Mycobacterium Tuberculosis Infection Following Kidney Transplantation

Abstract

Tuberculosis (TB) is one of the major causes of morbidity and mortality worldwide. Post-transplant TB is a problem in successful long-term outcome of renal transplantation recipients. It is a life-threatening opportunistic infection that is frequently encountered, but the diagnosis is often delayed. With the emergence of newer potent immunosuppressive regimens and an increased incidence of TB in the general population, post-transplant TB among transplant recipients can be anticipated. Our objective was to describe the pattern and risk factors of TB infection, and the prognosis in our transplant recipients. This study was a retrospective review of the records of 491 renal transplant recipients in our hospital during the period from January 1986 to December 2009. The demographic data, transplant characteristics, clinical manifestations, diagnostic criteria, treatment protocol, and long-term outcome of this cohort of patients were analyzed. 16 patients (3.2%) developed posttransplant TB with a mean age of 32.5 ± 12.7 (range: 13-60) years and a mean post-transplant period of 36,6 months (range: 12,3 months -15.9 years). The forms of the diseases were pulmonary in 10 /16 (62.6%), disseminated in 3/16 (18.7%) and extrapulmonary in 3/16 (18.7%). All patients initially received 4-drug combination therapy. Because of drug interaction, an increase in the dose of calcineurium inhibitor and steroid was done in 2 cases and in steroids alones in 1 case. Graft dysfunction was observed in 7 cases (43,7%) with tissue-proof acute rejection in 3 cases and loss of the graft in 4 cases. Hepatotoxicity developed in 3 patients (18.7%) during treatment. Reccurence were observed in 4 cases after early stop of treatment. Two patients (12.5%) died. Extrapulmonary and disseminated tuberculosis were observed in third of our patients. More than 9 months of treatment may be necessary to prevent recurrence.

Untitled

“…2,3 Tuberculosis generally occurs in the first year of renal transplant. [4][5][6] However, our patient was diagnosed with TB at 5 years after renal transplant.…”

“…1 In our transplant unit, between 1986 and 2013, the prevalence of TB was estimated at 3.2% among 491 renal transplant recipients. 2 Tuberculosis causes significant morbidity that imposes significant economic burden on patients and healthcare agencies. Pyrexia of unknown origin is a common clinical presentation.…”

Untitled

“…28 Although there are some controversial results in our immunocompromised study population, the frequencies of pulmonary and extrapulmonary TB were similar (47.4% and 42.1%). [29][30][31][32][33][34][35] Therefore, extrapulmonary TB should be considered in the differential diagnosis of all extrapulmonary infections in SOT recipients.…”

Latent TB Detection and Isolation of MDR TB Bacteria in, MP, India

“…give a positive reaction with Ziehl-Nielsen stain. TB organism was found in the patients with the kidney transplant described earlier [13].The TB of prostate is less common when compared with vesiculoseminal and epididymal TB [14], while the cases of ocular and extra ocular TB and 45 cases of isolated ocular TB were earlier identified in Italy. The cases of Mycobacterium induced uvitis also reported [15].…”

“…A high degree of clinical suspicion along with the radiological, microbiologic and biopsy findings are important for diagnosis and starting ATT, is main strategy [11]. New method of fine-needle aspiration cytology (FNAC) and fluid cytology are also demonstrated to be important in detection of extra-pulmonary tuberculosis as described earlier [12][13][14][15][16][17][18]. WHO has declared latent tuberculosis as too expensive and unaffordable for patients [19].…”