Multidrug-resistant tuberculosis in a lung transplant recipient

Lee, Joseph; Yew, Wing Wai; Wong, Chi Fong; Wong, Puisan; Chiu, Chia-Yu

doi:10.1016/s1053-2498(02)01189-0

Cited by 51 publications

(49 citation statements)

References 23 publications

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“…If rifampin use is mandatory, the cyclosporine or tacrolimus dose should be increased 3-5 fold, and serum levels should be closely monitored [2]. Other authors [37] have found it useful to use rifabutin instead of rifampin, which is reported to cause less enzyme induction and to make interaction more manageable, but in our opinion, many of the concerns associated with the use of rifampin remain when rifabutin is used.…”

Section: Treatmentmentioning

confidence: 97%

Mycobacterium tuberculosis Infection in Recipients of Solid Organ Transplants

Muñóz

Rodríguez

Bouza

2005

Clinical Infectious Diseases

309

333

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Tuberculosis is a serious opportunistic infection that may affect transplant recipients. The incidence of tuberculosis among such persons is 20-74 times higher than that for the general population, with a mortality rate of up to 30%. The most common form of acquisition of tuberculosis after transplantation is the reactivation of latent tuberculosis in patients with previous exposure. Clinical presentation is frequently atypical and diverse, with unsuspected and elusive sites of affection. Manifestations include fever of unknown origin and allograft dysfunction. Coinfection with other pathogens is not uncommon. New techniques, such as PCR and quantification of interferon-g, have been developed to achieve more-rapid and -accurate diagnoses. Treatment requires control of interactions between antituberculous drugs and immunosuppressive therapy. Prophylaxis against latent tuberculosis is the main approach to treatment, but many issues remain unsolved, because of the difficulty in identifying patients at risk (such as those with nonreactive purified protein derivative test results) and the toxicity of therapy.Tuberculosis tends to behave as an opportunistic infection in patients with solid organ transplants (SOTs). The incidence of infection among such patients is estimated to be 20-74 times that for the general population [1][2][3]. Because of the atypical clinical presentation in transplant recipients, diagnosis is frequently challenging. Furthermore, treatment presents special problems because interactions between immunosuppressive drugs and antituberculous therapy are very important and may lead to graft rejection.Tuberculosis may directly contribute to graft dysfunction, and it is associated with a high mortality rate. Prophylaxis remains the best therapeutic approach, but it is still hindered by the difficulty of identifying proper candidates for treatment and by the potential toxicity of isoniazid, particularly in liver transplant recipients.Our objective was to review the available information about tuberculosis in SOT recipients. With the exception of 2 large series [1,4], this data is scattered among reports of individual cases from many different sources.

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Section: Treatmentmentioning

confidence: 97%

Mycobacterium tuberculosis Infection in Recipients of Solid Organ Transplants

Muñóz

Rodríguez

Bouza

2005

Clinical Infectious Diseases

309

333

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“…resistance to isoniazid and rifampicin) has rarely been reported in SOT [111][112][113] or HSCT recipients [114]. Despite limitations in drug susceptibility testing (DST) MDR-TB should be treated according to the results of DST with at least four drugs that are active against M. tuberculosis in vitro.…”

Section: Special Situationsmentioning

confidence: 99%

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Bumbăcea

Arend

Eyüboğlu³

et al. 2012

Eur Respir J

219

261

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Tuberculosis (TB) is a possible complication of solid organ and hematopoietic stem cell transplantation. The identification of candidates for preventive chemotherapy is an effective intervention to protect transplant recipients with latent infection with Mycobacterium tuberculosis from progressing to active disease. The best available proxy for diagnosing latent infection with M. tuberculosis is the identification of an adaptive immune response by the tuberculin skin test or an interferon-c based ex vivo assay. Risk assessment in transplant recipients for the development of TB depends on, among other factors, the locally expected underlying prevalence of infection with M. tuberculosis in the target population. In areas of high prevalence, preventive chemotherapy for all transplant recipients may be justified without immunodiagnostic testing while in areas of medium and low prevalence, preventive chemotherapy should only be offered to candidates with positive M. tuberculosis-specific immune responses. The diagnosis of TB in transplant recipients can be challenging. Treatment of TB is often difficult due to substantial interactions between anti-TB drugs and immunosuppressive medications. This management guideline summarises current knowledge on the prevention, diagnosis and treatment of TB related to solid organ and hematopoietic stem cell transplantation and provides an expert consensus on questions where scientific evidence is still lacking. KEYWORDS: Guideline, management, Mycobacterium tuberculosis, transplantation, tuberculosis T uberculosis (TB) is caused by the pathogenic species of the Mycobacterium tuberculosis complex. Only a minority of individuals who develop an adaptive immune response following infection with M. tuberculosis will ever develop TB, with the actual risk depending on the extent to which the host immune system provides a successful or inadequate response [1,2]. Therefore, individuals with impaired immune response, such as solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, are more prone to develop TB than immunocompetent persons. TB in transplant recipients is more frequent compared to the general population (estimates from the last decades state 20-74 times as frequent in SOT [3,4] and twice as frequent in HSCT [5]), and more often fatal (up to 31% in SOT [6] and up to 50% in HSCT recipients [7]), thus adding effectiveness to interventions for its prevention, even in the face of difficulties, with treatment related to adverse drug events and drug-drug interactions. Active TB in transplant recipients can result from latent infection with M. tuberculosis (LTBI) in the transplant candidate or in the donor tissue, or from de novo post-transplant infection. These various scenarios prompt for targeted pre-transplant screening of both recipient and, if possible, donors to allow focused management of recipients selected for preventive intervention in the pre-and/or posttransplant period. The term ''preventive chemotherapy'' is used to denote treatmen...

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“…Rifabutin has similar drug interactions as Rifampicin but of a lesser degree. However, experience with use of Rifabutin [50][51][52] in the tropics is limited. An important concern is the increasing incidence of fluroquinolone resistance among M.TB isolates in tropics (non KTR).…”

Section: Mycobacterium Tuberculosismentioning

confidence: 99%

Infections After Kidney Transplantation: The Bug Bear Of Kidney Transplantation In Tropics

Basu¹

2015

TOUNJ

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Abstract:Infections are the bugbear of kidney transplantation in the tropics, being responsible for majority of the deaths. Despite the several challenges posed by infections in kidney transplant recipient in the tropics, various developments have resulted in a decline in the rate of infections as well as their consequences. This review aims to be a basic overview of the common infections in KTR with an attempt to provide a unique tropical country perspective.

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Multidrug-resistant tuberculosis in a lung transplant recipient

Cited by 51 publications

References 23 publications

Mycobacterium tuberculosis Infection in Recipients of Solid Organ Transplants

Mycobacterium tuberculosis Infection in Recipients of Solid Organ Transplants

The risk of tuberculosis in transplant candidates and recipients: a TBNET consensus statement

Infections After Kidney Transplantation: The Bug Bear Of Kidney Transplantation In Tropics

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