Abstract
Extrapulmonary mycobacteriosis is relatively common in hemodialysis patients, and it is hard to demonstrate the presence of acid-fast bacteria by smearstaining or by isolating the pathogen. In uremia the host's cellular defense mechanism is impaired, and so the specificity of the PPD-reaction is low, making the diagnosis of mycobacteriosis very difficult.
Detection of IgG antibody against trehalose-6, 6'-dimycolate (TDM), a common cell wall molecule of acidfast bacteria, e.g., Mycobacterium tuberculosis, was carried out by the enzyme-linked immunosorbent assay (ELISA) method in hemodialysis patients, and this method of diagnosis was evaluated as useful in this study.
Sera from 8 patients suspected of active or inactive mycobacteriosis, 5 patients on hemodialysis without mycobacteriosis and 5 healthy adults were examined. Three patients with suspected mycobacteriosis had higher titers of IgG antibody against TDM than the other groups and were diagnosed as having active mycobacteriosis.
The serum of a 71-year-old woman with low-grade fever of unknown origin was examined. This patient's serum had a high titer of IgG antibody against TDM, and she was diagnosed as having active mycobacteriosis. After combined therapy with SM, INH and REP, her low-grade fever resolved. The titer of anti-TDM antibody declined in parallel with her WBC counts and CRP levels.
In conclusion, detection of IgG antibody against TDM is useful in the serodiagnosis and treatment of mycobacteriosis in hemodialysis patients.
