title: Abdominal Tuberculosis: An Immigrant's Disease in the United States.
abstract: BACKGROUND
  Abdominal tuberculosis (TB) is an uncommon condition in the United States (US) except for patients with human immunodeficiency virus (HIV). An increasing number of cases have been reported in western countries amongst immigrants. It is important to be aware of the data and clinical characteristics in the immigrant population.
  
  
  OBJECTIVE
  The purpose of this study is to determine the epidemiologic characteristics of abdominal TB among immigrants in the US and to review the clinical presentations of abdominal TB with a focus particularly on unusual features.
  
  
  METHODS
  In a community teaching hospital in New Jersey, patients diagnosed with abdominal TB were examined and included in this report. All nine patients were immigrants from countries with high prevalence of TB and a majority had resided in the US for at least 5 years. None had clinical evidence of HIV and those that were tested were not found to be positive for HIV. Initial examination, diagnostic workup, and response to therapy were all pertinent to the management and diagnosis of these patients.
  
  
  RESULTS
  Three patients had atypical clinical presentations with normal chest X-rays and either negative or unknown tuberculin tests leading to delayed diagnosis and inappropriate therapy in at least one patient. With antituberculous therapy, all except for one patient had satisfactory outcomes. Immigrant patients with a diagnosis of abdominal TB had no evidence of HIV infection or other associated conditions in contrast to native-born individuals.
  
  
  CONCLUSIONS
  Atypical presentations may cause diagnostic difficulties. Failure to perform appropriate tests may lead to inappropriate therapy with adverse outcomes. Although there is a decline in the number of TB cases in the US and screening for latent pulmonary infection in foreigners has been implemented effectively, the diagnosis of abdominal TB continues to be under diagnosed.
authors.affiliation: Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States.
authors.forename: Waqas
authors.initials: W
authors.lastname: Jehangir
authors.affiliation: Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States.
authors.forename: Rafay
authors.initials: R
authors.lastname: Khan
authors.affiliation: Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States.
authors.forename: Constante
authors.initials: C
authors.lastname: Gil
authors.affiliation: Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Baruiz-Creel
authors.affiliation: Palm Springs General Hospital, Hialeah, Florida, United States.
authors.forename: Geraldo
authors.initials: G
authors.lastname: Bandel
authors.affiliation: Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States.
authors.forename: John R
authors.initials: JR
authors.lastname: Middleton
authors.affiliation: Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States.
authors.forename: Purnendu
authors.initials: P
authors.lastname: Sen
keywords: Abdominal tuberculosis; Diagnosis; Extrapulmonary; HIV; Immigrants; Tuberculosis