Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderbad, 082, India.
Int Urol Nephrol. 2013 Aug;45(4):1129-35. doi: 10.1007/s11255-012-0311-0. Epub 2012 Nov 10.
The aims of the present report were to document our experience of the prevalence of tuberculous peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients, mode of presentation, diagnosis and outcome and to discuss the current published data about catheter removal.
A retrospective study of CAPD patients with tuberculous peritonitis was done. A minimum of three specimens of peritoneal fluid were examined for acid-fast bacilli smears. The BACTEC 9000 Blood Culture Series of instruments were used for the culture of Mycobacterium tuberculosis. After 2005, patients were treated with anti-tuberculous treatment, and catheter retention was started in our patients.
There were eleven patients (2.6 %) with tuberculous peritonitis among 414 CAPD patients. M. tuberculosis accounted for 4.47 % of all peritonitis episodes. The incidence of tuberculous peritonitis was 1/794 months. There were eight males and three females. The mean age was 49 years. Intestinal obstruction was reported in two patients, and two patients were treated for antecedent peritonitis. One of them had a simultaneous fungal peritonitis. One patient each developed a peritoneo-cutaneous fistula and ultrafiltration failure. Three were successfully treated without the removal of catheter.
Based on the analysis of all published reports of tuberculous peritonitis, there was no significant difference in patient survival between patients in whom CAPD catheter was removed or retained. Tuberculous peritonitis should be considered in patients with neutrophilic 'sterile' peritonitis with no response to antibacterial medications, predominance of lymphocytic peritonitis and in bacterial peritonitis not responding to antibiotics. After an early diagnosis, with close monitoring, an effort to retain the catheter after 5 days of anti-tuberculous therapy may be attempted.
本报告的目的是记录我们在持续不卧床腹膜透析（CAPD）患者中发现结核性腹膜炎的经验，包括其表现形式、诊断和结果，并讨论目前关于导管去除的已发表数据。
对结核性腹膜炎的 CAPD 患者进行回顾性研究。对至少三份腹膜液标本进行抗酸杆菌涂片检查。使用 BACTEC 9000 血培养系列仪器培养结核分枝杆菌。2005 年后，患者接受抗结核治疗，并开始保留导管。
在 414 例 CAPD 患者中，有 11 例（2.6%）发生结核性腹膜炎。结核分枝杆菌占所有腹膜炎发作的 4.47%。结核性腹膜炎的发生率为 1/794 个月。患者中有 8 名男性和 3 名女性，平均年龄为 49 岁。有 2 例患者出现肠梗阻，有 2 例患者因先前的腹膜炎而接受治疗。其中 1 例同时并发真菌性腹膜炎。1 例患者发生腹膜-皮瘘，1 例患者超滤失败。3 例患者成功治疗而无需去除导管。
根据所有已发表的结核性腹膜炎报告的分析，保留或去除 CAPD 导管的患者在生存率方面没有显著差异。对于中性粒细胞性“无菌”腹膜炎且对抗菌药物无反应、以淋巴细胞性腹膜炎为主和对抗生素无反应的细菌性腹膜炎，应考虑结核性腹膜炎。早期诊断后，密切监测，如果在抗结核治疗 5 天后仍能保留导管，可以尝试保留导管。
