Diagnostic challenges of tuberculosis peritonitis in patients with and without end-stage renal failure
| Autor: | Wei-Kwang Luk, Ivy S C Luk, Siu Ho Lam, Tai Nin Chau, Yiu Wing Ho, Sunny Wong, Siu Tong Law, Wai Hong Chan, Vincent King Sun Leung |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Microbiology (medical)
Adult Male medicine.medical_specialty Tuberculosis Adolescent medicine.medical_treatment Bacterial Peritonitis Peritonitis Tuberculous Peritonitis Context (language use) urologic and male genital diseases Laparotomy Internal medicine medicine Humans Aged Retrospective Studies Aged 80 and over business.industry Incidence (epidemiology) Mortality rate Peritoneal fluid Middle Aged medicine.disease Surgery Infectious Diseases Kidney Failure Chronic Female business |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 45(12) |
| ISSN: | 1537-6591 |
| Popis: | Background. Information about diagnostic features of tuberculosis (TB) peritonitis among patients with endstage renal failure (ESRF), compared with those without ESRF, is limited. Here, we review our experience with TB peritonitis in patients with and without ESRF over a period of 11 years, with special reference to the clinical features of and diagnostic tools for TB peritonitis. Methods. The records of all patients with TB peritonitis who were seen at United Christian Hospital (Hong Kong) from 1996 through 2006 were reviewed. The diagnosis of TB peritonitis was based on (1) detection of mycobacteria on smear and/or Mycobacterium tuberculosis on culture of ascitic fluid and/or peritoneal biopsy specimens and/or (2) demonstration of caseating granulomata on histological assessment of peritoneal biopsy specimens. Results. During the study period, 52 patients (19 without ESRF and 33 with ESRF) had TB peritonitis. Patients with ESRF tended to have more-acute onset of symptoms and neutrophil-predominant peritoneal fluid, which mimicked bacterial peritonitis. Diagnosis was made earlier among patients without ESRF than among those with ESRF. Laparotomy or laparoscopy was the initial diagnostic tool for 12 patients (63%) without ESRF, whereas mycobacterial culture was the diagnostic method for 18 patients (55%) with ESRF. Conclusions. TB peritonitis has nonspecific and protean manifestations. It should be considered in the context of culture-negative peritonitis and in the context of culture-positive peritonitis that fails to respond to appropriate antibiotics. Laparoscopy with biopsy should be considered at an early stage when TB peritonitis is suspected. With the introduction of effective antituberculosis chemotherapy and improvements in the socioeconomic environment, the prevalence of and mortality rate associated with tuberculosis (TB) are decreasing globally. However, extrapulmonary TB has a reverse epidemiological trend. The incidence of extrapulmonary TB in Hong Kong increased 2-fold during the period 1995‐ 2005, whereas the incidence of reported pulmonary TB decreased by 10% during the same period. The incidence of TB peritonitis increased 4-fold, from 13 to 53 cases, over the past 10 years [1, 2]. |
| Databáze: | OpenAIRE |
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