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Yang TY, Tian YC, Yen TH, Chang MY, Lin CY, Liu SH. Tuberculous peritonitis in patients on peritoneal dialysis: a 35-year experience from a large medical center in Northern Taiwan. Ren Fail 2023; 45:2153064. [PMID: 36632795 PMCID: PMC9848244 DOI: 10.1080/0886022x.2022.2153064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Tuberculous peritonitis (TBP) is a rare but fatal complication in patients on peritoneal dialysis (PD). In this study, we aimed to determine the demographic features, clinical features, laboratory parameters, and clinical outcomes of PD patients with TBP and to clarify possible risk factors for mortality. MATERIALS AND METHODS We retrospectively reviewed 2084 PD patients from January 1985 to December 2019. The diagnosis of TBP was established by positive peritoneal fluid culture for Mycobacterium tuberculosis. RESULTS 18 patients were diagnosed with TBP. The incidence was 2.029 episodes per 1000 patient-years. The most common symptom was fever (94.4%), followed by cloudy effluent (83.3%) and abdominal pain (83.3%). The average peritoneal dialysis effluent (PDE) white blood cell (WBC) count was 172.7 cells/μL. Nine patients (50%) had WBC counts lower than 100 cells/μL and 13 patients (72.2%) had neutrophilic predominant WBC counts. Acid fast stain (AFS) was positive in 7 patients (38.9%). Only 2 patients (11.1%) continued with PD after TB infection, while 10 patients (55.6%) changed to hemodialysis. Seven patients (38.9%) died within 1 year. Significant differences were observed in sex (p = 0.040), the presence of diabetes mellitus (p = 0.024), and PD catheter removal (p < 0.001) between TBP patients with and without mortality. However, none of them was a significant factor for 1-year mortality in multivariate Cox regression model. CONCLUSION Physicians should pay attention to the unusual presentations of peritonitis, especially if symptoms include fever or an initial low PDE WBC count. Catheter removal is not mandatory if early diagnosis and appropriate therapy are available.
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Affiliation(s)
- Tzu-Yi Yang
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Ya-Chung Tian
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Yang Chang
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chan-Yu Lin
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shou-Hsuan Liu
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,CONTACT Shou-Hsuan Liu Department of Nephrology, Chang Gung Memorial Hospital, Linkou branch, No. 5, Fuxing Street, Guishan Dist, Taoyuan City, 33305, Taiwan
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Thomson Benjamin KA, Stephen V, Bogdan M. Mycobacterium Tuberculosis Peritonitis in Peritoneal Dialysis Patients: A Scoping Review. Nephrology (Carlton) 2021; 27:133-144. [PMID: 34743395 DOI: 10.1111/nep.13997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The clinical syndrome of Mycobacterium tuberculosis (TB) peritoneal dialysis (PD) peritonitis is poorly understood. Whether local TB patterns modify the clinical syndrome, and what factors associate with poor outcomes is also unknown. METHODS A scoping review identified published cases of TB PD peritonitis. Cases from low and high TB burden areas were compared, and cases that did or did not suffer a poor clinical outcome were compared. RESULTS There were 216 cases identified. Demographics, presentation, diagnosis, treatment and outcomes were described. Significant delays in diagnosis were common (6.1 weeks) and were longer in patients from low TB burden regions (7.3 vs 3.7 weeks). In low TB burden areas, slower diagnostic methods were more commonly used like PD fluid culture (64.3 vs. 32.7%), and treatment was less likely with quinolone antibiotics (6.9 vs 34.1%). Higher national TB incidence and lower GDP per capita were found in cases that suffered PD catheter removal or death. Diagnostic delays were not longer in cases in which a patient suffered PD catheter removal or death. Cases that suffered death were older (51.9 vs 45.1 years) and less likely female (37.8 vs. 55.7%). Removal of PD catheter was more common in cases in which a patient died (62.0 vs 49.1%). CONCLUSIONS Outcomes in TB PD peritonitis are best predicted by national TB incidence, patient age and sex. Several unique features are identified to alert clinicians to use more rapid diagnostic methods that might enhance outcomes in TB PD peritonitis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- K A Thomson Benjamin
- Department of Medicine, Division of Nephrology, Queen's University, 76 Stuart Street, Kingston, ON, Canada.,Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, United States
| | - Vaughan Stephen
- Department of Medicine, Division of Infectious Diseases, University of Calgary. Foothills Medical Centre (North Tower) Room 419, 1403-29th Street NW, Calgary, AB, Canada
| | - Momciu Bogdan
- Department of Medicine, Division of Nephrology, Queen's University, 76 Stuart Street, Kingston, ON, Canada
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Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
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4
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Bnaya A, Wiener-Well Y, Soetendorp H, Einbinder Y, Paitan Y, Kunin M, Tanasiychuk T, Kushnir D, Kruzel-Davila E, Gershkovitz R, Rosenberg R, Bloch A, Doviner V, Assous MV, Peretz O, Shavit L, Ben-Chetrit E. Nontuberculous mycobacteria infections of peritoneal dialysis patients: A multicenter study. Perit Dial Int 2020; 41:284-291. [PMID: 32400280 DOI: 10.1177/0896860820923461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Nontuberculous mycobacteria (NTM) infections pose a diagnostic challenge in peritoneal dialysis (PD) patients. In this study, we sought to identify findings that are suggestive of NTM infection in PD adult patients. METHODS All patients with NTM exit-site infection (ESI) with/without tunnel infection and peritonitis identified during the last decade in eight medical centers in Israel were included. Clinical, microbiological, and outcome data were collected and analyzed. RESULTS Thirty patients were identified; 16 had ESI (53%) and 14 had peritonitis (47%). Median age was 65 years (interquartile range 52-76). Abdominal pain and cloudy PD fluid were reported in all patients with peritonitis, whereas exit-site discharge and granulation tissue were common in patients with ESI. Fourteen patients (47%) had negative cultures prior NTM diagnosis, and isolation of diphtheroids or Corynebacterium spp. was reported in 9 of 30 patients (30%). Antimicrobial treatment prior to diagnosis was documented in 13 of 30 patients (43%). Delayed diagnosis was frequent. Treatment regimens and duration of therapy varied widely. In 26 of 30 (87%) patients, catheter was removed and 19 of 30 patients (63%) required permanent transition to hemodialysis. Two patients with peritonitis (2 of 14, 14%) and seven with ESI (7 of 16, 44%) were eligible for continuation of PD. CONCLUSIONS Culture negative peritonitis, isolation of diphtheroids or Corynebacterium spp., previous exposure to antibiotics, and/or a refractory infection should all prompt consideration of PD-related NTM infection and timely workup. Catheter removal is recommended aside prolonged antimicrobial therapy. In select patients with ESI, continuation of PD may be feasible.
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Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Yonit Wiener-Well
- Infectious Diseases Unit, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Hila Soetendorp
- Department of Nephrology, Sourasky Medical Center, Affiliated with the Tel Aviv University, Israel
| | - Yael Einbinder
- Department of Nephrology, Meir Medical Center, Kfar Saba, Affiliated with the Tel Aviv University, Israel
| | - Yossi Paitan
- Department of Clinical Microbiology and Immunology, 37253Meir Medical Center, Kfar Saba, Affiliated with the Tel Aviv University, Israel
| | - Margarita Kunin
- Institue of Nephrology and Hypertension, 26744Sheba Medical Center, Ramat Gan, Affiliated with the Tel Aviv University, Israel
| | - Tatiana Tanasiychuk
- Department of Nephrology, 37255Carmel Medical Center, Affiliated with the Technion - Israel Institute of Technology, Haifa, Israel
| | - Daniel Kushnir
- Department of Nephrology, 37255Carmel Medical Center, Affiliated with the Technion - Israel Institute of Technology, Haifa, Israel
| | - Etty Kruzel-Davila
- Department of Nephrology and Hypertension, 58878Rambam Health Care Campus, Affiliated with the Technion - Israel Institute of Technology, Haifa, Israel
| | - Regina Gershkovitz
- Israel Institute of Nephrology and Hypertension, 26736Hillel Yaffe Medical Center, Hadera, Affiliated with the Tel Aviv University, Israel
| | - Roza Rosenberg
- Division of Nephrology, 37256Assaf Harofeh Medical Center, Be'er Ya'akov, Affiliated with the Tel Aviv University, Israel
| | - Aharon Bloch
- Department of Nephrology and Hypertension, 58884Hadassah Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Victoria Doviner
- Department of Pathology, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Marc V Assous
- Clinical Microbiology Laboratory, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Orly Peretz
- Institute of Nephrology, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Linda Shavit
- Institute of Nephrology, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
| | - Eli Ben-Chetrit
- Infectious Diseases Unit, 26743Shaare Zedek Medical Center, Affiliated with the Hebrew University, Jerusalem, Israel
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Abstract
Although the general incidence of peritonitis has declined considerably with improvement in connectology, tuberculous peritonitis is still a major problem in patients who are from endemic regions and who belong to high risk groups. The problem stems mainly from less sensitive diagnostic tools. Confirmation of tuberculous peritonitis is based on mycobacterial culture of the peritoneal fluid, which takes a few weeks. For patients in whom tuberculous peritonitis cannot be confirmed, therapeutic trial has been recommended. Treatment of tuberculous peritonitis consists in removing the peritoneal catheter and initiating antituberculosis medications, though the dosage and duration of antituberculosis medication are not yet well defined. Early initiation of antituberculosis medication has been shown to preserve good ultrafiltration and solute clearance by the peritoneal membrane.
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6
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Keane WF, Bailie GR, Boeschoten E, Gokal R, Golper TA, Holmes CJ, Kawaguchi Y, Piraino B, Riella M, Vas S. Adult Peritoneal Dialysis-Related Peritonitis Treatment Recommendations: 2000 Update. Perit Dial Int 2020. [DOI: 10.1177/089686080002000406] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- William F. Keane
- Department of Medicine, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Elizabeth Boeschoten
- Department of Peritoneal Dialysis, Academic Medical Center, Amsterdam, The Netherlands
| | - Ram Gokal
- Manchester Royal Infirmary, Manchester, United Kingdom
| | | | | | | | - Beth Piraino
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Miguel Riella
- Renal Division, Department of Medicine, Evangelic School of Medicine, Curitiba Parana, Brazil
| | - Stephen Vas
- University of Toronto, Toronto Hospital, Toronto, Ontario, Canada
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Piraino B, Bailie GR, Bernardini J, Boeschoten E, Gupta A, Holmes C, Kuijper EJ, Li PKT, Lye WC, Mujais S, Paterson DL, Fontan MP, Ramos A, Schaefer F, Uttley L. Peritoneal Dialysis-Related Infections Recommendations: 2005 Update. Perit Dial Int 2020. [DOI: 10.1177/089686080502500203] [Citation(s) in RCA: 516] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Beth Piraino
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Judith Bernardini
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Amit Gupta
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Clifford Holmes
- Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois, USA
| | - Ed J. Kuijper
- Department of Medical Microbiology, University Medical Center, Leiden, The Netherlands
| | - Philip Kam-Tao Li
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Wai-Choong Lye
- Centre for Kidney Diseases, Mount Elizabeth Medical Centre, Singapore
| | - Salim Mujais
- Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois, USA
| | - David L. Paterson
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Alfonso Ramos
- Division of Nephrology, Hospital General de Zona #2, Instituto Mexicano del Seguro Social, Hermosillo, Mexico
| | - Franz Schaefer
- Pediatric Nephrology Division, University Children's Hospital, Heidelberg, Germany
| | - Linda Uttley
- Renal Dialysis Treatment, Manchester Royal Infirmary, Manchester, United Kingdom
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8
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Fontán MP, Rodríguez-Carmona A, García-Naveiro R, Rosales M, Villaverde P, Valdés F. Peritonitis-Related Mortality in Patients Undergoing Chronic Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080502500311] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Peritonitis is a well-known cause of mortality in peritoneal dialysis (PD) patients. We carried out a retrospective study to disclose the clinical spectrum and risk profile of peritonitis-related mortality. We analyzed 693 episodes of infectious peritonitis suffered by 565 patients (follow-up 1149 patient-years). Death was the final outcome in 41 cases (5.9% of episodes), peritonitis being directly implicated in 15.2% of the global mortality and 68.5% of the infectious mortality observed. In 41.5% of patients with peritonitis-related mortality, the immediate cause of death was a cardiovascular event. Highest mortality rates corresponded to fungal (27.5%), enteric (19.3%), and Staphylococcus aureus (15.2%) peritonitis. Multivariate analysis disclosed that the baseline risk of peritonitis-related mortality was significantly higher in female [relative risk (RR) 2.13, 95% confidence interval (CI) 1.24 – 4.09, p = 0.02], older (RR 1.10/year, CI 1.06 – 1.14, p < 0.0005), and malnourished patients (RR 2.51, CI 1.21 – 5.23, p = 0.01) with high serum C-reactive protein (s-CRP) levels (RR 4.04, CI 1.45 – 11.32, p = 0.008) and a low glomerular filtration rate (RR 0.75 per mL/minute, CI 0.64 – 0.87, p < 0.0005). Analysis of risk after a single episode of peritonitis and/or subanalysis restricted to peritonitis caused by more aggressive micro-organisms disclosed that overall comorbidity [odds ratio (OR) 1.21, CI 1.05 – 1.71, p = 0.005], depression (OR 2.35, CI 1.14 – 4.84, p = 0.02), and time on PD at the time of the event (OR 1.02/month, CI 1.00 – 1.03, p = 0.02) were other predictors of mortality. In summary, the etiologic agent is a definite marker of peritonitis-related mortality but gender, age, residual renal function, inflammation (s-CRP), malnutrition, and depression are other significant correlates of this outcome. Most of these risk factors are common to cardiovascular and peritonitis-related mortality, which may explain the high incidence of cardiovascular event as the immediate cause of death in patients with peritonitis-related mortality.
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Affiliation(s)
- Miguel Pérez Fontán
- Divisions of Nephrology, A Coruña, Spain
- Department of Medicine, University of A Coruña, A Coruña, Spain
| | | | | | - Miguel Rosales
- Public Health, Hospital Juan Canalejo, A Coruña, Spain
- Department of Medicine, University of A Coruña, A Coruña, Spain
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9
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Wu DC, Averbukh LD, Wu GY. Diagnostic and Therapeutic Strategies for Peritoneal Tuberculosis: A Review. J Clin Transl Hepatol 2019; 7:140-148. [PMID: 31293914 PMCID: PMC6609850 DOI: 10.14218/jcth.2018.00062] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023] Open
Abstract
Peritoneal tuberculosis (PTB), although rarer than its pulmonary counterpart, is a serious health concern in regions of the world with high tuberculosis prevalence. Individuals with baseline immunocompromise condition, whether acquired or medically induced, are at greatest risk for experiencing PTB. While medical treatment of the condition is similar to that of the pulmonary disease, the generally immunocompromised state of those infected with PTB, along with a lack of highly sensitive and specific testing methods make early diagnosis difficult. This review discusses the risks factors, clinical features, diagnostic methods, and treatment options for PTB.
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Affiliation(s)
| | - Leon D. Averbukh
- *Correspondence to: Leon D. Averbukh, Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, 236 Farmington Ave., Farmington, CT 06030, USA. Tel: +1-347-306-4752, Fax: +1-860-679-4613, E-mail:
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10
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Lam MF, Tang S, Lai K. Tuberculous Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis. Int J Artif Organs 2018. [DOI: 10.1177/039139880002300302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M. F. Lam
- Department of Medicine, University of Hong Kong and Queen Mary Hospital, Hong Kong - China
| | - S.C.W. Tang
- Department of Medicine, University of Hong Kong and Queen Mary Hospital, Hong Kong - China
| | - K.N. Lai
- Department of Medicine, University of Hong Kong and Queen Mary Hospital, Hong Kong - China
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11
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Li PKT, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG, Teitelbaum I, Johnson DW. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 2016; 36:481-508. [PMID: 27282851 PMCID: PMC5033625 DOI: 10.3747/pdi.2016.00078] [Citation(s) in RCA: 612] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Beth Piraino
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Javier de Arteaga
- Department of Nephrology, Hospital Privado and Catholic University, Cordoba, Argentina
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Ana E Figueiredo
- Nursing School-FAENFI, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas N Fish
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Eric Goffin
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Belgium
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - William Salzer
- University of Missouri-Columbia School of Medicine, Department of Internal Medicine, Section of Infectious Disease, MI, USA
| | - Dirk G Struijk
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
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12
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Tamayo-Isla RA, de la Cruz MC, Okpechi IG. Mycobacterial Peritonitis in CAPD Patients in Limpopo: A 6-Year Cumulative Report from a Single Center in South Africa. Perit Dial Int 2016; 36:218-22. [PMID: 27006437 DOI: 10.3747/pdi.2014.00322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
South Africa has one of the highest incidences of tuberculosis (TB) worldwide due to the ongoing human immunodeficiency virus (HIV) epidemic. There are, however, no reports on peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients due to Mycobacterium tuberculosis in South Africa. The aim of this study is to discuss our experience of tuberculous peritonitis in CAPD patients from a rural endemic area of South Africa. This is a retrospective descriptive study of CAPD patients diagnosed with mycobacterium peritonitis infection from January 2008 to August 2014 at the Limpopo Kidney and Dialysis Centre (LKDC) in South Africa. The diagnosis of peritonitis was based on the International Society for Peritoneal Dialysis (ISPD) 2010 recommendations. Peritoneal fluid samples were collected in BACTEC Myco/F Lytic Culture Vials (Becton, Dickinson and Company, Dublin, Ireland). Tenckhoff catheter tips were sent for acid-fast bacilli (AFB) smear and TB culture. Mycobacterium infection was considered in patients with clinical features of peritonitis if 1) AFB smear or TB culture was positive or 2) if the patient was smear- or culture-negative but had suggestive radiological features of TB in the lungs or abdomen or 3) if the patient improved clinically following treatment with anti-tuberculous drugs. Of 170 patients on CAPD for the period reviewed, 12 (7.1%) were diagnosed and treated for mycobacterial peritonitis. There was an equal number of males and females, and all the patients were Black Africans with a mean age of 35.4 years (17-51 years). Eight of the 12 patients (66.7%) had had previous episodes of non-tuberculous peritonitis. Four patients (33.3%) had elevated white blood cell count (WCC) while 9 had higher polymorph count in the PD fluid than lymphocyte count. Mycobacterial organism was confirmed in 9/12 (75%), while the diagnosis was made on clinical and radiological features in the remaining 3 patients. Seven patients (58.3%) died, 10 patients were permanently transferred to hemodialysis (HD), 1 patient returned to PD after a short stay on HD, 1 patient died after 2 years on HD due to lack of further access to dialysis, and in 1 patient, the catheter could not be removed before death. This case series corroborates findings from other previous series that mycobacterial infection in PD patients carries a high mortality and can often pose a diagnostic challenge to attending clinicians. Clinicians should have a high index of suspicion for mycobacterial peritonitis in CAPD patients with features of peritonitis who do not respond promptly to conventional anti-microbial agents. We feel that the recommendation about catheter removal during mycobacterial peritonitis should be revisited, as it had no impact on our patients' outcome.
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Affiliation(s)
- Ramon A Tamayo-Isla
- Polokwane Kidney and Dialysis Centre, Department of Internal Medicine, Pietersburg Provincial, Hospital and University of Limpopo, South Africa
| | - Mauro Cuba de la Cruz
- Polokwane Kidney and Dialysis Centre, Department of Internal Medicine, Pietersburg Provincial, Hospital and University of Limpopo, South Africa
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa
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13
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Jehangir W, Khan R, Gil C, Baruiz-Creel M, Bandel G, Middleton JR, Sen P. Abdominal Tuberculosis: An Immigrant's Disease in the United States. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015. [PMID: 26199920 PMCID: PMC4488990 DOI: 10.4103/1947-2714.157484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Abdominal tuberculosis (TB) is an uncommon condition in the United States (US) except for patients with human immunodeficiency virus (HIV). An increasing number of cases have been reported in western countries amongst immigrants. It is important to be aware of the data and clinical characteristics in the immigrant population. Aims: The purpose of this study is to determine the epidemiologic characteristics of abdominal TB among immigrants in the US and to review the clinical presentations of abdominal TB with a focus particularly on unusual features. Materials and Methods: In a community teaching hospital in New Jersey, patients diagnosed with abdominal TB were examined and included in this report. All nine patients were immigrants from countries with high prevalence of TB and a majority had resided in the US for at least 5 years. None had clinical evidence of HIV and those that were tested were not found to be positive for HIV. Initial examination, diagnostic workup, and response to therapy were all pertinent to the management and diagnosis of these patients. Results: Three patients had atypical clinical presentations with normal chest X-rays and either negative or unknown tuberculin tests leading to delayed diagnosis and inappropriate therapy in at least one patient. With antituberculous therapy, all except for one patient had satisfactory outcomes. Immigrant patients with a diagnosis of abdominal TB had no evidence of HIV infection or other associated conditions in contrast to native-born individuals. Conclusion: Atypical presentations may cause diagnostic difficulties. Failure to perform appropriate tests may lead to inappropriate therapy with adverse outcomes. Although there is a decline in the number of TB cases in the US and screening for latent pulmonary infection in foreigners has been implemented effectively, the diagnosis of abdominal TB continues to be under diagnosed.
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Affiliation(s)
- Waqas Jehangir
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Rafay Khan
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Constante Gil
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Marilyn Baruiz-Creel
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Geraldo Bandel
- Palm Springs General Hospital, Hialeah, Florida, United States
| | - John R Middleton
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
| | - Purnendu Sen
- Department of Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, United States
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14
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Rapid identification of bacteria and Candida pathogens in peritoneal dialysis effluent from patients with peritoneal dialysis-related peritonitis by use of multilocus PCR coupled with electrospray ionization mass spectrometry. J Clin Microbiol 2014; 52:1217-9. [PMID: 24430451 DOI: 10.1128/jcm.03106-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PCR coupled with electrospray ionization mass spectrometry (PCR/ESI-MS) was compared with culture for pathogen detection in peritoneal dialysis (PD)-related peritonitis. Of 21 samples of PD effluent, PCR/ESI-MS identified microorganisms in 18 (86%) samples, including Mycobacterium tuberculosis in 1 culture-negative sample. Of 15 double-positive samples, PCR/ESI-MS and culture reached levels of agreement of 100% (15/15) and 87.5% (7/8) at the genus and species levels, respectively. PCR/ESI-MS can be used for rapid pathogen detection in PD-related peritonitis.
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15
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Ram R, Swarnalatha G, Akpolat T, Dakshinamurty KV. Mycobacterium tuberculous peritonitis in CAPD patients: a report of 11 patients and review of literature. Int Urol Nephrol 2012; 45:1129-35. [PMID: 23143752 DOI: 10.1007/s11255-012-0311-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/27/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aims of the present report were to document our experience of the prevalence of tuberculous peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients, mode of presentation, diagnosis and outcome and to discuss the current published data about catheter removal. METHODS A retrospective study of CAPD patients with tuberculous peritonitis was done. A minimum of three specimens of peritoneal fluid were examined for acid-fast bacilli smears. The BACTEC 9000 Blood Culture Series of instruments were used for the culture of Mycobacterium tuberculosis. After 2005, patients were treated with anti-tuberculous treatment, and catheter retention was started in our patients. RESULTS There were eleven patients (2.6 %) with tuberculous peritonitis among 414 CAPD patients. M. tuberculosis accounted for 4.47 % of all peritonitis episodes. The incidence of tuberculous peritonitis was 1/794 months. There were eight males and three females. The mean age was 49 years. Intestinal obstruction was reported in two patients, and two patients were treated for antecedent peritonitis. One of them had a simultaneous fungal peritonitis. One patient each developed a peritoneo-cutaneous fistula and ultrafiltration failure. Three were successfully treated without the removal of catheter. CONCLUSION Based on the analysis of all published reports of tuberculous peritonitis, there was no significant difference in patient survival between patients in whom CAPD catheter was removed or retained. Tuberculous peritonitis should be considered in patients with neutrophilic 'sterile' peritonitis with no response to antibacterial medications, predominance of lymphocytic peritonitis and in bacterial peritonitis not responding to antibiotics. After an early diagnosis, with close monitoring, an effort to retain the catheter after 5 days of anti-tuberculous therapy may be attempted.
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Affiliation(s)
- Rapur Ram
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderbad, 082, India.
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16
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Akoh JA. Peritoneal dialysis associated infections: An update on diagnosis and management. World J Nephrol 2012; 1:106-22. [PMID: 24175248 PMCID: PMC3782204 DOI: 10.5527/wjn.v1.i4.106] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 06/09/2012] [Accepted: 06/20/2012] [Indexed: 02/06/2023] Open
Abstract
Peritoneal dialysis (PD) is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. Although quality standards demand an infection rate < 0.67 episodes/patient/year on dialysis, the reported overall rate of PD associated infection is 0.24-1.66 episodes/patient/year. It is estimated that for every 0.5-per-year increase in peritonitis rate, the risk of death increases by 4% and 18% of the episodes resulted in removal of the PD catheter and 3.5% resulted in death. Improved diagnosis, increased awareness of causative agents in addition to other measures will facilitate prompt management of PD associated infection and salvage of PD modality. The aims of this review are to determine the magnitude of the infection problem, identify possible risk factors and provide an update on the diagnosis and management of PD associated infection. Gram-positive cocci such as Staphylococcus epidermidis, other coagulase negative staphylococcoci, and Staphylococcus aureus (S. aureus) are the most frequent aetiological agents of PD-associated peritonitis worldwide. Empiric antibiotic therapy must cover both gram-positive and gram-negative organisms. However, use of systemic vancomycin and ciprofloxacin administration for example, is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis - success rate of 77%. However, for fungal PD peritonitis, it is now standard practice to remove PD catheters in addition to antifungal treatment for a minimum of 3 wk and subsequent transfer to hemodialysis. To prevent PD associated infections, prophylactic antibiotic administration before catheter placement, adequate patient training, exit-site care, and treatment for S. aureus nasal carriage should be employed. Mupirocin treatment can reduce the risk of exit site infection by 46% but it cannot decrease the risk of peritonitis due to all organisms.
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Affiliation(s)
- Jacob A Akoh
- Jacob A Akoh, South West Transplant Centre, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom
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Li PKT, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, Johnson DW, Kuijper EJ, Lye WC, Salzer W, Schaefer F, Struijk DG. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int 2012; 30:393-423. [PMID: 20628102 DOI: 10.3747/pdi.2010.00049] [Citation(s) in RCA: 585] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
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Khan FY, Al-Muzrakchi AM, Elbedawi MM, Al-Muzrakchi AA, Al Tabeb A. Peritoneal tuberculosis in Qatar: a five-year hospital-based study from 2005 to 2009. Travel Med Infect Dis 2011; 10:25-31. [PMID: 22209118 DOI: 10.1016/j.tmaid.2011.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 11/28/2011] [Accepted: 12/02/2011] [Indexed: 01/06/2023]
Abstract
There is limited information about peritoneal tuberculosis in Qatar. This retrospective study aimed to review our experience with peritoneal tuberculosis in patients admitted to Hamad general hospital over a period of 5 years, from 2005 to 2009, with emphasis on presentation, investigation, diagnosis and therapeutic outcome. Fifty-four patients with peritoneal tuberculosis identified during the study period were included. The mean age of them was 31.85 years and 96.3% (52/54) of them were non-Qataris with male predominance. The main symptoms and signs at the time of presentation were abdominal pain and ascites respectively. Underlying diseases were described in 24% (13/54) and history of contact with tuberculous cases was present in 31.5% (17/54) of patients. Tuberculin test was positive in 66.7% (36/54). The ascitic fluid smear showed acid fast bacilli in 2% (1/53), and culture was positive in 39.6% (21/53) of cases. Laparoscopically obtained peritoneal biopsy showed caseating granulomas in 93% (40/43) and mycobacteria were identified by acid fast staining and culture in 58.5% (24/41) and 98% (40/41) of the tested specimens respectively. Most of the patients (84%; 37/44) who had completed their therapy in Qatar improved with antituberculosis therapy, and only one patient died. In conclusion, the clinical features and the imaging findings of the disease were non-specific. A high index of suspicion is essential for early diagnosis. Culture of ascitic fluid delayed the diagnosis in clinically suspected cases, whereas laparoscopically guided peritoneal biopsy provided rapid and correct diagnosis. A Six-month course with antituberculous therapy was effective and improved the outcome.
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Affiliation(s)
- Fahmi Yousef Khan
- Department of Medicine, Hamad General Hospital, P.O.Box: 3050 Doha, Qatar.
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19
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Abdominal Tuberculosis in Adult: 10-Year Experience in a Teaching Hospital in Central Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2010; 43:395-400. [DOI: 10.1016/s1684-1182(10)60062-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 07/12/2009] [Accepted: 08/20/2009] [Indexed: 11/18/2022]
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Chadha V, Schaefer FS, Warady BA. Dialysis-associated peritonitis in children. Pediatr Nephrol 2010; 25:425-40. [PMID: 19190935 PMCID: PMC2810362 DOI: 10.1007/s00467-008-1113-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 11/18/2008] [Accepted: 12/09/2008] [Indexed: 01/06/2023]
Abstract
Peritonitis remains a frequent complication of peritoneal dialysis in children and is the most common reason for technique failure. The microbiology is characterized by a predominance of Gram-positive organisms, with fungi responsible for less than 5% of episodes. Data collected by the International Pediatric Peritonitis Registry have revealed a worldwide variation in the bacterial etiology of peritonitis, as well as in the rate of culture-negative peritonitis. Risk factors for infection include young age, the absence of prophylactic antibiotics at catheter placement, spiking of dialysis bags, and the presence of a catheter exit-site or tunnel infection. Clinical symptoms at presentation are somewhat organism specific and can be objectively assessed with a Disease Severity Score. Whereas recommendations for empiric antibiotic therapy in children have been published by the International Society of Peritoneal Dialysis, epidemiologic data and antibiotic susceptibility data suggest that it may be desirable to take the patient- and center-specific history of microorganisms and their sensitivity patterns into account when prescribing initial therapy. The vast majority of patients are treated successfully and continue peritoneal dialysis, with the poorest outcome noted in patients with peritonitis secondary to Gram-negative organisms or fungi and in those with a relapsing infection.
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Affiliation(s)
- Vimal Chadha
- Department of Pediatrics, Section of Nephrology, Virginia Commonwealth University Medical Center, Richmond, VA USA
| | - Franz S. Schaefer
- Center for Pediatric and Adolescent Medicine, Section of Pediatric Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Bradley A. Warady
- Department of Pediatrics, Section of Nephrology, The Children’s Mercy Hospital, Kansas City, MO USA
- University of Missouri–Kansas City School of Medicine, The Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108 USA
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21
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Sherman RA. Briefly Noted. Semin Dial 2008. [DOI: 10.1111/j.1525-139x.1997.tb00492.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Sing Leung L, Tak Mao C, Kar Neng L, Lo WK. Tuberculous and Fungal Peritonitis in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis. ARCH ESP UROL 2007. [DOI: 10.1177/089686080702702s45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tuberculous and fungal infections are two relatively uncommon but important causes of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The clinical features, diagnosis, and management of these two special forms of CAPD-related peritonitis are highlighted in this article.
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Affiliation(s)
- Lui Sing Leung
- Department of Medicine, The University of Hong Kong, Tung Wah Hospital
| | | | | | - Wai Kei Lo
- Department of Medicine, The University of Hong Kong, Tung Wah Hospital
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23
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Dervisoglu E, Sayan M, Sengul E, Yilmaz A. Rapid diagnosis of Mycobacterium tuberculous peritonitis with real-time PCR in a peritoneal dialysis patient. APMIS 2006; 114:656-8. [PMID: 16948820 DOI: 10.1111/j.1600-0463.2006.apm_456.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 49-year-old female patient on continuous ambulatory peritoneal dialysis presented with fever, abdominal pain and loss of appetite. While peritoneal fluid bacterial cultures remained negative, she had no relief after 3 weeks of broad-spectrum antibiotics for possible bacterial peritonitis. In a peritoneal fluid sample, Mycobacterium tuberculosis DNA was detected by nucleic acid amplification using real-time PCR testing. The initiation of antituberculous therapy (isoniazid, rifampicin, ethambutol and pyrazinamide) was followed by resolution of fever and abdominal pain within one week. Nucleic acid amplification tests can play an important role in the species-specific diagnosis of tuberculous peritonitis.
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Affiliation(s)
- Erkan Dervisoglu
- Department of Nephrology, Kocaeli University Hospital, Umuttepe, Kocaeli 41380, Turkey.
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24
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Vadivel N, Tucker JK, Trikudanathan S, Heher E, Singh AK. Tuberculous peritonitis: a race against time. Kidney Int 2006; 70:969-72. [PMID: 16820796 DOI: 10.1038/sj.ki.5001610] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- N Vadivel
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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25
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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: 224] [Impact Index Per Article: 11.8] [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.
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Affiliation(s)
- F M Sanai
- Division of Hepatology, Department of Internal Medicine, Riyadh, Saudi Arabia.
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26
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Sahin G, Kiraz N, Sahin I, Soydan M, Akgün Y. Tuberculous peritonitis in a case receiving continuous ambulatory peritoneal dialysis(CAPD) treatment. Ann Clin Microbiol Antimicrob 2004; 3:19. [PMID: 15461815 PMCID: PMC523858 DOI: 10.1186/1476-0711-3-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2004] [Accepted: 10/04/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis continues to be an important health problem in the world. Besides pulmonary involvement extrapulmonary involvement becomes an affair in developing countries, even in developed countries. CASE PRESENTATION A thirty-six year old male patient was admitted with abdominal pain, diarrhea, nausea, vomiting and fever which had started one week before. The patient had been followed up with predialisis Chronic Renal Failure(CRF) diagnosis for 4 years and receiving continuous ambulatory peritoneal dialysis (CAPD) treatment for 4 months. In peritoneal fluid, 1600/mm3 cells were detected and 70% of them were polymorphonuclear leukocytosis. The patient begun nonspesific antibiotherapy but no benefit was obtained after 12 days and peritoneal fluid bacterial cultures remained negative. Peritoneal smear was positive for Asid-fast basilli (AFB), and antituberculosis therapy was started with isoniazid, rifampicine, ethambutol and pyrazinamide. After 15 days his peritoneal fluid cell count was decreased and his symptoms were relieved. Peritoneal fluid tuberculosis culture was found positive. CONCLUSION Considering this case, we think that in patients with CAPD catheter and peritonitis; when peritoneal fluid leukocytes are high and PMNL are dominant, AFB and tuberculosis culture must be investigated besides bacterial culture routinely.
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Affiliation(s)
- Garip Sahin
- Department of Nephrology, Osmangazi University Medical School, Eskisehir, Turkey
| | - Nuri Kiraz
- Department of Microbiology, Osmangazi University Medical School, Eskisehir, Turkey
| | - Ilknur Sahin
- Department of Chest Diseases, Osmangazi University Medical School, Eskisehir, Turkey
| | - Mehmet Soydan
- Department of Microbiology, Osmangazi University Medical School, Eskisehir, Turkey
| | - Yurdanur Akgün
- Department of Microbiology, Osmangazi University Medical School, Eskisehir, Turkey
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Karayaylali I, Seyrek N, Akpolat T, Ateş K, Ozener C, Yilmaz ME, Utas C, Yavuz M, Akcicek F, Arinsoy ST, Ataman R, Bozfakioglu S, Camsari T, Ersoy F. The prevalence and clinical features of tuberculous peritonitis in CAPD patients in Turkey, report of ten cases from multi-centers. Ren Fail 2004; 25:819-27. [PMID: 14575289 DOI: 10.1081/jdi-120024296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine the rate, risk factors and outcome of Tuberculous Peritonitis (TBP) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) in our units. DESIGN Retrospectively, we reviewed the medical data of all CAPD patients from 12 centers for TBP, covering the period between 1986 and December 2002. SETTING All patients were from 12 renal clinics at tertiary-care university hospitals. RESULTS Ten cases of TBP were identified among the CAPD patients in our centers. There were five male and five female patients with a mean age of 37.2 years. None of the patients had tuberculosis history, 6 patients had predominance of PNL. One patient had coincidental bacterial peritonitis. Two patients were successfully treated without the removal of the Tenckhoff catheter. CONCLUSION TBP in CAPD patients is a very rare complication. In contrast to predominance of lymphocytes in nonuremic patients with tuberculous peritonitis, CAPD patients with tuberculous peritonitis may have predominance of PNL on examination of the peritoneal fluid. Since TBP has high morbidity and mortality, early diagnosis and treatment of disease are extremely important for improving outcome.
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Affiliation(s)
- Ibrahim Karayaylali
- Department of Nephrology, Medical Faculty, Cukurova University, Adana, Turkey.
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Ahn C, Oh KH, Kim K, Lee KY, Lee JG, Oh MD, Kim Y, Han JS, Kim S, Lee JS, Jang IJ, Shin SG. Effect of Peritoneal Dialysis on Plasma and Peritoneal Fluid Concentrations of Isoniazid, Pyrazinamide, and Rifampin. ARCH ESP UROL 2003. [DOI: 10.1177/089686080302300409] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
♦ Objective This study was performed to elucidate the pharmacokinetic profiles of antimycobacterial regimens for peritoneal dialysis patients. ♦ Patients Nine patients on maintenance continuous ambulatory peritoneal dialysis (CAPD) were included in this study. ♦ Methods After administering a conventional oral dose of antituberculosis medications, we measured plasma and peritoneal fluid concentrations of isoniazid by fluorometry, and rifampin and pyrazinamide by high performance liquid chromatography. The assay data were subjected to pharmacokinetic analysis. ♦ Results Average peak plasma concentrations of isoniazid, rifampin, and pyrazinamide were 3.3 mg/L, 6.5 mg/L, and 30.9 mg/L, respectively, all of which much exceed the minimum inhibitory concentration (MIC) for Mycobacterium tuberculosis. Peritoneal fluid concentrations of isoniazid and pyrazinamide were maintained well above the MICs for M. tuberculosis; however, peritoneal fluid concentration of rifampin was below the therapeutic range most of the time. ♦ Conclusion For the treatment of systemic or pulmonary tuberculosis in CAPD patients, no dose adjustments are required for isoniazid, rifampin, or pyrazinamide. On the contrary, for the treatment of tuberculous peritonitis, oral rifampin therapy is not expected to be effective because of its low peritoneal fluid concentration.
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Affiliation(s)
- Curie Ahn
- Departments of Nephrology, College of Medicine, Seoul National University
| | - Kook-Hwan Oh
- Department of Nephrology, College of Medicine, Hallym University
| | - Kiwon Kim
- Departments of Nephrology, College of Medicine, Seoul National University
| | - Kyung Yi Lee
- Departments of Nephrology, College of Medicine, Seoul National University
| | - Jung Geon Lee
- Department of Nephrology, Eulji University School of Medicine, Seoul, Korea
| | - Myung Don Oh
- Departments of Nephrology, College of Medicine, Seoul National University
| | - Yonsu Kim
- Departments of Nephrology, College of Medicine, Seoul National University
| | - Jin Suk Han
- Departments of Nephrology, College of Medicine, Seoul National University
| | - Suhnggwon Kim
- Departments of Nephrology, College of Medicine, Seoul National University
| | - Jung Sang Lee
- Departments of Nephrology, College of Medicine, Seoul National University
| | - In-jin Jang
- Clinical Pharmacology, College of Medicine, Seoul National University
| | - Sang-Goo Shin
- Clinical Pharmacology, College of Medicine, Seoul National University
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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.
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Affiliation(s)
- Magdi M Hussein
- Department of Nephrology and Dialysis, Al Hada Armed Forces Hospital, TAIF, Saudi Arabia.
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31
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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.
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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
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Affiliation(s)
- S L Lui
- Division of Nephrology, University Department of Medicine, Tung Wah Hospital, Sheung Wan, Hong Kong.
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Abstract
Considering experience acquired in the past years, it seems as though physicians have reached a plateau in the frequency of peritonitis. A peritonitis rate of 1 every 2 patient years may be acceptable. Further reduction of this peritonitis rate will require inordinately large efforts on all fronts. One will have to consider what are the acceptable costs and risks of peritonitis in patients on peritoneal dialysis. New developments in catheter technology, improved connections, better understanding of patient selection and training programs, improved diagnostic and therapeutic methods in the management of peritonitis, and understanding of the infectious and immune processes are eagerly awaited developments.
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Affiliation(s)
- S Vas
- Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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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.
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Affiliation(s)
- F D Pien
- University of Hawaii, John A. Burns School of Medicine, Straub Clinic and Hospital, Honolulu, Hawaii
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Abstract
Peritoneal dialysis related infections include infection of the catheter exit site, subcutaneous pathway, or effluent. Exit-site infections, predominately owing to Staphylococcus aureus, are defined as purulent drainage at the exit site, although erythema may be a less serious type of exit-site infection. Tunnel infections are underdiagnosed clinically, and sonography of the tunnel is useful to delineate the extent of the infection and to evaluate response to antibiotic therapy. S aureus infections occur more frequently in S aureus carriers and immunosuppressed patients and can be reduced by mupirocin prophylaxis either intranasally or at the exit site. Patients with peritonitis present with cloudy effluent and usually pain, although 6% of patients may initially have pain without cloudy effluent. A white blood cell count of 100 or greater per microL, 50% of which are polymorphonuclear cells, has long been the hallmark of peritonitis. Empiric therapy is controversial, with some recommending cefazolin and others vancomycin (with cefatazidime for Gram-negative coverage). The choice should depend on the center's antibiotic sensitivity profile; those centers with a high rate of Enterococcus- or methicillin resistant organisms should use vancomcycin. Peritonitis episodes occurring in association with a tunnel infection with the same organism seldom resolve with antibiotics and require catheter removal. Other indications for catheter removal are refractory peritonitis, relapsing peritonitis, tunnel infection with inner-cuff involvement that does not respond to antibiotic therapy (based on ultrasound criteria), fungal peritonitis, and enteric peritonitis owing to intra abdominal pathology. Centers can reduce dialysis related infections to very low levels by proper catheter selection and insertion, careful selection and training of patients, avoidance of spiking techniques, and use of antibiotic prophylaxis against S. aureus. Further research is required to identify methods to reduce the risk of enteric peritonitis.
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Affiliation(s)
- B Piraino
- Renal Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Talwani R, Horvath JA. Tuberculous peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: case report and review. Clin Infect Dis 2000; 31:70-5. [PMID: 10913399 DOI: 10.1086/313919] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/1999] [Revised: 12/20/1999] [Indexed: 11/03/2022] Open
Abstract
A case of tuberculous peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD) in a 37-year-old man who presented with fever, abdominal pain, and a malfunctioning Tenckhoff catheter is reported. The patient was initially treated for presumed bacterial peritonitis but remained febrile and had persistent abdominal pain and peritoneal fluid pleocytosis, despite broad-spectrum antibiotic therapy. Mycobacterium tuberculosis was isolated in a culture of peritoneal fluid, and the patient responded promptly to antituberculous therapy. More than 50 cases of tuberculous peritonitis complicating CAPD that have been reported in the English-language literature since the initial case was reported in 1980 are reviewed. The most common symptoms are fever (78%), abdominal pain (92%), and cloudy dialysate (90%); 76% of cases had a predominance of polymorphonuclear cells in peritoneal fluid. A smear for acid-fast bacilli or a culture was positive in 73% of cases. The peritoneal dialysis catheter was removed in 53% of cases, although this was rarely considered necessary for cure of tuberculosis. The attributable mortality rate is 15%, with the most significant factor being treatment delay (mean time from presentation to initiation of treatment, 6.74 weeks). We conclude that tuberculosis is an important diagnostic consideration for CAPD patients with peritonitis that is refractory to broad-spectrum antibiotics.
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Affiliation(s)
- R Talwani
- Division of Infectious Diseases, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, 29203, USA.
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Thomas M, Walker R, Hung N. Tuberculosis: still the great pretender! HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 1999; 60:602-3. [PMID: 10621820 DOI: 10.12968/hosp.1999.60.8.1184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tuberculosis is more common in uraemic patients, possibly related to impaired cell-medicated immunity, and previous or ongoing immunosuppressivetherapy. Tuberculous peritonitis makes up to 2–65% of all cases of peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD) (Vas, 1994). It is often difficult to diagnose, as tuberculosis iscapable of mimicking most intraabdominal pathologies including carcinoma and CAPD-peritonitis. Peritoneal white cell count (total and and cell type) are mostly unhelpful and culture is often negative or clouded by concurrent or seemingly resistant bacterial peritonitis (Lui et al, 1996).
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Affiliation(s)
- M Thomas
- Department of Nephrology, University of Otago, Dunedin, New Zealand
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