成人造血干细胞移植后分枝杆菌感染的研究进展。
An update on Mycobacterium tuberculosis infection after hematopoietic stem cell transplantation in adults.
机构信息
Section of Infectious Diseases, Department of Medicine, University of the Philippines Manila, UP-Philippine General Hospital, Manila, Philippines.
Division of Infectious Diseases, Department of Medicine, The William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
出版信息
Clin Transplant. 2018 Dec;32(12):e13430. doi: 10.1111/ctr.13430. Epub 2018 Nov 11.
BACKGROUND
Mycobacterium tuberculosis (TB) is common worldwide, but is rarely reported after hematopoietic transplantation (HSCT). We reviewed all TB cases among HSCT since 2010 to provide an update on its epidemiology, clinical presentation, management and outcome.
METHODS
Several databases were reviewed from January 1, 2010 to June 30, 2018 using key words tuberculosis and hematopoietic transplantation.
RESULTS
The 47 cases of TB were reported during the study period. The highest TB frequency was reported from India (2.9%), with a median frequency of 2% (range, 0.18%-2.9%). The majority were recipients of allogeneic transplants (45/47, 95.7%). Pulmonary TB was the most common clinical presentation (20/47, 42.6%). The median time to clinical presentation was 4.6 (range, 3-12.9) and 2.4 (range, 0.6-5) months, based on cohort data and case reports, respectively. Fever was reported in 87.5% (14/16) of patients. First-line quadruple drug therapy was frequently used (29/35, 82.9%), with a median length of 12 and 9 months for cohorts and case reports, respectively. All-cause and attributable mortality was 27.6% (13/47), and 8.5% (4/47), respectively.
CONCLUSIONS
Mycobacterium tuberculosis presents early after HSCT, most commonly as fever. A high index of suspicion is needed for early diagnosis and treatment, to prevent TB-attributable mortality.
背景
结核分枝杆菌（TB）在全球范围内很常见，但在造血移植（HSCT）后很少见。我们回顾了自 2010 年以来所有 HSCT 中的 TB 病例，以提供其流行病学、临床表现、治疗和结局的最新信息。
方法
使用“结核”和“造血移植”等关键词，从 2010 年 1 月 1 日至 2018 年 6 月 30 日，对多个数据库进行了回顾。
结果
研究期间报告了 47 例 TB 病例。TB 发病率最高的国家是印度（2.9%），中位数发病率为 2%（范围，0.18%-2.9%）。大多数是异基因移植受者（45/47，95.7%）。最常见的临床表现是肺结核（20/47，42.6%）。基于队列数据和病例报告，分别为 4.6（范围，3-12.9）和 2.4（范围，0.6-5）个月，出现临床症状的中位时间。87.5%（14/16）的患者出现发热。一线四联药物治疗经常使用（29/35，82.9%），分别为队列和病例报告的中位长度为 12 和 9 个月。全因死亡率和归因死亡率分别为 27.6%（13/47）和 8.5%（4/47）。
结论
结核分枝杆菌在 HSCT 后早期出现，最常见的表现为发热。需要高度怀疑，以便早期诊断和治疗，预防 TB 所致死亡。
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