Incidence and management of mycobacterial infection in solid organ transplant recipients

Fan, Ming-Hui; Hadjiliadis, Denis

doi:10.1007/s11908-009-0032-4

Cited by 11 publications

(25 citation statements)

References 49 publications

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“…M. fortuitum, M. abscessus and M. chelonae are the species most frequently reported as causative agents of skin, soft tissue and joint infections in SOT recipients. These agents can also be recovered from surgical site infections or infections associated with long-term intravenous or peritoneal catheters [12,[23][24][25]. Pleuropulmonary NTM disease is the predominant manifestation among lung transplant recipients (from 54% to 82% of reported cases) [25] and represents also a significant proportion of NTM infections after heart transplant (26%) [9,12].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Nonetheless, it is the second most frequent presentation among renal transplant recipients and the third most frequent one in heart and lung transplant recipients [9,25], potentially leading to uncontrolled disseminated illness and patient's death [24,28,29]. Causative NTM species described in disseminated disease are M. chelonae and M. abscessus.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Causative NTM species described in disseminated disease are M. chelonae and M. abscessus. Finally, M. haemophilum and M. genavense can rarely cause disseminated disease in SOT recipients [22,24,[30][31][32], which may also include unusual manifestations such as intestinal involvement [25].…”

Section: Clinical Presentationmentioning

confidence: 99%

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Nontuberculous mycobacteria infection in solid organ transplant recipients

Piersimoni¹

2011

Eur J Clin Microbiol Infect Dis

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Although advances in surgical technique, drug-induced immunosuppression, and supportive medical therapy have led to improved survival and quality of live after solid organ transplantations, infections still represent a major threat for transplant recipients.Infections with non tuberculous mycobacteria (NTM) are infrequent, but can be associated with relevant morbidity and mortality. With the exception of few comprehensive studies, the available literature consists predominantly of case reports and institutional experiences. This article reviews NTM infection in the setting of solid organ transplant (SOT) recipients dealing with clinical features, diagnosis, treatment and outcome. Published studies have documented a protean presentation of NTM infection in SOT recipients which may include skin and soft tissue lesions, osteoarticular infections and pleuropulmonary disease. An aggressive approach including histopathologic examination and acid-fast bacilli culture of aspirates or biopsy specimens from involved sites are essential for diagnosis. A combined treatment of debridement surgery, reduction of immunosuppressive medications and/or antimycobacterial drugs is frequently associated with a favorable outcome. It is strongly emphasized that a high index of suspicion for NTM infection should be maintained when managing SOT recipients with unusual clinical manifestations. Early diagnosis and initiation of therapy are essential to prevent morbidity and mortality in this vulnerable population.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

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Nontuberculous mycobacteria infection in solid organ transplant recipients

Piersimoni¹

2011

Eur J Clin Microbiol Infect Dis

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“…Despite recently published guidelines for the management of post-transplant tuberculosis [12][13][14][15], the diagnosis and treatment of tuberculosis after transplantation remain challenging, because of the potential side effects of antituberculous agents and interactions with immunosuppressive drugs [2,3,[16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Clinical features and outcomes of tuberculosis in transplant recipients as compared with the general population: a retrospective matched cohort study

Benito

García-Vázquez

Horcajada

et al. 2015

Clinical Microbiology and Infection

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There are no previous studies comparing tuberculosis in transplant recipients (TRs) with other hosts. We compared the characteristics and outcomes of tuberculosis in TRs and patients from the general population. Twenty-two TRs who developed tuberculosis from 1996 through 2010 at a tertiary hospital were included. Each TR was matched by age, gender and year of diagnosis with four controls selected from among non-TR non-human immunodeficiency virus patients with tuberculosis. TRs (21 patients, 96%) had more factors predisposing to tuberculosis than non-TRs (33, 38%) (p <0.001). Pulmonary tuberculosis was more common in non-TRs (77 (88%) vs. 12 TRs (55%); p 0.001); disseminated tuberculosis was more frequent in TRs (five (23%) vs. four non-TRs (5%); p 0.005). Time from clinical suspicion of tuberculosis to definitive diagnosis was longer in TRs (median of 14 days) than in non-TRs (median of 0 days) (p <0.001), and invasive procedures were more often required (12 (55%) TRs and 15 (17%) non-TRs, respectively; p 0.001). Tuberculosis was diagnosed post-mortem in three TRs (14%) and in no non-TRs (p <0.001). Rates of toxicity associated with antituberculous therapy were 38% in TRs (six patients) and 10% (seven patients) in non-TRs (p 0.014). Tuberculosis-related mortality rates in TRs and non-TRs were 18% and 6%, respectively (p 0.057). The adjusted Cox regression analysis showed that the only predictor of tuberculosis-related mortality was a higher number of organs with tuberculosis involvement (adjusted hazard ratio 8.6; 95% CI 1.2-63). In conclusion, manifestations of tuberculosis in TRs differ from those in normal hosts. Post-transplant tuberculosis resists timely diagnosis, and is associated with a higher risk of death before a diagnosis can be made.

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“…Beside the pleuropulmonary involvement that predominates in LuTx recipients infected with NTM (54–82% of patients, depending on the series) (Table ), skin and soft tissue infections are the second most common manifestation. Subcutaneous nodules on the extremities or in the region of the surgical wound are a typical clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

Early onset of nontuberculous mycobacterial pulmonary disease contributes to the lethal outcome in lung transplant recipients: report of two cases and review of the literature

Makek

Pavliša

Jakopović

et al. 2016

Transplant Infectious Dis

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Lung transplant (LuTx) recipients represent a population at risk of nontuberculous mycobacterial pulmonary disease (NTM-PD). Yet the risk factors, the timing of NTM-PD after transplantation, and the association with allograft dysfunction all remain poorly defined. We report 2 cases of early-onset NTM-PD and review the literature, focusing on NTM-PD in LuTx recipients not colonized with NTM prior to transplantation. In addition, we summarize the main characteristics and differences between early- and late-onset disease.

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Incidence and management of mycobacterial infection in solid organ transplant recipients

Cited by 11 publications

References 49 publications

Nontuberculous mycobacteria infection in solid organ transplant recipients

Nontuberculous mycobacteria infection in solid organ transplant recipients

Clinical features and outcomes of tuberculosis in transplant recipients as compared with the general population: a retrospective matched cohort study

Early onset of nontuberculous mycobacterial pulmonary disease contributes to the lethal outcome in lung transplant recipients: report of two cases and review of the literature

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