Miliary Tuberculosis with Hemophagocytosis in a Two Months Old Infant

Deshpande, Archana; Nayar, Priyanka S.; Pradhan, A M; Manchanda, Rumma V.

doi:10.1007/s12288-010-0038-y

Cited by 10 publications

(4 citation statements)

References 6 publications

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“…were found in the world literature till March 2014. [ 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 ] The following data were collected for TB-HLH cases and placed in Microsoft office Excel 2007 for statistical analysis: Age, gender, duration of symptoms, associated comorbidities, organomegaly, complete blood count, serum biochemical parameters (ferritin, triglyceride, fibrinogen, liver transaminases, alkaline phosphatase, total bilirubin, albumin, and lactate dehydrogenase), coagulation abnormalities, evidence of hemophagocytosis on bone marrow evaluation, source and method of isolation of the organism, usage of ATT and/or immunosuppressive/immunomodulators drugs, and final outcome (alive or dead). Finally, complete information was available in 63 out of 70 cases, and the remaining 7 were excluded due to inaccessibility of the complete articles and/or lack of adequate information.…”

Section: Methodsmentioning

confidence: 99%

Hemophagocytic lymphohistiocytosis: An unusual complication in disseminated Mycobacterium tuberculosis

et al. 2015

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Background:Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially fatal, hyperinflammatory syndrome that may rarely complicate the clinical course of disseminated Mycobacterium tuberculosis (MTB). The clinical course of tuberculosis-associated HLH (TB-HLH) has been reported to be unpredictable.Materials and Methods:Here we describe the clinicopathological features, laboratory parameters, management, and outcome data of a patient who satisfied the 2004 diagnostic criteria for HLH secondary to disseminated MTB; we also do a systematic review of the international literature on TB-HLH. The literature review (January 1975–March 2014) found that HLH complicated the clinical course of 63 tuberculosis patients (41 males, 22 females, mean age = 45 ± 23.5 years) with a high mortality rate of 49% (31/63 died). The mean serum ferritin level (n = 44/63) was 5963 ng/mL (range 500–38,539 ng/mL); and a higher proportion (54.2%) of patients had pancytopenia at presentation. On univariate analysis (n = 53/63), age >30 years [hazard ratio (HR): 2.79, 95% confidence interval (CI):1.03–7.56, P = 0.03], presence of comorbidities (HR 4.59, CI: 1.08–19.52, P = 0.04), marked hemophagocytosis in bone marrow (HR: 2.65, CI: 1.16–6.05, P = 0.02), and nonusage/delayed usage of antitubercular therapy (ATT) (HR: 3.44, CI: 1.51–7.87, P = 0.003) were associated with decreased survival, though none of these parameters attained statistical significance (P > 0.05) in multivariate analysis. Usage of corticosteroids and/or immunomodulator drugs (HR 1.00, CI: 0.66–3.22, P = 0.35) did not alter the outcome in these patients.Conclusion:HLH should be considered as a differential diagnosis in patients with tuberculosis who present with cytopenias, organomegaly, and coagulopathy. Strong clinical suspicion and early usage of ATT might be useful in reducing the morbidity and mortality. The utility of immunosuppressive/immunomodulator therapy lacks general concensus among treating physicians, and warrants further studies.

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Section: Methodsmentioning

confidence: 99%

Hemophagocytic lymphohistiocytosis: An unusual complication in disseminated Mycobacterium tuberculosis

et al. 2015

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“…The limitation of this report is that TBC is known to trigger secondary HLH. We found 8 other cases with TBC and HLH in neonates and infants (38)(39)(40)(41)(42)(43)(44)(45) (Table 2) but none of them need ECMO-support. Most of these patients presented with respiratory failure.…”

Section: Discussionmentioning

confidence: 94%

Tuberculosis-Associated HLH in an 8-Month-Old Infant: A Case Report and Review

Hauch

Skrzypek²,

Woessmann

et al. 2020

Front. Pediatr.

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“…The number of criteria fulfilled by patients ranged from two to eight, with five being the most common. Table S3 provides an overview of each of the criteria for every patient in this study [ 3 , 4 , 5 , 6 , 7 , 10 , 13 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ...…”

Section: Resultsmentioning

confidence: 99%

Tuberculosis-Associated Hemophagocytic Lymphohistiocytosis: A Review of Current Literature

Fauchald,

Blomberg,

Reikvam

2023

JCM

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Hemophagocytic lymphohistiocytosis (HLH) is a condition of immune dysregulation and hyperinflammation, leading to organ failure and death. Malignancy, autoimmune conditions, and infections, including Mycobacterium tuberculosis (TB), are all considered triggers of HLH. The aim of this study was to review all reported cases of TB-associated HLH in English literature, and to summarize the epidemiology, diagnostics, treatment, and mortality in patients with concomitant HLH and TB. A systematic review of described cases with TB-associated HLH, via a structured literature search in the medical database PubMed, is presented. Additional articles were included through cross-referencing with existing review articles. Articles were reviewed based on a predetermined set of criteria. A total of 116 patients with TB-associated HLH were identified with a male:female ratio of about 3:2. The age at presentation ranged from 12 days to 83 years. Malignancy, autoimmunity, and renal failure were the most common comorbid conditions. Most patients received both tuberculostatic and specific immunomodulating treatment, which was associated with a 66% (48/73) survival rate compared to 56% (15/27) in those receiving only tuberculostatic treatment, and 0% (0/13) in those receiving only immunomodulating treatment. The survival rate was 55% overall. The overlapping presentation between disseminated TB and HLH poses challenging diagnostics and may delay diagnosis and treatment, leading to increased mortality. TB should be considered as a potential trigger of HLH; clinicians’ knowledge and awareness of this may result in the appropriate investigations needed to ensure diagnosis and proper treatment.

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Miliary Tuberculosis with Hemophagocytosis in a Two Months Old Infant

Cited by 10 publications

References 6 publications

Hemophagocytic lymphohistiocytosis: An unusual complication in disseminated Mycobacterium tuberculosis

Hemophagocytic lymphohistiocytosis: An unusual complication in disseminated Mycobacterium tuberculosis

Tuberculosis-Associated HLH in an 8-Month-Old Infant: A Case Report and Review

Tuberculosis-Associated Hemophagocytic Lymphohistiocytosis: A Review of Current Literature

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