The diagnosis of tuberculosis in dialysis patients

Jebali, H.; Barrah, Sana; Raïs, L.; Kheder, R.; Khouja, Nihel; Mhiri, Salma Nadia; Béji, M.; Abdelmalek, R.; Tiouiri, H.; Smaoui, Wided; Béji, S.; Hmida, F. Ben; Fatma, L. Ben; Zouaghi, Mohamed Karim

doi:10.4103/1319-2442.220882

Cited by 4 publications

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“…Vu le potentiel de présentation et de localisation inhabituelles de la TB chez les patients de DP, le diagnostic de la Tb doit être évoqué chez les patients présentant des symptômes systémiques non spécifiques [15].…”

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“…L'intervalle médian entre l'apparition des symptômes et le diagnostic de Tb était d'environ 20 jours chez nos patients, et le diagnostic de Tb a été posé sur des critères de présomption dans 42 % des cas. Jebali et al ont posé le Diagnostic de tubercuose en DP après un délai moyen de 113 jours, avec un diagnostic de présomption dans 31 % de cas [15]. Vikrant et al ont eu un diagnostic de présomption dans 54% de cas [10].…”

Section: Discussionunclassified

“…Cette toxicité est essentiellement hépatique, gastro-intestinale, neuropsychiatriques. L'incidence de ces effets indésirables varie de 10 à 50% selon les séries [10,15]. Dans notre série, l'incidence des effets indésirables du traitement anti-tuberculeux était de 25%, résolutifs après l'adaptation du traitement.…”

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Diagnostic et prise en charge de la tuberculose en dialyse péritonéale

et al. 2023

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Résumé Les complications infectieuses représentent la deuxième cause de mortalité chez l’insuffisant rénal chronique notamment la tuberculose (Tb) qui reste plus fréquente chez les dialysés.Le but de notre travail est de déterminer la prévalence de la Tb chez nos patients en dialyse péritonéale (DP) et d’analyser le profil clinique, paraclinique et évolutif de cette infection.Il s’agit d’une étude transversale rétrospective, incluant les patients en DP avec diagnostic de la Tb. Nous avons analysé leur profil clinique et paraclinique, le diagnostic et la localisation de Tb, ainsi que l’évolution sous traitement.Nous avons retenu 12 cas de Tb parmi les 228 patients suivis en DP (5.26%) de 2006 à 2022, avec un sex-ratio H/F à 0.7 et un âge moyen de 52.7 ± 10 ans. Le délai médian entre le début de la DP et le diagnostic de la Tb était à 21 mois.Le diagnostic de Tb était retenu avec certitude dans 7 cas, en se basant sur des preuves bactériologiques et/ou histologiques. Le diagnostic était présomptif dans 5 cas sur un faisceau d’arguments cliniques et paracliniques. La localisation de Tb est pulmonaire dans 4 cas et extra-pulmonaire dans 8 cas dont 3 cas de péritonite tuberculeuse.Le traitement anti-bacillaire est débuté après un délai médian de 20 jours après le début des symptômes. Ce traitement s’est compliqué de 2 cas d’hépatite médicamenteuse et 1 cas de polynévrite.L’évolution est marquée par la guérison chez 11 patients. Concernant la péritonite tuberculeuse, le cathéter a été retiré chez un patient et maintenu dans les deux autres cas avec évolution favorable.En DP, le diagnostic de Tb est souvent difficile et les atteintes extra-pulmonaires sont plus fréquentes.

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Diagnostic et prise en charge de la tuberculose en dialyse péritonéale

et al. 2023

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The relationship between lymphocyte subsets, nutritional status and tuberculin reactivity in continuous ambulatory peritoneal dialysis and hemodialysis patients

et al. 2020

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Aim Skin test anergy is common in patients with uremia and during maintenance hemodialysis treatment. However, up to date only one study concerning skin test in peritoneal dialysis patients has focused on the issue. Our cross-sectional controlled study was conducted to analyze the correlation of purified protein derivative (PPD) test response with demographical features, nutritional parameters and the distribution of peripheral blood lymphocyte subsets in peritoneal dialysis and hemodialysis patients Patients and methods Stable 30 hemodialysis (HD) patients (16 men, 14 women) and 30 continuous ambulatory peritoneal dialysis (PD) patients (17 men, 13 women) were included. Thirty healthy cases (15 men, 15 women) with a mean age of 32.4 ± 9.4 constituted the control group. Results In the HD group, 14 patients (46.6%) were PPD positive, and ın the PD group 16 patients (53.3%) were PPD positive. In the PPD-positive HD patients 64.2% (9/14), and in the PPD-positive PD patients 62.4% (10/16) had an induration of 10 mm or greater. In the control group, 21 of 30 patients (70%) were PPD positive. Comparison of both HD and PD groups with the control group showed significant differences in PPD reactivity (p < 0.01). Albumin levels were significantly high in the control groups (p < 0.01), and cholesterol levels were significantly high in the PD and the control groups (p < 0.05). Transferrin levels were significantly high in the PD (p < 0.01). The lymphocyte counts were significantly high in the control group compared to the HD patients (p < 0.05). The lymphocyte subset percentages CD19 were high in the control groups (p < 0.05), and CD16/56 was significantly high in the PD groups (p < 0.05). All the parameters were also similar between PPD-positive and-negative same groups. Conclusion The prevalence of PPD positivity was lower in the PD and HD groups. The PPD test responses were not related to the peripheral lymphocyte counts, subsets and malnutrition parameters.

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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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The diagnosis of tuberculosis in dialysis patients

Cited by 4 publications

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Diagnostic et prise en charge de la tuberculose en dialyse péritonéale

Diagnostic et prise en charge de la tuberculose en dialyse péritonéale

The relationship between lymphocyte subsets, nutritional status and tuberculin reactivity in continuous ambulatory peritoneal dialysis and hemodialysis patients

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

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