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Tuberculosis and Transplantation

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  • Authors: José M. Aguado1, José Tiago Silva2, Palash Samanta3, Nina Singh4
  • Editor: David Schlossberg6
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: University Hospital 12 de Octubre, Unit of Infectious Diseases, 28041 Madrid, Spain; 2: University Hospital 12 de Octubre, Unit of Infectious Diseases, 28041 Madrid, Spain; 3: University of Pittsburgh Medical Center, Infectious Diseases Section, Pittsburgh, PA 15213; 4: University of Pittsburgh Medical Center, Infectious Diseases Section, Pittsburgh, PA 15213; 5: VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA 15240; 6: Philadelphia Health Department, Philadelphia, PA
  • Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0005-2016
  • Received 16 September 2016 Accepted 22 September 2016 Published 04 November 2016
  • José M. Aguado, jaguadog1@gmail.com
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  • Abstract:

    is a major opportunistic pathogen in transplant recipients. Compared to that in the general population, the frequency of tuberculosis (TB) is 10 to 40 times higher in hematopoietic stem cell transplant (HSCT) recipients and 20 to 74 times higher in solid-organ transplant (SOT) recipients. Transplant recipients with TB are also more likely to develop disseminated disease, have longer time to definitive diagnosis, require more invasive diagnostic procedures, and experience greater anti-TB treatment-related toxicity than the general population. Specific risk factors for TB in SOT recipients include previous exposure to (positive tuberculin skin tests and/or residual TB lesions in pretransplant chest X ray) and the intensity of immunosuppression (use of antilymphocyte antibodies, type of basal immunosuppression, and intensification of immunosuppressive therapy for allograft rejection). Risk factors in HSCT recipients are allogeneic transplantation from an unrelated donor; chronic graft-versus-host disease treated with corticosteroids; unrelated or mismatched allograft; pretransplant conditioning using total body irradiation, busulfan, or cyclophosphamide; and type and stage of primary hematological disorder. Transplant recipients with evidence of prior exposure to should receive treatment appropriate for latent TB infection. Optimal management of active TB disease is particularly challenging due to significant drug interactions between the anti-TB agents and the immunosuppressive therapy. In this chapter, we address the epidemiology, clinical presentation, diagnostic considerations, and management strategies for TB in SOT and HSCT recipients.

  • Citation: Aguado J, Silva J, Samanta P, Singh N. 2016. Tuberculosis and Transplantation. Microbiol Spectrum 4(6):TNMI7-0005-2016. doi:10.1128/microbiolspec.TNMI7-0005-2016.

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/content/journal/microbiolspec/10.1128/microbiolspec.TNMI7-0005-2016
2016-11-04
2017-11-25

Abstract:

is a major opportunistic pathogen in transplant recipients. Compared to that in the general population, the frequency of tuberculosis (TB) is 10 to 40 times higher in hematopoietic stem cell transplant (HSCT) recipients and 20 to 74 times higher in solid-organ transplant (SOT) recipients. Transplant recipients with TB are also more likely to develop disseminated disease, have longer time to definitive diagnosis, require more invasive diagnostic procedures, and experience greater anti-TB treatment-related toxicity than the general population. Specific risk factors for TB in SOT recipients include previous exposure to (positive tuberculin skin tests and/or residual TB lesions in pretransplant chest X ray) and the intensity of immunosuppression (use of antilymphocyte antibodies, type of basal immunosuppression, and intensification of immunosuppressive therapy for allograft rejection). Risk factors in HSCT recipients are allogeneic transplantation from an unrelated donor; chronic graft-versus-host disease treated with corticosteroids; unrelated or mismatched allograft; pretransplant conditioning using total body irradiation, busulfan, or cyclophosphamide; and type and stage of primary hematological disorder. Transplant recipients with evidence of prior exposure to should receive treatment appropriate for latent TB infection. Optimal management of active TB disease is particularly challenging due to significant drug interactions between the anti-TB agents and the immunosuppressive therapy. In this chapter, we address the epidemiology, clinical presentation, diagnostic considerations, and management strategies for TB in SOT and HSCT recipients.

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Tables

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TABLE 1

Prevalence and incidence of TB in SOT

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0005-2016
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TABLE 2

Risk factors for TB

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0005-2016
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TABLE 3

Suggested regimens for the treatment of latent TB in SOT

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0005-2016
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TABLE 4

Treatment of TB in SOT recipients according to the GESITRA of the Spanish Society of Infectious Diseases and Clinical Microbiology ( 35 )

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0005-2016
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TABLE 5

Risk factors of TB in HSCT recipients

Source: microbiolspec November 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0005-2016

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