The prevalence of tuberculin sensitivity and anergy in chronic renal failure in an endemic area: tuberculin test and the risk of post-transplant tuberculosis

Shankar, Machiraju S. Ravi; Aravindan, Ananthakrishnapuram; Sohal, P.M.; Kohli, Harbir Singh; Sud, Kamal; Gupta, Krishan Lal; Sakhuja, Vinay; Jha, Vivekanand

doi:10.1093/ndt/gfi141

Cited by 73 publications

(64 citation statements)

References 16 publications

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“…Patients in ESRD have high rates of cutaneous anergy when using the TST (10,17). A nonreactive TST (0 mm) may indicate that a patient did not have latent TB infection or had TB infection but was anergic.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of latent TB infection in ESRD patients varies from 11% to 63% using the tuberculin skin test (TST) (12)(13)(14). The TST may grossly underestimate the prevalence because of the high rates of cutaneous anergy (up to 44%) (10,(15)(16)(17) and is limited by a low specificity, with cross-reactions to Bacille-Calmette-Guérin (BCG) vaccination and exposure to nontuberculous mycobacteria.…”

mentioning

confidence: 99%

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High Prevalence of Latent Tuberculosis Infection in Dialysis Patients Using the Interferon-γ Release Assay and Tuberculin Skin Test

Lee¹,

Chou²,

Dou³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

High Prevalence of Latent Tuberculosis Infection in Dialysis Patients Using the Interferon-γ Release Assay and Tuberculin Skin Test

Lee¹,

Chou²,

Dou³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Low sensitivity of 50% for predicting post-transplant TB is explained by anergy due to deterioration of cellular immunity particularly in poor-nourished and anaemic patients, males, elderly, smokers, patients with hepatic pathology, peptic ulcer and/or prolonged duration of pretransplant hemodialysis [43,44,45,46]. Sensitivity of skin-test increases to 75% in kidney transplant recipients after exclusion of patients with anergy [9,26,34].…”

Section: Disscussionmentioning

confidence: 99%

“…Sensitivity of skin-test increases to 75% in kidney transplant recipients after exclusion of patients with anergy [9,26,34]. The sensitivity of the skin-test is not affected by BacillusCalmette -Guerin (BCG) vaccine [43]. Low specificity of 52% for predicting post-transplant TB is explained by higher positivity of the test in the endemic countries [9,26,43].…”

Section: Disscussionmentioning

confidence: 99%

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Mycobacterium Tuberculosis Infection Following Kidney Transplantation

Boubaker¹,

Abderrahim²,

Abdallah³

et al. 2013

AJMSM

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Tuberculosis (TB) is one of the major causes of morbidity and mortality worldwide. Post-transplant TB is a problem in successful long-term outcome of renal transplantation recipients. It is a life-threatening opportunistic infection that is frequently encountered, but the diagnosis is often delayed. With the emergence of newer potent immunosuppressive regimens and an increased incidence of TB in the general population, post-transplant TB among transplant recipients can be anticipated. Our objective was to describe the pattern and risk factors of TB infection, and the prognosis in our transplant recipients. This study was a retrospective review of the records of 491 renal transplant recipients in our hospital during the period from January 1986 to December 2009. The demographic data, transplant characteristics, clinical manifestations, diagnostic criteria, treatment protocol, and long-term outcome of this cohort of patients were analyzed. 16 patients (3.2%) developed posttransplant TB with a mean age of 32.5 ± 12.7 (range: 13-60) years and a mean post-transplant period of 36,6 months (range: 12,3 months -15.9 years). The forms of the diseases were pulmonary in 10 /16 (62.6%), disseminated in 3/16 (18.7%) and extrapulmonary in 3/16 (18.7%). All patients initially received 4-drug combination therapy. Because of drug interaction, an increase in the dose of calcineurium inhibitor and steroid was done in 2 cases and in steroids alones in 1 case. Graft dysfunction was observed in 7 cases (43,7%) with tissue-proof acute rejection in 3 cases and loss of the graft in 4 cases. Hepatotoxicity developed in 3 patients (18.7%) during treatment. Reccurence were observed in 4 cases after early stop of treatment. Two patients (12.5%) died. Extrapulmonary and disseminated tuberculosis were observed in third of our patients. More than 9 months of treatment may be necessary to prevent recurrence.

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Tuberculosis in Hemodialysis Patients in Area of High Incidence of Mycobacterium tuberculosis and Human Immunodeficiency Virus Infection

Marques

Rioja

Pacheco

et al. 2008

Dialysis & Transplantation

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BACKGROUND Hemodialysis (HD) patients have an increased incidence of tuberculosis (TB), which may be due to decreased cellular immunity, the presence of malnutrition, and the use of immunosuppressive drugs. Poor living conditions, overcrowding, and human immunodeficiency virus (HIV) infection could be considered added risk factors. This study analyzed the incidence and clinical characteristics of TB among HD patients in an area where TB and HIV infection have a high prevalence. METHODS In this multicenter study, 1266 patients (663 men and 603 women) ages 20–91 years (46.1 ± 16.8 years) from 8 HD centers in different cities of Rio de Janeiro State, Brazil, were studied. HIV‐infected patients were excluded from the study. RESULTS TB was observed in 30 patients (2.3%), the pulmonary type in 11 (36.6%) and the extrapulmonary type in 19 (63.4%). The time of emergence during the HD period was very wide (2–117 months). All patients presented with unexplained fever and general symptoms such as weight loss, fatigue, and malaise in variable frequencies. The purified protein derivative (tuberculin) test was positive in only 16.6% of TB patients. They were treated with a combination of rifampicin (450–6000 mg/day), isoniazid (200–300 mg/day), and pyrazinamide (1.5–2 g/day); only 1 patient died, and 2 underwent a successful renal transplantation after the treatment. CONCLUSIONS TB incidence in HD patients was higher than in the general population (p < 0.0001) with a relative risk (RR) of 19.68 (13.81 < RR < 29.03), which points to the urgent need to investigate TB in all uremic patients with unexplained fever, continuous nonspecific symptoms, or when TB is suspect, whereas the response to therapy is directly dependent on early diagnosis, and the specific treatment may offer HD patients a good prognosis.

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The prevalence of tuberculin sensitivity and anergy in chronic renal failure in an endemic area: tuberculin test and the risk of post-transplant tuberculosis

Cited by 73 publications

References 16 publications

High Prevalence of Latent Tuberculosis Infection in Dialysis Patients Using the Interferon-γ Release Assay and Tuberculin Skin Test

High Prevalence of Latent Tuberculosis Infection in Dialysis Patients Using the Interferon-γ Release Assay and Tuberculin Skin Test

Mycobacterium Tuberculosis Infection Following Kidney Transplantation

Tuberculosis in Hemodialysis Patients in Area of High Incidence of Mycobacterium tuberculosis and Human Immunodeficiency Virus Infection

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