Peritonitis occurs when the peritoneum becomes inflamed. The serous membrane lining the abdominal cavity and covering viscera is inflamed. The term tuberculous indicates that the inflammatory condition is related to infiltration by a specific tubercle.

The causative organism of tuberculosis is Mycobacterium tuberculosis. The most common cause is related to perforation of an organ, but the bloodstream can be the source of contamination. Tuberculous peritonitis is common in alcoholics with cirrhosis, and people infected with human immunodeficiency virus (HIV).

Manifestations of the condition may be mild and nonspecific, and include low-grade fever, and loss of weight and appetite. However, they may be severe enough to appear to be an acute peritonitis. Abdominal swelling and apparent ascites are common. Due to the possibility of an underlying cirrhosis and portal hypertension, the condition is difficult to diagnose. (See Diagnostic Code: 7301 Peritoneum, adhesions of.)

Chest x-rays are usually abnormal, but active pulmonary tuberculosis is seen in less than 25% of patients. Skin tests for tuberculosis are positive in only 50% of patients. Ascitic fluid tests are not specific for a diagnosis, and a laparoscopy is the best means of establishing a diagnosis. Peritoneal nodules are seen and granulomas can be biopsied. Peritoneal cultures are positive in 60% of cases. It takes 4 to 6 weeks for results of the cultures to be obtained. (See Diagnostic Code: 7301 Peritoneum, adhesions of.)

Tuberculosis treatment has specific protocols. The protocols have been revised due to the increase in drug-resistant tuberculosis. The Centers for Disease Control (CDC) has recommended three different options using a four-drug regimen for respiratory tuberculosis. Patients with HIV use the protocol longer, i.e., a minimum of nine months and at least for 6 months after culture conversion. (See Diagnostic Code: 7301 Peritoneum, adhesions of.)

Tuberculosis does not often spread from the lungs to other sites. However, when it does, it can remain inactive for years and then be reactivated if the person's defense mechanisms become weakened, e.g., in the presence of HIV. (See Diagnostic Code: 7301 Peritoneum, adhesions of.)

• This disease, (condition), only in its active form , has a 3 year presumptive period and shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied. [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309 (a). [chronic disease].

• Reference 38 CFR 3.375 when determining inactivity (complete arrest) in tuberculosis

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Total plus 60% – Special Monthly Compensation (SMC).

• Inactive: See 38 CFR 4.88b and 4.89.

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. [38 CR 4.114]

• Rate any residual disability of infection within the appropriate body system as indicated by the notes in the evaluation criteria. As applicable, consider the long-term health effects potentially associated with infectious diseases as listed in 38 CFR 3.317(d) of this chapter, specifically Brucellosis, Campylobacter jejuni, Coxiella burnetii (Q fever), Malaria, Mycobacterium Tuberculosis, Nontyphoid Salmonella, Shigella, Visceral Leishmaniasis, and West Nile virus. [38 CFR 4.88b]

• Public Law 90–493 repealed section 356 of title 38, United States Code which provided graduated ratings for inactive tuberculosis. The repealed section, however, still applies to the case of any veteran who on August 19, 1968, was receiving or entitled to receive compensation for tuberculosis. The use of the protective provisions of Pub. L. 90–493 should be mentioned in the discussion portion of all ratings in which these provisions are applied. For use in rating cases in which the protective provisions of Pub. L. 90–493 apply, the former evaluations are retained in this section. [38 CFR 4.89]