title: Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians.
abstract: OBJECTIVE
  To assess the clinical features, yield of the diagnostic tests and outcome of abdominal tuberculosis in non-HIV patients.
  
  
  METHODS
  Adult patients with discharge diagnosis of abdominal tuberculosis (based upon; positive microbiology, histo-pathology, imaging or response to trial of anti TB drugs) during the period 1999 to 2004 were analyzed. Patient's characteristics, laboratory investigations, radiological, endoscopic and surgical findings were evaluated. Abdominal site involved (intestinal, peritoneal, visceral, and nodal) and response to treatment was also noted.
  
  
  RESULTS
  There were 209 patients enrolled. One hundred and twenty-three (59%) were females. Symptoms were abdominal pain 194 (93%), fever 134 (64%), night sweats 99 (48%), weight loss 98 (47%), vomiting 75 (36%), ascites 74 (35%), constipation 64 (31%), and diarrhea 25 (12%). Sub-acute and acute intestinal obstruction was seen in 28 (13%) and 12 (11%) respectively. Radiological evidence of pulmonary tuberculosis was found in 134 (64%) patients. Basis of diagnosis of abdominal tuberculosis were radiology (Chest and barium X-Rays, Ultrasound and CT scan abdomen) in 111 (53%) and histo-pathology (tissue obtained during surgery, colonoscopy, CT or ultrasound guided biopsy, laparoscopy and upper gastro intestinal endoscopy) in 87 (42%) patients. Mycobacterium culture was positive in 6/87 (7%) patients and response to therapeutic trial of anti tubercular drugs was the basis of diagnosis in 5 (2.3%) patients. Predominant site of involvement by abdominal TB was intestinal in 103 (49%) patients, peritoneal in 87 (42%) patients, solid viscera in 10 (5%) and nodal in 9 (4%) patients. Response to medical treatment was found in 158 (76%) patients and additionally 35 (17%) patients also underwent surgery. In a 425 +/- 120 d follow-up period 12 patients died (eight post operative) and no case of relapse was noted.
  
  
  CONCLUSIONS
  Abdominal TB has diverse and non- specific symptomatology. No single test is adequate for diagnosis of abdominal tuberculosis in all patients. Abdominal TB in non-HIV patients remains an ongoing diagnostic dilemma requiring a high index of clinical suspicion.
authors.affiliation: Department of Medicine, Aga Khan University Hospital, National Stadium Road, Karachi 74800, Pakistan.
authors.forename: Rustam
authors.initials: R
authors.lastname: Khan
authors.forename: Shahab
authors.initials: S
authors.lastname: Abid
authors.forename: Wasim
authors.initials: W
authors.lastname: Jafri
authors.forename: Zaigham
authors.initials: Z
authors.lastname: Abbas
authors.forename: Khalid
authors.initials: K
authors.lastname: Hameed
authors.forename: Zubair
authors.initials: Z
authors.lastname: Ahmad
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology* / Q000601:surgery; D007813:Laparotomy; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000473:pathology* / Q000601:surgery; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D013902:Radiography, Thoracic; D016896:Treatment Outcome; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D014388:Tuberculosis, Lymph Node / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery
chemical_list: D000995:Antitubercular Agents