Abstract :
Objective: Hepatic tuberculosis remains the world wide problem especially in the AIDS era. The aim
of this study was to compare the clinico-pathological manifestations of hepatic tuberculosis in immunocompromised and immunocompetent patients.
Patients and Methods: We reviewed retrospectively 20 Thai patients with hepatic tuberculosis during
the year 1993-2000. There were 12 immunocompromised patients (10 HIV males, 1 SLE male, 1 SLE female) and 8 immunocompetent patients (6 males, 2 females). The diagnosis of Mycobacterium tuberculosis (M. tb) were the combination of demonstrate the organism in hemo- or specimen culture, histopathology (positive acid fast bacilli) and rapid identification of M.tb from nested polymerase chain reaction (nPCR) assay based on amplification of the IS 6110 insertion sequences.
Results: The clinical features were similar in both groups with fever, weight loss and hepatomegaly as
the main manifestations. The biochemical findings were also similar but the alkaline phosphatase (ALP) was
significantly higher in the immunocompromised group (p <0.001). Non-caseating granuloma without detection of acid fast bacilli was a common finding in both groups. The nested PCR assay increased the sensitivity from 49 percent to 86 percent compare to the regular PCR assay but specificity was 100 percent in both techniques. The mortality was significantly higher in immunocompetent patients (p <0.05) due to the extreme age and severe coex-isting diseases.
Conclusion: Fever, weight loss, hepatomegaly, disproportionate elevation of ALP and reverse A/G
ratio were common in hepatic tuberculosis. A disproportionate elevation of ALP was significantly higher in
immunocompromised hosts. Nested-PCR assay showed good sensitivity and specificity in the diagnosis of this disease.
Key words : Hepatic tuberculosis, clinico-pathological study
[Thai J Gastroenterol 2004; 5(1): 19-23] |
file/Thai-Journal-of-gastroenterology-vol-5-no-1-1956428.pdf