INCREASING INCIDENCE OF TUBERCULOSIS IN HEMODIALYSIS-PATIENTS

In recent years, an increase in the incidence of tuberculosis (TB) has been observed worldwide, including Poland. In the Department of Nephr ology of the Gdansk School of Medicine, a remarkable increase in the i ncidence of TB has been observed among patients undergoing maintenance hemodialysis (m.h.). The purpose of this study was to analyze the nat ural history of TB infection in this group of patients. Over the past 7 years, TB was diagnosed in 11 patients (7 female, 4 male) out of 188 patients on m.h. (5.8%). The average age of infected patients was 48. 8 years. Three patients became infected during their first year of m.h ., with the rest becoming infected over a 5-year-period. The diagnosis was made after a mean period of 4.6 months from the onset of the symp toms. In one-third of the patients, however, this period was more than 9 months (mean = 9.6 months), and in one case it was 13 months. TB wa s extra-pulmonary (lymph nodes, pericardium, and bones) in 6 of the af fected patients (54.5%). In most cases, the clinical symptoms of TB we re present; however, one patient was asymptomatic. Forty percent of th e cases were confirmed microbiologically and/or histopathologically. A ll patients were treated with antituberculous drugs and showed clinica l improvement or cure. In 70% of the patients, however, the anti-TB tr eatment was complicated by adverse drug reactions. In the one patient who died, TB was diagnosed post-mortem. There were no cases of TB amon g hemodialysis unit staff. Our study concluded that there is an increa sing incidence of TB in our population of m.h. patients. The high mort ality of untreated TB warrants treatment with antituberculous drugs in all cases of chronic infection of unclear etiology, different organ l ocalization, and resistance to standard antimicrobial therapy.