Nontuberculous Mycobacterial Infection in Hematopoietic Stem Cell and Solid Organ Transplant Recipients

Abstract

Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms. In immunocompetent hosts, they are a rare cause of disease. In immunocompromised hosts, disease due to NTM is well documented. Reports of NTM disease have increased in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. This increase may reflect increased numbers of transplants, intensification of immune suppressive regimens, prolonged survival of transplant recipients, and/or improved diagnostic techniques. The difficulty of diagnosis and the impact associated with infections due to NTM in HSCT and SOT recipients necessitates that, to ensure prompt diagnosis and early initiation of therapy, a high level of suspicion for NTM disease be maintained. The most common manifestations of NTM infection in SOT recipients include cutaneous and pleuropulmonary disease, and, in HSCT recipients, catheter-related infection. Skin and pulmonary lesions should be biopsied for histologic examination, special staining, and microbiologic cultures, including cultures for bacteria, Nocardia species, fungi, and mycobacteria. Mycobacterial infections associated with catheters may be documented by tunnel or blood (isolator) cultures. Susceptibility testing of mycobacterial isolates is an essential component of optimal care. The frequent isolation of NTM other than Mycobacterium avium complex (MAC) from transplant recipients limits the extrapolation of therapeutic data from human immunodeficiency virus-infected individuals to the population of transplant recipients. Issues involved in the management of NTM disease in transplant recipients are characterized by a case of disseminated infection due to Mycobacterium avium complex in a lung transplant recipient, with a review of the relevant literature.

Pulmonary disease caused by nontuberculous mycobacteria

“…What is perhaps remarkable is that the incidence of NTM lung disease is not higher among such patients. The incidence of all NTM disease among solid organ transplant recipients appears to vary and when disease occurs, it typically is well after the initial perioperative period [60]. Incidence among renal recipients is estimated at 0.16-2.8%, while heart and lung recipients have reported rates of 0.24-2.8 and 0.46-2.3%, respectively [60,61].…”

“…The incidence of all NTM disease among solid organ transplant recipients appears to vary and when disease occurs, it typically is well after the initial perioperative period [60]. Incidence among renal recipients is estimated at 0.16-2.8%, while heart and lung recipients have reported rates of 0.24-2.8 and 0.46-2.3%, respectively [60,61]. Stem cell transplant patients may have an incidence of NTM disease as high as 3-5.4% with the lung being the predominant site of involvement [60,62].…”

Non-Tuberculous Mycobacterial Infection Localized in Small Intestine Developing after Allogeneic Bone Marrow Transplantation

“…Although NTM infection after allogeneic HSCT is considered rare, the incidence seems relatively higher than that in the general population (3). An increased incidence of NTM infection has been reported among allogeneic HSCT recipients in recent years, ranging from 0.4% to 9.7% of cases (3)(4)(5)(6)(7).…”

“…An increased incidence of NTM infection has been reported among allogeneic HSCT recipients in recent years, ranging from 0.4% to 9.7% of cases (3)(4)(5)(6)(7). However, intestinal NTM infection is quite rare, and there has been only one other reported case after allogeneic HSCT (5) T a b l e 1 .…”

Infections After Orthotopic Liver Transplantation

“…Infections from Mycobacterium avium intracellulare, Mycobacterium chelonae, Mycobacterium mucogenicum, Mycobacterium triplex, and Mycobacterium xenopi have been reported in liver transplant recipients. 41 Pulmonary and multifocal cutaneous infections are more common presentations. 42 Treatment decisions are guided by susceptibility tests and may be complicated by medication interactions with immunosuppressive regimens.…”