Tuberculous peritonitis

Tuberculous Peritonitis is a form of tuberculosis that affects the peritoneum, the thin layer of tissue that lines the inside of the abdomen and covers most of the abdominal organs. This condition is a secondary form of tuberculosis and arises from the spread of the tuberculosis bacteria from another site in the body, often the lungs, to the peritoneum. It is considered a serious and potentially life-threatening condition if not diagnosed and treated promptly.

Causes and Risk Factors

Tuberculous peritonitis is caused by the bacterium Mycobacterium tuberculosis. The bacteria usually reach the peritoneum through the bloodstream or lymphatic system from a primary site of infection, typically the lungs. However, it can also spread from nearby abdominal organs such as the intestines. Risk factors for developing tuberculous peritonitis include a weakened immune system, HIV/AIDS, history of tuberculosis, or exposure to someone with active tuberculosis.

Symptoms

The symptoms of tuberculous peritonitis can be non-specific and may mimic other abdominal conditions. Common symptoms include:

• Abdominal pain and distension
• Fever
• Weight loss
• Night sweats
• Anorexia
• Diarrhea or constipation

Due to its vague symptomatology, diagnosis can often be delayed, leading to complications.

Diagnosis

Diagnosis of tuberculous peritonitis involves a combination of clinical assessment, imaging studies, and laboratory tests. Imaging studies such as ultrasound or CT scan of the abdomen can show ascites (fluid in the abdomen) and thickening of the peritoneum. Definitive diagnosis usually requires the analysis of peritoneal fluid obtained through a procedure known as paracentesis. Laboratory tests on the fluid typically show an elevated white cell count with a predominance of lymphocytes, elevated protein levels, and low glucose levels. The presence of Mycobacterium tuberculosis can be confirmed through culture, PCR, or histopathological examination.

Treatment

Treatment of tuberculous peritonitis involves a long course of multiple antibiotics, similar to the treatment of pulmonary tuberculosis. The standard regimen includes isoniazid, rifampicin, ethambutol, and pyrazinamide for a minimum of 6 months. The treatment may be adjusted based on drug sensitivity testing and the patient's response to therapy. In some cases, adjunctive surgery may be required to manage complications such as intestinal obstruction.

Prognosis

With timely and appropriate treatment, the prognosis for tuberculous peritonitis is generally good. However, delays in diagnosis and treatment can lead to complications and a worse outcome. Early detection and adherence to the treatment regimen are crucial for recovery.

Prevention

Prevention of tuberculous peritonitis involves controlling the spread of tuberculosis through public health measures, early detection and treatment of active tuberculosis cases, and treatment of latent tuberculosis infection in high-risk individuals.