The use of cyclosporine modifies the clinical and histopathological presentation of tuberculosis after renal transplantation

Tuberculosis is one of the most frequent opportunistic infections after renal transplantation and occurred in 30 of 1264 patients transplanted between 1976 and 1996 at Hospital São Paulo - UNIFESP and Hospital Dom Silvério, Brazil. The incidence of 2.4% is five times higher than the Brazilian genera...

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Published in:Revista do Instituto de Medicina Tropical de São Paulo 2000-08, Vol.42 (4), p.225-230
Main Authors: Biz, E, Pereira, C A, Moura, L A, Sesso, R, Vaz, M L, Silva Filho, A P, Pestana, J O
Format: Article
Language:English
Subjects:
Adolescent
Adult
Brazil - epidemiology
Cyclosporine
Cyclosporine - administration & dosage
Female
Humans
Immunosuppressive Agents - administration & dosage
Incidence
Kidney Transplantation
Male
Middle Aged
Opportunistic Infections - epidemiology
Opportunistic Infections - pathology
Postoperative Period
Renal transplantation
Retrospective Studies
Steroids
TROPICAL MEDICINE
Tuberculosis
Tuberculosis - epidemiology
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Summary:Tuberculosis is one of the most frequent opportunistic infections after renal transplantation and occurred in 30 of 1264 patients transplanted between 1976 and 1996 at Hospital São Paulo - UNIFESP and Hospital Dom Silvério, Brazil. The incidence of 2.4% is five times higher than the Brazilian general population. The disease occurred between 50 days to 18 years after the transplant, and had an earlier and worse development in patients receiving azathioprine, prednisone and cyclosporine, with 35% presenting as a disseminated disease, while all patients receiving azathioprine and prednisone had exclusively pulmonary disease. Ninety percent of those patients had fever as the major initial clinical manifestation. Diagnosis was made by biopsy of the lesion (50%), positivity to M. tuberculosis in the sputum (30%) and spinal cerebral fluid analysis (7%). Duration of treatment ranged from 6 to 13 months and hepatotoxicity occurred in 3 patients. The patients who died had a significant greater number of rejection episodes and received higher doses of corticosteroid. In conclusion, the administration of cyclosporine changed the clinical and histopathological pattern of tuberculosis occurring after renal transplantation.
ISSN:0036-4665
1678-9946
0036-4665
1678-9946
DOI:10.1590/S0036-46652000000400008