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Tuberculous peritonitis in a cohort of continuous ambulatory peritoneal dialysis patients
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.
Insights
Tuberculous peritonitis is a rare complication of continuous ambulatory peritoneal dialysis (CAPD). Early diagnosis and chemotherapy are crucial for preserving peritoneal membrane integrity and improving patient outcomes.
Area of Science:
- Nephrology
- Infectious Diseases
- Gastroenterology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
- Peritonitis is a serious complication of CAPD, with various causative agents.
- Tuberculous peritonitis is a rare but severe form of peritonitis that can occur in CAPD patients.
Purpose of the Study:
- To report on the incidence and characteristics of tuberculous peritonitis in CAPD patients.
- To highlight diagnostic challenges and outcomes associated with this condition.
- To emphasize the importance of early diagnosis and treatment for preserving peritoneal membrane function.
Main Methods:
- Retrospective analysis of 4 CAPD patients who developed tuberculous peritonitis.
- Review of diagnostic methods including Mycobacterium tuberculosis detection, peritoneal biopsy, and PCR.
- Assessment of treatment strategies and patient outcomes.
Main Results:
- Four out of 155 CAPD patients (2.6%) developed tuberculous peritonitis.
- Diagnosis was confirmed through various methods, including PCR detection of Mycobacterium tuberculosis genes.
- Two patients experienced ultrafiltration failure; outcomes varied after treatment, with some progressing to hemodialysis and mortality.
- One patient successfully continued CAPD after catheter reimplantation and chemotherapy.
Conclusions:
- Tuberculous peritonitis should be suspected in CAPD patients with peritonitis unresponsive to conventional therapy.
- Prompt initiation of anti-tuberculosis chemotherapy is vital to preserve peritoneal membrane integrity.
- Early diagnosis and management can significantly impact patient prognosis and dialysis modality choices.