Diagnostic features of tuberculous peritonitis in the absence and presence of chronic liver disease: a case control study.
OBJECTIVE
To determine diagnostic features of tuberculous peritonitis (TBP) in the absence and presence of chronic liver disease.


METHODS
Thirty-four patients with TBP (13 without [Group I] and 21 with chronic liver disease [Group II] and 26 controls with cirrhosis and uninfected ascites (Group III) were studied.


RESULTS
The clinical features in Groups I and II were similar and all patients had elevated ascitic fluid total mononuclear cell count. In Groups I, II, and III, respectively, ascitic fluid protein was > 25 g/L in 100% (13/13), 70% (14/20), and 0% (0/26); serum-ascites albumin gradient (SAAG) was > 11 g/L in 0% (0/13), 52% (11/21), and 96% (25/26), (0% [0/13], 71% [15/21], and 96% [25/26] after correction for serum globulin); and ascitic fluid lactate dehydrogenase (LDH) level was > 90 U/L in 100% (12/12), 84% (16/19), and 0% (0/20), respectively. In Groups I and II combined, ascitic fluid acid-fast stain was negative in all but Mycobacterium tuberculosis culture was positive in 45% (10/22); peritoneal nodules occurred in 94% (31/33), granulomas in 93% (28/30), and positive peritoneal M tuberculosis culture in 63% (10/16).


CONCLUSIONS
In patients with suspected TBP, ascitic fluid protein of > 25 g/L, SAAG of < 11 g/L and LDH of > 90 U/L have high sensitivity for the disease. With coexistent chronic liver disease, a lower protein level and higher SAAG are usually not helpful but LDH > 90 U/L is a useful parameter for screening. Diagnosis is best confirmed by laparoscopy with peritoneal biopsy and M tuberculosis culture.
Shakil
A O
AO
Liver Unit, University of Southern California School of Medicine, Rancho Los Amigos Medical Center, Downey, USA.
Korula
J
J
Kanel
G C
GC
Murray
N G
NG
Reynolds
T B
TB
D000368:Aged; D001202:Ascitic Fluid / Q000166:cytology; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D014395:Peritonitis, Tuberculous / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity