1
|
Kumar J, Nagaraju SP, Saravu K, Rangaswamy D. Report of renal allograft tuberculosis a decade after transplant: challenges in diagnosis and management. CEN Case Rep 2024:10.1007/s13730-024-00904-z. [PMID: 38926296 DOI: 10.1007/s13730-024-00904-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] [Received: 06/19/2023] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Post-transplant infections constitute an important cause of morbidity and mortality in renal transplant recipients worldwide. Tuberculosis (TB) contributes significantly to this burden in endemic countries, such as India. We report a case of renal allograft TB, 10 years post-transplantation, diagnosed during a routine outpatient visit. An asymptomatic rise in serum creatinine level and a 6 month history of immunosuppressive drug non-compliance prompted evaluation of graft dysfunction. Biopsy of the renal allograft tissue suggested chronic active antibody mediated rejection with epithelioid granulomas in the interstitium. Guided by kidney biopsy, further testing with urine acid fast bacilli and urinary GeneXpert yielded positive results for TB. Treatment of TB was further complicated by the development of anti-tubercular therapy induced hepatitis and immune reconstitution inflammatory syndrome, which were managed with the reintroduction regimen and escalation of steroid dose, respectively. Our case highlights the atypical presentation and challenges in managing patients with TB in a post-renal transplant setting.
Collapse
Affiliation(s)
- Joy Kumar
- Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Hospital and Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Kavitha Saravu
- Department of Infectious Diseases, Kasturba Hospital and Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Dharshan Rangaswamy
- Department of Nephrology, Kasturba Hospital and Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.
| |
Collapse
|
2
|
Ghazi M, Saleh A, Abdallah M, El Masri D, El Masri J, El Ayoubi LM, Hawi J, Jurjus A. Barriers toward xenotransplantation in Arab World. Xenotransplantation 2024; 31:e12852. [PMID: 38526015 DOI: 10.1111/xen.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/26/2024]
Abstract
Organ transplant is a crucial therapeutic strategy offering a life-saving and transformative medical intervention. It provides an opportunity to improve their quality of life and increase their lifespan. The shortage of organs remains a critical global challenge, leading to a prolonged waiting times for organ receivers, which contributes to an increase in morbidity and mortality rates. Hence, xenotransplantation offered a promising solution to the global shortage of organs through the use of animal organs, leading to an increase in donor availability, reducing waiting times, minimizing organ trafficking, improving genetic engineering advancements, and driving scientific innovation. Even though xenotransplantation has many benefits in the clinical setting, it has many barriers that are hindering its achievements and constraining its occurrence. Some barriers to xenotransplant are general, such as the immunological barrier, while others are specific to certain regions due to local causes. The Arab region exhibits disparities in clinical settings compared to the global context, marked by the huge economic crisis and a shortage of trained healthcare professionals. Considering the huge resources and advancements needed in the field of xenotransplantation, this review aims to explore the specific barriers toward xenotransplantation in the Arab countries, highlighting the challenges to overcome these barriers.
Collapse
Affiliation(s)
- Maya Ghazi
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Aalaa Saleh
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Malak Abdallah
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Diala El Masri
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, University of Balamand, Koura, Lebanon
| | - Jad El Masri
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | | | - Jihad Hawi
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Abdo Jurjus
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
3
|
Bansal SB, Ramasubramanian V, Prasad N, Saraf N, Soman R, Makharia G, Varughese S, Sahay M, Deswal V, Jeloka T, Gang S, Sharma A, Rupali P, Shah DS, Jha V, Kotton CN. South Asian Transplant Infectious Disease Guidelines for Solid Organ Transplant Candidates, Recipients, and Donors. Transplantation 2023; 107:1910-1934. [PMID: 36749281 DOI: 10.1097/tp.0000000000004521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
These guidelines discuss the epidemiology, screening, diagnosis, posttransplant prophylaxis, monitoring, and management of endemic infections in solid organ transplant (SOT) candidates, recipients, and donors in South Asia. The guidelines also provide recommendations for SOT recipients traveling to this region. These guidelines are based on literature review and expert opinion by transplant physicians, surgeons, and infectious diseases specialists, mostly from South Asian countries (India, Pakistan, Bangladesh, Nepal, and Sri Lanka) as well as transplant experts from other countries. These guidelines cover relevant endemic bacterial infections (tuberculosis, leptospirosis, melioidosis, typhoid, scrub typhus), viral infections (hepatitis A, B, C, D, and E; rabies; and the arboviruses including dengue, chikungunya, Zika, Japanese encephalitis), endemic fungal infections (mucormycosis, histoplasmosis, talaromycosis, sporotrichosis), and endemic parasitic infections (malaria, leishmaniasis, toxoplasmosis, cryptosporidiosis, strongyloidiasis, and filariasis) as well as travelers' diarrhea and vaccination for SOT candidates and recipients including travelers visiting this region. These guidelines are intended to be an overview of each topic; more detailed reviews are being published as a special supplement in the Indian Journal of Transplantation .
Collapse
Affiliation(s)
- Shyam Bihari Bansal
- Department of Nephrology and Kidney Transplantation, Medanta Institute of Kidney and Urology Medanta-Medicity, Gurgaon, India
| | | | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Neeraj Saraf
- Department of Hepatology, Medanta, Medicity, Gurgaon, India
| | - Rajeev Soman
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, and Hospital, Hyderabad, India
| | - Vikas Deswal
- Department of Infectious Diseases, Medanta, Medicity, Gurgaon, India
| | - Tarun Jeloka
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | - Sishir Gang
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujrat, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, PGIMER, Chandigarh, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dibya Singh Shah
- Department of Nephrology and Transplant Medicine, Institute of Medicine, Tribhuvan University of Teaching hospital, Kathmandu, Nepal
| | | | - Camille Nelson Kotton
- Transplant and Immunocompromised Host Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
4
|
Rathore H, Thaker N. A Rare Presentation of Tuberculosis in Transplanted Kidney on Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography Scan. Indian J Nucl Med 2023; 38:177-179. [PMID: 37456186 PMCID: PMC10348506 DOI: 10.4103/ijnm.ijnm_129_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/07/2022] [Accepted: 12/24/2022] [Indexed: 07/18/2023] Open
Abstract
Tuberculosis (TB) is currently the world's leading cause of infectious mortality. Infective complications are common after renal transplantation. TB is one of the leading infections following renal transplantation; however, TB affecting the transplanted kidney is a rare presentation. Reactivation of the Mycobacterium tuberculosis is the most common mode of infection. The use of immunosuppressive agents such as cyclosporin, azathioprine, and steroids advance the onset of TB to an earlier date which most often presents as a fever or pyrexia of unknown origin (PUO). The use of 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) scan images of the whole body and provides the metabolic map of the infection as well as also helps in its radiological localization and characterization and selecting the most appropriate site of the biopsy. Currently, the combined FDG-PET/CT scan modality is the investigation of the choice of physicians for the diagnosis of PUO. Not only the diagnosis but 18F-FDG-PET/CT is also very valuable in assessing early disease response to therapy, and plays an important role in cases where conventional microbiological methods are unavailable for monitoring response to the therapy in cases of pulmonary, extrapulmonary, or multidrug resistant TB.
Collapse
Affiliation(s)
- Hemant Rathore
- Department of Nuclear Medicine and PET CT, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Nirav Thaker
- Department of Radiodiagnosis, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| |
Collapse
|
5
|
Tuberculosis incidence in patients with chronic kidney disease: a systematic review and meta-analysis. Int J Infect Dis 2022; 122:188-201. [PMID: 35609860 DOI: 10.1016/j.ijid.2022.05.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/04/2022] [Accepted: 05/19/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The aim of this study was to estimate global TB incidence in patients with CKD. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was followed to perform the study. Electronic and gray literature sources were investigated for studies published between 2000 and 2021. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the studies, and STATA version 16 was used for analysis. The I2 heterogeneity test was employed to assess heterogeneity. To examine publication bias, funnel plots and Egger's regression tests were performed. RESULTS A total of 104 studies with a sample size of 1,548,774 were included. TB incidence in patients with CKD ranges from 60 per 100,000 in the UK to 19,270 per 100,000 in China. The pooled TB incidence was estimated as 3718 per 100,000 (95%CI; 3024, 4411). Higher pooled TB incidence was found in the African region (9952/100,000, 95%CI; 6854, 13,051), followed by the South-East Asian (7200/100,000, 95%CI; 4537, 9863) and Eastern Mediterranean (5508/100,000, 95%CI; 3470, 7547) regions. In particular, patients on hemodialysis (5611/100,000) and on peritoneal dialysis (3533/100,000) had higher incidence of TB than did renal transplantation patients (2700/100,000) and patients with predialysis CKD (913/100,000). Furthermore, extrapulmonary TB (2227/100,000) was more common than pulmonary TB (1786/100,000). CONCLUSION This study identifies high TB incidence in patients with CKD with regional disparities. Thus, the authors recommend active TB screening in this group of individuals.
Collapse
|
6
|
Makanda-Charambira PD, Nourse P, Luyckx VA, Coetzee A, McCulloch MI. TB in paediatric kidney transplant recipients - A single-centre experience. Pediatr Transplant 2022; 26:e14141. [PMID: 34528349 DOI: 10.1111/petr.14141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/15/2021] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND TB remains a major challenge in transplantation, particularly in endemic countries. This study aimed to describe the incidence, clinical presentation and outcomes of TB in paediatric kidney transplant recipients and to assess the impact of INH prophylaxis. METHODS Single-centre retrospective descriptive analysis of children who received kidney transplants from 1995 to 2019 was carried out. The cohort was stratified according to receipt of INH prophylaxis which began in 2005. RESULTS A total of 212 children received a kidney transplant during the study period. Median age at transplantation was 11.2 years (IQR: 2.2-17.9), and 56% were males. TB was diagnosed in 20 (9%) children, with almost two-thirds (n = 12) occurring within the first year. Most infections were pulmonary. The main presenting symptoms included fever (n = 13/20), weight loss (n = 12/20) and cough (n = 10/20). TST was positive in four of 20 children. Coinfection with EBV, CMV or Staph was found in five children. Due to drug interactions, an up to threefold increase in calcineurin inhibitor dose was required to maintain therapeutic blood levels. INH prophylaxis was protective against development of TB (p = .04). Gender, age and type of allograft were not significant risk factors. Graft and patient survival was 100% upon completion of TB treatment. CONCLUSION Kidney transplant recipients in endemic countries have a high risk of developing TB. Diagnosis remains a challenge. Frequent and meticulous monitoring of immunosuppression drug levels during treatment of TB is required to avoid loss of patient or graft. INH prophylaxis protects against development of TB in this population.
Collapse
Affiliation(s)
| | - Peter Nourse
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Valerie A Luyckx
- Paediatric Nephrology Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ashton Coetzee
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Mignon I McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
7
|
Nasir N, Sarfaraz S, Khanum I, Ansari T, Nasim A, Dodani SK, Luxmi S. Tuberculosis in Solid Organ Transplantation: Insights from TB Endemic Areas. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00756-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
Lwin PW, Htun YY, Myint AK, Swe HK. Posttransplantation tuberculosis management in terms of immunosuppressant cost: a case report in Myanmar. KOREAN JOURNAL OF TRANSPLANTATION 2021; 35:48-52. [PMID: 35769623 PMCID: PMC9235332 DOI: 10.4285/kjt.20.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/26/2021] [Accepted: 02/17/2021] [Indexed: 11/19/2022] Open
Abstract
Drug interactions between anti-tuberculosis and immunosuppressive medications after renal transplantation are a common problem in Myanmar. The efficacy of both types of drugs can be reduced during the treatment period, which can lead to graft failure and flare-ups of infection. Drug adjustments, with frequent monitoring and close follow-up, are crucial in this period. Ketoconazole decreases tacrolimus metabolism by inhibiting cytochrome P450-3A5 enzymes and P-glycoprotein. It is cost effective and has been frequently used to reduce the dose and cost of tacrolimus. Here, we report the case of a 56-year-old male renal transplant recipient with anti-tuberculosis medications.
Collapse
Affiliation(s)
- Phyo Wai Lwin
- Department of Nephrology, University of Medicine, Mandalay, Mandalay, Myanmar
| | - Yi Yi Htun
- Department of Pharmacology, University of Medicine, Mandalay, Mandalay, Myanmar
| | - Aung Kyaw Myint
- Department of Nephrology, Mandalay General Hospital, Mandalay, Myanmar
| | - Htar Kyi Swe
- Department of Nephrology, University of Medicine, Mandalay, Mandalay, Myanmar
| |
Collapse
|
9
|
Felipe-Reyes D, Buitrago-Toro K, Jiménez-Salazar S, Carlos-Alvarez L. Pericarditis tuberculosa en paciente inmunocompetente. Reporte de caso. DUAZARY 2021. [DOI: 10.21676/2389783x.3834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La pericarditis tuberculosa es una rara manifestación extrapulmonar que afecta a menos del 4% de los pacientes con tuberculosis (TB), con alta morbimortalidad ante diagnósticos tardíos, especialmente en aquellos pacientes inmunocomprometidos. Su presentación es inespecífica y la sintomatología deriva de la velocidad de instauración del derrame pericárdico, registrándose casos mortales debido a taponamiento cardiaco. La confirmación diagnóstica se obtiene con la identificación de la micobacteria en muestra de pericardio o líquido pericárdico, con una alta tasa de sospecha fundamentada en pruebas adicionales como la cuantificación del interferón gamma no estimulado, lisozima pericárdica y adenosina desaminasa (ADA) en liquido pericárdico. El tratamiento consiste en una combinación de terapia antituberculosa, drenaje pericárdico, y corticoesteroides como adyuvantes. Se presenta el caso de un varón de 64 años inmunocompetente, fumador frecuente en el pasado, con una alta sospecha diagnostica para TB, confirmada con resultado positivo para ADA (55,8 UI/L) en fluido pericárdico permitiendo iniciar un tratamiento adecuado con mejoría clínica posterior durante el seguimiento.
Collapse
|
10
|
Relvas M, Beco A, Pereira L, Oliveira A, Silvano J, Silva R, Marques N, Santos L, Coentrão L, Pestana M. Clearing the clouds: Case-report and review of the literature. Semin Dial 2020; 34:83-88. [PMID: 33140512 DOI: 10.1111/sdi.12931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In peritoneal dialysis (PD), a cloudy dialysate is an alarming finding. Bacterial peritonitis is the most common cause, however, atypical infections and non-infectious causes must be considered. A 46-year-old man presented with asthenia, paraesthesia, foamy urine and hypertension. Laboratory testing revealed severe azotaemia, anaemia, hyperkalaemia and nephrotic-range proteinuria. Haemodialysis was started through a central venous catheter. Later, due to patient preference, a Tenckhoff catheter was inserted. Conversion to PD occurred 3 weeks later, during hospitalization for a presumed central line infection. A month later, the patient was hospitalized for neutropenic fever. He was diagnosed an acute parvovirus infection and was discharged under isoniazid for latent tuberculosis. Four months later, the patient presented with fever and a cloudy effluent. Peritoneal fluid (PF) cytology was suggestive of infectious peritonitis, but the symptoms persisted despite antibiotic therapy. Bacterial and mycological cultures were negative. No neoplastic cells were detected. Mycobacterium tuberculosis eventually grew in PF cultures, despite previous negative molecular tests. Directed therapy was then initiated with excellent response. Thus, facing a cloudy effluent, one must consider multiple aetiologies. Diagnosis of peritoneal tuberculosis is hampered by the lack of highly sensitive and specific exams. Here, diagnosis was only possible due to positive mycobacterial cultures.
Collapse
Affiliation(s)
- Miguel Relvas
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Ana Beco
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Luciano Pereira
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Ana Oliveira
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - José Silvano
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Rui Silva
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Nídia Marques
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Lurdes Santos
- Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal.,Infectious Diseases Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal
| | - Luís Coentrão
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| | - Manuel Pestana
- Nephrology Department, Centro Hospitalar e Universitário de São João, Oporto, Portugal.,Nephrology & Infectious Diseases R&D, i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Oporto, Portugal
| |
Collapse
|
11
|
Tuberculosis in renal transplant recipients: Our decade long experience with an opportunistic invader. Indian J Tuberc 2019; 67:73-78. [PMID: 32192621 DOI: 10.1016/j.ijtb.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 11/22/2022]
Abstract
AIM To study the incidence, pattern of tuberculosis, Its risk factors, and prognosis in renal transplantation recipients in Indian population. SETTINGS AND DESIGN This study retrospectively analyzed the patients who underwent renal transplantation at Ramaiah medical college Hospitals, India from 2004 to 2015. METHODS AND MATERIAL The study enrolled 244 patients. Diagnosis was based on radio0imaging, sputum smear, culture and polymerase chainreaction and histology. STATISTICAL ANALYSIS USED A descriptive univariate analysis was performed to identify the individual risk factors. RESULTS The TB infection was present in 21/244 (8.6%) renal transplantation patients (mean age ± SD = 44.3 ± 12.9 years). Pulmonary tuberculosis was the commonest (57%) followed by extrapulmonary tuberculosis (43%). Type II diabetes mellitus (DM) (14.6%; p = 0.0169)was significant risk factor. Majority of the patients (n = 18, 10.7%) were on standard tripledrug immunosuppression. The median duration of anti0tubercular therapy was 14 months and crude mortality was 19%. CONCLUSIONS High index of suspicion for tuberculosis is require d in renal transplant recipients owing to their immunocompromised status and atypical presentations. Higher age, DM and use of immunosuppressants increase the risk for post0renal transplantation tuberculosis. Interactions between anti0tubercular drugs and immunosuppressants need to be considered in these patients.
Collapse
|
12
|
Psoriasis: Which therapy for which patient. J Am Acad Dermatol 2019; 80:43-53. [DOI: 10.1016/j.jaad.2018.06.056] [Citation(s) in RCA: 169] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/24/2018] [Accepted: 06/01/2018] [Indexed: 12/17/2022]
|
13
|
Cikova A, Vavrincova-Yaghi D, Vavrinec P, Dobisova A, Gebhardtova A, Flassikova Z, Seelen MA, Henning RH, Yaghi A. Gastrointestinal tuberculosis following renal transplantation accompanied with septic shock and acute respiratory distress syndrome: a survival case presentation. BMC Gastroenterol 2017; 17:131. [PMID: 29179699 PMCID: PMC5704353 DOI: 10.1186/s12876-017-0695-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/20/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Post-transplant tuberculosis (PTTB) is a serious opportunistic infection in renal graft recipients with a 30-70 fold higher incidence compared to the general population. PTTB occurs most frequently within the first years after transplantation, manifesting as pulmonary or disseminated TB. Gastrointestinal TB (GITB) is a rare and potentially lethal manifestation of PTTB and may show delayed onset in renal transplant recipients due to the use of lower doses of immunosuppressants. Further, non-specificity of symptoms and the common occurrence of GI disorders in transplant recipients may delay diagnosis of GITB. CASE PRESENTATION Here we report a rare survival case of isolated GITB in a renal transplant recipient, occurring seven years after transplantation. The patient's condition was complicated by severe sepsis with positive blood culture Staphylococcus haemolyticus, septic shock, multiple organ failure including acute respiratory distress syndrome (ARDS) and acute renal failure, requiring mechanical ventilation, vasopressor circulatory support and intermittent hemodialysis. Furthermore, nosocomial infections such as invasive aspergillosis and Pseudomonas aeruginosa occurred during hospitalization. Antituberculosis therapy (rifampicin, isoniazid, ethambutol and pyrazinamide) was initiated upon Mycobacterium confirmation. Moreover, treatment with voriconazole due to the Aspergillus flavus and meropenem due to the Pseudomonas aeruginosa was initiated, the former necessitating discontinuation of rifampicin. After 34 days, the patient was weaned from mechanical ventilation and was discharged to the pulmonary ward, followed by complete recovery. CONCLUSION This case offers a guideline for the clinical management towards survival of GITB in transplant patients, complicated by septic shock and multiple organ failure, including acute renal injury and ARDS.
Collapse
Affiliation(s)
- Andrea Cikova
- University Hospital Bratislava, Nemocnica Ruzinov, ICU, KAIM, Clinic of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Diana Vavrincova-Yaghi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Odbojarov 10, 832 32 Bratislava, Slovakia
| | - Peter Vavrinec
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Odbojarov 10, 832 32 Bratislava, Slovakia
| | - Anna Dobisova
- University Hospital Bratislava, Nemocnica Ruzinov, ICU, KAIM, Clinic of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Andrea Gebhardtova
- University Hospital Bratislava, Nemocnica Ruzinov, ICU, KAIM, Clinic of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Zora Flassikova
- University Hospital Bratislava, Nemocnica Ruzinov, ICU, KAIM, Clinic of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Mark A. Seelen
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robert H. Henning
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Aktham Yaghi
- University Hospital Bratislava, Nemocnica Ruzinov, ICU, KAIM, Clinic of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| |
Collapse
|
14
|
Barbouch S, Hajji M, Helal I, Ounissi M, Bacha MM, Ben Hamida F, Abderrahim E, Ben Abdallah T. Tuberculosis After Renal Transplant. EXP CLIN TRANSPLANT 2017; 15:200-203. [PMID: 28260468 DOI: 10.6002/ect.mesot2016.p79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tuberculosis is one of the leading infections after renal transplant, particularly in developing countries where the incidence and prevalence in the general population are high. Diagnosis requires bacteriologic and histologic confirmation. Interactions among the antitubercular drugs and the immunosuppressive agents have to be considered while prescribing, and surveillance for adverse effects is required. Although rare, case reports are available on extrapulmonary tuberculosis in allograft recipients. Here, we present a 25-year-old kidney transplant recipient who was diagnosed with lymph node tuberculosis under uncommon circumstances but who had a good outcome. This case report illustrates the difficulties in diagnosis of tuberculosis, changes in therapeutic protocols, and prognostic factors and highlights the effects of infectious complications with immunosuppressive therapy in this particular patient population.
Collapse
Affiliation(s)
- Samia Barbouch
- Nephrology Department, Laboratory of Renal Pathology and Laboratory of Kidney Transplantation Immunology and Immunopathology, Charles Nicolle Hospital, Tunis, Tunisia
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Choi EW, Lee KW, Kim TM, Park H, Jeon MR, Cho CW, Park JB, Kim S. Mycobacterium tuberculosis infections in cynomolgus monkey transplant recipients and institution of a screening program for the prevention and control of tuberculosis. BMC Vet Res 2016; 12:289. [PMID: 27998279 PMCID: PMC5168865 DOI: 10.1186/s12917-016-0898-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/28/2016] [Indexed: 11/12/2022] Open
Abstract
Background Tuberculosis is a major health concern in not only humans, but also in non-human primates. In this paper, we report recent cases of Mycobacterium tuberculosis in cynomolgus monkeys from Cambodia used in transplantation research in a Korean facility and describe a program instituted to prevent and control subsequent infections. Case presentation All monkeys were antibody negative for tuberculosis during quarantine; however, suspected tuberculosis gross lesions were observed in two cynomolgus monkeys who underwent allograft kidney transplantation. Lung tissue from one monkey was found to be weakly positive by PCR for detection of M. tuberculosis. After PCR confirmation of tuberculosis, we decided to sacrifice the remaining animals and instituted a program for preventing subsequent infections. During necropsy of the remaining monkeys, two additional suspected tuberculosis cases were observed. A total of four monkeys with nodular lesions in the respiratory tract, suspected to be tuberculosis, demonstrated no clinical signs. Acid-fast bacilli were identified on slides from the lung or liver in all four monkeys. Two of four monkeys tested PCR positive. We decided that new monkeys entering from Cambodia should undergo a single gastric aspiration PCR and tuberculin skin testing (TST) every 2 weeks until four consecutive negatives to detect latent tuberculosis are obtained before starting experiments. Monkeys should then undergo a chest X-ray monthly and TST every 6 months. Conclusions Detection of latent tuberculosis by an effective preventive screening program before starting experiments is an essential process to reduce the risk of reactivation of tuberculosis, especially in studies using immunosuppressive drugs. It also serves to protect the health of captive non-human primates, their caretakers and researchers.
Collapse
Affiliation(s)
- Eun Wha Choi
- Laboratory Animal Research Center, Samsung Biomedical Research Institute, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Kyo Won Lee
- Department of Surgery, Division of Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.,Transplantation Research Center, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Tae Min Kim
- Laboratory Animal Research Center, Samsung Biomedical Research Institute, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Hyojun Park
- Department of Surgery, Division of Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.,Transplantation Research Center, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Mi Ri Jeon
- Department of Surgery, Division of Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.,Transplantation Research Center, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Chan Woo Cho
- Department of Surgery, Division of Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.,Transplantation Research Center, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae Berm Park
- Department of Surgery, Division of Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.,Transplantation Research Center, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Sungjoo Kim
- Department of Surgery, Division of Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea. .,Transplantation Research Center, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
16
|
Amin-Beidokhty A, Norouzi Z, Amiri A, Almasian M, Azadi A, Kheirollahi AR. Pericardial tuberculosis with an emphasis on empiric therapy in endemic areas for tuberculosis (a case report). Int J Mycobacteriol 2016; 5:360-365. [PMID: 27847027 DOI: 10.1016/j.ijmyco.2016.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 11/18/2022] Open
Abstract
Pericardial tuberculosis (TB) is rare, but has particularly severe complications and a high mortality rate when not treated. Prompt treatment of pericardial TB is important and can be life-saving. We report a 13-year-old girl with massive pericardial effusion and negative workup for TB, who was empirically treated with an excellent response.
Collapse
Affiliation(s)
- Arash Amin-Beidokhty
- Department of Cardiology, Lorestan University of Medical Sciences, Khorramabad, Lorestan, Iran
| | - Zeinab Norouzi
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Lorestan, Iran.
| | - Ali Amiri
- Lorestan University of Medical Sciences, Clinical Research Center, Ashayer Hospital, Khorramabad, Lorestan, Iran
| | - Mohammad Almasian
- School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Lorestan, Iran
| | - Abbas Azadi
- Department of Infectious Disease, Lorestan University of Medical Sciences, Khorramabad, Lorestan, Iran
| | - Abdol-Reza Kheirollahi
- Department of Urology, Urology and Nephrology Research Center, Lorestan University of Medical Sciences, Khorramabad, Lorestan, Iran
| |
Collapse
|