Disseminated tuberculosis: A neglected entity in immunocompromised hemodialysis patients

Abstract

End-stage renal disease is considered a factor predisposing to increased risk of tuberculosis with frequent extrapulmonary localization. Although extrapulmonary tuberculosis has been observed for decades, disseminated tuberculosis, a major cause of morbidity and mortality in immunocompromised hosts, remains rather neglected. We report an unusual case of an immunocompromised patient with a late diagnosis and delayed treatment of genitourinary tuberculosis that subsequently led to the diagnosis of vertebral and miliary tuberculosis (disseminating tuberculosis). Therefore, increased awareness is warranted from physicians dealing with hemodialysis patients in order to avoid delays in diagnosis and treatment initiation.

γδ T-cell function is inhibited in end-stage renal disease and impacted by latent tuberculosis infection

“…1 Patients with renal failure who require dialysis exhibit a 7-to 50-fold increased risk of reactivation of latent TB infection (LTBI) to active TB (ATB), which when coupled with the high prevalence of LTBI among these cohorts, places a significant clinical burden on this patient group. [2][3][4][5][6][7] Data suggest that the worldwide ESRD prevalence will continue to increase, particularly in geographical areas with a high burden of LTBI, thereby making TB acquisition and the treatment of chronic kidney disease and ESRD important public health concerns. 8 While the impact of inflammation and uremia on immune function are broadly understood with respect to ESRD, many details regarding their specific impact on lymphocyte populations involved in immunity to Mycobacterium tuberculosis (Mtb) remain unknown.…”

Disseminated tuberculosis mimicking metastatic colon cancer in a hemodialysis patient

“…We have read the interesting tuberculosis-related articles. [1][2][3] We agree that disseminated tuberculosis (DT) is quite a neglected entity, notably in hemodialysis patients. To further complicate things, DT has become even more frequent (due to the increase in hemodialysis, immunosuppressant use, and human immunodeficiency virus [HIV] infection); but DT diagnosis is often delayed, potentially compromising patients' prognosis.…”