Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia

Abstract

BackgroundThe diagnosis of abdominal tuberculosis (TB) is difficult, especially so in health care facilities in developing countries where laparoscopy and colonoscopy are rarely available. There is little information on abdominal TB in HIV infection. We estimated the prevalence and clinical features of abdominal (excluding genitourinary) TB in HIV infected adults attending the University Teaching Hospital, Zambia.MethodsWe screened 5,609 medical inpatients, and those with fever, weight loss, and clinical features suggestive of abdominal pathology were evaluated further. A clinical algorithm was used to specify definitive investigations including laparoscopy or colonoscopy, with culture of biopsies and other samples.ResultsOf 140 HIV seropositive patients with these features, 31 patients underwent full evaluation and 22 (71%) had definite or probable abdominal TB. The commonest presenting abdominal features were ascites and persistent tenderness. The commonest ultrasound findings were ascites, para-aortic lymphadenopathy (over 1 cm in size), and hepatomegaly. Abdominal TB was associated with CD4 cell counts over a wide range though 76% had CD4 counts <100 cells/μL.ConclusionThe clinical manifestations of abdominal TB in our HIV-infected patients resembled the well-established pattern in HIV-uninfected adults. Patients with fever, weight loss, abdominal tenderness, abdominal lymphadenopathy, ascites and/or hepatomegaly in Zambia have a high probability of abdominal TB, irrespective of CD4 cell count.

A prospective audit of the use of diagnostic laparoscopy to establish the diagnosis of abdominal tuberculosis

“…78,79 Generalized lymphadenopathy was much more common in our series (64%) than the others (11% and 39%) most probably due to high prevalence of HIV infection. 78,81 Fever was less common in our series (24%) than in others (46% to 92%). 78,79,80 Ascites was present in 94-95% of patients in some of the series in the past 18,78 and in 61-65% of patients in some of the recent series, 56,83 …”

Polymerase Chain Reaction Amplifying Mycobacterial DNA from Aspirates Obtained by Endoscopic Ultrasound Allows Accurate Diagnosis of Mycobacterial Disease in HIV-Positive Patients with Abdominal Lymphadenopathy

“…In HIV-infected individuals the aberrant immune response may affect EUS interpretation of lymph nodes and the diagnostic accuracy of the aspirate. Such patients are predisposed to a multitude of opportunistic infections as well as hematological and other malignancies, frequently with atypical clinical presentations (Sinkala et al 2009). Additionally, cytological findings characteristic of bacterial infection, such as granuloma formation or the presence of acid fast bacilli, may be absent or altered (Mendelson 2007).…”

“…Tuberculosis lymphadenitis is now the most common extra-pulmonary manifestation of tuberculosis in both HIV positive and negative individuals in the USA (Fiske et al 2010;Heller et al 2010) Isolated abdominal lymphadenopathy especially presents a diagnostic challenge in HIV-infected patients. The dysfunctional immune response in HIV may obscure signs of infection which may lead to atypical clinical presentations (Bos et al 2013;Sinkala et al 2009). In endemic areas, Mycobacterium tuberculosis (MTB) accounts for the majority of cases of lymphadenopathy but needs to be differentiated from infections by atypical mycobacteria, other bacterial species, fungi and parasites, conditions such as reactive lymphadenopathy and various malignancies (Giordani et al 2013;Radin 1995;Sarma et al 2010).…”

Spectrum of Abdominal Tuberculosis and its Manifestations in a Tertiary Care Centre- A Cross Sectional Study

“…However in Zambia the most common form of ATB in HIV was ascites. The CD4 count in these patients was (<150/ mm 3 ) (19) . The higher CD4 count in our patients may explain the difference in presentation.…”