CLC number: R692.5
On-line Access: 2024-08-27
Received: 2023-10-17
Revision Accepted: 2024-05-08
Crosschecked: 2012-12-04
Cited: 1
Clicked: 5469
Wen-fang Yang, Fei Han, Xiao-hui Zhang, Ping Zhang, Jiang-hua Chen. Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases: case reports and literature review[J]. Journal of Zhejiang University Science B, 2013, 14(1): 76-82.
@article{title="Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases: case reports and literature review",
author="Wen-fang Yang, Fei Han, Xiao-hui Zhang, Ping Zhang, Jiang-hua Chen",
journal="Journal of Zhejiang University Science B",
volume="14",
number="1",
pages="76-82",
year="2013",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1200244"
}
%0 Journal Article
%T Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases: case reports and literature review
%A Wen-fang Yang
%A Fei Han
%A Xiao-hui Zhang
%A Ping Zhang
%A Jiang-hua Chen
%J Journal of Zhejiang University SCIENCE B
%V 14
%N 1
%P 76-82
%@ 1673-1581
%D 2013
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1200244
TY - JOUR
T1 - Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases: case reports and literature review
A1 - Wen-fang Yang
A1 - Fei Han
A1 - Xiao-hui Zhang
A1 - Ping Zhang
A1 - Jiang-hua Chen
J0 - Journal of Zhejiang University Science B
VL - 14
IS - 1
SP - 76
EP - 82
%@ 1673-1581
Y1 - 2013
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1200244
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.
[1]Ahmed, W., Rylance, P.B., Jackson, M.A., Nicholas, J.C., Odum, J., 2003. A diabetic haemodialysis patient with dysphagia and weight loss. Nephrol. Dial. Transplant., 18(5):1018-1020.
[2]Alper, M., Balbay, O., Akman, Y., Arbak, P., Cam, K., 2004. Tuberculous orchitis in chronic renal failure. Med. J. Malaysia, 59(1):118-119.
[3]Ates, G., Yildiz, T., Danis, R., Akyildiz, L., Erturk, B., Beyazit, H., Topcu, F., 2010. Incidence of tuberculosis disease and latent tuberculosis infection in patients with end stage renal disease in an endemic region. Ren. Fail., 32(1):91-95.
[4]Borrajo Prol, M., Perez Melon, C., Novoa, E.F., Carrera, J.M., Iglesias, A., Camba, M., Bravo, J.J., Armada, E., Blanco, R.G., Santos, J., et al., 2009. Tuberculous peritonitis in peritoneal dialysis. Nefrologia, 29(2):170-172 (in Spanish).
[5]Chien, C.C., Chiou, T.J., Lee, M.Y., Hsiao, L.T., Kwang, W.K., 2004. Tuberculosis-associated hemophagocytic syndrome in a hemodialysis patient with protracted fever. Int. J. Hematol., 79(4):334-336.
[6]Chou, K.J., Fang, H.C., Bai, K.J., Hwang, S.J., Yang, W.C., Chung, H.M., 2001. Tuberculosis in maintenance dialysis patients. Nephron, 88(2):138-143.
[7]Christopoulos, A.I., Diamantopoulos, A.A., Dimopoulos, P.A., Goumenos, D.S., Barbalias, G.A., 2009. Risk factors for tuberculosis in dialysis patients: a prospective multi-center clinical trial. BMC Nephrol., 10:36.
[8]Dervisoglu, E., Sayan, M., Sengul, E., Yilmaz, A., 2006. Rapid diagnosis of Mycobacterium tuberculous peritonitis with real-time PCR in a peritoneal dialysis patient. APMIS, 114(9):656-658.
[9]El-Shahawy, M.A., Gadallah, M.F., Campese, V.M., 1994. Tuberculosis of the spine (Pott’s disease) in patients with end-stage renal disease. Am. J. Nephrol., 14(1):55-59.
[10]Fang, J.T., Huang, C.C., 1997. Unusual presentations of extrapulmonary tuberculosis in three hemodialysis patients. Ren. Fail., 19(3):485-490.
[11]Fang, J.T., Huang, C.C., Liu, H.P., 1996. Apparent neoplasm of the clavicle of a dialysis patient, ultimately revealed as tuberculosis. Nephrol. Dial. Transplant., 11(7):1380-1382.
[12]Ferrara, E., Lemire, J., Grimm, P.C., Reznik, V.M., Mendoza, S.A., Leake, J.A., Benador, N.M., 2004. Mycobacterial peritonitis in pediatric peritoneal dialysis patients. Pediatr. Nephrol., 19(1):114-117.
[13]Fukasawa, H., Suzuki, H., Kato, A., Yamamoto, T., Fujigaki, Y., Yonemura, K., Hishida, A., 2001. Tuberculous arthritis mimicking neoplasm in a hemodialysis patient. Am. J. Med. Sci., 322(6):373-375.
[14]Gupta, N., Prakash, K.C., 2001. Asymptomatic tuberculous peritonitis in a CAPD patient. Perit. Dial. Int., 21(4):416-417.
[15]Ha, S.K., Lee, C.H., Park, C.H., Lee, H.Y., Han, D.S., 1995. A case of tuberculous peritonitis associated with abdominal-wall pseudocyst in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD). Nephrol. Dial. Transplant., 10(5):706-708.
[16]Hung, S.C., Yang, W.C., Tarng, D.C., 2003. Fistulizing TB peritonitis during CAPD. Nephrol. Dial. Transplant., 18(6):1226-1227.
[17]Hung, Y.M., Chan, H.H., Chung, H.M., 2004. Tuberculous peritonitis in different dialysis patients in Southern Taiwan. Am. J. Trop. Med. Hyg., 70(5):532-535.
[18]Ko, Y.C., Lee, C.T., Cheng, Y.F., Hung, K.H., Kuo, C.Y., Huang, C.C., Chen, J.B., 2004. Hypercalcaemia and haemophagocytic syndrome: rare concurrent presentations of disseminated tuberculosis in a dialysis patient. Int. J. Clin. Pract., 58(7):723-725.
[19]Kuno, Y., Iyoda, M., Aoshima, Y., Hosaka, N., Sanada, D., Hirai, Y., Shibata, T., Akizawa, T., 2010. A case of tuberculous peritonitis in a hemodialysis patient with high serum soluble interleukin-2 receptor and CA-125 levels. Intern. Med., 49(16):1783-1786.
[20]Kuo, K.L., Hung, S.C., Tarng, D.C., 2001. Fever and backache in a haemodialysis patient. Nephrol. Dial. Transplant., 16(11):2267-2269.
[21]Lee, C.T., Hung, K.H., Lee, C.H., Eng, H.L., Chen, J.B., 2002. Chronic hypercalcemia as the presenting feature of tuberculous peritonitis in a hemodialysis patient. Am. J. Nephrol., 22(5-6):555-559.
[22]Lee, S.S., Chou, K.J., Su, I.J., Chen, Y.S., Fang, H.C., Huang, T.S., Tsai, H.C., Wann, S.R., Lin, H.H., Liu, Y.C., 2009. High prevalence of latent tuberculosis infection in patients in end-stage renal disease on hemodialysis: comparison of QuantiFERON-TB GOLD, ELISPOT, and tuberculin skin test. Infection, 37(2):96-102.
[23]Li, S.Y., Chen, T.J., Chung, K.W., Tsai, L.W., Yang, W.C., Chen, J.Y., Chen, T.W., 2011. Mycobacterium tuberculosis infection of end-stage renal disease patients in Taiwan: a nationwide longitudinal study. Clin. Microbiol. Infect., 17(11):1646-1652.
[24]Lui, S.L., Tang, S., Li, F.K., Choy, B.Y., Chan, T.M., Lo, W.K., Lai, K.N., 2001. Tuberculosis infection in Chinese patients undergoing continuous ambulatory peritoneal dialysis. Am. J. Kidney Dis., 38(5):1055-1060.
[25]Lui, S.L., Yip, T., Tse, K.C., Chan, T.M., Lai, K.N., Lo, W.K., 2007. Tuberculous lymphadenitis in patients undergoing continuous ambulatory peritoneal dialysis. Int. Urol. Nephrol., 39(3):971-974.
[26]Lund, R.J., Koch, M.J., Oldemeyer, J.B., Meares, A.J., Dunlay, R.W., 2000. Extrapulmonary tuberculosis in patients with end stage renal disease—two case reports and a brief review. Int. Urol. Nephrol., 32(2):181-183.
[27]Nakamura, H., Tateyama, M., Tasato, D., Teruya, H., Chibana, K., Tamaki, Y., Haranaga, S., Yara, S., Higa, F., Fujita, J., 2009. Active tuberculosis in patients undergoing hemodialysis for end-stage renal disease: a 9-year retrospective analysis in a single center. Intern. Med., 48(24):2061-2067.
[28]Oner-Eyuboglu, A.F., Akcay, M.S., Arslan, H., Demirhan, B., Kalpaklioglu, A.F., 1999. Extrapulmonary involvement of mycobacterial infections in dialysis patients. Transplant. Proc., 31(8):3199-3201.
[29]Peces, R., de la Torre, M., Alcazar, R., 1996. Visceral leishmaniasis and renal tuberculosis in a patient on maintenance haemodialysis. Nephrol. Dial. Transplant., 11(4):707-708.
[30]Pradhan, R.P., Katz, L.A., Nidus, B.D., Matalon, R., Eisinger, R.P., 1974. Tuberculosis in dialyzed patients. JAMA, 229(7):798-800.
[31]Prakash, K.C., 1999. Tuberculous peritonitis. Perit. Dial. Int., 19(Suppl. 2):S283-S285.
[32]Ram, R., Swarnalatha, G., Prasad, N., Dakshinamurty, K.V., 2007. Ulcerative tuberculin skin test in a dialysis patient. Nephrol. Dial. Transplant., 22(4):1268.
[33]Siu, Y.P., Tong, M.K., Kwok, Y.L., Leung, K.T., Kwan, T.H., Lam, C.S., Au, T.C., 2008. An unusual case of both upper and lower gastrointestinal bleeding in a kidney transplant recipient. Transpl. Infect. Dis., 10(4):276-279.
[34]Stevenson, C.R., Critchley, J.A., Forouhi, N.G., Roglic, G., Williams, B.G., Dye, C., Unwin, N.C., 2007. Diabetes and the risk of tuberculosis: a neglected threat to public health? Chronic Illness, 3(3):228-245.
[35]Su, N.W., Chen, C.K., Chen, G.S., Hsieh, R.K., Chang, M.C., 2009. A case of tuberculosis-induced hemophagocytic lymphohistiocytosis in a patient under hemodialysis. Int. J. Hematol., 89(3):298-301.
[36]Summers, S.A., Gupta, R.K., Clutterbuck, E.J., Laing, C., Cooke, G.S., 2005. Haemodialysis catheter-associated infection: common pathogens in unusual places. Nephrol. Dial. Transplant., 20(10):2287-2288.
[37]Talwani, R., Horvath, J.A., 2000. Tuberculous peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: case report and review. Clin. Infect. Dis., 31(1):70-75.
[38]Tarng, D.C., Su, W.J., Huang, T.P., 1998. PCR diagnosis on formalin-fixed, paraffin-embedded tissues with acid-fast stain and culture negativity in chronic dialysis patients of cervico-mediastinal tuberculous lymphadenitis. Nephrol. Dial. Transplant., 13(6):1543-1546.
[39]Vadivel, N., Tucker, J.K., Trikudanathan, S., Heher, E., Singh, A.K., 2006. Tuberculous peritonitis: a race against time. Kidney Int., 70(5):969-972.
[40]Verettas, D.J., Ververidis, A.N., Boyiatzis, C., Panagoutsos, S., Galanis, V., Passadakis, P., Kazakos, K., Vargemezis, V., 2006. Tuberculous spondylitis in patients with end-stage renal disease undergoing chronic hemodialysis therapy. Clin. Nephrol., 65(4):299-302.
[41]Wang, I.K., Chuang, F.R., Lee, K.F., Lin, C.L., Chang, H.Y., Huang, C.K., 2005. Tuberculous peritonitis in a haemodialysis patient with elevated serum CA 125 and hypercalcaemia. Int. J. Clin. Pract. Suppl., 59(s147):56-59.
[42]Yalcinkaya, F., Tumer, N., Akar, N., Ekim, M., Bildirici, Y., 1995. Tuberculous osteomyelitis: an unusual case of tuberculous infection in a child undergoing continuous ambulatory peritoneal dialysis. Pediatr. Nephrol., 9(4):485-486.
[43]Yazici, O., Mescigil, P., Kepenekci, I., Celepli, P., Sengul, S., Azap, A., Ertürk, S., 2011. Tuberculosis of the breast in a patient undergoing hemodialysis. Int. Urol. Nephrol., 43(1):241-244.
Open peer comments: Debate/Discuss/Question/Opinion
<1>