Mycobacterial Peritonitis in CAPD Patients in Limpopo: A 6-Year Cumulative Report from a Single Center in South Africa

Abstract

Of 170 patients on CAPD for the period reviewed, 12 (7.1%) were diagnosed and treated for mycobacterial peritonitis. There was an equal number of males and females, and all the patients were Black Africans with a mean age of 35.4 years (17 -51 years). Eight of the 12 patients (66.7%) had had previous episodes of non-tuberculous peritonitis. Four patients (33.3%) had elevated white blood cell count (WCC) while 9 had higher polymorph count in the PD fluid than lymphocyte count. Mycobacterial organism was confirmed in 9/12 (75%), while the diagnosis was made on clinical and radiological features in the remaining 3 patients. Seven patients (58.3%) died, 10 patients were permanently transferred to hemodialysis (HD), 1 patient returned to PD after a short stay on HD, 1 patient died after 2 years on HD due to lack of further access to dialysis, and in 1 patient, the catheter could not be removed before death. This case series corroborates findings from other previous series that mycobacterial infection in PD patients carries a high mortality and can often pose a diagnostic challenge to attending clinicians. Clinicians should have a high index of suspicion for mycobacterial peritonitis in CAPD patients with features of peritonitis who do not respond promptly to conventional anti-microbial agents. We feel that the recommendation about catheter removal during mycobacterial peritonitis should be revisited, as it had no impact on our patients' outcome.

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

“…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.…”

“…That suggests against continuing PD after the diagnosis of TB peritonitis and favor switch to HD. However, mortality can still be high in TB peritonitis even if patients are switched to HD …”

“…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.…”

“…However, mortality can still be high in TB peritonitis even if patients are switched to HD. 9 Pleural and lymph node TB were the next most common cause sites of extrapulmonary TB after the peritoneum. TB is a common cause of pleural effusion in dialysis.…”

“…The number of patients initiated on PD therapy has also increased in recent years . Various studies across the world have reported TB in dialysis patients, but there are limited data among ESRD patients on maintenance dialysis in India. Therefore, we studied the clinical spectrum and outcome of TB in dialysis at our hospital.…”