Disseminated nontuberculous mycobacterial infections after allogeneic hematopoietic stem cell transplantation: a risk-based strategy for early diagnosis

Daenen, Laura G.M.; Bruggen, Jan-Tom van der; Leguit, Roos J.; Wagen, Lotte E. van der; Rhenen, Anna van; Wunderink, Herman F.; Witte, Moniek A. de; Bruns, Anke H. W.; Kuball, Jürgen

doi:10.1038/s41409-023-02011-6

Cited by 2 publications

(1 citation statement)

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“…This could be achieved by identifying pulmonary involvement, detecting increased activity in various affected organs, and highlighting FDG-avid lymphadenopathy, which could subsequently guide the selection of potential biopsy sites. 75 Moreover, follow-up PET-CT scans have been proposed as a method to monitor treatment response in both tuberculous and nontuberculous mycobacterial disease where a decrease in the F-FDG uptake might be suggestive of adequate response to therapy. 79 Depending on the type of infection, multiple patient specimens may be required to isolate the NTM pathogen, including from respiratory, blood, marrow, urine, stool, and biopsy of bone, lymph node or other tissue when appropriate.…”

Section: Diagnosismentioning

confidence: 99%

Nontuberculous mycobacterial infections in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation

El Zein,

Mendoza,

Wilson

2023

Transplant Infectious Dis

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BackgroundThe incidence of mycobacterial infections in patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients is increasing, contributing to significant mortality and morbidity. This review explores the epidemiology, risk factors, clinical presentation, diagnosis, and treatment of nontuberculous mycobacteria (NTM) in this population.MethodsA literature search was performed using PubMed with keywords and MeSH terms pertaining to the topics of nontuberculous mycobacteria, hematologic malignancies, hematopoietic stem cell transplant, cellular therapies, chimeric antigen therapies, epidemiology, diagnosis, and treatment. Additionally, we examined the reference lists of the included articles to identify other pertinent studies.ResultsDiagnosing mycobacterial disease among patients with hematologic disease and treatment‐associated immunosuppressive conditions is challenging due to the lack of distinctive clinical, radiographic, and laboratory markers, as well as the atypical manifestations compared to immunocompetent patients. Treatment involves using a combination of antibiotics for extended durations, coupled with strategies to achieve source control and reduce immunosuppression when feasible. This is complicated by the absence of clear data correlating in‐vitro drug susceptibility and clinical outcome for many antimicrobials use to treat NTM, adverse drug‐drug interactions, and the frequent challenges related to poor medication tolerability and toxicities.ConclusionThe rising incidence and corresponding clinical challenges of mycobacterial infections in this unique patient population necessitate a heightened awareness and familiarity of NTM disease by clinicians to achieve timely diagnosis and favorable treatment outcomes. image

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Section: Diagnosismentioning

confidence: 99%