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TB in HSCT
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The following forms of EPTB are
classified as severe: meningeal,
pericardial, peritoneal, bilateral or
extensive pleural effusive, spinal,intestinal, genitourinary.
Lymph node, pleural effusion (unilateral),
bone (excluding spine), peripheral joint
and skin tuberculosis are classified as
less severe.
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Characteristics of TB in SCT
patients Limited information on the epidemiology and
characteristics of TB, and on the clinical manifestationsof TB in SCT patients.
TB in HSCT patients is mainly due to reactivation oflatent infection.
The data show that the ratio of TB in allogeneic SCTpatients correlates with the countrys TB rate
No increased risk of TB in autologous SCT patients
GVHD can be a risk factor for TB. The ratios of acuteand chronic GVHD are 63.8% and 34%, respectively, inSCT patients with TB
Most cases are diagnosed after day 100
Pulmonary TB is the most common localization (84%),but approximately 15% of cases had extrapulmonary TB
such as renal, bone marrow, central nervous system andeven knee
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Data from the USA show that theincidence of Mycobacterium infectionamong HSCT recipients ranges from
0.0014% to 3%. Countries in which the prevalence of TB in
the general population is higher than in the
USA have reported varying incidences 1.6%in Spain and Turkey to 8.57% in HongKong and Taiwan and 16% in Pakistan
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Most of the reports of TB were from Asia (48%)
The incidence of TB varied from 0.0014% (USA) to 16%(Pakistan)
Lung was the organ most frequently involved
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Microbiology
More than half the cases were diagnosed
with culture (55%)
Histology is the second most commonapproach (20.3%)
AFB smear was responsible for 26% of
diagnoses.
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Radiology
Most common abnormalities were air
space consolidation (100%) and nodules
(80%)
Chest CT scans (n = 7): the most common
parenchymal lesions were consolidation
(100%), nodules (71%), tree-in-bud
appearance (43%), and ground-glassopacity (43%)
J Thorac Imaging 2009;1:106
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Patients are treated using standard drugsand there are no reports of drug-resistant
TB in SCT patients.
The response to therapy was satisfactory. Ninety-one percent of patients were
diagnosed and treated, and five cases
were diagnosed post mortem (9%). Tendeaths were reported due to TB (18.5%).
Journal of Hospital Infection (2006) 62, 421426
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The survey of EBMT-IDWP mycobacterial
infections in SCT patients To obtain information about the frequency,
presentation and treatment of mycobacterialinfection in SCT recipients between 1994 and1998.
Thirty-nine centres responded and 31mycobacterial infections were reported, 20 ofwhich were TB.
TB was diagnosed in 0.92% of 1513 allogeneictransplant patients and 0.20% of 3012
autologous transplant patients. Infection was highest after matched unrelated
and mismatched family transplants.
Five patients died, all following allogeneic SCT
Clin Infect Dis 2004;38:12291236.
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Some risk factors were defined, such as historyof previous TB, a positive PPDO15 mm, GVHD,T-cell depletion, corticosteroids, matchedunrelated and mismatched transplants and total
body irradiation No increased risk of developing TB was reported
in autologous SCT patients.
There is no need for INH prophylaxis in
autologous SCT patients, and there is notenough evidence to support prophylaxis forallogeneic SCT patients.
Clin Infect Dis 2004;38:12291236.
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Thank You