Murillo Juan Miguel L, Gregorio Germana Emerita V
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila.
Acta Med Philipp. 2024 Aug 30;58(15):24-31. doi: 10.47895/amp.vi0.7879. eCollection 2024.
Peritoneal tuberculosis comprises 5% of all forms of tuberculosis in children. There are limited reports of peritoneal TB in children.
To determine the clinical, biochemical, radiologic, histologic, and microbiologic features and outcome of pediatric patients diagnosed with peritoneal tuberculosis.
Review of medical records from 2011-2020 of patients fulfilling diagnostic criteria of peritoneal TB. Patient was considered as bacteriologically-confirmed if with positive AFB smear, culture, or PCR on peritoneal or omental tissue; and clinically-diagnosed if with clinical findings AND presence of histologic and/or radiologic evidence of extra-pulmonary TB. Data was presented as mean (SD) or n (%), as appropriate.
Eighteen patients [Mean (SD) age: 14.27 (± 4.1) years old, 56% males] were included. All had disseminated TB with peritoneal involvement. One case was bacteriologically-confirmed (TB PCR positive omental tissue); 17 were clinically-diagnosed. Most common presentation was abdominal distention (83%) and abdominal pain (61%). Most common physical finding was abdominal distention (83%) and abdominal tenderness (44%). Seven patients (39%) had anemia, 11 (61%) had leukocytosis, and three (17%) had thrombocytosis. Thirteen (72%) had hypoalbuminemia. Ten (56%) were positive on AFB smear, TB culture, and PCR of various specimens. Fourteen of sixteen (88%) with abdominal CT scan had ascites and intrabdominal lymphadenopathy. Nine of 12 tissue samples from seven patients demonstrated chronic granulomatous inflammation. Seventeen were given quadruple anti-TB. Six also had surgery. Overall, 15 were discharge improved after mean of 4.2 weeks of hospital stay, while three died of sepsis. Eleven of the 15 were well one month after discharge.
Peritoneal TB presents with non-specific clinical and laboratory features. Radiologic and histologic findings increase the likelihood of diagnosis. The prognosis is favorable for patients who are diagnosed and treated with anti-TB drugs.
腹膜结核占儿童所有结核病形式的5%。关于儿童腹膜结核的报道有限。
确定诊断为腹膜结核的儿科患者的临床、生化、放射学、组织学和微生物学特征及转归。
回顾2011年至2020年符合腹膜结核诊断标准患者的病历。如果腹膜或网膜组织的抗酸杆菌涂片、培养或聚合酶链反应呈阳性，则患者被视为细菌学确诊；如果有临床发现以及肺外结核的组织学和/或放射学证据，则为临床诊断。数据根据情况以均值（标准差）或例数（%）表示。
纳入18例患者[平均（标准差）年龄：14.27（±4.1）岁，56%为男性]。所有患者均为播散性结核伴腹膜受累。1例细菌学确诊（网膜组织结核聚合酶链反应阳性）；17例临床诊断。最常见的表现是腹胀（83%）和腹痛（61%）。最常见的体格检查发现是腹胀（83%）和腹部压痛（44%）。7例患者（39%）有贫血，11例（61%）有白细胞增多，3例（17%）有血小板增多。13例（72%）有低蛋白血症。16例中10例（56%）各种标本的抗酸杆菌涂片、结核培养和聚合酶链反应呈阳性。16例进行腹部CT扫描的患者中有14例（88%）有腹水和腹腔淋巴结肿大。7例患者的12份组织样本中有9份显示慢性肉芽肿性炎症。17例接受四联抗结核治疗。6例还接受了手术。总体而言，15例患者在平均住院4.2周后出院时病情改善，3例死于败血症。15例中的11例出院后1个月情况良好。
腹膜结核表现为非特异性临床和实验室特征。放射学和组织学发现增加了诊断的可能性。对抗结核药物诊断和治疗的患者预后良好。
