Tuberculosis before hematopoietic stem cell transplantation in patients with hematologic diseases: report of a single‐center experience

Patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk of acquiring tuberculosis (TB) due to a status of immunosuppression. We conducted a nested case control study to investigate the incidence and risk factors for TB after allo-HSCT. Between 2012 and 2017, 730 consecutive allo-HSCT recipients were enrolled, and 14 patients (1.92%) were diagnosed with TB. Relatively, 54 allo-HSCT recipients were selected as control. Patients who suffered TB had a significantly higher 3-year non-relapse mortality rate than the control group (30.36% vs 5.39%, P < 0.01). In multivariate analysis, invasive fungal disease (HR 4.87, 95% CI 1.39–17.09), treatment with a relatively high dose of prednisone (HR 10.34, 95% CI 1.12–95.47) and treatment with tacrolimus (HR 4.79, 95% CI 1.18–19.44) were identified independent risk factors for TB occurrence post allo-HSCT (P < 0.05). Meanwhile, donor type, dose and type of anti-thymocyte globulin (ATG) administrated, as well as treatment intensity, did not alter the incidence of TB. Therefore, allo-HSCT recipients with unexplained fever, especially those who suffer from invasive fungal disease and ongoing immunosuppression with a relatively high dose of prednisone or tacrolimus, are at a high-risk of developing active TB. Closely Monitoring TB occurrence, making a timely diagnosis and administering the proper treatment may be beneficial to those high-risk patients.

show abstract

“…2. The patient’s condition recovered with anti-TB treatment when other antibacterial and antifungal agents were ineffective 12–14 . 3.…”

Section: Methodsmentioning

confidence: 99%

Allo-HSCT recipients with invasive fungal disease and ongoing immunosuppression have a high risk for developing tuberculosis

Yang

Shi

Luo

et al. 2019

Sci Rep

View full text Add to dashboard Cite

show abstract

“…In turn, pulmonary tuberculosis is an independent risk factor for MDR organism co-infection like Stenotrophomonas, Pseudomonas, Enterobacter, Proteus etc. (10) This patient was also treated for Mycobacterium tuberculosis based on clinical diagnosis of Koch's disease along with S. maltophilia co-infection.…”

Section: Discussionmentioning

confidence: 99%

Community acquired Stenotrophomonas maltophilia causing empyema in an adult with HIV

Sharma

Duggal

Gupta

et al. 2018

SAARC J. Tuber. Lung Dis. HIV/AIDS

View full text Add to dashboard Cite

Introduction: Stenotrophomonas maltophilia (S. maltophilia) is multidrug resistant (MDR) organism usually associated with hospital acquired infections. Here we report a rare case of community acquired S. maltophilia empyema in a human immunodeficiency virus (HIV) positive patient. Case Report: A 54 year old male presented with cough, breathlessness and chest pain for one month. On investigation, radiological picture was suggestive of massive right empyema. Pleural fluid culture grew S. maltophilia repeatedly which was treated with cotrimoxazole and levofloxacin based on antibiogram. Following improvement patient was discharged on anti-retro viral and anti-tubercular treatment. Conclusion: Community acquired invasive S. maltophilia infections should be kept as differential diagnosis in immunocompromised patients. Being MDR, appropriate microbiological identification and susceptibility play an important role in treatment and outcome of these patients.

show abstract

“…Few studies have described the feasibility of Allo-HSCT and risk of re-activation in patients of acute leukemia who had a TB in recent past. In the study by Eom et al [30], 13 patients with a recent history of TB underwent allo-HSCT, out of which, 9 patients had a diagnosis of acute leukemia. Post transplant, 12 of the 13 patients did not have reactivation of Tuberculosis post transplant with a follow up ranging from 0.7 to 87.5 months.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Clinical Profile and Outcome of Tuberculosis in Patients with Acute Leukemia

Jain

Prakash

Singh

et al. 2017

Indian J Hematol Blood Transfus

View full text Add to dashboard Cite

Patients with acute leukemia (AL) are predisposed to develop infections including tuberculosis (TB). The risk is specifically higher in patients from TB endemic areas. Patients (≥12 years) with AL treated between January-2014 to January-2017 who developed TB were reviewed. Patients were classified into three groups: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML) and acute promyelocytic leukemia (APML) and a systematic analysis of clinical features and outcomes was conducted. Over the study period, 26 patients of AL developed TB. The median time to diagnosis of TB was 8 weeks (0-432 weeks) following the diagnosis of AL and it was comparable between the three leukemia groups. The diagnosis of TB required alteration of anti-leukemia therapy in 26.9% patients and rescheduling in another 42.3% patients. Therapy alteration/rescheduling were more frequent in patients with AML as compared to ALL and APML ( < 0.03, <0.04). Disseminated TB was more common in AML patients ( < 0.016). ATT could be successfully administered in 86.9% patients with improvement of TB. The incidence of ATT induced hepatitis was 34.9%. Mortality was directly attributable to TB in 10% patients. Managing tuberculosis remains a challenge during treatment of acute leukemia. With this analysis, we advocate for a need of early suspicion and evaluation for TB in patients receiving treatment for acute leukemia. Rescheduling and or alteration of anticancer therapy due to TB is associated with significantly higher mortality. Therefore, in carefully selected cases, antileukemia therapy should continue after starting ATT as early as possible.

show abstract

Tuberculosis before hematopoietic stem cell transplantation in patients with hematologic diseases: report of a single‐center experience

Cited by 11 publications

References 23 publications

Allo-HSCT recipients with invasive fungal disease and ongoing immunosuppression have a high risk for developing tuberculosis

Allo-HSCT recipients with invasive fungal disease and ongoing immunosuppression have a high risk for developing tuberculosis

Community acquired Stenotrophomonas maltophilia causing empyema in an adult with HIV

Analysis of Clinical Profile and Outcome of Tuberculosis in Patients with Acute Leukemia

Contact Info

Product

Resources

About