Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
J Microbiol Immunol Infect. 2010 Oct;43(5):395-400. doi: 10.1016/S1684-1182(10)60062-X.
BACKGROUND/PURPOSE: Tuberculosis (TB) is an important communicable disease worldwide. The clinical presentation of abdominal TB often mimics various gastrointestinal disorders and may delay accurate diagnosis. In this study, we conducted a 10-year retrospective study to investigate the clinical manifestations, treatment responses and outcomes of abdominal TB.
This retrospective study recruited patients presenting between January 1998 and December 2007; all patients ≥ 18 years of age with a diagnosis of abdominal TB were enrolled. Patient charts were thoroughly reviewed and clinical specimens were processed in the laboratory using the BBL MycoPrep System and BACTEC MGIT 960 Mycobacterial Detection System. Mycobacterium tuberculosis complex was confirmed by acid fast stain and the BD ProbeTec ET System.
During the study period, 34 patients were diagnosed with abdominal TB. The mean age was 55+18 years. Fourteen patients (41%) had no risk factors; however, 20 patients (59%) had at least one risk factor. Abdominal pain (94.1%), abdominal fullness (91.2%), anorexia (88.2%) and ascites (76.5%) were the most common presenting symptoms. The peritoneum (88%) was the most commonly involved site. Patients with risk factors such as liver cirrhosis, end-stage renal disease and diabetes mellitus had a higher positive rate of acid-fast stain and mycobacterial culture from abdominal specimens (p = 0.02 and 0.05, respectively). The crude mortality rate was 9% and the attributed mortality rate was 3%.
In an endemic area like Taiwan, regardless of whether a patient has risk factors for TB, abdominal TB should be seriously considered as a differential diagnosis when a patient presents with gastrointestinal symptoms and unexplained ascites.
背景/目的：结核病（TB）是一种重要的全球传染病。腹部 TB 的临床表现常类似于各种胃肠道疾病，可能会延迟准确诊断。在这项研究中，我们进行了一项为期 10 年的回顾性研究，以调查腹部 TB 的临床表现、治疗反应和结果。
这项回顾性研究招募了 1998 年 1 月至 2007 年 12 月期间就诊的患者；所有年龄≥18 岁、诊断为腹部 TB 的患者均纳入研究。仔细查阅患者病历，使用 BBL MycoPrep 系统和 BACTEC MGIT 960 分枝杆菌检测系统对临床标本进行实验室处理。采用抗酸染色和 BD ProbeTec ET 系统确认结核分枝杆菌复合体。
在研究期间，34 例患者被诊断为腹部 TB。平均年龄为 55±18 岁。14 例（41%）患者无危险因素；然而，20 例（59%）患者至少有一个危险因素。腹痛（94.1%）、腹胀（91.2%）、食欲不振（88.2%）和腹水（76.5%）是最常见的临床表现。腹膜（88%）是最常受累的部位。有肝硬化、终末期肾病和糖尿病等危险因素的患者，从腹部标本中获得的抗酸染色和分枝杆菌培养的阳性率更高（p=0.02 和 0.05）。粗死亡率为 9%，归因死亡率为 3%。
在台湾这样的流行地区，无论患者是否有结核病危险因素，当患者出现胃肠道症状和不明原因腹水时，应认真考虑将腹部 TB 作为鉴别诊断。
