RESUMEN
BACKGROUND: Mycobacteria avium (M. avium) is a species of ubiquitous slowly growing nontuberculous mycobacteria. It causes opportunistic infections. However, M. avium-related peritonitis in peritoneal dialysis (PD) patients is rare. CASE PRESENTATION: A 51-year-old female end-stage kidney disease patient undergoing PD was admitted for a noninfectious complication. She presented catheter exit site drainage and slightly increased PD effluent white cell count (WCC) with polymorphonuclear predominance on admission. Exit site infection and PD-related peritonitis were diagnosed. Repeated cultures of effluent and drainage were negative. Initial empirical antibiotics and further adjustment were not rewarding. PD was terminated 2 weeks later, however, shortly the patient developed stupor, high fever, peritoneal irritation, and spontaneous chylous ascites, and showed elevated ascitic adenosine deaminase (ADA). The manifestations persisted and the patient's general condition deteriorated despite intensified antibiotic therapy. Massive parallel sequencing identified M. avium in ascites on hospital day 25, and 4-drug treatment with azithromycin, amikacin, rifampin, and ethambutol was initiated. Nevertheless, the patient died from sepsis on hospital day 30. CONCLUSIONS: We report a case of PD-related M. avium peritonitis. Prolonged culture-negative peritonitis, chylous ascites, and elevated ascitic ADA may hint the possibility of mycobacterial infections. Diagnostic method allowing prompt identification of the pathogen is warranted. The prognosis can be extremely poor, and the prophylaxis and treatment should be better defined.
Asunto(s)
Fallo Renal Crónico/terapia , Mycobacterium avium , Diálisis Peritoneal/efectos adversos , Peritonitis Tuberculosa/microbiología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: We performed a meta-analysis to determine diagnostic accuracy of Xpert MTB/RIF for diagnosis of abdominal (intestinal or peritoneal) tuberculosis (TB) in various tissues (intestinal, omental/peritoneal tissue or ascitic fluid). METHODS: Electronic databases were searched for observational studies on use of Xpert MTB/RIF in ascitic fluid, peritoneal, or omental tissue for diagnosis of peritoneal and intestinal TB. We calculated the pooled sensitivity, specificity and diagnostic odds ratio of Xpert MTB/RIF for diagnosis of peritoneal TB in comparison to composite reference standard (CRS) and culture, and in comparison to CRS for intestinal TB. RESULTS: Twenty-five observational studies were included. The pooled sensitivity and specificity as assessed with peritoneal culture from ascites as an Index test was 64% (95% Confidence Interval [C.I.] 49-76%) and 97% (95% C.I., 95-99%) respectively and with peritoneal CRS was 30% (95% C.I., 22-40%) and 100% (95% C.I., 98-100%) respectively. In the intestinal group, the pooled sensitivity and specificity of Xpert MTB/RIF was 23% (95% C.I., 16-32%) and 100% (95% C.I., 52-100%). The AUC of peritoneal culture and intestinal tissue was 0.935 and 0.499. CONCLUSION: Xpert MTB/RIF has modest sensitivity for diagnosis of peritoneal and intestinal tuberculosis but has a good specificity. PROSPERO REGISTRATION: CRD42020140545.
Asunto(s)
Peritonitis Tuberculosa/diagnóstico , Reacción en Cadena de la Polimerasa/métodos , Tuberculosis Gastrointestinal/diagnóstico , Humanos , Técnicas de Amplificación de Ácido Nucleico , Peritonitis Tuberculosa/microbiología , Sensibilidad y Especificidad , Tuberculosis Gastrointestinal/microbiologíaAsunto(s)
Peritonitis Tuberculosa/complicaciones , Vena Porta , Trombosis de la Vena/etiología , Antituberculosos/uso terapéutico , Diagnóstico Diferencial , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Peritonitis Tuberculosa/diagnóstico , Peritonitis Tuberculosa/tratamiento farmacológico , Peritonitis Tuberculosa/microbiología , Vena Porta/diagnóstico por imagen , Valor Predictivo de las Pruebas , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológicoAsunto(s)
Antituberculosos/administración & dosificación , Fallo Renal Crónico/terapia , Mycobacterium tuberculosis/aislamiento & purificación , Técnicas de Amplificación de Ácido Nucleico/métodos , Diálisis Peritoneal/efectos adversos , Peritonitis Tuberculosa , Anciano , Antibacterianos/administración & dosificación , Líquido Ascítico/microbiología , Diagnóstico Diferencial , Humanos , Masculino , Diálisis Peritoneal/métodos , Peritonitis Tuberculosa/diagnóstico , Peritonitis Tuberculosa/tratamiento farmacológico , Peritonitis Tuberculosa/etiología , Peritonitis Tuberculosa/microbiología , Resultado del TratamientoRESUMEN
BACKGROUND: Peritoneal tuberculosis is the most common cause of low albumin gradient ascites in developing countries, but it can be easily confused with other causes of ascites. Peritoneal tuberculosis requires early recognition of symptoms and signs in order to make a quick diagnosis for appropriate treatment. Measurement of adenosine deaminase (ADA) level > 39 in ascites fluid is an established test to diagnose peritoneal tuberculosis. Many low-income countries do not currently test for adenosine deaminase in ascites fluid, including Rwanda. METHOD: Cross-sectional, descriptive study conducted through the Internal Medicine Department of three university teaching hospitals in Rwanda. Participants were patients older than 16 years presenting to tertiary referral hospitals with ascites of unknown cause. RESULTS: Of 103 ascites fluid samples collected, 52 of them (50.5%) had an elevated ADA, consistent with a presumptive diagnosis of peritoneal TB. Among those 52 subjects diagnosed with peritoneal TB, 39 out of 52 (75%) did not receive anti-TB medications. Among the 17 subjects who were treated with anti-TB medications, 4 of 17 (23.6%) did not have peritoneal TB based on ADA level. Samples with low-albumin gradient ascites were more likely to have high ADA ≥39 IU/L (p = 0.039). CONCLUSION: Our findings suggest that 3out of 4 patients with PTB in Rwanda are not getting TB treatment and 1 in 4 patients who are taking TB medications do not need it. Even if the true number of Rwandans who are being undertreated and overtreated is less than our study suggests, these results should prompt a larger study of peritoneal tuberculosis. Adding adenosine deaminase (ADA) to the diagnostic tools available to clinicians could help achieve the goal of correctly putting every Rwandan with tuberculosis on treatment, while avoiding unnecessary tuberculosis medications in those who do not have the disease.
Asunto(s)
Adenosina Desaminasa/análisis , Ascitis/diagnóstico , Peritonitis Tuberculosa/diagnóstico , Peritonitis Tuberculosa/epidemiología , Adulto , Líquido Ascítico/enzimología , Pruebas Enzimáticas Clínicas , Estudios Transversales , Países en Desarrollo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/inmunología , Peritoneo/microbiología , Peritonitis Tuberculosa/microbiología , Prevalencia , Rwanda/epidemiologíaRESUMEN
OBJECTIVES: Isoniazid (INH) prophylaxis is recommended for the prevention of tuberculosis (TB) reactivation before or/and during initiation of treatment with tumour necrosis factor antagonists (anti-TNF agents). Nonetheless, the long-term effectiveness of chemoprophylaxis is not clear. In this study, we aimed to evaluate the characteristics of patients who developed TB reactivation in spite of INH prophylaxis associated with anti-TNF treatment. PATIENTS AND METHODS: In this retrospective study, medical records of 1263 patients with inflammatory bowel disease were reviewed. Baseline TB screening tests (purified protein derivative test and/or QuantiFERON-TB Gold test) were performed on all patients before initiation of anti-TNF therapy. Patients with purified protein derivative of more than 5 mm and/or a positive result of the QuantiFERON-TB Gold test received INH prophylaxis for 9 months. We analysed the data of patients diagnosed with TB reactivation during the anti-TNF treatment despite INH chemoprophylaxis. RESULTS: Overall, 175 patients underwent anti-TNF treatment. Sixty of these 175 patients had pretreatment testing showing latent TB infection and therefore were treated concomitantly with INH for 9 months in addition to their anti-TNF treatment. TB reactivation occurred in four of these 60 co-INH/anti-TNF treated patients. Active TB was diagnosed after 37.5±27 (range: 18-84) months of anti-TNF treatment. In two of the four patients that active TB was diagnosed, was also detected other Mycobacterium spp.: M. bovis in one patient and M. genavense in the other one. CONCLUSION: INH chemoprophylaxis may not prevent the reactivation of TB during anti-TNF therapy in the long-term. Patients should be carefully and periodically screened for TB reactivation during anti-TNF therapy.
Asunto(s)
Antituberculosos/uso terapéutico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Isoniazida/uso terapéutico , Tuberculosis Latente/tratamiento farmacológico , Peritonitis Tuberculosa/prevención & control , Tuberculosis Pleural/prevención & control , Inhibidores del Factor de Necrosis Tumoral/uso terapéutico , Adulto , Anciano , Quimioprevención , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/complicaciones , Ensayos de Liberación de Interferón gamma , Tuberculosis Latente/complicaciones , Tuberculosis Latente/diagnóstico , Masculino , Mycobacterium , Mycobacterium bovis , Mycobacterium tuberculosis , Peritonitis Tuberculosa/microbiología , Estudios Retrospectivos , Prueba de Tuberculina , Tuberculosis/microbiología , Tuberculosis/prevención & control , Tuberculosis Pleural/microbiologíaAsunto(s)
Enfermedad de Crohn/diagnóstico , Tuberculosis Latente/diagnóstico , Peritonitis Tuberculosa/diagnóstico , Adulto , Antiinflamatorios/efectos adversos , Antituberculosos/uso terapéutico , Toma de Decisiones Clínicas , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/inmunología , Diagnóstico Diferencial , Femenino , Fármacos Gastrointestinales/efectos adversos , Humanos , Huésped Inmunocomprometido , Tuberculosis Latente/tratamiento farmacológico , Tuberculosis Latente/inmunología , Tuberculosis Latente/microbiología , Peritonitis Tuberculosa/tratamiento farmacológico , Peritonitis Tuberculosa/inmunología , Peritonitis Tuberculosa/microbiología , Factores de Riesgo , Resultado del TratamientoAsunto(s)
Peritonitis Tuberculosa/microbiología , Dolor Abdominal/etiología , Anciano , Antituberculosos/uso terapéutico , Humanos , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Peritonitis Tuberculosa/diagnóstico , Peritonitis Tuberculosa/tratamiento farmacológico , Tomografía Computarizada por Rayos XAsunto(s)
Fluorodesoxiglucosa F18/administración & dosificación , Diálisis Peritoneal/efectos adversos , Peritonitis Tuberculosa/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos/administración & dosificación , Adulto , Antituberculosos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Peritonitis Tuberculosa/tratamiento farmacológico , Peritonitis Tuberculosa/microbiología , Valor Predictivo de las Pruebas , Imagen de Cuerpo EnteroRESUMEN
Peritoneal dialysis (PD)-related peritonitis remains to be one of the most frequent and serious complications of PD. In this study, existing literature has been reviewed on PD peritonitis caused by atypical organisms and antibiotic resistant organisms and their impact on patient outcomes. Although uncommon, delay in recognition of PD peritonitis caused by atypical organisms can lead to poor patient outcomes if there is a delay in diagnosis and implementation of appropriate treatment. There is also a large difference in prevalence of antibiotic-resistant infections across the world with variable impact on reported patient-level outcomes.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Farmacorresistencia Bacteriana , Fallo Renal Crónico/terapia , Diálisis Peritoneal , Peritonitis/tratamiento farmacológico , Aspergilosis/tratamiento farmacológico , Aspergilosis/microbiología , Infecciones Relacionadas con Catéteres/microbiología , Criptococosis/tratamiento farmacológico , Criptococosis/microbiología , Humanos , Mucormicosis/tratamiento farmacológico , Mucormicosis/microbiología , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/microbiología , Peritonitis/microbiología , Peritonitis Tuberculosa/tratamiento farmacológico , Peritonitis Tuberculosa/microbiología , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Staphylococcus aureusAsunto(s)
Enfermedades de los Anexos/diagnóstico , Ascitis/microbiología , Peritonitis Tuberculosa/diagnóstico , Adenocarcinoma/diagnóstico , Enfermedades de los Anexos/microbiología , Adulto , Antígeno Ca-125/sangre , Diagnóstico Diferencial , Neoplasias de las Trompas Uterinas/diagnóstico , Femenino , Humanos , Neoplasias Ováricas/diagnóstico , Peritonitis Tuberculosa/microbiologíaAsunto(s)
Dolor Abdominal/etiología , Peritonitis Tuberculosa/complicaciones , Dolor Abdominal/diagnóstico , Adulto , Antituberculosos/uso terapéutico , Técnicas Bacteriológicas , Biopsia , Femenino , Humanos , Laparoscopía , Peritonitis Tuberculosa/diagnóstico por imagen , Peritonitis Tuberculosa/tratamiento farmacológico , Peritonitis Tuberculosa/microbiología , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We report the case of an 81-year-old man diagnosed with liver cirrhosis complicated by spontaneous bacterial peritonitis and septic shock. Mycobacterium tuberculosis complex was isolated from the ascites, sputum, and blood culture 1 month after the patient died. Clinicians should be aware of the unusual diagnosis of sepsis tuberculosa gravissima presenting with tuberculous peritonitis, which is easily misdiagnosed as spontaneous bacterial peritonitis and Gram-negative bacillus sepsis in patients with cirrhosis. Clinicians should cautiously evaluate the patient's sputum, gastric contents, urine, cerebrospinal fluid, and bone marrow for early diagnosis of disseminated tuberculosis in patients with a high degree of suspicion of this diagnosis.
Asunto(s)
Infecciones Bacterianas/microbiología , Mycobacterium tuberculosis/aislamiento & purificación , Peritonitis Tuberculosa/diagnóstico , Peritonitis Tuberculosa/microbiología , Sepsis/microbiología , Anciano de 80 o más Años , Ascitis/microbiología , Infecciones Bacterianas/mortalidad , Sangre/microbiología , Diabetes Mellitus , Humanos , Cirrosis Hepática/complicaciones , Masculino , Sepsis/mortalidad , Esputo/microbiologíaRESUMEN
BACKGROUND: Xpert™ MTB/Rif is a multiplex hemi-nested real-time PCR-based assay to detect presence of M. tuberculosis within 2 hours of sample collection. The present study aimed at assessing efficacy of Xpert™ MTB/Rif assay for diagnosing peritoneal tuberculosis. METHODS: Patients with exudative ascites, fluid negative for acid-fast bacilli on auramine O fluorescence staining and unyielding fluid cytology for malignant cells, were included. Ultrasound-guided omental biopsy samples were obtained in all. Xpert™ MTB/Rif assay on tissue samples was assessed against a composite "reference" standard for diagnosis of peritoneal tuberculosis, defined as presence of any of the three-culture showing M tuberculosis, granulomatous inflammation on histology or resolution of ascites with 2 months of antitubercular therapy. RESULTS: During January 2012-July 2013, 28 patients (age:43 ± 15 years; mean ± SD; male:20) were recruited. Serum ascitic albumin gradient was <1.1 in all except in four patients with underlying cirrhosis. Twenty-one of the 28 patients had peritoneal TB as diagnosed by composite reference standard (histology:18; culture:4; treatment response:3). Seven patients (25%) had an alternative diagnosis (metastatic carcinoma 2, adenocarcinoma 2, mesothelioma 2, and systemic lupus erythematous 1). Xpert™ MTB/Rif assay was positive in 4/21 patients with peritoneal tuberculosis and in none of the 7 patients with alternative diagnosis. Thus, sensitivity, specificity, positive, and negative predictive values for tissue Xpert™ MTB/Rif assay in diagnosing peritoneal tuberculosis were 19% (95% C.I: 6% to 42%), 100% (95% C.I: 59% to 100%), 100% (40% to 100%), and 29% (95% C.I: 13% to 51%), respectively. INTERPRETATION AND CONCLUSION: Tissue Xpert™ MTB/Rif assay was of limited use in diagnosing peritoneal tuberculosis.
Asunto(s)
Ascitis/microbiología , Exudados y Transudados/microbiología , Peritonitis Tuberculosa/diagnóstico , Peritonitis Tuberculosa/microbiología , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/aislamiento & purificación , Epiplón/microbiología , Sensibilidad y Especificidad , Factores de TiempoAsunto(s)
Mycobacterium bovis/aislamiento & purificación , Peritonitis Tuberculosa/microbiología , Tuberculosis Pleural/microbiología , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Terapia Combinada , Farmacorresistencia Microbiana , Quimioterapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Mycobacterium bovis/efectos de los fármacos , Peritonitis Tuberculosa/tratamiento farmacológico , Derrame Pleural/tratamiento farmacológico , Derrame Pleural/etiología , Derrame Pleural/microbiología , Derrame Pleural/cirugía , Pirazinamida/farmacología , Pirazinamida/uso terapéutico , Toracocentesis , Tuberculosis Pleural/tratamiento farmacológico , Tuberculosis Pleural/cirugíaRESUMEN
This case report introduces a 26-year-old male IV drug abuser with fever, abdominal pain and distension referred to the emergency ward. According to these findings, abdominal tenderness and involuntary guarding, an explorative laparotomy was performed. Multiple biopsies of omentum, peritoneum and liver were taken. Pathologic assessment of multiple biopsies confirmed intra-abdominal TB infection.
Asunto(s)
Abdomen Agudo/diagnóstico , Infecciones por VIH/complicaciones , Peritonitis Tuberculosa/diagnóstico , Abdomen Agudo/tratamiento farmacológico , Abdomen Agudo/etiología , Abdomen Agudo/microbiología , Adulto , Antituberculosos/administración & dosificación , Humanos , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/fisiología , Peritonitis Tuberculosa/tratamiento farmacológico , Peritonitis Tuberculosa/etiología , Peritonitis Tuberculosa/microbiologíaRESUMEN
Peritoneal tuberculosis (TB) is an extrapulmonary form of presentation of tuberculosis. HIV infection is a primary risk factor for this condition. Diagnosis requires microbiological or histopathological confirmation in addition to supporting radiological imaging studies. Abdominal ultrasonography and CT are useful to obtain a radiographic diagnosis, with typical findings including diffuse peritoneal thickening, presence of ascites in varying volumes, adenopathies, and caseating nodes. We report 2 cases of patients with ascites and nodular peritoneal thickening on diagnostic images, as well as high CA-125 levels in laboratory tests. In both patients, a diagnosis of peritoneal tuberculosis was reached following a US-guided peritoneal biopsy.
Asunto(s)
Peritonitis Tuberculosa/diagnóstico por imagen , Peritonitis Tuberculosa/diagnóstico , Adulto , Biopsia , Femenino , Infecciones por VIH/complicaciones , Hepatitis C/complicaciones , Humanos , Masculino , Mycobacterium tuberculosis , Peritonitis Tuberculosa/microbiología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
La tuberculosis (TBC) peritoneal es una de las formas de presentación extrapulmonar de la tuberculosis. La infección por VIH es uno de los principales factores de riesgo para esta enfermedad. El diagnóstico requiere una confirmación microbiológica o histopatológica, además de pruebas radiológicas que lo apoyen. En el diagnóstico radiológico son útiles la ecografía y la TC abdominal, los hallazgos característicos son el engrosamiento peritoneal difuso, la presencia de ascitis en cantidades variables, adenopatías y nódulos caseificantes. Presentamos 2 casos de pacientes con ascitis y engrosamiento nodular del peritoneo en las pruebas de imagen y un CA 125 elevado en las pruebas de laboratorio. En ambos casos se llegó al diagnóstico de tuberculosis peritoneal después de realizar biopsia peritoneal guiada por ecografía (AU)
Peritoneal tuberculosis (TB) is an extrapulmonary form of presentation of tuberculosis. HIV infection is a primary risk factor for this condition. Diagnosis requires microbiological or histopathological confirmation in addition to supporting radiological imaging studies. Abdominal ultrasonography and CT are useful to obtain a radiographic diagnosis, with typical findings including diffuse peritoneal thickening, presence of ascites in varying volumes, adenopathies, and caseating nodes. We report 2 cases of patients with ascites and nodular peritoneal thickening on diagnostic images, as well as high CA-125 levels in laboratory tests. In both patients, a diagnosis of peritoneal tuberculosis was reached following a US-guided peritoneal biopsy (AU)