REDUCED INFLAMMATORY RESPONSE TO PERITONEAL INFECTION BY MYCOBACTERIUM-TUBERCULOSIS IN ALCOHOLIC CIRRHOSIS

Objective: To compare the diagnostic value of clinical and laboratory findings in the ascitic fluid of patients with peritoneal tuberculosis and underlying liver alcoholic cirrhosis, and patients with tuberculo us peritonitis without liver disease. Patients: Data on 36 patients fr om three general hospitals, admitted over a 4-year period were studied . Twenty-four patients did not have underlying liver disease (group A) , while 12 patients had cirrhosis of alcoholic origin (group B). Metho ds: Clinical and laboratory data, including ascites lymphocyte count, lactate dehydrogenase activity, total protein content, adenosine deami nase activity (ADA) and Lowenstein culture, were analysed. The diagnos is was confirmed by bacteriological or pathological means in all cases . In 23 patients, laparoscopy was performed (17 patients from group A and six from group B). Results: Clinical presentation was similar in b oth groups. Initially, patients from group B were more frequently misd iagnosed. The ascites protein content directly correlated with the ADA activity and ascites lactate dehydrogenase activity. The ascites prot ein content and the ascites ADA activity were higher in group A than i n group B. Laparoscopy was of poor diagnostic value in group B. The mo rtality in this group was 83.3% compared with 0% in group A (P<0.001). Conclusions: Alcoholic cirrhosis is a risk factor for peritoneal infe ction by Mycobacterium tuberculosis. Biochemical and laparoscopic find ings in these patients are of less diagnostic value than in those with out underlying liver disease. In addition, there is a strikingly high mortality rate in those patients with associated cirrhosis.