Pediatric Abdominal Tuberculosis in Singapore: A 10-Year Retrospective Series

Abstract

Background. Tuberculosis (TB) remains a major cause of mortality and morbidity globally. Pediatric patients are more likely to develop severe disease. Abdominal TB is a rare manifestation of pediatric TB and can present with chronic and nonspecific abdominal symptoms. This study examines the clinical profile of pediatric patients with abdominal TB and treatment outcomes. Method. A retrospective study of patients admitted to a tertiary pediatric hospital in Singapore over 10 years. Clinical characteristics and outcomes were examined. Results. There were 3 male and 3 female patients with mean age of 11.3 years. Household contacts were traced in 3 cases. The most common presenting symptoms were fever, weight loss, and abdominal symptoms such as diarrhea, vomiting, and loss of appetite. Inflammatory markers were raised with mean C-reactive protein (CRP) and erythrocyte sedimentation (ESR) rate at 70.9 mg/L and 90 mm/h respectively. Abdominal imaging showed abnormalities such as splenic foci and thickened bowel wall with significant intraabdominal lymphadenopathy. Mycobacterium tuberculosis was isolated from stool, rectal swabs and intra-adominal specimens. Two patients underwent excisional biopsy of lymph node to obtain diagnosis. Two patients required emergency laparotomy and 1 patient received esophagogastroduodenoscopy and colonoscopy. Four out of the 6 patients had pulmonary involvement. Conclusion. Abdominal TB should be a differential diagnosis in children with chronic abdominal symptoms for at least 8 weeks with anemia, raised ESR and CRP. The gold standard for diagnosis still remains as positive microbiological culture. However, abdominal imaging studies are also vital in obtaining further supportive evidence for chronic infection.

A Challenging Case of the Forgotten Abdominal Tuberculosis in the Developed World

“…In a developed country with low incidence of tuberculosis, differentiating abdominal TB from CD is crucial, as starting immunosuppressive medication carries the risk of developing disseminated miliary TB, a fatal complication. As in our case, history of exposure is not always available at presentation (5,6). While ascites is regarded as one of the key differentiating factors between abdominal TB and CD, it is not sufficient to make the diagnosis.…”

“…Typical treatment duration is 2 months for the quadruple therapy and 6–9 months with dual therapy (Isoniazid, Rifampin). Medication choice and duration can vary based on known resistance of the bacteria in different countries ( 6 ). Response to therapy and a repeat endoscopy is the preferred approach to demonstrate macroscopic and microscopic healing, which is considered confirmatory of the diagnosis of Abdominal TB in challenging cases ( 3 , 4 ).…”

Examination of Surgically Important Healthy Life Expectancy and Respiratory Tract Deaths: The Relationship between Tuberculosis-Related Deaths and Health Adjusted Life Expectancy (HALE)

“…In the majority of tuberculosis studies, the disease is more in contact with the airways. In addition, although there are other types, it is mainly included in research as a respiratory disease [21][22][23][24][25][26][27][28] . In our study, respiratory tuberculosis rates and males tuberculosis rates were higher in males than females.…”