title: Childhood abdominal tuberculosis: Disease patterns, diagnosis, and drug resistance.
abstract: OBJECTIVE
  Childhood abdominal tuberculosis may be difficult to diagnose with certainty. Drug resistance adds to the challenge. We present our experience in children with this condition.
  
  
  METHODS
  The case records of all children <18 years of age and diagnosed as abdominal tuberculosis from January 2000 to April 2012 were reviewed. The clinical details; investigative profile (imaging, ascitic fluid analysis, upper gastrointestinal (GI) endoscopy, colonoscopy, and laparotomy); histopathology; microbiology; and response to antitubercular therapy was noted.
  
  
  RESULTS
  Thirty-eight children (median age 11, range 4-16 years) were diagnosed. Multiple intraabdominal sites were involved in 12 (32 %), peritoneal alone in 9 (24 %); isolated intestinal and isolated lymph nodal in 6 (16 %) each. Three children had atypical presentations with gastric outlet obstruction, acute lower GI bleeding, and duodenal perforation, respectively. Overall, definitive bacteriological diagnosis was possible in 47 % (18/38). In others, diagnosis was supported by histopathology (19 %) or other supportive investigations (34 %) along with a response to treatment without relapse. Drug-resistant disease was diagnosed in three (8 %, two multidrug resistant, one extended drug resistant) all of whom presented with a similar clinical picture of large abdominal lymph node masses.
  
  
  CONCLUSIONS
  Abdominal tuberculosis is still a challenging diagnosis with microbiological confirmation possible only in half of the cases. Atypical presentations and emergence of drug resistance should be kept in mind while managing these patients.
authors.affiliation: Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors.forename: Rohan
authors.initials: R
authors.lastname: Malik
authors.affiliation: Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors.forename: Anshu
authors.initials: A
authors.lastname: Srivastava
authors.affiliation: Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India. skyachha@sgpgi.ac.in.
authors.forename: Surender K
authors.initials: SK
authors.lastname: Yachha
authors.affiliation: Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors.forename: Ujjal
authors.initials: U
authors.lastname: Poddar
authors.affiliation: Department of Pediatric Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India.
authors.forename: Richa
authors.initials: R
authors.lastname: Lal
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use; D001202:Ascitic Fluid; D044963:Biopsy, Fine-Needle; D002648:Child; D002675:Child, Preschool; D003113:Colonoscopy; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology
chemical_list: D000995:Antitubercular Agents
keywords: Abdominal tuberculosis; Children; Drug resistance; Multidrug resistant tuberculosis