Abdominal tuberculosis

Tuberculosis (TB) still remains a major health problem worldwide. Even though TB most often affects the lungs, abdominal TB is the most important extrapulmonary manifestation. The entire gastrointestinal tract from mouth to anus (most often in the ileocecal region), the peritoneum, the abdominal lymph nodes and any solid abdominal organ can be affected. Abdominal TB can mimic other diseases, such as a neoplasm or inflammatory bowel disease. The diagnosis of abdominal TB is often delayed, especially if additional risk factors, such as HIV infection or immigration from a high-prevalence area are absent. The clinical presentation of abdominal TB is diverse and nonspecific symptoms, such as fever, weight loss and pain are common and ascites, obstruction, perforation and gastrointestinal bleeding can be the leading signs depending on the localization. Diagnosis is usually confirmed by detection of Mycobacterium tuberculosis by culturing or PCR from a biopsy or fine needle aspiration. Therapy consists of an initial regimen with isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months, which can be reduced to isoniazid, rifampicin and pyrazinamide as soon as resistance testing indicates full sensitivity. This is followed by isoniazid and rifampicin for an additional 4 months. Drug resistance, interactions and side effects have to be considered. A concomitant pulmonary TB has to be excluded as this may have an impact on isolation precautions and contact tracin.