Spectrum of mycobacterial infections: tuberculosis and Mycobacterium other than tuberculosis in dialysis patients.
BACKGROUND
Patients with end-stage renal disease are at high risk of mycobacterial infection.


OBJECTIVE
To analyze the difficulties in reaching an accurate diagnosis of tuberculosis in dialysis patients.


METHODS
We conducted a retrospective follow-up of patients who attended our peritoneal and hemodialysis units during the 10 year period 1995-2005.


RESULTS
Our dialysis unit diagnosed 10 cases of tuberculosis caused by Mycobacterium tuberculosis and 9 cases of Mycobacterium other than tuberculosis. In the former group, five patients had Mycobacterium in the sputum, which was diagnosed by intraabdominal mass biopsy in one, culture of the gastric juices in one, and pleural fluid culture or pleural biopsy in three. One of these patients was suffering from pleural TB as well as Potts disease. Of the patients with Mycobacterium other than tuberculosis, five were diagnosed by sputum cultures, three by urine cultures and one in peritoneal fluid. Differences in treatment and outcome were also reviewed.


CONCLUSIONS
The diagnosis of TB in dialysis patients should be approached with a high index of suspicion. It is clear that extensive diagnostic procedures are required to ensure an accurate diagnosis of the disease. Tuberculosis incurs a significant added burden due to the need for isolation of infected patients within the dialysis unit. Treatment of patients with Mycobacterium other than tuberculosis should be addressed individually.
Basok
Anna
A
Department of Nephrology, Soroka University Hospital and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. basok@bgu.ac.il
Vorobiov
Marina
M
Rogachev
Boris
B
Avnon
Luna
L
Tovbin
David
D
Hausmann
Michael
M
Belenko
Natalya
N
Zlotnik
Moshe
M
Shnaider
Alla
A
D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D005750:Gastric Juice / Q000382:microbiology; D006436:Hemodialysis Units, Hospital; D006801:Humans; D007557:Israel; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000302:isolation & purification; D009164:Mycobacterium Infections / Q000175:diagnosis / Q000473:pathology / Q000652:urine; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010356:Patient Isolation; D035422:Pleural Cavity / Q000382:microbiology; D010996:Pleural Effusion / Q000382:microbiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000652:urine; D016482:Urinalysis