Mycobacterium tuberculosis infection and laboratory diagnosis in solid‐organ transplant recipients

Abstract

Tuberculosis (TB) is an unusual infection in transplant recipients. We evaluated (i) the frequency of TB, (ii) the duration to develop the TB infection, and (iii) clinical consequences, in 380 solid-organ recipients from January 1995 to December 2000. A total of 10 (2.63%) patients (eight renal, two liver transplant recipients) were found to have post-transplantation TB. The frequency of TB in this patient population is 8.5-fold higher than the prevalance in the general Turkish population. Tuberculosis developed within 2-33 months after transplantation, with a median of 15 months. In all of these 10 patients, Mycobacterium tuberculosis (MTB) was isolated from the culture. All the patients continued to have low dose immunosuppressive treatment, and also quadriple antituberculosis treatment [isoniazid (INH), rifampin (RIF), pyrazinamide (PRZ) and ethambutol (ETB)] has been given. The two recipients had died of disseminated form of TB. Relapse was detected in one patient 6 months after the completion of the treatment. As post-transplant TB infection develops mostly within the first year after transplantation, clinicians should be more careful for early and fast diagnosis and treatment should be started immediately.

Tuberculosis in Renal Transplant Recipients

“…Primary infection in renal transplant patients is rare and occurs commonly as a result of transmission by donor kidney. 4 In our study, the prevalence of TB was 2.8% owing to the high frequency of TB in general Turkish population, and 44% of the patients developed TB within 1 year after transplantation that may be due to reactivation of latent infection. Ergun et al 6 reported the prevalence as 3.5% in their study.…”

“…The risk is mainly determined by endemicity of the infection in specific geographic area. Cavusoglu et al 4 reported that TB prevalence after solid organ transplantations was 2.63%, which was 8.5-fold higher than the prevalence in the general Turkish population (0.3%). The rate of occurrence of M. tuberculosis infection according to data from WHO was estimated to be 45/100,000 in Turkey.…”

“…3 The data from our country demonstrated that TB prevalence after solid organ transplantations was 2.63%, which was 8.5-fold higher than in the general Turkish population (0.3%). 4 Primary infection in renal transplant patients is rare and occurs commonly as a result of transmission by donor kidney. Majority of the cases are due to reactivation of latent infection.…”

“…Majority of the cases are due to reactivation of latent infection. [4][5][6] TB infection among renal transplant recipients carries important diagnostic difficulties because of frequent extrapulmonary involvement and the atypical presentation. 2 Tuberculin skin test has several limitations in diagnosis of latent TB infection since cutaneous anergy rate due to underlying immunosuppression and false positivity due to exposure to non-TB mycobacteria or prior bacille CalmetteGuérin vaccination among these patients are high.…”

Differential Diagnosis of an Unusual Pelvic Mass in a Renal Transplant Recipient: Multidrug-Resistant Abdominopelvic Tuberculosis

“…In this patient population, TB has been associated with graft dysfunction and increased mortality rates. [4][5][6] Not only the overall immunosuppression, but also older age and coexisting diseases such as diabetes, chronic liver disease, and co-infections have been associated with predisposition to TB. 7 TB can be frequently pulmonary, but extrapulmonary involvement is not rare, affecting 16% of the transplant patients.…”