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


METHODS
We 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.


RESULTS
Of 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/microL.


CONCLUSIONS
The 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.
Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Lusaka, Zambia. sinkalaeddie@yahoo.com
Edford
E
Sinkala
Sylvia
S
Gray
Isaac
I
Zulu
Victor
V
Mudenda
Lameck
L
Zimba
Sten H
SH
Vermund
Francis
F
Drobniewski
Paul
P
Kelly
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D000005:Abdomen / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D003113:Colonoscopy; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014385:Tuberculosis, Gastrointestinal / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014463:Ultrasonography; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology