Summary: Tuberculosis is a common infectious disease in chronic hemodialysis due to alteration of the immune system associated with chronic kidney disease. The objectives of this study are to determine the prevalence of tuberculosis in chronic hemodialysis patients and to identify its diagnostic and therapeutic difficulties. Methods and patients: This was a descriptive retrospective study over a period of 20 years (1994-2014). It includes the records of periodic hemodialysis patients in the Nephrology Department of the Aristide Le Dantec University Teaching Hospital in Dakar which clinical symptoms and laboratory favor tuberculosis. Results: Of 258 chronic hemodialysis patients treated in Hospital Aristide Le Dantec hemodialysis center, 29 cases (11.4%) of tuberculosis disease are diagnosed. The mean age is 43.21 ± 12.48 years, and the sex-ratio is 0.8. The median time to onset of tuberculosis after initiation of hemodialysis is 22.86 ± 28.86 months. The diagnosis of tuberculosis is sure only in 17% of cases. Extra-pulmonary sites are found in 79% of cases. The average duration of treatment is 9.39 ± 1.64 months (6 - 13 months). Various treatment protocols are adopted. Mortality is 21%, 50% due to disseminated tuberculosis. Conclusion: The diagnosis of tuberculosis in the chronic hemodialysis patients is often difficult due to the atypical symptoms, the frequency of extra-pulmonary location and the lack of evidence of sure diagnosis.
References
[1]
Man, N.K., Touam, M. and Jungers, P. (2010) Hemodialysis for Renal Replacement Therapy. Lavoisier SAS, 56-61, 112-116.
[2]
Kato, S., Chmielewski, M., et al. (2008) Aspects of Immune Dysfunction in End-Stage Renal Disease. Clinical Journal of the American Society of Nephrology, 3, 1526-1533. http://dx.doi.org/10.2215/CJN.00950208
[3]
Niang, A., Diouf, B., Leye, A., Ndiaye, F.S. and Diop, T.M. (2005) Diagnostic and Therapeutic Characteristics of Tuberculosis in Chronic Hemodialysis Patients in Dakar. Medecine Tropicale, 65, 49-52.
[4]
Quantrill, S.J., Woodhead, M.A., Bell, C.E., Hardy, C.C., et al. (2002) Side-Effects of Antituberculosis Drug Treatment in Patients with Chronic Renal Failure. European Respiratory Journal, 20, 440-443. http://dx.doi.org/10.1183/09031936.02.00298002
[5]
Hassine, E., Marniche, K., Hamida, J., Hassine, K., Bouaziz, A. and Ben Mustapha, M.A. (2002) Tuberculosis of Hemodialysis Patients in Tunisia. Nephrology, 23, 135-140.
[6]
Chagas, A.C.F., Filho, G.H., et al. (2014) Prevalence of Latent Tuberculosis and Treatment Adherence among Patients with Chronic Kidney Disease in Campo Grande, State of Mato Grosso do Sul. Revista da Sociedade Brasileira de Medicina Tropical, 47, 204-211. http://dx.doi.org/10.1590/0037-8682-0035-2014
[7]
Manmadha Rao, T., Ram, R., Swarnalatha, G., Santhosh Pai, B.H., Ramesh, V., et al. (2013) Tuberculosis in Haemodialysis Patients: A Single Center Experience. Indian Journal of Nephrology, 23, 340-345. http://dx.doi.org/10.4103/0971-4065.116296
[8]
Fongoro, S., Diallo, D., Toloba, Y., Diallo, S., et al. (2011) The Case of Tuberculosis to the Chronic Hemodialysis Patients at the Teaching Hospital of Point G (CHU) in Bamako about 10 Remarks. Mali Medical, XXVI, 27-30.
[9]
Sen, N., Turunc, T., Karatasli, M., Sezer, S., Demiroglu, Y.Z. and Eyuboglu, O. (2008) Tuberculosis in Patients with End-Stage Renal Disease Undergoing Dialysis in an Endemic Region of Turkey. Transplantation Proceedings, 40, 81-84.
[10]
Yao, K.H., Bakayoko, A., Henyo, F., et al. (2011) Particularities of Tuberculosis in Black Africans Chronically Dialysed. Néphrologie & Thérapeutique, 7, 242-244.
[11]
El Kabbaj, D., Bahadi, A. and Oualim, Z. (2010) Prevalence of Tuberculosis in Hemodialysis Patients. Saudi Journal of Kidney Diseases and Transplantation, 21, 164-167.
[12]
Klote, M.M., Agodoa, L.Y. and Abbott, K.C. (2006) Risk Factors for Mycobacterium tuberculosis in US Chronic Dialysis Patients. Nephrology Dialysis Transplantation, 21, 3287-3292. http://dx.doi.org/10.1093/ndt/gfl488
[13]
Inoue, T., Nakamura, T., Katsuma, A., et al. (2009) The Value of QuantiFERON® TB-Gold in the Diagnosis of Tuberculosis among Dialysis Patients. Nephrology Dialysis Transplantation, 24, 2252-2257. http://dx.doi.org/10.1093/ndt/gfp030
[14]
Wauters, A., Peetermans, W.E., Van den Brande, P., et al. (2004) The Value of Tuberculin Skin Testing in Hemodialysis Patients. Nephrology Dialysis Transplantation, 19, 433-438. http://dx.doi.org/10.1093/ndt/gfg569
[15]
Marques, L.P.J., Rioja, L.S., Pacheco, G.G.L.C., et al. (2008) Tuberculosis in Hemodialysis Patient in Area of High Incidence of Mycobacterium tuberculosis and Human Immunodeficiency Virus Infection. Dialysis & Transplantation, 37, 486-490. http://dx.doi.org/10.1002/dat.20275
[16]
Hussein, M.M., Mooij, J.M. and Roujouleh, H. (2003) Tuberculosis and Chronic Renal Disease. Seminars in Dialysis, 16, 38-44. http://dx.doi.org/10.1046/j.1525-139X.2003.03010.x
[17]
Lee, C.-T., Hung, K.-H., Lee, C.-H., et al. (2002) Chronic Hypercalcemia as the Presenting Feature of Tuberculous Peritonitis in a Hemodialysis Patient. American Journal of Nephrology, 22, 555-559. http://dx.doi.org/10.1159/000065264
[18]
Hung, Y.-M., Chan, H.-H. and Chung, H.-M. (2004) Tuberculous Peritonitis in Different Dialysis Patients in Southern Taiwan. American Journal of Tropical Medicine and Hygiene, 70, 532-535.
[19]
Segall, L. and Covic, A. (2010) Diagnosis of Tuberculosis in Dialysis Patients: Current Strategy. Clinical Journal of the American Society of Nephrology, 5, 1114-1122. http://dx.doi.org/10.2215/CJN.09231209
[20]
Agarwal, S.K., Gupta, S., Bhowmik, D. and Mahajan, S. (2011) Reaction Size in Tuberculin Test Positivity in Hemodialysis Patients-Author’s Reply. Indian Journal of Nephrology, 21, 139-140. http://dx.doi.org/10.4103/0971-4065.82381
[21]
Savaj, S., Savoj, J., Ranjbar, M. and Sabzghabaei, F. (2014) Interferon-Gamma Release Assay Agreement with Tuberculin Skin Test in Pretransplant Screening for Latent Tuberculosis in a High-Prevalence Country. Iranian Journal of Kidney Diseases, 8, 329-332.
[22]
Maden, E., Bekci, T.T., Kesli, R., Atalay, H., et al. (2011) Evaluation of Performance of Quantiferon Assay and Tuberculin Skin Test in End Stage Renal Disease Patients Receiving Hemodialysis. New Microbiologica, 34, 351-356.
[23]
Al Jahdali, H., Ahmed, A.E., Balkhy, H.H., et al. (2012) Comparison of the Tuberculin Test Skin and Quanti-Feron-TB Gold In-Tube (QFT-G) Test for the Diagnosis of Latent Tuberculosis Infection in Dialysis Patients. Journal of Infection and Public Health, 6, 166-172. http://dx.doi.org/10.1016/j.jiph.2013.02.002
[24]
Gobert, D., Lidove, O., de Fontbrune, F.S., Peltier, J., et al. (2007) Adenosine Deaminase Is Useful for the Diagnosis of Peritoneal Tuberculosis in Patients with End-Stage Renal Failure. Review of Medicine, 28, 507-509.
[25]
Richardson, R.M.A. (2012) The Diagnosis of Tuberculosis in Dialysis Patients. Seminars in Dialysis, 4, 419-422. http://dx.doi.org/10.1111/j.1525-139X.2012.01093.x
[26]
Fang, J.-T., Chen, Y.-C. and Chang, M.-Y. (2004) Ethambutol-Induced Optic Neuritis in Patients with End Stage Renal Disease on Hemodialysis: Two Case Reports and Literature Review. Renal Failure, 26, 189-193. http://dx.doi.org/10.1081/JDI-120038521
[27]
Eleftheriadis, T., Tsiaga, P., Antiniadi, G., et al. (2005) The Value of Serum Antilipoarabinomannan Antibody Detection in the Diagnosis of Latent Tuberculosis in Hemodialysis Patients. American Journal of Kidney Diseases, 46, 706-712. http://dx.doi.org/10.1053/j.ajkd.2005.06.021