Tuberculosis in Solid Organ Transplantation: Insights from TB Endemic Areas

Tuberculosis is of particular concern in lung transplant recipients. We present the case of a patient who received a double lung transplant from a deceased donor from Mexico and developed disseminated tuberculosis 60 days post-transplant manifested as tenosynovitis, liver abscesses, and subcutaneous nodules with no definitive lung allograft involvement. The recipient did not have evidence of tuberculosis on explanted lungs, had a negative interferon gamma release assay pre-transplant, and did not have risk factors for this infection. Mycobacterium tuberculosis should remain in the differential diagnosis of early post-transplant infections with atypical presentations, evidence of dissemination, or lack of improvement with appropriate antimicrobial coverage, even in the absence of typical lung findings.

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“…Other manifestations of involvement can be esophagitis, sacroiliitis, dactylitis, skin nodules, and laryngitis. 14 …”

Section: Discussionmentioning

confidence: 99%

Disseminated tuberculosis in a lung transplant recipient presenting as tenosynovitis, subcutaneous nodules, and liver abscesses

Barahona

Henao-Cordero

Smith

et al. 2022

Therapeutic Advances in Infection

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“…There are several risk factors that predispose KT recipient to develop TB more frequently than the general population [24,26]. The risk is mainly influenced by endemicity of TB in the population, but key factors associated with the recipient, donor and transplantation increase it (Figure 1) [8,10,11,14,24,37,50,64,[68][69][70]. Among them, of particular importance are transplant-associated risk factors, such as immunosuppression therapy, presence of acute rejection episodes and chronic graft disfunction [24,32,50,64].…”

Section: Risk Factors For Tuberculosis In Kidney Transplantationmentioning

confidence: 99%

“…Thitisuriyarax et al showed that acute rejection significantly increases the risk of TB by 7.6 times (95%CI: 1.2-47.9, p = 0.03) [50]. Moreover, Basiri et al showed that the number of rejections after transplant is an independent risk factor for TB appearance [69]. The mechanistic link between rejection and TB development could be indirectly explained by the use of aggressive immunosuppression in the treatment of rejection, leading to TB reactivation.…”

Section: Risk Factors For Tuberculosis In Kidney Transplantationmentioning

confidence: 99%

Mycobacterium Tuberculosis Infection after Kidney Transplantation: A Comprehensive Review

et al. 2022

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Tuberculosis (TB) in kidney transplant (KT) recipients is an important opportunistic infection with higher incidence and prevalence than in the general population and is associated with important morbidity and mortality. We performed an extensive literature review of articles published between 1 January 2000 and 15 June 2022 to provide an evidence-based review of epidemiology, pathogenesis, diagnosis, treatment and outcomes of TB in KT recipients. We included all studies which reported epidemiological and/or outcome data regarding active TB in KT, and we approached the diagnostic and treatment challenges according to the current guidelines. Prevalence of active TB in KT recipients ranges between 0.3–15.2%. KT recipients with active TB could have a rejection rate up to 55.6%, a rate of graft loss that varies from 2.2% to 66.6% and a mortality rate up to 60%. Understanding the epidemiological risk, risk factors, transmission modalities, diagnosis and treatment challenges is critical for clinicians in providing an appropriate management for KT with TB. Among diagnostic challenges, which are at the same time associated with delay in management, the following should be considered: atypical clinical presentation, association with co-infections, decreased predictive values of screening tests, diverse radiological aspects and particular diagnostic methods. Regarding treatment challenges in KT recipients with TB, drug interactions, drug toxicities and therapeutical adherence must be considered.

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Tuberculosis in Solid Organ Transplantation: Insights from TB Endemic Areas

Cited by 2 publications

References 102 publications

Disseminated tuberculosis in a lung transplant recipient presenting as tenosynovitis, subcutaneous nodules, and liver abscesses

Disseminated tuberculosis in a lung transplant recipient presenting as tenosynovitis, subcutaneous nodules, and liver abscesses

Mycobacterium Tuberculosis Infection after Kidney Transplantation: A Comprehensive Review

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