DIAGNOSTIC FEATURES OF TUBERCULOUS PERITONITIS IN THE ABSENCE AND PRESENCE OF CHRONIC LIVER-DISEASE - A CASE-CONTROL STUDY

PURPOSE: To determine diagnostic features of tuberculous peritonitis ( TBP) in the absence and presence of chronic liver disease. PATIENTS AN D METHODS: Thirty-four patients with TBP (13 without [Group I] and 21 with chronic liver disease [Group II]) and 26 controls with cirrhosis and uninfected ascites (Group III) were studied. RESULTS: The clinical features in Groups I and II were similar and all patients had elevate d ascitic fluid total mononuclear cell count. In Groups I, II, and III , respectively, ascitic fluid protein was >25 g/L in 100% (13/13), 70% (14/20), and 0% (0/26); serum-ascites albumin, gradient (SAAG) was >1 1 g/L in 0% (0/13), 52% (11/21), and 96% (25/26) (0% [0/13], 71% [15/2 1], and 96% [25/26] after correction for serum globulin); and ascitic fluid lactate dehydrogenase (LDH) level was >90 U/L in 100% (12/12), 8 4% (16/19), and 0% (0/20), respectively. In Groups I and II combined, ascitic fluid acid-fast stain was negative in all but Mycobacterium tu berculosis culture was positive in 45% (10/22); peritoneal nodules occ urred in 94% (31/33), granulomas in 93% (28/30), and positive peritone al M tuberculosis culture in 63% (10/16). CONCLUSIONS: In patients wit h suspected TBP, ascitic fluid protein of >25 g/L, SAAG of <11 g/L and LDH of >90 U/L have high sensitivity for the disease. With coexistent chronic liver disease, a lower protein level and higher SAAG are usua lly not helpful but LDH >90 U/L is a useful parameter for screening. D iagnosis is best confirmed by laparoscopy with peritoneal biopsy and M tuberculosis culture.