Fatal primary multidrug-resistant tuberculosis in a heart transplant recipient

The incidence of tuberculosis (TB) worldwide is currently on the rise, not only in the general population but also quite notably among immunosuppressed patients. Its incidence among patients undergoing antirejection therapy is considerably higher than in the general population, and heart transplant...

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Bibliographic Details
Published in:Transplant international 1998-07, Vol.11 (4), p.305-307
Main Authors: DI PERRI, G, LUZZATI, R, FORNI, A, ALLEGRANZI, B, CAZZADORI, A, BONORA, S, MAZZUCCO, A, CONCIA, E
Format: Article
Language:English
Subjects:
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
Fatal Outcome
Heart Transplantation - adverse effects
Humans
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Tuberculosis, Multidrug-Resistant - etiology
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Summary:The incidence of tuberculosis (TB) worldwide is currently on the rise, not only in the general population but also quite notably among immunosuppressed patients. Its incidence among patients undergoing antirejection therapy is considerably higher than in the general population, and heart transplant recipients have been found to carry the highest risk of TB. There are no reported data, however, on primary TB caused by multidrug-resistant (MDR) Mycobacterium tuberculosis (M. tuberculosis) in heart transplant recipients. We describe the case of a patient who developed active primary MDR TB following the reactivation of a latent tuberculous infection 6 months after transplantation. The patient was most likely infected by M. tuberculosis during a period of time he spent in prison 10 years before undergoing transplantation, but he never developed active tuberculosis, nor did he ever receive antituberculous medication prior to transplantation. Because of the atypical clinical presentation, establishment of the diagnosis was postponed, and the resistance pattern of the isolate grown from bronchoalveolar lavage (BAL) specimens (resistant to isoniazid and rifampicin) led to treatment failure and a fatal outcome. The adoption of the most rapid diagnostic tools for the identification of M. tuberculosis and for a quick screening of drug-resistant isolates is urgently needed in those centers where organ transplantation is carried out.
ISSN:0934-0874
1432-2277
DOI:10.1007/s001470050147