透析患者に発生した結核症

概要

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Thirty four patients with tuberculosis were identified over a 17 year period in a group of 643 patients undergoing peritoneal and hemodialysis. The incidence of tuberculosis was more frequent in the early stages of dialysis. Sixteen patients were diagnosed definitely as having lymphogenic tuberculosis (6), miliary tuberculosis (5), pulmonary tuberculosis (1), tuberculous pleurisy (1), tuberculous peritonitis (1) and tuberculous arthritis (1), and the other 18 patients, 14 having fever of unknown origin and 4 pleurisy, were diagnosed ther apoiticaly as having tuberculosis. The diagnosis of tuberculosis in dialysis patients was difficult because the symptoms were nonspecific, there were more frequent extrapulmonary involvements and tubercle bacilli were rarely isolated from dialysis patients. We inves tigated cell mediated immunity in dialysis patients. The data indicated that dialysis patients have lymphopenia, decreased reaction of PPD, alteration of T cell subset and decreased T cell activity. The experience suggests that patients on dialysis have decreased immunologic host defence and have a greater chance of contracting tuberculosis infection.