Tuberculosis in allogeneic stem cell transplant recipients: still a problem in the 21st century.
Tuberculosis in allogeneic stem cell transplant recipients: still a problem in the 21st century.
复制标题
DOI：
10.1111/j.1399-3062.2004.00068.x
复制
发表时间：
2004-12-01
期刊：
影响因子：
--
通讯作者：
Hertzberg, M S
中科院分区：
文献类型：
--
作者：
Erdstein, A A;Daas, P;Hertzberg, M S
异基因干细胞移植(ASCT)受者因其预适应方案、免疫抑制治疗和移植物抗宿主病(GVHD)而严重损害细胞免疫。因此，他们容易受到细菌、病毒和真菌的感染。分枝杆菌感染也可能发生在这些患者身上，尽管发病率并不高，即使在结核病(TB)常见的国家也是如此。我们描述了来自我们医院的四名患者，他们在移植后3年多的时间里发生了肺部T结核感染。在此期间，共有127名患者接受了ASCT，结核病发病率为2.3%。移植前诊断为急性髓系白血病3例，慢性髓系白血病1例。所有四名患者都接受了环孢素和皮质类固醇的联合治疗，以治疗急性和/或慢性移植物抗宿主病。四名患者中有三名出生在澳大利亚以外，每个人都来自结核病流行的地区。2例患者在开始抗结核治疗后2周内死亡，3例存活良好，4例住院4个月后死于多器官功能衰竭和脓毒症。在评估ASCT接受者，特别是那些出生在结核病常见或流行地区的人时，需要对以前接触和感染结核病的人进行更高的怀疑指数。
Allogeneic stem cell transplant (ASCT) recipients have severely impaired cell-mediated immunity as a result of their conditioning regimen, immunosuppressive therapy, and graft-versus-host disease (GVHD). Accordingly, they are susceptible to bacterial, viral, and fungal infections. Mycobacterial infections can also occur in these patients, although the incidence is not high, even in countries where tuberculosis (TB) is common. We describe four patients from our hospital who developed pulmonary T tuberculous infection in the post-transplant period over a 3-year period. During that time a total of 127 patients have undergone an ASCT, representing an incidence of TB of 2.3%. The pretransplant diagnosis was acute myeloid leukemia in three patients and chronic myeloid leukemia in one case. All four patients were treated with a combination of cyclosporine and corticosteroids for acute and/or chronic GVHD. Three of the four patients were born outside Australia, each from an area where TB is endemic. Two patients died within 2 weeks of the commencement of antituberculous therapy, the third is alive and well, and the fourth died of multi-organ failure and sepsis after 4 months in hospital. A higher index of suspicion of previous TB exposure and infection is required in the assessment of ASCT recipients, particularly in those born in areas where TB is common or endemic.