Extrapulmonary tuberculosis in chronic hemodialysis patients

Area of Science:

• Nephrology
• Infectious Diseases
• Public Health

Background:

• Dialysis patients exhibit a higher incidence of extrapulmonary tuberculosis compared to the general population.
• Extrapulmonary tuberculosis presents a significant health challenge in individuals undergoing dialysis.

Purpose of the Study:

• To characterize the clinical presentation of extrapulmonary tuberculosis in hemodialysis patients.
• To identify common sites and diagnostic challenges associated with extrapulmonary tuberculosis in this population.

Main Methods:

• A retrospective investigation of hemodialysis patients diagnosed with extrapulmonary tuberculosis between October 1986 and January 2001.
• Review of 2208 hemodialysis patients to identify cases of extrapulmonary tuberculosis.

Main Results:

• Seventeen patients (mean age 57.4 years) were identified with extrapulmonary tuberculosis.
• The most frequent sites involved were the peritoneum (35.3%), cervical lymph nodes (17.6%), and other sites including bone marrow, spine, knee, brain, pericardium, skin, and genitourinary system.
• Tissue biopsy revealed granulomatous inflammation in most cases, but mycobacterial culture and PCR yielded low positive results (11.1% and 33.3% respectively).
• Three patients died during treatment.

Conclusions:

• Extrapulmonary tuberculosis is a substantial component of tuberculosis in dialysis patients.
• Invasive diagnostic procedures, such as tissue biopsy via laparoscopy or laparotomy, may be essential for diagnosis when clinical suspicion is high.
• The diagnostic yield of conventional methods is limited, underscoring the need for timely and potentially invasive investigations.