Tuberculosis and hematopoietic stem cell transplant: Review of a difficult and often underestimated problem

Table 1 Mycobacterium Tuberculosis infections after allogeneic stem cell transplantation

Ref.	Country	Patients with	TB incidence	Site of
	(period of	TB/No. of	in general	infection (n)
	study)	HSCT	population (%)
Navari et al[20]	United States (1983)	2/682	0.014-0.03	Lung
Kurzrock et al[21]	United States (1984)	2/90	0.014-0.03	Lung
Roy et al[8]	United States (1974-1994)	11/2241	0.014-0.03	Lung (1), EP (11)
Ip et al[22]	Hong Kong (1991-1994)	10/183	5.5	Lung
Aljurf et al[23]	Saudi Arabia (1986-1997)	4/641	0.62	Lung, CNS, spine
Budak-Alpdogan et al[19]	Turkey (1988-1998)	5/351	1.42	Lung (4), renal (1)
de la Cámara et al[11]	Spain (2000)	12/2866	0.41	Lung
Ullah et al[24]	Pakistan (2001-2006)	4/154	2.6	Lung (3), EP (1)
George et al[25]	India (1986-2001)	9/304	2.3	Lung (2), EP (7)
Lee et al[26]	South Korea (1996-2003)	9/295	3.1	Lung (8), EP (1)
Ullah et al[27]	Pakistan (2002-2007)	2/37	5.4	Lung
Shima et al[28]	Japan (2009)	Case report	-	EP

TB: Tuberculosis; HSCT: Hematopoietic stem cell transplantation; EP: Extrapulmonary; CNS: Central nervous system.

Table 2 Salient aspects for diagnosing tuberculosis in a hematopoietic stem cell transplantation recipient

Test	Sensitivity (%)1	Specificity (%)1	Indicates
TB skin test	72	35	LTBI or active TB
Acid-fast bacillus	50-80	98	Infection
Nucleic acid amplification test	80-98	95-99	Infection
Culture	70-90	98	Active TB
Serology	20-70	47-81	Active TB or infection
Interferon gamma release assays	50-99	85-99	LTBI or active TB
Chest radiography	47-73	76	Probable active TB

¹These numbers are influenced by the epidemiological situation. LTBI: Latent tuberculosis infection; TB: Tuberculosis.

Table 3 Clinical manifestations of nontuberculous mycobacterial disease in recipients of hematopoietic stem cell transplant and solid organ transplants

Transplantation type	Mycobacterium species	Types of infection
HSCT	MAC, M. haemophilum, M. fortuitum, M. Chelonae, M. abscessus	Catheter-related, pulmonary, cutaneous, disseminated
Kidney	M. chelonae, M. kansasii, M. haemophilum, M.fortuitum	Local cutaneous, disseminated, disseminated cutaneous, osteoarticular, pleuro-pulmonary
Heart	M. kansasii, MAC, M. haemophilum, M. scrofulaceum	Pleuro-pulmonary, disseminated, disseminated cutaneous
Lung	MAC, M. abscessus, M. haemophilum, M. fortuitum	Pleuro-pulmonary, local cutaneous, disseminated

HSCT: Hematopoietic stem cell transplant; MAC: Mycobacterium avium- intracellulare complex.