Non-tuberculous and tuberculous mycobacterial peritonitis in peritoneal dialysis patients.
BACKGROUND
Peritoneal dialysis (pd)-associated mycobacterium peritonitis is an important clinical entity in patients with end stage renal disease. They present a significant diagnostic and therapeutic challenge for clinicians because clinical findings and laboratory investigations can not be differentiated from symptoms caused by non-tuberculous mycobacterium (ntm), Mycobacterium tuberculosis (tb) or other bacteria. The aim of the present article is to know the differences between the clinical manifestations and laboratory investigations, the appropriate diagnosis, treatment strategies and prognosis for tb and ntm disease in patients with pd-associated mycobacterial infections.


METHODS
This was a retrospective observational study conducted over a period of 25 years. Out of 1737 patients, only 7 were diagnosed with mycobacterial peritonitis.


RESULTS
Evaluable data showed that there were three patients diagnosed with ntm peritonitis and four patients with tuberculous peritonitis. The mean age of the patients was 53.9 ± 11.8 years. Although all patients developed abdominal pain and cloudy dialysate, only four patients (57.1%) had fever. Two patients (28.6%) suffered severe sepsis and septic shock. Therefore, the patient survival rates for ntm and tuberculous peritonitis were 100.0% and 75.0%, respectively. Two patients were shifted to long-term hemodialysis; therefore, the technical survival rates for ntm and tuberculous peritonitis were 66.7% and 50.0%, respectively. Notably, recurrence of mycobacterial infection was found in one patient with both pulmonary tuberculosis and tuberculous peritonitis.


CONCLUSIONS
The diagnosis of mycobacterial peritonitis remains a challenge to medical staffs because of its insidious nature, the variability of its presentation and the limitations of available diagnostic test.
Division of Toxicology, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University , Taipei , Taiwan .
Jui-Hsiang
JH
Lin
Wei-Jie
WJ
Wang
Huang-Yu
HY
Yang
Mei-Hua
MH
Cheng
Wen-Hung
WH
Huang
Chih-Yuan
CY
Lin
Shen-Yang
SY
Lee
Tzung-Hai
TH
Yen
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D014395:Peritonitis, Tuberculous / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies
Non-tuberculous mycobacterial peritonitis; peritoneal dialysis; tuberculous mycobacterial peritonitis