Non-tuberculous mycobacterial infections in solid organ transplant recipients: An update

Abstract

Non-tuberculous mycobacteria are ubiquitous environmental organisms that are now increasingly recognized as important causes of clinical disease in solid organ transplant recipients. Risk factors of non-tuberculous mycobacteria infection are severe immunologic defects and structural abnormalities. Lung transplant recipients are at higher risk for non-tuberculous mycobacterial disease compared to recipients of other solid organs. The clinical presentation could be skin and soft tissue infection, osteoarticular disease, pleuropulmonary infection, bloodstream (including catheter-associated) infection, lymphadenitis, and disseminated or multi-organ disease. Management of non-tuberculous mycobacteria infection is complex due to the prolonged treatment course with multi-drug regimens that are anticipated to interact with immunosuppressive medications. This review article provides an update on infections due to non-tuberculous mycobacteria after solid organ transplantation, and discusses the epidemiology, risk factors, clinical presentation, and management.

A rare case of disseminated Mycobacterium avium complex with colitis in a renal transplant recipient

“…Although limited, the available literature suggests that the prognosis of such infections is variable and dependent on the type of transplantation. In a review of disseminated NTM infections, death occurred in 5.9% (1/17 cases) of infected liver recipients, 5.6% (7/124 cases) of infected kidney recipients, 17.6% (3/17 cases) of infected heart recipients, and 10.1% (8/79 cases) of infected lung recipients . However, outcome data for all organs was incomplete or, in the case of the lung transplant recipients, described as a pooled outcome of pulmonary or disseminated disease.…”

“…However, outcome data for all organs was incomplete or, in the case of the lung transplant recipients, described as a pooled outcome of pulmonary or disseminated disease. Of the cases with a specified organism, death was attributed to MAC in a single renal transplant recipient and a single heart transplant recipient …”

“…However, there are no guidelines specific to SOT recipients regarding MAC treatment. Generally, these infections are treated using the same regimens used for MAC infections in non‐HIV–infected individuals . Regimens usually include a macrolide, ethambutol, and rifampin, with or without an aminoglycoside .…”

Pulmonary non-tuberculous mycobacterial infections: current state and future management

“…• HIV [110][111][112][113][114][115][116][117][118][119] • Autoimmune diseases [120] • Cancer [121][122][123] • Immunosuppressive drugs [124][125][126][127][128][129] • Surgery [130][131][132][133] o Transplantation [134][135][136][137][138] • Age over 60 years old/Immunosenescence [139][140][141][142][143][144][145][146][147][148][149][150][151] • Malnutrition [152][153][154][155][156][157][158][159]…”

“…The risk of PNTM is high among SOT recipients, especially in lung transplant patients, which have the highest risk of lung infection compared to other organ transplant recipients [134,135]. The risk of PNTM in haematopoietic cell transplants has also been reported [136][137][138].…”