• Anti-Saccharomyces cerevisiae antibody
• Peritoneal tuberculosis
• Xpert
• clinical response
• colonoscopy
• histology
• interferon gamma release assay
• polymerase chain reaction

• Humans
• Tuberculosis, Gastrointestinal/diagnosis
• Tuberculosis, Gastrointestinal/therapy
• Tuberculosis, Gastrointestinal/drug therapy
• Tuberculosis, Gastrointestinal/microbiology
• Antitubercular Agents/therapeutic use
• Antitubercular Agents/administration & dosage
• Peritonitis, Tuberculous/diagnosis
• Peritonitis, Tuberculous/microbiology
• Peritonitis, Tuberculous/drug therapy
• Peritonitis, Tuberculous/therapy
• Adenosine Deaminase/metabolism

• ascites
• laparoscopy
• peritonitis
• tuberculosis
• tuberculous peritonitis

• Ascites
• Children
• Portal hypertension
• Serum ascites albumin gradient

• Humans
• Ascites/etiology
• Ascites/diagnosis
• Male
• Female
• Child
• Retrospective Studies
• Child, Preschool
• Hypertension, Portal/diagnosis
• Hypertension, Portal/complications
• Ascitic Fluid/chemistry
• Ascitic Fluid/metabolism
• Adolescent
• Infant
• Serum Albumin/analysis
• Diagnosis, Differential
• Sensitivity and Specificity

• Ascitic fluid
• GenExpert MTB/RIF
• HIV/AIDS
• Peritoneal tuberculosis
• Small bowel obstruction

• Diagnostic challenge
• Gastrointestinal tuberculosis
• Infectious diseases
• Mycobacterium
• Tuberculosis

• Adenosina desaminasa
• Adenosine deaminase
• Líquido sinovial
• Sensibilidad y especificidad
• Sensitivity and specificity
• Synovial fluid
• Tuberculosis

• Humans
• Adenosine Deaminase/analysis
• Synovial Fluid/chemistry
• Sensitivity and Specificity
• Tuberculosis, Osteoarticular
• Arthritis

• Bacillus Calmette–Guérin
• Bladder cancer
• Peritoneal tuberculosis

• ADA
• Ascitic fluid
• Meta-analysis
• Systematic review
• Tuberculous peritonitis

• Ascites
• Ascitic fluid
• Case report
• Peritoneal tuberculosis
• Tuberculosis
• Tuberculosis-gastrointestinal

• ascites
• extrapulmonary
• peritoneal
• tuberculosis

Portal vein thrombosis associated with peritoneal tuberculosis is an uncommon manifestation of extrapulmonary tuberculosis. We report one such case of a 33-year-old male with a one-year history of dyspepsia, having been on proton pump inhibitors all this time with temporary relief. In view of ongoing symptoms, an endoscopy was done, which at first showed duodenal ulcer. On repeat endoscopy after an interval, there was evidence of mucosa-associated lymphoid tissue (MALT) lymphoma, which prompted a host of investigations in the patient. A positron emission tomography (PET) scan revealed extensive omento-peritoneal involvement along with a hypodense lesion in the liver with interval development of portal vein thrombosis on a CT scan of the abdomen. The biopsy of the hepatic lesion showed granulomatous inflammation. Faced with a diagnostic dilemma, finally, a laparoscopic biopsy was done, which confirmed the diagnosis of peritoneal TB with portal vein thrombosis.

This case highlights the importance of keeping a high index of suspicion to include tuberculosis as a differential when presented with a case such as this and to conduct appropriate investigations to establish the correct diagnosis.

• abdominal tuberculosis
• adenosine deaminase
• ascites
• diagnostic value
• meta-analysis

• Ascitic adenosine deaminase
• Ascitic tumor markers
• Peritoneal carcinomatosis
• Tuberculous peritonitis

• Adenosine Deaminase
• Ascitic Fluid
• Biomarkers, Tumor
• CA-19-9 Antigen
• Carcinoembryonic Antigen
• Diagnosis, Differential
• Humans
• Peritoneal Neoplasms/diagnosis
• Peritonitis, Tuberculous/diagnosis
• Retrospective Studies

• 2020CFB421 Science and Technology Department, Hubei Provincial People's Government
• 82070631 National Natural Science Foundation of China
• Science and Technology Department, Hubei Provincial People’s Government

Ascites is defined as the accumulation of fluid in the peritoneal cavity, following an imbalance between production and reabsorption; it is detectable from 50 mL on ultrasound. Three mechanisms have been classically implicated, according to Starling's forces: an increase in the hydrostatic pressure gradient (increased portal venous pressure), a reduction in the oncotic pressure gradient (loss of total proteins, especially albumin), and an increase in peritoneal capillary permeability. This latter mechanism, plus the difference between lymph production and excretion (which favors the accumulation of exudate), explains some of the most notable causes of non-hypertensive ascites (according to the serum albumin in ascites gradient (SAAG)), including peritoneal carcinomatosis and tuberculosis. We present the case of a young man, originally from a tuberculosis endemic area, in whom the study of ascitic fluid guided the workup and the definitive diagnosis, which was unexpected for his age. Finally, a practical approach to non-hypertensive ascites is provided.

• CT
• FNAC
• MRI
• Tuberculosis
• Ultrasonography

• Diagnosis, Differential
• Humans
• Tuberculosis/diagnosis

• Carcinoma/diagnosis
• Humans
• Peritoneal Neoplasms/diagnosis
• Peritonitis, Tuberculous/diagnosis

• gastrointestinal system
• gynaecology and fertility
• infections
• obstetrics

• Abdomen/diagnostic imaging
• Adult
• Ascites/diagnosis
• Ascites/etiology
• CA-125 Antigen
• Carcinoma, Ovarian Epithelial/diagnosis
• Diagnosis, Differential
• Female
• Humans
• Ovarian Neoplasms/diagnosis
• Tuberculosis, Lymph Node/diagnosis

• Mycobacterium Tuberculosis
• high-burden tuberculosis country
• multi-drug resistant tuberculosis
• peritoneal dialysis
• peritonitis

• Humans
• Kidney Failure, Chronic/therapy
• Peritoneal Dialysis/adverse effects
• Peritonitis, Tuberculous/etiology

Adult-onset Still's disease (AOSD) is a systemic inflammatory disease of unknown etiology, lacking specific diagnosis and disease activity evaluation indicators. This study will analyze the activity and clinical significance of Adenosine deaminase (ADA) in AOSD patients.

Totally 53 AOSD patients, 60 patients with other autoimmune diseases including systemic lupus erythematosus (SLE), sjogren syndrome (SS) and rheumatoid arthritis (RA), as well as 60 healthy subjects were included in this study. AOSD activity was determined by Pouchot score. We analyzed the correlation between ADA activity and clinical parameters. In addition, the correlation between ADA activity and disease activity score was also analyzed.

This study showed that the activity of ADA in AOSD patients was significantly higher than that of healthy controls, SLE, SS and RA patient groups (p < 0.0001). The ADA activity of AOSD patients decreased significantly after systemic treatment (p < 0.0001). Correlation analysis showed that ADA activity was positively correlated with ALT(r = 0.54, p < 0.0001), AST (r = 0.82, p < 0.0001) and serum ferritin (r = 0.67, p < 0.001). ADA activity was negatively correlated with white blood cell (r = − 0.42, p = 0.002) and platelet counts (r = − 0.44, p = 0.001). We also found a significant positive correlation between the activity of ADA and Pouchot score in AOSD patients (r = 0.51, p = 0.001). Receiver operating characteristic (ROC) curve analysis showed that ADA activity had a sensitivity of 93.3%, and a specificity of 83% for the diagnosis of AOSD, with an area under the curve of 0.93.

This study showed that serum ADA activity can be used as a potential biomarker for AOSD diagnosis and disease activity assessment.

• Abdominal TB
• I-PCR
• NAATs
• colonoscopy
• diagnosis
• histopathology
• imaging
• intestinal TB
• laparoscopy
• peritoneal TB

• ADA, Adenosine deaminase
• AFB, Acid-fast bacilli
• AKI, Acute kidney injury
• ATT, Anti-Tuberculosis therapy
• AUROC, Area under receiver operator curve
• CI, Confidence interval
• CT, Computed tomography
• CTP, Child-Turcotte-Pugh
• DILI, Drug-induced liver injury
• EPTB, Extrapulmonary Tuberculosis
• LSM, Liver stiffness measurement
• MELD, Model for End-stage liver disease
• MELD-Na, Model for End-stage liver disease with sodium
• MTB, Mycobacterium Tuberculosis
• NAAT, Nucleic acid amplification test
• SAAG, Serum-ascitic albumin gradient
• SBE, Spontaneous bacterial empyema
• SBP, Spontaneous Bacterial Peritonitis
• SD, Standard deviation
• SPAG, Serum-pleural fluid albumin gradient
• TB, Tuberculosis
• ZN, Ziehl-Neilson
• adenosine deaminase
• antituberculosis therapy
• chronic liver disease
• cirrhosis
• mTB-PCR, multiplex TB-polymerase chain reaction
• tuberculosis

• Adenosine deaminase
• Chylous ascites
• Mycobacteria avium
• Nontuberculous mycobacteria
• Peritoneal dialysis-related peritonitis case report

• abdominal tuberculosis
• ovarian cancer
• primary peritoneal cancer

• Adenosine deaminase
• Liver cirrhosis
• Peritonitis
• Tuberculosis

• Adenosine Deaminase
• Ascites/diagnosis
• Ascites/etiology
• Ascitic Fluid
• Humans
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis
• Peritonitis, Tuberculous/diagnosis
• Sensitivity and Specificity

• Abdominal tuberculosis
• clinical features
• diagnosis
• extrapulmonary tuberculosis
• gastrointestinal tuberculosis
• pathogenesis
• risk factors
• treatment
• tuberculosis

• Humans
• Mycobacterium tuberculosis
• Prevalence
• Tuberculosis, Gastrointestinal/diagnosis
• Tuberculosis, Gastrointestinal/drug therapy
• Tuberculosis, Gastrointestinal/epidemiology

• Crohn’s disease
• Intestine
• Pediatrics
• Tuberculosis

• colonoscopy
• crohn’s disease
• inflammatory bowel disease
• laparascopy
• tuberculosis

• Extrapulmonary tuberculosis
• Gastrointestinal Mycobacterium avium complex infection
• Gastrointestinal tuberculosis
• Granulomatous hepatitis
• Inflammatory bowel disease
• Peritoneal tuberculosis
• Tuberculosis-associated immune reconstitution inflammatory syndrome

• Abdominal pain
• Adenosine deaminase
• Ascites
• Liver

Gas forming liver abscess (GFLA) though rare is seen in diabetic patients. Rupture of such abscesses usually requires surgical intervention. These cases are associated with high morbidity and mortality due to sepsis. Tuberculous liver abscesses are more often silent in presentation. GFLA formed in the background of a tuberculous liver abscess is rare. We present a case of ruptured GFLA with underlying tuberculous pathology in a normoglycemic patient. The abscess was managed by image guided intervention. A brief case report along with review of literature is presented.

• gas forming liver abscess
• rupture
• tuberculosis

Background: Tuberculous peritonitis (TP) is a common form of abdominal tuberculosis (TB). Diagnosing TP remains challenging in clinical practice. The aim of the present meta-analysis was to evaluate the diagnostic accuracy of peripheral blood (PB) T-SPOT and peritoneal fluid (PF) T-SPOT for diagnosing TP.

Methods: PubMed, EmBase, Cochrane, Scopus, Google scholar, China national knowledge internet, and Wan-Fang databases were searched for relevant articles from August 1, 2005 to July 5, 2020. Statistical analysis was performed using Stata, Revman, and Meta-Disc software. Diagnostic parameters including pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were determined. Summary receiver operating characteristic curve was used to determine the area under the curve (AUC).

Results: Twelve studies were eligible and included in the meta-analysis. The analysis showed that the pooled sensitivity and specificity of PB T-SPOT in diagnosing TP were 0.91 (95% CI, 0.88–0.94) and 0.78 (95% CI, 0.73–0.81), respectively, while the pooled PLR, NLR, and DOR were 4.05 (95% CI, 2.73–6.01), 0.13 (95% CI, 0.07–0.23), and 37.8 (95% CI, 15.04–94.98), respectively. On the other hand, the summary estimates of sensitivity, specificity, PLR, NLR, and DOR of PF T-SPOT for TP diagnosis were 0.90 (95% CI, 0.85–0.94), 0.78 (95% CI, 0.72–0.83), 6.35 (95% CI, 2.67–15.07), 0.14 (95% CI, 0.09–0.21), and 58.22 (95% CI, 28.76–117.83), respectively. Furthermore, the AUC of PB T-SPOT and PF T-SPOT for TP diagnosis were 0.91 and 0.94, respectively.

Conclusions: Our results indicate that both PB T-SPOT and PF T-SPOT can be served as sensitive approaches for the diagnosis of TP. However, the unsatisfactory specificities of these two methods limit their application as rule-in tests for TP diagnosis. Furthermore, the standardization of the operating procedure of PF T-SPOT is further needed.

• Mycobacterium tuberculosis
• T-SPOT.TB assay
• diagnosis
• peripheral blood
• peritoneal fluid
• tuberculous peritonitis

•

A rare case of Tuberculosis Peritonitis regarding the aspect of perioperative infection control.

Tuberculous peritonitis (TBP) is uncommon in Japan, and its diagnosis with conventional methods is time taking and requires a high clinical index of suspicion. Laparoscopy with peritoneal biopsy is a tool for rapid and accurate diagnosis of TBP. However, few cases have mentioned the infectious control and prevention during the perioperative period.

This case is written following the SCARE scale for case report writing.

A 30-year-old man from Southeast Asia with a past medical history of pulmonary tuberculosis at 3-year-old admitted to our institution with abdominal pain and slight fever lasting for a week. With the elevation of inflammatory response and CA125, we conducted CT (Computed tomography). Not only ascites, panniculitis with peritoneal nodules, and the thickening of the omentum were found. Considering the possibility of malignancy and TBP, we performed a diagnostic laparoscopy. Slightly cloudy ascites, peritoneal and thickening omentum with white nodules were seen, and pathological diagnosis from the omentum during the operation raised the possibility of TBP due to its caseating granuloma and these findings allowed us to start the rapid treatment.

We reported the effectiveness of diagnostic laparoscopy along with the aspect of perioperative prevention for TBP.

• Diagnostic laparoscopy
• Laparoscopic features
• Minimal invasion
• Perioperative infection control
• Tuberculous peritonitis (TBP)

• abdominal
• children
• gastrointestinal
• tuberculosis

Tuberculous peritonitis is difficult to diagnose due to its varying clinical features, in addition to the low yield on bacterial culture or polymerase chain reaction using ascitic fluid samples. This study aimed to investigate the sensitivity and specificity of elevated adenosine deaminase (ADA) levels as a diagnostic marker for tuberculous peritonitis.

A retrospective cohort of 181 adult patients who underwent ascitic fluid ADA level examination at Jichi Medical University Hospital between January 2006 and December 2015 were included. We collected data regarding ascitic fluid analyses including ADA levels, bacteriology and cytology, final diagnosis (cause of ascites), basis of the diagnosis, duration to diagnosis, and disease outcome.

Among 181 patients, elevated ascitic ADA levels (≥40 IU/L) were observed in 15 patients (median, 87.2 IU/L; range, 44.0–176.1 IU/L); 8 patients had tuberculous peritonitis, 4 had lymphoma-related ascites, and 2,had peritoneal carcinomatosis with bacterial coinfection, and 1 had chlamydial pelvic inflammatory disease. Among 166 patients without ascitic ADA level elevation (median, 7.3 IU/L; range, <2.0–39.1 IU/L), none had tuberculosis, 4 had lymphoma-related ascites, 28 had cancer/mesothelioma-related ascites, and 134 had ascites due to other causes. In our cohort, elevated ascitic fluid ADA levels (≥40 IU/L) showed 100% sensitivity, 96.0% specificity, 53.3% positive predictive value (PPV), and 100% negative predictive value for the diagnosis of peritoneal tuberculosis.

Ascitic fluid ADA levels ≥40 IU/L showed excellent sensitivity, despite a low PPV, for the diagnosis of tuberculous peritonitis. Lymphoma-related ascites is an important mimic of tuberculous peritonitis that can result in high ascitic fluid ADA levels with similar clinical manifestations.

To investigate the diagnostic value of interferon-gamma release assays combined with multiple indicators for tuberculous peritonitis.

Patients who were admitted to the hospital due to suspected tuberculous peritonitis were prospectively included during the 30-month study period. Moreover, healthy individuals were recruited and included in the control group. All the study participants were assessed using various indexes, such as interferon-gamma release assays.

A total of 180 patients with suspected tuberculous peritonitis were enrolled, and 24 were excluded. 73 patients with a confirmed diagnosis of tuberculous peritonitis were included in the tuberculous peritonitis group, 83 patients with other diseases in the other-disease control group, and 52 healthy individuals in the control group. Moreover, 83 patients in the other-disease control group and 52 participants in the control group were identified as 135 nontuberculous peritonitis patients. The area under the receiver operating characteristics curve for the QuantiFERON-TB test was 0.851 (95% confidence interval: 0.799–0.903), and the optimal cutoff value was 0.55 IU/mL, which corresponds to a sensitivity and specificity of 86.30% and 80.00%, respectively. The receiver operating characteristic curves for the combination of the QuantiFERON-TB test and the use of erythrocyte sedimentation rate, serum adenosine deaminase level, serum cancer antigen 125 level, and hypersensitive C-reactive protein level had an area under the curve of 0.859 (95% confidence interval: 0.809–0.909), with a sensitivity and specificity of 97.26% and 62.96%, respectively.

The combined use of the QuantiFERON-TB test and multiple indexes can significantly improve the accuracy of diagnosing tuberculous peritonitis.

• polycythemia vera
• ruxolitinib
• tuberculosis peritonitis

Peritoneal tuberculosis is the most common cause of low albumin gradient ascites in developing countries, but it can be easily confused with other causes of ascites. Peritoneal tuberculosis requires early recognition of symptoms and signs in order to make a quick diagnosis for appropriate treatment. Measurement of adenosine deaminase (ADA) level > 39 in ascites fluid is an established test to diagnose peritoneal tuberculosis. Many low-income countries do not currently test for adenosine deaminase in ascites fluid, including Rwanda.

Cross-sectional, descriptive study conducted through the Internal Medicine Department of three university teaching hospitals in Rwanda. Participants were patients older than 16 years presenting to tertiary referral hospitals with ascites of unknown cause.

Of 103 ascites fluid samples collected, 52 of them (50.5%) had an elevated ADA, consistent with a presumptive diagnosis of peritoneal TB. Among those 52 subjects diagnosed with peritoneal TB, 39 out of 52 (75%) did not receive anti-TB medications. Among the 17 subjects who were treated with anti-TB medications, 4 of 17 (23.6%) did not have peritoneal TB based on ADA level. Samples with low-albumin gradient ascites were more likely to have high ADA ≥39 IU/L (p = 0.039).

Our findings suggest that 3out of 4 patients with PTB in Rwanda are not getting TB treatment and 1 in 4 patients who are taking TB medications do not need it. Even if the true number of Rwandans who are being undertreated and overtreated is less than our study suggests, these results should prompt a larger study of peritoneal tuberculosis. Adding adenosine deaminase (ADA) to the diagnostic tools available to clinicians could help achieve the goal of correctly putting every Rwandan with tuberculosis on treatment, while avoiding unnecessary tuberculosis medications in those who do not have the disease.

• Adenosine deaminase
• Infectious disease
• Rwanda
• Tuberculosis

Abdominal tuberculosis is an uncommon variant of extrapulmonary tuberculosis. It accounts for 3.5% of extrapulmonary tuberculosis. Diagnosis of abdominal tuberculosis is still a challenge due to its non-specific symptoms. Abdominal tuberculosis and ovarian cancer may show similar symptoms, laboratory and imaging features. The goal of our report is to emphasize for the need of a diagnostic approach based on clinical manifestations, laboratory, imaging findings, and additional tests for considering a diagnosis of abdominal tuberculosis rather than ovarian cancer.

We report 3 cases of abdominal tuberculosis in our Onco-gynaecology Division, Department of Obstetrics and Gynaecology, Sardjito Hospital, Yogyakarta, Indonesia in 2018 which were previously diagnosed as ovarian malignancy and managed surgically. All of our patients experienced abdominal pain and enlargement but only two of them had significant weight loss. The general symptoms were typically found in onco-gynaecology patients, especially in those with ovarian malignancy. Ultrasound examination showed multilocular masses, 2 of them with solid parts and ascites. Cancer antigen 125 (CA-125) levels were found increasing in those three patients. All of them were treated surgically and diagnosis of abdominal tuberculosis was established through the histopathological result of tissue biopsy. Based on our cases and literature, we consider the need of a diagnostic approach to differentiate abdominal tuberculosis from ovarian malignancy, an attempt to avoid unnecessary invasive procedures that put burden risk for the patients.

Minimally invasive tests to establish the diagnosis of abdominal tuberculosis should be optimized to reduce the burden risk of laparotomy. Careful diagnostic steps should be followed to avoid wrong diagnosis.

• Abdominal tuberculosis
• Diagnosis
• Laparotomy
• Ovarian mass

Extravascular body fluids (EBF) analysis can provide useful information in the differential diagnosis of conditions that caused their accumulation. Their unique nature and particular requirements accompanying EBF analysis need to be recognized in order to minimize possible negative implications on patient safety. This recommendation was prepared by the members of the Working group for extravascular body fluid samples (WG EBFS). It is designed to address the total testing process and clinical significance of tests used in EBF analysis. The recommendation begins with a chapter addressing validation of methods used in EBF analysis, and continues with specific recommendations for serous fluids analysis. It is organized in sections referring to the preanalytical, analytical and postanalytical phase with specific recommendations presented in boxes. Its main goal is to assist in the attainment of national harmonization of serous fluid analysis and ultimately improve patient safety and healthcare outcomes. This recommendation is intended to all laboratory professionals performing EBF analysis and healthcare professionals involved in EBF collection and processing. Cytological and microbiological evaluations of EBF are beyond the scope of this document.

• ascites
• harmonization
• pericardial effusion
• pleural effusion