BACKGROUND: Dialysis patients are at increased risk of tuberculosis (TB) and anergy due to attenuated cellular immunity. AIM: To define specific risks of TB in anergic and non-anergic dialysis patients. METHODS: A total of 272 dialysis patients were enrolled in this prospective study over a 36-month follow-up. Entering the study, participants had Mantoux and 2,4-dinitrochlorobenzene skin tests and their cell-mediated immunity (CMI)-index was estimated. Patients were classified as anergic (CMI-index<or=2 and Mantoux<or=4 mm) or non-anergic. Specific relative risks of TB were then calculated, using data from both the general population and 49 non-uremic health care workers. The independent effect of sex, age and diabetes mellitus was determined using Cox's proportional hazard method. RESULTS: Among the 116 (42.6%) anergics 13 (11.2%), and among the 156 non-anergics 11 (7%) developed active tuberculosis. Anergics had a significantly higher risk of TB than non-anergics (Adjusted Relative Risks, 98.3, 95% CI 58.65-113.6 versus 61.6, 95% CI 13.6-72.1, P=0.003). Tuberculin reactivity was weakly associated with the subsequent risk of TB (r=0.51). The latter showed a steadily decreasing trend with increasing CMI-index (r=-0.99). CONCLUSION: Anergy distorts the association of tuberculin reactivity with risk of TB. Anergic dialysis patients are at increased risk of developing active TB and chemoprophylaxis is justified in them too.
BACKGROUND: Dialysis patients are at increased risk of tuberculosis (TB) and anergy due to attenuated cellular immunity. AIM: To define specific risks of TB in anergic and non-anergic dialysis patients. METHODS: A total of 272 dialysis patients were enrolled in this prospective study over a 36-month follow-up. Entering the study, participants had Mantoux and 2,4-dinitrochlorobenzene skin tests and their cell-mediated immunity (CMI)-index was estimated. Patients were classified as anergic (CMI-index<or=2 and Mantoux<or=4 mm) or non-anergic. Specific relative risks of TB were then calculated, using data from both the general population and 49 non-uremic health care workers. The independent effect of sex, age and diabetes mellitus was determined using Cox's proportional hazard method. RESULTS: Among the 116 (42.6%) anergics 13 (11.2%), and among the 156 non-anergics 11 (7%) developed active tuberculosis. Anergics had a significantly higher risk of TB than non-anergics (Adjusted Relative Risks, 98.3, 95% CI 58.65-113.6 versus 61.6, 95% CI 13.6-72.1, P=0.003). Tuberculin reactivity was weakly associated with the subsequent risk of TB (r=0.51). The latter showed a steadily decreasing trend with increasing CMI-index (r=-0.99). CONCLUSION: Anergy distorts the association of tuberculin reactivity with risk of TB. Anergic dialysis patients are at increased risk of developing active TB and chemoprophylaxis is justified in them too.
Authors: A I Christopoulos; A A Diamantopoulos; P A Dimopoulos; D S Goumenos; G A Barbalias Journal: Int Urol Nephrol Date: 2008-10-24 Impact factor: 2.370
Authors: Antonios I Christopoulos; Athanasios A Diamantopoulos; Panagiotis A Dimopoulos; Demetrios S Goumenos; George A Barbalias Journal: BMC Nephrol Date: 2009-11-07 Impact factor: 2.388
Authors: Hamdan H Al Jahdali; Salim Baharoon; Abdullah A Abba; Ziad A Memish; Abdulrahman A Alrajhi; Ali AlBarrak; Qais A Haddad; Mohammad Al Hajjaj; Madhukar Pai; Dick Menzies Journal: Ann Saudi Med Date: 2010 Jan-Feb Impact factor: 1.526