient (4%), and therapeutic trial in one patient (4%). The most common type of abdominal tuberculosis was gastrointestinal in 13 patients (54.2%) followed by free wet peritonitis in five patients (20.8%). All patients had quadruple anti-tuberculous therapy for a minimum of six months. The median hospital stay was 6.5 days. None of our patients died. Conclusions: Diagnosis of abdominal tuberculosis remains challenging despite advancements in medical technology and diagnostic tools. The low percentage for the need for diagnostic therapy in our study supports the benefit of PCR assay. Surgery was mainly indicated as the last option to reach the diagnosis or to treat complications.

scholarly journals Streptococcus salivarius kot povzročitelj iatrogenega meningitisa – predstavitev primera

2017 ◽  
Vol 86 (9-10) ◽  
Author(s):  
Kristina Praper ◽  
Uršula Tišler ◽  
Matjaž Jereb
Keyword(s):  
Clinical Presentation ◽  
Diagnostic Tools ◽  
Streptococcus Salivarius ◽  
Viridans Streptococci ◽  
Aseptic Technique ◽  
Neuraxial Blockade ◽  
Normal Human ◽  
Symptoms And Signs ◽  
Droplet Transmission ◽  
Iatrogenic Meningitis

We present a case of a 28-year-old patient who underwent spinal anaesthesia for caesarean section, and developed meningitis, Streptococcus salivarius was isolated in the cerebrospinal fluid. The Viridans streptococci are a part of a normal human mouth flora, therefore the patient most likely developed iatrogenic meningitis due to droplet transmission of bacteria intrathecally. We discuss etiology, pathogenesis, clinical presentation, diagnostic tools, treatment and prognosis of meningitis afer intrathecal procedures and we emphasize the importance of strict aseptic technique while performing neuraxial procedures. Iatrogenic meningitis should be considered as a possible differential diagnosis in patients who present with symptoms and signs of meningitis after neuraxial blockade.

scholarly journals Diagnostic value of computed tomography in the patients of abdominal tuberculosis

2016 ◽  
Vol 5 (1) ◽  
pp. 206
Author(s):  
B. S. Salooja ◽  
Sadhan Mukhi
Keyword(s):  
Computed Tomography ◽  
Age Groups ◽  
Abdominal Tuberculosis ◽  
Diagnostic Value ◽  
Diagnostic Tools ◽  
Wall Thickening ◽  
Anatomical Location ◽  
Diagnostic Study ◽  
X Ray ◽  
Abdominal Symptoms

Background: Abdominal tuberculosis (ATB) is a rare form of extra-pulmonary tuberculosis which is clinically challenging. It remains difficult to diagnose due to the non-specific presentation, variable anatomical location and lack of sensitive diagnostic tools. To evaluate the diagnostic value of computed tomography (CT) in the patients of abdominal tuberculosis.Methods: This was a retrospective diagnostic study design. The study was conducted among adults aged>18 years of either gender with clinical suspected ATB. The detailed demographic and clinical history was noted on pre-designed proforma. After obtaining the history, the patient was subjected to general physical and systematic examinations. The patients were then subjected to radiological evaluation that included chest X-ray, X-ray of abdomen and CT.Results: A total of 55 clinically suspected adult cases of abdominal tuberculosis were enrolled in the study. 45 (81.8%) were found to be abdominal tuberculosis on final diagnosis. The abdominal tuberculosis was found to be higher in the age groups 21-40 years (64.4%).The abdominal tuberculosis was observed to be higher among female patients (62.2%) than males (37.8%). CT findings showed that the bowel wall thickening & narrowing and dilatation was found in 64.4% patients.Conclusions: ATB is still a diagnosis to consider in individuals presenting with abdominal symptoms in the developing world, particularly in patients from ethnic minorities. Diagnosis can be challenging and requires a multidisciplinary approach with involvement from Radiology, Microbiology, Gastroenterology, Surgery, Infectious Diseases and Respiratory teams.

scholarly journals Management of abdominal tuberculosis in a community-based hospital in a high-income developing country

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hussam Mousa ◽  
Saleh Abdel-Kader ◽  
Fikri M. Abu-Zidan
Keyword(s):  
United Arab Emirates ◽  
Clinical Presentation ◽  
Delayed Diagnosis ◽  
Abdominal Tuberculosis ◽  
Diagnostic Methods ◽  
Diagnostic Tools ◽  
Therapeutic Trial ◽  
Al Ain ◽  
Chest X Ray ◽  
Immunological Assays

Abstract Background The delayed diagnosis and management of abdominal tuberculosis increases its mortality. We aimed to study the clinical presentation, management, and outcome of patients who had abdominal tuberculosis and were treated at Al-Ain Hospital, Al-Ain City, United Arab Emirates. Methods All patients who had abdominal tuberculosis and were treated at Al-Ain Hospital between January 2011 and December 2018 were studied. Data were collected retrospectively using a structured protocol including demography, clinical presentation, diagnostic methods, management, and outcome. Results Twenty-four patients having a median age of 30 years were studied with an incidence of 0.6/100,000 population. The most common symptoms were abdominal pain (95.8%) and malaise (79.2%). Fever was present only in nine patients (37.5%). Laboratory investigations, except for polymerase chain reaction immunoassay, were not helpful. Chest X-ray was abnormal in three patients (12.5%). Ultrasound and abdominal CT scan were non-specific. Thirteen patients needed surgical intervention for diagnosis or therapy. Diagnosis was confirmed by histopathology in 15 patients (62.5%), immunological assays in 7 patients (29.2%), microbiological culture in 1 patient (4%), and therapeutic trial in 1 patient (4%). The most common type of abdominal tuberculosis was gastrointestinal in 13 patients (54.2%) followed by free wet peritonitis in 5 patients (20.8%). All patients had quadruple anti-tuberculous therapy for a minimum of 6 months. The median hospital stay was 6.5 days. None of our patients died. Conclusions Diagnosis of abdominal tuberculosis remains challenging despite advances in medical technology and diagnostic tools. The limited need for diagnostic therapy in our study supports the benefit of PCR assay. Surgery was mainly indicated as the last option to reach the diagnosis or to treat complications.

scholarly journals Screening for aneurysms of the abdominal aorta using a simple screening device

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
J. W. Brakel ◽  
T. A. Berendsen ◽  
P. M. C. Callenbach ◽  
J. van der Burgh ◽  
R. J. Hissink ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Abdominal Aorta ◽  
Predictive Value ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Predictive Values ◽  
Bladder Scan ◽  
Health Council ◽  
Screening Device

Abstract Introduction Several countries advocate screening for aneurysms of the abdominal aorta (AAA) in selected patients. In the Netherlands, routine screening is currently under review by the National Health Council. In any screening programme, cost-efficiency and accuracy are key. In this study, we evaluate the Aorta Scan (Verathon, Amsterdam, Netherlands), a cost-effective and easy-to-use screening device based on bladder scan technology, which enables untrained personnel to screen for AAA. Methods We subjected 117 patients to an Aorta Scan and compared the results to the gold standard (abdominal ultrasound). We used statistical analysis to determine sensitivity and specificity of the Aorta Scan, as well as the positive and negative predictive values, accuracy, and inter-test agreement (Kappa). Results Sensitivity and specificity were 0.86 and 0.98, respectively. Positive predictive value was 0.98 and negative predictive value was 0.88. Accuracy was determined at 0.92 and the Kappa value was 0.85. When waist–hip circumferences (WHC) of > 115 cm were excluded, sensitivity raised to 0.96, specificity stayed 0.98, positive and negative predictive value were 0.98 and 0.96, respectively, accuracy to 0.97, and Kappa to 0.94. Conclusion Herein, we show that the Aorta Scan is a cost-effective and very accurate screening tool, especially in patients with WHC below 115 cm, which makes it a suitable candidate for implementation into clinical practice, specifically in the setting of screening selected populations for the presence of AAA.

INCIDENCE OF ABDOMINAL TUBERCULOSIS IN PATIENTS PRESENTING WITH PAIN ABDOMEN

2021 ◽  
pp. 13-15
Author(s):  
Pankaj Prasad Verma ◽  
Manjar Ali ◽  
Sanjay Singh ◽  
Vinay Pratap
Keyword(s):  
Health Care Services ◽  
Abdominal Tuberculosis ◽  
Morbidity And Mortality ◽  
Medical Sciences ◽  
Major Health Problem ◽  
Major Health ◽  
Care Services ◽  
Abdominal Symptoms ◽  
Pain Abdomen ◽  
Considerable Morbidity

Tuberculosis is a major health problem worldwide and in India continues to be responsible for considerable morbidity and mortality despite tremendous effort made in diagnosis, prophylaxis and therapy. The disease may involve any system of body but abdomen is one of the commonest site of involvement after lungs. This study is carrying to nd out Incidence of Abdominal Tuberculosis in patients of pain abdomen presenting as acute/chronic cases. The present study was carried out in the Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi, from April 2018 to September 2019. The total number of cases selected disease remains early detection. A continual awareness on the part of the clinician of the possibility of abdominal Tuberculosis in many patients with obscure abdominal symptoms should avoid errors and aid in the detection of a condition, which if treated early, not only produces remarkable remission and relief on the part of for this study was 1800. According to the presentation, the patients were clinically divided into 2 broad groups: those who were admitted as acute emergencies and those who came with a chronic presentation. From these two groups 100 cases were fall in our inclusion criteria. Of these 100 patients, most were in their third or fourth decades of life, and females were approx two times more commonly affected as their male counterparts, maintaining an approximate ratio of 1.86:1. Thus we had a 5.55 % incidence of abdominal Tuberculosis in this series. The development of cheap and efcient procedures for early diagnosis remains one of the practical problems to battle this disease, because the only way to decrease morbidity and mortality of this the patients but also takes unnecessary burden off the health care services.

Very early onset inflammatory bowel disease (VEO-IBD); spectrum of clinical presentation, diagnostic tools and outcome in children

2021 ◽  
Vol 71 (10) ◽  
pp. 2350-2354
Author(s):  
Huma Arshad Cheema ◽  
Nadia Waheed ◽  
Anjum Saeed ◽  
Zafar Fayyaz ◽  
Muhammad Nadeem Anjum ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Early Onset ◽  
Clinical Presentation ◽  
Association Studies ◽  
Diagnostic Tools ◽  
Genome Wide Association Studies ◽  
Genome Wide ◽  
Basic Work ◽  
Inflammatory Bowel

Background: Very early-onset inflammatory bowel disease (VEO-IBD) is defined as diagnosis of Ulcerative Colitis (UC) or Crohn’s Disease (CD) in children under six years of age. Genome wide association studies have linked a strong genetic component responsible for VEO-IBD. Approximately, 30-40% children of VEO-IBD have underlying immunodeficiency states. We aimed to study the spectrum of presentation, underlying monogenetic defects and outcome in VEO-IBD. Methods: This is a prospective, observational study conducted at division of Gastroenterology, the Children's Hospital & the Institute of Child Health, Lahore, over 2 years. Children developing features of IBD under six-years of age were included. Data included demography, clinical presentation, diagnostic tools and outcome. Gastroscopy and colonoscopy were performed in all patients in addition to basic work up done for associatedimmunodeficiency states and molecular genetics.  SPSS version 21 was used for analysis. Continuous...

DIAGNOSTICS OF THE ISCHEMIC HEART DISEASE WITH THE USE OF HEART RATE VARIABILITY AND DISPERSION MAPPING OF THE MYOCARDIUM DURING STRESS-ECHOCARDIOGRAPHY

2021 ◽  
Vol 55 (5) ◽  
pp. 53-58
Author(s):  
S.V. Zhuravlev ◽  
◽  
V.N. Ardashev ◽  
E.M. Novikov ◽  
O.M. Maslennikova ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Sensitivity And Specificity ◽  
Stress Echocardiography ◽  
Ischemic Heart ◽  
Diagnostic Tools ◽  
Heart Rate Variability Analysis ◽  
Variability Analysis

The authors present a stress-echocardiography (stress-echoECG) technique enhanced with dispersion mapping and heart rate variability analysis. This combination of diagnostic tools increases IHD diagnostics sensitivity and specificity to 96 and 89 % respectively.

Non-malignant gall bladder perforation: Our experience from an institution-based retrospective analysis of 25 cases

2021 ◽  
pp. 004947552110365
Author(s):  
Abhijeet Kumar ◽  
Nirmal Prasad Shah ◽  
Narendra Pandit ◽  
Suresh Prasad Sah ◽  
Rakesh Kumar Gupta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Gall Bladder ◽  
Clinical Presentation ◽  
Gallbladder Perforation ◽  
Type I ◽  
Computed Tomography Scan ◽  
Duration Of Hospital Stay ◽  
Symptoms And Signs ◽  
Tomography Scan ◽  
Better Than

Gallbladder perforation still continues to perplex surgeons; 25 such patients diagnosed either pre- or intra-operatively and managed at our institute over the last 10 years period were analysed. Only eight were diagnosed pre-operatively, while a large majority (17) had a wrong initial working diagnosis. Symptoms and signs were variable. No blood investigation was specific. A computed tomography scan was generally better than ultrasound in detecting the perforation. All our cases were managed operatively with no mortality and a mean duration of hospital stay of 6.8 days. Most perforations were extra-hepatic (84%) and those of Niemeier’s type I (52.2%). Because of its varied clinical presentation, gallbladder perforation is often an intra-operative diagnosis, but early intervention carries a good outcome.

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