Démarche diagnostique de la tuberculose chez le dialysé

Mesbahi, T.; Jebali, H.; Barrah, Sana; Raîs, L.; Béji, S.; Mami, I.; Kheder, R.; Krid, M.; Smaoui, W.; Hamida, F. Ben; Fatma, L. Ben; Zouaghi, Mohamed Karim

doi:10.1016/j.revmed.2018.03.066

Cited by 2 publications

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“…The extra-pulmonary localization of tuberculosis is the most frequent in dialysis patients. It is characterized in this population by evolving quietly, representing between 51.6% and 100% of localizations according to the series [ 2 , 11 , 15 , 17 , 21 , 22 ], which is similar to our results of 75.5%.…”

Section: Discussionsupporting

confidence: 89%

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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Section: Discussionsupporting

confidence: 89%

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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“…In a longitudinal prospective study carried out in southern Senegal, Y. Kane et al reported that GeneXpert confirmed tuberculosis involvement in 6 out of 7 possible cases (or 85.80%), including 4 cases from pleural puncture fluid, in chronic hemodialysis patients [4]. According to T. Mesbahi et al, in Tunisia, 56% of tuberculosis diagnoses were retained in front of clinical and biological presumption associated with the radiological one, despite the negativity of the bacteriological and histological samples [5].…”

Section: Introductionmentioning

confidence: 99%

Pleurisy in Hemodialysis Patients: Epidemiological and Etiological Aspects at Donka National Hemodialysis Center

Traoré¹,

Diakité²,

Baldé³

et al. 2021

OJNeph

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Introduction: Pleural effusion being a frequent complication in hemodialysis patients, its etiologies are diverse and the diagnosis is easy, based on clinical and radiological proofs. The main objective of this study was to describe the epidemiological and etiological profiles of pleurisy in hemodialysis patients at the National Hemodialysis Center of Donka National Hospital. Patients and methods: it was a retrospective, descriptive and analytical study that extended over a period of three years from January 1, 2017 to December 31, 2019. It concerned, among hemodialysis patients in the center during the study period, all those who had a confirmed pleurisy on chest x-ray. The variables were epidemiological (based on frequency, sex and age), clinical (based on history of the disease, physical examination looking for a reduction or elimination of vesicular murmur) and paraclinical (mainly radiological). Results: Among 286 patients undergoing hemodialysis in our center, pleural effusion was diagnosed in 35 or 12.24%. The average age of our patients was 52.22 years with ranges of 18 and 78 years. The sex ratio M/F was 2.5. Bilateral pleurisy was found in 51.43% of patients; unilateral right in 40% of cases and unilateral left in 8.57%. We observed 68.57% citrus yellow fluid and 31.43% sero haematic fluid. The bacteriology of the pleural fluid was positive in 62.86% against 37.14% negative. Tumor, tuberculosis and non-specific bacterial etiologies have been encountered. Conclusion: Pleurisy is therefore a frequent complication in hemodialysis patients at Donka National Hemodialysis Center. Etiological research is a major step for better management of these patients. Improving the technical platform of the laboratories should be an important contribution to this stage.

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Démarche diagnostique de la tuberculose chez le dialysé

Cited by 2 publications

References 0 publications

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

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

Pleurisy in Hemodialysis Patients: Epidemiological and Etiological Aspects at Donka National Hemodialysis Center

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