Cargando…
Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out
BACKGROUND: Allogeneic stem cell transplant (AlloSCT) recipients remain at a higher risk of developing tuberculosis (TB), especially in endemic populations. We conducted a retrospective study to identify the incidence, clinical presentation, and risk factors for active TB among our alloSCT recipient...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047838/ https://www.ncbi.nlm.nih.gov/pubmed/33912346 http://dx.doi.org/10.1177/20499361211008674 |
_version_ | 1783679121634623488 |
---|---|
author | Kapoor, Jyotsna Mirgh, Sumeet Prakash Khushoo, Vishvdeep Mehta, Pallavi Ahmed, Rayaz Bansal, Nitin Bhurani, Dinesh Agrawal, Narendra |
author_facet | Kapoor, Jyotsna Mirgh, Sumeet Prakash Khushoo, Vishvdeep Mehta, Pallavi Ahmed, Rayaz Bansal, Nitin Bhurani, Dinesh Agrawal, Narendra |
author_sort | Kapoor, Jyotsna |
collection | PubMed |
description | BACKGROUND: Allogeneic stem cell transplant (AlloSCT) recipients remain at a higher risk of developing tuberculosis (TB), especially in endemic populations. We conducted a retrospective study to identify the incidence, clinical presentation, and risk factors for active TB among our alloSCT recipients. METHODS: Records of all patients transplanted between 1 January 2012 and 31 July 2020 were reviewed. Patients were followed up for outcome until 30 September 2020. None of the patients received prophylactic anti-tubercular drugs. Proven diagnosis of active TB was considered if Mycobacterium tuberculosis (MTB) was cultured from clinical samples or acid-fast bacilli (AFB) or MTB demonstrated on Ziehl-Neelsen (ZN) staining or histopathology or XPERT MTB, while probable diagnosis of TB was considered if histopathology findings were suggestive of caseation necrosis/epithelioid cell granulomas without any evidence of malignancy or lymphocyte rich exudative effusions (pleural/pericardial) without an alternative cause. RESULTS: Among 381 alloSCT recipients, 15 patients (3.9%) developed TB at median of 246 (74–279) days post AlloSCT, after being symptomatic for a median of 22 (7–60) days, amounting to a cumulative incidence of 4.9%. All patients were started on four-drug anti tubercular therapy, ATT [Rifampicin, Isoniazid, Ethambutol, Pyrazinamide (RHEZ)], of which five patients developed hepatotoxicity at a median of 12 days after start of ATT, leading to drug modification. At last follow up, TB was cured in 13 (86.67%) patients, one succumbed to disease relapse, while others are still on treatment. Age ⩾ 30 years, immunosuppression for graft versus host disease (GvHD) > 6 months, prior use of tyrosine kinase inhibitors (TKI) and chronic GvHD on univariate analysis and immunosuppression for GvHD > 6 months on multivariate analysis were found to be associated with development of TB. CONCLUSION: A high index of suspicion with timely workup and treatment of TB is the key in AlloSCT recipients, especially in endemic TB populations. |
format | Online Article Text |
id | pubmed-8047838 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-80478382021-04-27 Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out Kapoor, Jyotsna Mirgh, Sumeet Prakash Khushoo, Vishvdeep Mehta, Pallavi Ahmed, Rayaz Bansal, Nitin Bhurani, Dinesh Agrawal, Narendra Ther Adv Infect Dis Infectious Disease in Hematopoetic Stem Cell Transplantation BACKGROUND: Allogeneic stem cell transplant (AlloSCT) recipients remain at a higher risk of developing tuberculosis (TB), especially in endemic populations. We conducted a retrospective study to identify the incidence, clinical presentation, and risk factors for active TB among our alloSCT recipients. METHODS: Records of all patients transplanted between 1 January 2012 and 31 July 2020 were reviewed. Patients were followed up for outcome until 30 September 2020. None of the patients received prophylactic anti-tubercular drugs. Proven diagnosis of active TB was considered if Mycobacterium tuberculosis (MTB) was cultured from clinical samples or acid-fast bacilli (AFB) or MTB demonstrated on Ziehl-Neelsen (ZN) staining or histopathology or XPERT MTB, while probable diagnosis of TB was considered if histopathology findings were suggestive of caseation necrosis/epithelioid cell granulomas without any evidence of malignancy or lymphocyte rich exudative effusions (pleural/pericardial) without an alternative cause. RESULTS: Among 381 alloSCT recipients, 15 patients (3.9%) developed TB at median of 246 (74–279) days post AlloSCT, after being symptomatic for a median of 22 (7–60) days, amounting to a cumulative incidence of 4.9%. All patients were started on four-drug anti tubercular therapy, ATT [Rifampicin, Isoniazid, Ethambutol, Pyrazinamide (RHEZ)], of which five patients developed hepatotoxicity at a median of 12 days after start of ATT, leading to drug modification. At last follow up, TB was cured in 13 (86.67%) patients, one succumbed to disease relapse, while others are still on treatment. Age ⩾ 30 years, immunosuppression for graft versus host disease (GvHD) > 6 months, prior use of tyrosine kinase inhibitors (TKI) and chronic GvHD on univariate analysis and immunosuppression for GvHD > 6 months on multivariate analysis were found to be associated with development of TB. CONCLUSION: A high index of suspicion with timely workup and treatment of TB is the key in AlloSCT recipients, especially in endemic TB populations. SAGE Publications 2021-04-12 /pmc/articles/PMC8047838/ /pubmed/33912346 http://dx.doi.org/10.1177/20499361211008674 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Infectious Disease in Hematopoetic Stem Cell Transplantation Kapoor, Jyotsna Mirgh, Sumeet Prakash Khushoo, Vishvdeep Mehta, Pallavi Ahmed, Rayaz Bansal, Nitin Bhurani, Dinesh Agrawal, Narendra Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out |
title | Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out |
title_full | Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out |
title_fullStr | Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out |
title_full_unstemmed | Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out |
title_short | Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out |
title_sort | study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out |
topic | Infectious Disease in Hematopoetic Stem Cell Transplantation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047838/ https://www.ncbi.nlm.nih.gov/pubmed/33912346 http://dx.doi.org/10.1177/20499361211008674 |
work_keys_str_mv | AT kapoorjyotsna studyofclinicalcharacteristicsriskfactorsandoutcomesfortuberculosispostallogeneicstemcelltransplantnevercountitout AT mirghsumeetprakash studyofclinicalcharacteristicsriskfactorsandoutcomesfortuberculosispostallogeneicstemcelltransplantnevercountitout AT khushoovishvdeep studyofclinicalcharacteristicsriskfactorsandoutcomesfortuberculosispostallogeneicstemcelltransplantnevercountitout AT mehtapallavi studyofclinicalcharacteristicsriskfactorsandoutcomesfortuberculosispostallogeneicstemcelltransplantnevercountitout AT ahmedrayaz studyofclinicalcharacteristicsriskfactorsandoutcomesfortuberculosispostallogeneicstemcelltransplantnevercountitout AT bansalnitin studyofclinicalcharacteristicsriskfactorsandoutcomesfortuberculosispostallogeneicstemcelltransplantnevercountitout AT bhuranidinesh studyofclinicalcharacteristicsriskfactorsandoutcomesfortuberculosispostallogeneicstemcelltransplantnevercountitout AT agrawalnarendra studyofclinicalcharacteristicsriskfactorsandoutcomesfortuberculosispostallogeneicstemcelltransplantnevercountitout |