Mycobacterium tuberculous peritonitis in CAPD patients: a report of 11 patients and review of literature.

Abstract

BACKGROUND:

The aims of the present report were to document our experience of the prevalence of tuberculous peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients, mode of presentation, diagnosis and outcome and to discuss the current published data about catheter removal.

METHODS:

A retrospective study of CAPD patients with tuberculous peritonitis was done. A minimum of three specimens of peritoneal fluid were examined for acid-fast bacilli smears. The BACTEC 9000 Blood Culture Series of instruments were used for the culture of Mycobacterium tuberculosis. After 2005, patients were treated with anti-tuberculous treatment, and catheter retention was started in our patients.

RESULTS:

There were eleven patients (2.6 %) with tuberculous peritonitis among 414 CAPD patients. M. tuberculosis accounted for 4.47 % of all peritonitis episodes. The incidence of tuberculous peritonitis was 1/794 months. There were eight males and three females. The mean age was 49 years. Intestinal obstruction was reported in two patients, and two patients were treated for antecedent peritonitis. One of them had a simultaneous fungal peritonitis. One patient each developed a peritoneo-cutaneous fistula and ultrafiltration failure. Three were successfully treated without the removal of catheter.

CONCLUSION:

Based on the analysis of all published reports of tuberculous peritonitis, there was no significant difference in patient survival between patients in whom CAPD catheter was removed or retained. Tuberculous peritonitis should be considered in patients with neutrophilic 'sterile' peritonitis with no response to antibacterial medications, predominance of lymphocytic peritonitis and in bacterial peritonitis not responding to antibiotics. After an early diagnosis, with close monitoring, an effort to retain the catheter after 5 days of anti-tuberculous therapy may be attempted.

• Authors: Rapur Ram, Guditi Swarnalatha, Tekin Akpolat, Kalogotla Venkata Dakshinamurty
• Journal: International urology and nephrology (Int Urol Nephrol) Vol. 45 Issue 4 Pg. 1129-35 (Aug 2013) ISSN: 1573-2584 [Electronic] Netherlands
• PMID: 23143752 (Publication Type: Comparative Study, Journal Article, Review)

Chemical References

• Antitubercular Agents

Topics

• Adult
• Age Distribution
• Aged
• Antitubercular Agents (administration & dosage)
• Catheters, Indwelling (adverse effects)
• Chi-Square Distribution
• Cohort Studies
• Confidence Intervals
• Device Removal
• Female
• Follow-Up Studies
• Humans
• India
• Kidney Failure, Chronic (diagnosis, therapy)
• Male
• Middle Aged
• Mycobacterium tuberculosis (drug effects, isolation & purification)
• Peritoneal Dialysis, Continuous Ambulatory (adverse effects, methods)
• Peritonitis, Tuberculous (diagnosis, drug therapy, epidemiology, etiology)
• Prevalence
• Retrospective Studies
• Risk Assessment
• Sex Distribution
• Survival Rate
• Treatment Outcome