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Latent and active tuberculosis infection in allogeneic hematopoietic stem cell transplant recipients: a prospective cohort study

Bone Marrow Transplantation volume 56, pages 2241–2247 (2021)Cite this article

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Abstract

Tuberculosis (TB) is a major infectious complication in hematopoietic stem cell transplant (HSCT) recipients in countries with high TB prevalence. Identifying and treating latent tuberculosis infection (LTBI) helps to prevent TB reactivation after transplantation. Few studies have compared the tuberculin skin test (TST) with interferon Gamma release assays (IGRA) to diagnose LTBI in HSCT candidates. We compared TST and QuantiFeron TB gold in tube (QTF-GIT) and prospectively evaluated the incidence of active tuberculosis in 126 HSCT candidates and 58 HSCT recipients with chronic GVHD followed at the outpatient clinic. TB was diagnosed by culture in Mycobacteria media and by commercial real-time PCR kit. Considering the positivity of any test, the prevalence of LTBI was 8.7% in HSCT candidates (11 out of 126) and 12.5% in HSCT recipients with chronic GVHD (6 out of 48). QTF-GIT indeterminate results were detected in 2.4% of the HSCT candidates. Fair to good agreement (K > 0.50) between tests was observed in both cohorts. Cumulative incidence of TB was 3% in the GVHD cohort. TB was diagnosed in 2 chronic GVHD recipients, both cases confirmed by positive culture and PCR. None of the 11 patients with LTBI diagnosed pre-HSCT who received INH prophylaxis developed TB.

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Fig. 1: Study algorithm showing TB cases in the chronic GVHD cohort.

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Acknowledgements

The study received financial support from FAPESP grant 2010/08816–1. The authors thank Giovana H. da Rocha, Anderson João Simioni and Ana Paula Ribeiro for database update support, and the Centro de Laboratórios Regionais (Núcleo de Ciências Biomédicas) - Instituto Adolfo Lutz Bauru II for performing the culture in Mycobacteria media during the study.

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Authors and Affiliations

  1. Universidade Paulista UNIP – Instituto de Ciências da Saúde, Bauru, Brazil

    Marina de Oliveira Rodrigues

  2. HSCT Program - Amaral Carvalho Foundation, Jaú, Brazil

    Lucia H. de Almeida Testa, Ana Cláudia F. dos Santos, Lilian P. Zanetti, Mair Pedro de Souza, Vergílio R. Colturato & Clarisse M. Machado

  3. Centro de Laboratórios Regionais, Instituto Adolfo Lutz – Bauru II, São Bauru, Brazil

    Luciana da Silva Ruiz

  4. Institute of Tropical Medicine, University of São Paulo School of Medicine (LIM 52 HC-FMUSP), São Paulo, Brazil

    Clarisse M. Machado

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  1. Marina de Oliveira Rodrigues
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Correspondence to Clarisse M. Machado.

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de Oliveira Rodrigues, M., de Almeida Testa, L.H., dos Santos, A.C.F. et al. Latent and active tuberculosis infection in allogeneic hematopoietic stem cell transplant recipients: a prospective cohort study. Bone Marrow Transplant 56, 2241–2247 (2021). https://doi.org/10.1038/s41409-021-01329-3

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