Nontuberculous Mycobacterial Infection in Hematopoietic Stem Cell and Solid Organ Transplant Recipients

• Published in: Clinical infectious diseases 2004-05, Vol.38 (10), p.1428-1439
• Main Authors: Doucette, Karen, Fishman, Jay A.
• Format: Article
• Language: English
• Subjects: Adult; Bacterial diseases; Biological and medical sciences; Female; Fungal infections; Fungal lung diseases; Graft vs host disease; Hematopoietic Stem Cell Transplantation - adverse effects; Human bacterial diseases; Human viral diseases; Humans; Immunocompromised Hosts; Infections; Infectious diseases; Liver Transplantation - adverse effects; Lung diseases; Lungs; Medical sciences; Mycobacterium; Mycobacterium avium; Mycobacterium avium Complex; Mycobacterium Infections - diagnosis; Mycobacterium Infections - therapy; Nocardia; Prognosis; Skin diseases; Transplantation; Tuberculosis and atypical mycobacterial infections; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/420746

Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms. In immunocompetent hosts, they are a rare cause of disease. In immunocompromised hosts, disease due to NTM is well documented. Reports of NTM disease have increased in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. This increase may reflect increased numbers of transplants, intensification of immune suppressive regimens, prolonged survival of transplant recipients, and/or improved diagnostic techniques. The difficulty of diagnosis and the impact associated with infections due to NTM in HSCT and SOT recipients necessitates that, to ensure prompt diagnosis and early initiation of therapy, a high level of suspicion for NTM disease be maintained. The most common manifestations of NTM infection in SOT recipients include cutaneous and pleuropulmonary disease, and, in HSCT recipients, catheter-related infection. Skin and pulmonary lesions should be biopsied for histologic examination, special staining, and microbiologic cultures, including cultures for bacteria, Nocardia species, fungi, and mycobacteria. Mycobacterial infections associated with catheters may be documented by tunnel or blood (isolator) cultures. Susceptibility testing of mycobacterial isolates is an essential component of optimal care. The frequent isolation of NTM other than Mycobacterium avium complex (MAC) from transplant recipients limits the extrapolation of therapeutic data from human immunodeficiency virus-infected individuals to the population of transplant recipients. Issues involved in the management of NTM disease in transplant recipients are characterized by a case of disseminated infection due to Mycobacterium avium complex in a lung transplant recipient, with a review of the relevant literature.