Diagnosis and management of tuberculosis in peritoneal dialysis
DOI:
https://doi.org/10.25796/bdd.v6i1.76633Keywords:
Peritoneal dialysis, peritonitis, tuberculosis, anti-bacillaryAbstract
Infectious complications represent the second cause of death in chronic renal failure, in particular tuberculosis (Tb), which remains more frequent in dialysis patients.
The aim of our work is to determine the prevalence of Tb in our patients on peritoneal dialysis (PD) and to analyze the clinical, paraclinical and evolutionary profile of this infection.
This is a retrospective cross-sectional study, including PD patients diagnosed with Tb. We analyzed their clinical and paraclinical profile, the diagnosis and localization of Tb, as well as the evolution under treatment.
We retained 12 cases of Tb among the 228 patients followed in PD (5.26%) from 2006 to 2022, with an M/F sex ratio of 0.7 and an average age of 52.7 ± 10 years. The median time between the start of PD and the diagnosis of Tb was 21 months [5 - 37].
The diagnosis of Tb was retained with certainty in 7 cases, based on bacteriological and/or histological evidence. The diagnosis was presumptive in 5 cases on a bundle of clinical and paraclinical arguments. The localization of Tb is pulmonary in 4 cases and extra-pulmonary in 8 cases including 3 cases of tuberculous peritonitis.
Anti-bacillary treatment is started after a median delay of 20 days [9-37] after the onset of symptoms. This treatment was complicated by 2 cases of drug-induced hepatitis and 1 case of polyneuritis.
The evolution is marked by healing in 11 patients. Regarding tuberculous peritonitis, the catheter was removed in one patient and maintained in the other two cases with favorable outcome.
In PD, the diagnosis of Tb is often difficult and extra-pulmonary involvement is more frequent.
References
Ministère de la santé, Royaume du Maroc. Progrès de la lutte anti-tuberculeuse au Maroc. 2021, Vol. 38(78), p. 22.
El Bardai G, Kabbali N, Baba H, Chouhani BA, Sqalli Houssaini T. Tuberculosis in Dialysis Patients in the Central Region of Morocco: What Is the Health-Care Delay? Cureus. 2022 Oct 16;14(10):e30369.
Karie S, Launay-Vacher V, Deray G et al. GPR Antibactériens. 2ème Edition. Guide de prescription des médicaments chez le patient insuffisant rénal. Méditions Interstan, 2005, Paris.
Lui SL, Tang S, Li FK et al. Tuberculosis infection in Chinese patients undergoing continuous ambulatory peritoneal dialysis. Am J Kidney Dis.2001. 38: 1055–1060.
Vikrant S. Clinical profile of tuberculosis in patients with chronic kidney disease: A report from an endemic Country. Saudi J Kidney Dis Transpl. 2019 Mar-Apr;30(2):470-477
Dobler CC, McDonald SP, Marks GB. Risk of Tuberculosis in Dialysis Patients: A Nationwide Cohort Study. PLoS ONE. 2011 ; 6(12): e29563.
Erkoc R, Dogan E, Sayarlioglu H et al. Tuberculosis in dialysis patients, single center experience from an endemic area. Int J Clin Pract. 2004. 58 : 1115-1117.
Unsal A, Ahbap E, Basturk T et al. Tuberculosis in dialysis patients: a nine-year retrospective analysis. J Infect Dev Ctries. 2013. Mar 14;7(3):208-13
Carrero JJ, Stenvinkel P. Inflammation in end-stage renal disease : what have we learned in 10 years? Semin Dial. 2010;23:498–509.
Vikrant S: Tuberculosis in dialysis: clinical spectrum and outcome from an endemic region, Hemodial Int. 2019, 23:88-92.
Klote MM, Agodoa LY, Abbott KC. Risk factors for Mycobacterium tuberculosis in US chronic dialysis patients. Nephrol Dial Transpl 2006;21(11):3287-3292.
Hussein MM, Mooij MJ, Roujouleh H. Tuberculosis and chronic renal disease Semin Dial. 2003 ; 1: 38-44.
Richardson RM. The diagnosis of tuberculosis in dialysis patients. Semin Dial. 2012;25:419–422.
Segall L, Covic A. Diagnosis of tuberculosis in dialysis patients : current strategy. Clin J Am Soc Nephrol. 2010 ;5:1114–1122)
Jebali H, Barrah S, Rais L, et al. The diagnosis of tuberculosis in dialysis patients. Saudi J Kidney Dis Transpl. 2017;28:1362–1368
Pradhan, Ravi & Sigdel, Mahesh. (2020). Prevalence, Clinical Presentation, and Outcome of Tuberculosis in Patients with Chronic Kidney Disease at a Tertiary Care Hospital in Nepal. International Journal of Nephrology. 2020. 1-10.
Steingart KR, Sohn H, Schiller I, et coll. Test Xpert MTB/RIF pour la tuberculose pulmonaire et la résistance à la rifampicine chez l’adulte. Base de données des revues systématiques Cochrane. 2013; 1:1-131
World Health Organization. (2013). Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children: policy update. World Health Organisation http://www.who.int/iris/handle/10665/112472.
Pelouse SD, Zumla AI. Diagnosis of extrapulmonary tuberculosis by the Xpert ® MTB/RIF Test. Expert Rev Anti Infect Ther 2012; 10(6): 631-5
Romanowski K, Clark EG, Levin A, Cook VJ, Johnston JC. Tuberculosis and chronic kidney disease: An emerging global syndemic. Kidney Int 2016;90:34-40.
Akpolat T. Tuberculous peritonitis. Perit Dial Int. 2009 ;29 (Suppl 2): S166–S169.
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 2013;45:1129–35.
Tan D, Fein Pa, Jorden A, Avram Mm. Successful treatment of tuberculous peritonitis while maintaining patient on CAPD. Adv Perit Dial 1991, 7:102-104.
Li PK, Szeto CC, Piraino B et al ; ISPD Guidelines/recommendations. Peritoneal dialysis-related infections recommendations : 2010 update. Perit Dial Int. 2010;30(4):393-423
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 latifa driouch, Safae BOUGHLALA, Ouafae ASSAL, Ouzeddoun, BAYAHIA, BENAMAR
This work is licensed under a Creative Commons Attribution 4.0 International License.
