Abstract
Diagnosis of tuberculosis (TB) among dialysis patients may be difficult because of increased frequency of extra-pulmonary presentations, atypical clinical manifestations, and non-specific symptoms. This study aimed to investigate the spectrum of clinical presentations and outcome in dialysis patients during a nine-year period. A total of 651 patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) for at least three months in our unit between 2001 and 2010 were studied. Dialysis and follow-up were performed in our tertiary care center located in the eastern region of Turkey. Diagnosis of TB was established by combining clinical, radiological, biochemical, microbiological, and histological findings. Choice of anti-TB drug used, the results of therapy, and patient outcome were noted. Out of 651 dialysis patients studied, 322 (49.4%) were on PD and the remainder on HD (50.6%). Twenty-six (4%) of the 651 dialysis patients were diagnosed with TB (15 PD, 11 HD), 5 of whom were diagnosed by microbiological assessment, 9 by pathological assessment, and 12 by clinical and radiological findings. Mean age at diagnosis was 41.5 ± 16.5 years and the female/male ratio was 1.18. Three patients had a history of pulmonary TB. Extra-pulmonary involvement was observed in 17 (65.4%) patients. All patients were treated with rifampicin isoniazid, ethambutol, pyrazinamide and pyridoxine. Four patients died during the study. TB occurred in dialysis patients and extra-pulmonary TB was more commonly identified than pulmonary TB. Tuberculous lymphadenitis was the most frequent form of extra-pulmonary TB in our cohort.
Highlights
Diagnosis of tuberculosis (TB) among dialysis patients may be difficult because of increased frequency of extra-pulmonary presentations, atypical clinical manifestations, and non-specific symptoms
Diagnosis of TB was based on interpreting the results of radiological findings, smear and culture specimens from sputum and possible other foci [peritoneal, pleural, pericardial or cerebrospinal (CSF) fluid]; related tissue biopsy sampling; and purified protein derivative (PPD) skin or tuberculin test
The prevalence of tuberculosis was higher in the peritoneal dialysis (PD) group than in the HD group
Summary
Diagnosis of tuberculosis (TB) among dialysis patients may be difficult because of increased frequency of extra-pulmonary presentations, atypical clinical manifestations, and non-specific symptoms. This study aimed to investigate the spectrum of clinical presentations and outcome in dialysis patients during a nine-year period. Extra-pulmonary involvement was observed in 17 (65.4%) patients. Diagnosis of TB may be complicated and difficult in dialysis patients because of the increased frequency of extra-pulmonary involvement, atypical clinical presentations, and non-specific symptoms [1]. Data on the incidence and prevalence of TB in dialysis patients varies and depends on the study region [5,6]. Noted mostly as case reports, PD patients have increased incidence of peritoneal involvement compared to the HD population, suggesting a direct relationship with dialysis [5]
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