Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely available. In Congo there is little published data on this entity. Objectives: To describe the epidemiological, diagnostic, and progression characteristics of peritoneal tuberculosis at the university hospital center in Brazzaville. PatientsandMethods: This study is a descriptive and retrospective analysis conducted from January 1, 2015, to December 31, 2021, in the Gastroenterology and Internal Medicine department of the CHU of Brazzaville. It included all patients hospitalized during this period with a confirmed diagnosis of peritoneal tuberculosis, encompassing 54 records that met the inclusion criteria. Results: Out of the study period, 54 records that fulfilled the inclusion criteria were analyzed. The annual incidence of peritoneal tuberculosis was 7.7 patients, with a prevalence of 1.4%, showing a male predominance of 61% and an average age of 39.93 ± 14.62 years. The primary symptoms were abdominal bloating and abdominal pain, present in 100% and 74% of cases, respectively. The clinical presentation was primarily characterized by febrile ascites observed in all patients. HIV co-infection was noted in 29.6% of cases. Anemia was present in 79.6% of patients, and an elevated sedimentation rate was observed in 74% of cases. The tuberculin skin test returned positive in 50% of cases. The ascitic fluid was exudative, rich in proteins and white blood cells (exceeding 1000/mm3, predominantly lymphocytes) in the majority of cases (100%, 83.3%, 83.3%, respectively). The diagnosis was deemed highly probable based on the clinical and paraclinical signs and the favorable response to treatment in 79.6% of cases. There were instances of pleural involvement (33.3%) and lymph node involvement (pulmonary 22.2% and lymph node 16.6%). Treatment outcomes were favorable in 37% of cases, with a mortality rate of 9%. Conclusion: Peritoneal tuberculosis is prevalent in Brazzaville, predominantly affecting young males. The diagnosis relies chiefly on a combination of clinical, paraclinical, and progression indicators.
References
[1]
Mjid, M., Cherif, J., Ben Salah, N., Toujani, S., Ouahchi, Y., Zakhama, H., etal. (2015) Épidémiologie de la tuberculose. Revue de Pneumologie Clinique, 71, 67-72. https://doi.org/10.1016/j.pneumo.2014.04.002
[2]
Mazza-Stalder, J., Nicod, L. and Janssens, J.-P. (2012) La tuberculose extrapulmonaire. RevuedesMaladiesRespiratoires, 29, 566-578. https://doi.org/10.1016/j.rmr.2011.05.021
[3]
Bennani, A., Ouazzani, H., Fadili, F., et al. (1988) Diagnostic et aspects thérapeutiques de la tu-berculose péritonéale au Maroc. A propos de 300 cas. Annales de Gastroentérologie et d’Hépatologie, 24, 347-354.
[4]
Marshall, J.B. (1993) Tuberculosis of the Gastrointestinal Tract and Peritoneum. American Journal of Gastroenterology, 88, 989-990.
[5]
Sanai, F.M. and Bzeizi, K.I. (2005) Systematic Review: Tuberculous Peritonitis—Presenting Features, Diagnostic Strategies and Treatment. AlimentaryPharmacology&Therapeutics, 22, 685-700. https://doi.org/10.1111/j.1365-2036.2005.02645.x
[6]
Chow, K.M., Chow, V.C. and Szeto, C.C. (2003) Indication for Peritoneal Biopsy in Tuberculous Peritonitis. TheAmericanJournalofSurgery, 185, 567-573. https://doi.org/10.1016/s0002-9610(03)00079-5
[7]
Peghini, M., Rajaonarison, P., Pecarrère, J.L. and Razafindramboa, H. (1995) La tuberculose péritone-ale à Madagascar: A propos de 55 observations recueillies au Centre hospitalier de Soa-vinandriana à Antananarivo. Archives de l’Institut Pasteur de Madagascar, 62, 99-102.
[8]
El Ajmi, S., Chatti, N. and Limam, K. (1992) La tuberculose péritonéale. Aspects actuels à propos de 39 cas observés au centre tunisien. Médecine et chirurgie digestives, 21, 87-88.
[9]
Bemba, E.L.P., Okombi, F.O., Bopaka, R.G., Abacka, K.O., Koumeka, P.P. and Ayet, M.I. (2020) Profil Clinique et Évolutif de la Tuberculose au Service de Pneumophtisiologie du CHU de Brazzaville. Health Sciences and Disease, 21, 47-51.
[10]
Redah, D., Amedegnato, D., Napo-Koura, G., Doeh, E., Sanni, S., Carsuzaam, G. and Kpodzro, K. (1993) La tuberculose péritonéale au CHU de Lomé-Tokoin: À propos de 108 cas. Médecine et chirurgie digestives, 22, 104-106.
[11]
Hamdani, A., Sekkan, N., Alyoune, A., Merzouk, M., Moufid, S., Meknassi, A.E. and Mourid, A. (1987) Tuberculose péritonéale chez l’adulte. Etude de 207 cas. Annales de Gastroentérologie et d’Hépatologie, 23, 115-122.
[12]
Bennani, A., Chahed Ouazzani, H., Fadli, F., Dafiri, N. and Benaissa, A. (1986) La tuberculose ab-dominale. A propos de 345 cas. La Semaine des hopitaux de Paris, 62, 251-257.
[13]
El Ajmi, S., Chatti, N. and Limam, K. (1992) La tuberculose péritonéale. Aspects actuels à propos de 39 cas observés au centre tunisien. Médecine et chirurgie digestives, 21, 87-88.
[14]
Tolo, N., Keita, K., Dao, K., Traoré, A., Cissé, H., et al. (2024) Tuberculoses extra-pulmonaires: Aspects épidémiologiques, cliniques, diagnostiques et thérapeutiques en médecine interne. Jaccr Infectiology, 6, 17-22.
[15]
Cissé, M., Tandian, F., Konaté, I., Ka, O., Dieng, M., Dia, A., et al. (2009) Prise en charge de la tuberculose péritoneale en milieu chirurgical. A propos de 23 cas. Dakar Médical, 54, 219-225.
[16]
Fall, F., Ndiaye, A.R., Ndiaye, B., Gning, S.B., Diop, Y., Fall, B., etal. (2010) La tuberculose péritonéale: Étude rétrospective de 61 cas à l’hôpital Principal de Dakar. Journal Africain d'Hépato-Gastroentérologie, 4, 38-43. https://doi.org/10.1007/s12157-009-0143-4
[17]
Sankale, M. (1988) La tuberculose abdominale. Epidémiologie comparée de la tuberculose ab-dominale dans les pays développés et dans le tiers monde. Médecine et chirurgie digestives, 17, 119-120.
[18]
Mpemba Loufoua-Lemay, A.B. and Nzingoula, S. (2003) Tuberculose péritonéale de l’enfant au CHU de Brazzaville: À propos de 35 cas. Archives de Pédiatrie, 10, 358. https://doi.org/10.1016/s0929-693x(03)00047-2
[19]
Darré, T., Tchaou, M., Sonhaye, L., Patassi, A.A., Kanassoua, K., Tchangai, B., et al. (2015) Analyse d’une série de 44 cas de tuberculose péritonéale diagnostiqués au laboratoire d’anatomie pathologique du CHU Tokoin de Lomé (1993-2014). Bulletin de la Société de pathologie exotique, 108, 324-327. https://doi.org/10.1007/s13149-015-0458-x
[20]
Khoury, G.A., Payne, C.R. and Harvey, D.R. (1978) Tuberculosis of the Peritoneal Cavity. JournalofBritishSurgery, 65, 808-811. https://doi.org/10.1002/bjs.1800651113
[21]
Amouri, A., Boudabbous, M., Mnif, L. and Tahri, N. (2009) Profil actuel de la tuberculose péritonéale: étude d’une série tunisienne de 42 cas et revue de la littérature. La Revue de Médecine Interne, 30, 215-220. https://doi.org/10.1016/j.revmed.2008.09.005
[22]
Hanson, R. and Hunter, T. (1985) Tuberculous Peritonitis: CT Appearance. AmericanJournalofRoentgenology, 144, 931-932. https://doi.org/10.2214/ajr.144.5.931
[23]
Dembele, M., Maiga, M.Y., Minta, D.K., Traore, S.A., Sacko, M., Traore, A.K., et al. (2003) Tuberculose périfonéale dans un service de médecine interne en milieu tropical: Aspects clinique, biologique et laparoscopique Bamako—Mali. ActaEndoscopica, 33, 561-567. https://doi.org/10.1007/bf03002421
[24]
Elmghari, M., Zaghba, N., Benjelloun, H. and Yassine, N. (2017) La tuberculose péritonéale. Revue des Maladies Respiratoires, 34, A244-A245. https://doi.org/10.1016/j.rmr.2016.10.592
[25]
Fall, F., Ndiaye, A.R., Ndiaye, B., Gning, S.B., Diop, Y., Fall, B., etal. (2010) La tuberculose péritonéale: Étude rétrospective de 61 cas à l’hôpital Principal de Dakar. Journal Africain d’Hépato-Gastroentérologie, 4, 38-43. https://doi.org/10.1007/s12157-009-0143-4
[26]
Debray, C.H. and Geffroy, Y. (1977) Tuberculose péritonéale. Précis des maladies du tube Digestif. Masson, 784-790.
[27]
Piéron, R., Mafart, Y. and Lesobre, B. (1979) La laparoscopie chez le noir Africain Transplanté. A propos de 60 observations. La Semaine des hopitaux de Paris, 55, 130-136.
[28]
Sawadogo, A., Ilboudo, P., Zerbo, G., et al. (2001) Tuberculose péritonéale et infection par le VIH. Réflexion à propos de 22 cas à l’hôpital de Bolo Dioulasso, Burkina Faso. Bacteriology, 94, 296-300.
[29]
Thoreau, N., Fain, O., Babinet, P., et al. (2002) Tuberculose péritonéale. 27 cas dans la banlieue nordest de Paris. The International Journal of Tuberculosis and Lung Disease, 6, 253-258.
[30]
Quantrill, S.J., Woodhead, M.A., Bell, C.E., Hutchison, A.J. and Gokal, R. (2001) Peritoneal Tuberculosis in Patients Receiving Continuous Ambulatory Peritoneal Dialysis. NephrologyDialysisTransplantation, 16, 1024-1027. https://doi.org/10.1093/ndt/16.5.1024
[31]
Abolo, L. (1991) Tuberculose péritonéale à propos de 5 cas d’abdomens aigus récents opérés à l’hôpital central de Yaoundé. Journal de Chirurgie, 128, 377-380.
[32]
Gendron, Y., Aubry, P. and Peghini, M. (1982) Les aspects actuels de la tuberculose péritonéale en Afrique. Etude de 77 observations. Medecinetropicale, 42, 307-314.
[33]
Huebner, R.E., Schein, M.F. and Bass, J.B. (1993) The Tuberculin Skin Test. ClinicalInfectiousDiseases, 17, 968-975. https://doi.org/10.1093/clinids/17.6.968
[34]
Aubry, P., Capdevielle, P. and Gendron, Y. (1979) La tuberculose péritonéale en Afrique. Medecinetropicale, 39, 165-175.
[35]
Etienne, J.P., Chaput, J.C., Jost, B. and Groult, N. (1973) Les aspects actuels des péritonites tubercule-uses de l’adulte. Nouvelle Presse Medicale, 2, 371-374.
[36]
Nafeh, M.A., Medhat, A., Abdul-Hameed, A., Ahmad, Y.A., Rashwan, N.M. and Strickland, G.T. (1992) Tuberculous Peritonitis in Egypt: The Value of Laparoscopy in Diagnosis. TheAmericanJournalofTropicalMedicineandHygiene, 47, 470-477. https://doi.org/10.4269/ajtmh.1992.47.470
[37]
Singh, M.M., Bhargava, A.N. and Jain, K.P. (1969) Tuberculous Peritonitis. New England Journal of Medicine, 281, 1091-1094. https://doi.org/10.1056/nejm196911132812003
