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🦠 ABDOMINAL TUBERCULOSIS (AB TB): A Silent Epidemic

(Comprehensive Guide for Medical Professionals)

Abdominal tuberculosis remains a diagnostic challenge due to its nonspecific symptoms and ability to mimic other conditions like Crohn’s disease and malignancies. In endemic regions, it accounts for nearly 12% of extrapulmonary TB cases, often affecting young adults with compromised immunity. The insidious onset and varied presentations frequently lead to delayed diagnosis, resulting in severe complications.

🔍 WHAT IS ABDOMINAL TUBERCULOSIS?

Abdominal TB is an extrapulmonary manifestation of Mycobacterium tuberculosis infection that primarily targets the gastrointestinal tract and peritoneum. It typically develops through reactivation of latent foci or ingestion of infected sputum. The disease manifests in three main forms: intestinal (55-60% cases), peritoneal (30%), and nodal (5-10%).

Key Fact: Post-primary infection, the bacilli can lie dormant for years before causing symptoms, making epidemiological history crucial.

⚠️ ALARMING GLOBAL STATS

In developing nations, abdominal TB represents a significant public health burden. India alone reports over 50,000 new cases annually, with higher prevalence in urban slums and HIV-positive populations. The mortality rate escalates to 40% in cases with multidrug-resistant strains, emphasizing the need for early detection.

📋 CLASSIC CLINICAL TRIAD

Patients typically present with a constellation of chronic symptoms:

  1. Dull, intermittent abdominal pain (worsening post-prandially)

  2. Distension (due to ascites or partial obstruction)

  3. Constitutional symptoms (night sweats, low-grade fever)

🔴 Red Flags: Acute surgical emergencies may develop from strictures or perforations, requiring immediate intervention.

🩺 DIAGNOSTIC WORKUP

A multimodal approach is essential for accurate diagnosis:

Imaging:

  • CT abdomen reveals pathognomonic findings like necrotic lymph nodes and ileocecal thickening

  • Ultrasound guides ascitic fluid sampling

Laboratory:

  • Ascitic fluid analysis shows lymphocytic predominance with high ADA levels

  • IGRA tests support TB exposure history

Histopathology:

  • Caseating granulomas on biopsy confirm diagnosis

💊 WHO-RECOMMENDED TREATMENT

The standard 6-month ATT regimen requires careful monitoring:

Intensive Phase (2 months):

  • Four-drug therapy including rifampicin and isoniazid

Continuation Phase (4 months):

  • Dual therapy to complete treatment course

Nutritional rehabilitation is equally critical, with high-protein diets correcting the catabolic state induced by chronic infection.

🌿 NUTRITIONAL MANAGEMENT

Malabsorption and weight loss necessitate aggressive nutritional support:

  • Caloric intake should exceed basal requirements by 30%

  • Medium-chain triglycerides are preferred for fat absorption

  • Micronutrient supplementation addresses deficiencies

📉 COMPLICATIONS TO WATCH

Long-term sequelae include:

  • Fibrotic strictures causing recurrent obstruction

  • Enterocutaneous fistulas requiring surgical management

  • Secondary amyloidosis in chronic cases

✅ PREVENTION STRATEGIES

Community-level interventions:

  • Active case finding in high-risk populations

  • Improved sanitation to reduce transmission

  • BCG vaccination in childhood

🔬 CURRENT RESEARCH TRENDS

Emerging diagnostic tools:

  • Molecular assays like GeneXpert Ultra

  • Biomarker panels for early detection

Therapeutic advances:

  • Shorter regimens for drug-sensitive cases

  • Novel drugs for resistant strains

🎯 KEY TAKEAWAY

“In endemic areas, abdominal TB should top the differential for chronic abdominal symptoms. A high index of suspicion, combined with judicious use of diagnostics, can prevent catastrophic outcomes.”

📌 For detailed treatment algorithms or case discussions, consult infectious disease specialists.