Tuberculosis in Immunosuppessed Patients

Millar, James R.; Horne, N. W.

doi:10.1016/s0140-6736(79)91852-x

Cited by 108 publications

(33 citation statements)

References 7 publications

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“…Si bien de forma excepcional, la inmunosupresión secundaria a corticoterapia prolongada puede ser responsable de la reactivación y diseminación de un foco tuberculoso (20,21). A esta circunstancia habría que aña-dir en nuestro paciente el padecimiento de una hemopatía maligna, con un componente de mielodisplasia que predispone a padecer complicaciones infecciosas (22).…”

Section: Discussionunclassified

Tuberculosis peritoneal como complicación en un caso de síndrome mielodisplásico/mieloproliferativo inclasificable

Santos

Morabito

Sánchez

et al. 2008

An. Med. Interna (Madrid)

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INTRODUCCIÓNLas enfermedades mielodisplásicas/mieloproliferativas (SMD/SMP) constituyen neoplasias clonales hematopoyéticas que reúnen características clínicas, de laboratorio y morfológi-cas que apoyan un diagnóstico tanto de síndrome mielodisplási-co como de síndrome mieloproliferativo. Dentro de este grupo de hemopatías malignas, la clasificación OMS de los tumores hematopoyéticos y de los tejidos linfoides reconoce tres enfermedades con criterios definidos (leucemia mielomonocítica crónica, leucemia mieloide crónica atípica y leucemia mielomonocítica juvenil) y una cuarta, denominada enfermedad mielodisplásica/mieloproliferativa inclasificable, no encuadrable en las anteriores (1). Aunque no existen trabajos con una casuística amplia que describan las características clínicas y evolutivas de esta última entidad (2), es un hecho conocido la asociación de las enfermedades mielodisplásicas con complicaciones de tipo infeccioso (3). Sin embargo, la infección por Mycobacterium tuberculosis, local o diseminada, es muy infrecuente en pacientes con síndrome mielodisplásico, y las publicaciones que recogen esta asociación son ocasionales (4). Describimos a continuación el caso de un paciente diagnosticado de SMD/SMP inclasificable que presentó en su evolución un cuadro de tuberculosis diseminada que inicialmente simulaba una carcinomatosis peritoneal. CASO APORTADOVarón de 68 años de edad, con antecedentes personales de nefrectomía derecha por carcinoma renal de células claras, litiasis renal, hiperplasia prostática benigna y herpes zóster de repetición. En [0212-7199 (2008) RESUMENPresentamos el caso de un paciente de 68 años diagnosticado de sín-drome mieloproliferativo/mielodisplásico inclasificable (clasificación OMS), con tratamiento corticoesteroideo prolongado y mala respuesta a terapia citorreductora, que presenta en su evolución un cuadro clínico de astenia progresiva, dolor torácico, disnea a mínimos esfuerzos y distensión abdominal, que hace sospechar inicialmente una rotura esplénica. La laparotomía exploradora pone de manifiesto la existencia de implantes peritoneales múltiples, y la biopsia de éstos es diagnóstica de tuberculosis peritoneal. A ello se añade la positividad del cultivo y la PCR en orina, para Mycobacterium tuberculosis, y la posibilidad de probables afectaciones tuberculosas pleural y esplénica. La respuesta al tratamiento antituberculoso fue favorable. No hemos encontrado en la literatura revisada un caso de características similares.

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Section: Discussionunclassified

Tuberculosis peritoneal como complicación en un caso de síndrome mielodisplásico/mieloproliferativo inclasificable

Santos

Morabito

Sánchez

et al. 2008

An. Med. Interna (Madrid)

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“…9 The clinical features of TB can be unusual, and may be masked because of the blunted response to infection. 4,7,8 In addition, extrapulmonary lesions are more frequent in patients following transplantation compared to patients without immunosuppression. 8,9 Disseminated TB is common in renal transplant patients, accounting for 40% of cases, 9 in marked contrast to the 0.6%-1.4% incidence in the general population.…”

Section: Discussionmentioning

confidence: 99%

“…3 Little attention has been given to mycobacterial infections compared to other opportunistic infections, such as Pneumocystis carinii and Cytomegalovirus in renal transplant recipients. 4 Earlier reports emphasized the rarity of tuberculosis (TB) in these patients, 5,6 however, more recent ones have documented high incidence of TB in renal transplant recipients. 7,8 Qunibi et al 8 noted the presence of TB in 14 of 403 renal transplant recipients operated over a nine-year period, giving an incidence rate of 3.5%.…”

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confidence: 99%

Renal Allograft Tuberculosis: A Case Report

2002

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“…Drugs that depress cellular immunity, such as corticosteroids and cytotoxic agents, also predispose patients to tuberculosis. 4 Clinical manifestations of tuberculosis vary and depend on the degree of immunodeficiency. 5 Diabetes, HIV and other conditions associated with immunosuppression is likely to influence the clinical presentation and severity of tuberculosis as well as the response to therapy.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcome in new smear positive pulmonary tuberculosis patients with and without immunosuppression on RNTCP regimen: a comparative observational study

2017

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Background: Immune status of a patient influences the susceptibility, clinical presentation of tuberculosis and its treatment outcome. Some of the most common conditions associated with immune deficiency includes, human immunodeficiency virus (HIV) infection, diabetes and chronic steroid therapy for any underlying diseases.Methods: A cohort study, enrolled patients with tuberculosis alone (n=51) and those with tuberculosis and immunosuppressed state (patients with HIV, diabetes and those on steroid therapy, n=97).Results: All patients received Directly Observed Treatment Short course (DOTS) regimen implemented through RNTCP. Among the immunosuppressed patients, 32 were HIV patients, 45 of them were diabetic and 20 received chronic steroid therapy. All immunocompetent patients (control) were totally cured but 62.5% and 88.9% of HIV and diabetic patients in the immunosuppressed group were cured. Mortality was high in the immunosuppressed group (18.75% in HIV, and 11.11% in diabetic group). The grade of sputum smear had significant influence on the treatment outcome after adjusting for death and default (p>0.05). After intensive phase, the smear conversion rate were 86.27% in the control group,37.5% in the HIV patients, 22.22% in diabetics and 55% among chronic steroid use. The mortality and cure rate among those who received treatment for diabetes mellitus is comparable with that of immunocompetent group. Treatment prolongation was required for patients in the immunosuppressed group (62.5% in HIV group, 77.7% in diabetes group and 45% in chronic steroid users group).Conclusions: Immunosuppression was a risk factor for increased morbidity and mortality among new smear positive pulmonary tuberculosis patients. Prolonged DOTS regimen requires long-term close follow-up of patients who are immunocompromised.

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Tuberculosis in Immunosuppessed Patients

Cited by 108 publications

References 7 publications

Tuberculosis peritoneal como complicación en un caso de síndrome mielodisplásico/mieloproliferativo inclasificable

Tuberculosis peritoneal como complicación en un caso de síndrome mielodisplásico/mieloproliferativo inclasificable

Renal Allograft Tuberculosis: A Case Report

Treatment outcome in new smear positive pulmonary tuberculosis patients with and without immunosuppression on RNTCP regimen: a comparative observational study

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