Peritoneal tuberculosis in patients receiving continuous ambulatory peritoneal dialysis

Quantrill, Simon; Woodhead, Mark; Bell, Christine; Hutchison, Alastair J.; Gokal, Ram

doi:10.1093/ndt/16.5.1024

Cited by 44 publications

(37 citation statements)

References 21 publications

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“…Most studies have shown a predominance of extrapulmonary TB in dialysis patients [10][11][12] and this was also the case in this series. Peritoneal TB, otherwise relatively uncommon and which occurred in eight of 14 (57%) of the CAPD patients in this study, is the subject of a separate paper [13]. The other main extrapulmonary site was lymph nodes that were affected in six patients, all on dialysis.…”

Section: Discussionmentioning

confidence: 60%

Side-effects of antituberculosis drug treatment in patients with chronic renal failure

Quantrill

Woodhead²,

Bell³

et al. 2002

Eur Respir J

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Patients with chronic renal failure (CRF) have a high incidence of tuberculosis (TB). Those from the Indian subcontinent are at particular risk. The frequency of side-effects associated with antituberculous treatment in a group of patients with CRF was studied. All cases of TB in patients with CRF occurring over a 13-yr period at the Manchester Royal Infirmary, from 1986-1999, were identified by diagnostic coding, microbiology records and a TB database. The case notes were then reviewed. Twenty-four cases were identified, eight predialysis and 16 requiring regular dialysis. TB occurring in the dialysis group was extrapulmonary in every case. Nineteen of 24 (79%) patients were of Indian subcontinent origin and 14 of 16 (87%) dialysis patients were non-Caucasian. Adverse effects of treatment occurred in two of eight (25%) in the predialysis group and nine of 16 (56%) of the dialysis group. These were most commonly neuropsychiatric (6), hepatic (4) and gastrointestinal (4). Neuropsychiatric symptoms occurred exclusively in dialysis patients. In conclusion, a high incidence of side-effects from antituberculous medication, especially neuropsychiatric, hepatic and gastrointestinal, was identified in patients with chronic renal failure. Careful monitoring for side-effects is essential in this group, and consideration should be given to administering antituberculous chemoprophylaxis to all high-risk groups. Eur Respir J 2002; 20: 440-443. Patients with chronic renal failure (CRF) have a high incidence of tuberculosis (TB), possibly due to a decrease in cellular immunity [1-4]. Treatment of TB in CRF may be complicated by an increased risk of toxicity from antituberculous drugs, particularly isoniazid and ethambutol. Current British Thoracic Society (BTS) guidelines lack explicit recommendations for the management of these patients [5]. The Manchester Royal Infirmary (MRI) has a large renal unit with dialysis facilities and a catchment population that includes a high proportion of non-Caucasians, especially from the Indian subcontinent. In this study, all cases of TB occurring in patients with pre-existing CRF over a 13-yr period at the MRI were reviewed. Methods CRF can be defined as an irreversible deterioration of kidney function occurring usually over a period of years. Between 1986-1999, cases of TB in patients with CRF were identified by three methods: medical outpatient coding, microbiology records and the respiratory department TB database. For the purpose of this study, a case of TB was considered to be any patient receiving a course of antituberculous chemotherapy, regardless of whether the diagnosis was based on clinical suspicion or microbiological results. Adverse effects were defined as symptoms and/ or signs thought to be due to antituberculous treatment and of sufficiently serious or severe nature to warrant an alteration in therapy. Patients9 case notes were then inspected and relevant data recorded. All patients were treated at the same institution (MRI) for both CRF and TB. Results Twenty-four cases we...

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Section: Discussionmentioning

confidence: 60%

Side-effects of antituberculosis drug treatment in patients with chronic renal failure

Quantrill

Woodhead²,

Bell³

et al. 2002

Eur Respir J

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“…A lymphocyte or monocyte pleocytosis has been reported in several cases of PD tuberculous peritonitis and is a consistent finding in non-PD tuberculous peritonitis patients [3,4,10,13]. AFB smears were frequently negative [4,7,10,11,12] and mycobacterium was cultured from the effluent in only 0%-79% of cases [4,7,8,10,11,12]. Because it is a slow-growing and fastidious organism, mycobacterium requires special media for growth and culture for a prolonged period of time.…”

Section: Discussionmentioning

confidence: 92%

“…Other reported presentations included Tenckhoff catheter failure, paraplegia from a spinal abscess, relapsing peritonitis, and bone pain from TB osteomyelitis [2,7,8,9]. In two case series evaluating tuberculous peritonitis in nondialysis-dependent as well as PD-dependent patients, presenting signs and symptoms were abdominal distention and ascites, fever, weight loss, and abdominal pain [4,7,10,11,12] (Table 1). …”

Section: Discussionmentioning

confidence: 99%

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Mycobacterial peritonitis in pediatric peritoneal dialysis patients

Ferrara

Lemire

Grimm

et al. 2004

Pediatric Nephrology

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Peritonitis is the most common complication and the leading cause of death in pediatric peritoneal dialysis (PD) patients. According to the most recent data available from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), approximately 25% of pediatric PD patients who die succumb to infection. There are no reported cases of Mycobacterium tuberculosis (MTB) or Mycobacterium avium-intracellulare peritonitis in the NAPRTCS registry. With an increasing incidence of MTB worldwide and the impairment of cellular immunity in chronic renal failure patients, it is not surprising that mycobacterium peritonitis can occur in PD patients. We report two pediatric PD patients with mycobacterial peritoneal infection diagnosed over an 11-year period at our institution. One patient presented with a malfunctioning Tenckhoff catheter and again 3 years later with hyponatremia and ascites. The other presented with recurrent culture-negative peritonitis. These cases illustrate the importance of more extensive evaluation of PD complications, to include evaluation for mycobacterium with special media or peritoneal biopsy, in the above clinical settings if the routine work-up is unrevealing.

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“…In addition to this, patients on peritoneal dialysis who are at risk of intra -abdominal infection also require special consideration. 9,21 A chest radiograph should be performed as part of the workup of all renal patients to show any evidence of previous TB disease, but also so that future radiographs can be compared with previous studies, and any new infiltrates warrant further investigation. Further site -specific investigations such as abdominal ultrasound, computed tomography, or spinal magnetic resonance imaging should be considered based on symptoms.…”

Section: Tuberculin Skin Testmentioning

confidence: 99%

An update of management of latent tuberculosis infection and active disease in patients with chronic kidney disease

Myall¹,

Milburn²

2017

Polish Archives of Internal Medicine

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Peritoneal tuberculosis in patients receiving continuous ambulatory peritoneal dialysis

Abstract: Peritoneal TB, whilst otherwise relatively uncommon, is an important manifestation of TB in CAPD patients and usually develops soon after commencing dialysis. The reasons for this are unknown and require further research.

Cited by 44 publications

References 21 publications

Side-effects of antituberculosis drug treatment in patients with chronic renal failure

Side-effects of antituberculosis drug treatment in patients with chronic renal failure

Mycobacterial peritonitis in pediatric peritoneal dialysis patients

An update of management of latent tuberculosis infection and active disease in patients with chronic kidney disease

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