Tuberculosis in patients undergoing maintenance dialysis

Tuberculosis was diagnosed in 23 of 205 patients undergoing maintenance dialysis, an incidence of 11%. Seventeen patients (74%) were females. It was characterised clinically by a very insidious onset, the main symptoms being anorexia, loss of weight, and low-grade fever. There were extrapulmonary presentations in 18 of the 23 patients (78%). Tuberculous lymphadenitis predominated in the extrapulmonary form (55%) with peritoneal involvement coming second in frequency (16%). Pulmonary tuberculosis was seen in five patients (21.7%), four of them presenting with pleural effusions. Total white cell and differential count was normal in all patients studied. Most of the patients developed the disease about 1 year from the start of their dialysis treatment. With early therapy all patients survived their tuberculous disease and no recurrence was seen in up to 5 years follow-up. Despite earlier reports of high mortality we suggest that awareness of the increased incidence of tuberculosis in dialysis patients, together with its unusual presentation and consequent early diagnosis, results in a very good prognosis.