Increased Incidence of Tuberculosis in Chronic Hemodialysis Patients

Kürşat, Seyhun; Özgür, Bülent

doi:10.1159/000046654

Cited by 11 publications

(5 citation statements)

References 11 publications

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“…In Turkey, the percentage of extrapulmonary tuberculosis in 2007 was 30.5% according to the report of the Ministry of Health. Extrapulmonary involvement has been reported to be high in both Turkey (38–77%) and other countries (up to 50%) among the dialysis population, 1,2,4,5,7–12 and it was 48.39% in the present study. These difficulties lead to a delayed diagnosis, sometimes postmortem.…”

Section: Discussionsupporting

confidence: 49%

Tuberculosis in patients on hemodialysis in an endemic region

Kazancıoğlu

Öztürk

Gürsu

et al. 2010

Hemodialysis International

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Clinical presentation of tuberculosis is different in hemodialysis patients than in the general population. This study aimed to analyze hemodialysis patients with tuberculosis in Istanbul. Patients who were on a chronic hemodialysis program in Istanbul for more than 3 months and diagnosed to have tuberculosis at least 3 months after the start of hemodialysis were included. To discard the effect of immigration from other cities, we included only patients who had started their dialysis program in Istanbul. Their demographic and clinical data were analyzed using Statistical Package for Social Sciences for Windows ver. 13.0. Of the 925 patients screened from 7 different centers, 31 (3.35%) were found to have tuberculosis. The mean age was 52.3±13.5 years. The male/female ratio was 18/13. The mean duration of dialysis therapy and the duration of dialysis till the diagnosis of tuberculosis were 62.6±54.3 and 21.7±25.7 months, respectively. Extrapulmonary tuberculosis constituted 48.39%. Treatment ended with a cure in 18 (58.05%); was still ongoing in 12 (38.70%) patients; and 1 (3.25%) died of pulmonary tuberculosis. The lower incidence of tuberculosis compared with previous reports may be related to the differences in the diagnostic criteria and the decrease in the rate of tuberculosis during recent years. The demographic and clinical parameters of the patients were quite similar to the average dialysis population in Turkey. Hence, we cannot address a subpopulation with additional risk. It is important to prevent tuberculosis in hemodialysis patients due to difficulties in the diagnosis and treatment. Thus we recommend routine screening of hemodialysis patients and effective isolation and treatment of infected patients.

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Section: Discussionsupporting

confidence: 49%

Tuberculosis in patients on hemodialysis in an endemic region

Kazancıoğlu

Öztürk

Gürsu

et al. 2010

Hemodialysis International

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“…The first report of an increased prevalence of TB in dialysis patients appeared in 1974 (2). Later, many studies, several of which are summarized in Table 1, have confirmed a 6.9‐ to 52.5‐fold increased risk of TB in patients with chronic renal failure and on dialysis as compared to the general population (3–30); an even higher risk (100‐fold) was reported from a center in London with a high immigrant population (31). Despite the well‐known association between diabetes mellitus and TB, especially pulmonary (32), only two (22,31) of the quoted studies (2–31) found a higher prevalence of TB in dialysis patients with diabetes mellitus, as compared with other renal diseases.…”

Section: Epidemiologymentioning

confidence: 98%

“…The nonspecific presenting symptoms together with the frequent extrapulmonary localization constitute risk factors for a delay in the diagnosis of TB, which unfortunately has been observed in several studies. Within the extrapulmonary group, tuberculous lymphadenitis and peritonitis are the most reported localizations; less frequently cases of military, spine (Pott's syndrome), cerebral, and genitourinary TB have been reported (2–31).…”

Section: Featuresmentioning

confidence: 99%

Tuberculosis and Chronic Renal Disease

Hussein

Mooij

Roujouleh

2003

Seminars in Dialysis

181

164

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There is an increased risk (6.9- to 52.5-fold) of tuberculosis (TB) in patients with chronic renal failure and on dialysis as compared to the general population. The symptomatology in renal patients is often insidious and nonspecific, mimicking uremic symptoms, whereas the localization is often extrapulmonary (most frequently tuberculous lymphadenitis and peritonitis). Tuberculous peritonitis makes up a large part (37%) of the total number of TB cases in continuous ambulatory peritoneal dialysis (CAPD) patients. The prognosis is very much dependent on early diagnosis and treatment. Renal physicians should be aware of the unusual presentation and localization, and include TB in the differential diagnosis of any patient having nonspecific symptoms like anorexia, fever, and weight loss. All efforts should then be made (including invasive investigations) to reach an early diagnosis, a major determinant of the outcome. However, if this is not possible or the result is negative and the diagnosis remains strongly suspected, an empirical trial with anti-TB medication is justified, especially in endemic areas. In view of the increased prevalence of the disease in the dialysis population, TB prophylaxis is recommended in those patients with a positive tuberculin (Mantoux) skin test and radiographs suggestive of old TB.

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“…Actuellement, l'importance de la polymerase chain reaction (PCR) a été soulignée [15]. Devant cette difficulté diagnostique et la lourde mortalité liée au retard de traitement, certains auteurs préconisent un traitement d'épreuve chez les dialysés suspect de tuberculose [6,16]. Hachicha a traité 11 patients sur une simple présomption diagnostique [3].…”

Section: Discussionunclassified

Tuberculose chez les patients hémodialysés chroniques: à propos de quatre observations

Randriamanantsoa,

Rakotoarivelo,

Raharivelina

et al. 2011

Rev méd Madag

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Introduction. Patients in end stage renal disease undergoing haemodialysis are at high risk of tuberculosis. Patients and methods. The 4 cases we report illustrate the frequency of extrapulmonary localization and the difficulties to set the diagnosis. Results. The mean age was 34.5 years and the sex ratio 1. The mean delay from the initiation of haemodialysis to the diagnosis of tuberculo- sis infection was 4.25 months. Three cases were extrapulmonary: 2 pleural only, and 1 localised in lymph nodes. One patient had both pleural and lymph node localizations. Two patients showed good clinical response to therapy. Conclusion. For the tuberculosis infection’s signs are non-specific, the diagnosis is made by presumption. The early begining of the therapy is crucial for it can assure a better response.

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Increased Incidence of Tuberculosis in Chronic Hemodialysis Patients

Cited by 11 publications

References 11 publications

Tuberculosis in patients on hemodialysis in an endemic region

Tuberculosis in patients on hemodialysis in an endemic region

Tuberculosis and Chronic Renal Disease

Tuberculose chez les patients hémodialysés chroniques: à propos de quatre observations

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