Extra-pulmonary tuberculosis infection in the dialysis patients with end stage renal diseases:case reports and literature review  

作　　者：Wen-fang YANG Fei HAN Xiao-hui ZHANG Ping ZHANG Jiang-hua CHEN 

机构地区：[1]Kidney Disease Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China

出　　处：《Journal of Zhejiang University-Science B(Biomedicine & Biotechnology)》2013年第1期76-82,共7页浙江大学学报（英文版）B辑（生物医学与生物技术）

摘　　要：The diagnosis of extra-pulmonary tuberculosis(TB) seems relatively difficult due to the absence of specific symptoms and signs in patients on peritoneal dialysis or hemodialysis.We report four cases of extra-pulmonary tuberculosis on dialysis,with two cases on peritoneal dialysis and two cases on hemodialysis.The presentations,therapy,and outcomes of TB infection in these patients were reviewed.Otherwise,the English literature published in the PubMed database associating extra-pulmonary tuberculosis on dialysis over the last three decades is reviewed.A total of 61 studies containing 70 cases were included.The most common primary disease was diabetic nephropathy(22.86%,16/70).The peritoneum(31.42%,22/70),bone(21.42%,15/70),and lymph node(20%,14/70) were the most frequently infected.Single organ infection was common(90%,63/70).Fever(58.57%,41/70),pain(35.71%,25/70),and enlarged lymph node(20%,14/70) were the most common symptoms.Biopsy(67.14%,47/70) and culture(40%,28/70) provided most reliable methods for clear diagnosis of tuberculosis.The combined treatment of isoniazid,rifampicin,pyrazinamide,and ethambutol(44.29%,31/70) was the most common therapy.The majority of patients improved(82.86%,58/70);however,12 cases got worse(17.14%),with 10 of them dying(14.29%).Physicians should be aware of the non-specific symptoms and location of infection,and consider tuberculosis in their differential diagnoses in dialysis patients presenting with symptoms such as fever,pain,and weight loss.The diagnosis of extra-pulmonary tuberculosis （TB） seems relatively difficult due to the absence of specific symptoms and signs in patients on peritoneal dialysis or hemodialysis. We report four cases of extra-pulmonary tu- berculosis on dialysis, with two cases on peritoneal dialysis and two cases on hemodialysis. The presentations, therapy, and outcomes of TB infection in these patients were reviewed. Otherwise, the English literature published in the PubMed database associating extra-pulmonary tuberculosis on dialysis over the last three decades is reviewed. A total of 61 studies containing 70 cases were included. The most common primary disease was diabetic nephropathy （22.86%, 16/70）. The peritoneum （31.42%, 22/70）, bone （21.42%, 15/70）, and lymph node （20%, 14/70） were the most frequently infected. Single organ infection was common （90%, 63/70）. Fever （58.57%, 41/70）, pain （35.71%, 25/70）, and enlarged lymph node （20%, 14/70） were the most common symptoms. Biopsy （67.14%, 47/70） and culture （40%, 28/70） provided most reliable methods for clear diagnosis of tuberculosis. The combined treatment of isoniazid, ri- fampicin, pyrazinamide, and ethambutol （44.29%, 31/70） was the most common therapy. The majority of patients improved （82.86%, 58/70）; however, 12 cases got worse （17.14%）, with 10 of them dying （14.29%）. Physicians should be aware of the non-specific symptoms and location of infection, and consider tuberculosis in their differential diag- noses in dialysis patients presenting with symptoms such as fever, pain, and weight loss.

关 键 词：Extra-pulmonary tuberculosis End stage renal disease DIALYSIS 

分 类 号：R692.5[医药卫生—泌尿科学]