Mycobacterial Infection After Renal Transplantation--Report of 14 Cases and Review of the Literature

Qunibi, Wajeh Y.; Al-Sibai, M. Badawi; Taher, Saadi; Harder, Edward J.; Vol, Edward De; Alfurayh, Osman; Ginn, H. Earl

doi:10.1093/qjmed/77.1.1039

Cited by 142 publications

(104 citation statements)

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“…We found that this direct translation of relative frequency of tuberculosis into annual incidence has also been made in all the major series of tuberculosis in solid organ transplants. 14,[26][27][28] In the published series of tuberculosis after transplantation, the number of cases observed is divided by the total number of transplant patients over a period of several years, without taking into account the period of time (that is the amount of population-time accrued). As a consequence, the denominator of the equation decreases and the resulting incidence is overestimated.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis after hematopoietic stem cell transplantation: incidence, clinical characteristics and outcome

Cámara

Martino

Granados

et al. 2000

Bone Marrow Transplant

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Summary:A national survey of tuberculosis after hematopoietic stem cell transplant (SCT) was undertaken to study incidence, clinical presentation and outcome. Twenty confirmed cases were found among 8013 patients (eight in 5147 autologous and 12 in 2866 allogeneic SCT). The estimated incidence in cases/10 5 patients/year (95% CI) was 101 (56.5-145) for the whole group, 71.1 (21.8-120) in autologous and 135.6 (58.9-212) in allogeneic transplants. Compared with the general population, tuberculosis was more frequent after allogeneic (RR 2.95) but not after autologous SCT. Tuberculosis after SCT is a late infection (median 324 days post transplant), predominately affects the lungs (80% of the cases), appears to respond well to treatment but has a high mortality (25%) in allogeneic recipients. It can also complicate the post-transplant management as antituberculosis drugs frequently decrease the serum levels of cyclosporine causing an aggravation of GVHD. Graft-versus-host disease, corticosteroid treatment and total body irradiation appear to be associated with tuberculosis in allogeneic recipients. No obvious factors were associated with tuberculosis in autologous transplants. Finally, we found that the published literature on tuberculosis after solid and SCT has overestimated its incidence due to the direct translation of tuberculosis frequency into incidence. Bone Marrow Transplantation (2000) 26, 291-298.

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Section: Discussionmentioning

confidence: 99%

Tuberculosis after hematopoietic stem cell transplantation: incidence, clinical characteristics and outcome

Cámara

Martino

Granados

et al. 2000

Bone Marrow Transplant

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“…The prevalence of mycobacterial infection in the 9 12/1202 (1.0) Heart 9 6/585 (1.0) Kidney (Saudi Arabia) 10 14/403 (3.5) BMT (current report) 4/641 (0. 6) immunosuppressed BMT patient is lower than one would expect in this immunocompromised patient population, and this holds true in endemic and non-endemic areas.…”

Section: Discussionmentioning

confidence: 99%

“…9 Renal transplant recipients in Saudi Arabia had a tuberculosis rate of 3.5%. 10 AIDS patients are another group of immunosuppressed patients in whom TB is more common. Incidence of tuberculosis in AIDS patients also varies according to location.…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium tuberculosis infection in allogeneic bone marrow transplantation patients

Aljurf

Gyger

Alrajhi

et al. 1999

Bone Marrow Transplant

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Summary:Bone marrow transplant (BMT) recipients are prone to bacterial, viral and fungal infections. Mycobacterium tuberculosis infection can occur in these patients, but the incidence is lower than that of other infections. This report describes four patients with Mycobacterium tuberculosis infection identified from 641 adult patients who received a BMT over a 12-year period (prevalence 0.6%). The pre-transplant diagnosis was AML in two patients and CML in the other two. Pre-transplant conditioning consisted of BU/CY in three patients and CY/TBI in one. Graft-versus-host disease (GVHD) prophylaxis was MTX/CsA in three patients and T cell depletion of the graft in one patient. Sites of infection were lung (two), spine (one) and central nervous system (one). Onset of infection ranged from 120 days to 20 months post BMT. Two patients had co-existing CMV infection. One patient had graft failure. The two patients who received anti-tuberculous (TB) therapy recovered from the infection. Although the incidence of tuberculosis in BMT patients is not as high as in patients with solid organ transplants, late diagnosis due to the slow growth of the bacterium can lead to delay in instituting anti-TB therapy. A high index of suspicion should be maintained, particularly in endemic areas.

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“…The prevalence of TB in renal transplant recipients is between 0.4 and 1.7% in the Western world (171,172) and up to 11.8% in developing countries where there is a higher rate of endemic tuberculosis (173)(174)(175)(176). Immunosuppression can cause aggressive disease with wide dissemination (171,(176)(177)(178)(179). Evaluation of potential renal transplant candidates should include a thorough clinical history, as well as both chest X-ray and PPD skin testing (if there is no history of a positive skin test or active TB).…”

Section: Rationalementioning

confidence: 99%

“…Many US transplant centers require pre-and/or posttransplant isoniazid prophylaxis for patients with a positive PPD skin test and no contraindications to therapy (177,180,181). Others would argue that routine prophylaxis is unnecessary, and that only high-risk individuals should be treated prophylactically, e.g.…”

Section: Recommendationsmentioning

confidence: 99%

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

2001

American Journal of Transplantation

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Mycobacterial Infection After Renal Transplantation--Report of 14 Cases and Review of the Literature

Cited by 142 publications

References 0 publications

Tuberculosis after hematopoietic stem cell transplantation: incidence, clinical characteristics and outcome

Tuberculosis after hematopoietic stem cell transplantation: incidence, clinical characteristics and outcome

Mycobacterium tuberculosis infection in allogeneic bone marrow transplantation patients

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

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