الفهرس 
patlents and Methods
EthambutolOnly 14 pages are availabe for public view
 |  | from | 133 |  |  |
| | | from | 133 | | |
Abstract
In the presant stuay 150 P!ltlents undergoing reguler hemodto1ys1s treetment
were examined to find out the lncidenca of tuberculosis. They were subjected to history
t11kl ng tlnd full clinical exemtrnrttcn. UbOI’8tOJ y exemlnetlon tnc:ludie(l PPD skin test, ES
.WBCs counts, renl function tests (blood uree. serum creo\lnine, serum sodium. serum poteslum,
urlnelysis for patients th8t st11l evoke urine), microscopic examination by Z-N. stein
for detection of eotd-fest b8Cilll in samples of sputum. urine. pleurol flulcl, esc!t!c:
fluid ..... etc es epproprl!!te for each case. Redloh: fcal examtnetlon by plain x-r&{ chest,
histological ex rolnatlon of specimens of lymph node, perie rdium ........ etc were
performed when needed. Therepeutlc trlels by antituberculosis drugs were used In
petlents with highly suggestllle history end clinlctll aata.
Six out of I SO p11t1ents exam I ned were found ta heve tuberculosis giving
an Incidence of 4which Is 2-4 times that of the oenerel population In Egypt
Petlents having regular dialysis treetment neva a lowered resistance to Infection, probably
owing to a defflc:lency In their callulsr Immunity. While this m JY be an ffiventage when they
rece1ve e kidney trensplent, th!JY ere vulnerable to Infection with the tubercle
beo11lus.
Risk fectors thai mey increese the susceptibility of dialysis petlents to Infection with
tuberculosis Include the reh!tlvely encad
7
-
oases of uremia, oovanced !IIJB, history of previous Infection with tuberculosis or
tuberculosis contact, presence of diabetes mellitus, Intake of cortlcosterolciS and
Immunosuppressive drugs.
The wly clinical dlegnosis or tuberculosis In hemoo1elys1s patients is not easy, but If one
suspects \t, a percentage of up to 41 of chron 1c u rem 1c pet ien ts on d1alys1s could
be found Infected with
tuberculosIs.
The presentlno symptoms of tuberculosis In hem!XIIalysls patients ere non-specific 111’\d
constitutional In nature InclUding fever, antrexla, weight loss, night sweetlno and chllls,
mela1se, generelized weeknass, heedeche, neusee end/or vomiting. other presenting feetures,
depend on the site of Infection. A !most half of all patients heva pulmonary or plaurel
Infection or both. SubseQuently. the presenting features 11re OOUQh, hemoptysis, dyspnea,
chest pain, pleural effusion, pulmcnary
!nfllterates or cevltatlon. Another Quarter h6Ve tuberculous lymphadenitis, USWIIIV
cervical, which ere datecteble bv sight and pelpetlon. Genito-urinary tuberculosis cen be
cllnlcelly silent In 11
Iaroe number of patients. In others the present!no symptoms of ectlva urinary tract
tuberculosis are avsurea, pyurle, hemeturle, urgency, frequency, nocturia, ebdomlnel peln
together with other cons!tut!onal symotoms of tuberculosis. 7 uberculous per1ton1tls mey be
presented by fever, Moraxle, we1ght loss, abillm lnel patn, esc1tes and hapatomeoeJy, however
painless 8SC11es wes elso reported. Other extrl!pulmonery sites inc1uda tuberculous
osteitis, menlnaltls, ertl1r1tis es well es miliary tuberculosis.
Even when the dl!!Qnosls or tutlerculClSls Is suspected, cHniCIII conflrmetlon mey often
prove d1fflcu lt There ere. usu!llly leucocytosis, rtse in ESR end worsen1no of elreoov
present an!IBmte. The reduced celluler Immunity makes tuberculin s tn test results negative.
Boctarloloote lly, examinetlon of sputum, pleurel fluid, esc\tlc fluid, urine eno other semples
for Mycobacterium tuberculosis mey be negative lnsplte of ecttve tuberculous disaose.
R!ldlologle lly. chest x-rey mms ere velueble In showing evidence of tuberculous
Infection. R!ldloloolcel chenges In tuberculous spondylitis end oste1t1s ere l!!te 11nd
di!!Qnosls usu1111y depends on culture of drolned pus or on biopsy.
H\stologic!llly, dl!:gnos\s of tuberculosis can be confirmed by the presence of us
granulomas in specimens obteined from lymph nodes, p\eure. end other sites.
1ause of the dlff!cullv m estflbH!I’IH\0 Ute dlegnosts In til”’lmles end hem!XIIelysls patients,
It mey hsve to be est&bllshed by 11 trlel of antituberculous chemotherapy In P!lt!ents
with highly suggestive c11niC111 dllte of tuberculosis.