Clinical Spectrum of Hepatic Thberculosis : Comparison between Immunocompetent and Immunocompromised Hosts
RATHA-KORN VILAICHONE, MD, PhD*, WARAKARN VILAICHONE, MD****, SOMYING TUMWASORN, PhD** PONGSEPEERA SUWANAGOOL, MD***, HENRY WILDE, MD, FACP*****, VA ROCHA MAHACHAI, MD, FRCP, FACG*
Affiliation : * Department of Medicine, **Department of Microbiology, *** Department of Pathology, Faculty of Medicine, Chulalongkom University, Bangkok 10330, **** Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, ***** Queen Saovabha Memorial Institute, Thai Red Cross Society, Bangkok 10330, Thailand.
Method : The authors reviewed retrospectively 20 patients with hepatic tuberculosis admitted between January 1993 and October 2000 to Chulalongkom University Hospital, Thailand. There were 12 immunocompromised patients (10 HIV-infected males, 1 systemic lupus erythematosus (SLE) male, 1 SLE female) and 8 immunocompetent patients (6 males, 2 females). The clinical manifestations, biochemical tests, radiologic features and pathological findings were compared between these 2 groups. The diagnosis of Mycobacterium tuberculosis (M. tb) was the combination of a demonstrated organism in hemo- or specimen culture, histopathology (positive acid fast bacilli) and rapid identifica tion 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 hepato megaly as the main manifestations. The biochemical findings were also similar but the alkaline phos phatase (ALP) was significantly higher in the immunocompromised group (p < 0.001). Hepatomegaly and diffuse increased echogenicity were common in both groups. Ascitis and calcifications were found more commonly in the immunocompetent subjects, although the differences were not statistically significant. 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 per cent to 86 per cent compared to the regular PCR assay but specificity was 100 per cent in both techniques. The mortality was signi ficantly higher in immunocompetent patients (p < 0.05) due to the extreme age and severe coexisting 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 sig nificantly higher in the immunocompromised hosts. Nested PCR assay showed good sensitivity and specificity in the diagnosis of this disease.
Keywords : Hepatic Tuberculosis, Immunocompetent, Immunocompromised
