Prevalence and presentation of tuberculosis among hemodialysis patients in Khartoum, Sudan

Abstract

Tuberculosis (TB) is a major health problem in the developing countries. There are limited data about the prevalence of TB patients on maintenance hemodialysis (HD) in Sudan. The aim of this study is to identify the prevalence and presentation of TB among Sudanese maintenance HD patients. This is a hospital-based descriptive study. The participants of the study are all HD patients distributed in 13 HD centers in Khartoum and Khartoum North Provinces in Sudan. All patients attended the HD centers from November 1, 2014 to February 1, 2015, were interviewed by a questionnaire focused on personal and clinical data. Those who were diagnosed as having active TB were studied regarding their clinical presentation, presence of comorbidities, site of TB, and methods used on diagnosis. The total number of HD patients during the study period was 1328 patients. We found 19 patients who already diagnosed and treated for TB infection. The prevalence rate of TB among HD patients is 1.4%. The mean age of patient was 44.53±8.69 years, 89.5% of them were males. The majority of them have comorbidities: 31.6%% have hypertension and 21.1% have diabetes. Extrapulmonary TB was the major presentation (57.9%) mainly tuberculous lymphadenitis (26.3%). The pulmonary presentation was found to be 42.1%. The diagnosis of TB was supported by microbiological evidence of alcohol acid-fast Bacilli present in sputum smear (21%), histological diagnosis (31.6%), polymerase chain reaction (21%), and imaging in (26.3%). Patients on maintenance HD are at an increased risk of TB and diagnosis of TB among HD patients need a high index of suspicion. There is a great need for establishing a screening scheme for TB among HD patients and further epidemiological studies are needed to fully evaluate this problem.

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

“…A mortality rate of 14.3%-36.8% has been reported among TB in dialysis. 4,7,8,23 About half of our TB patients died. All except one died while on anti-TB drug therapy.…”

“…TB in dialysis has a poor prognosis and high mortality due to delay in diagnosis and adverse effects of anti‐TB drugs. A mortality rate of 14.3%–36.8% has been reported among TB in dialysis . About half of our TB patients died.…”

“…Recent studies place lymph node TB on the second position in frequency after the pleural TB among HIV-negative patients, while, in patients with HIV/AIDS, it has been determined to be at first position of extrapulmonary TB. 22 Microbiological diagnosis of TB in dialysis ranges from 19.2% to 42%, 2,4,6,8,23,24 and histological diagnosis range from 22.7% to 67.1%. 4,6,8,15,23 The clinical diagnosis of TB has been reported in 28%-48.5% of the patients in various studies.…”

“…22 Microbiological diagnosis of TB in dialysis ranges from 19.2% to 42%, 2,4,6,8,23,24 and histological diagnosis range from 22.7% to 67.1%. 4,6,8,15,23 The clinical diagnosis of TB has been reported in 28%-48.5% of the patients in various studies. 4,6,8,23 TB diagnosis was on clinical grounds in half of our study patients.…”

“…4,6,8,15,23 The clinical diagnosis of TB has been reported in 28%-48.5% of the patients in various studies. 4,6,8,23 TB diagnosis was on clinical grounds in half of our study patients. TB diagnosis is more complicated and confusing in dialysis patients.…”