Immunosuppressants
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Mycobacterium tuberculosis: 14 case reports In a nested case control study of 730 patients, who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) between January 2012 and December 2017 for various haematological diseases, 14 patients (4 women, 1 girl and 9 men) aged 9 years–60 years were described, who developed Mycobacterium tuberculosis (pulmonary or spine or lymph node tuberculosis) following immunosuppressant therapy with ciclosporin, methotrexate, prednisone, tacrolimus, etanercept, ruxolitinib or basiliximab [dosages, routes and durations of treatments to reactions onsets not stated]. The patients with acute lymphoblastic leukaemia (3 patients), acute myeloid leukaemia (AML, 8 patients), chronic myeloid leukaemia (1 patient), non-Hodgkin’s lymphoma (1 patient) or hybrid acute leukaemia (1 patient) underwent allo-HSCT. Prior to the transplantation all the patients received graft-versus-host disease (GVHD) prophylaxis with ciclosporin [cyclosporin A] and shortterm methotrexate. Following the transplantation patients received immunosuppressive therapy with prednisone (14 patients) along with ciclosporin (5 patients) or tacrolimus (FK506; 9 patients). Seven patients also received second line immunosuppressive therapy with etanercept (3 patients), etanercept and ruxolitinib (1 patient) or etanercept and basiliximab [simulect] (3 patients). During the treatment patients developed symptoms of fever, cough, lumbar soas abscess, emaciation, lymphadenectasis, expectoration, hemoptysis, hyperthermia, breathlessness, perinephric abscess, night sweat, chest pain or pericardial effusion. Based on interferon-gamma release assays such as T-SPOT.TB, biopsy or sputum smear findings and the symptoms, all the patients were diagnosed with Mycobacterium tuberculosis at a duration of 43 days–909 days after the transplantation. Twelve patients out of the 14 patients were diagnosed with pulmonary tuberculosis, while the other 2 patients were diagnosed with extrapulmonary tuberculosis (spine or lymph node). Thirteen patients received first-line anti-tuberculosis treatment with isoniazid, rifampicin, ethambutol and pyrazinamide. The remaining one patient received second-line therapy due to of isoniazid and rifampicin resistance. Eight patients achieved complete response with the treatment, 5 patients did not respond to the treatment and one patient had relapse of the primary disease. Six patients died during the study period with respiratory failure (4 patients) or engraftment failure/multiorgan failure (1 patient) or due to relapse of the primary disease (1 patient). Yang A, et al. Allo-HSCT recipients with invasive fungal disease and ongoing immunosuppression have a high risk for developing tuberculosis. Scientific Reports 9: No. 1, 803520000 2019. Available from: URL: http://doi.org/10.1038/s41598-019-56013-w
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Reactions 12 Dec 2020 No. 1834
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