Diagnostic delay and mortality of active tuberculosis in patients after kidney transplantation in a tertiary care hospital in China

Abstract

TB infection in patients after kidney transplantation remains a concern in a successful long-term outcome. This retrospective, descriptive study was performed on tuberculosis infection after kidney transplantation in the Department of Infectious Disease of the First Affiliated Hospital of Zhejiang University, a tertiary care hospital in China, from January 2011 to April 2017, with the aim to explain the clinical features of active tuberculosis after kidney transplantation and explore the correlated factors for diagnostic delay and mortality. It included 48 cases. All these cases were followed up for at least 12 months after anti-tuberculosis therapy, except the ones who died during this period. The median time of transplantation to active tuberculosis of these 48 patients was about 5.4 years. The time from a first hospital visit to the diagnosis (diagnostic delay) of 12 (25%) cases was more than 30 days. The correlated factors for the diagnostic delay more than 30 days were a fever for more than 2 weeks and antibiotic use for more than 2 weeks. Nine (18.8%) cases died during the anti-tuberculosis therapy or following-up period due to TB relapse. The risk factors for mortality were severe complications, such as encephaledema, severe pneumonia, intestinal perforation, liver function failure, and the following multiple-organ failure. In conclusion, the possibility of tuberculosis infection should be carefully assessed and sometimes diagnostic anti-tuberculosis therapy may be required for patients who had a fever for more than 2 weeks or used antibiotics for more than 2 weeks after kidney transplantation. Severe complications and the following multiple-organ failure might increase the mortality among these patients.

Tuberculosis among Full-Time Teachers in Southeast China, 2005–2016

“…Patients who are not diagnosed in a timely manner will be contagious for a long period of time, which will greatly increase the risk of group transmission [ 31 ]. According to previous studies, the case-finding delay among full-time teachers with TB is shorter than that among typical PTB patients [ 25 , 32 , 33 ], and the mean diagnosis interval was also shorter than those of PTB patients in Taiwan [ 34 ], tuberculous meningitis patients [ 35 ], and active TB patients after kidney transplantation [ 36 ]. The case-finding interval among full-time teachers with TB was longer than that among PTB patients in Zhejiang province [ 37 ].…”

Identifying Risk Factors for Pulmonary Tuberculosis Diagnosis Delays in Mali a West-African Endemic Country

“…In China, the median diagnosis of TB was significantly longer among immigrants than natives (30 vs. 9) with a high proportion of patients with a duration of >28 days (52% vs. 13%) [ 19 ]. In another Chinese study, the time from the first consultation to diagnosis was more than 30 days in 25% of kidney transplanted patients [ 20 ]. In Cambodia, a median diagnosis delay of 49 days was found in TB patients [ 21 ].…”

Cryptococcosis in Patients following Kidney Transplantation: A 9-Year Retrospective Clinical Analysis at a Chinese Tertiary Hospital

“…We performed the first allograft KT in July 1977 at the First Affiliated Hospital of School of Medicine, Zhejiang University, which is the main transplantation centre in China. However, opportunistic infections, including invasive fungal or viral infections and tuberculosis, remain a concern in patients who have undergone KT in terms of successful long-term outcomes [1, 13]. Only a small number of cases of post-KT cryptococcosis have been reported in mainland China [9–11].…”