Mycobacterium Tuberculosis Infection Following Kidney Transplantation

Karima Boubaker^1, , Ezzedine Abderrahim¹, Taieb Ben Abdallah¹ and Adel Kheder¹

¹Internal Medecine Department, Charles Nicole Hospital, Tunis

Cite this paper:
Karima Boubaker, Ezzedine Abderrahim, Taieb Ben Abdallah and Adel Kheder. Mycobacterium Tuberculosis Infection Following Kidney Transplantation. American Journal of Medical Sciences and Medicine. 2013; 1(5):75-82. doi: 10.12691/ajmsm-1-5-1

Abstract

Tuberculosis (TB) is one of the major causes of morbidity and mortality worldwide. Post-transplant TB is a problem in successful long-term outcome of renal transplantation recipients. It is a life-threatening opportunistic infection that is frequently encountered, but the diagnosis is often delayed. With the emergence of newer potent immunosuppressive regimens and an increased incidence of TB in the general population, post-transplant TB among transplant recipients can be anticipated. Our objective was to describe the pattern and risk factors of TB infection, and the prognosis in our transplant recipients. This study was a retrospective review of the records of 491 renal transplant recipients in our hospital during the period from January 1986 to December 2009. The demographic data, transplant characteristics, clinical manifestations, diagnostic criteria, treatment protocol, and long-term outcome of this cohort of patients were analyzed. 16 patients (3.2%) developed posttransplant TB with a mean age of 32.5 ± 12.7 (range: 13-60) years and a mean post-transplant period of 36,6 months (range: 12,3 months – 15.9 years). The forms of the diseases were pulmonary in 10 /16 (62.6%), disseminated in 3/16 (18.7%) and extrapulmonary in 3/16 (18.7%). All patients initially received 4-drug combination therapy. Because of drug interaction, an increase in the dose of calcineurium inhibitor and steroid was done in 2 cases and in steroids alones in 1 case. Graft dysfunction was observed in 7 cases (43,7%) with tissue-proof acute rejection in 3 cases and loss of the graft in 4 cases. Hepatotoxicity developed in 3 patients (18.7%) during treatment. Reccurence were observed in 4 cases after early stop of treatment. Two patients (12.5%) died. Extrapulmonary and disseminated tuberculosis were observed in third of our patients. More than 9 months of treatment may be necessary to prevent recurrence.

Keywords:
kidney transplantation tuberculosis

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Figures

References:

[1]	Jellis JE. Bacterial infections: bone and joint tuberculosis. Clin Rhumatol 1995;9:151-9.
[2]	Pratish G, Basant P, Nalini C. Tubeculosis in a renal allograft: a successful outcome. Saoudi J Kidney Dis Transplant 2008;19:790-2.
[3]	République Tunisienne, Ministère de la santé publique, Direction des soins de santé de base, Bulletin épidémiologique 1995 n 4195: 5-6.
[4]	Garcaa-Goez JF, Linares L, Benito N et al. Tuberculosis in solid organ transplant recipients at a tertiary hospital in the last 20 years in Barcelona. Transplant Proc. 2009;41:2268-70.
[5]	Enarson DA, Fujii M, Nakielna EM, Grzybowski S. Bone and joint tuberculosis: a continuing problem. Can Med Assoc J 1979;120: 139-45.
[6]	Pertuiset E, Beaudreuil J, Horusitzky A, Lioté F, Kemiche F, Richette P, et al. Aspects épidémiologiques de la tuberculose ostéoarticulaire de l’adulte, étude rétrospective de 206 cas diagnostiqués en région parisienne de 1980 à 1994. Presse Méd 1997;26:311-5.
[7]	Chadha VK. Tuberculin test. Indian J Pediatr 2001; 68: 53-58
[8]	Alvarez S, Mc Cabe WR. Extrapulmonary tuberculosis revisited: a review of experience at Boston city and other hospitals. Medecine 1984;63:25-55.
[9]	Sester U, Junker H, Hodapp T and al. Improved efficiency in detecting cellular immunity towards M. tuberculosis in patients receiving immunosuppressive drug therapy. Nephrol Dial Transplant. 2006;21:3258-68.
[10]	http://www.tunisia-today.com/archives/30118
[11]	Korzeniewska A et al. Tuberculosis after renal transplantation. Pneumonol Alergol Pol. 2009;77:61-5.
[12]	Siu YP, Tong MK, Leung KT, Yung CY. Successful kidney re-transplantation in a patient with previous allograft kidney tuberculosis. Transpl Infect Dis 2004;6:132-5.
[13]	De paula FJ, Azevedo IS, Saldanha LB, Ianhez LE, Sabbaga et al. Tuberculosis in renal transplant patients. Revista do Instituto de Medicina Tropical de São Paulo; 1987,29:268-75.
[14]	Basiri A, Hosseini-Moghaddam SM, Simforoosh Net al. The risk factors and laboratory diagnostics for post renal transplant tuberculosis: a case-control, country-wide study on definitive cases. Transpl Infect Dis. 2008;10:231-5.
[15]	Sakhuja V, Jha V, Varma PP, Joshi K, Chugh KS. The high incidence of tuberculosis among renal transplant recipients in India. Transplantation 1996; 61: 211-215.
[16]	John GT, Shankar V, Abraham AM, Mukundan U, Thomas PP, Jacob CK. Risk factors for post-transplant tuberculosis. Kidney Int 2001; 60: 1148-1153.
[17]	Naqvi R, Akhtar S, Noor H, Saeed T, Bhatti S, Sheikh R, Ahmed E, Akhtar F, Naqvi A, Rizvi A. Efficacy of isoniazid prophylaxis in renal allograft recipients. Transplant Proc. 2006;38:2057-8.
[18]	Rungruanghiranya S, Ekpanyaskul C, Jirasiritum S, Nilthong C, Pipatpanawong K, Mavichak V. Tuberculosis in Thai renal transplant recipients: a 15-year experience. Transplant Proc. 2008;40:2376-9.
[19]	Torres J et al. Hepatitis C virus, an important risk factor for tuberculosis in immunocompromised: experience with kidney transplantation. Transpl Int. 2008;21:873-8.
[20]	Ghafari A, Makhdoomi K, Ahmadpoor P, Afshari AT, Fallah MM, Rezaee K. Tuberculosis in Iranian kidney transplant recipients: a single-center experience. Transplant Proc. 2007;39:1008-11.
[21]	Chen CH, Lian JD, Cheng CH, Wu MJ, Lee WC, Shu KH. Mycobacterium tuberculosis infection following renal transplantation in Taiwan. Transpl Infect Dis. 2006;8:148-56.
[22]	Mercadal L, Foltz V, Isnard-Bagnis C, Ourahma S, Deray G. Tuberculosis after conversion from azathioprine to mycophenolate mofetil in a long-term renal transplant recipient. Transplant Proc. 2005;37:4241-3.
[23]	Atasever A, Bacakoglu F, Toz H, et al. Tuberculosis in renal transplant recipients on various immunosuppressive regimens. Nephrol Dial Transplant 2005;20:797-802.
[24]	Walsh R, Ortiz J, Foster P, Palma-Vargas J, Rosenblatt S, Wright F. Fungal and mycobacterial infections after Campath (alemtuzumab) induction for renal transplantation. Transpl Infect Dis. 2008;10:236-9.
[25]	Khaira A, Bagchi S, Sharma A et al. Renal allograft tuberculosis: report of three cases and review of literature. Clin Exp Nephrol. 2009;13:392-6.
[26]	Chen SY, Wang CX, Chen LZ, Fei JG, Deng SX, Qiu J, Li J, Chen GO, Fu HM, Xie CM. Tuberculosis in southern Chinese renal-transplant recipients. Clin Transplant. 2008;22:780-4.
[27]	Ram R, Uppin S, Swarnalatha G, Desai M, Harke M, Prasad N, Dakshinamurty KV. Isolated skin ulcers due to Mycobacterium tuberculosis in a renal allograft recipient. Nat Clin Pract Nephrol. 2007;3:688-93.
[28]	Ruangkanchanasetr P, Natejumnong C, Kitpanich S, Chaiprasert A, Luesutthiviboon L, Supaporn T. Prevalence and manifestations of tuberculosis in renal transplant recipients: a single-center experience in Thailand. Transplant Proc. 2008;40:2380-1.
[29]	Dowdy L, Ramgopal M, Hoffman T, et al. Genitourinary tuberculosis after renal Transplantation: report of 3 cases and review. Clin Infect Dis 2001;32:662-6.
[30]	Lian M, Chan W, Slavin M, Cohney S. Miliary tuberculosis in a Caucasian male transplant recipient and the role of intravenous immunoglobulin as an immunosuppressive sparing agent. Nephrology. 2006;11:156-8.
[31]	Figueiredo AA, Lucon AM, Jànior RF, Ikejiri DS, Nahas WC, Srougi M. Urogenital tuberculosis in immunocompromised patients. Int Urol Nephrol. 2009;4:327-33.
[32]	Ergun I, Ekmekci Y, Sengul S, Kutlay S, Dede F, Canbakan B, Erbay B. Mycobacterium tuberculosis infection in renal transplant recipients.Transplant Proc. 2006;38:1344-5.
[33]	Kaaroud H, Beji S, Boubaker K, Abderrahim E, Ben Hamida F, Ben Abdallah T, El Younsi F, Ben Moussa F, Kheder A. Tuberculosis after renal transplantation. Transplant Proc. 2007;39:1012-3.
[34]	George P, Pawar B, Calton N. Tuberculosis in a renal allograft: a successful outcome. Saudi J Kidney Dis Transpl. 2008;19:790-2.
[35]	Amirzargar MA, Yavangi M, Amirzargar N. Primary tuberculosis of the glans penis in male kidney transplant recipients: a report on two cases.Saudi J Kidney Dis Transpl.2006;17:213-5.
[36]	Nemati E, Taheri S, Nourbala MH, Einollahi B. Vaginal tuberculosis in an elderly kidney transplant recipient. Saudi J Kidney Dis Transpl. 2009;20:465-7.
[37]	Nayak S, Satish R. Genitourinary tuberculosis after renal transplantation-a report of three cases with a good clinical outcome. Am J Transplant. 2007;7:1862-4.
[38]	Eastwood JB, Corbishley CM, Grange JM. Tuberculosis and the kidney. J Am Soc Nephrol 2001:12:1307-14.
[39]	Biz E, Pereira CA, Moura LA, et al. The use of cyclosporine modifies the clinical and histopathological presentation of tuberculosis after renal transplantation. Rev Inst Med Trop Sao Paulo 2000;42:225-30.
[40]	Abutaleb N, Obaideen A, Hamza A, Zakaria M, Afifi H, Fallata S, Younis S, Adem M. Fatal hemorrhagic intracranial TB in a renal transplant recipient despite INH prophylaxis. Saudi J Kidney Dis Transpl. 2007;18:594-8.
[41]	Costalonga EC, Melo NC, Rodrigues CE, Sette LH, Ianhez LE. The potential role of C-reactive protein in distinguishing cytomegalovirus from tuberculosis and bacterial infections in renal transplant recipients. Clin Transplant. 2009;23:710-5.
[42]	Zhang XF, Lv Y, Xue WJ, Wang B, Liu C, Tian PX, Yu L, Chen XY, Liu XM. ycobacterium tuberculosis infection in solid organ transplant recipients: experience from a single center in China. Transplant Proc. 2008;40:1382-5.
[43]	Ravi Shankar M S, Aravindan A N, Sohal P Met al. The prevalence of tuberculin sensitivity and anergy in chronic renal failure in an endemic area: tuberculin test and the risk of post-transplant tuberculosis. Nephrol Dial Transplant 2005; 20: 2720-2724
[44]	Wauters A, Peetermans WE, Van den Brande P et al. The value of tuberculin skin testing in haemodialysis patients. Nephrol Dial Transplant 2004;19: 433-438.
[45]	Woeltje KF, Mathew A, Rothstein M, Seiler S, Fraser VJ. Tuberculosis infection and anergy in hemodialysis patients. Am J Kidney Dis 1998; 31: 848-852
[46]	Akiyama M, Numata A, Imagawa A. Influence of protein intake on phytohemagglutinin skin test in patients undergoing maintenance hemodialysis. Nippon Hinyokika Gakkai Zasshi 1989; 80: 1175-1180.
[47]	Tissot F, Zanetti G, Francioli P, Zellweger JP, Zysset F. Influence of bacille Calmette-Guerin vaccination on size of tuberculin skin test reaction: to what size? Clin Infect Dis 2005; 40: 211-217.
[48]	Malhotra KK. Challenge of tuberculosis in renal transplantation. Transplant Proc. 2007;39:756-8.
[49]	Ram R, Swarnalatha G, Prasad N, Dakshinamurty KV. Tuberculosis in renal transplant recipients.Transpl Infect Dis. 2007;9:97-101.
[50]	Cheng JW, Chen YC, Tian YC, Fang JT, Yang CW. Coinfection of cytomegalovirus and miliary tuberculosis in a post-renal transplant recipient. J Nephrol. 2007;20:114-8.
[51]	Eschard JP, Leone J, Etienne JC. Tuberculose osseuse et articulaire des membres. Ed techniques Encycl Med Chir (Paris-France), Appareil locomoteur 1993;A10:14-185.
[52]	Abdu A, Adamu B, Sani MU, Mohammed AZ, Borodo MM. Post kidney transplant tuberculosis in Nigeria: a case report. Niger J Med. 2008;17:217-9.
[53]	Seyahi N, Apaydin S, Kahveci A, Mert A, Sariyar M, Erek E. Cellulitis as a manifestation of miliary tuberculosis in a renal transplant recipient. Transpl Infect Dis. 2005;7:80-5.
[54]	Lorimer I et al. Genitourinary tuberculosis after renal transplantation. Trans Infect Dis 1999;1:83-6.
[55]	Guida JP, Bignotto Rosane D, Urbini-Santos C, Alves-Filho G, Ribeiro Resende M, Mazzali M. Tuberculosis in renal transplant recipients: a Brazilian center registry. Transplant Proc. 2009;41:883-4.
[56]	Zlitni M, Kassab MT. Spondylodiscites tuberculeuses (Mal de Pott). Encycl Méd Chir (Paris-France) Appareil locomoteur 1988;15852: A10, 4.
[57]	Bernard L, Perronne C. La tuberculose ostéoarticulaire aujourd’hui. Presse Med 1997;26:308-10.
[58]	Pertuiset E, Beaudreuil J, HorusitzkyA, Lioté F, et al. Traitement de la tuberculose ostéoarticulaire, étude rétrospective de 143 cas chez l’adulte. Rev Rhum (Ed Fr) 1999;6:26-31.
[59]	Ulasli SS, Ulubay G, Arslan NG, Sezer S, Akcay S, Eyuboglu FO, Haberal M. Characteristics and outcomes of end-stage renal disease patients with active tuberculosis followed in intensive care units. Saudi J Kidney Dis Transpl. 2009;20:254-9.