Abstract
Although advances in surgical technique, drug-induced immunosuppression, and supportive medical therapy have led to improved survival and quality of live after solid organ transplantations, infections still represent a major threat for transplant recipients.
Infections with non tuberculous mycobacteria (NTM) are infrequent, but can be associated with relevant morbidity and mortality. With the exception of few comprehensive studies, the available literature consists predominantly of case reports and institutional experiences. This article reviews NTM infection in the setting of solid organ transplant (SOT) recipients dealing with clinical features, diagnosis, treatment and outcome. Published studies have documented a protean presentation of NTM infection in SOT recipients which may include skin and soft tissue lesions, osteoarticular infections and pleuropulmonary disease. An aggressive approach including histopathologic examination and acid-fast bacilli culture of aspirates or biopsy specimens from involved sites are essential for diagnosis. A combined treatment of debridement surgery, reduction of immunosuppressive medications and/or antimycobacterial drugs is frequently associated with a favorable outcome. It is strongly emphasized that a high index of suspicion for NTM infection should be maintained when managing SOT recipients with unusual clinical manifestations. Early diagnosis and initiation of therapy are essential to prevent morbidity and mortality in this vulnerable population.
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References
Alangaden GJ, Chandrasekar P, Samuel R, Bettiker RL, Truant AL, Jungkind D et al (2008) Cumitech 45: Infections in solid organ transplant recipients. Truant AL (ed) American Society for Microbiology, Washington D.C.
Rubin RH (2002) The direct and indirect effects of infection in liver transplantation: pathogenesis, impact and clinical management. Curr Clin Top Infect Dis 22:125–154
Snydman DR (1999) Infections in solid organ transplantation. Transpl Infect Dis 1:21–28
Wolinsky E (1979) Nontuberculous mycobacteria and associated diseases. Am Rev Respir Dis 119:107–159
Falkinham JO (1996) Epidemiology of infection by nontuberculous mycobacteria. Clin Microbiol Rev 9:177–215
Tortoli E (2003) Impact of genotypic studies on mycobacterial taxonomy: the new mycobacteria of the 1990s. Clin Microbiol Rev 16:319–354
Wood GL, Washington JA II (1987) Mycobacteria other than Mycobacterium tuberculosis: review of microbiologic and clinical aspects. Rev Infect Dis 9:275–294
Herdman AV, Steele JCH (2004) The new mycobacterial species. Emerging or newly distinguished pathogens. Clin Lab Med 24:651–690
Doucette K, Fishman JA (2004) Nontuberculous mycobacterial infection in hemopoietic stem cell and solid organ transplant recipients. Clin Infect Dis 38:1428–1439
Marras TK, Chedore P, Ying AM, Jamieson F (2007) Isolation prevalence of pulmonary non-tuberculous mycobacteria in Ontario, 1997–2003. Thorax 62:661–666
Khan K, Wang J, Marras TK (2007) Nontuberculous mycobacteria sensitization in the United States: national trends over three decades. Am J Crit Care Med 176:306–313
Daley C (2009) Nontuberculous mycobacterial disease in transplant recipients: early diagnosis and treatment. Curr Opin Org Transpl 4:619–624
Escalante P (2007) Mycobacterial infections in solid organ transplantation. Curr Opin Organ Trasplant 12:585–590
Garrison AP, Morris ML, Doblecki LS, Smith L, Cleary TJ et al (2009) Mycobacterium abscessus infection in solid organ transplant recipients: report of three cases and review of the literature. Transpl Infect Dis 11:541–548
Dorman S (2004) Nontuberculous mycobacteria. Am J Transplant 4(suppl 10):42–46
American Thoracic Society (2007) Diagnosis, treatment, and prevention of nontuberculous mycobacterial disease. Am J Respir Crit Care Med 175:367–416
Field SK, Cowie RL (2006) Lung disease due the more common nontuberculous mycobacteria. Chest 129:1653–1672
Chalemskurlat W, Sood N, Neuringer IP, Hecker TM, Chang L, Rivera MP et al (2006) Non-tuberculous mycobacteria in end stage cystic fibrosis: implications for lung transplantation. Thorax 61:507–513
Haas S, Scully B, Cohen J (2005) Mycobacterium avium complex infection in kidney transplant patients. Transpl Infect Dis 7:75–79
Malouf MA, Glanville AR (1999) The spectrum of mycobacterial infections after lung transplantation. Am J Crit Care Med 160:1611–1616
Patel R, Paya CV (1997) Infections in solid-organ transplant recipients. Clin Microbiol Rev 10:86–124
Young JH, Weisdorf DJ (2010) Typical and atypical Mycobacterium infections after hematopoietic stem cell or solid organ transplantation. In: Bowden RA, Ljungman P, Snydman DR (eds) Transplant infections, 3rd edn. Lippincott, Williams & Wilkins, Philadelphia, pp 282–294
Patel R, Roberts GD, Keating MR, Paya CV (1994) Infections due to nontuberculous mycobacteria in kidney, heart, and liver transplant recipients. Clin Infect Dis 19:263–273
Dorman S, Subramanian A (2009) Nontuberculous mycobacteria in solid organ transplant recipients. Am J Transplant 9(suppl 4):S63–S69
Fan MH, Hadjiliadis D (2009) Incidence and management of mycobacterial infections in solid organ transplant recipients. Curr Infect Dis Rep 11:216–222
Martìn-Penagos M, Rodrigo E, Ruiz JC, Agüero J, Fernandez-Mazarrasa C et al (2009) Lung cavitation due to Mycobacterium xenopi in a renal transplant recipient. Transpl Infect Dis 11:249–252
Thaunat O, Morelon E, Stern M, Buffet P, Offredo C, Mamzer-Bruneel MF, Kreis H (2004) Mycobacterium xenopi pulmonary infection in two renal transplant recipients under sirolimus therapy. Transpl Infect Dis 6:179–182
Muñoz RM, Pulpòn LA, Yebra M, Segovia J, Gallego JC, Daz RM (2000) Intestinal involvement by nontuberculous mycobacteria after heart transplantation. Clin Infect Dis 30:603–605
Todd JL, Lakey J, Howell D, Reidy M, Zaas D (2007) Portal hypertension and granulomatous liver disease in a lung transplant recipient due to disseminated atypical mycobacterial infection. Am J Transpl 7:1300–1303
Saubolle MA, Kiehn TE, White MH et al (1996) Mycobacterium haemophilum: microbiology and expanding clinical and geographic spectra of disease in humans. Clin Microbiol Rev 9:435–447
Nurmohamed S, Weenink A, Moenilaram H, Visser C, Bemelman F (2007) Hyperammonemia in generalized Mycobacterium genavense infection after renal transplantation. Am J Transpl 7:722–723
Doggett JS, Strasfeld L (2011) Disseminated Mycobacterium genavense with pulmonary nodules in a kidney transplant recipient: case report and review of the literature. Transpl Infect Dis 13:38–43
Piersimoni C, Scarparo C (2008) Pulmonary infections associated with non-tuberculous mycobacteria in immunocompetent patients. Lancet Infect Dis 8:323–334
Torre-Cisneiros J, De La Mata M, Rufian S, Villanueva Marcos JL, Aroca JG et al (1995) Importance of surveillance mycobacterial cultures after liver transplantation. Transplantation 60:1054–1055
Cernoch PL, Enns RK, Saubolle MA, Wallace RJ Jr (1994) Cumitechs 16A: laboratory diagnosis of the mycobacterioses. Weissfeld AS (ed) American Society for Microbiology, Washington D.C.
Thomsen VØ, Dragsted UB, Bauer J, Fuursted K, Lundgren J (1999) Disseminated infection with Mycobacterium genavense: a challenge to physicians and mycobacteriologists. J Clin Microbiol 37:3901–3905
Realini L, van der Stuyft P, De Ridder K, Hirschel B, Portaels F (1997) Inhibitory effects of polyoxyethylene stearate, PANTA and neutral pH on growth of Mycobacterium genavense in BACTEC primary cultures. J Clin Microbiol 35:2791–2794
CLSI (2007) Laboratory detection and identification of mycobacteria; proposed guideline. M48-P. Clinical and Laboratory Standards Institute, Wayne, PA
Wallace RJ Jr, Tanner D, Brannan PJ, Brown BA (1993) Clinical trial of clarithromycin for cutaneous (disseminated) infection due to Mycobacterium chelonae. Ann Intern Med 119:482–486
Wallace RJ Jr, Griffith DE, Oliver KN, Cook JL, Gordin F (1997) Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am J Crit Care Med 156:S1–S25
CLSI (2011) Susceptibility testing of mycobacteria, nocardia and other aerobic actinomycetes. Approved standard, 2nd edn, CLSI document M24-A2. Clinical and Laboratory Standards Institute, Wayne, PA
Iseman MD, Fischer A (2008) Tumor necrosis factor-α at the intersection of mycobacterial immunity and pathogenesis: an important new address in medicine. Clin Infect Dis 46:1738–1740
Wallis RS (2008) Mycobacterial disease attributable to tumor necrosis factor-α blockers. Clin Infect Dis 47:1603–1605
Van Ingen J, Boerce MJ, Dekhuijzen R, van Soolingen D (2008) Mycobacterial disease in patients with rheumatic disease. Nat Clin Pract Rheumathol 4:649–656
Kesten S, Chaparro C (1999) Mycobacterial infections in lung transplant recipients. Chest 115:741–745
Finch CK, Chrisman CR, Baciewicz AM, Self TH (2002) Rifampin and rifabutin drug interaction: an update. Arch Intern Med 162:958–992
Ferrari SL, Goffin E, Moraud M, Wallemacq P, Squiffiet JP, Pirsom Y (1994) The interaction between clarithromycin and cyclosporine in kidney transplant recipients. Transplantation 58:725–727
Piemmons RM, McAllister CL, Garces MC, Ward RL (1997) Osteomyelitis due to Mycobacterium haemophilum in a cardiac transplant patient. Case report and analysis of interactions among clarithromycin, rifampin and cyclosporine. Clin Infect Dis 24:995–997
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Piersimoni, C. Nontuberculous mycobacteria infection in solid organ transplant recipients. Eur J Clin Microbiol Infect Dis 31, 397–403 (2012). https://doi.org/10.1007/s10096-011-1329-4
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DOI: https://doi.org/10.1007/s10096-011-1329-4