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TB in HSCT

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The following forms of EPTB are

classified as severe: meningeal,

pericardial, peritoneal, bilateral or

extensive pleural effusive, spinal,intestinal, genitourinary.

Lymph node, pleural effusion (unilateral),

bone (excluding spine), peripheral joint

and skin tuberculosis are classified as

less severe.

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Characteristics of TB in SCT

patients Limited information on the epidemiology and

characteristics of TB, and on the clinical manifestationsof TB in SCT patients.

TB in HSCT patients is mainly due to reactivation oflatent infection.

The data show that the ratio of TB in allogeneic SCTpatients correlates with the countrys TB rate

No increased risk of TB in autologous SCT patients

GVHD can be a risk factor for TB. The ratios of acuteand chronic GVHD are 63.8% and 34%, respectively, inSCT patients with TB

Most cases are diagnosed after day 100

Pulmonary TB is the most common localization (84%),but approximately 15% of cases had extrapulmonary TB

such as renal, bone marrow, central nervous system andeven knee

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Data from the USA show that theincidence of Mycobacterium infectionamong HSCT recipients ranges from

0.0014% to 3%. Countries in which the prevalence of TB in

the general population is higher than in the

USA have reported varying incidences 1.6%in Spain and Turkey to 8.57% in HongKong and Taiwan and 16% in Pakistan

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Most of the reports of TB were from Asia (48%)

The incidence of TB varied from 0.0014% (USA) to 16%(Pakistan)

Lung was the organ most frequently involved

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Microbiology

More than half the cases were diagnosed

with culture (55%)

Histology is the second most commonapproach (20.3%)

AFB smear was responsible for 26% of

diagnoses.

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Radiology

Most common abnormalities were air

space consolidation (100%) and nodules

(80%)

Chest CT scans (n = 7): the most common

parenchymal lesions were consolidation

(100%), nodules (71%), tree-in-bud

appearance (43%), and ground-glassopacity (43%)

J Thorac Imaging 2009;1:106

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Patients are treated using standard drugsand there are no reports of drug-resistant

TB in SCT patients.

The response to therapy was satisfactory. Ninety-one percent of patients were

diagnosed and treated, and five cases

were diagnosed post mortem (9%). Tendeaths were reported due to TB (18.5%).

Journal of Hospital Infection (2006) 62, 421426

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The survey of EBMT-IDWP mycobacterial

infections in SCT patients To obtain information about the frequency,

presentation and treatment of mycobacterialinfection in SCT recipients between 1994 and1998.

Thirty-nine centres responded and 31mycobacterial infections were reported, 20 ofwhich were TB.

TB was diagnosed in 0.92% of 1513 allogeneictransplant patients and 0.20% of 3012

autologous transplant patients. Infection was highest after matched unrelated

and mismatched family transplants.

Five patients died, all following allogeneic SCT

Clin Infect Dis 2004;38:12291236.

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Some risk factors were defined, such as historyof previous TB, a positive PPDO15 mm, GVHD,T-cell depletion, corticosteroids, matchedunrelated and mismatched transplants and total

body irradiation No increased risk of developing TB was reported

in autologous SCT patients.

There is no need for INH prophylaxis in

autologous SCT patients, and there is notenough evidence to support prophylaxis forallogeneic SCT patients.

Clin Infect Dis 2004;38:12291236.

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Thank You