TUBERCULOSIS IN LIVER CIRRHOSIS

About one-third of the world’s population is infected with Mycobacterium tuberculosis.In India, 40-50 % of the adult population is infected, although only 5 % of these may develop active disease during first year or two and another 2-5 % will develop disease later on in life. The estimated incidence of tuberculosis in India is 1.96 million new cases annually and the estimated prevalence is 3.8 million cases. Certain medical conditions increase the risk of latent TB infection progressing to active disease e.g. HIV infection, injection drug use, history of organ transplant, immunosuppressive therapy (including steroids and anti-TNF alpha drugs), diabetes mellitus, and chronic renal failure. The progression from latent infection to active disease depends on a number of factors, of which the most important is immunodeficient state.1 Cirrhosis of liver is also a relatively common condition. Although the exact prevalence in India is unknown, the autopsy studies in USA showed a prevalence of 5-10 %. In addition to Hepatitis B and C, there has been a massive increase in alcoholism In India contributing to an increase in chronic liver disease including cirrhosis. This leads to an immunodeficient state and along with malnutrition which is commonly present in such patients, may increase the risk of tuberculosis. When discussing tuberculosis in liver cirrhosis, the following issues need to be addressed