An update on Mycobacterium tuberculosis infection after hematopoietic stem cell transplantation in adults

Cybele Lara R. Abad, Raymund R Razonable

Research output: Contribution to journalArticle

Abstract

Background: Mycobacterium tuberculosis (TB) is common worldwide, but is rarely reported after hematopoietic transplantation (HSCT). We reviewed all TB cases among HSCT since 2010 to provide an update on its epidemiology, clinical presentation, management and outcome. Methods: Several databases were reviewed from January 1, 2010 to June 30, 2018 using key words tuberculosis and hematopoietic transplantation. Results: The 47 cases of TB were reported during the study period. The highest TB frequency was reported from India (2.9%), with a median frequency of 2% (range, 0.18%-2.9%). The majority were recipients of allogeneic transplants (45/47, 95.7%). Pulmonary TB was the most common clinical presentation (20/47, 42.6%). The median time to clinical presentation was 4.6 (range, 3-12.9) and 2.4 (range, 0.6-5) months, based on cohort data and case reports, respectively. Fever was reported in 87.5% (14/16) of patients. First-line quadruple drug therapy was frequently used (29/35, 82.9%), with a median length of 12 and 9 months for cohorts and case reports, respectively. All-cause and attributable mortality was 27.6% (13/47), and 8.5% (4/47), respectively. Conclusions: Mycobacterium tuberculosis presents early after HSCT, most commonly as fever. A high index of suspicion is needed for early diagnosis and treatment, to prevent TB-attributable mortality.

Original languageEnglish (US)
Article numbere13430
JournalClinical Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

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Mycobacterium Infections
Hematopoietic Stem Cell Transplantation
Mycobacterium tuberculosis
Tuberculosis
Fever
Transplantation
Mortality
Pulmonary Tuberculosis
Early Diagnosis
India
Epidemiology
Databases
Drug Therapy

Keywords

  • bone marrow transplant
  • hematopoietic stem cell transplant
  • Mycobacterium tuberculosis

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{d956b1a8203047b3a2634cd15868a816,
title = "An update on Mycobacterium tuberculosis infection after hematopoietic stem cell transplantation in adults",
abstract = "Background: Mycobacterium tuberculosis (TB) is common worldwide, but is rarely reported after hematopoietic transplantation (HSCT). We reviewed all TB cases among HSCT since 2010 to provide an update on its epidemiology, clinical presentation, management and outcome. Methods: Several databases were reviewed from January 1, 2010 to June 30, 2018 using key words tuberculosis and hematopoietic transplantation. Results: The 47 cases of TB were reported during the study period. The highest TB frequency was reported from India (2.9{\%}), with a median frequency of 2{\%} (range, 0.18{\%}-2.9{\%}). The majority were recipients of allogeneic transplants (45/47, 95.7{\%}). Pulmonary TB was the most common clinical presentation (20/47, 42.6{\%}). The median time to clinical presentation was 4.6 (range, 3-12.9) and 2.4 (range, 0.6-5) months, based on cohort data and case reports, respectively. Fever was reported in 87.5{\%} (14/16) of patients. First-line quadruple drug therapy was frequently used (29/35, 82.9{\%}), with a median length of 12 and 9 months for cohorts and case reports, respectively. All-cause and attributable mortality was 27.6{\%} (13/47), and 8.5{\%} (4/47), respectively. Conclusions: Mycobacterium tuberculosis presents early after HSCT, most commonly as fever. A high index of suspicion is needed for early diagnosis and treatment, to prevent TB-attributable mortality.",
keywords = "bone marrow transplant, hematopoietic stem cell transplant, Mycobacterium tuberculosis",
author = "Abad, {Cybele Lara R.} and Razonable, {Raymund R}",
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AU - Abad, Cybele Lara R.

AU - Razonable, Raymund R

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N2 - Background: Mycobacterium tuberculosis (TB) is common worldwide, but is rarely reported after hematopoietic transplantation (HSCT). We reviewed all TB cases among HSCT since 2010 to provide an update on its epidemiology, clinical presentation, management and outcome. Methods: Several databases were reviewed from January 1, 2010 to June 30, 2018 using key words tuberculosis and hematopoietic transplantation. Results: The 47 cases of TB were reported during the study period. The highest TB frequency was reported from India (2.9%), with a median frequency of 2% (range, 0.18%-2.9%). The majority were recipients of allogeneic transplants (45/47, 95.7%). Pulmonary TB was the most common clinical presentation (20/47, 42.6%). The median time to clinical presentation was 4.6 (range, 3-12.9) and 2.4 (range, 0.6-5) months, based on cohort data and case reports, respectively. Fever was reported in 87.5% (14/16) of patients. First-line quadruple drug therapy was frequently used (29/35, 82.9%), with a median length of 12 and 9 months for cohorts and case reports, respectively. All-cause and attributable mortality was 27.6% (13/47), and 8.5% (4/47), respectively. Conclusions: Mycobacterium tuberculosis presents early after HSCT, most commonly as fever. A high index of suspicion is needed for early diagnosis and treatment, to prevent TB-attributable mortality.

AB - Background: Mycobacterium tuberculosis (TB) is common worldwide, but is rarely reported after hematopoietic transplantation (HSCT). We reviewed all TB cases among HSCT since 2010 to provide an update on its epidemiology, clinical presentation, management and outcome. Methods: Several databases were reviewed from January 1, 2010 to June 30, 2018 using key words tuberculosis and hematopoietic transplantation. Results: The 47 cases of TB were reported during the study period. The highest TB frequency was reported from India (2.9%), with a median frequency of 2% (range, 0.18%-2.9%). The majority were recipients of allogeneic transplants (45/47, 95.7%). Pulmonary TB was the most common clinical presentation (20/47, 42.6%). The median time to clinical presentation was 4.6 (range, 3-12.9) and 2.4 (range, 0.6-5) months, based on cohort data and case reports, respectively. Fever was reported in 87.5% (14/16) of patients. First-line quadruple drug therapy was frequently used (29/35, 82.9%), with a median length of 12 and 9 months for cohorts and case reports, respectively. All-cause and attributable mortality was 27.6% (13/47), and 8.5% (4/47), respectively. Conclusions: Mycobacterium tuberculosis presents early after HSCT, most commonly as fever. A high index of suspicion is needed for early diagnosis and treatment, to prevent TB-attributable mortality.

KW - bone marrow transplant

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