Mycobacterial Infections in Patients With Chronic Renal Disease

Pien, Francis D.; Younoszai, Barak G.; Pien, Brian C.

doi:10.1016/s0891-5520(05)70176-8

Cited by 15 publications

(13 citation statements)

References 98 publications

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“…Extra-pulmonary involvement has been reported to be high in Turkey (38% to 77%) and in other countries (up to 50%) among the dialysis population (7,8,11,12,13). Erkoc et al reported identifying 30 (10.5%) tuberculosis patients among 287 dialysis patients (223 HD, 64 PD), and 65.4% of these cases had extra-pulmonary disease [12].…”

Section: Discussionmentioning

confidence: 99%

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Tuberculosis in dialysis patients: a nine-year retrospective analysis

Ünsal

Ahbap

Baştürk

et al. 2013

J Infect Dev Ctries

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Introduction: Diagnosis of tuberculosis (TB) among dialysis patients may be difficult because of increased frequency of extra-pulmonary presentations, atypical clinical manifestations, and non-specific symptoms. This study aimed to investigate the spectrum of clinical presentations and outcome in dialysis patients during a nine-year period. Methodology: A total of 651 patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) for at least three months in our unit between 2001 and 2010 were studied. Dialysis and follow-up were performed in our tertiary care center located in the eastern region of Turkey. Diagnosis of TB was established by combining clinical, radiological, biochemical, microbiological, and histological findings. Choice of anti-TB drug used, the results of therapy, and patient outcome were noted. Results: Out of 651 dialysis patients studied, 322 (49.4%) were on PD and the remainder on HD (50.6%). Twenty-six (4%) of the 651 dialysis patients were diagnosed with TB (15 PD, 11 HD), 5 of whom were diagnosed by microbiological assessment, 9 by pathological assessment, and 12 by clinical and radiological findings. Mean age at diagnosis was 41.5 ± 16.5 years and the female/male ratio was 1.18. Three patients had a history of pulmonary TB. Extra-pulmonary involvement was observed in 17 (65.4%) patients. All patients were treated with rifampicin isoniazid, ethambutol, pyrazinamide and pyridoxine. Four patients died during the study. Conclusion: TB occurred in dialysis patients and extra-pulmonary TB was more commonly identified than pulmonary TB. Tuberculous lymphadenitis was the most frequent form of extra-pulmonary TB in our cohort.

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Section: Discussionmentioning

confidence: 99%

“…Anergy to the tuberculin skin test was noted in 55.6% of MTB patients compared with 15% of tuberculosis patients in the general population. In uremia there is a decreased T-cell response, as indicated by the high rate of anergy to intracutaneously administered antigens, reported to be as high as 32% and 40% (6,13,14,15).…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis in dialysis patients: a nine-year retrospective analysis

Ünsal

Ahbap

Baştürk

et al. 2013

J Infect Dev Ctries

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“…[43] Some authors follow the same treatment guidelines as in patients who are not on dialysis. We followed a more conservative approach, continuing the therapy for 9 months.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis in haemodialysis patients: A single centre experience

Rao¹,

Ram²,

Swarnalatha³

et al. 2013

Indian J Nephrol

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We prospectively followed-up new patients of tuberculosis while on maintenance hemodialysis at a State Government-run tertiary care institute. Between 2000 and 2010, 1237 new patients were initiated on maintainence hemodialysis. The number of patients diagnosed with tuberculosis after initiation of hemodialysis was 131 (10.5% of 1237). The age was 46.4 ± 10.4 (range 8-85) years and there were 90 (68.7%) males. The number of patients diagnosed with tuberculosis on the basis of organ involvement were: Pulmonary-60, pleural effusion-31, lymph node-21, meningitis-8, pericardial effusion-7, peritoneum-2, latent tuberculosis-2. The incidence of tuberculosis in hemodialysis was found to be 105.9 per 1000 patient years. Male gender, diabetes mellitus, past history of tuberculosis, mining as an occupation, low serum albumin, and duration of hemodialysis more than 24 months, and unemployment were found to be significant risk-factors on univariate analysis.

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“…All studies report an insidious onset of symptoms, with fever, anorexia, and loss of weight being the main complaints, mimicking uremic symptoms. In a review of the literature, Pien et al (39) found fever occurring in a mean of 72% of the cases (range 29–100%), malaise in a mean of 69% (range 29–100%), and weight loss in a mean of 54% (range 10–100%). However, cough and hemoptysis, classic symptoms of TB in the general population, are less frequently reported in dialysis patients (mean 22% of cases; range 5–71%) (39).…”

Section: Featuresmentioning

confidence: 99%

“…There are no controlled studies or consensus statements about the treatment regimen in patients with renal insufficiency (39). Some authors followed the same treatment guidelines as in patients not on dialysis, although others have proceeded with a more conservative approach, continuing the therapy for 9–12 months (with RIF and INH), with EMB and PZA added for the first 2 months (22–24,31).…”

Section: Treatmentmentioning

confidence: 99%

Tuberculosis and Chronic Renal Disease

Hussein

Mooij

Roujouleh

2003

Seminars in Dialysis

181

164

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There is an increased risk (6.9- to 52.5-fold) of tuberculosis (TB) in patients with chronic renal failure and on dialysis as compared to the general population. The symptomatology in renal patients is often insidious and nonspecific, mimicking uremic symptoms, whereas the localization is often extrapulmonary (most frequently tuberculous lymphadenitis and peritonitis). Tuberculous peritonitis makes up a large part (37%) of the total number of TB cases in continuous ambulatory peritoneal dialysis (CAPD) patients. The prognosis is very much dependent on early diagnosis and treatment. Renal physicians should be aware of the unusual presentation and localization, and include TB in the differential diagnosis of any patient having nonspecific symptoms like anorexia, fever, and weight loss. All efforts should then be made (including invasive investigations) to reach an early diagnosis, a major determinant of the outcome. However, if this is not possible or the result is negative and the diagnosis remains strongly suspected, an empirical trial with anti-TB medication is justified, especially in endemic areas. In view of the increased prevalence of the disease in the dialysis population, TB prophylaxis is recommended in those patients with a positive tuberculin (Mantoux) skin test and radiographs suggestive of old TB.

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Mycobacterial Infections in Patients With Chronic Renal Disease

Cited by 15 publications

References 98 publications

Tuberculosis in dialysis patients: a nine-year retrospective analysis

Tuberculosis in dialysis patients: a nine-year retrospective analysis

Tuberculosis in haemodialysis patients: A single centre experience

Tuberculosis and Chronic Renal Disease

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