Diagnosis and treatment of tuberculosis in hemodialysis and renal transplant patients

Background: The incidence of Mycobacterium tuberculosis in hemodialysis (HD ) and renal transplant (RT) patients in developing countries is high. With the resurgence of tuberculosis in the US, insights gained in the diagnosis and treatment of this infection in HD and RT patients in developing countri es should be valuable to physicians in the West. Methods: A retrospective s tudy of 40 cases of tuberculosis, 24 in HD patients (24/177, 13.6%) and 16 in RT patients (16/109, 14.7%) diagnosed over a period of 21 months in one center. Results: The clinical features, diagnostic procedures, and manageme nt dilemmas of this group of patients are described in this report. Diabete s mellitus was the most common associated disease in both groups of patient s. Fever, the most common presenting sign, was persistent low grade in 66.6 % of HD patients and high intermittent in 56.2% of RT patients. Fever of un known origin was only seen in RT patients. Pulmonary involvement was most c ommon in both groups, presenting either as infiltrates or effusions. Tuberc ulous peritonitis was seen only in HD patients (33.3%). Eight HD patients w ere treated for tuberculosis for variable periods prior to transplantation, 4 of whom had less than 6 months of therapy. None had a recurrence of tube rculosis after transplantation. Because of the known cyclosporin-lowering e ffect of rifampicin resulting in an increased cost of immunosuppressive the rapy, 13 patients were treated successfully with rifampicin-sparing therapy . Conclusion: Tuberculosis should be included in the differential diagnosis of fever in HD and PT patients, especially if fever is of unknown origin i n the PT patient. M. tuberculosis in the renal transplant patient can prese nt with high intermittent fever. Partial treatment of tuberculosis is suffi cient prior to renal transplantation but treatment should be continued to c ompletion after transplantation. If the cost of immunosuppressive therapy i s prohibitive because of rifampicin, rifampicinsparing antituberculosis the rapy can be successfully employed in RT patients. Copyright (C) 2000 S. Kar ger AG, Basel.