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.

Initiation of Post-Primary Tuberculosis of the Lungs: Exploring the Secret Role of Bone Marrow Derived Stem Cells

“…Such an approach may also be helpful to screen potential HSC transplantation donors. Reports showing Mtb infection after allogeneic HSC transplantation ( 124 ) suggest that it is necessary to confirm intracellular Mtb dormancy status of the donor to avoid risk of future d Mtb reactivation in the acceptor. In this context, we suggest that genotyping and WGS approaches may help to confirm the reactivation potential of dormant Mtb residing in donor’s BM-stem cells.…”

Tuberculosis in Pediatric Solid Organ and Hematopoietic Stem Cell Recipients

“…65 In a literature review of TB disease in 47 adult HSCT recipients between 2010 and 2018, the median time to clinical presentation was 4.6 months based on cohort data and 2.4 months based on individual case reports. 44 Given variable clinical presentation and diagnostic delays, it is important to maintain a high index of suspicion for TB among HSCT recipients from endemic areas. 10…”

“…Risk factors for post-transplant TB in HSCT recipients include social factors 37 ; allogeneic transplantation 10,[38][39][40] ; underlying indication for transplantation 10 ; pre-transplant conditioning therapies, particularly T-cell depleting agents 10,41 and total body irradiation 10,38,40,42,43 ; and transplant complications, particularly chronic graft versus host disease 10,25,[38][39][40][41][43][44][45][46][47][48] (Table 1).…”

In vitro Effects of Mesenchymal Stem Cells and Their Niches in The Inhibition of M. tuberculosis Growth

“…The incidence of multidrug-resistant TB has been found to be significantly higher in organ transplant recipients compared to the general population. However, the recipients of allogenic bone marrow, lung, and heart transplant have been shown to exhibit good response to second-line therapy 35 . Bone TB is a rarely known form of TB affecting the spine, long bones and joints.…”