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Article: Tuberculosis in blood and marrow transplant recipients

TitleTuberculosis in blood and marrow transplant recipients
Authors
Issue Date2002
PublisherJohn Wiley & Sons Ltd. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jhome/3182
Citation
Hematological Oncology, 2002, v. 20 n. 2, p. 51-62 How to Cite?
AbstractAlthough one third of the world's population is infected with tuberculosis (TB), TB in blood and marrow transplant (BMT) recipients is relatively less well studied, as the incidence of TB is relatively low in developed countries with BMT units. Since the report of the first two cases in 1983, 52 cases of TB complicating BMT have been reported in the English literature from BMT centers in ten different countries. Not unexpectedly, the two largest series were reported from areas with a high incidence of TB in the general population, with about 45 cases per 105 inhabitants per year in Spain and about 100 cases per 105 inhabitants per year in Hong Kong respectively. The overall frequency of occurrence of TB in BMT recipients was 0.4% (52 cases among 13 881 BMT recipients), with a male:female ratio of 11:9 and median age of 33 (range 7-57). The incidence of TB in the general population is a major predictor of a higher frequency of occurrence in BMT recipients. Moreover, allogeneic transplantation, graft-versus-host disease, and total body irradiation were found to be risk factors associated with TB. Among the 48 cases in whom the time of manifestation were reported, only one case manifested during the neutropenic period (day 11). On the other hand, 11 cases (23%) manifest after engraftment but before day 100, and 36 (75%) manifest after day 100. The most important aspect towards making the diagnosis is a high index of suspicion, as TB occurred in relatively low frequencies especially in developed countries, and the clinical patterns usually mimic other more common infectious and non-infectious complications after BMT. As the incidence of drug resistant TB is increasing, we prefer to treat our patients for at least one year (as compared with six months in immunocompetent hosts) with four drugs in the first six months and two or three drugs for another six months. In those patients who could not tolerate oral medication, we used an intravenous regimen of rifampicin, ciprofloxacin, and amikacin until oral therapy could be instituted. The absence of relapse after termination of treatment in our patients suggested that secondary prophylaxis would not be necessary as long as immune function has been restored. With the rising incidence of TB in countries that previously enjoyed a very low prevalence of TB, attributed to the growing population of HIV-infected subjects with TB, and the changing patterns of population migration, it is important to bear a high index of suspicion of Mycobacterium tuberculosis as a pathogen in BMT recipients. Copyright © 2001 John Wiley & Sons, Ltd.
Persistent Identifierhttp://hdl.handle.net/10722/79256
ISSN
2015 Impact Factor: 3.494
2015 SCImago Journal Rankings: 0.767
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorYuen, KYen_HK
dc.contributor.authorWoo, PCYen_HK
dc.date.accessioned2010-09-06T07:52:28Z-
dc.date.available2010-09-06T07:52:28Z-
dc.date.issued2002en_HK
dc.identifier.citationHematological Oncology, 2002, v. 20 n. 2, p. 51-62en_HK
dc.identifier.issn0278-0232en_HK
dc.identifier.urihttp://hdl.handle.net/10722/79256-
dc.description.abstractAlthough one third of the world's population is infected with tuberculosis (TB), TB in blood and marrow transplant (BMT) recipients is relatively less well studied, as the incidence of TB is relatively low in developed countries with BMT units. Since the report of the first two cases in 1983, 52 cases of TB complicating BMT have been reported in the English literature from BMT centers in ten different countries. Not unexpectedly, the two largest series were reported from areas with a high incidence of TB in the general population, with about 45 cases per 105 inhabitants per year in Spain and about 100 cases per 105 inhabitants per year in Hong Kong respectively. The overall frequency of occurrence of TB in BMT recipients was 0.4% (52 cases among 13 881 BMT recipients), with a male:female ratio of 11:9 and median age of 33 (range 7-57). The incidence of TB in the general population is a major predictor of a higher frequency of occurrence in BMT recipients. Moreover, allogeneic transplantation, graft-versus-host disease, and total body irradiation were found to be risk factors associated with TB. Among the 48 cases in whom the time of manifestation were reported, only one case manifested during the neutropenic period (day 11). On the other hand, 11 cases (23%) manifest after engraftment but before day 100, and 36 (75%) manifest after day 100. The most important aspect towards making the diagnosis is a high index of suspicion, as TB occurred in relatively low frequencies especially in developed countries, and the clinical patterns usually mimic other more common infectious and non-infectious complications after BMT. As the incidence of drug resistant TB is increasing, we prefer to treat our patients for at least one year (as compared with six months in immunocompetent hosts) with four drugs in the first six months and two or three drugs for another six months. In those patients who could not tolerate oral medication, we used an intravenous regimen of rifampicin, ciprofloxacin, and amikacin until oral therapy could be instituted. The absence of relapse after termination of treatment in our patients suggested that secondary prophylaxis would not be necessary as long as immune function has been restored. With the rising incidence of TB in countries that previously enjoyed a very low prevalence of TB, attributed to the growing population of HIV-infected subjects with TB, and the changing patterns of population migration, it is important to bear a high index of suspicion of Mycobacterium tuberculosis as a pathogen in BMT recipients. Copyright © 2001 John Wiley & Sons, Ltd.en_HK
dc.languageengen_HK
dc.publisherJohn Wiley & Sons Ltd. The Journal's web site is located at http://www3.interscience.wiley.com/cgi-bin/jhome/3182en_HK
dc.relation.ispartofHematological Oncologyen_HK
dc.rightsHematological oncology. Copyright © John Wiley & Sons Ltd.en_HK
dc.subject.meshAdulten_HK
dc.subject.meshAmikacin - therapeutic useen_HK
dc.subject.meshAnti-Bacterial Agents - therapeutic useen_HK
dc.subject.meshBlood Transfusion - adverse effectsen_HK
dc.subject.meshBone Marrow Transplantation - adverse effectsen_HK
dc.subject.meshCiprofloxacin - therapeutic useen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshGraft vs Host Disease - etiologyen_HK
dc.subject.meshHumansen_HK
dc.subject.meshIncidenceen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMycobacterium tuberculosis - isolation & purificationen_HK
dc.subject.meshRifampin - therapeutic useen_HK
dc.subject.meshRisk Factorsen_HK
dc.subject.meshTuberculosis - drug therapy - epidemiology - etiologyen_HK
dc.subject.meshWhole-Body Irradiationen_HK
dc.titleTuberculosis in blood and marrow transplant recipientsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0278-0232&volume=20&spage=51&epage=62&date=2002&atitle=Tuberculosis+in+blood+and+marrow+transplant+recipientsen_HK
dc.identifier.emailYuen, KY:kyyuen@hkucc.hku.hken_HK
dc.identifier.emailWoo, PCY:pcywoo@hkucc.hku.hken_HK
dc.identifier.authorityYuen, KY=rp00366en_HK
dc.identifier.authorityWoo, PCY=rp00430en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1002/hon.681en_HK
dc.identifier.pmid12111868-
dc.identifier.scopuseid_2-s2.0-0036080188en_HK
dc.identifier.hkuros80169en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036080188&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume20en_HK
dc.identifier.issue2en_HK
dc.identifier.spage51en_HK
dc.identifier.epage62en_HK
dc.identifier.isiWOS:000176334100001-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridYuen, KY=36078079100en_HK
dc.identifier.scopusauthoridWoo, PCY=7201801340en_HK

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