Akı Şahika Zeynep, Sucak Gülsan Türköz, Tunçcan Özlem Güzel, Köktürk Nurdan, Şenol Esin
Departments of Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey.
Departments of Infectious Disease, Faculty of Medicine, Gazi University, Ankara, Turkey.
Transpl Infect Dis. 2018 Aug;20(4):e12912. doi: 10.1111/tid.12912. Epub 2018 May 9.
Immune-compromised patients with latent TB infection (LTBI) are at risk for TB reactivation and should receive prophylaxis. Whereas the tuberculin skin test (TST) has limitations particularly in immune-compromised patients.
This retrospective study was conducted to determine the incidence of TB infection in adult HSCT recipients whose preventive therapy for LTBI was determined according to the guidance of targeted TST.
Five hundred and fifty-eight consecutive HSCT recipients (287 autologous and 271 allogeneic) who survived ≥100 days post-transplantation were included in this analysis.
Tuberculin skin test results were available in 493 of 558 transplants (88.3%). The incidence of negative TST was 54.5% (269 of 493 patients). One multiple myeloma patient with a history of TB and negative TST result and was not on INH prophylaxis developed reactivation of TB infection. None of the recipients under INH prophylaxis (151 of 558 transplants; 27.1%) and none of the 224 patients with TST ≥5 mm developed TB infection.
Despite the limitations of being a retrospective analysis and variable prophylaxis thresholds of TST, there are some remarkable results of this analysis. We had no TB infection in the allogeneic HSCT recipients. The high incidence of negative TST results may be attributed to the underlying immune-deficiency. TST may not be a reliable guide for predicting TB reactivation risk in hematology patients.
Tuberculin skin test may have a high rate of false-negative and false-positive results in HSCT recipients. The general guidelines for targeted TST to guide treatment of LTBI may not apply to all regions and situations. More reliable methods are required to predict and treat LTBI in these specific conditions.
潜伏性结核感染（LTBI）的免疫功能低下患者有发生结核病复发的风险，应接受预防性治疗。然而，结核菌素皮肤试验（TST）存在局限性，尤其是在免疫功能低下的患者中。
本回顾性研究旨在确定根据靶向TST指导进行LTBI预防性治疗的成年造血干细胞移植（HSCT）受者中结核感染的发生率。
本分析纳入了558例移植后存活≥100天的连续HSCT受者（287例自体移植和271例异体移植）。
558例移植中有493例（88.3%）可获得结核菌素皮肤试验结果。TST结果为阴性的发生率为54.5%（493例患者中的269例）。1例有结核病病史且TST结果为阴性且未接受异烟肼预防性治疗的多发性骨髓瘤患者发生了结核感染复发。接受异烟肼预防性治疗的受者（558例移植中的151例；27.1%）和TST≥5mm的224例患者中均无结核感染发生。
尽管本分析存在回顾性分析以及TST预防性治疗阈值可变的局限性，但仍有一些显著结果。我们的异体HSCT受者中没有结核感染。TST结果阴性的高发生率可能归因于潜在的免疫缺陷。TST可能不是预测血液学患者结核复发风险的可靠指标。
结核菌素皮肤试验在HSCT受者中可能有较高的假阴性和假阳性率。靶向TST指导LTBI治疗的一般指南可能不适用于所有地区和情况。在这些特定情况下，需要更可靠的方法来预测和治疗LTBI。
