Abdominal tuberculosis in Bradford, UK: 1992-2002

Abstract

Introduction: Bradford, in West Yorkshire, United Kingdom, has a population of 486 340 of which 17.3% originate from South Asia. We describe our experience of abdominal tuberculosis over a 10 year period.

Methods: Fifty-nine cases of abdominal tuberculosis were identified between 1992 and 2002 from the Tuberculosis Registry, Bradford hospitals. Fifty case records were available for retrospective review.

Results: Median age of the patients was 38 years (range, 14-81) and 35 (59.3%) were females. Fifty-four (91.5%) patients were of South Asian origin, four (6.8%) were Caucasians and one patient was an Arab. The mean standardized incidence of abdominal tuberculosis in the South Asian population during the study period was 9.32 cases/10(5)/year whereas in the local white population it was 0.1/10(5)/year (relative risk=93). Fever (90%), abdominal pain (88%) and weight loss (82%) were the commonest presenting features. Ileocaecal region in 20 (40%) patients and tubercular peritonitis in 16 (32%) cases were the common sites involved. Active pulmonary tuberculosis was present in 18 (36%) patients. Diagnosis of tuberculosis was confirmed by isolating acid-fast bacilli or by demonstrating caseating granulomas on biopsy in 36 (72%) cases. Acid-fast bacilli isolated in all the 29 (58%) cases were Mycobacterium tuberculosis and were sensitive to all standard anti-tubercular drugs except one patient who was resistant to isoniazid.

Conclusion: Abdominal tuberculosis remains a common problem in a multicultural community in the United Kingdom with a varied presentation. High index of suspicion is required for early diagnosis. Most of the patients respond very well to standard anti-tubercular therapy and surgery is required only in a minority of cases. Drug resistant abdominal tuberculosis has not been a problem in this series.