Tuberculous Peritonitis Complicating Long-Term Peritoneal Dialysis

Abstract

The characteristics of 5 patients who developed tuberculous peritonitis while receiving long-term peritoneal dialysis (PD) are presented. There were 2 males and 3 females. 3 patients were on intermittent and 2 were on continuous ambulatory peritoneal dialysis when tuberculous peritonitis was first diagnosed. None of the patients had recently received immunosuppression therapy or were diabetics. The clinical presentations were similar to other forms of peritonitis complicating PD except for a more insidious onset. As extraperitoneal involvement and peritoneal lymphocytosis were rarely present, the diagnosis was mainly dependent on the direct demonstration of Mycobacterium tuberculosis with smear (1 patient) and culture (4 patients). In 1 patient with a pleuroperitoneal communication, the diagnosis was made by pleural biopsy and a positive response to antituberculous therapy. All patients responded to treatment with a combination of three antituberculous drugs which included streptomycin, isoniazid, rifampicin and pyrazinamide. Two patients were transferred to hemodialysis. In 3 patients, peritoneal dialysis was continued. Peritoneal clearance and ultrafiltration capacity were unchanged for up to 16 months after treatment in 2 patients who continued peritoneal dialysis but was reduced by 30 and 50%, respectively, in the remaining patient. Only 1 patient died, but her death was not directly related to tuberculous peritonitis. It was concluded that with a high index of suspicion and early institution of treatment, tuberculous peritonitis complicating PD can be successfully treated with low mortality and without compromising the dialysis capacity of the peritoneal membrane.

Renal Tuberculosis in the Modern Era

“…Tuberculosis seems to be more common today than in the past among patients receiving peritoneal dialysis, who have a high incidence of peritoneal TB. 30,[34][35][36][37] Tuberculosis among hemodialysis patients can also occur because of infection with Mycobacterium and is observed mainly as the pulmonary form (disseminated or cutaneous). 18 Contamination of dialysis equipment is an important risk factor for disease transmission.…”

Fibroadhesive Form of Tuberculous Peritonitis: Chyloperitoneum in a Patient Undergoing Automated Peritoneal Dialysis

“…Most cases of tuberculous peritonitis complicating peritoneal dialysis occur as a result of reacti vation of a long latent tuberculous focus in the peritone um [12,13]. The clinical presentations were similar to other forms of peritonitis except for a more insidious onset [12].…”

“…Most cases of tuberculous peritonitis complicating peritoneal dialysis occur as a result of reacti vation of a long latent tuberculous focus in the peritone um [12,13]. The clinical presentations were similar to other forms of peritonitis except for a more insidious onset [12]. The peritoneal fluid differential white blood cell count was not helpful in the diagnosis of the majority of cases of tuberculous peritonitis complicating peritoneal dialysis [ 12]: lymphocyte predominance was occasionally present, but polymorph predominance was more com mon [14], The definite diagnosis of tuberculous peritoni tis depends on direct demonstration of M. tuberculosis in smear and culture of peritoneal effusion or biopsy materi al obtained at laparotomy.…”

“…However, it required 4-8 weeks to obtain culture results. Some invasive procedures to get histological information, such as laparotomy and laparoscopy, will be indicated to make a more timely diag nosis and to initiate appropriate treatment for preserva tion of peritoneal clearance and ultrafiltration capacity [ 12], The most frequent manifestations at laparoscopy are free ascites with multiple nodules in the parietal and vis ceral peritoneum, thickening and hyperemia of the viscer al peritoneum, and retraction of the greater omentum [15]. In our patient, who presented with a fibroadhesive form of tuberculous peritonitis, exploratory laparotomy would have been more appropriate [16],…”

Streptomycin Pharmacokinetics in Relapsing Mycobacterium xenopi Peritonitis

“…The major ity of the cases (65-70%) of peritonitis are due to gram positive organisms, with gram-negative bacteria isolated in approximately 20% of all episodes [1,2). Anaerobic bacteria, fungi, and mycobacteria, each account for less than 5% of the cases [3], Both tuberculous [4][5][6][7][8][9][10] and nontuberculous [11][12][13][14][15] forms of mycobacterial perito nitis have been described in patients treated with CAPD and have been associated with catheter removal and dis continuation of CAPD. The present report describes relapsing Mycobacterium xenopi peritonitis in a patient continuing CAPD.…”