慢性透析患者結核症10例の臨床的検討
スポンサーリンク
概要
- 論文の詳細を見る
As immunopotency including PPD skin test is suppressed in dialysis patients, they might belong to the high risk group for developing tuberculosis. A study was made on tuberculosis in dialysis patients treated at our dialysis unit.<BR>For the past 11 years we treated 194 chronic dialysis patients in Keio University Hospital, and 10 cases developed tuberculosis. The incidence of tuberculosis was enormously high, 4, 065 per 100, 000, which was 58 times higher than that of the general population in 1978. Three of 10 patients died and the fatality was 30%. The type of the disease was lymphadenitis in 5, miliary in 2, respiratory tract and peritoneal in 1, urinary tract in I and lung tuberculosis in 1. Nine of 10 cases had extrapulmonary lesions and 4 had pulmonary lesions. This data revealed remarkably high frequency of extrapulmonary tuberculosis in dialysis patients. Past history of tuberculosis was obtained from 5 cases. Another one case was found at autopsy to have an old tuberculous lesion in the lung. Two patients developed tuberculosis just before the initiation of dialysis therapy and 4 in the first year. The patients might have been infected with tubercle bacilli in the past, and had occult hematogenous spread to some organs. It was suggested that under certain circumstances such as uremia and being treated with dialysis, the bacilli might begin to grow again after a long time dormancy, leading to the development of extrapulmonary tuberculosis. Among persons who have the quiescent tuberculous foci, tuberculosis may develop when they face such conditions as mentioned above. Consequently, the majority of onset of tuberculosis were seen soon after the initiation of dialysis therapy, and thereafter, the number of new cases was reduced according to the decrement of such persons. The remarkably high incidence of tuberculosis observed in dialysis patients suggests that they are mainly due to recurrence or endogenous reactivation.<BR>Fever, symptoms arising from involved organs, accelerated erythrocyte sedimentation rate were useful for the diagnosis. Chest X-ray films are also sometimes useful information. The skin test to PPD was stronger among tuberculosis cases than among non-tuberculous dialysis patients. The patients responded well to anti-tuberculous drugs when used timely in proper combination and dosage.
- 一般社団法人 日本結核病学会の論文
著者
関連論文
- 5.連日透析により化学療法に伴う重篤な副作用を回避しえた非小細胞肺癌透析患者の1例(第150回日本肺癌学会関東支部会,関東支部,支部活動)
- 再発性多発軟骨炎に繰り返すバスキュラーアクセス異常を合併した透析患者の1例
- 透析患者の免疫不全と結核症
- ヒトリンパ球のDNA合成を抑制する尿毒症患者血清因子
- 慢性腎不全患者における肺外結核の特性に関する疫学的検討
- 慢性腎不全患者の結核症に対する易感染性および脆弱抵抗性に関する疫学的検討
- 透析患者における肺外結核症の疫学的検討
- 透析患者の結核症 : 第8報リンパ節結核の特性
- 透析患者の結核症 : 第7報 リンパ節結核の易感染性
- 透析患者の結核症 : 第9報骨・関節結核
- 透析患者の結核症 : 第5報粟粒結核の疫学
- 透析患者の結核症 : 第4報肺結核発病り特性
- 透析患者の結核症 : 第3報肺結核の疫学
- 透析患者の結核症 : 第2報 罹患臓器の特性
- 透析患者の結核症 : 第1報肺, 肺外および両者合併病巣を有する結核症の致命率
- 慢性透析患者結核症10例の臨床的検討