How is tuberculosis peritonitis (TP) diagnosed?

Updated: Jul 23, 2019
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Praveen K Roy, MD, AGAF  more...
  • Print
Answer

In most cases, chest radiographic findings in patients with TP peritonitis are abnormal; active pulmonary disease is uncommon (< 30%). Results on Gram stain of ascitic fluid are rarely positive, and culture results may be falsely negative in up to 80% of patients. A peritoneal fluid protein level greater than 2.5 g/dL, a lactate dehydrogenase (LDH) level greater than 90 U/mL, or a predominantly mononuclear cell count of greater than 500 cells/μ L should raise suspicion of TP but have limited specificity for the diagnosis. Laparoscopy and visualization of granulomas on peritoneal biopsy specimens, as well as cultures (requires 4-6 wk), may be needed for the definitive diagnosis; however, empiric therapy should begin immediately.

Table 3. Microbiology of Primary, Secondary, and Tertiary Peritonitis (Open Table in a new window)

Peritonitis

(Type)

Etiologic Organisms

Antibiotic Therapy

(Suggested)

Class

Type of Organism

Primary

Gram-negative

E coli (40%)

K pneumoniae (7%)

Pseudomonas species (5%)

Proteus species (5%)

Streptococcus species (15%)

Staphylococcus species (3%)

Anaerobic species (< 5%)

Third-generation cephalosporin

Secondary

Gram-negative

E coli

Enterobacter species

Klebsiella species

Proteus species

Second-generation cephalosporin

Third-generation cephalosporin

Penicillins with anaerobic activity

Quinolones with anaerobic activity

Quinolone and metronidazole

Aminoglycoside and metronidazole

Gram-positive

Streptococcus species

Enterococcus species

Anaerobic

Bacteroides fragilis

Other Bacteroides species

Eubacterium species

Clostridium species

Anaerobic Streptococcus species

Tertiary

Gram-negative

Enterobacter species

Pseudomonas species

Enterococcus species

Second-generation cephalosporin

Third-generation cephalosporin

Penicillins with anaerobic activity

Quinolones with anaerobic activity

Quinolone and metronidazole

Aminoglycoside and metronidazole

Carbapenems

Triazoles or amphotericin (considered in fungal etiology)

(Alter therapy based on culture results.)

Gram-positive

Staphylococcus species

Fungal

Candida species


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!