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Childhood abdominal tuberculosis: Disease patterns, diagnosis, and drug resistance

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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 intrabdominal 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.

Conclusion

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.

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References

  1. Chadha VK, Sarin R, Narang P, et al. Trends in the annual risk of tuberculous infection in India. Int J Tuberc Lung Dis. 2013;17:312–9.

    Article  PubMed  CAS  Google Scholar 

  2. World Health Organization. WHO Global tuberculosis report 2014. 2014.

    Google Scholar 

  3. Mukherjee JS, Joseph JK, Rich ML, et al. Clinical and programmatic considerations in the treatment of MDR-TB in children: a series of 16 patients from Lima, Peru. Int J Tuberc Lung Dis. 2003;7:637–44.

    PubMed  CAS  Google Scholar 

  4. Shah I, Rahangdale A. Partial extensively drug resistance (XDR) tuberculosis in children. Indian Pediatr. 2011;48:977–9.

    PubMed  Google Scholar 

  5. Seddon JA, Hesseling AC, Godfrey-Faussett P, Fielding K, Schaaf HS. Risk factors for infection and disease in child contacts of multidrug-resistant tuberculosis: a cross-sectional study. BMC Infect Dis. 2013;13:392.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schaaf HS, Shean K, Donald PR. Culture confirmed multidrug resistant tuberculosis: diagnostic delay, clinical features, and outcome. Arch Dis Child. 2003;88:1106–11.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  7. Seddon JA, Hesseling AC, Willemse M, Donald PR, Schaaf HS. Culture-confirmed multidrug-resistant tuberculosis in children: clinical features, treatment, and outcome. Clin Infect Dis. 2012;54:157–66.

    Article  PubMed  Google Scholar 

  8. Seddon JA, Hesseling AC, Marais BJ, Jordaan A, Victor T, Schaaf HS. The evolving epidemic of drug-resistant tuberculosis among children in Cape Town, South Africa. Int J Tuberc Lung Dis. 2012;16:928–33.

    Article  PubMed  CAS  Google Scholar 

  9. Schaaf HS, Moll AP, Dheda K. Multidrug- and extensively drug-resistant tuberculosis in Africa and South America: epidemiology, diagnosis and management in adults and children. Clin Chest Med. 2009;30:667–83.

    Article  PubMed  Google Scholar 

  10. Carricajo A, Fonsale N, Vautrin AC, Aubert G. Evaluation of BacT/Alert 3D liquid culture system for recovery of mycobacteria from clinical specimens using sodium dodecyl (lauryl) sulfate NaOH decontamination. J Clin Microbiol. 2001;39:3799–800.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  11. Treatment of childhood tuberculosis: consensus Statement of IAP Working Group. Indian Academy of Pediatrics. Indian Pediatr. 1997;34:1093–6.

  12. Goyal JP, Shah VB, Kukkar SR. Consensus statement on childhood tuberculosis. Indian Pediatr. 2010;47:539–40.

    PubMed  Google Scholar 

  13. Drobac PC, Mukherjee JS, Joseph JK, et al. Community-based therapy for children with multidrug-resistant tuberculosis. Pediatrics. 2006;117:2022–9.

    Article  PubMed  Google Scholar 

  14. Schaaf HS, Marais BJ. Management of multidrug-resistant tuberculosis in children: a survival guide for paediatricians. Paediatr Respir Rev. 2011;12:31–8.

    Article  PubMed  Google Scholar 

  15. Singh V, Kaur S. Multi-drug resistant childhood tuberculosis. Indian J Pediatr. 2011;78:456–63.

    Article  PubMed  Google Scholar 

  16. Dhiman RK, Saraswat VA, Rajekar H, Reddy C, Chawla YK. A guide to the management of tuberculosis in patients with chronic liver disease. J Clin Exp Hepatol. 2012;2:260–70.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Yew WW, Leung CC. Antituberculosis drugs and hepatotoxicity. Respirology. 2006;11:699–707.

    Article  PubMed  Google Scholar 

  18. Essop AR, Posen JA, Hodkinson JH, Segal I. Tuberculosis hepatitis: a clinical review of 96 cases. Q J Med. 1984;53:465–77.

    PubMed  CAS  Google Scholar 

  19. Kapoor VK. Abdominal tuberculosis: the Indian contribution. Indian J Gastroenterol. 1998;17:141–7.

    PubMed  CAS  Google Scholar 

  20. Thapa BR, Yachha SK, Mehta S. Abdominal tuberculosis. Indian Pediatr. 1991;28:1093–100.

    PubMed  CAS  Google Scholar 

  21. Basu S, Ganguly S, Chandra PK, Basu S. Clinical profile and outcome of abdominal tuberculosis in Indian children. Singapore Med J. 2007;48:900–5.

    PubMed  CAS  Google Scholar 

  22. Tinsa F, Essaddam L, Fitouri Z, et al. Abdominal tuberculosis in children. J Pediatr Gastroenterol Nutr. 2010;50:634–8.

    Article  PubMed  Google Scholar 

  23. Hablani N, Souei Mhiri M, Tlili Graies K, Jemni Gharbi H, Abdallah S, Bel Hadj Hamida R. Pseudotumoral form of abdominal tuberculosis: report of four cases. J Radiol. 2005;86:1021–5.

    Article  PubMed  CAS  Google Scholar 

  24. Radhika S, Rajwanshi A, Kochhar R, Kochhar S, Dey P, Roy P. Abdominal tuberculosis. Diagnosis by fine needle aspiration cytology. Acta Cytol. 1993;37:673–8.

    PubMed  CAS  Google Scholar 

  25. Dinler G. Tuberculous peritonitis in children: report of nine patients and review of the literature. World J Gastroenterol. 2008;14:7235.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Demir K, Okten A, Kaymakoglu S, et al. Tuberculous peritonitis—reports of 26 cases, detailing diagnostic and therapeutic problems. Eur J Gastroenterol Hepatol. 2001;13:581–5.

    Article  PubMed  CAS  Google Scholar 

  27. Misra SP, Misra V, Dwivedi M, Gupta SC. Colonic tuberculosis: clinical features, endoscopic appearance and management. J Gastroenterol Hepatol. 1999;14:723–9.

    Article  PubMed  CAS  Google Scholar 

  28. Mukewar S, Mukewar S, Ravi R, Prasad A, Dua KS. Colon tuberculosis: endoscopic features and prospective endoscopic follow-up after anti-tuberculosis treatment. Clin Transl Gastroenterol. 2012;3: e24.

  29. Singh V, Kumar P, Kamal J, Prakash V, Vaiphei K, Singh K. Clinicocolonoscopic profile of colonic tuberculosis. Am J Gastroenterol. 1996;91:565–8.

    PubMed  CAS  Google Scholar 

  30. Bhargava DK, Tandon HD, Chawla TC, Shriniwas, Tandon BN, Kapur BM. Diagnosis of ileocecal and colonic tuberculosis by colonoscopy. Gastrointest Endosc. 1985;31:68–70.

    Article  PubMed  CAS  Google Scholar 

  31. Becerra MC, Swaminathan S. Commentary: a targets framework: dismantling the invisibility trap for children with drug-resistant tuberculosis. J Public Health Policy. 2014;35:425–54.

    Article  PubMed  Google Scholar 

  32. Poorana Ganga Devi NP, Swaminathan S. Drug-resistant tuberculosis: pediatric guidelines. Curr Infect Dis Rep. 2013;15:356–63.

    Article  PubMed  Google Scholar 

  33. Swaminathan S, Rekha B. Pediatric tuberculosis: global overview and challenges. Clin Infect Dis. 2010;50 Suppl 3:S184–94.

  34. Shah I, Uppuluri R. Clinical profile of abdominal tuberculosis in children. Indian J Med Sci. 2010;64:204–9.

    Article  PubMed  Google Scholar 

  35. Shah I. Multidrug-resistant tuberculosis in children from 2003 to 2005: a brief report. Indian J Med Microbiol. 2012;30:208–11.

    Article  PubMed  CAS  Google Scholar 

  36. Berney T, Badaoui E, Tötsch M, Mentha G, Morel P. Duodenal tuberculosis presenting as acute ulcer perforation. Am J Gastroenterol. 1998;93:1989–91.

    Article  PubMed  CAS  Google Scholar 

  37. Gupta SK, Jain AK, Gupta JP, Agrawal AK, Berry K. Duodenal tuberculosis. Clin Radiol. 1988;39:159–61.

    Article  PubMed  CAS  Google Scholar 

  38. Kela M, Agrawal A, Sharma R, Agarwal R, Agarwal VB. Ileal tuberculosis presenting as a case of massive rectal bleeding. Clin Exp Gastroenterol. 2009;2:129–31.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Talwar BS, Talwar R, Chowdhary B, Prasad P. Abdominal tuberculosis in children: an Indian experience. J Trop Pediatr. 2000;46:368–70.

    Article  PubMed  CAS  Google Scholar 

  40. Sharma AK, Agarwal LD, Sharma CS, Sarin YK. Abdominal tuberculosis in children: experience over a decade. Indian Pediatr. 1993;30:1149.

    PubMed  CAS  Google Scholar 

  41. Machingaidze S, Wiysonge CS, Gonzalez-Angulo Y, et al. The utility of an interferon gamma release assay for diagnosis of latent tuberculosis infection and disease in children: a systematic review and meta-analysis. Pediatr Infect Dis J. 2011;30:694–700.

    Article  PubMed  Google Scholar 

  42. Devarbhavi H, Dierkhising R, Kremers WK, Sandeep MS, Karanth D, Adarsh CK. Single-center experience with drug-induced liver injury from India: causes, outcome, prognosis, and predictors of mortality. Am J Gastroenterol. 2010;105:2396–404.

    Article  PubMed  Google Scholar 

  43. Devarbhavi H, Singh R, Patil M, Sheth K, Adarsh CK, Balaraju G. Outcome and determinants of mortality in 269 patients with combination anti-tuberculosis drug-induced liver injury. J Gastroenterol Hepatol. 2013;28:161–7.

    Article  PubMed  CAS  Google Scholar 

  44. Kumar R, Bhatia V, Khanal S, et al. Antituberculosis therapy-induced acute liver failure: magnitude, profile, prognosis, and predictors of outcome. Hepatology. 2010;51:1665–74.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India

    Rohan Malik, Anshu Srivastava, Surender K. Yachha & Ujjal Poddar

  2. Department of Pediatric Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India

    Richa Lal

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  1. Rohan Malik
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  2. Anshu Srivastava
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Corresponding author

Correspondence to Surender K. Yachha.

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RM, AS, SKY, UP, and RL declare that they have no competing interests.

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The authors confirm that the study was performed in a manner that conforms with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights.

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Malik, R., Srivastava, A., Yachha, S.K. et al. Childhood abdominal tuberculosis: Disease patterns, diagnosis, and drug resistance. Indian J Gastroenterol 34, 418–425 (2015). https://doi.org/10.1007/s12664-015-0582-3

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  • DOI: https://doi.org/10.1007/s12664-015-0582-3

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