1
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Zheng S, Bargman JM. Unusual and complicated peritonitis: Your questions answered. Perit Dial Int 2024:8968608241237400. [PMID: 38532707 DOI: 10.1177/08968608241237400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Effective treatment of infections is a growing challenge owing to antimicrobial resistance. Peritoneal dialysis (PD) patients experience more frequent hospitalisations than the general population and have greater exposure to antibiotics, making them particularly vulnerable to this threat. Over the last decade, we have noted a surge in cases of complicated peritoneal dialysis-associated peritonitis (PD peritonitis) caused by antimicrobial-resistant organisms, including extended-spectrum beta-lactamase (ESBL), AmpC beta-lactamase-producing Enterobacterales, Pseudomonas aeruginosa and fungi. Practitioners must be alert to these organisms, seek early recognition of these resistance patterns and make timely adjustments in order to avoid delay in treatment that may increase risk of PD catheter removal and technique failure. We present a case of successful treatment of ESBL peritonitis, highlight its challenges, while providing guidance on management of other unusual and complicated PD peritonitis.
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Affiliation(s)
- Sijia Zheng
- Division of Nephrology, University of Toronto, University Health Network/Toronto General Hospital, Toronto, ON, Canada
| | - Joanne M Bargman
- Division of Nephrology, University of Toronto, University Health Network/Toronto General Hospital, Toronto, ON, Canada
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2
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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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3
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Misra R, Kar M, Mohindra S, Gupta A. Acid fast bacillus smear, mycobacterial culture and Xpert MTB/RIF assay for the diagnosis of tuberculous peritonitis in patients with and without end stage renal failure. Access Microbiol 2022; 4:acmi000414. [PMID: 36133176 PMCID: PMC9484662 DOI: 10.1099/acmi.0.000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction. Diagnosis of tuberculous peritonitis (TBP) requires a high index of suspicion. Hypothesis /gap statement. Information about the diagnostic features of TBP among patients with end-stage renal failure (ESRF) from India is limited. Aim. To assess the utility of the Gene Xpert MTB/RIF assay in the diagnosis of TBP in patients with end-stage renal failure (ESRF), compared with those without ESRF. Methodology. This prospective observational single centre cohort study was performed at a tertiary care centre in Northern India. Ascitic fluid and/or whole continuous ambulatory peritoneal dialysis (CAPD) bag with effluent from 300 clinically suspected cases of TBP were included in the study. Diagnosis was based on detection of Mycobacteria on smear, Xpert MTB/RIF assay and/or culture. Cell counting was done in a Neubauer chamber. Cell predominance was seen by Giemsa stain. Line probe assay (LPA) for drug susceptibility testing was performed on all positive cultures. Results. TBP was diagnosed in 168 cases. Diabetes mellitus was a significant risk factor for developing TBP in patients with ESRF (P value<0.01). Lymphocytic predominance was seen in 21 patients without ESRF (P value 0.033) while majority of the patients in both groups had neutrophils in their ascitic and peritoneal fluids (138/168; P value 0.033). We recovered 15 cases of laboratory diagnosed TBP (11 without ESRF and four with ESRF). Microscopy was positive in two cases while ten isolates were recovered on culture. The Xpert MTB/RIF assay was positive in seven ascitic fluid samples out of which three were rifampicin resistant. All these were patients without renal failure (P value 0.010). Eight culture positive samples tested by the line probe assay did not detect any resistance to either rifampicin or isoniazid. Conclusion. The GeneXpert MTB/RIF assay has a limited value in the diagnosis of TBP in patients with ESRF.
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Affiliation(s)
- Richa Misra
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Mitra Kar
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Samir Mohindra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
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4
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Li PKT, Chow KM, Cho Y, Fan S, Figueiredo AE, Harris T, Kanjanabuch T, Kim YL, Madero M, Malyszko J, Mehrotra R, Okpechi IG, Perl J, Piraino B, Runnegar N, Teitelbaum I, Wong JKW, Yu X, Johnson DW. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int 2022; 42:110-153. [PMID: 35264029 DOI: 10.1177/08968608221080586] [Citation(s) in RCA: 184] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.
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Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Stanley Fan
- Translational Medicine and Therapeutic, William Harvey Research Institute, Queen Mary University, London, UK
| | - Ana E Figueiredo
- Nursing School Escola de Ciências da Saúde e da Vida Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tess Harris
- Polycystic Kidney Disease Charity, London, UK
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Magdalena Madero
- Division of Nephrology, Department of Medicine, National Heart Institute, Mexico City, Mexico
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Diseases, The Medical University of Warsaw, Poland
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, DC, USA
| | - Ikechi G Okpechi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, South Africa
| | - Jeff Perl
- St Michael's Hospital, University of Toronto, ON, Canada
| | - Beth Piraino
- Department of Medicine, Renal Electrolyte Division, University of Pittsburgh, PA, USA
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Isaac Teitelbaum
- Division of Nephrology, Department of Medicine, University of Colorado, Aurora, CO, USA
| | | | - Xueqing Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangzhou, China
- Guangdong Academy of Medical Sciences, Guangzhou, China
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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5
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Yuananda A, Tjahjodjati. Peritonitis related to continuous ambulatory peritoneal dialysis due to Mycobacterium tuberculosis: A case report. Urol Case Rep 2021; 41:101963. [PMID: 34934631 PMCID: PMC8654790 DOI: 10.1016/j.eucr.2021.101963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
Continuous ambulatory peritoneal dialysis (CAPD) has been an effective treatment for end-stage renal disease (ESRD). Tuberculous peritonitis (TBP) in patients on CAPD is a perilous condition. A 28-years-old female presented to the emergency unit with a chief complaint of intermittent abdominal pain and fever. The patient had a history of renal failure and CAPD was inserted. CAPD fluid analysis revealed leukocytes of +3/visual field and positive for acid-fast bacilli. The patient was given antituberculous agents, CAPD removal, and AV shunt installment for the subsequent HD access. A high index of suspicion must always be maintained for CAPD-associated tuberculous peritonitis.
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Affiliation(s)
- Andria Yuananda
- Department of Urology, Faculty of Medicine Universitas Padjadjaran, General Hospital Hasan Sadikin Bandung, Indonesia
| | - Tjahjodjati
- Department of Urology, Faculty of Medicine Universitas Padjadjaran, General Hospital Hasan Sadikin Bandung, Indonesia
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6
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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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7
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Kim E. The Role of Adenosine Deaminase in Tuberculosis Peritonitis in Patients with Cirrhosis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021. [DOI: 10.4166/kjg.2021.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Eunju Kim
- Division of Gastroenterology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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8
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Value of gamma interferon enzyme-linked immunospot assay in the diagnosis of peritoneal dialysis-associated tuberculous peritonitis. Int Urol Nephrol 2021; 54:843-849. [PMID: 34263436 PMCID: PMC8924085 DOI: 10.1007/s11255-021-02960-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 07/10/2021] [Indexed: 11/24/2022]
Abstract
Background Tuberculous peritonitis is the most common form of extrapulmonary tuberculosis infection in peritoneal dialysis patients. However, diagnosing tuberculous peritonitis quickly and early has always been a challenge for nephrologists. Mycobacterium tuberculosis antigen-specific gamma interferon enzyme-linked immunospot (IFN-γ ELISPOT) assay has been widely used in the clinical diagnosis of tuberculous pleurisy and peritonitis, but its use has not been reported for uremia. Methods This study mainly verified the feasibility of using the M. tuberculosis antigen-specific IFN-γ ELISPOT assay in the diagnosis of continuous ambulatory peritoneal dialysis (CAPD) patients with tuberculous peritonitis. Taking M. tuberculosis culture as the gold standard, the IFN-γ ELISPOT assay was used to analyze peripheral blood and peritoneal dialysis fluid of patients, and the receiver operating characteristic (ROC) curves in patients with tuberculous peritonitis (TBP) or non-tuberculous peritonitis (NTBP) were analyzed. Results The area under the receiver operating characteristic curve (AUC) was 0.927 (95% CI 0.816–1.000, P = 0.001) for the ELISPOT assay with peritoneal fluid mononuclear cells (PFMC), which was higher than that for the ELISPOT assay with peripheral blood mononuclear cells (PBMC) (0.825, 95% CI 0.6490–1.000, P = 0.011). The cutoff value for the diagnosis of TBP was 40 spot-forming cells (SFCs)/2 × 105 for the ELISPOT with PBMC, with a sensitivity of 55.6%, a specificity of 92.3%, and a diagnostic efficiency of 77.3%. The cutoff value for the diagnosis of TBP was 100 SFCs/2 × 105 for the ELISPOT on PFMC, with a sensitivity, specificity, and diagnostic efficiency 77.8%, 84.6%, and 81.8%, respectively. Parallel and serial testing algorithms appeared more accurate than single ELISPOT assays with PBMC, but ELISPOT assays with PFMC. Conclusions The IFN-γ release test can be used for the early diagnosis of CAPD-related TBP; compared with peripheral blood, peritoneal fluid may be a more effective and accurate medium to diagnose CAPD complicated with tuberculous peritonitis.
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9
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Luo Y, Xue Y, Mao L, Lin Q, Tang G, Song H, Wang F, Sun Z. Diagnostic Value of T-SPOT.TB Assay for Tuberculous Peritonitis: A Meta-Analysis. Front Med (Lausanne) 2020; 7:585180. [PMID: 33425937 PMCID: PMC7785855 DOI: 10.3389/fmed.2020.585180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/26/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Tuberculous peritonitis (TP) is a common form of abdominal tuberculosis (TB). Diagnosing TP remains challenging in clinical practice. The aim of the present meta-analysis was to evaluate the diagnostic accuracy of peripheral blood (PB) T-SPOT and peritoneal fluid (PF) T-SPOT for diagnosing TP. Methods: PubMed, EmBase, Cochrane, Scopus, Google scholar, China national knowledge internet, and Wan-Fang databases were searched for relevant articles from August 1, 2005 to July 5, 2020. Statistical analysis was performed using Stata, Revman, and Meta-Disc software. Diagnostic parameters including pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were determined. Summary receiver operating characteristic curve was used to determine the area under the curve (AUC). Results: Twelve studies were eligible and included in the meta-analysis. The analysis showed that the pooled sensitivity and specificity of PB T-SPOT in diagnosing TP were 0.91 (95% CI, 0.88–0.94) and 0.78 (95% CI, 0.73–0.81), respectively, while the pooled PLR, NLR, and DOR were 4.05 (95% CI, 2.73–6.01), 0.13 (95% CI, 0.07–0.23), and 37.8 (95% CI, 15.04–94.98), respectively. On the other hand, the summary estimates of sensitivity, specificity, PLR, NLR, and DOR of PF T-SPOT for TP diagnosis were 0.90 (95% CI, 0.85–0.94), 0.78 (95% CI, 0.72–0.83), 6.35 (95% CI, 2.67–15.07), 0.14 (95% CI, 0.09–0.21), and 58.22 (95% CI, 28.76–117.83), respectively. Furthermore, the AUC of PB T-SPOT and PF T-SPOT for TP diagnosis were 0.91 and 0.94, respectively. Conclusions: Our results indicate that both PB T-SPOT and PF T-SPOT can be served as sensitive approaches for the diagnosis of TP. However, the unsatisfactory specificities of these two methods limit their application as rule-in tests for TP diagnosis. Furthermore, the standardization of the operating procedure of PF T-SPOT is further needed.
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Affiliation(s)
- Ying Luo
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Xue
- Department of Immunology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liyan Mao
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qun Lin
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoxing Tang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijuan Song
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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10
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Relvas M, Beco A, Pereira L, Oliveira A, Silvano J, Silva R, Marques N, Santos L, Coentrão L, Pestana M. Clearing the clouds: Case-report and review of the literature. Semin Dial 2020; 34:83-88. [PMID: 33140512 DOI: 10.1111/sdi.12931] [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] [Indexed: 11/26/2022]
Abstract
In peritoneal dialysis (PD), a cloudy dialysate is an alarming finding. Bacterial peritonitis is the most common cause, however, atypical infections and non-infectious causes must be considered. A 46-year-old man presented with asthenia, paraesthesia, foamy urine and hypertension. Laboratory testing revealed severe azotaemia, anaemia, hyperkalaemia and nephrotic-range proteinuria. Haemodialysis was started through a central venous catheter. Later, due to patient preference, a Tenckhoff catheter was inserted. Conversion to PD occurred 3 weeks later, during hospitalization for a presumed central line infection. A month later, the patient was hospitalized for neutropenic fever. He was diagnosed an acute parvovirus infection and was discharged under isoniazid for latent tuberculosis. Four months later, the patient presented with fever and a cloudy effluent. Peritoneal fluid (PF) cytology was suggestive of infectious peritonitis, but the symptoms persisted despite antibiotic therapy. Bacterial and mycological cultures were negative. No neoplastic cells were detected. Mycobacterium tuberculosis eventually grew in PF cultures, despite previous negative molecular tests. Directed therapy was then initiated with excellent response. Thus, facing a cloudy effluent, one must consider multiple aetiologies. Diagnosis of peritoneal tuberculosis is hampered by the lack of highly sensitive and specific exams. Here, diagnosis was only possible due to positive mycobacterial cultures.
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Affiliation(s)
- Miguel Relvas
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Ana Beco
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Luciano Pereira
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Ana Oliveira
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - José Silvano
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Rui Silva
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Nídia Marques
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Lurdes Santos
- Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal.,Infectious Diseases Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal
| | - Luís Coentrão
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Manuel Pestana
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
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11
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Sartoris G, Seddon JA, Rabie H, Nel ED, Schaaf HS. Abdominal Tuberculosis in Children: Challenges, Uncertainty, and Confusion. J Pediatric Infect Dis Soc 2020; 9:218-227. [PMID: 31909804 DOI: 10.1093/jpids/piz093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
Abstract
The diagnosis of abdominal tuberculosis (TB) is challenging, and the prevalence of abdominal TB in children is likely underestimated. It may present with nonspecific abdominal symptoms and signs, but children who present with pulmonary TB may have additional abdominal subclinical involvement. Diagnosis is specifically challenging because none of the available diagnostic tools provide adequate sensitivity and specificity. In this review, we summarize the best available evidence on abdominal TB in children, covering the epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment. We propose a diagnostic approach that could be followed for symptomatic children. We believe that a combination of investigations could be useful to both aid diagnosis and define the extent of the disease, and we propose that abdominal ultrasound should be used more frequently in children with possible TB and any abdominal symptoms. This neglected disease has received little attention to date, and further research is warranted.
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Affiliation(s)
- Giulia Sartoris
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Department of Pediatric Sciences, Giannina Gaslini Institute, University of Genoa, Italy
| | - James A Seddon
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Helena Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Etienne D Nel
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - H Simon Schaaf
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Abraham G, Mathews M, Sekar L, Srikanth A, Sekar U, Soundarajan P. Tuberculous Peritonitis in a Cohort of Continuous Ambulatory Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s34] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Among 155 patients who were initiated on continuous ambulatory peritoneal dialysis (CAPD), 4 patients (2 men, 2 women) developed tuberculous peritonitis. They had been on PD for between 2 months and 84 months when they developed the peritonitis. The Mantoux test was negative in all of them. The diagnosis was made by a variety of means in the various cases: demonstration of Mycobacterium tuberculosis in the peritoneal cavity; presence of caseating granuloma in a peritoneal biopsy; Mycobacterium tuberculosis in a cold abscess adjacent to the peritoneal cavity; and demonstration of IS6110 and MPB64 genes of Mycobacterium tuberculosis by polymerase chain reaction (PCR) technique. Two of the patients developed ultrafiltration failure. Among 3 patients who were switched to hemodialysis, 2 died and 1 continues on maintenance dialysis. The last patient, whose catheter was removed, was reimplanted with a new catheter and continues on PD without ultrafiltration failure. Any patient with peritonitis unresponsive to conventional therapy should be investigated for tuberculous peritonitis. Institution of chemotherapy without delay will preserve peritoneal membrane integrity.
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Affiliation(s)
- Georgi Abraham
- Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Milly Mathews
- Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Lena Sekar
- Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Aparajitha Srikanth
- Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - Uma Sekar
- Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
| | - P. Soundarajan
- Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
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13
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Li PK, Chow KM. The Cost Barrier to Peritoneal Dialysis in the Developing World—An Asian Perspective. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s54] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Countries in Asia vary significantly in culture and socioeconomic status. Dialysis costs and reimbursement structures are significant factors in decisions about the rates and modalities of renal replacement therapy. From our survey of Asian nephrologists conducted in 2001, a number of observations can be made. In many developing countries, the annual cost of continuous ambulatory peritoneal dialysis (CAPD) is greater than the per-capita gross national income (GNI). The median cost of a 2-L bag of peritoneal dialysis (PD) fluid is around US$5. The absolute cost of PD fluid among countries with significant differences in per-capita GNI actually varies very little. Thus, most renal failure patients can be expected to have problems accessing PD therapy in developing countries in Asia. In countries with unequal reimbursement policies for PD versus hemodialysis, a lack of incentive to prescribe PD also exists. Automated PD is nearly non existent in many developing countries in Asia. Some possible ways to reduce the cost barriers to PD in those countries include • individual governments providing more public funding for treating dialysis patients; • dialysate-producing companies reducing the cost of their products; • physicians using appropriately smaller exchange volumes (3 x 2 L) in some Asian patients with smaller body sizes and with residual renal function; and • reducing the complication rate for PD (for example, peritonitis) thereby reducing the costs required for treatment and hospitalization.
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Affiliation(s)
- Philip K.T. Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, P.R. China
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, P.R. China
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14
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Pérez-Fontán M, Rodríguez-Carmona A. Peritoneal Catheter Removal for Severe Peritonitis: Landscape after a Lost Battle. Perit Dial Int 2020. [DOI: 10.1177/089686080702700210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Multicenter evaluation of the acid-fast bacillus smear, mycobacterial culture, Xpert MTB/RIF assay, and adenosine deaminase for the diagnosis of tuberculous peritonitis in China. Int J Infect Dis 2020; 90:119-124. [DOI: 10.1016/j.ijid.2019.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/05/2019] [Accepted: 10/27/2019] [Indexed: 11/22/2022] Open
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16
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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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17
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Abstract
Peritoneal dialysis is an effective treatment modality for patients with end-stage renal disease. The relative use of peritoneal dialysis versus hemodialysis varies widely by country. Data from a 2004 survey reports the percentage of patients with end-stage renal disease treated with peritoneal dialysis to be 5%-10% in economically developed regions like the US and Western Europe to as much as 75% in Mexico. This disparity is probably related to the availability and access to hemodialysis, or in some cases patient preference for peritoneal over hemodialysis. Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis. Fifty years ago, with the advent of the Tenckhoff catheter, patients averaged six episodes of peritonitis per year on peritoneal dialysis. In 2016, the International Society for Peritoneal Dialysis proposed a benchmark of 0.5 episodes of peritonitis per year or one episode every 2 years. Despite the marked reduction in peritonitis over time, peritonitis for the individual patient is problematic. The mortality for an episode of peritonitis is 5% and is a cofactor for mortality in another 16% of affected patients. Prevention of peritonitis and prompt and appropriate management of peritonitis is essential for the long-term success of peritoneal dialysis in all patients. In this review, challenges and solutions are addressed regarding the pathogenesis, clinical features, diagnosis, treatment, and prevention of peritoneal dialysis-related peritonitis from the viewpoint of an infectious disease physician.
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Abstract
Tuberculous peritonitis is rare in the United States but continues to be reported to occur in certain high-risk populations, which include patients with AIDS or cirrhosis, patients on continuous ambulatory peritoneal dialysis, recent immigrants from areas of high endemicity, and those who are immunosuppressed. The diagnosis of this disease requires a high clinical index of suspicion and should be considered in the differential of ascites with a lymphocyte predominance and serum-ascitic albumin gradient of <1.1 mg/dl. Microbiological or pathological confirmation remains the gold standard for diagnosis. Ascitic fluid cultures have low yield, but peritoneoscopy with biopsy or cultures frequently confirms the diagnosis. Newer techniques with future application include determination of adenosine deaminase and interferon gamma levels in ascitic fluid. Ultrasound and computed tomography are frequently used to guide fluid aspiration and biopsies. Six months of treatment with antituberculosis therapy is adequate except in cases of drug-resistant tuberculosis. The role of steroids remains controversial. Surgical approaches may be required to deal with complications including bowel perforation, intestinal obstruction from adhesions, fistula formation, or bleeding.
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Mogili HKR, C. V. AK, Boju SL, M. A, Mantri RG, Kalawat TC, R. R, V. SK. Tuberculous peritonitis diagnosed with the help of 18 F-FDG PET/CT scan. Nephrology (Carlton) 2017; 22:334-335. [DOI: 10.1111/nep.12802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | - Ranadheer Gupta Mantri
- Nuclear Medicine; Sri Venkateswara Institute of Medical Sciences (SVIMS); Tirupati, India
| | - Tek Chand Kalawat
- Nuclear Medicine; Sri Venkateswara Institute of Medical Sciences (SVIMS); Tirupati, India
| | - Ram R.
- Nephrology; SVIMS; Tirupati
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20
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Rohit A, Abraham G. Peritoneal dialysis related peritonitis due to Mycobacterium spp.: A case report and review of literature. J Epidemiol Glob Health 2016; 6:243-248. [PMID: 27443487 PMCID: PMC7320463 DOI: 10.1016/j.jegh.2016.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/22/2016] [Accepted: 06/25/2016] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium tuberculous peritonitis is a less common cause of peritoneal dialysis related infection in developed countries. As both CAPD and APD are being used as renal replacement therapy in developing countries of South Asia, Mycobacterium tuberculous peritonitis are being reported. Any culture negative peritonitis should be investigated for this entity. In this manuscript, we report an index case and our experience with literature review of Mycobacterium tuberculous peritonitis. The diagnostic techniques, management and outcome are described.
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Affiliation(s)
- Anusha Rohit
- Department of Microbiology and Department of Nephrology, The Madras Medical Mission, Mogappair, Chennai, India.
| | - Georgi Abraham
- Department of Microbiology and Department of Nephrology, The Madras Medical Mission, Mogappair, Chennai, India
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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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Inagaki K, Mizutani M, Nagahara Y, Asano M, Masamoto D, Sawada O, Aono A, Chikamatsu K, Mitarai S. Successful Treatment of Peritoneal Dialysis-related Peritonitis due to Mycobacterium iranicum. Intern Med 2016; 55:1929-31. [PMID: 27432106 DOI: 10.2169/internalmedicine.55.5219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 68-year-old man on peritoneal dialysis (PD) was hospitalized with the clinical picture of peritonitis. The patient was diagnosed with peritonitis caused by nontuberculous mycobacteria (NTM) according to positive Ziehl-Neelsen staining and negative Mycobacterium tuberculosis polymerase chain reaction results. Oral levofloxacin and clarithromycin, and later intraperitoneal imipenem were started. According to the anti-NTM susceptibility test results, oral minocycline was administered. The patient was treated for 6 months. He recovered without PD catheter removal; thus, PD was successfully continued. A genetic analysis identified the isolate as Mycobacterium iranicum. This is the first report of PD-related peritonitis caused by M. iranicum.
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Affiliation(s)
- Koji Inagaki
- Department of Nephrology, Handa City Hospital, Japan
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Joyati Tarafder A, Mahtab MA, Ranjan Das S, Karim R, Rahaman H, Rahman S. Abdominal Tuberculosis: A Diagnostic Dilemma. Euroasian J Hepatogastroenterol 2015; 5:57-59. [PMID: 29201690 PMCID: PMC5578524 DOI: 10.5005/jp-journals-10018-1133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/08/2014] [Indexed: 11/23/2022] Open
Abstract
According to the World Health Organization, more than 2 billion people are estimated to be infected with tuberculosis (TB) and approximately 95% of tuberculosis cases occur in developing countries. Extrapulmonary forms of tuberculosis constitute approximately one-sixth of all cases and the prevalence of extrapulmonary tuberculosis (TB) seems to be rising, particularly due to increasing prevalence of acquired immunodeficiency syndrome (AIDS). In patients with extrapulmonary TB, abdomen is involved in 12% of patients. Gastrointestinal involvement is found in 66 to 75% of abdominal cases, with the terminal ileum and the ileocecal region being the most common sites of involvement. Here, we report a case of abdominal TB.
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Affiliation(s)
| | - Mamun-Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Sisir Ranjan Das
- Department of Neonatology, Dhaka Medical College, Dhaka, Bangladesh
| | - Rezaul Karim
- Upazila Health Complex, Dhamrai, Dhaka, Bangladesh
| | | | - Salimur Rahman
- Department of Hepatology, Mymensingh Medical College, Mymensingh, Bangladesh
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25
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Lin JH, Wang WJ, Yang HY, Cheng MH, Huang WH, Lin CY, Lee SY, Yen TH. Non-tuberculous and tuberculous mycobacterial peritonitis in peritoneal dialysis patients. Ren Fail 2014; 36:1158-61. [PMID: 24827383 DOI: 10.3109/0886022x.2014.918842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Lee CY, Tsai HC, Lee SSJ, Sy C, Chen YS. Disseminated tuberculosis presenting as tuberculous peritonitis and sepsis tuberculosa gravissima in a patient with cirrhosis of the liver: A diagnosis of challenge. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:608-12. [PMID: 24530253 DOI: 10.1016/j.jmii.2013.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 11/19/2013] [Accepted: 12/23/2013] [Indexed: 11/27/2022]
Abstract
We report the case of an 81-year-old man diagnosed with liver cirrhosis complicated by spontaneous bacterial peritonitis and septic shock. Mycobacterium tuberculosis complex was isolated from the ascites, sputum, and blood culture 1 month after the patient died. Clinicians should be aware of the unusual diagnosis of sepsis tuberculosa gravissima presenting with tuberculous peritonitis, which is easily misdiagnosed as spontaneous bacterial peritonitis and Gram-negative bacillus sepsis in patients with cirrhosis. Clinicians should cautiously evaluate the patient's sputum, gastric contents, urine, cerebrospinal fluid, and bone marrow for early diagnosis of disseminated tuberculosis in patients with a high degree of suspicion of this diagnosis.
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Affiliation(s)
- Chun-Yuan Lee
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hung-Chin Tsai
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Susan Shin-Jung Lee
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - ChengLen Sy
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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27
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Yang WF, Han F, Zhang XH, Zhang P, Chen JH. Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases: case reports and literature review. J Zhejiang Univ Sci B 2013; 14:76-82. [PMID: 23303634 DOI: 10.1631/jzus.b1200244] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The diagnosis of extra-pulmonary tuberculosis (TB) seems relatively difficult due to the absence of specific symptoms and signs in patients on peritoneal dialysis or hemodialysis. We report four cases of extra-pulmonary tuberculosis on dialysis, with two cases on peritoneal dialysis and two cases on hemodialysis. The presentations, therapy, and outcomes of TB infection in these patients were reviewed. Otherwise, the English literature published in the PubMed database associating extra-pulmonary tuberculosis on dialysis over the last three decades is reviewed. A total of 61 studies containing 70 cases were included. The most common primary disease was diabetic nephropathy (22.86%, 16/70). The peritoneum (31.42%, 22/70), bone (21.42%, 15/70), and lymph node (20%, 14/70) were the most frequently infected. Single organ infection was common (90%, 63/70). Fever (58.57%, 41/70), pain (35.71%, 25/70), and enlarged lymph node (20%, 14/70) were the most common symptoms. Biopsy (67.14%, 47/70) and culture (40%, 28/70) provided most reliable methods for clear diagnosis of tuberculosis. The combined treatment of isoniazid, rifampicin, pyrazinamide, and ethambutol (44.29%, 31/70) was the most common therapy. The majority of patients improved (82.86%, 58/70); however, 12 cases got worse (17.14%), with 10 of them dying (14.29%). Physicians should be aware of the non-specific symptoms and location of infection, and consider tuberculosis in their differential diagnoses in dialysis patients presenting with symptoms such as fever, pain, and weight loss.
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Affiliation(s)
- Wen-fang Yang
- Kidney Disease Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Steele DJR, Kasmar AG, Guimaraes AR, Dekker JP. Case records of the Massachusetts General Hospital. Case 3-2013. A 72-year-old woman with abdominal pain and distention after peritoneal dialysis. N Engl J Med 2013; 368:375-85. [PMID: 23343067 DOI: 10.1056/nejmcpc1208142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David J R Steele
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, USA
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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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An unusual cause of non-infectious peritonitis in a peritoneal dialysis patient. Int Urol Nephrol 2012; 46:265-8. [DOI: 10.1007/s11255-012-0312-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
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Abstract
Tuberculosis is an important issue for nephrologists caring for dialysis patients. Because dialysis patients are immunocompromised, they are at higher risk for reactivation of latent tuberculosis, and they frequently have atypical presentation. Furthermore, hemodialysis units may foster rapid spread of active pulmonary tuberculosis. The diagnosis of active pulmonary tuberculosis still depends on detection of organisms by smear and culture. Newer nucleic acid detection techniques are more sensitive and specific. Nephrologists should remember that nonspecific presentation of tuberculosis including fever, weight loss, and adenopathy are more common in dialysis patients than in the general population, and diagnosis may require biopsy of extrapulmonary tissue. Detection of latent tuberculosis in dialysis patients should only be undertaken if treatment is planned. Generally, this should apply only to potential transplant candidates and younger dialysis patients with longer life expectancy. Tuberculin skin test is very insensitive in dialysis patients, and false-positives occur in patients born in countries where Bacillus Calmette-Guérin vaccine has been used. Blood tests using stimulation of gamma interferon have been shown to be more sensitive tests of latent tuberculosis and may be used in conjunction with tuberculin skin tests.
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Affiliation(s)
- Robert M A Richardson
- Division of Nephrology, Department of Medicine, The Toronto General Hospital, Toronto, Ontario, Canada.
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Comparison between laparoscopy and noninvasive tests for the diagnosis of tuberculous peritonitis. World J Surg 2012; 35:2369-75. [PMID: 21882025 DOI: 10.1007/s00268-011-1224-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Despite recent progress, the fast and accurate diagnosis of tuberculous peritonitis (TBP) continues to be a challenge, mainly because of the lack of specific clinical features and the difficulty in isolating the M. tuberculosis. The present study aimed to investigate the role of laparoscopy in the diagnosis of TBP, compared to noninvasive tests. METHODS We retrospectively studied 60 patients who had diagnostic laparoscopy for suspected TBP between January 2002 and June 2010. RESULTS Forty-one patients were diagnosed with TBP. In terms of accuracy and predictive value, the visual diagnosis via laparoscope was the most diagnostic test. In the noninvasive tests, both the ascitic adenosine deaminase (ADA) level over 30 U/l, and the ascitic lactate dehydrogenase (LDH) level over 90 U/l had relatively high positive, as well as negative, predictive values. The overall morbidity and mortality rates for laparoscopy were 5 and 5%, respectively. CONCLUSIONS Laparoscopy is a rapid and accurate diagnostic test for TBP. However, complications may occur. In older patients with associated conditions, a combination of various noninvasive tests and empirical treatments is needed prior to laparoscopy.
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Müller C, Puttinger H, Winnicki W, Winkler HM, Vychytil A, Winkler S. Rapid T-cell-based immunodiagnosis of tuberculous peritonitis in a peritoneal dialysis patient. ACTA ACUST UNITED AC 2012; 46:314-6. [DOI: 10.3109/00365599.2012.659206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Catharina Müller
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine
| | - Heidemarie Puttinger
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Austria
| | - Wolfgang Winnicki
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Austria
| | - Heide-Maria Winkler
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine
| | - Andreas Vychytil
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Austria
| | - Stefan Winkler
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine
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Song Y, Wu J, Yan H, Chen J. Peritoneal dialysis-associated nontuberculous mycobacterium peritonitis: a systematic review of reported cases. Nephrol Dial Transplant 2011; 27:1639-44. [PMID: 21891775 DOI: 10.1093/ndt/gfr504] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Peritonitis caused by nontuberculous mycobacterium (NTM) is an important complication in peritoneal dialysis (PD) patients. METHODS Cases of PD complicated by NTM peritonitis reported in the English language literature were identified in the PubMed database. The characteristics of these cases were reviewed. RESULTS In 41 articles, we identified 57 cases of PD-associated NTM peritonitis in patients ranging from 5 to 82 years. The prevalent clinical findings of these cases were fever, abdominal pain, cloudy fluid and an elevated leukocyte count in peritoneal fluid. These findings were non-specific and could not be differentiated from symptoms caused by Mycobacterium tuberculosis or other bacteria. The majority of these cases received empirical antibacterial therapy before diagnosis of NTM peritonitis. Isolates in more than half of the peritonitis cases were the rapidly growing Mycobacterium, Mycobacterium fortuitum (38.6%) and Mycobacterium chelonae (14.0%). In most cases, PD catheters were removed and experience with non-removal was limited. CONCLUSION Diagnosis of NTM infection should be considered in PD patients with peritonitis that are culture negative or refractory to empirical antibiotic therapy.
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Affiliation(s)
- Yan Song
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hanghzou, People’s Republic of China
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35
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Tuberculose abdominale : étude rétrospective de 90 cas. Rev Med Interne 2011; 32:212-7. [DOI: 10.1016/j.revmed.2010.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 08/16/2010] [Accepted: 09/19/2010] [Indexed: 11/18/2022]
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Guirat A, Koubaa M, Mzali R, Abid B, Ellouz S, Affes N, Ben Jemaa M, Frikha F, Ben Amar M, Beyrouti MI. Peritoneal tuberculosis. Clin Res Hepatol Gastroenterol 2011; 35:60-9. [PMID: 21215540 DOI: 10.1016/j.gcb.2010.07.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 05/27/2010] [Accepted: 07/19/2010] [Indexed: 02/04/2023]
Abstract
The peritoneum is one of the locations outside the most common pulmonary tuberculosis. Peritoneal tuberculosis poses a public health problem in endemic regions of the world. The phenomenon of migration, the increased use of immunosuppressive therapy and the epidemic of AIDS have contributed to a resurgence of this disease in regions where it was previously controlled. The aim of this review is to expose the clinical, biologic end radiologic futures of the peritoneal tuberculosis and to present the methods of diagnosis and treatment. The diagnosis of this disease is difficult and still remains a challenge because of its insidious nature, the variability of presentation and limitations of available diagnostic tests. The disease usually presents a picture of lymphocytic exudative ascites. There are many complementary tests with variable sensitivities and specificities to confirm the diagnosis of peritoneal tuberculosis. Isolation of mycobacteria by culture of ascitic fluid or histological examination of peritoneal biopsy ideally performed by laparoscopy remains the investigation of choice. The role of PCR, ascitic adenosine deaminase, interferon gamma and the radiometric BACTEC system can improve the diagnostic yield. An antituberculous treatment with group 1 of the WHO for 6 months is sufficient in most cases.
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Affiliation(s)
- A Guirat
- Service de chirurgie générale, CHU Habib Bourguiba, 3029 Sfax, Tunisia.
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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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38
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Interferon-Gamma Release Assay in the Ascites: Early Hint for Diagnosis of Abdominal Tuberculosis. Infection 2009; 38:69-72. [DOI: 10.1007/s15010-009-9469-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
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Amouri A, Boudabbous M, Mnif L, Tahri N. Profil actuel de la tuberculose péritonéale : étude d’une série tunisienne de 42 cas et revue de la littérature. Rev Med Interne 2009; 30:215-20. [DOI: 10.1016/j.revmed.2008.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 07/21/2008] [Accepted: 09/21/2008] [Indexed: 11/29/2022]
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Abstract
Compared with the general population, dialysis patients are at higher risk of acquiring mycobacterial infections. The aim of the present article is to review case reports and studies published since the report by Talwani and Horvath (2000) and to discuss the main problems that arise in daily practice. After a comprehensive review of the literature, cumulative data about peritoneal dialysis and peritoneal tuberculosis from reports of 98 patients in 21 papers were analyzed. The clinical and laboratory findings of peritoneal tuberculosis are nonspecific. Diagnosis requires a high index of suspicion. The most difficult cases present as culture-negative peritonitis or culture-positive peritonitis resistant to appropriate antibiotics without any additional clues of tuberculosis. The sensitivity of smears and cultures can be enhanced by centrifuging a 50 – 150 mL dialysate sample.
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Affiliation(s)
- Tekin Akpolat
- Ondokuz Mayis University, School of Medicine, Department of Nephrology, Samsun, Turkey
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41
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Lee KF, Chen HH, Wu CJ. Mycobacterium chelonae peritonitis in a patient on peritoneal dialysis. Ren Fail 2008; 30:335-8. [PMID: 18350455 DOI: 10.1080/08860220701861185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Non-tuberculous mycobacteria peritonitis is uncommon with the majority of cases reported in patients on peritoneal dialysis with diagnostic and therapeutic challenges. Here we present a case of Mycobacterium chelonae peritonitis and review other cases in the literature to discuss the clinical spectrum, diagnostics, regimens and duration of treatment, and outcome.
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Affiliation(s)
- Kun-Feng Lee
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
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Chau TN, Leung VKS, Wong S, Law ST, Chan WH, Luk ISC, Luk WK, Lam SH, Ho YW. Diagnostic challenges of tuberculosis peritonitis in patients with and without end-stage renal failure. Clin Infect Dis 2008; 45:e141-6. [PMID: 18190308 DOI: 10.1086/523727] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Information about diagnostic features of tuberculosis (TB) peritonitis among patients with end-stage renal failure (ESRF), compared with those without ESRF, is limited. Here, we review our experience with TB peritonitis in patients with and without ESRF over a period of 11 years, with special reference to the clinical features of and diagnostic tools for TB peritonitis. METHODS The records of all patients with TB peritonitis who were seen at United Christian Hospital (Hong Kong) from 1996 through 2006 were reviewed. The diagnosis of TB peritonitis was based on (1) detection of mycobacteria on smear and/or Mycobacterium tuberculosis on culture of ascitic fluid and/or peritoneal biopsy specimens and/or (2) demonstration of caseating granulomata on histological assessment of peritoneal biopsy specimens. RESULTS During the study period, 52 patients (19 without ESRF and 33 with ESRF) had TB peritonitis. Patients with ESRF tended to have more-acute onset of symptoms and neutrophil-predominant peritoneal fluid, which mimicked bacterial peritonitis. Diagnosis was made earlier among patients without ESRF than among those with ESRF. Laparotomy or laparoscopy was the initial diagnostic tool for 12 patients (63%) without ESRF, whereas mycobacterial culture was the diagnostic method for 18 patients (55%) with ESRF. CONCLUSIONS TB peritonitis has nonspecific and protean manifestations. It should be considered in the context of culture-negative peritonitis and in the context of culture-positive peritonitis that fails to respond to appropriate antibiotics. Laparoscopy with biopsy should be considered at an early stage when TB peritonitis is suspected.
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Affiliation(s)
- Tai Nin Chau
- Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong Special Administrative Region, People's Republic of China.
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Affiliation(s)
- Angeline A Lazarus
- Uniformed Services, University of Health Sciences, Division of Pulmonary Medicine, National Navy Medical Cneter, Betheada, Maryland, USA
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44
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Canbakan B, Ergun I, Ekmekci Y, Ates K, Karatan O. Pulmonary and peritoneal tuberculosis in a CAPD patient. Int Urol Nephrol 2006; 39:975-8. [PMID: 17165157 DOI: 10.1007/s11255-006-9135-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Accepted: 10/22/2006] [Indexed: 10/23/2022]
Abstract
Patients with chronic renal failure have an increased incidence of tuberculosis due to decreased cellular immunity. More than half of the tuberculosis infection in these patients presented with extrapulmonary involvement. Tuberculous peritonitis is an important problem in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Simultaneous pulmonary and peritoneal tuberculosis is a very rare condition. We describe a 39-year-old man with culture negative CAPD peritonitis. In spite of conventional antimicrobial therapy the patient had persistent fever, weight loss, and night sweats. Approximately after one month from starting treatment, both sputum specimen and peritoneal fluid were positive for mycobacterium. Quadruple therapy for tuberculosis has been started. The response to treatment was promptly. He is still on treatment for six months and receiving CAPD. Tuberculous peritonitis should always be considered when patients on CAPD develop culture negative peritonitis treated with conventional antibiotics without improvement. In addition, the existence of extraperitoneal tuberculosis, especially pulmonary disease must be investigated.
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Affiliation(s)
- Basol Canbakan
- Department of Nephrology, Ibni Sina Hospital, Ankara University School of Medicine, Sihhiye, Ankara, 06100, Turkey
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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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46
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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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47
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Robaday S, Belizna C, Kerleau JM, Héron F, Cailleux N, Lecomte F, Marie I, Lévesque H. La tuberculose péritonéale : une entité toujours présente. À propos de quatre observations. Rev Med Interne 2005; 26:738-43. [PMID: 15946774 DOI: 10.1016/j.revmed.2005.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Accepted: 05/02/2005] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Tuberculous peritonitis, a major problem in developing country, occurs preferentially in immigrant population and in patients with acquired immune deficiency syndrome (AIDS). Although rare in France, it did not disappear and epidemiological, clinical and therapeutic approach deserve to be reminded. EXEGESIS We reported 4 patients (immigrants in two cases), occurred in caucasian and African persons (one with AIDS). Disease was characterized by fever, abdominal pain, anorexia, weight loss and ascites. Biological and radiological were unconclusive. Cell count analysis from ascitic fluid show a lymphocytic predominance with negative direct smear for Ziehl-Neelsen strain. Tuberculous peritonitis was established with combined visual and histological diagnosic laparoscopic examination. CONCLUSION These observations have the interest to underline that tuberculous peritonitis must be evoked in case of lymphocytic ascitis. We believe an aggressive diagnostic approach, particulary with peritoneal biopsy, is warranted for the diagnosis of tuberculous peritonitis. Validity of PCR amplification is ascitic fluid still needs to be established.
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Affiliation(s)
- S Robaday
- Département de médecine interne, CHU de Rouen, 76031 Rouen cedex, France
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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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Affiliation(s)
- R K Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
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50
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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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