Division of Pulmonology, Geneva University Hospitals, Geneva, Switzerland; University of Paris, ECSTRRA Team, Inserm, Paris, France.
Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; San Martino Polyclinic Hospital, Genoa, Italy.
Lancet Infect Dis. 2022 Dec;22(12):e359-e369. doi: 10.1016/S1473-3099(22)00227-4. Epub 2022 May 27.
Mycobacterial infections, both tuberculosis and nontuberculous, are more common in patients with haematological malignancies and haematopoietic stem cell transplant recipients than in the general population-although these infections remain rare. Mycobacterial infections pose both diagnostic and therapeutic challenges. The management of mycobacterial infections is particularly complicated for patients in haematology because of the many drug-drug interactions between antimycobacterial drugs and haematological and immunosuppressive treatments. The management of mycobacterial infections must also consider the effect of delaying haematological management. We surveyed the management practices for latent tuberculosis infection (LTBI) in haematology centres in Europe. We then conducted a meticulous review of the literature on the epidemiology, diagnosis, and management of LTBI, tuberculosis, and nontuberculous mycobacterial infections among patients in haematology, and we formulated clinical guidelines according to standardised European Conference on Infections in Leukaemia (ECIL) methods. In this Review, we summarise the available literature and the recommendations of ECIL 8 for managing mycobacterial infections in patients with haematological malignancies.
分枝杆菌感染，包括结核分枝杆菌和非结核分枝杆菌，在血液系统恶性肿瘤患者和造血干细胞移植受者中比普通人群更为常见——尽管这些感染仍然很少见。分枝杆菌感染既带来诊断挑战，也带来治疗挑战。由于抗分枝杆菌药物与血液学和免疫抑制治疗之间存在许多药物相互作用，因此分枝杆菌感染的管理对血液科患者来说特别复杂。分枝杆菌感染的管理还必须考虑延迟血液学管理的影响。我们调查了欧洲血液中心潜伏性结核感染 (LTBI) 的管理实践。然后，我们对血液科患者 LTBI、结核分枝杆菌和非结核分枝杆菌感染的流行病学、诊断和管理方面的文献进行了细致的回顾，并根据标准化的欧洲白血病感染会议 (ECIL) 方法制定了临床指南。在这篇综述中，我们总结了现有文献和 ECIL 8 针对血液恶性肿瘤患者管理分枝杆菌感染的建议。
