Risk factors for pulmonary tuberculosis in bone marrow transplant recipients

• Published in: American journal of respiratory and critical care medicine 1998-10, Vol.158 (4), p.1173-1177
• Main Authors: IP, M. S. M, YUEN, K. Y, WOO, P. C. Y, LUK, W. K, TSANG, K. W. T, LAM, W. K, LIANG, R. H. S
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antitubercular Agents - therapeutic use; Biological and medical sciences; Biopsy; Bone Marrow Transplantation - adverse effects; Bone Marrow Transplantation - immunology; Bone marrow, stem cells transplantation. Graft versus host reaction; Case-Control Studies; Chronic Disease; Cough - physiopathology; Evaluation Studies as Topic; Female; Fever - physiopathology; Graft vs Host Disease - complications; Graft vs Host Disease - immunology; Humans; Incidence; Lung - diagnostic imaging; Lung - microbiology; Lung - pathology; Male; Medical sciences; Mycobacterium tuberculosis; Mycobacterium tuberculosis - immunology; Mycobacterium tuberculosis - isolation & purification; Prospective Studies; Radiography; Risk Factors; Sputum - microbiology; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Homologous; Tuberculosis, Pulmonary - diagnostic imaging; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - etiology; Tuberculosis, Pulmonary - immunology; Tuberculosis, Pulmonary - physiopathology; Whole-Body Irradiation - adverse effects
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.158.4.9712072

Little is known about the profile of infection with Mycobacterium tuberculosis in bone marrow transplant (BMT) recipients. Of five BMT series with a total of more than 5,000 patients, only 10 cases of M. tuberculosis infection were described, with an overall incidence of 0.19%. We have conducted a prospective evaluation of 183 consecutive BMT recipients, and 10 patients were found to develop pulmonary tuberculosis post-BMT, yielding an incidence of 5.5%. We described the clinical features of these 10 patients, and analyzed the risk factors for development of tuberculosis using age- and sex-matched case control subjects who did not develop the disease. The median age of the 10 patients who developed tuberculosis was 29 yr (range, 17 to 40 yr). The median time for onset of symptoms was 150 d (range, 23 to 550 d), mainly presenting with fever and cough, with infiltrates on chest radiograph. Respiratory tract specimens, mostly sputum, yielded positive smears for acid-fast bacilli in three and positive M. tuberculosis culture in eight, whereas lung tissue histology was the first diagnostic test in two patients. Treatment with standard antituberculosis drugs for a longer duration was highly effective, with no excessive side effects. Risk factors identified for development of tuberculosis included allogeneic BMT (p < 0.05, relative risk [RR] = 23.7), total body irradiation (p < 0. 05, RR = 4.9), and chronic graft-versus-host disease (GVHD) (p < 0. 05, RR = 3.6). It is postulated that chronic GVHD predisposed to development of tuberculosis mainly via disruption of host reconstitution of immune defenses against M. tuberculosis.