Chronic kidney disease, immunosuppression and tuberculin test sensitivity

Sa, Zaki

doi:10.4103/0971-4065.78088

Cited by 3 publications

(6 citation statements)

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“…Patients with ESRD undergoing chronic dialysis are 6–52.5 times more likely to develop TB than the general population, mainly because of the impaired cellular immunity characteristic of this condition . Impaired cellular immunity suppresses the mitogenic response of lymphocytes.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with ESRD undergoing chronic dialysis are 6-52.5 times more likely to develop TB than the general population, mainly because of the impaired cellular immunity characteristic of this condition. 5,6,[9][10][11][12] Impaired cellular immunity suppresses the mitogenic response of lymphocytes. Protein malnutrition, zinc and pyridoxine deficiency, and defects in leukocyte function following exposure to dialysis membranes increase the susceptibility of dialysis patients to TB.…”

Section: Discussionmentioning

confidence: 99%

“…Protein malnutrition, zinc and pyridoxine deficiency, and defects in leukocyte function following exposure to dialysis membranes increase the susceptibility of dialysis patients to TB. 6,11 However, socioeconomic, demographic, and comorbid factors also predispose these patients to the risk of TB. 3 Mean age of patients reported to develop TB on dialysis being 41.5-73 years.…”

Section: Discussionmentioning

confidence: 99%

“…Impaired cellular immunity suppresses the mitogenic response of lymphocytes. Protein malnutrition, zinc and pyridoxine deficiency, and defects in leukocyte function following exposure to dialysis membranes increase the susceptibility of dialysis patients to TB . However, socioeconomic, demographic, and comorbid factors also predispose these patients to the risk of TB .…”

Section: Discussionmentioning

confidence: 99%

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Tuberculosis in dialysis: Clinical spectrum and outcome from an endemic region

Vikrant

2018

Hemodialysis International

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Introduction: Tuberculosis (TB) is a significant health problem in developing countries. There are limited data on TB among end stage renal disease (ESRD) patients on maintenance dialysis in India. Clinical profile and outcome of TB in dialysis were studied. Methods: Retrospective study of ESRD patients who were on maintenance dialysis (either peritoneal dialysis [PD] or hemodialysis (HD]) and diagnosed to have TB over a period of 11 years. Findings: Thirty‐two patients had a diagnosis of TB. Mean age of the patients was 50.3 ±13.9 years. The majority (56.2%) of the patients were female. The modality of dialysis was HD in 53.1% and PD in 46.9%. Mean duration of dialysis at the diagnosis of TB was 15.1 ± 13.9 months. Over three‐quarter of the patients had an extrapulmonary involvement. Pleuro‐pulmonary (40.6%), peritoneum (34.4%), and lymph node (15.6%) were the most common sites for TB. About 6.3%patients had disseminated TB, and 3.1% had pericardial TB. The clinical presentation of TB was: fever/pyrexia of unknown origin 28.1%, constitutional symptoms of anorexia, fever, night sweats and weight loss 34.4%, abnormal chest radiograph 37.5%, ascites/peritonitis 34.4%, pleural effusion 25%, lymphadenopathy 18.8%, meningoencephalitis 6.3%, and pericardial effusion 3.1%. Peritoneal TB presented as nonresolving peritonitis in PD and ascites in HD. The diagnosis was a microbiological/histological in 50% and rest 50% only on clinical grounds. Nine (29%) patients had adverse effects of anti‐TB drugs. Four patients of TB peritonitis had a poor gastrointestinal tolerance of anti‐TB drugs and defaulted on the treatment and had an adverse outcome. About 53.1% of the patients survived, and 46.9% died. Discussion: TB in dialysis is mostly extrapulmonary. Early diagnosis is difficult, and the adverse effects of anti‐TB medications complicate the treatment. TB in dialysis carries high morbidity and mortality. TB peritonitis has a poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Tuberculosis in dialysis: Clinical spectrum and outcome from an endemic region

Vikrant

2018

Hemodialysis International

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“…We would like to thank the authors[ 1 ] for comments on our manuscript. [ 2 ] According to the 1995, Centers for Disease Control (CDC) recommendations[ 3 ] about the size of reaction of tuberculin skin test for diagnosing latent tuberculosis (TB) in high risk population >5 mm size is restricted to only three situations: persons who have had recent close contact with persons who have active TB, persons who have human immunodeficiency virus (HIV) infection or risk factors for HIV infection but unknown HIV status, and those with fibrotic chest radiographs consistent with healed TB.…”

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confidence: 99%

Reaction size in tuberculin test positivity in hemodialysis patients - Authors′ reply

et al. 2011

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Tuberculosis in Dialysis Patients in the Central Region of Morocco: What Is the Health-Care Delay?

Bardai¹,

Kabbali²,

Baba³

et al. 2022

Cureus

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Introduction: Due to the predominantly cellular immunosuppression, infections are frequent in chronic dialysis patients, in particular tuberculosis (TB). The main objective of our study is to evaluate tuberculosis healthcare delay in dialysis patients and to raise the diagnostic challenge in these patients. Material and methods: The study is retrospective and multicenter including tuberculosis cases of chronic dialysis patients either in hemodialysis (HD) or peritoneal dialysis (PD) in the central region of Morocco during a 10-year period between 2012 and 2021. Results: We included 94 patients, five of whom were in PD, with a mean age of 50.79 ± 16.72 years, and a sex ratio of 0.67. The time between the initiation of dialysis and the onset of the clinical and biological presentation was 50.3 ± 67.12 months. The most frequent initial manifestations were an alteration of the general state (85.1%), a biological inflammatory syndrome (83%) or a prolonged fever (70.1%). Among our 94 patients, the diagnosis was confirmed with bacteriological evidence only in 18 cases (19.1%), by identification of Koch's Bacillus (BK) in 13 cases, by molecular biology test (GeneXpert; Cepheid, Inc., Sunnyvale, CA, USA) in five cases. The diagnosis of tuberculosis was presumptive in most cases (79 cases), i.e. 80.9%. Twenty-one patients underwent the interferon gamma release essay test (QuantiFERON; Qiagen, Hilden, Germany) which was positive in 14 patients. Thirty-four (36.1%) cases had a histological diagnosis. The remaining patients were offered a trial treatment. Tuberculosis localization was mostly extra-pulmonary (75.5%): lymph node (23.4%), pleural (13.8%), peritoneal (13.8%), whereas it was pulmonary in 23 cases (24.5%). Most of our patients had a clear delay in management from symptom onset to initiation of anti-TB treatment 78.9% (time >21days) vs 21.1% (time ≤21days). The median time to management delay was 46.5 interquartile range (IQR) (28.5-90), the mean delay was 78.4 ± 87.9 (6-360). All patients were treated according to the RHZE/RH protocol (R: rifampicin, H: isoniazid Z: pyrazinamide and E: ethambutol), with a duration between six and 18 months. Side effects associated with anti-tuberculosis treatment were observed in half of the patients (51.1%). The evolution was favorable with remission and improvement of the general condition in 90% of cases. Two cases of resistance were noted in our series. The overall mortality was 7.7%. Conclusion: We have confirmed a delay in the diagnosis and treatment of tuberculosis in chronic dialysis patients. This can be explained by the often atypical or incomplete clinical and paraclinical presentation and the extra-pulmonary localizations, making diagnosis difficult in this population whose prognosis remains poor. It is therefore necessary to establish a diagnostic approach that is adapted to the specificities of these high-risk patients within the framework of a national tuberculosis control program.

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Chronic kidney disease, immunosuppression and tuberculin test sensitivity

Cited by 3 publications

References 1 publication

Tuberculosis in dialysis: Clinical spectrum and outcome from an endemic region

Tuberculosis in dialysis: Clinical spectrum and outcome from an endemic region

Reaction size in tuberculin test positivity in hemodialysis patients - Authors′ reply

Tuberculosis in Dialysis Patients in the Central Region of Morocco: What Is the Health-Care Delay?

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