title: Rapid T-cell-based immunodiagnosis of tuberculous peritonitis in a peritoneal dialysis patient.
abstract: Tuberculous peritonitis is a rare complication during peritoneal dialysis (PD). This report presents the case of a patient with clinical signs and symptoms indicative of bacterial peritonitis, but without culture growth of conventional bacteria or fungi. Cytokine flow cytometry after overnight stimulation of cells from peripheral blood and the peritoneal dialysate with Mycobacterium tuberculosis (MTB)-specific antigens revealed a 40-fold increase in MTB-specific CD4 + T cells expressing interferon-γ (IFN-γ) in peritoneal fluid compared with blood, which was indicative of active tuberculosis (TB). The presence of TB was later confirmed by polymerase chain reaction and growth of MTB in culture of the dialysate. The case illustrates the usefulness of MTB-specific immunodiagnosis for the rapid identification of peritoneal TB in PD patients.
authors.affiliation: Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Austria.
authors.forename: Catharina
authors.initials: C
authors.lastname: Müller
authors.forename: Heidemarie
authors.initials: H
authors.lastname: Puttinger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Winnicki
authors.forename: Heide-Maria
authors.initials: HM
authors.lastname: Winkler
authors.forename: Andreas
authors.initials: A
authors.lastname: Vychytil
authors.forename: Stefan
authors.initials: S
authors.lastname: Winkler
mesh_terms: D000328:Adult; D000942:Antigens, Bacterial / Q000276:immunology; D001426:Bacterial Proteins / Q000276:immunology; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology* / Q000378:metabolism; D015314:Dialysis Solutions; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000209:etiology
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D015314:Dialysis Solutions; C093276:ESAT-6 protein, Mycobacterium tuberculosis; D007371:Interferon-gamma