Clinical Presentation, Diagnosis, and Bacterial Epidemiology of Peritoneal Tuberculosis in Two University Hospitals in France.
BACKGROUND
Diagnosis of peritoneal tuberculosis (pTB) is difficult, even in developed countries, where data are lacking. The aim of the present study was to describe the clinical presentation, diagnosis, and bacterial epidemiology of pTB in France over a 10-year period.


METHODS
A retrospective study was conducted on pTB in two university hospitals in France, between January 2004 and December 2014.


RESULTS
Among the 34 patients, 76.5% were migrants from areas of endemic tuberculosis (TB), mainly Africa. The main presentation (85.3%) was a checkup of ascites or suspicion of peritoneal carcinomatosis. On abdominal computed tomography, ascites was found in 90.6% and peritoneal thickening in 75%. Surgery was required for diagnosis in 58.8% of patients. Six of the patients who did not undergo surgery had ultrasound-guided peritoneal biopsy. Bacteriology was positive for ascites in only 58.1% of cases, for peritoneal biopsy in 73.3%, while granuloma was found in 95.5%. TB polymerase chain reaction (PCR) was positive in 25% of peritoneal biopsy. Mycobacterium bovis was isolated in 23.1% of cases and Mycobacterium tuberculosis in 76.9%. Isolates were fully susceptible (except M. bovis naturally resistant to pyrazinamide). Many (38%) belonged to the lineage T (genetic analysis by spoligotyping). Cure rate was high (76.5%), after a 6-9 months of anti-tuberculous therapy.


CONCLUSIONS
In developed countries, early diagnosis of pTB is still a challenge. Ultrasound-guided peritoneal biopsy may facilitate diagnosis. TB PCR can be useful on peritoneal biopsy. The lineage T was the most prevalent lineage, but more data are required to directly incriminate this lineage in the pathophysiology of pTB.
Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France. zoe.cavalli@chu-lyon.fr.|Université Claude Bernard 1, Lyon, France. zoe.cavalli@chu-lyon.fr.
Zoé
Z
Cavalli
Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.|Université Claude Bernard 1, Lyon, France.|Centre Internationale de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France.
Florence
F
Ader
Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.|Université Claude Bernard 1, Lyon, France.|Centre Internationale de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France.
Florent
F
Valour
Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.|Université Claude Bernard 1, Lyon, France.
Julien
J
Saison
Université Claude Bernard 1, Lyon, France.|Service de Radiologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
Loïc
L
Boussel
Université Claude Bernard 1, Lyon, France.|Laboratoire de Bactériologie, Hôpital de Lyon Sud, Hospices Civils de Lyon, Lyon, France.
Oana
O
Dumitrescu
Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.|Université Claude Bernard 1, Lyon, France.
Thomas
T
Perpoint
Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.|Université Claude Bernard 1, Lyon, France.|Centre Internationale de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France.
Christian
C
Chidiac
Service de Maladies Infectieuses et Tropicales, Hôpital de Brabois, CHU de Nancy, Vandœuvre-lès-Nancy, France.|Université de Lorraine, Nancy, France.
Thierry
T
May
Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.|Université Claude Bernard 1, Lyon, France.|Centre Internationale de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France.
Tristan
T
Ferry
Ascites; Mycobacterium tuberculosis; Peritoneal biopsy; Peritoneal tuberculosis; Spoligotyping; Tuberculous peritonitis