Tuberculosis Infection, a Challenge to Diagnose and Treatment in Hemodialysis Patients

Abstract

PURPOSE OF STUDY: The immunologic rearrangements in chronic renal failure have increased the susceptibility to tuberculosis (TB) infection. We present our experience in the diagnosis and treatment of TB among hemodialysis patients in our centre. METHODS: Since 1997–2001 tuberculosis was diagnosed in 26 patients (17 male, 9 female, mean age: 44.5 ± 14.3 years, HD duration 52.6 ± 34.1 months) that make an incidence of %2 per year. RESULTS: TB infection was characterized with an insidious while the main symptoms were fever in 80.7%, weight loss in 46.1% and night sweats in 30.7% of the patients. PPD skin test was ≥ 10 mm in 46.1%, 5–10 mm in 30.8%, and anergic in 23.1% of the patients. The major site of presentation was extrapulmonary TB in 76.9% of the patients predominating as lymphadenitis in 11 patients where as there were bone involvements in 2, peritoneum 4, and liver granuloma formation in liver in 1 patient. In addition to 4 patients with pulmonary involvement, 2 patients were diagnosed to have miliary TB. Our therapy protocol included administration of morfazinamid and ethambutol for 2 months and isoniazid, rifampicin for 9 months. In patients with miliary TB streptomycin was added to therapy. Mortality rate was 15.3%, while the rest of the patients were completely cured of TB. Old age, presences of malnutrition and infection with other bacterial agents have been found to be the major factors influencing the morbidity and mortality in these patients. CONCLUSION: There is a high incidence of TB infection in HD patients in Turkey. Insidious onset and extrapulmonary involvement are challenging problems in the diagnosis. Mortality rate is still high despite appropriate treatment.