Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases: case reports and literature review

Yang, Wen-fang; Han, Fei; Zhang, Xiaohui; Zhang, Ping; Chen, Jianghua

doi:10.1631/jzus.b1200244

Cited by 10 publications

(9 citation statements)

References 41 publications

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“…Microbiological diagnosis of TB in dialysis ranges from 19.2% to 42%, and histological diagnosis range from 22.7% to 67.1% . The clinical diagnosis of TB has been reported in 28%–48.5% of the patients in various studies .…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Vikrant

2018

Hemodialysis International

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Introduction: Tuberculosis (TB) is a significant health problem in developing countries. There are limited data on TB among end stage renal disease (ESRD) patients on maintenance dialysis in India. Clinical profile and outcome of TB in dialysis were studied. Methods: Retrospective study of ESRD patients who were on maintenance dialysis (either peritoneal dialysis [PD] or hemodialysis (HD]) and diagnosed to have TB over a period of 11 years. Findings: Thirty‐two patients had a diagnosis of TB. Mean age of the patients was 50.3 ±13.9 years. The majority (56.2%) of the patients were female. The modality of dialysis was HD in 53.1% and PD in 46.9%. Mean duration of dialysis at the diagnosis of TB was 15.1 ± 13.9 months. Over three‐quarter of the patients had an extrapulmonary involvement. Pleuro‐pulmonary (40.6%), peritoneum (34.4%), and lymph node (15.6%) were the most common sites for TB. About 6.3%patients had disseminated TB, and 3.1% had pericardial TB. The clinical presentation of TB was: fever/pyrexia of unknown origin 28.1%, constitutional symptoms of anorexia, fever, night sweats and weight loss 34.4%, abnormal chest radiograph 37.5%, ascites/peritonitis 34.4%, pleural effusion 25%, lymphadenopathy 18.8%, meningoencephalitis 6.3%, and pericardial effusion 3.1%. Peritoneal TB presented as nonresolving peritonitis in PD and ascites in HD. The diagnosis was a microbiological/histological in 50% and rest 50% only on clinical grounds. Nine (29%) patients had adverse effects of anti‐TB drugs. Four patients of TB peritonitis had a poor gastrointestinal tolerance of anti‐TB drugs and defaulted on the treatment and had an adverse outcome. About 53.1% of the patients survived, and 46.9% died. Discussion: TB in dialysis is mostly extrapulmonary. Early diagnosis is difficult, and the adverse effects of anti‐TB medications complicate the treatment. TB in dialysis carries high morbidity and mortality. TB peritonitis has a poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Vikrant

2018

Hemodialysis International

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“…They also described that the peritoneum (31.4%) was the major organ that developed extrapulmonary TB, followed by the bone, lymph nodes, bone marrow, spleen, and liver. [ 9 ] In addition, fever (58.6%), pain, and lymphadenopathy were the most common clinical findings at the presentation of extrapulmonary TB, but non-specific symptoms, such as weight loss, anorexia, vomiting, and chronic anemia, were also often reported. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

Intestinal tuberculosis in a patient with end-stage renal disease on hemodialysis

Lee¹,

Kim²,

Kwon³

et al. 2020

Medicine

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Rationale: Intestinal tuberculosis (TB) is rarely seen in patients with end-stage renal disease (ESRD). We report an intestinal TB case with a clinical presentation similar to that of colon cancer in a patient with ESRD on hemodialysis. Patient concerns: A 49-year-old man presented with a 3-month history of general weakness and anorexia. He had been treated for stage 5 chronic kidney disease (CKD) due to diabetic nephropathy for the last 3 years. His blood urea nitrogen and serum creatinine levels were 96.9 and 8.1 mg/dL, respectively, at the time of admission; azotemia was accompanied by severe anemia, hypoalbuminemia, hyperkalemia, and metabolic acidosis. Hemodialysis was initiated for suspected exacerbation of uremia; however, intermittent fever, night sweats, and abdominal discomfort persisted. Diagnoses: Abdominal computed tomography (CT) and whole-body 18 F-fluorodeoxyglucose positron emission tomography were indicative of ascending colon cancer with lymph node metastases. However, colonoscopy with biopsy revealed the formation of submucosal caseating granuloma and acid-fast bacillus. Interventions: We initiated quadruple therapy with isoniazid, rifampicin, pyrazinamide, and ethambutol. The patient continued the quadruple regimen for the first 2 months before switching to dual therapy and received anti-TB medications for a total of 12 months. Outcomes: After 9 months of standard anti-TB chemotherapy, polypoid residual lesions were noted during follow-up colonoscopy. Laparoscopy-assisted ileocecal resection was performed. No findings suggestive of recurrence of colonic TB were observed on follow-up abdominal CT at 6 months after discontinuation of anti-TB medications. Lessons: If non-specific uremic symptoms persist in patients with advanced CKD, the possibility of extrapulmonary TB such as intestinal TB must be considered. Also, in patients with radiologic suspicion of colon cancer, endoscopy with biopsy should be performed promptly to exclude colonic TB with similar clinical manifestations.

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“…Tuberculosis should also be considered as a cause of prolonged fevers . Particularly, extrapulmonary tuberculosis is more frequent in hemodialysis patients than in healthy people . The TSPOT‐TB test is useful for diagnosing active tuberculosis .…”

Section: Discussionmentioning

confidence: 99%

“…11 Particularly, extrapulmonary tuberculosis is more frequent in hemodialysis patients than in healthy people. 12 The TSPOT-TB test is useful for diagnosing active tuberculosis. 13 In addition, CRP level is usually increased in pulmonary and extrapulmonary tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary sarcoidosis as a cause of intermittent fever of unknown origin in a hemodialysis patient with renal cell carcinoma: A case report and literature review

Shima¹,

Nishitani²,

Tashiro³

et al. 2019

Hemodialysis International

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Hemodialysis patients have weakened immune systems and can exhibit fever due to various causes. Herein, we describe the case of a 61‐year‐old hemodialysis patient who exhibited intermittent low‐grade fever after a pacemaker had been implanted 2 months before due to sick sinus syndrome. She had a medical history of subcutaneous sarcoidosis and uveitis. Active pulmonary sarcoidosis was diagnosed based on elevated soluble interleukin‐2 receptor, elevated lysozyme level, and gallium‐67 scintigraphy uptake in hilar and mediastinal lymph nodes. She was also diagnosed with renal cell carcinoma via contrast computed tomography. However, because her C‐reactive protein level remained normal, the possibility of neoplastic fever was considered low. After the initiation of prednisolone administration, her fever gradually disappeared. Her serum soluble interleukin‐2 receptor and lysozyme level improved in parallel with the enlargement of the mediastinal lymph node and gallium‐67 scintigraphy uptake.

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Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases: case reports and literature review

Cited by 10 publications

References 41 publications

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

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

Intestinal tuberculosis in a patient with end-stage renal disease on hemodialysis

Pulmonary sarcoidosis as a cause of intermittent fever of unknown origin in a hemodialysis patient with renal cell carcinoma: A case report and literature review

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