Tuberculous Peritonitis in Different Dialysis Patients in Southern Taiwan

Abstract

Eleven cases of tuberculous peritonitis (TBP) in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients at the Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan between 1991 and 2000 were studied retrospectively (six cases in the HD group and five cases in the CAPD group) The diagnosis of TBP was established by either positive ascite tuberculosis (TB) culture or biopsy-proven chronic granulomatous inflammation. Fever and abdominal pain were the most common symptoms, while leukocytosis and unexplained hypercalcemia were the most common laboratory findings. Ascite analysis showed a lymphocyte predominance in all HD patients, but in only 40% of the CAPD patients. The mean duration of a diagnosis by ascite TB cultures was six weeks, while a diagnosis confirmed by laparascopic biopsy took one week. All four fatal cases were diagnosed by TB cultures. Laparoscopic biopsy provided a rapid diagnosis and resulted in low morbidity and mortality in our patients. Based on our review of all possible abstracts found in a Medline search from 1966 to 2002 using the keywords tuberculosis, peritonitis, uremia, and dialysis, this may be the first study of TBP in different dialysis patients.

Diagnostic Challenges of Tuberculosis Peritonitis in Patients With and Without End-Stage Renal Failure

“…Notably, treatment delay has been proven to be the most important predictive factor of mortality from TB peritonitis [5,16]. Recently, a retrospective study from Taiwan revealed that laparoscopic biopsy was safe and could provide a prompt diagnosis of TB peritonitis, resulting in low morbidity and mortality among patients undergoing dialysis [17]. In general, complications of laparoscopy are uncommon, and the reported mortality is !0.1% [18].…”

Endocrine and Metabolic Aspects of Tuberculosis

“…However, hypercalcemia is frequently reported to occur in tuberculosis patients with chronic kidney disease, including patients receiving peritoneal dialysis or hemodialysis (124–126). Tuberculosis-associated hypercalcemia has even been observed in anephric patients (119, 120, 122).…”

Endocrine and Metabolic Aspects of Tuberculosis

“…However, hypercalcemia is frequently reported to occur in tuberculosis patients with chronic kidney disease, including patients receiving peritoneal dialysis or hemodialysis (124)(125)(126). Tuberculosis-associated hypercalcemia has even been observed in anephric patients (119,120,122).…”