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Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out
| Content Provider | SAGE Publishing |
|---|---|
| Author | Kapoor, Jyotsna Mirgh, Sumeet Prakash Khushoo, Vishvdeep Mehta, Pallavi Ahmed, Rayaz Bansal, Nitin Bhurani, Dinesh Agrawal, Narendra |
| Copyright Year | 2021 |
| Abstract | 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. |
| Related Links | https://journals.sagepub.com/doi/pdf/10.1177/20499361211008674?download=true |
| ISSN | 20499361 |
| Volume Number | 8 |
| Journal | Therapeutic Advances in Infectious Disease (TAI) |
| e-ISSN | 2049937X |
| DOI | 10.1177/20499361211008674 |
| Language | English |
| Publisher | Sage Publications UK |
| Publisher Date | 2021-04-12 |
| Publisher Place | London |
| Access Restriction | Open |
| Rights Holder | © The Author(s), 2021 |
| Subject Keyword | chronic graft versus host disease immunosuppression tyrosine kinase inhibitors allogeneic stem cell transplantation endemic population tuberculosis |
| Content Type | Text |
| Resource Type | Article |
| Subject | Infectious Diseases Pharmacology (medical) |
