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A qualitative, enzyme-linked immunospot assay is a promising diagnostic method for tuberculous peritonitis among continuous ambulatory peritoneal dialysis patients: A single-center experience

Qijun Wan, Dan Zhu, Ying Liao, Haiying Song, Jiahui Yang, Xiaojuan Hou, Guangkun Ma, Xiujuan He, Jing Li

The prevalence of Tuberculous Peritonitis (TBP) among Continuous Ambulatory Peritoneal Dialysis (CAPD) patients in China is unknown. A qualitative Enzyme-Linked Immunospot (ELISPOT) assay has been proven effective for Tuberculosis (TB) diagnosis. The effectiveness of ELISPOT for TBP diagnosis is unknown. We report our single-center experience of TBP management among CAPD patients. This is a single-center retrospective study of 178 CAPD patients from August 1997 to December 2015. The ELISPOT assay was used for detection of interferon (IFN)-γ, IFN-γ (PB+P8.10), and IFN-γ (P8.10) in blood and peritoneal effluent fluid in suspected cases of TBP. Antituberculous therapy combined with CAPD was administered to confirmed TBP patients. Clinical and laboratory data were reassessed. The prevalence of TBP in this study was only 0.56%, accounting for 0.9% of all peritonitis cases. The incidence of TBP was 1/806 person-months. Levels of IFN-γ, IFN-γ (PB+P8.10), and IFN-γ (P8.10) in blood and dialysate effluent were more than 10 times higher than the reference range at the onset of TBP and gradually returned to normal with antituberculous treatment. Tenckhoff catheters functioned well. The prevalence of TBP among CAPD patients was low in our center. TBP should be considered in patients with neutrophilic sterile peritonitis and no response to broad-spectrum antibacterial medication. ELISPOT is a promising diagnostic method for TBP among CAPD patients. The peritoneal catheter can be retained with early diagnosis and timely antituberculous treatment.