Tuberculous peritonitis diagnosed using laparoscopy with assistance of a central venous catheter

Expression of Adenosine Deaminase and NLRP3 Inflammasome in Tuberculous Peritonitis and Their Relationship with Clinical Efficacy

Objective. Tuberculous peritonitis (TP) can cause multiple infections of surrounding organs and tissues, leading to organ failure and endangering life safety. In this research, the relationship between adenosine deaminase (ADA), NLRP3 inflammasome, and TP and its clinical significance will be deeply explored, so as to provide new directions and reliable reference opinions for future clinical diagnosis and treatment. Methods. Altogether, 59 TP patients (research group, RG) and 52 non-TP patients (control group, CG) who were admitted to our hospital from May 2014 to June 2018 were regarded as research objects. Ascites samples of RG before treatment (admission) and one month after treatment and CG before treatment were obtained, and the ADA and NLRP3 levels were tested to evaluate the clinical and prognostic significance of the two in TP. Results. Before treatment, ADA and NLRP3 in RG were higher than CG ( $P<0.05$ ), and the sensitivity and specificity of combined detection of the two in predicting TP occurrence were 89.83% and 73.08% ( $P<0.05$ ). In addition, ADA and NLRP3 in RG patients were positively correlated with the disappearance time of abdominal pain and ascites ( $P<0.05$ ) and had excellent predictive effect on the adverse reactions during treatment ( $P<0.05$ ). After treatment, both in RG patients decreased, which was inversely proportional to the clinical efficacy ( $P<0.05$ ). Prognostic follow-up manifested that ADA and NLRP3 in relapse patients were higher than those without recurrence after treatment ( $P<0.05$ ). Conclusion. The increase of ADA and NLRP3 in TP is relevant to the adverse reactions during treatment, clinical efficacy, and prognosis recurrence after treatment. It can be used as a disease marker to confirm, intervene, and evaluate TP progression promptly.

[Role of laparoscopy in the diagnosis of peritoneal tuberculosis in an endemic area of Tunisia]

Tuberculosis is a public health problem in Tunisia. Tataouine governorate is an endemic area. Peritoneal involvement occurs in 1 - 2% of cases. We here report a retrospective, descriptive epidemiological study of 32 patients operated in the Department of Surgery at the Tataouine Hospital between 2010 and 2020. Laparoscopy was mainly performed (28 patients) to take biopsy samples for histologic confirmation of peritoneal tuberculosis. Twenty-four women and 8 men were involved in the study, with a M/F ratio of 0.33. The median age was 43 years, ranging from 14 to 78 years. Diagnostic laparoscopy was performed in 28 cases (87.5%). Given the intraoperative macroscopic aspect, the diagnosis of peritoneal tuberculosis was strongly suspected in 16 patients (50%). The anatomopathological study confirmed the diagnosis in all patients. The purpose of this study is to highlight the epidemiological, clinical features of peritoneal tuberculosis in an endemic region of Tunisia as well as the current role of laparoscopy as a rapid and effective diagnostic procedure.

Visual Diagnosis of Pleural Tuberculosis and its Association with Tissue Biopsy, Culture and Xpert Assay

INTRODUCTION

 The diagnosis of pleural tuberculosis remains a clinical challenge due to the paucibacillary nature of disease. Medical thoracoscopy remains the gold standard in diagnosing tuberculous pleuritis.

OBJECTIVE

 To establish the diagnostic yield of sago-seed thoracoscopic appearance of pleura in tuberculosis and its correlation with histopathology, tissue AFB culture and tissue Xpert MTB/Rif assay.

METHODS

 All consecutive patients with lymphocytic exudative pleural effusion, who fulfilled inclusion criteria of the study underwent medical thoracoscopy under local anesthesia and pleural tissue was sent for histopathology, AFB culture and Xpert MTB/Rif assay. Chronic granulomatous inflammation on histopathology and response to anti-tuberculous treatment was taken as reference standard for diagnosis of tuberculous pleurisy.

RESULTS

 A total of 249 patients were included in the study, out of which 168 had effusion secondary to tuberculosis. Sago-like nodules visualized on thoracoscopy had a sensitivity of 58.9 %, specificity of 92.6 % and diagnostic accuracy of 69.88 % for pleural tuberculosis. There is a strong association between the presence of sago-like nodules and detection of mycobacterium tuberculosis on Xpert MTB/Rif assay and AFB culture of pleura (p-value 0.007).

CONCLUSION

 Sago seed nodules on pleura have a high positive predictive value for tuberculous pleurisy. In high endemic countries patients with this finding on thoracoscopy can be commenced on anti-tuberculous treatment before histopathology or culture results are available.