Table 4.

Tropical infectious diseases producing cIAI.

Condition	Symptoms	Diagnostic options	Treatment	Comments
Amebic infection	Fever, pain in right upper abdomen, liver tenderness, tachycardia, hepatomegaly, nausea and vomiting, jaundice	Test for Entamoeba histolytica via IHA, ELISA, or PCR test for DNA in urine; abdominal ultrasound or CT	Metronidazole, tinidazole	Medical management is sufficient for simple amebiasis; for liver abscesses larger than 5 cm, percutaneous drainage may also be required
Intestinal ascariasis	Intestinal obstruction, vomiting of passing of worms in stool, symptoms of appendicitis	X-Ray of abdomen; abdominal ultrasound to confirm; gastrograffin	Albendazole, mebendazole	Ascariasis is endemic in Asia Pacific. Drug therapy should be followed by repeat stool examination to confirm eradication, as recurrence is common
Abdominal tuberculosis	Acute or chronic intestinal obstruction, abdominal distention, perforation, enterocutaneous or perianal fistula	Sputum for AFB smear and culture; AFB smear and culture of abdominal biopsy sample; abdominal ultrasound or CT scan	Isoniazid, rifampin, pyrazinamide, ethambutol; plus coverage for IAI	Treatment will depend on the type of abdominal complication. Resistance to drug treatment is a problem in Asia
Intra-abdominal salmonellosis	Nausea, vomiting, diarrhea, dyspepsia, bloating; in severe cases, perforation or abscess	Culture for Salmonella of blood, stool, rectal swab or gastric washing samples; ultrasound of abdomen	Antibiotic coverage for high-severity IAI Ceftriaxone, cefotaxime; various second-line regimens	Drug resistance is an increasing problem in Asia High mortality