Tuberculosis infection in Chinese patients undergoing continuous ambulatory peritoneal dialysis

A retrospective study of the prevalence and pattern of tuberculosis in pati ents undergoing continuous ambulatory peritoneal dialysis (CAPD) was perfor med. Thirty-eight cases of tuberculosis were diagnosed among 790 patients ( 18 men, 20 women; mean age, 58 +/- 12.6 years) between July 1994 and June 2 000. The interval between the initiation of CAPD and onset of tuberculosis ranged from 1 to 168 months (median, 22 months). There were 18 cases of pul monary tuberculosis, 14 cases of tuberculous peritonitis, 5 cases of tuberc ulous lymphadenitis, and 1 case of tuberculous synovitis. Patients with pul monary tuberculosis usually presented with fever, constitutional symptoms, and pleural effusion or pulmonary infiltrates on chest radiograph. Abdomina l pain and turbid dialysate were the main presenting symptoms in patients w ith tuberculous peritonitis. Diagnosis was established by positive culture in 20 patients, typical histological characteristics on a tissue biopsy spe cimen in 10 patients, and response to empirical antituberculous treatment i n 8 patients. The duration of symptoms before the diagnosis of tuberculosis and initiation of antituberculous treatment ranged from 7 to 57 days (medi an, 30 days). Antituberculous treatment consisted of isoniazid, rifampicin, pyrazinamide, and ofloxacin for 9 to 15 months. Antituberculous treatment generally was well tolerated. Twenty-seven patients (71%) completed antitub erculous treatment. No recurrence of tuberculosis was observed after a mean follow-up of 19.8 months. Eleven patients (29%) died while on antitubercul ous treatment; none of the deaths appeared to be directly caused by tubercu losis. We conclude that: (1) tuberculosis is prevalent among CAPD patients in our locality; (2) extrapulmonary tuberculosis, particularly tuberculous peritonitis, is common; and (3) a high index of suspicion for tuberculosis among CAPD patients is warranted to ensure early diagnosis and prompt initi ation of treatment. (C) 2001 by the National Kidney Foundation, Inc.