Shohaib S A, Scrimgeour E M, Shaerya F
Department of Medicine, National Guard Khalid Hospital, Jeddah, Kingdom of Saudi Arabia.
Am J Nephrol. 1999;19(1):34-7. doi: 10.1159/000013422.
The incidence of tuberculosis in The Kingdom of Saudi Arabia remains high. The objective of this study is to determine the prevalence of Tuberculosis among haemodialysis patients, since they are highly susceptible to this infection. A retrospective study, over a 5-year period, was carried out in the Renal Units of two large hospitals in Jeddah. Diagnosis was established by Ziehl Neelsen microscopy and culture of specimens on Lowenstein-Jensen media, radiological and histological examinations. Tuberculosis was diagnosed in 17 of 210 patients on hemodialysis. Pulmonary tuberculosis was present in 10 cases and tuberculous lymphadenitis in 8 cases. One patient had both pulmonary and lymph node involvement while another one had both pulmonary and peritoneal tuberculosis. Mycobacterium tuberculosis was diagnosed in sputum in 5 cases, by lymph node histopathology in 5 cases, and combined radiological and clinical evidence in the remaining patients. The Mantoux test was positive in 9 (60%) cases. Eight patients were diabetics (47%) and there appears to be some association of tuberculosis with diabetes in patients on dialysis. Treatment with first-line anti-tuberculosis agents was continued for 6-18 months. Fourteen (82%) patients were completely cured while 3 showed clinical improvement only. The study showed that successful therapy of tuberculosis in this group of dialysis patients could be achieved but high index of suspicion is required to recognize the unusual presentation in this group of patients so that early diagnosis can be achieved and prompt treatment instituted. Diabetic patients presenting for dialysis, in areas with high endemicity for tuberculosis, chemoprophylaxis with anti-tuberculosis agents should be considered.
沙特阿拉伯王国的结核病发病率仍然很高。本研究的目的是确定血液透析患者中的结核病患病率，因为他们极易感染这种疾病。在吉达的两家大型医院的肾脏科进行了一项为期5年的回顾性研究。通过萋尼氏显微镜检查以及在罗-琴培养基上对标本进行培养、放射学和组织学检查来确诊。210例血液透析患者中有17例被诊断为结核病。其中10例为肺结核，8例为结核性淋巴结炎。1例患者同时有肺部和淋巴结受累，另1例同时有肺结核和结核性腹膜炎。5例痰中诊断出结核分枝杆菌，5例通过淋巴结组织病理学诊断，其余患者通过放射学和临床证据相结合来诊断。9例（60%）患者结核菌素试验呈阳性。8例患者为糖尿病患者（47%），透析患者中结核病与糖尿病之间似乎存在某种关联。一线抗结核药物治疗持续6至18个月。14例（82%）患者完全治愈，3例仅临床症状有所改善。该研究表明，对这组透析患者的结核病可以实现成功治疗，但需要高度怀疑指数来识别该组患者的异常表现，以便实现早期诊断并及时进行治疗。在结核病高流行地区，对于接受透析的糖尿病患者，应考虑使用抗结核药物进行化学预防。
