Tuberculosis in patients on maintenance dialysis

Tuberculosis was diagnosed in 7 of 25 patients who underwent maintenance dialysis, an incidence of 28%, five of the patients (71.4%) were females. It was characterized clinically by an insidious onset, the main symptoms being anorexia, loss of weight, and a low-grade fever. There were extrapulmonary presentations in 5 of the 7 patients. Tuberculous lymphadenitis predominated in the extrapulmonary form (5 patients, 57%). Pulmonary tuberculosis was noted in one patient (21.7%) who presented with pleural effusion. One patient had a tuberculous abscess involving the seventh rib. Total white cell and differential count was normal in all patients examined. All of the patients were diagnosed at the beginning of their dialysis treatment and early therapy was initiated. Treatment led to recovery in all seven patients, and no recurrence was observed. Despite earlier reports of high mortality in similar groups of patients, it is suggested that awareness of the increased incidence of tuberculosis in dialysis patients, together with recognition of its unusual presentation and consequent early diagnosis, results in a good prognosis.