RESUMO
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.
Assuntos
Falência Renal Crônica/terapia , Mycobacterium avium , Diálise Peritoneal/efeitos adversos , Peritonite Tuberculosa/microbiologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Peritonite Tuberculosa/diagnóstico , Reação em Cadeia da Polimerase/métodos , Tuberculose Gastrointestinal/diagnóstico , Humanos , Técnicas de Amplificação de Ácido Nucleico , Peritonite Tuberculosa/microbiologia , Sensibilidade e Especificidade , Tuberculose Gastrointestinal/microbiologiaAssuntos
Peritonite Tuberculosa/complicações , Veia Porta , Trombose Venosa/etiologia , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/tratamento farmacológico , Peritonite Tuberculosa/microbiologia , Veia Porta/diagnóstico por imagem , Valor Preditivo dos Testes , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológicoRESUMO
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.
Assuntos
Adenosina Desaminase/análise , Ascite/diagnóstico , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/epidemiologia , Adulto , Líquido Ascítico/enzimologia , Ensaios Enzimáticos Clínicos , Estudos Transversais , Países em Desenvolvimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/imunologia , Peritônio/microbiologia , Peritonite Tuberculosa/microbiologia , Prevalência , Ruanda/epidemiologiaAssuntos
Antituberculosos/administração & dosagem , Falência Renal Crônica/terapia , Mycobacterium tuberculosis/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico/métodos , Diálise Peritoneal/efeitos adversos , Peritonite Tuberculosa , Idoso , Antibacterianos/administração & dosagem , Líquido Ascítico/microbiologia , Diagnóstico Diferencial , Humanos , Masculino , Diálise Peritoneal/métodos , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/tratamento farmacológico , Peritonite Tuberculosa/etiologia , Peritonite Tuberculosa/microbiologia , Resultado do TratamentoRESUMO
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.
Assuntos
Antituberculosos/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Isoniazida/uso terapêutico , Tuberculose Latente/tratamento farmacológico , Peritonite Tuberculosa/prevenção & controle , Tuberculose Pleural/prevenção & controle , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Adulto , Idoso , Quimioprevenção , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , Testes de Liberação de Interferon-gama , Tuberculose Latente/complicações , Tuberculose Latente/diagnóstico , Masculino , Mycobacterium , Mycobacterium bovis , Mycobacterium tuberculosis , Peritonite Tuberculosa/microbiologia , Estudos Retrospectivos , Teste Tuberculínico , Tuberculose/microbiologia , Tuberculose/prevenção & controle , Tuberculose Pleural/microbiologiaAssuntos
Doença de Crohn/diagnóstico , Tuberculose Latente/diagnóstico , Peritonite Tuberculosa/diagnóstico , Adulto , Anti-Inflamatórios/efeitos adversos , Antituberculosos/uso terapêutico , Tomada de Decisão Clínica , Doença de Crohn/tratamento farmacológico , Doença de Crohn/imunologia , Diagnóstico Diferencial , Feminino , Fármacos Gastrointestinais/efeitos adversos , Humanos , Hospedeiro Imunocomprometido , Tuberculose Latente/tratamento farmacológico , Tuberculose Latente/imunologia , Tuberculose Latente/microbiologia , Peritonite Tuberculosa/tratamento farmacológico , Peritonite Tuberculosa/imunologia , Peritonite Tuberculosa/microbiologia , Fatores de Risco , Resultado do TratamentoAssuntos
Peritonite Tuberculosa/microbiologia , Dor Abdominal/etiologia , Idoso , Antituberculosos/uso terapêutico , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/tratamento farmacológico , Tomografia Computadorizada por Raios XAssuntos
Fluordesoxiglucose F18/administração & dosagem , Diálise Peritoneal/efeitos adversos , Peritonite Tuberculosa/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos/administração & dosagem , Adulto , Antituberculosos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite Tuberculosa/tratamento farmacológico , Peritonite Tuberculosa/microbiologia , Valor Preditivo dos Testes , Imagem Corporal TotalRESUMO
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.
Assuntos
Antibacterianos/uso terapêutico , Infecções Relacionadas a Cateter/tratamento farmacológico , Farmacorresistência Bacteriana , Falência Renal Crônica/terapia , Diálise Peritoneal , Peritonite/tratamento farmacológico , Aspergilose/tratamento farmacológico , Aspergilose/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Humanos , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Peritonite/microbiologia , Peritonite Tuberculosa/tratamento farmacológico , Peritonite Tuberculosa/microbiologia , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureusAssuntos
Doenças dos Anexos/diagnóstico , Ascite/microbiologia , Peritonite Tuberculosa/diagnóstico , Adenocarcinoma/diagnóstico , Doenças dos Anexos/microbiologia , Adulto , Antígeno Ca-125/sangue , Diagnóstico Diferencial , Neoplasias das Tubas Uterinas/diagnóstico , Feminino , Humanos , Neoplasias Ovarianas/diagnóstico , Peritonite Tuberculosa/microbiologiaAssuntos
Dor Abdominal/etiologia , Peritonite Tuberculosa/complicações , Dor Abdominal/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Técnicas Bacteriológicas , Biópsia , Feminino , Humanos , Laparoscopia , Peritonite Tuberculosa/diagnóstico por imagem , Peritonite Tuberculosa/tratamento farmacológico , Peritonite Tuberculosa/microbiologia , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
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.
Assuntos
Infecções Bacterianas/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/microbiologia , Sepse/microbiologia , Idoso de 80 Anos ou mais , Ascite/microbiologia , Infecções Bacterianas/mortalidade , Sangue/microbiologia , Diabetes Mellitus , Humanos , Cirrose Hepática/complicações , Masculino , Sepse/mortalidade , Escarro/microbiologiaRESUMO
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.
Assuntos
Ascite/microbiologia , Exsudatos e Transudatos/microbiologia , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/microbiologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Omento/microbiologia , Sensibilidade e Especificidade , Fatores de TempoRESUMO
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.
Assuntos
Abdome Agudo/diagnóstico , Infecções por HIV/complicações , Peritonite Tuberculosa/diagnóstico , Abdome Agudo/tratamento farmacológico , Abdome Agudo/etiologia , Abdome Agudo/microbiologia , Adulto , Antituberculosos/administração & dosagem , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/fisiologia , Peritonite Tuberculosa/tratamento farmacológico , Peritonite Tuberculosa/etiologia , Peritonite Tuberculosa/microbiologiaAssuntos
Mycobacterium bovis/isolamento & purificação , Peritonite Tuberculosa/microbiologia , Tuberculose Pleural/microbiologia , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Terapia Combinada , Resistência Microbiana a Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Mycobacterium bovis/efeitos dos fármacos , Peritonite Tuberculosa/tratamento farmacológico , Derrame Pleural/tratamento farmacológico , Derrame Pleural/etiologia , Derrame Pleural/microbiologia , Derrame Pleural/cirurgia , Pirazinamida/farmacologia , Pirazinamida/uso terapêutico , Toracentese , Tuberculose Pleural/tratamento farmacológico , Tuberculose Pleural/cirurgiaRESUMO
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.
Assuntos
Peritonite Tuberculosa/diagnóstico por imagem , Peritonite Tuberculosa/diagnóstico , Adulto , Biópsia , Feminino , Infecções por HIV/complicações , Hepatite C/complicações , Humanos , Masculino , Mycobacterium tuberculosis , Peritonite Tuberculosa/microbiologia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
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)