Abdominal tuberculosis:-
(TB) includes infection of the gastrointestinal tract, peritoneum, mesentery, abdominal lymph nodes, liver, spleen, and pancreas. The most common forms of abdominal TB in children are adhesive peritonitis and nodal disease.
Clinical manifestations :-
The common presentation included fever, weight loss, and abdominal symptoms such as diarrhea, vomiting, and loss of appetite. Abdominal distension was observed in 1 case. The mean duration of symptoms prior to presentation was between 3 and 6 months. In the sixth case, the child was on outpatient follow-up for persistent hepatosplenomegaly with intermittent fevers following an infection with clinical features of infectious mononucleosis (Epstein-Barr virus serology was tested negative). It was in the third month of outpatient follow-up that he developed preauricular lymphadenitis with right index finger dactylitis, which necessitated hospital admission for further workup.
Causes:-
The most common forms of disease include involvement of the peritoneum, intestine, and/or liver. Tuberculosis of the abdomen may occur via reactivation of latent TB infection or by ingestion of tuberculous mycobacteria (as with ingestion of unpasteurized milk or undercooked meat)
Diagnosis:-
Tuberculin skin tests (Mantoux test) were examined 48–72 h after the intradermal injection of five tuberculin units of purified protein derivative. Tests were considered positive if the diameter of induration was ≥15 mm.
1.“Confirmed case of abdominal tuberculosis”—diagnosis based on the bacteriological identification of Mycobacterium tuberculosis .
2.“Clinically diagnosed abdominal tuberculosis”—diagnosis based on strong clinical suspicion and exclusion of other diseases, with suggestive features on imaging, histology (noncaseating granulomas and/or chronic inflammatory changes), and biochemistry (elevated ascitic adenosine deaminase >30 U/L) and with a subjective and/or objective response to antitubercular therapy (ATT) with no relapse within 3 months of completion of therapy.
Treatment:-
Most of the guidelines on the treatment of tuberculosis suggest that 6 months treatment is sufficient for extrapulmonary tuberculosis except for bone tuberculosis and tubercular meningitis. Despite these recommendations, most physicians treating abdominal tuberculosis use antituberculous therapy for 9 months, sometimes even 12 months without any scientific justification. In a randomized controlled trial, Balasubramaniam et al reported no difference in success rate of 6mo (99%) vs 12 months (94%) antituberculous drugs (conventional strategy) in the treatment of abdominal tuberculosis.
Although Directly Observed Therapy (DOTs) have been proved to be effective in patients with pulmonary tuberculosis, lymph nodal tuberculosis, however, there is a lack of data on efficacy of DOTS in other extra-pulmonary disease including abdominal tuberculosis. Therefore, there is an urgent need to establish the efficacy of DOTs strategy of antituberculous therapy in the treatment of abdominal tuberculosis.
Therefore, the investigators planned to conduct a multicenter randomized controlled trial to determine the difference in the recurrence of disease after only observation for three months and three months extension of DOTs in a subset of patients with definite clinical response after 6 months of DOTs.
