High-resolution CT findings of pulmonaryMycobacterium tuberculosisinfection in renal transplant recipients

Abstract

Objective: Renal transplantation recipients are at increased risk of Mycobacterium tuberculosis infection because of immunosuppression. The aim of this study was to assess high-resolution CT (HRCT) findings in renal transplantation recipients diagnosed with pulmonary tuberculosis (TB). Methods: We reviewed HRCT findings from patients diagnosed with pulmonary TB, established by M. tuberculosis detection in bronchoalveolar lavage, sputum or biopsy sample. Two observers independently reviewed HRCT images and reached consensus decisions on the presence and distribution of: (i) miliary nodules, (ii) cavitation and centrilobular tree-in-bud nodules, (iii) ground-glass attenuation and consolidation, (iv) mediastinal lymph node enlargement and (v) pleural effusion. Results: The sample comprised 40 patients [26 males, 14 females; median age, 45 years (range, 12-69 years)]. The main HRCT pattern was miliary nodules (40%), followed by cavitation and centrilobular tree-in-bud nodules (22.5%), ground-glass attenuation and consolidation (15%), mediastinal lymph node enlargement (12.5%) and pleural effusion (10%). The distribution of findings in patients with miliary nodules was random. In patients with cavitation and centrilobular tree-in-bud nodules, 66.6% of abnormalities were found in the upper lobes. Pleural effusion was unilateral in 75% of cases. The overall mortality rate was 27.5%. This rate was 50% in patients with miliary nodules, and 72.6% of all deaths occurred in this group. Thus, mortality was increased significantly in patients with miliary nodules (p , 0.05). Conclusion:The main HRCT finding in renal transplantation recipients with pulmonary TB was miliary nodules, followed by cavitation and centrilobular tree-in-bud nodules. Miliary nodules were associated with a worse prognosis in these patients. Advances in knowledge: We report the first series on HRCT findings of microbiologically confirmed pulmonary TB exclusively in renal transplantation recipients. The main HRCT finding was miliary nodules, and mortality was increased significantly in these patients.

Mycobacterium tuberculosisafter solid organ transplantation: A review of more than 2000 cases

“…The overall incidence of TB was 1.69% (range, 0.027‐13.27). Twenty‐nine studies provided incidence of TB among kidney‐only recipients, while 13 studies provided kidney recipient information in combination with other SOT data.…”

“…During the period from 1998 to 2016, a total of 187 studies reported 2082 cases of TB after SOT. 2, The majority (135/187 [72.19%]) were case reports or series, while the remainder were retrospective studies (n = 43), 40,138,139,[141][142][143][144][145][146][147][148]150,[152][153][154][156][157][158][159][160][161][162]164,[166][167][168][169][170][173][174][175][176][179][180][181][182][183][184][185][186][187][188][189] case-control studies (n = 5), 140,163,171,172,…”

“…Twenty-nine studies [138][139][140]143,145,148,150,152,[154][155][156][158][159][160][165][166][167][168]170,173,174,[178][179][180][181][182][183]186,188 provided incidence of TB among kidney-only recipients, while 13 studies 141,142,146,149,157,161,164,171,172,184,185,187,189 Rejection prior to TB occurred in 184 of 531 (34.65%) cases. The use of CD4-depleting agents such as muromonab (OKT-3) or alemtuzumab (anti-CD52) was detailed in 13 of 38 (34.21%) case reports, 9,13,21,25,39,59,74,…”

Diagnosis of severe respiratory infections in immunocompromised patients

“…Immunocompromised patients may have only one or a few mild symptoms, such as persistent fever [42], even though dissemination of the organism outside the lungs is common [43]. HRCT findings include miliary nodules, cavitation, centrilobular tree-in-bud nodules, consolidation, mediastinal lymphadenopathy, and pleural effusion [44]. Cavitation and centrilobular tree-in-bud nodules are often located in the upper lobes.…”

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“…High-resolution computerized tomography, which may show characteristic lesions, may help in an improved ability to diagnose. 16 In addition, histopathologic proof, whenever possible, may also improve obtaining a diagnosis. Any histopathologic tissue with evidence of granuloma should be suspected to be due to tuberculosis unless proven otherwise.…”