1448. Socio-demographic and clinical characteristic of Tuberculosis in Tor Vergata Hospital, Rome: a 9-years analysis

Background

Tuberculosis (TB) represents one of the major global health problems worldwide. Italy is a low-incidence country for TB with a prevalence of 23% of extrapulmonary forms (EPTB). Migrants coming from high TB incidence country might modify local epidemiology.

Methods

We conducted a retrospective, single-center observational study including data from patients with an active TB diagnosis, admitted to the Infectious Diseases Department of Tor Vergata Hospital, Rome, from 2013 to 2021

Results

The study included 210 patients with a median age of 38 years (IQR 36-46), 77% were male, 74% were not Italians (31% Africans,26% East-Europeans,11% Asian and 6% Latin Americans)

28% of patients were immunocompromised: 5.7% tested positive for HIV, 4.7% were on immunosuppressive treatment with anti-TNF drugs, 4.7% had onco-hematological diseases, 15.7% had severe malnutrition. PPD, performed in 90 patients, resulted positive in 77; QuantiFERON-TB Gold (QTF), performed in 187 patients, resulted positive in 149, indeterminate in 9 and negative in 29 patients. 43% of patients presented with EPTB, of whom 38 had lymph node TB, 24 bone TB, 20 pleural TB, 17 abdominal TB, 9 central nervous system TB and 23 were disseminated TB (≥3 systems involved). EPTB forms, compared to pulmonary TB (PTB), were significantly more common in males (p=0.027), of younger age (p< 0.001), from Africa and Asia (p< 0.01). Immunosuppression was not significantly associated with EPTB. Lymphocytes and monocytes absolute count were significantly lower in patients with EPTB, compared to PTB (Fig. 1). Lymphocyte subpopulations were analyzed in 89 patients, showing a significantly lower CD4 count in patients with EPTB, compared to PTB (p=0.006) (Fig. 2). QTF tube 2 titer was higher in the EPTB forms (p=0.024), no association was found with QTF tube 1 (p=0.069) and QTF mitogen (p=0.118) with TB localization. (Fig.3) QTF negativity rate was higher in patients with EPTB (p=0.063).

Lymphocytes and monocytes in extrapulmonary TB (E) and pulmonary TB (P)

Analysis of lymphocytes subpopulations in extrapulmonary TB (E) and pulmonary TB (P)

Analysis of Quanti-FERON titer in extrapulmonary TB (E) and pulmonary TB (P)

Conclusion

In our cohort, there was a high prevalence of EPTB (43%), mainly diagnosed in young, otherwise healthy men from high-endemic areas, highlighting the connection of EPTB with socio-demographic determinants. Although QFT negativity rate was higher in EPTB patients, a prudent interpretation of QFT might be needed in patients with high suspicion of EPTB.

Disclosures

All Authors: No reported disclosures.

1438. Latent tuberculosis infection (LTBI) in hematopoietic stem cell transplantation (HSCT) recipients: a retrospective Italian cohort study in Tor Vergata University Hospital, Rome

Background

Patients undergoing haematopoietic stem cell transplantation (HSCT) have severe and prolonged immunodeficiency and the incidence of tuberculosis (TB) disease in those patients is 10 to 40 times higher than the general population

Methods

This retrospective study performed at Tor Vergata University Hospital in Rome (Italy) included all adult patients who underwent a HSCT in the Hematologic Transplant Unit from January 2015 to December 2019. Data on TB screening, performed through interferon-γ release assay (IGRA), were collected; patients were observed for TB reactivation in a follow up period of at least 3 years

Results

323 HSCT recipients were enrolled in this study. Patients’ characteristics are summarized in table 1. 63 patients (19.5%) were not screened for TB, of which 6.3% were born overseas. 260 HSCT recipients (80.5%) were screened: 228 patients (87.7%) had a negative IGRA result, 21 (8.1%) tested positive, and 11 (4.2%) had an indeterminate result. 98.5% were screened before the HSCT. Of the 21 patients with a positive pre-HSCT IGRA test, 14 (66.7%) were males and significantly (p< 0.001) older (median age 60 [IQR] 58-65 years) than those with negative or indeterminate results. Almost all patients (95.2%) were Italian. Patients with a positive IGRA showed a higher monocyte count compared to the other groups (p=0.044), while those with indeterminate IGRA showed a tendence to lower lymphocyte absolute counts, compared to the other groups (p=0.060) (Table 2).

All the 21 patients with a pre-HSCT positive IGRA test were radiologically and clinically screened for active TB and, once it was ruled out, treated for latent TB (LTBI) with isoniazid (INH) for 6 months. No events of toxicity or treatment interruption were reported. None of the patients was treated with rifampin. None of the 21 patients with pre-HSCT positive IGRA test developed active TB during the follow up period. Table 1.