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Open Access Research article

Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia

Edford Sinkala1, Sylvia Gray2, Isaac Zulu13, Victor Mudenda1, Lameck Zimba1, Sten H Vermund4, Francis Drobniewski56 and Paul Kelly15*

Author Affiliations

1 Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine, Lusaka, Zambia

2 Harvard Medical School, Boston, MA, USA

3 University of Alabama at Birmingham, Birmingham, AL, USA

4 Vanderbilt University School of Medicine, Nashville, TN, USA

5 Barts & The London School of Medicine, Queen Mary University of London, London, UK

6 UK Health Protection Agency, London, UK

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BMC Infectious Diseases 2009, 9:44  doi:10.1186/1471-2334-9-44

Published: 17 April 2009

Abstract

Background

The diagnosis of abdominal tuberculosis (TB) is difficult, especially so in health care facilities in developing countries where laparoscopy and colonoscopy are rarely available. There is little information on abdominal TB in HIV infection. We estimated the prevalence and clinical features of abdominal (excluding genitourinary) TB in HIV infected adults attending the University Teaching Hospital, Zambia.

Methods

We screened 5,609 medical inpatients, and those with fever, weight loss, and clinical features suggestive of abdominal pathology were evaluated further. A clinical algorithm was used to specify definitive investigations including laparoscopy or colonoscopy, with culture of biopsies and other samples.

Results

Of 140 HIV seropositive patients with these features, 31 patients underwent full evaluation and 22 (71%) had definite or probable abdominal TB. The commonest presenting abdominal features were ascites and persistent tenderness. The commonest ultrasound findings were ascites, para-aortic lymphadenopathy (over 1 cm in size), and hepatomegaly. Abdominal TB was associated with CD4 cell counts over a wide range though 76% had CD4 counts <100 cells/μL.

Conclusion

The clinical manifestations of abdominal TB in our HIV-infected patients resembled the well-established pattern in HIV-uninfected adults. Patients with fever, weight loss, abdominal tenderness, abdominal lymphadenopathy, ascites and/or hepatomegaly in Zambia have a high probability of abdominal TB, irrespective of CD4 cell count.