Clinical Features of Tuberculosis in Dialysis Patients.
- Author:
Soo Young YOON
1
;
So Rae CHOI
;
Ea Wha KANG
;
Young Seok GOO
;
Beom Seok KIM
;
Hyun Jin YOUN
;
Shin Wook KANG
;
Kyu Hun CHOI
;
Ho Yung LEE
;
Dae Suk HAN
Author Information
1. Department of Internal Medicine, The Institute of Kidney Disease, College of Medicine, Yonsei University, Seoul, Korea. dshan@yumc.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Hemodialysis;
Peritoneal dialysis;
Tuberculosis
- MeSH:
Acute-Phase Proteins;
Anemia;
Biopsy;
C-Reactive Protein;
Catheters;
Cough;
Diagnosis;
Dialysis*;
Drainage;
Dyspnea;
Early Diagnosis;
Ethambutol;
Ferritins;
Fever;
Humans;
Hypoalbuminemia;
Isoniazid;
Leukocytosis;
Medical Records;
Pericardiocentesis;
Pericarditis, Tuberculous;
Peritoneal Dialysis;
Peritonitis, Tuberculous;
Pyrazinamide;
Recurrence;
Renal Dialysis;
Retrospective Studies;
Rifampin;
Sputum;
Thigh;
Tuberculosis*;
Tuberculosis, Lymph Node;
Tuberculosis, Miliary;
Tuberculosis, Pulmonary;
Tuberculosis, Spinal;
Weight Loss
- From:Korean Journal of Nephrology
2003;22(1):73-79
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: A retrospective study of the clinical features of tuberculosis in patients undergoing maintenance dialysis was performed. METHODS: We reviewed medical records of patients. RESULTS: Among thirty-four patients, fourteen were on hemodialysis and twenty were on peritoneal dialysis. Mean age was 52.4 +/- 13.8 years, and interval between initiation of dialysis and onset of tuberculosis ranged from 1 to 146 months. There were 14 cases of pulmonary tuberculosis, 10 cases of tuberculous lymphadenitis, 4 cases of tuberculous peritonitis, 3 cases of miliary tuberculosis, 1 case of spinal tuberculosis, 1 case of tuberculous pericarditis, and 1 case of tuberculosis of thigh. Patients with pulmonary tuberculosis usually presented with dyspnea and malaise. But typical symptoms of tuberculosis such as fever, cough, sputum, and weight loss were rarely observed. Leukocytosis was absent but anemia, hypoalbuminemia and significant increase in acute phase reactants such as ferritin and C-reactive protein was obvious. Diagnosis was established by positive AFB in 3 patients, and in cases of extrapulmonaty tuberculosis, 13 among 20 patients were diagnosed by typical histologic characteristics on a tissue biopsy. Antituberculous treatment consisted of isoniazid, rifampicin, pyrazinamide, and occasionally ethambutol. And in several cases, incision and drainage, pericardiocentesis, or removal of peritoneal catheter were performed. Among the patients, just one recurrence was observed and four patients died while on antituberculous treatment. CONCLUSION: In dialysis patients, extrapulmonary tuberculosis is common and diagnosis of tuberculosis is difficult for its atypical manifestations. Therefore, early diagnosis and prompt initiation of treatment is needed in patients with high suspicion of tuberculosis.
