An unusual cause of acute abdomen following allogeneic transplantation: a zoonotic disease revisited

Buyck, Hubertus; Holliman, R. E.; Else, J. Earl; O'Regan, L; Willis, Fenella; Grubnic, Sisa; Marsh, James E.; Chakrabarti, Suparno

doi:10.1038/bmt.2008.29

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…CNS disease can manifest as space-occupying lesions (115). On rare occasions patients may present with fever of unknown origin or acute abdomen secondary to abdominal mass or intestinal obstruction (118,119). Notably, TB in umbilical cord blood transplant recipients may manifest as bacteremia with a fulminant course (94,105,120).…”

Section: Clinical Presentationmentioning

confidence: 99%

Tuberculosis and Transplantation

et al. 2016

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Mycobacterium tuberculosis 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 M. tuberculosis (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 M. tuberculosis 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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Section: Clinical Presentationmentioning

confidence: 99%

Tuberculosis and Transplantation

et al. 2016

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“…Extra-pulmonary sites of infection include: liver, spleen, bone, bone marrow, brain, and spine (1, 13, 16, 24, 32, 38, 39). Central nervous system involvement may take the form of space occupying lesions in the brain.…”

Section: Tuberculosis Infections In Recipients Of Hsctmentioning

confidence: 99%

“…Central nervous system involvement may take the form of space occupying lesions in the brain. Abdominal involvement may be in the form of acute abdomen due to abdominal masses causing acute abdominal pain and intestinal obstruction (1, 13, 16, 24, 32, 38, 39). In recipients of allogeneic HSCT, M. tuberculosis infections may present in an atypical manner such as pyrexia of unknown origin, non-specific features particularly in patients with extra-pulmonary involvement.…”

Section: Tuberculosis Infections In Recipients Of Hsctmentioning

confidence: 99%

Infections Caused by Mycobacterium tuberculosis in Recipients of Hematopoietic Stem Cell Transplantation

2014

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Mycobacterium tuberculosis (M. tuberculosis) infections are uncommon in recipients of hematopoietic stem cell transplantation. These infections are 10–40 times commoner in recipients of stem cell transplantation than in the general population but they are 10 times less in stem cell transplantation recipients compared to solid organ transplant recipients. The incidence of M. tuberculosis infections in recipients of allogeneic stem cell transplantation ranges between <1 and 16% and varies considerably according to the type of transplant and the geographical location. Approximately 80% of M. tuberculosis infections in stem cell transplant recipients have been reported in patients receiving allografts. Several risk factors predispose to M. tuberculosis infections in recipients of hematopoietic stem cell transplantation and these are related to the underlying medical condition and its treatment, the pre-transplant conditioning therapies in addition to the transplant procedure and its own complications. These infections can develop as early as day 11 and as late as day 3337 post-transplant. The course may become rapidly progressive and the patient may develop life-threatening complications. The diagnosis of M. tuberculosis infections in stem cell transplant recipients is usually made on clinical grounds, cultures obtained from clinical specimens, tissues biopsies in addition to serology and molecular tests. Unfortunately, a definitive diagnosis of M. tuberculosis infections in these patients may occasionally be difficult to be established. However, M. tuberculosis infections in transplant recipients usually respond well to treatment with anti-tuberculosis agents provided the diagnosis is made early. A high index of suspicion should be maintained in recipients of stem cell transplantation living in endemic areas and presenting with compatible clinical and radiological manifestations. High mortality rates are associated with infections caused by multidrug-resistant strains, miliary or disseminated infections, and delayed initiation of therapy. In recipients of hematopoietic stem cell transplantation, isoniazid prophylaxis has specific indications and bacillus Calmette-Guerin vaccination is contraindicated as it may lead to disseminated infection. The finding that M. tuberculosis may maintain long-term intracellular viability in human bone marrow-derived mesenchymal stem cells complicates the development of effective vaccines and strategies to eliminate tuberculosis. However, the introduction of linezolid, cellular immunotherapy, and immunomodulation in addition to autologous mesenchymal stem cell transplantation will ultimately have a positive impact on the overall management of infections caused by M. tuberculosis.

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