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Liu Z, Cai D, Su N. Case report: Difficult diagnosis of Mycobacterium tuberculosis infection in patients after allogeneic hematopoietic stem cell transplantation: two case reports and a literature review. Front Oncol 2024; 14:1283320. [PMID: 38863639 PMCID: PMC11165128 DOI: 10.3389/fonc.2024.1283320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Background Mycobacterium tuberculosis (MTB) is a relatively infrequent infection encountered during hematopoietic stem-cell transplantation (HSCT). The identification of MTB following HSCT remains a complex task, with delayed detection and misdiagnosis potentially resulting in unfavorable outcomes. Metagenomic next-generation sequencing (mNGS) represents a novel, highly sensitive, and rapid diagnostic tool in clinical settings for discerning intricate infections and detecting exceedingly rare pathogens. Methods With the aid of mNGS, we diagnosed MTB in the lymph nodes and lungs of two patients with hematological diseases following allogeneic peripheral blood hematopoietic stem cell transplantation. Both patients presented with a fever, localized symptoms, and clinical signs. Following inconclusive results from routine tests, impractical biopsy procedures, and unsuccessful responses to empirical treatments, mNGS was employed as a final recourse, revealing DNA fragments of MTB in blood samples. Results The diagnoses were ultimately confirmed in conjunction with additional clinical evidence. The application of mNGS in MTB cases after allogeneic HSCT has rarely been reported. The mNGS technique can provide a prompt and highly sensitive indication leading to the definitive diagnosis of MTB in complex post-transplant scenarios.
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Affiliation(s)
| | - Dali Cai
- Department of Hematology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Nan Su
- Department of Hematology, The First Hospital of China Medical University, Shenyang, Liaoning, China
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[The Chinese consensus on the diagnosis and treatment of mycobacterium tuberculosis infection in allogeneic hematopoietic stem cell transplantation patients (2023)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:98-105. [PMID: 36948862 PMCID: PMC10033270 DOI: 10.3760/cma.j.issn.0253-2727.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Indexed: 03/24/2023]
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Saj F, Reddy VN, Kayal S, Dubashi B, Singh R, Joseph NM, Ganesan P. Double Infection in a Patient with Chronic GVHD Post Allogeneic Transplant: “Hickam's Dictum” Trumps “Occam's Razor”!—A Case Report with Review of Literature. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1748166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AbstractDouble pneumonia with Pneumocystis jirovecii (PCP) and Mycobacterium tuberculosis (MTB) has been reported in patients with acquired immune deficiency syndrome. A similar immune-suppressed state exists in allogeneic transplant survivors treated for graft-versus-host disease (GVHD). The clinical features and imaging findings could be quite similar in both the etiologies. Reaching a timely diagnosis and initiation of appropriate therapy is essential to prevent complications. We report a patient who had concurrent PCP and MTB pneumonia while on treatment for chronic GVHD. We describe the diagnostic challenge, the treatment, and outcome of this patient. We intend to sensitize physicians to consider more than one etiology in this subset of patients.
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Affiliation(s)
- Fen Saj
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vendoti Nitheesha Reddy
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Smita Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Biswajit Dubashi
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Rakesh Singh
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Noyal Mariya Joseph
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Dubois M, Dixit A, Lamb G. Tuberculosis in Pediatric Solid Organ and Hematopoietic Stem Cell Recipients. Glob Pediatr Health 2021; 8:2333794X20981548. [PMID: 33506075 PMCID: PMC7812398 DOI: 10.1177/2333794x20981548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022] Open
Abstract
Children undergoing solid organ and hematopoietic stem cell transplantation are at high risk of morbidity and mortality from tuberculosis (TB) disease in the post-transplant period. Treatment of TB infection and disease in the post-transplant setting is complicated by immunosuppression and drug interactions. There are limited data that address the unique challenges for the management of TB in the pediatric transplant population. This review presents the current understanding of the epidemiology, clinical presentation, diagnosis, management, and prevention for pediatric transplant recipients with TB infection and disease. Further studies are needed to improve diagnosis of TB and optimize treatment outcomes for these patients.
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Affiliation(s)
- Melanie Dubois
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Avika Dixit
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gabriella Lamb
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
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Mahmoudi S, Pourakbari B, Sadeghi RH, Hamidieh AA, Safari Sharari A, Salajegheh P, Aziz-Ahari A, Mamishi S. High prevalence of latent tuberculosis in hematopoietic stem cell transplant recipients: A First Report. Pediatr Transplant 2020; 24:e13770. [PMID: 32573900 DOI: 10.1111/petr.13770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/14/2020] [Accepted: 04/20/2020] [Indexed: 11/26/2022]
Abstract
TB is an increasing health problem, and patients undergoing HSCT are more prone to develop tuberculosis. The aim of our study was to evaluate prevalence of latent tuberculosis in HSCT recipients. In this study, 84 patients (2 months to 18 years) who were candidates for HSCT at the referral hospital of Tehran Children's Medical Center were enrolled. The TST and the QFT-GIT test were performed in all 84 patients, simultaneously. LTBI was considered when one of the tests was positive. Overall, the prevalence of LTBI in HSCT recipients in our study was 12% (10 cases). TST induration ≥5 mm was seen in only three patients (3.5%). Eight patients (9.5%) had a positive result for IGRA test, and 11 of them (13%) had indeterminate QFT-GIT result. The agreement between the TST results (induration size ≥5 mm) and the QFT-GIT results was poor (kappa = 0.14). In conclusion, there was a high rate of discordance between TST and IGRA results with many more positive QFT-GIT tests. However, more studies are needed in this population to determine whether this discordance reflects true infection.
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Affiliation(s)
- Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Babak Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | | | - Amir Ali Hamidieh
- Pediatric Cell Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alieh Safari Sharari
- Department of Pediatrics, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouria Salajegheh
- Department of Pediatric Hematology-Oncology, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Aziz-Ahari
- Radiology Department, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran.,Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Liu YC, Wu CJ, Ko PS, Chien SH, Fan NW, Wang HY, Gau JP, Liu CJ, Hsiao LT, Chiou TJ, Liu CY, Liu JH. Mycobacterial infections in adult recipients of allogeneic hematopoietic stem cell transplantation: A cohort study in a high endemic area. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:274-282. [DOI: 10.1016/j.jmii.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/04/2018] [Accepted: 07/10/2018] [Indexed: 12/19/2022]
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Brockhaus L, Brune J, Battegay R, Gerull S, Nägele M, Bättig V. [Disseminated tuberculosis during induction chemotherapy in acute myeloid leukemia]. Internist (Berl) 2019; 60:634-637. [PMID: 30762085 DOI: 10.1007/s00108-019-0565-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A patient with acute myeloid leukemia developed disseminated tuberculosis with cerebral involvement in the early phase of induction chemotherapy before allogenic stem cell transplantation. He presented with persisting fever of unknown origin, and initially misinterpreted organ lesions in CT scans.
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Affiliation(s)
- L Brockhaus
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
| | - J Brune
- Klinik für Innere Medizin, Universitätsspital Basel, Basel, Schweiz
| | - R Battegay
- Klinik für Hämatologie, Universitätsspital Basel, Basel, Schweiz
| | - S Gerull
- Klinik für Hämatologie, Universitätsspital Basel, Basel, Schweiz
| | - M Nägele
- Klinische Mikrobiologie, Universitätsspital Basel, Basel, Schweiz
| | - V Bättig
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
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Abad CLR, Razonable RR. An update on Mycobacterium tuberculosis infection after hematopoietic stem cell transplantation in adults. Clin Transplant 2018; 32:e13430. [PMID: 30347465 DOI: 10.1111/ctr.13430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mycobacterium tuberculosis (TB) is common worldwide, but is rarely reported after hematopoietic transplantation (HSCT). We reviewed all TB cases among HSCT since 2010 to provide an update on its epidemiology, clinical presentation, management and outcome. METHODS Several databases were reviewed from January 1, 2010 to June 30, 2018 using key words tuberculosis and hematopoietic transplantation. RESULTS The 47 cases of TB were reported during the study period. The highest TB frequency was reported from India (2.9%), with a median frequency of 2% (range, 0.18%-2.9%). The majority were recipients of allogeneic transplants (45/47, 95.7%). Pulmonary TB was the most common clinical presentation (20/47, 42.6%). The median time to clinical presentation was 4.6 (range, 3-12.9) and 2.4 (range, 0.6-5) months, based on cohort data and case reports, respectively. Fever was reported in 87.5% (14/16) of patients. First-line quadruple drug therapy was frequently used (29/35, 82.9%), with a median length of 12 and 9 months for cohorts and case reports, respectively. All-cause and attributable mortality was 27.6% (13/47), and 8.5% (4/47), respectively. CONCLUSIONS Mycobacterium tuberculosis presents early after HSCT, most commonly as fever. A high index of suspicion is needed for early diagnosis and treatment, to prevent TB-attributable mortality.
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Affiliation(s)
- Cybele Lara R Abad
- Section of Infectious Diseases, Department of Medicine, University of the Philippines Manila, UP-Philippine General Hospital, Manila, Philippines
| | - Raymund R Razonable
- Division of Infectious Diseases, Department of Medicine, The William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Akı ŞZ, Sucak GT, Tunçcan ÖG, Köktürk N, Şenol E. The incidence of tuberculosis infection in hematopoietic stem cell transplantation recipients: A retrospective cohort study from a center in Turkey. Transpl Infect Dis 2018; 20:e12912. [DOI: 10.1111/tid.12912] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 01/23/2018] [Accepted: 03/25/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Şahika Zeynep Akı
- Departments of Hematology; Faculty of Medicine; Gazi University; Ankara Turkey
| | - Gülsan Türköz Sucak
- Departments of Hematology; Faculty of Medicine; Gazi University; Ankara Turkey
| | - Özlem Güzel Tunçcan
- Departments of Infectious Disease; Faculty of Medicine; Gazi University; Ankara Turkey
| | - Nurdan Köktürk
- Departments of Pulmonary Disease; Faculty of Medicine; Gazi University; Ankara Turkey
| | - Esin Şenol
- Departments of Infectious Disease; Faculty of Medicine; Gazi University; Ankara Turkey
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Reactivation and Dissemination of Tuberculosis to Extrapulmonary Sites in Patients With Hematologic Malignancies. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Mycobacterial infections are uncommon in solid organ and hematopoietic stem cell transplant recipients but carry significant morbidity and mortality. Donor screening strategies for tuberculosis should be emphasized in high-risk populations. Both tuberculosis and nontuberculous mycobacterial infections can have pulmonary and extrapulmonary manifestations of infections. Recommended treatment regimens typically involve multiple drugs with significant adverse effects and drug interactions.
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Abstract
Mycobacterium tuberculosis is a major opportunistic pathogen in transplant recipients. Compared to that in the general population, the frequency of tuberculosis (TB) is 10 to 40 times higher in hematopoietic stem cell transplant (HSCT) recipients and 20 to 74 times higher in solid-organ transplant (SOT) recipients. Transplant recipients with TB are also more likely to develop disseminated disease, have longer time to definitive diagnosis, require more invasive diagnostic procedures, and experience greater anti-TB treatment-related toxicity than the general population. Specific risk factors for TB in SOT recipients include previous exposure to M. tuberculosis (positive tuberculin skin tests and/or residual TB lesions in pretransplant chest X ray) and the intensity of immunosuppression (use of antilymphocyte antibodies, type of basal immunosuppression, and intensification of immunosuppressive therapy for allograft rejection). Risk factors in HSCT recipients are allogeneic transplantation from an unrelated donor; chronic graft-versus-host disease treated with corticosteroids; unrelated or mismatched allograft; pretransplant conditioning using total body irradiation, busulfan, or cyclophosphamide; and type and stage of primary hematological disorder. Transplant recipients with evidence of prior exposure to M. tuberculosis should receive treatment appropriate for latent TB infection. Optimal management of active TB disease is particularly challenging due to significant drug interactions between the anti-TB agents and the immunosuppressive therapy. In this chapter, we address the epidemiology, clinical presentation, diagnostic considerations, and management strategies for TB in SOT and HSCT recipients.
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Abstract
PURPOSE OF REVIEW The detection of latent tuberculosis infection (LTBI) in different categories of compromised patients is reviewed with focus on the role of strategies incorporating immunodiagnostic tests and analysis of epidemiological and clinical risk factors. RECENT FINDINGS The development of active tuberculosis (TB) is increased in compromised patients and is closely related to determinants for disease reactivation or newly acquired TB infection. A targeted detection of LTBI in these high-risk groups should be performed especially if preventive treatment is planned. The performance of immunodiagnostic tests is highly variable among different groups of immunocompromised individuals. Findings of cross-sectional studies indicate a better diagnostic accuracy of interferon-γ release assays over the tuberculin skin test. The critical issue is that in low-incidence countries, the positive and negative predictive values of any of immunodiagnostic tests were very poor. A targeted testing process involving analysis of TB risk factors increases the predictive positive values of immunodiagnostic tests and may improve LTBI detection. SUMMARY The LTBI detection in immunocompromised patients is a challenge. The development of new immunological biomarkers and integrated clinical and epidemiological strategies are needed to identify LTBI in compromised individuals and to plan preventive chemotherapies in those at risk of developing active TB.
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Omri HE, Hascsi Z, Taha R, Szabados L, Sabah HE, Gamiel A, Hijji IA. Tubercular Meningitis and Lymphadenitis Mimicking a Relapse of Burkitt's Lymphoma on (18)F-FDG-PET/CT: A Case Report. Case Rep Oncol 2015; 8:226-32. [PMID: 26078742 PMCID: PMC4464102 DOI: 10.1159/000430768] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Tuberculosis (TB) can present with various forms and can occasionally be mistaken for malignancy. Hereby, we report a 53-year-old man diagnosed and treated for Burkitt's lymphoma in 2009 who achieved a complete remission confirmed by a computed tomography (CT) scan. During the follow-up 2 years later, he complained of left hip pain that warranted investigation with magnetic resonance imaging and whole-body 18F-fludeoxyglucose-positron emission tomography (FDG-PET)/CT which showed a benign lesion in the left hip associated with multiple lymph nodes in the chest and abdomen not amenable for biopsy. A follow-up PET/CT scan a few months later showed intense tracer uptake in the lymph nodes with size progression and appearance of new lymph nodes suspicious of lymphoma relapse. The patient was asymptomatic, and all investigations including viral and connective tissue disease studies were negative. Also the tuberculin skin test and QuantiFERON were negative. Lymph node biopsy was planned; however, the patient presented a few days earlier with fever, headache and photophobia. Cerebrospinal fluid (CSF) examination confirmed meningitis with lymphocytic pleocytosis and elevated protein. The CSF Gram stain, culture, viral and acid-fast bacilli were negative. CSF flow cytometry and cytopathology confirmed polyclonal lymphocytosis and suggested reactive causes. CSF TB culture grew Mycobacterium tuberculosis. Mediastinal lymph node biopsy also confirmed TB lymphadenitis. Four antituberculosis drugs were started. One year later, a PET/CT scan showed regression of all the involved lymph nodes. This case highlights the importance of excluding TB in patients with suspected malignancy, especially if they belong to endemic regions, and the increasing role of 18F-FDG-PET/CT in the early detection of extrapulmonary TB.
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Affiliation(s)
- Halima El Omri
- Department of Medical Oncology, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar
| | - Zsolt Hascsi
- Department of PET/CT, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar
| | - Ruba Taha
- Department of Medical Oncology, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar
| | - Lajos Szabados
- Department of PET/CT, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar
| | - Hesham El Sabah
- Department of Medical Oncology, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar
| | - Amna Gamiel
- Department of Medical Oncology, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Al Hijji
- Department of PET/CT, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar
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Tuberculosis in umbilical cord blood transplant recipients: clinical characteristics and challenges. Bone Marrow Transplant 2015; 50:465-8. [DOI: 10.1038/bmt.2014.289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Al-Anazi KA, Al-Jasser AM, Alsaleh K. Infections Caused by Mycobacterium tuberculosis in Recipients of Hematopoietic Stem Cell Transplantation. Front Oncol 2014; 4:231. [PMID: 25207262 PMCID: PMC4144006 DOI: 10.3389/fonc.2014.00231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/11/2014] [Indexed: 12/11/2022] Open
Abstract
Mycobacterium tuberculosis (M. tuberculosis) infections are uncommon in recipients of hematopoietic stem cell transplantation. These infections are 10-40 times commoner in recipients of stem cell transplantation than in the general population but they are 10 times less in stem cell transplantation recipients compared to solid organ transplant recipients. The incidence of M. tuberculosis infections in recipients of allogeneic stem cell transplantation ranges between <1 and 16% and varies considerably according to the type of transplant and the geographical location. Approximately 80% of M. tuberculosis infections in stem cell transplant recipients have been reported in patients receiving allografts. Several risk factors predispose to M. tuberculosis infections in recipients of hematopoietic stem cell transplantation and these are related to the underlying medical condition and its treatment, the pre-transplant conditioning therapies in addition to the transplant procedure and its own complications. These infections can develop as early as day 11 and as late as day 3337 post-transplant. The course may become rapidly progressive and the patient may develop life-threatening complications. The diagnosis of M. tuberculosis infections in stem cell transplant recipients is usually made on clinical grounds, cultures obtained from clinical specimens, tissues biopsies in addition to serology and molecular tests. Unfortunately, a definitive diagnosis of M. tuberculosis infections in these patients may occasionally be difficult to be established. However, M. tuberculosis infections in transplant recipients usually respond well to treatment with anti-tuberculosis agents provided the diagnosis is made early. A high index of suspicion should be maintained in recipients of stem cell transplantation living in endemic areas and presenting with compatible clinical and radiological manifestations. High mortality rates are associated with infections caused by multidrug-resistant strains, miliary or disseminated infections, and delayed initiation of therapy. In recipients of hematopoietic stem cell transplantation, isoniazid prophylaxis has specific indications and bacillus Calmette-Guerin vaccination is contraindicated as it may lead to disseminated infection. The finding that M. tuberculosis may maintain long-term intracellular viability in human bone marrow-derived mesenchymal stem cells complicates the development of effective vaccines and strategies to eliminate tuberculosis. However, the introduction of linezolid, cellular immunotherapy, and immunomodulation in addition to autologous mesenchymal stem cell transplantation will ultimately have a positive impact on the overall management of infections caused by M. tuberculosis.
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Affiliation(s)
- Khalid Ahmed Al-Anazi
- Section of Adult Hematology and Oncology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | | | - Khalid Alsaleh
- Section of Adult Hematology and Oncology, Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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