Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases: case reports and literature review
- 75 Downloads
The diagnosis of extra-pulmonary tuberculosis (TB) seems relatively difficult due to the absence of specific symptoms and signs in patients on peritoneal dialysis or hemodialysis. We report four cases of extra-pulmonary tuberculosis on dialysis, with two cases on peritoneal dialysis and two cases on hemodialysis. The presentations, therapy, and outcomes of TB infection in these patients were reviewed. Otherwise, the English literature published in the PubMed database associating extra-pulmonary tuberculosis on dialysis over the last three decades is reviewed. A total of 61 studies containing 70 cases were included. The most common primary disease was diabetic nephropathy (22.86%, 16/70). The peritoneum (31.42%, 22/70), bone (21.42%, 15/70), and lymph node (20%, 14/70) were the most frequently infected. Single organ infection was common (90%, 63/70). Fever (58.57%, 41/70), pain (35.71%, 25/70), and enlarged lymph node (20%, 14/70) were the most common symptoms. Biopsy (67.14%, 47/70) and culture (40%, 28/70) provided most reliable methods for clear diagnosis of tuberculosis. The combined treatment of isoniazid, rifampicin, pyrazinamide, and ethambutol (44.29%, 31/70) was the most common therapy. The majority of patients improved (82.86%, 58/70); however, 12 cases got worse (17.14%), with 10 of them dying (14.29%). Physicians should be aware of the non-specific symptoms and location of infection, and consider tuberculosis in their differential diagnoses in dialysis patients presenting with symptoms such as fever, pain, and weight loss.
Key wordsExtra-pulmonary tuberculosis End stage renal disease Dialysis
Unable to display preview. Download preview PDF.
- Ates, G., Yildiz, T., Danis, R., Akyildiz, L., Erturk, B., Beyazit, H., Topcu, F., 2010. Incidence of tuberculosis disease and latent tuberculosis infection in patients with end stage renal disease in an endemic region. Ren. Fail., 32(1):91–95. [doi:10.3109/08860220903367528]PubMedCrossRefGoogle Scholar
- Borrajo Prol, M., Perez Melon, C., Novoa, E.F., Carrera, J.M., Iglesias, A., Camba, M., Bravo, J.J., Armada, E., Blanco, R.G., Santos, J., et al., 2009. Tuberculous peritonitis in peritoneal dialysis. Nefrologia, 29(2):170–172 (in Spanish). [doi:10.3265/Nefrologia.2009.29.2.4664.en.full]PubMedGoogle Scholar
- Ko, Y.C., Lee, C.T., Cheng, Y.F., Hung, K.H., Kuo, C.Y., Huang, C.C., Chen, J.B., 2004. Hypercalcaemia and haemophagocytic syndrome: rare concurrent presentations of disseminated tuberculosis in a dialysis patient. Int. J. Clin. Pract., 58(7):723–725. [doi:10.1111/j.1368-5031.2004.00054.x]PubMedCrossRefGoogle Scholar
- Kuno, Y., Iyoda, M., Aoshima, Y., Hosaka, N., Sanada, D., Hirai, Y., Shibata, T., Akizawa, T., 2010. A case of tuberculous peritonitis in a hemodialysis patient with high serum soluble interleukin-2 receptor and CA-125 levels. Intern. Med., 49(16):1783–1786. [doi:10.2169/internal medicine.49.3760]PubMedCrossRefGoogle Scholar
- Lee, S.S., Chou, K.J., Su, I.J., Chen, Y.S., Fang, H.C., Huang, T.S., Tsai, H.C., Wann, S.R., Lin, H.H., Liu, Y.C., 2009. High prevalence of latent tuberculosis infection in patients in end-stage renal disease on hemodialysis: comparison of QuantiFERON-TB GOLD, ELISPOT, and tuberculin skin test. Infection, 37(2):96–102. [doi:10. 1007/s15010-008-8082-3]PubMedCrossRefGoogle Scholar
- Li, S.Y., Chen, T.J., Chung, K.W., Tsai, L.W., Yang, W.C., Chen, J.Y., Chen, T.W., 2011. Mycobacterium tuberculosis infection of end-stage renal disease patients in Taiwan: a nationwide longitudinal study. Clin. Microbiol. Infect., 17(11):1646–1652. [doi:10.1111/j.1469-0691.2011.03473.x]PubMedCrossRefGoogle Scholar
- Nakamura, H., Tateyama, M., Tasato, D., Teruya, H., Chibana, K., Tamaki, Y., Haranaga, S., Yara, S., Higa, F., Fujita, J., 2009. Active tuberculosis in patients undergoing hemodialysis for end-stage renal disease: a 9-year retrospective analysis in a single center. Intern. Med., 48(24):2061–2067. [doi:10.2169/internalmedicine.48.2660]PubMedCrossRefGoogle Scholar
- Tarng, D.C., Su, W.J., Huang, T.P., 1998. PCR diagnosis on formalin-fixed, paraffin-embedded tissues with acid-fast stain and culture negativity in chronic dialysis patients of cervico-mediastinal tuberculous lymphadenitis. Nephrol. Dial. Transplant., 13(6):1543–1546. [doi:10.1093/ndt/13.6.1543]PubMedCrossRefGoogle Scholar