Mycobacterium tuberculosis in Transplantation
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 ski
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Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Disease Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Clinical Impact in Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Diagnostic Strategies and Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Treatment of Active TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Prevention/Treatment of Latent TB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Abstract
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 transplantation are often extrapulmonary or disseminated in nature. Strategies for treatment of latent and active tuberculosis in both solid organ and hematopoietic stem cell transplantation are discussed in this chapter. The optimization of antituberculous drug dosing, treatment duration, and combinations in drug-sensitive and multidrug-resistant TB in transplantation needs further study.
A. K. Subramanian (*) Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA e-mail: [email protected] © Springer Nature Switzerland AG 2020 M. I. Morris et al. (eds.), Emerging Transplant Infections, https://doi.org/10.1007/978-3-030-01751-4_15-1
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A. K. Subramanian
Keywords
Tuberculosis · Latent TB · Antituberculous drugs · Isoniazid · Rifampin · Solid organ transplant · Hematopoietic stem cell transplant
Introduction Tuberculosis (TB) in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients can present a diagnostic challenge due to the immunosuppressed state of the patients, their comorbid conditions, and multiple concomitant medications. Screenin
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