1
|
Zhang X, Chen P, Xu G. Update of the mechanism and characteristics of tuberculosis in chronic kidney disease. Wien Klin Wochenschr 2022; 134:501-510. [DOI: 10.1007/s00508-022-02009-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/24/2022] [Indexed: 10/18/2022]
|
2
|
Bonkain F, De Clerck D, Dirix V, Singh M, Locht C, Mascart F, Corbière V. Early diagnosis of miliary tuberculosis in a hemodialysis patient by combining two interferon-γ-release assays: a case report. BMC Nephrol 2020; 21:214. [PMID: 32498706 PMCID: PMC7273678 DOI: 10.1186/s12882-020-01875-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/26/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patients with end-stage renal disease undergoing chronic hemodialysis (HD) are at high risk to develop tuberculosis (TB) associated with a high mortality rate. TB diagnosis is often delayed due to non-specific symptoms, frequent extra-pulmonary manifestations, and rare microbiological confirmation. This case report illustrates the clear added value of combined interferon-γ -release assays (IGRA) in response to different mycobacterial antigens for an early diagnosis of TB in HD patients. CASE PRESENTATION We report the case of an Egyptian patient under chronic HD treatment, who presented with recurrent episodes of fever and myalgia of unknown origin, associated with an important inflammatory syndrome. These episodes resolved partially or completely within less than 1 month without any treatment but recurred 10 times within 3 years. Chest Computed Tomography and 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18FDG PET-CT) demonstrated several active mediastinal lymphadenopathies. TB was the first suspected diagnosis but cultures and polymerase chain reaction (PCR) remained negative on a mediastinal lymph node aspiration. In contrast, the results from two different IGRA performed on blood were highly suggestive of TB disease. Several granulomas, some of them with central non-caseating necrosis, were demonstrated on a pulmonary nodule obtained by thoracoscopic resection, but PCR and culture remained negative for M. tuberculosis. Three years after the initial symptoms, a new PET-CT revealed a retro-clavicular lymphadenopathy in addition to the mediastinal lymphadenopathies, and the M. tuberculosis culture performed on the resected lymphadenopathy was positive. Antibiotic treatment for TB was started and resulted in a clear improvement of the patient's clinical condition, allowing him to successfully receive a renal graft. CONCLUSIONS In view of the high frequency of TB in patients undergoing chronic HD and of the limitations of the classical diagnosis procedures, nephrologists have to diagnose TB mostly on clinical suspicion. We demonstrate here that the use of a combined IGRA to two different mycobacterial antigens may significantly raise the index of suspicion and help clinicians to decide starting anti-TB treatment in HD patients.
Collapse
Affiliation(s)
- Florence Bonkain
- Department of Nephrology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Dieter De Clerck
- Department of Nephrology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Violette Dirix
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Mahavir Singh
- Lionex Diagnostics and Therapeutics, Braunschweig, Germany
| | - Camille Locht
- U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, F-59000, Lille, France
| | - Françoise Mascart
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.
| | - Véronique Corbière
- Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| |
Collapse
|
3
|
Eshiwe C, Shahi F, Gordon N, Lillie P. Rare and unusual case of hepatic and disseminated tuberculosis in an immunocompetent patient. BMJ Case Rep 2019; 12:12/6/e229384. [PMID: 31229981 DOI: 10.1136/bcr-2019-229384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Mycobacterium tuberculosis complex disease (tuberculosis (TB)) of the liver is rare and liver abscesses as a result are even rarer. In an immunocompetent individual, the disease tends to be localised. To the best of our knowledge, we report one of the most severe TB involvements of the liver in an immunocompetent individual. A young woman with a history of previous TB infection, presented in septic shock. Scans showed a liver filled with possible abscesses, one of which was aspirated and confirmed TB. Multiple HIV tests were negative but she remained lymphopaenic. Although she improved substantially with anti-tuberculous treatment, she later developed non-tuberculous central nervous system disease that we were unable to fully explain. Despite a stormy recovery period, she continues to do well.
Collapse
Affiliation(s)
- Celestine Eshiwe
- Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Farah Shahi
- Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Neil Gordon
- Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Patrick Lillie
- Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| |
Collapse
|
4
|
Ethambutol-induced optic neuropathy in renal disorder: a clinico-electrophysiological study. Can J Ophthalmol 2019; 54:301-305. [DOI: 10.1016/j.jcjo.2018.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/24/2018] [Accepted: 06/07/2018] [Indexed: 11/19/2022]
|
5
|
Al Wakeel JS, Makoshi Z, Al Ghonaim M, Al Harbi A, Al Suwaida A, Algahtani F, Al Hedaithy M, Almogairin S, Abdullah S. The use of Quantiferon-TB gold in-tube test in screening latent tuberculosis among Saudi Arabia dialysis patients. Ann Thorac Med 2015; 10:284-8. [PMID: 26664568 PMCID: PMC4652296 DOI: 10.4103/1817-1737.157295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIM Screening for tuberculosis (TB) is a key strategy for controlling infection. This study aimed to detect latent TB among dialysis patients. METHODS This is a prospective study conducted in King Saud University, Riyadh involving hemodialysis (HD) and peritoneal dialysis (PD) patients aged ≥18 years. Patients were screened for latent TB infection (LTBI) using both TBskin test (TST) and QuantiFERONTB Gold In-Tube test (QFT-GIT). All participants were followed-up clinically and radiologically every 3 months for 2 years. RESULTS A total of 243 (181 HD and 62 PD) patients were included and 112(46.1%) were males. 45.3% showed positive QFT in HD patients with sensitivity of 91.7%, specificity of 71.4%, positive predictive value (PPV) of 19.5%, and negative predictive value (NPV) of 91.1%. TST results in HD showed that positive TST was 17.4%, sensitivity was 63.2%, specificity was 95.5%, PPV was 51.5%, and NPV was 91.1%. Five (8.1%) showed positive QFT in PD patients with sensitivity of 7.7%, specificity of 91.8%, PPV of 6.6%, and NPV of 92.3%. TST results in PD showed that positive TST was 9.8%, sensitivity was 35.7%, specificity was 97.9%, PPV was 55.8%, and NPV was 93.3%. Previous TB infection was significantly correlated with QFT only in HD patients, but significantly associated with TST in both HD and PD patients. Also in HD, QFT was significantly associated with TST (P = 0.043). CONCLUSIONS Due to high variability of QFT-GIT sensitivity, we recommend its use for its NPV and to use either TST or QFT in screening latent TB.
Collapse
Affiliation(s)
- Jamal Saleh Al Wakeel
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ziyad Makoshi
- Neurosurgery Department, The Ottawa Hospital-Civic Campus, The University of Ottawa, Ontario, Canada
| | - Mohammed Al Ghonaim
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali Al Harbi
- Nephrology Division, Security Forces Hospital, Riyadh, Saudi Arabia
| | | | - Farjah Algahtani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mogbil Al Hedaithy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sultan Almogairin
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sami Abdullah
- College of Applied Studies and Community Service, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
6
|
Koulmane Laxminarayana SL, Nagaraju SP, Prabhu Attur R, Manohar C, Parthasarathy R, Chari B. Hemophagocytic lymphohistiocytosis: An unusual presentation of tuberculosis in hemodialysis patients. Hemodial Int 2014; 19:E16-9. [PMID: 25307022 DOI: 10.1111/hdi.12232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a series of three patients with end-stage renal disease on maintenance hemodialysis presenting with hemophagocytic lymphohistiocytosis (HLH) as an unusual manifestation of extrapulmonary tuberculosis. All three patients were middle-aged men. They presented with fever, pancytopenia, varying degrees of hepatosplenomegaly, abnormal liver function tests, coagulopathy, increased serum ferritin, and triglycerides. Tests for fever work-up were negative. Bone marrow examination revealed hemophagocytosis and caseating granuloma. Acid fast bacilli were demonstrated in two patients. The HLH-2004 diagnostic criteria suggested by the histiocytic society were followed to arrive at the diagnosis. All of them succumbed to death even before the definitive diagnosis could be made. We suggest that aggressive diagnostic work-up must be done when hemodialysis patients present with fever and pancytopenia. Priority should be toward early diagnosis and appropriate treatment to improve the prognosis.
Collapse
Affiliation(s)
| | - Shankar P Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal University, Udupi, Karnataka, India
| | - Ravindra Prabhu Attur
- Department of Nephrology, Kasturba Medical College, Manipal University, Udupi, Karnataka, India
| | - Chethan Manohar
- Department of Pathology, Kasturba Medical College, Manipal University, Udupi, Karnataka, India
| | | | - Brahmaiah Chari
- Department of Pathology, Melaka Manipal Medical College, Manipal University, Udupi, Karnataka, India
| |
Collapse
|
7
|
Rao TM, Ram R, Swarnalatha G, Santhosh Pai BH, Ramesh V, Rao CSS, Naidu GD, Dakshinamurty KV. Tuberculosis in haemodialysis patients: A single centre experience. Indian J Nephrol 2013; 23:340-5. [PMID: 24049269 PMCID: PMC3764707 DOI: 10.4103/0971-4065.116296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We prospectively followed-up new patients of tuberculosis while on maintenance hemodialysis at a State Government-run tertiary care institute. Between 2000 and 2010, 1237 new patients were initiated on maintainence hemodialysis. The number of patients diagnosed with tuberculosis after initiation of hemodialysis was 131 (10.5% of 1237). The age was 46.4 ± 10.4 (range 8-85) years and there were 90 (68.7%) males. The number of patients diagnosed with tuberculosis on the basis of organ involvement were: Pulmonary-60, pleural effusion-31, lymph node-21, meningitis-8, pericardial effusion-7, peritoneum-2, latent tuberculosis-2. The incidence of tuberculosis in hemodialysis was found to be 105.9 per 1000 patient years. Male gender, diabetes mellitus, past history of tuberculosis, mining as an occupation, low serum albumin, and duration of hemodialysis more than 24 months, and unemployment were found to be significant risk-factors on univariate analysis.
Collapse
Affiliation(s)
- T Manmadha Rao
- Department of Nephrology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Hassanien AA, Al-Shaikh F, Vamos EP, Yadegarfar G, Majeed A. Epidemiology of end-stage renal disease in the countries of the Gulf Cooperation Council: a systematic review. JRSM SHORT REPORTS 2012; 3:38. [PMID: 22768372 PMCID: PMC3386663 DOI: 10.1258/shorts.2012.011150] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objectives To describe the epidemiology of end stage renal disease (ESRD). Design Mixed-methods systematic review. Setting The countries of the Gulf Cooperation Council (GCC) which consist of Saudi Arabia, the United Arab Emirates, Kuwait, Qatar, Bahrain, and Oman. Participants Defined to have ESRD or patients on regular dialysis for a minimum dialysis period of at least three months. Since many outcomes were reviewed, studies that estimated the incidence and prevalence of ESRD as outcomes should not have defined the study population as ESRD population or patients on regular dialysis. Studies where the study population mainly comprised children or pregnant woman were excluded. Main outcome measures The trends of the incidence, prevalence, and mortality rate of ESRD; also, causes of mortality, primary causes and co-morbid conditions associated with ESRD. Results 44 studies included in this review show that the incidence of ESRD has increased while the prevalence and mortality rate of ESRD in the GCC has not been reported sufficiently. The leading primary causes of ESRD recorded in the countries of the GCC is diabetes with the most prevalent co-morbid conditions being Hypertension and Hepatitis C Virus infection; the most common cause of death was cardiovascular disease and sepsis. Conclusions This review highlights that the lack of national renal registries data is a critical issue in the countries of the GCC. The available data also do not provide an accurate and updated estimate for relevant outcomes. Additionally, considering the increasing burden of chronic kidney disease (CKD), these results stressed the needs and the importance of preventative strategies for leading causes of ESRD. Furthermore, more studies are needed to describe the epidemiology of ESRD and for assessing the overall quality of renal care.
Collapse
Affiliation(s)
- Amal A Hassanien
- Department of Primary Care & Public Health, School of Public Health , Imperial College London , UK
| | | | | | | | | |
Collapse
|
9
|
Swarnalatha G, Ram R, Prasad N, Dakshinamurty KV. End-stage renal disease patients on hemodialysis: a study from a tertiary care center in a developing country. Hemodial Int 2011; 15:312-9. [PMID: 21518245 DOI: 10.1111/j.1542-4758.2011.00546.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The exact number of patients with chronic renal failure requiring renal replacement therapy in developing world is not known. Unlike the developed world, most developing countries lack renal registries. This study was initiated to know demographic and clinical data of end-stage renal disease (ESRD) patients presenting to maintenance hemodialysis (MHD) at a government funded tertiary care centre in a developing country. A prospective analysis of all new ESRD patients attending to hemodialysis at our centre from 2004 to 2007 had been done. There were 237 new hemodialysis patients during a three-year period. Males were 153 and females were 84, with the mean age 44.92 years. Diabetes mellitus (31.22%) was the most common cause of ESRD. Only 29.95% of patients had education on renal replacement therapy. 65.40% patients had emergency hemodialysis. Internal jugular catheter was the most common form of vascular access at initiation of hemodialysis. Arteriovenous fistula was secured in 29.95% of patients at presentation. Catheter-related infection appeared in 13.55% of patients on catheter. The most common infection in dialysis patients was urinary tract infection (37.14%). Renal transplantation was opted by 9.7% patients and continuous ambulatory peritoneal dialysis in 20.25% and 103 (43.45%) were lost to follow up. The rest (8.86%) continued on MHD. There were 42 (17.72%) deaths over a three-year period. The present study provided the information of the practice of hemodialysis, its population characteristics and outcomes from a developing country.
Collapse
Affiliation(s)
- Gudithi Swarnalatha
- Department of Nephrology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderbad 082, India
| | | | | | | |
Collapse
|
10
|
Tuberculosis of the breast in a patient undergoing hemodialysis. Int Urol Nephrol 2010; 43:241-4. [PMID: 20364402 DOI: 10.1007/s11255-010-9731-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 03/19/2010] [Indexed: 10/19/2022]
Abstract
A 61-year-old female patient with diabetes undergoing maintenance hemodialysis presented with fever and swelling of her right breast. She had been unresponsive to nonspecific antimicrobial therapies. Breast tuberculosis and tuberculous lymphadenitis were diagnosed by excision biopsy and tissue culture. A combination antituberculous treatment including isoniazid, rifampin, ethambutol, and pyrazinamide was started and resulted in the remission of the lesions by the end of the first month of therapy.
Collapse
|
11
|
Kayabasi H, Sit D, Kadiroglu AK, Kara IH, Yilmaz ME. The Prevalence and the Characteristics of Tuberculosis Patients Undergoing Chronic Dialysis Treatment: Experience of a Dialysis Center in Southeast Turkey. Ren Fail 2009; 30:513-9. [DOI: 10.1080/08860220802064721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
12
|
Dogan E, Erkoc R, Sayarlioglu H, Uzun K. Tuberculin Skin Test Results and the Booster Phenomenon in Two-Step Tuberculin Skin Testing in Hemodialysis Patients. Ren Fail 2009. [DOI: 10.1081/jdi-65379] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
13
|
Chuang FR, Lee CH, Wang IK, Chen JB, Wu MS. Extrapulmonary Tuberculosis in Chronic Hemodialysis Patients. Ren Fail 2009; 25:739-46. [PMID: 14575282 DOI: 10.1081/jdi-120024289] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The incidence of extrapulmonary tuberculosis is higher in dialysis than general population. The aim of the study was to characterize clinical picture in dialysis patients, who developed extrapulmonary tuberculosis. METHODS We retrospectively investigated the hemodialysis patients with extrapulmonary tuberculosis. 2208 hemodialysis patients were reviewed for extrapulmonary tuberculosis from October 1986 to January 2001. RESULTS Seventeen patients (10 male, 7 female) were enrolled. The mean age was 57.4 +/- 12.4 years. The sites for extrapulmonary tuberculosis were peritoneum (35.3%, 6/17), cervical lymph node (17.6%. 3/17), bone marrow (5.9%, 1/17), spine (5.9%, 1/17), knee (5.9%, 1/17), brain (5.9%, 1/17), pericardium (5.9%, 1/17), cutaneous tissue (5.9%, 1/17) and genitourinary system (5.9%, 1/17). Fourteen of 15 tissue-biopsy specimens from suspicious sites revealed granulomatous inflammation. There were low yield in mycobacteria culture (11.1%, 1/9) and PCR (33.3%, 2/6). Three patients died during the treatment of the disease. CONCLUSION Extrapulmonary tuberculosis constitutes a major part of tuberculosis in dialysis patients. Tissue biopsy with invasive procedures, such as laparoscopy or laparotomy, may be necessary if clinical presentations are suspicious.
Collapse
Affiliation(s)
- Feng-Rong Chuang
- Division of Nephrology, Chang Gung Memorial Hospital at Chiayi, Taiwan
| | | | | | | | | |
Collapse
|
14
|
Sen N, Turunc T, Karatasli M, Sezer S, Demiroglu YZ, Oner Eyuboglu F. Tuberculosis in patients with end-stage renal disease undergoing dialysis in an endemic region of Turkey. Transplant Proc 2008; 40:81-4. [PMID: 18261551 DOI: 10.1016/j.transproceed.2007.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The incidence of tuberculosis (TB) is high in end-stage renal disease (ESRD) patients undergoing dialysis. Diagnosis is difficult and delayed in this patient group owing to extrapulmonary involvement and nonspecific symptoms. Adverse effects of antituberculosis treatment are seen more frequently in these patients. We retrospectively evaluated the frequency and clinical progression of TB in 18 of 343 dialysis patients diagnosed with TB over a 5-year period at a university hospital in Adana, Turkey. Mean time between initiation of dialysis to diagnosis of TB was 19.5 +/- 26.1 months. Extrapulmonary TB was more frequent (77.8%) than pulmonary TB (22.2%). Diagnosis of TB was made based on clinical data in 1 patient, and microbiologically or pathologically in others. Antituberculosis treatment with 3 or 4 drugs was administered to patients for 6 to 12 months; second-line treatment was initiated in 1 patient infected with multidrug-resistant bacilli. One patient died owing to a cause other than TB; another was lost to follow-up. Adverse effects were hepatotoxicity in 3, optic neuritis in 1, and neuropsychiatric in 3 patients. A clinical response to therapy was achieved in all of the 16 patients who completed treatment. In conclusion, the incidence of TB and the frequency of extrapulmonary involvement are high in dialysis patients. Physicians must be alert to unusual presentations and localizations of the disease; TB must be strongly suspected in endemic regions. Owing to the greater frequency of adverse effects of treatment in these patients, they must be carefully observed during treatment.
Collapse
Affiliation(s)
- N Sen
- Department of Chest Diseases, Faculty of Medicine, Adana Teaching and Medical Research Center Baskent University, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
15
|
Okada M, Sugimoto K, Yagi K, Yanagida H, Tabata N, Takemura T. A boy undergoing maintenance hemodialysis who developed mediastinal lymph node tuberculosis. Clin Exp Nephrol 2006; 10:152-5. [PMID: 16791404 DOI: 10.1007/s10157-006-0419-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 03/17/2006] [Indexed: 10/24/2022]
Abstract
The incidence of tuberculosis (TBC) in patients undergoing maintenance hemodialysis is reported to be higher than that in the general population. We report an 8-year-old boy receiving such treatment for chronic renal failure who developed mediastinal lymph node TBC. He showed only intermittent fever, recurring every 2 weeks, with no other symptoms suggesting TBC. Although staining and culture of pharyngeal swab and gastric juice specimens failed to provide evidence of TBC, a lymph node biopsy specimen disclosed typical pathologic findings of tuberculoma, including caseating granulomas. Antituberculous therapy with isoniazid (INH), rifampicin, pyrazinamide, and ethambutol was given for 12 months, resulting in complete resolution of the TBC, with no subsequent recurrence. To our knowledge, mediastinal lymph node localization of TBC is relatively rare, in a patient on maintenance hemodialysis, especially in a child.
Collapse
Affiliation(s)
- Mitsuru Okada
- Department of Pediatrics, Kinki University School of Medicine, 377-2 Ohno-higashi, Osaka-Sayama 589-8511, Japan
| | | | | | | | | | | |
Collapse
|
16
|
Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis--presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther 2005; 22:685-700. [PMID: 16197489 DOI: 10.1111/j.1365-2036.2005.02645.x] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The peritoneum is one of the most common extrapulmonary sites of tuberculous infection. Peritoneal tuberculosis remains a significant problem in parts of the world where tuberculosis is prevalent. Increasing population migration, usage of more potent immunosuppressant therapy and the acquired immunodeficiency syndrome epidemic has contributed to a resurgence of this disease in regions where it had previously been largely controlled. Tuberculous peritonitis frequently complicates patients with underlying end-stage renal or liver disease that further adds to the diagnostic difficulty. The diagnosis of this disease, however, remains a challenge because of its insidious nature, the variability of its presentation and the limitations of available diagnostic tests. A high index of suspicion is needed whenever confronted with unexplained ascites, particularly in high-risk patients. Based on a systematic review of the literature, we recommend: tuberculous peritonitis should be considered in the differential diagnosis of all patients presenting with unexplained lymphocytic ascites and those with a serum-ascites albumin gradient (SAAG) of <11 g/L; culture growth of Mycobacterium of the ascitic fluid or peritoneal biopsy as the gold standard test; further studies to determine the role of polymerase chain reaction, ascitic adenosine deaminase and the BACTEC radiometric system for acceleration of mycobacterial identification as means of improving the diagnostic yield; increasing utilization of ultrasound and computerized tomographic scan for the diagnosis and as a guidance to obtain peritoneal biopsies; low threshold for diagnostic laparoscopy; treatment for 6 months with the first-line antituberculous drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) in uncomplicated cases.
Collapse
Affiliation(s)
- F M Sanai
- Division of Hepatology, Department of Internal Medicine, Riyadh, Saudi Arabia.
| | | |
Collapse
|
17
|
Wang IK, Chuang FR, Lee KF, Lin CL, Chang HY, Huang CK. Tuberculous peritonitis in a haemodialysis patient with elevated serum CA 125 and hypercalcaemia. Int J Clin Pract 2005:56-9. [PMID: 15875624 DOI: 10.1111/j.1368-504x.2005.00401.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
CA 125, a glycoprotein derived from coelomic epithelium, is used primarily as a marker of epithelial ovarian cancer. However, elevated levels of serum CA 125 have also been detected in other benign and malignant disorders. This study describes a haemodialysis patient who contracted tuberculous peritonitis associated with hypercalcaemia, erythropoietin-resistant anaemia and elevated CA 125, which normalised gradually following antituberculosis treatment. Tuberculous peritonitis should be considered in the differential diagnosis of ascites with elevated serum CA 125. Additionally, CA 125 is a useful marker for monitoring response to tuberculous peritonitis treatment.
Collapse
Affiliation(s)
- I K Wang
- Division of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | | | | | | | | | | |
Collapse
|
18
|
|
19
|
Genitourinary Tuberculosis. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
20
|
Akcay A, Erdem Y, Altun B, Usalan C, Agca E, Yasavul U, Turgan C, Caglar S. The booster phenomenon in 2-step tuberculin skin testing of patients receiving long-term hemodialysis. Am J Infect Control 2003; 31:371-4. [PMID: 14608305 DOI: 10.1016/s0196-6553(02)48238-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tuberculosis remains a significant health problem for patients receiving long-term hemodialysis (HD). The tuberculin skin test (TST) is an important method for detecting Mycobacterium tuberculosis infection. This study examined the significance and frequency of the booster phenomenon in serial TST of HD patients. METHOD Fifty-three outpatients in a hospital-based HD center in Turkey were screened for tuberculosis with the TST between August and October 1999. To determine the frequency of booster phenomenon, patients with less than 10 mm indurations to the initial TST were given a second test 7 days later. RESULTS Nineteen (35.8%) of 53 patients had a significant tuberculin reaction (> or = 10 mm) on the initial TST. The booster effect was detected in 10 (29.4%) of 34 patients who had a negative reaction (< 10 mm) to the initial test. Overall, 29 (54.7%) patients showed a significant reaction on both tests. CONCLUSIONS These results showed significant rates of TST positivity and the booster effect in this HD center.
Collapse
Affiliation(s)
- Ali Akcay
- Hacettepe Universty Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Ankara, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
There is an increased risk (6.9- to 52.5-fold) of tuberculosis (TB) in patients with chronic renal failure and on dialysis as compared to the general population. The symptomatology in renal patients is often insidious and nonspecific, mimicking uremic symptoms, whereas the localization is often extrapulmonary (most frequently tuberculous lymphadenitis and peritonitis). Tuberculous peritonitis makes up a large part (37%) of the total number of TB cases in continuous ambulatory peritoneal dialysis (CAPD) patients. The prognosis is very much dependent on early diagnosis and treatment. Renal physicians should be aware of the unusual presentation and localization, and include TB in the differential diagnosis of any patient having nonspecific symptoms like anorexia, fever, and weight loss. All efforts should then be made (including invasive investigations) to reach an early diagnosis, a major determinant of the outcome. However, if this is not possible or the result is negative and the diagnosis remains strongly suspected, an empirical trial with anti-TB medication is justified, especially in endemic areas. In view of the increased prevalence of the disease in the dialysis population, TB prophylaxis is recommended in those patients with a positive tuberculin (Mantoux) skin test and radiographs suggestive of old TB.
Collapse
Affiliation(s)
- Magdi M Hussein
- Department of Nephrology and Dialysis, Al Hada Armed Forces Hospital, TAIF, Saudi Arabia.
| | | | | |
Collapse
|
22
|
Linquist JA, Rosaia CM, Riemer B, Heckman K, Alvarez F. Tuberculosis exposure of patients and staff in an outpatient hemodialysis unit. Am J Infect Control 2002; 30:307-10. [PMID: 12163866 DOI: 10.1067/mic.2002.123394] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients receiving hemodialysis are generally considered to be at increased risk of developing tuberculosis (TB). We evaluated a 13-station chronic outpatient hemodialysis unit associated with a community hospital in northern California. Within 6 months, there were 2 incident source cases in the unit of active smear positive pulmonary tuberculosis; the first in a health care worker (HCW), diagnosed April 3, 1998, and the second in a patient undergoing dialysis treatment in October 1998. We describe the cases; the evaluation of exposures; and the institution of an intentional prospective TB control plan, designed specifically for the unique hemodialysis setting. METHODS We evaluated 23 HCWs twice and 89 patients undergoing hemodialysis treatment who were exposed to case 1 and 38 patients who were exposed to case 2. All 23 HCWs had documented prior negative Sierbert purified protein derivative of tuberculin (PPD) status and were retested at 12 weeks after exposure. None of the patients had documentation of PPD status. All of the patients were skin-tested initially with use of the 2-step method, and those with positive test results were offered isoniazid (INH). RESULTS One of the 23 HCWs' negative baseline PPD skin test status converted after exposure to case 1, and none of the remaining 22 converted after exposure to case 2. Twelve of 89 exposed patients with no prior skin test record had positive results for PPD after initial testing with the 2-step method. Three of the 12 (25%) patients were treated with INH at the discretion of their attending nephrologist. The 77 patients with negative results for PPD still had negative test results when retested at 3 months. None of 38 patients who underwent dialysis on the same schedule as source case 2 had a converted PPD test. Restriction fragment length polymorphism on TB isolates from both source cases ultimately showed them to be unrelated strains. CONCLUSION Our experience with these exposures suggests that TB screening of patient populations undergoing renal dialysis-though they have intrinsic high anergy rates-is advisable with a designed prospective plan before any inadvertent and/or repetitive exposure of that population to active TB. A planned intentional TB control program increases HCW awareness of TB, establishes baselines for evaluation, decreases "panic" in the event of subsequent exposures, and emphasizes the rationale for preventive therapy.
Collapse
Affiliation(s)
- Jeanne A Linquist
- Department of Medicine, Mills-Peninsula Health Services, Burlingame, California 94010, USA
| | | | | | | | | |
Collapse
|
23
|
Vanholder R, Peleman R. Increased incidence of tuberculosis in immigrant dialysis populations. Artif Organs 2002; 26:661-3. [PMID: 12139491 DOI: 10.1046/j.1525-1594.2002.00924.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
24
|
Kuo KL, Hung SC, Tarng DC. Fever and backache in a haemodialysis patient. Nephrol Dial Transplant 2001; 16:2267-9. [PMID: 11682683 DOI: 10.1093/ndt/16.11.2267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K L Kuo
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taiwan
| | | | | |
Collapse
|
25
|
Lui SL, Tang S, Li FK, Choy BY, Chan TM, Lo WK, Lai KN. Tuberculosis infection in Chinese patients undergoing continuous ambulatory peritoneal dialysis. Am J Kidney Dis 2001; 38:1055-60. [PMID: 11684559 DOI: 10.1053/ajkd.2001.28599] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A retrospective study of the prevalence and pattern of tuberculosis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) was performed. Thirty-eight cases of tuberculosis were diagnosed among 790 patients (18 men, 20 women; mean age, 58 +/- 12.6 years) between July 1994 and June 2000. The interval between the initiation of CAPD and onset of tuberculosis ranged from 1 to 168 months (median, 22 months). There were 18 cases of pulmonary tuberculosis, 14 cases of tuberculous peritonitis, 5 cases of tuberculous lymphadenitis, and 1 case of tuberculous synovitis. Patients with pulmonary tuberculosis usually presented with fever, constitutional symptoms, and pleural effusion or pulmonary infiltrates on chest radiograph. Abdominal pain and turbid dialysate were the main presenting symptoms in patients with tuberculous peritonitis. Diagnosis was established by positive culture in 20 patients, typical histological characteristics on a tissue biopsy specimen in 10 patients, and response to empirical antituberculous treatment in 8 patients. The duration of symptoms before the diagnosis of tuberculosis and initiation of antituberculous treatment ranged from 7 to 57 days (median, 30 days). Antituberculous treatment consisted of isoniazid, rifampicin, pyrazinamide, and ofloxacin for 9 to 15 months. Antituberculous treatment generally was well tolerated. Twenty-seven patients (71%) completed antituberculous treatment. No recurrence of tuberculosis was observed after a mean follow-up of 19.8 months. Eleven patients (29%) died while on antituberculous treatment; none of the deaths appeared to be directly caused by tuberculosis. We conclude that: (1) tuberculosis is prevalent among CAPD patients in our locality; (2) extrapulmonary tuberculosis, particularly tuberculous peritonitis, is common; and (3) a high index of suspicion for tuberculosis among CAPD patients is warranted to ensure early diagnosis and prompt initiation of treatment.
Collapse
MESH Headings
- Aged
- Antitubercular Agents/therapeutic use
- Female
- Hong Kong
- Humans
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/therapy
- Male
- Middle Aged
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/isolation & purification
- Peritoneal Dialysis, Continuous Ambulatory
- Peritonitis, Tuberculous/complications
- Peritonitis, Tuberculous/drug therapy
- Peritonitis, Tuberculous/mortality
- Survival Rate
- Treatment Outcome
- Tuberculosis/complications
- Tuberculosis/drug therapy
- Tuberculosis/mortality
- Tuberculosis, Lymph Node/complications
- Tuberculosis, Lymph Node/drug therapy
- Tuberculosis, Lymph Node/mortality
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/drug therapy
- Tuberculosis, Pulmonary/mortality
Collapse
Affiliation(s)
- S L Lui
- Division of Nephrology, University Department of Medicine, Tung Wah Hospital, Sheung Wan, Hong Kong.
| | | | | | | | | | | | | |
Collapse
|
26
|
Pien FD, Younoszai BG, Pien BC. Mycobacterial infections in patients with chronic renal disease. Infect Dis Clin North Am 2001; 15:851-76. [PMID: 11570145 DOI: 10.1016/s0891-5520(05)70176-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this article, the authors have provided a comprehensive review of TB and MOTT infections in patients on renal dialysis and receiving kidney transplants. Because most published series are small retrospective studies or case reports, there are several uncertainties still involved in the diagnosis and treatment of such patients. Unanswered questions include selection of optimal dosage and duration of therapeutic agents; the best tests for screening and diagnosis, especially in high prevalence areas; and the best management of MOTT infections because of unavailability of highly effective therapy.
Collapse
Affiliation(s)
- F D Pien
- University of Hawaii, John A. Burns School of Medicine, Straub Clinic and Hospital, Honolulu, Hawaii
| | | | | |
Collapse
|
27
|
Pleuro-Pulmonary Tuberculosis Presenting as a Chest Wall Mass in a Patient Undergoing Long-Term Hemodialysis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2001. [DOI: 10.1097/00019048-200109000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Sessler R, Konyar H, Hasche G, Olbricht CJ. The haemodialysis patient with night sweats, ascites, and increased CA 125. Nephrol Dial Transplant 2001; 16:175-7. [PMID: 11209018 DOI: 10.1093/ndt/16.1.175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Sessler
- Zentrum für Innere Medizin, Klinik für Nieren- und Hochdruckkrankheiten, Katharinenhospital Stuttgart, Stuttgart, Germany
| | | | | | | |
Collapse
|
29
|
Collazos J, Guerra E, Mayo J, Martínez E. Tuberculosis as a cause of recurrent fever of unknown origin. J Infect 2000; 41:269-72. [PMID: 11120618 DOI: 10.1053/jinf.2000.0727] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recurrent fever constitutes a diagnostic challenge for clinicians, due mainly to the intermittent nature of the fever that results in incomplete investigations. We describe three patients with recurrent fever thought to be due to tuberculosis, and review the 14 previously reported cases who fulfil the criteria of recurrent fever for at least 1 month's duration. The median duration of symptoms before diagnosis was 5 months, and the duration of the febrile bouts ranged from a few hours to 1 week. The most common complaints were constitutional symptoms and abdominal pain, and most patients had significant underlying conditions. The mortality rate was 31%, and was limited to the earlier cases. Routine laboratory studies are not very helpful for the diagnosis of this condition, and chest radiographs showed some alteration in half the cases at the time of diagnosis, although in some cases represented old, healed lesions. PPD testing was positive in most cases, particularly in those without underlying conditions. Empirical antituberculous therapy should be considered in cases of recurrent fever, especially in areas of high prevalence or in patients with predisposing conditions.
Collapse
Affiliation(s)
- J Collazos
- Section of Infectious Diseases, Hospital de Galdakao, Vizcaya, Spain
| | | | | | | |
Collapse
|
30
|
Waiser J, Schötschel R, Budde K, Neumayer HH. Reactivation of tuberculosis after conversion from azathioprine to mycophenolate mofetil 16 years after renal transplantation. Am J Kidney Dis 2000; 35:E12. [PMID: 10692297 DOI: 10.1016/s0272-6386(00)70224-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The incidence of tuberculosis among transplant recipients is greater than in the general population. Mycophenolate mofetil (MMF) is a potent immunosuppressive agent that has become part of most standard immunosuppressive protocols after renal transplantation. We have recently shown that conversion from azathioprine (AZA) to MMF in patients with chronic allograft dysfunction may be beneficial. Here, we report a patient with a history of pulmonary tuberculosis during his childhood. This patient was converted from AZA to MMF therapy 16 years after allogenic renal transplantation because of chronic allograft dysfunction. Two months later, he developed axillary lymph node tuberculosis caused by Mycobacterium tuberculosis. Because he denied contact with infectious persons, we diagnosed reactivation of old dormant tuberculosis. After surgical extirpation, quadruple antituberculous therapy was administered for 3 months (isoniazid, rifampicin, ethambutol, and pyrazinamide), followed by dual therapy for 3 months (isoniazid and rifampicin), and monotherapy for another 3 months (isoniazid). In the follow-up period, he remained asymptomatic with stable graft function. We conclude that MMF therapy in renal allograft recipients may cause reactivation of old dormant tuberculosis, even in the very late posttransplantation period. In these patients, close monitoring and isoniazid prophylaxis may be useful.
Collapse
Affiliation(s)
- J Waiser
- Department of Nephrology, University Hospital Charité, Campus Charité Mitte, Humboldt-University, Berlin, Germany.
| | | | | | | |
Collapse
|
31
|
Abstract
OBJECTIVE Immunocomprised patients with chronic renal failure haemodialysis have been reported to be at increased risk of developing tuberculosis. The purpose of this study was to monitor the development of tuberculosis in patients with chronic renal failure that have not yet been dialysed, presenting at the Renal Clinic of the King Khalid National Guard Hospital, Jeddah, Saudi Arabia. METHODS Eighty patients with chronic renal failure were followed up for a period of 3 years and were carefully monitored for the development of tuberculosis. Mantoux test, chest radiograph and sputum examinations were performed at the beginning of the study and every 6 months thereafter. RESULTS At the end of 3 years, eight out of 80 patients (10%) had developed tuberculosis, confirming the high incidence of tuberculosis in this group of patients. All the eight patients who developed tuberculosis before being started on dialysis had relatively low creatinine clearances. No particular underlying renal disease was associated with the development of tuberculosis. Four patients developed pulmonary tuberculosis, two renal tuberculosis and one each cervical tuberculous lymphadenitis and tuberculous meningitis. All patients responded satisfactorily to anti-tuberculosis therapy, as diagnosis was established early. CONCLUSION Routine screening for tuberculosis is recommended for patients with chronic renal failure presenting at Renal Units, and tuberculosis chemoprophylaxis should be considered for those undergoing haemodialysis, particularly in countries with a high incidence of tuberculosis.
Collapse
Affiliation(s)
- S Al Shohaib
- Department of Medicine, King Khalid National Guard Hospital, Jeddah, King of Saudi Arabia
| |
Collapse
|
32
|
Abstract
The incidence of tuberculosis is still high in many developing countries and immunocompromised patients with chronic renal failure requiring haemodialysis have been reported to be at increased risk of developing tuberculosis. In this study 80 patients with chronic renal failure were followed up for a period of three years and were carefully monitored for the development of tuberculosis. Mantoux test, chest radiograph and sputum were performed at the beginning of the study and every six months thereafter. At the end of the study period, 8 (10%) of the patients had developed tuberculosis, confirming the high incidence of tuberculosis in this group of patients. No particular underlying renal disease was associated with the development of tuberculosis. Four patients developed pulmonary tuberculosis, 2 renal tuberculosis and one each with cervical tuberculous lymphadenitis and tuberculous meningitis. All patients responded satisfactorily to anti-tuberculosis therapy as diagnosis was established early. The delayed recognition of tuberculosis and therefore a delay in the initiation of effective treatment is not only detrimental to the patient but also results in a potentially profound impact on public health. We recommend routine screening for tuberculosis in patients with chronic renal failure presenting at Renal Units and tuberculosis chemoprophylaxis for those undergoing haemodialysis, particularly in countries with high incidence of tuberculosis.
Collapse
Affiliation(s)
- S Al Shohaib
- Department of Medicine, King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia
| |
Collapse
|
33
|
Oner-Eyüboglu AF, Akçay MS, Arslan H, Demirhan B, Kalpaklioglu AF. Extrapulmonary involvement of mycobacterial infections in dialysis patients. Transplant Proc 1999; 31:3199-201. [PMID: 10616438 DOI: 10.1016/s0041-1345(99)00686-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A F Oner-Eyüboglu
- Department of Pulmonary Diseases, Baskent University, Ankara, Turkey
| | | | | | | | | |
Collapse
|
34
|
Malone RS, Fish DN, Spiegel DM, Childs JM, Peloquin CA. The effect of hemodialysis on cycloserine, ethionamide, para-aminosalicylate, and clofazimine. Chest 1999; 116:984-90. [PMID: 10531163 DOI: 10.1378/chest.116.4.984] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Determine hemodialysis clearances of the second-line antitubercular drugs cycloserine (CS), ethionamide (ETA), para-aminosalicylate (PAS), and clofazimine (CFZ). DESIGN Open-label, pharmacokinetic study SETTING Outpatient long-term hemodialysis unit PARTICIPANTS Eight long-term hemodialysis patients Interventions: Single oral doses of CS, 500 mg, ETA, 500 mg, PAS, 4,000 mg, and CFZ, 200 mg, were given 2 h (4 h for PAS) prior to hemodialysis (median blood flow rate, 400 mL/min; median dialysate flow rate, 600 mL/min; median hemodialysis time, 3.5 h). MEASUREMENTS AND RESULTS Arterial and venous serum samples were collected at the beginning and end of hemodialysis, and hourly during hemodialysis. Dialysate fluid was collected for the duration of hemodialysis. All samples were assayed for drug concentrations using validated high-performance liquid chromatography (for ETA and PAS), capillary electrophoresis (for CS), and colorimetry (for CFZ). Dialysate samples were analyzed for acetyl-PAS. Median recoveries of drug in dialysate were 56% (CS), 2.1% (ETA), 6.3% (PAS parent compound), and 0% (CFZ) of the doses administered. Acetyl-PAS was dialyzed to a greater extent than its parent compound. Median hemodialysis clearances calculated by dividing the amount recovered in dialysate by the serum area under the curve during dialysis were 189 (CS), 58 (ETA), 206 (PAS), and 0 (CFZ) mL/min. CONCLUSIONS ETA, CFZ, and PAS were not significantly dialyzed. CS is significantly removed by hemodialysis and should be dosed after hemodialysis.
Collapse
Affiliation(s)
- R S Malone
- Infectious Disease Pharmacokinetics Laboratory , National Jewish Medical and Research Center, Denver, CO 80206, USA
| | | | | | | | | |
Collapse
|
35
|
Simon TA, Paul S, Wartenberg D, Tokars JI. Tuberculosis in hemodialysis patients in New Jersey: a statewide study. Infect Control Hosp Epidemiol 1999; 20:607-9. [PMID: 10501258 DOI: 10.1086/501679] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study the incidence of tuberculosis (TB), tuberculin skin testing (TST) practices, and infection control practices at outpatient hemodialysis centers. DESIGN Mail surveys performed in December 1994 and 1995. MAIN OUTCOME MEASURES The numbers of patients with incident active TB during 1994 and 1995, TST policies during 1994, and TB infection control policies in 1994. SETTING All outpatient dialysis centers in New Jersey. PATIENTS OR PARTICIPANTS Healthcare workers and patients in dialysis centers in New Jersey. RESULTS Of 47 centers, 41 provided information on TST and TB infection control policies and practices. TSTs were performed on newly hired healthcare workers at all 41 centers and on established workers at 39 centers. In contrast, only 1 center reported performing TSTs on hemodialysis patients; 5 other centers reported screening of patients for TB using chest radiographs. Active TB was reported in 3 of 4,550 chronic hemodialysis patients in 1994 (rate, 66/100,000 patient-years) and in 4 of 4,831 patients in 1995 (rate, 83/100,000 patient-years). Both rates were several times higher than the rate in the New Jersey general population during this period (10.7-10.8/100,000). CONCLUSION Although based on small numbers of patients with TB, we found a relatively high incidence of TB among hemodialysis patients in New Jersey. Most centers reported performing TSTs on workers but not on patients. These results suggest the need for improved TB screening and infection control precautions at outpatient dialysis centers.
Collapse
Affiliation(s)
- T A Simon
- New Jersey University of Medicine and Dentistry, Trenton, USA
| | | | | | | |
Collapse
|
36
|
Nergizoglu G, Duman N, Ertürk S, Keven K, Ateş K, Akar H, Bademci G, Berk C, Erekul S, Erbay B, Karatan O, Ertug AE. Tuberculosis of the skull in a patient on maintenance haemodialysis. Nephrol Dial Transplant 1999; 14:2019-21. [PMID: 10462291 DOI: 10.1093/ndt/14.8.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Nergizoglu
- Department of Nephrology, Ankara University Medical School, Ibni Sina Hospital, Turkey
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Malone RS, Fish DN, Spiegel DM, Childs JM, Peloquin CA. The effect of hemodialysis on isoniazid, rifampin, pyrazinamide, and ethambutol. Am J Respir Crit Care Med 1999; 159:1580-4. [PMID: 10228130 DOI: 10.1164/ajrccm.159.5.9810034] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examines hemodialysis clearances of isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB). Seven chronic hemodialysis patients were studied. Six were given single oral doses (INH 300 mg, RIF 600 mg, PZA 1000 mg, and EMB 25 mg/kg) 2 h before hemodialysis (Cobe Centrysystem 3 hemodialysis machine; Fresenius F80B dialyzer; median blood flow rate 400 ml/min; dialysate flow rate 600 ml/min; median hemodialysis time 3.5 h). The seventh subject, being treated for tuberculosis (TB), was studied with his usual regimen. Arterial and venous serum samples were collected at the beginning and end of hemodialysis, and hourly during hemodialysis. Dialysate was collected for the duration of hemodialysis. All samples were assayed for drug concentrations using high-performance liquid chromatography (HPLC) (INH, RIF) and gas chromatography/mass spectrometry (GC/MS) (PZA, EMB) methods. Median recoveries of drug in dialysate were 9% (INH), 4% (RIF), 45% (PZA), and 2% (EMB) of the doses administered. Median hemodialysis clearances calculated by dividing the amount recovered in dialysate by the serum area under the curve during hemodialysis were 124 (INH), 40 (RIF), 270 (PZA), and 46 (EMB) ml/min. INH, RIF, and EMB were not significantly removed by hemodialysis. PZA is significantly dialyzed and should be dosed after hemodialysis.
Collapse
Affiliation(s)
- R S Malone
- Infectious Disease Pharmacokinetics Laboratory, National Jewish Medical and Research Center, Denver, Colorado, USA
| | | | | | | | | |
Collapse
|
38
|
L'Ecuyer PB, Woeltje KF, Seiler SM, Fraser VJ. Management and Outcome of Tuberculosis in Two St Louis Hospitals, 1988 to 1994. Infect Control Hosp Epidemiol 1998. [DOI: 10.2307/30141561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
39
|
Smirnoff M, Patt C, Seckler B, Adler JJ. Tuberculin and anergy skin testing of patients receiving long-term hemodialysis. Chest 1998; 113:25-7. [PMID: 9440563 DOI: 10.1378/chest.113.1.25] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVES Immunocompromised patients with chronic renal failure requiring hemodialysis (HD) are at increased risk of developing tuberculosis (TB). Routine TB screening of this population is recommended. This study examined the frequency of TB reactions and anergy in HD patients in a community with a high prevalence of TB. DESIGN Outpatients in a hospital-based HD center were screened with tuberculin, Candida, and mumps antigen. RESULTS Forty percent of patients were anergic and 19% were tuberculin reactors. No demographic factors correlated with either test results. CONCLUSIONS There was a high rate of TB infection and anergy in this HD center. Despite the high rate of anergy, tuberculin testing remains a useful test in this population. Anergic patients require further clinical evaluation for TB. Other HD programs should tuberculin and anergy test their patients to determine prevalence in their populations.
Collapse
Affiliation(s)
- M Smirnoff
- Department of Nursing, The Mount Sinai Medical Center, New York, New York, USA
| | | | | | | |
Collapse
|
40
|
Fang JT, Huang CC. Unusual presentations of extrapulmonary tuberculosis in three hemodialysis patients. Ren Fail 1997; 19:485-90. [PMID: 9154666 DOI: 10.3109/08860229709047735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We report three patients who received maintenance hemodialysis and suffered from extrapulmonary tuberculosis with unusual presentations. The first patient presented with fever of unknown origin. All studies showed negative findings except high erythrocyte sedimentation rate and high value of C-reactive protein. He failed to response to broad-spectrum antibiotics but showed a complete response to antituberculosis therapy. The second patient presented with right supraclavicular lymphadenopathy and weakness. Lymph node biopsy revealed caseating granuloma with positive acid-fast bacilli. The third patient presented with tumor mass of left sternoclavicular joint for which malignancy was suspected initially. Ultimately, tuberculosis was documented by histopathologic studies showing caseating granuloma. All three patients had normal findings of chest x-ray and did not have previous history of tuberculosis and diabetes mellitus.
Collapse
Affiliation(s)
- J T Fang
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung Medical and Technological College, Taipei, Taiwan, Republic of China
| | | |
Collapse
|
41
|
De Rossi SS, Glick M. Dental considerations for the patient with renal disease receiving hemodialysis. J Am Dent Assoc 1996; 127:211-9. [PMID: 8682990 DOI: 10.14219/jada.archive.1996.0171] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
An increasing number of Americans are living with end-stage renal disease. This disease has many implications for dentistry, in terms of oral manifestations and management of afflicted patients. The authors present pertinent information to help dentists treat patients who exhibit the oral and systemic manifestations of renal disease, from the onset of renal impairment through hemodialysis.
Collapse
Affiliation(s)
- S S De Rossi
- University of Pennsylvania School of Dental Medicine, Philadelphia, USA
| | | |
Collapse
|
42
|
Jarratt MJ, Sahn SA. Pleural effusions in hospitalized patients receiving long-term hemodialysis. Chest 1995; 108:470-4. [PMID: 7634886 DOI: 10.1378/chest.108.2.470] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To determine the incidence, causes, and clinical features of pleural effusions in hospitalized patients receiving long-term hemodialysis. DESIGN Retrospective. PARTICIPANTS One hundred patients receiving hemodialysis for at least 3 months with pleural effusion hospitalized at the Medical University of South Carolina hospitals. RESULTS The incidence of pleural effusions in hospitalized patients receiving long-term hemodialysis was 21%. The mean (+/- SEM) age was 55 +/- 1.4 years and the male to female and black to white ratios were 3:2. Pleural effusions resulted from heart failure in 46% and nonheart failure causes in 54%. Uremic pleurisy (n = 16), parapneumonic effusion (n = 15), and atelectasis (n = 11) accounted for most of the nonheart failure causes of pleural effusions. Three of 15 (20%) parapneumonic effusions were empyemas. The presence of chest pain was not different in patients with parapneumonic effusions than in other patients with nonheart failure effusion (all p = NS) but was more frequent compared to those with heart failure (p = 0.006). Patients with parapneumonic effusions (p = 0.0006) and atelectasis (p = 0.003) were more likely to have unilateral pleural effusions than patients with heart failure. CONCLUSIONS Pleural effusions are common in hospitalized patients receiving chronic hemodialysis. Although heart failure was the most common cause, other diseases were responsible for most of the effusions. The presence of a unilateral effusion suggests a diagnosis other than heart failure, most commonly parapneumonic effusion or atelectasis and deserves prompt thoracentesis as these effusions often cannot be reliably differentiated clinically. The reduced humoral and cellular immunity, in addition to delay in diagnosis because of an attenuated clinical response, may explain the high rate of empyemas in this study population.
Collapse
Affiliation(s)
- M J Jarratt
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston 29425, USA
| | | |
Collapse
|