Abstract
Peritonitis is the most common complication and the leading cause of death in pediatric peritoneal dialysis (PD) patients. According to the most recent data available from the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), approximately 25% of pediatric PD patients who die succumb to infection. There are no reported cases of Mycobacterium tuberculosis (MTB) or Mycobacterium avium-intracellulare peritonitis in the NAPRTCS registry. With an increasing incidence of MTB worldwide and the impairment of cellular immunity in chronic renal failure patients, it is not surprising that mycobacterium peritonitis can occur in PD patients. We report two pediatric PD patients with mycobacterial peritoneal infection diagnosed over an 11-year period at our institution. One patient presented with a malfunctioning Tenckhoff catheter and again 3 years later with hyponatremia and ascites. The other presented with recurrent culture-negative peritonitis. These cases illustrate the importance of more extensive evaluation of PD complications, to include evaluation for mycobacterium with special media or peritoneal biopsy, in the above clinical settings if the routine work-up is unrevealing.
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References
Pulliam JP, Vernon DD, Alexander SR, Hartstein AI, Golper TA (1983) Nontuberculous mycobacterial peritonitis associated with continuous ambulatory peritoneal dialysis. Am J Kidney Dis 2:610–614
Hakim A, Hisam N, Reuman PD (1993) Environmental Mycobacterial peritonitis complicating peritoneal dialysis: three cases and review. Clin Infect Dis 16:426–431
Vas SI (1994) Renaissance of tuberculosis in the 1990s: lessons for the nephrologist. Perit Dial Int 14:209–214
Mallat SG, Brensilver JM (1989) Tuberculous peritonitis in a CAPD patient cured without catheter removal: case report, review of the literature, and guidelines for treatment and diagnosis. Am J Kidney Dis 13:154–157
Jorres A, Gahl G, Frei U (1996) In vitro studies on the effect of dialysis solutions on peritoneal leukocytes. Perit Dial Int 15:S41–S46
Khanna R, Fenton SS, Cattran DC, Thompson D, Deitel M, Oreopoulos DG (1980) Tuberculous peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Perit Dial Bull 1:10–12
Talwani R, Horvath JA (2000) Tuberculous peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: case report and review. Clin Infect Dis 31:70–75
Abraham G, Matthews M, Sekar L, Srikanth A, Sekar U, Soundarajan P (2001) Tuberculous peritonitis in a cohort of continuous ambulatory peritoneal dialysis patients. Perit Dial Int 21 [Suppl 3]:S202–S204
Ekim M, Tumer N, Bakkaloglu S (1999) Tuberculosis in children undergoing continuous ambulatory peritoneal dialysis. Pediatr Nephrol 13:577–579
Wang HK, Hsueh PR, Hung CC, Chang SC, Luh KT, Hsieh WC (1998) Tuberculous peritonitis: analysis of 35 cases. J Microbiol Immunol Infect 31:113–118
Gurkan F, Ozates M, Bosnak M, Dikici B, Bosnak V, Tas MA, Haspolat K (1999) Tuberculous peritonitis in 11 children: clinical features and diagnostic approach. Pediatr Int 41:510–513
Quantrill SJ, Woodhead MA, Bell CE, Hutchson AJ, Gokal R (2001) Peritoneal tuberculosis in patients receiving continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 16:1024–1027
Erb N (2002) Understanding the Gram stain and differential in the treatment of peritonitis. CANNT J 12:24–25
Taskapan H, Oymak O, Utas C (2000) Tuberculin and anergy testing in CAPD patients. Perit Dial Int 20:807–809
Abin DS, Jain KA, Azouz EM (1994) Abdominal tuberculosis in children. Pediatr Radiol 24:473–477
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Ferrara, E., Lemire, J., Grimm, P.C. et al. Mycobacterial peritonitis in pediatric peritoneal dialysis patients. Pediatr Nephrol 19, 114–117 (2004). https://doi.org/10.1007/s00467-003-1348-1
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DOI: https://doi.org/10.1007/s00467-003-1348-1