Extrapulmonary involvement of mycobacterial infections in dialysis patients

Abstract

END-STAGE renal disease (ESRD) leads to changes in host defense mechanisms, particularly impairment of cellular immunity, that causes higher incidence of mycobacterial infections as compared to general population. In areas where tuberculosis (TB) is endemic, the incidence of mycobacterial infections in chronic renal failure patients is reported to be 10 times higher. Reactivation of the dormant microorganisms due to deficient host defense is suggested to be the main cause of mycobacterial infection in ESRD patients. Furthermore in these patients, extra pulmonary involvement of mycobacterial infections appears to be more frequent than isolated pulmonary disease. However, because extrapulmonary manifestations usually present in atypical forms, diagnosis can be delayed or missed entirely. In western countries the association between ESRD and mycobacterial infections is well documented, particularly TB. However, information is scanty on this patient population in regions where TB is endemic, mainly due to the lack of yearly statistical records. Turkey is one country where TB remains an important cause of morbidity and mortality; to date, no large studies have been carried out with regard to the incidence of mycobacterial infection in CRF patients in Turkey. In this descriptive study, we analyzed data of 36 patients who were diagnosed with mycobacterial infection from a total of 407 at our center over a 15-month period.