Clinical characteristics, risk factors, and outcome of tuberculosis in kidney transplant recipients: A multicentric case‐control study in a low‐endemic area

Gras, Julien; Castro, Nathalie De; Montlahuc, Claire; Champion, L.; Scemla, Anne; Matignon, Marie; Lachâtre, Marie; Raskine, Laurent; Grall, Nathalie; Peraldi, Marie Noëlle; Molina, Jean Michel

doi:10.1111/tid.12943

Cited by 22 publications

(51 citation statements)

References 27 publications

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“…The symptoms of mycobacterial infections are more insidious compared to those of CAP, and include persistent cough, lymphadenopathy, fever, night sweats, and weight loss. Immunocompromised patients may have only one or a few mild symptoms, such as persistent fever [42], even though dissemination of the organism outside the lungs is common [43]. HRCT findings include miliary nodules, cavitation, centrilobular tree-in-bud nodules, consolidation, mediastinal lymphadenopathy, and pleural effusion [44].…”

Section: Mycobacterial Pneumoniamentioning

confidence: 99%

Diagnosis of severe respiratory infections in immunocompromised patients

et al. 2020

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An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis.

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Section: Mycobacterial Pneumoniamentioning

confidence: 99%

Diagnosis of severe respiratory infections in immunocompromised patients

et al. 2020

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“…Our extensive review of the literature identified four other detailed case reports that documented the development of active TB disease after LTBI treatment . In addition, we found a total of 56/2651 (2.1%) cases of active TB among 41 observational cohorts and six RCT . Among them, only five cases were described in detail.…”

Section: Resultsmentioning

confidence: 95%

“…We found 41 cohort studies that evaluated the outcome of LTBI therapy. Eleven were from Europe, 10 from US and Asia, seven from South America, and one each from Africa, Australia, and Canada . Only nine were prospective .…”

Section: Resultsmentioning

confidence: 99%

“…Only nine were prospective . Most studies included kidney (22) and liver (12) transplant recipients only. There were three studies on lung and four on multiple organ transplants .…”

Section: Resultsmentioning

confidence: 99%

“…The decision to start LTBI therapy was based on clinician preference, universal prophylaxis or the presence of risk factors (22/39) including past history of treated or untreated TB, close exposure to a person with active TB, evidence of TB on imaging, reactive or anergic response to TST or a positive Interferon based Gamma Release Assay (IGRA) response. The indication was not specified in two studies . Fifteen studies initiated prophylaxis based on TST or IGRA responses alone.…”

Section: Resultsmentioning

confidence: 99%

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Treatment of latent TB Infection and the risk of tuberculosis after solid organ transplantation: Comprehensive review

Abad

Deziel

Razonable

2019

Transplant Infectious Dis

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Background: Mycobacterium tuberculosis disease may occur after treatment of latent TB infection (LTBI). Prompted by a case of reactivation TB disease in a solid organ transplant (SOT) recipient who received LTBI treatment, we reviewed the literature to examine outcomes, adverse effects, resistance, and treatment choices of tuberculosis after LTBI therapy.Methods: MEDLINE and Web of Science from inception to 5/2019 were reviewed using key words "latent tuberculosis infection" and "SOT" or "transplantation." The search yielded nine cases, 41 cohort studies and six randomized controlled trials (RCT). Results: Cohort and RCT demonstrated significant reduction in TB disease among transplanted patients who received LTBI therapy; only 56/2651 (2.1%) SOT patients developed TB after LTBI therapy. Adverse drug reactions occurred in 149/1148 (12.9%) and 73/641 (11.4%) of cohort and RCT patients, respectively. Among liver recipients, 56/266 (21%) developed side effects, of which half (29/56, 51.8%) was INH-related. There was no reported INH resistance. Conclusions: Latent TB infection treatment is efficacious in SOT recipients at risk of TB disease. However, tuberculosis may still occur despite LTBI treatment. Hepatotoxicity associated with LTBI therapy is infrequent, although more commonly observed among liver recipients. K E Y W O R D S latent TB, Mycobacterium tuberculosis, solid organ transplant

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