B CHOY, L KWAN, M MOK, T CHAN
1Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
Aim:To determine the incidence and outcome of tuberculous peritonitis among patients on peritoneal dialysis (PD)
Background:Mycobacterial infection is prevalent in Asia. Peritonitis caused by mycobacterium tuberculous may cause significant morbidity to patients on peritoneal dialysis.
Methods:We retrospective analyzed the 716 patients (Continuous Ambulatory PD 83.3%, Automated PD 16.7%) who had been followed up in our center between 2006 to December 2016.
Results:There were altogether 1624 episodes of peritonitis, among which 16 were due to mycobacterium tuberculous (TB) which accounted for 1% of peritonitis (gram positive 46.2%, gram negative 34.8%, fungal 3.5%, TB 1%, atypical TB 0.5%, no growth 14%). Mean age of patients with TB peritonitis was 71.4 ±11.7 years, 56% had diabetes mellitus . All patients presented with turbidity of peritoneal fluid (PDF), abdominal pain and persistent low grade elevation of PDF WBC count (232.6 ±120 /uL) not responding to first and second line antibiotic. Two patients also had fever and chest symptoms. The mean time from onset of symptoms to diagnosis was 26.2 ±16.6 days (all by culture). Two patients died of gastrointestinal bleeding before diagnosis and treatment. All others responded to anti-TB treatment (isoniazid, rifampicin, pyrazinamide and levofloxacin with reduction to 2 drugs after 3 months) for a total course of 9 to 12 months. Five patients needed Tenckhoff catheter (TC) removal. The TC removal rate was similar to peritonitis caused by other organisms (5/14 vs 279/1599, P=0.08) but only 1 patient was able to resume PD
Conclusions:Tuberculous peritonitis was uncommon among PD patients. However, diagnosis was often delayed resulting in significant morbidity. High index of suspicion and appropriate culture was needed for proper diagnosis and treatment.
Dr. Choy is the nephrologist in-charge of the Renal Replacement Services of Queen Mary Hospital, Hong Kong. Dr. Choy graduated from the University of Hong Kong. She received her nephrology training in University Department of Medicine of Queen Mary Hospital in Hong Kong and Department of Nephrology of Royal Melbourne Hospital in Australia. Her clinical and research interest is in medical and infective complications of patients on dialysis and renal transplantation.