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Background: On the basis of recent clinical trial data for the treatment of drug-susceptible and drug-resistant tuberculosis (TB), the American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America have updated clinical practice guidelines for TB treatment in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among...
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Background Tuberculosis (TB) is a common infection in chronic kidney disease. The prolonged therapy of TB can delay kidney transplantation in patients on antitubercular therapy (ATT). Methods This was a retrospective single-center study to analyze the safety of kidney transplantation and its outcomes in patients undergoing transplantation while on the continuation phase of ATT. Results Between 2013 and 2022, 30 patients underwent kidney transplantation while on ATT. Median age was 38 years...
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Background. Despite being a common infection in end-stage kidney disease patients, there are no evidence-based guidelines to suggest the ideal time of transplantation in patients on antitubercular therapy (ATT). This study aimed to examine the outcome of transplantation in patients while on ATT compared with those without tuberculosis (TB). Methods. This was a retrospective study. Renal transplant recipients transplanted...
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Background Testing and treatment for latent tuberculosis infection (LTBI) can mitigate risk of active tuberculosis (TB) post-liver transplant (LT). Testing and treatment completion rates have been reported low in this population. Our study aims to quantify the proportion of LT candidates who completed LTBI care cascade in our center. Methods A retrospective chart review was conducted on LT candidates from 2012 to 2021. Primary outcome was the proportion of patients who completed each cascade...
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Background: The best approach to tuberculosis (TB) treatment in transplanted patients is still unknown. Current guidelines are based on evidence either extrapolated from other populations or observational. Rifampin-containing regimens have strong pharmacokinetic interactions with immunosuppressive regimens, with high rates of organ dysfunction and ∼20% mortality. This report describes the results obtained using non-rifampin-containing regimens to treat confirmed TB in adult patients with kidney/kidney–pancreas transplantation.
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Tuberculosis (TB) is a major infectious complication in hematopoietic stem cell transplant (HSCT) recipients in countries with high TB prevalence. Identifying and treating latent tuberculosis infection (LTBI) helps to prevent TB reactivation after transplantation. Few studies have compared the tuberculin skin test (TST) with interferon Gamma release assays (IGRA) to diagnose LTBI in HSCT candidates. We compared TST and QuantiFeron TB gold in tube (QTF-GIT) and prospectively evaluated the...
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This chapter reviews the epidemiology, clinical impact, diagnosis, prevention, and management of tuberculosis (TB) in solid organ and hematopoietic stem cell transplantation. Given the limitations of screening for latent TB using either the tuberculin skin test or interferon gamma release assays, it is important to also consider exposure history and chest imaging; promising new TB diagnostic strategies are currently under development. The clinical manifestations of active tuberculosis in...
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These updated 2020 latent tuberculosis infection treatment guidelines include the recommended treatment regimens that comprise three preferred rifamycin-based regimens and two alternative monotherapy
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Background: The American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America jointly sponsored this new practice guideline on the treatment of drug-resistant tuberculosis (DR-TB). The document includes recommendations on the treatment of multidrug-resistant TB (MDR-TB) as well as isoniazid-resistant but rifampin-susceptible TB.Methods: Published systematic reviews, meta-analyses, and a new individual...
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Solid organ transplantation (SOT) is the best treatment option for end-stage organ disease. Newer immunosuppressive agents have reduced the incidence of graft rejection but have increased the risk of infection, particularly due to the reactivation of latent infections due to opportunistic agents such as Mycobacterium tuberculosis. Active tuberculosis (TB) after SOT is a significant cause of morbidity and mortality. Most cases of posttransplant TB are secondary to reactivation of latent...
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Reactivation of latent tuberculosis following solid organ transplantation has serious consequences for the recipient. The most useful diagnostic test for latent TB is not clear. We conducted a systematic review and meta-analysis to assess the relative test performance of interferon gamma release assays (IGRAs) and the tuberculin skin test (TST) in people undergoing solid organ transplantation. The clinical or radiological risk factors were used as the proxy reference standard. Test...
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Mycobacterial disease is commonly encountered during transplant evaluations and can be a major source of morbidity and mortality among transplant recipients. The impact of TB and NTM around the world has gained increased awareness, and the global impact of disease varies from country to country thus making mycobacterial epidemiology an important aspect of disease management. Risk factors for both tuberculosis (TB) and nontuberculous mycobacteria (NTM) must be assessed by transplant...
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This chapter will review the basic biology of Mycobacterium tuberculosis and then focus on the epidemiology, clinical manifestations, and diagnosis in transplant patients. Prevention and treatment will be considered elsewhere. Tuberculosis (TB) remains a leading cause of human mortality in resource-limited settings, in part because it is still a diagnostic and treatment challenge. These challenges are compounded in immunocompromised hosts such as transplant patients because the performance...
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