Hepatic Tuberculosis With HIV Co-Infection
Hepatic Tuberculosis With HIV Co-Infection
We conducted a systematic literature search in PubMed and ScienceDirect for articles pertaining to hepatic TB (Figure 1). The primary search term used was "hepatic tuberculosis." We included all articles published between 1960 and July 2013. There were a total of 965 hits (806 in PubMed, 159 in ScienceDirect). Of these, there were 21 duplicate articles which were removed, leaving 944 to be screened. Of the 944 articles screened, 840 were excluded under the following criteria: published in language other than English, non-human animal study, subject of study was not hepatic TB, and study was not a case report or case series. The remaining 104 articles were assessed for eligibility for quantitative analysis. For the purpose of our study, we included only hepatic TB case series, and we defined a case series as having five or more patients diagnosed with hepatic TB. We also required that the case series have sufficient data to perform quantitative analysis on clinical presentation, diagnosis, and treatment of hepatic TB. Of the 104 articles assessed for eligibility, 14 met our inclusion criteria for quantitative analysis, and the remaining 90 were excluded for the following reasons: patients had tuberculosis infections that did not include the liver, fewer than 5 patients with hepatic TB in study, and insufficient data on presentation, diagnosis, and treatment to perform quantitative analysis. We also reviewed references from the selected manuscripts to obtain additional information relevant to the epidemiology, pathophysiology, clinical features, diagnosis, and treatment of hepatic TB. These references were published any time prior to July 2013.
(Enlarge Image)
Figure 1.
Flow diagram of literature search and study selection.
From identified manuscripts and case series, we abstracted data on the epidemiology, pathogenesis, clinical features, diagnosis, and treatment. The method of analysis varied by the aspect of hepatic TB being examined and the data available from the manuscripts. The epidemiology of hepatic TB was evaluated by abstracting the year of the study, geographic location, proportion of male patients, and mean age of cases. The incidence and mortality of hepatic TB were approximated using data available from some of the larger case series. Pathological features were determined by calculating the proportion of total hepatic TB cases that were miliary hepatic TB and those that were local hepatic TB. Where available, we also abstracted information on pathogenesis from the introduction and discussion sections, as well as from other manuscripts referenced in the studies. To determine the key clinical features of hepatic TB, we determined the most common signs and symptoms by calculating the proportion of patients with each sign and symptom from each of the case series, and we then presented the median value and range of these percentages. For assessing liver function test abnormalities, the median values from each case series were calculated, and the range of these medians, rounded to the nearest 50 U/L, were reported. The diagnosis of hepatic TB was evaluated by calculating the median proportion and range of positive diagnostic findings on chest radiograph, abdominal ultrasound, abdominal computerized tomography (CT), and liver biopsy. The treatment of hepatic TB cases was not provided in all cases series. When treatment information was provided, the regimen, number of patients receiving that regimen, median treatment duration, and outcomes were assessed and tabulated.
This study was a systematic review of the medical literature and did not involve any human subjects. As such, no approval from an ethics committee was required.
Methods
Literature Search and Inclusion Criteria
We conducted a systematic literature search in PubMed and ScienceDirect for articles pertaining to hepatic TB (Figure 1). The primary search term used was "hepatic tuberculosis." We included all articles published between 1960 and July 2013. There were a total of 965 hits (806 in PubMed, 159 in ScienceDirect). Of these, there were 21 duplicate articles which were removed, leaving 944 to be screened. Of the 944 articles screened, 840 were excluded under the following criteria: published in language other than English, non-human animal study, subject of study was not hepatic TB, and study was not a case report or case series. The remaining 104 articles were assessed for eligibility for quantitative analysis. For the purpose of our study, we included only hepatic TB case series, and we defined a case series as having five or more patients diagnosed with hepatic TB. We also required that the case series have sufficient data to perform quantitative analysis on clinical presentation, diagnosis, and treatment of hepatic TB. Of the 104 articles assessed for eligibility, 14 met our inclusion criteria for quantitative analysis, and the remaining 90 were excluded for the following reasons: patients had tuberculosis infections that did not include the liver, fewer than 5 patients with hepatic TB in study, and insufficient data on presentation, diagnosis, and treatment to perform quantitative analysis. We also reviewed references from the selected manuscripts to obtain additional information relevant to the epidemiology, pathophysiology, clinical features, diagnosis, and treatment of hepatic TB. These references were published any time prior to July 2013.
(Enlarge Image)
Figure 1.
Flow diagram of literature search and study selection.
Data Analysis
From identified manuscripts and case series, we abstracted data on the epidemiology, pathogenesis, clinical features, diagnosis, and treatment. The method of analysis varied by the aspect of hepatic TB being examined and the data available from the manuscripts. The epidemiology of hepatic TB was evaluated by abstracting the year of the study, geographic location, proportion of male patients, and mean age of cases. The incidence and mortality of hepatic TB were approximated using data available from some of the larger case series. Pathological features were determined by calculating the proportion of total hepatic TB cases that were miliary hepatic TB and those that were local hepatic TB. Where available, we also abstracted information on pathogenesis from the introduction and discussion sections, as well as from other manuscripts referenced in the studies. To determine the key clinical features of hepatic TB, we determined the most common signs and symptoms by calculating the proportion of patients with each sign and symptom from each of the case series, and we then presented the median value and range of these percentages. For assessing liver function test abnormalities, the median values from each case series were calculated, and the range of these medians, rounded to the nearest 50 U/L, were reported. The diagnosis of hepatic TB was evaluated by calculating the median proportion and range of positive diagnostic findings on chest radiograph, abdominal ultrasound, abdominal computerized tomography (CT), and liver biopsy. The treatment of hepatic TB cases was not provided in all cases series. When treatment information was provided, the regimen, number of patients receiving that regimen, median treatment duration, and outcomes were assessed and tabulated.
Ethics
This study was a systematic review of the medical literature and did not involve any human subjects. As such, no approval from an ethics committee was required.