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Zou J, Wang T, Qiu T, Chen Z, Zhou J, Ma X, Jin Z, Xu Y, Zhang L. Clinical characteristics of tuberculous infection following renal transplantation. Transpl Immunol 2022; 70:101523. [PMID: 34973371 DOI: 10.1016/j.trim.2021.101523] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study investigated the clinical characteristics of patients with tuberculosis (TB) following renal transplantation (RT) in order to identify markers or signs that can facilitate early diagnosis. METHODS A retrospective analysis was performed on 12 cases of Mycobacterium tuberculosis infection treated at our hospital between 2005 and 2020. RESULTS The incidence of TB after RT at our hospital was 0.9%, and the median postoperative onset time was 22 months. The average age of patients included in our analysis was 44.2 ± 9.4 years; 11 of the 12 patients were male, and most patients had (low) fever as the first or only manifestation. Five patients had respiratory symptoms; 5 had typical computed tomography (CT) presentation; and 2 had a confirmed history of TB. Two sputum smears from 12 patients were positive by acid fast staining, and M. tuberculosis was detected in peripheral blood samples by metagenomic next-generation sequencing (NGS). One patient had a positive result in the purified protein derivative (PPD) test, 7 were positive with the interferon gamma release assay (IGRA), 8/12 patients were confirmed to have TB infection by NGS and 1 was confirmed positive by lung biopsy. CONCLUSION Because of the use of immunosuppressive agents, most patients with TB following RT have atypical clinical symptoms and CT findings, and may have a high probability of a false negative result with the traditional PPD test and a low probability of M. tuberculosis detection, making early diagnosis difficult. Therefore, in RT recipients with prolonged fever of unknown origin and unusual clinical manifestations, especially those who are unresponsive to antibiotic treatment, a diagnosis of TB should be considered. The interferon gamma release assay and NGS are relatively new detection methods with high sensitivity and specificity; these along with regular, repeated testing by various approaches can aid the early diagnosis of TB.
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Affiliation(s)
- Jilin Zou
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Tianyu Wang
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Tao Qiu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhongbao Chen
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jiangqiao Zhou
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xiaoxiong Ma
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zeya Jin
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yu Xu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Long Zhang
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China.
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Tuberculosis in renal transplant recipients: Our decade long experience with an opportunistic invader. Indian J Tuberc 2019; 67:73-78. [PMID: 32192621 DOI: 10.1016/j.ijtb.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 11/22/2022]
Abstract
AIM To study the incidence, pattern of tuberculosis, Its risk factors, and prognosis in renal transplantation recipients in Indian population. SETTINGS AND DESIGN This study retrospectively analyzed the patients who underwent renal transplantation at Ramaiah medical college Hospitals, India from 2004 to 2015. METHODS AND MATERIAL The study enrolled 244 patients. Diagnosis was based on radio0imaging, sputum smear, culture and polymerase chainreaction and histology. STATISTICAL ANALYSIS USED A descriptive univariate analysis was performed to identify the individual risk factors. RESULTS The TB infection was present in 21/244 (8.6%) renal transplantation patients (mean age ± SD = 44.3 ± 12.9 years). Pulmonary tuberculosis was the commonest (57%) followed by extrapulmonary tuberculosis (43%). Type II diabetes mellitus (DM) (14.6%; p = 0.0169)was significant risk factor. Majority of the patients (n = 18, 10.7%) were on standard tripledrug immunosuppression. The median duration of anti0tubercular therapy was 14 months and crude mortality was 19%. CONCLUSIONS High index of suspicion for tuberculosis is require d in renal transplant recipients owing to their immunocompromised status and atypical presentations. Higher age, DM and use of immunosuppressants increase the risk for post0renal transplantation tuberculosis. Interactions between anti0tubercular drugs and immunosuppressants need to be considered in these patients.
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Das S, Das S, Jena M, Kundu P, Behera S. Mediastinal tuberculous abscess: A rare presentation after renal transplant. INDIAN JOURNAL OF TRANSPLANTATION 2019. [DOI: 10.4103/ijot.ijot_36_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sakpal SV, Donahue S, Crespo HS, Auvenshine C, Agarwal SK, Nazir J, Santella RN, Steers J. Utility of fiber-optic bronchoscopy in pulmonary infections among abdominal solid-organ transplant patients: A comprehensive review. Respir Med 2018; 146:81-86. [PMID: 30665523 DOI: 10.1016/j.rmed.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/28/2018] [Accepted: 12/09/2018] [Indexed: 10/27/2022]
Abstract
Pulmonary infections are frequent complications in abdominal solid-organ transplantation (aSOT) which may threaten patient and allograft survival. Accurate diagnosis and treatment of pulmonary infections in this population can be challenging. Immunosuppressive therapy not only increases the risk of acquiring opportunistic and non-opportunistic infections, but it also impairs the inflammatory responses associated with microbial invasion which in an otherwise normal host produce clinical and radiologic responses that allow for early identification of the offending pathogen. Serologic testing is not a reliable diagnostic modality. Direct microbiological sampling is often necessary to make a definitive diagnosis early in the clinical course to optimize timely, targeted therapy while reducing the risk of developing antimicrobial resistance, and minimize adverse effects of therapy, if any. Fiber-optic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) or transbronchial lung biopsy (TBB) offers such diagnostic advantage and possesses a potential therapeutic value too. This comprehensive review discusses the potential benefits of FOB alongside its risks and complications, indications and contraindications, and techniques. Additionally, the essay highlights FOB's utility and yield specifically with regard to type and timing of infections in aSOT patients.
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Affiliation(s)
- Sujit Vijay Sakpal
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA; Department of Surgery, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA; Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA.
| | - Steven Donahue
- Department of Surgery, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Hector Saucedo Crespo
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA; Department of Surgery, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Christopher Auvenshine
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA; Department of Surgery, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Suresh Kumar Agarwal
- Division of Acute Care, Trauma, Surgical Critical Care, Department of Surgery, Duke University, Durham, NC, USA
| | - Jawad Nazir
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA
| | - Robert N Santella
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA; Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Jeffery Steers
- Avera McKennan Hospital & University Health Center: Avera Medical Group Transplant & Liver Surgery, Sioux Falls, SD, USA
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Kafle MP, Sigdel MR, Shrestha M, Shah DS. Spectrum of Infections in Living Donor Kidney Transplant Recipients: An Experience From a Tertiary Center in Nepal. Transplant Proc 2018; 50:2493-2495. [PMID: 30316384 DOI: 10.1016/j.transproceed.2018.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Kidney transplant recipients are always at risk of infections because they are on lifelong immunosuppressive medications. The spectrum of infections in this special population is not the same as in the general population. Post-transplant infections are extensively studied in the developed world. Publications about post-transplant infections from Nepal are scarce. This study was carried out to study the spectrum of infections, the trends in treatment, and the incidence of tuberculosis in kidney transplant recipients. METHODS This is a retrospective analysis of the patient data in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Follow-up data from the first 100 kidney transplant recipients was recorded in a Microsoft Excel worksheet and descriptive analysis was done. RESULTS In the first 100 transplants done until 21 September 2011, 92 patients' data were recorded and 8 patients' data were missing. The mean follow-up period was 61.03 months. The population was 76.09% male (n = 70) and 23.91% female (n = 22). A total of 641 episodes of infections were recorded. Urinary tract infections were the most common type of infection. Escherichia coli was the most common organism isolated (36% of all cultures). There were 17 (2.65%) episodes of viral and 42 (6.6%) episodes of fungal infections. Tuberculosis was diagnosed in 6 (6.5%) patients. CONCLUSION Urinary tract infection is the most common type of infection in post-kidney transplant patients. Quinolones were the most common agents used to treat urinary tract infections. The incidence of tuberculosis in kidney transplant recipients is 6.5% in 5 years' follow-up.
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Affiliation(s)
- M P Kafle
- Department of Nephrology and Transplant Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
| | - M R Sigdel
- Department of Nephrology and Transplant Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - M Shrestha
- Department of Nephrology and Transplant Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - D S Shah
- Department of Nephrology and Transplant Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Active tuberculosis in patients with systemic lupus erythematosus from Southern China: a retrospective study. Clin Rheumatol 2018; 38:535-543. [DOI: 10.1007/s10067-018-4303-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/29/2018] [Accepted: 09/16/2018] [Indexed: 11/25/2022]
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Abad CLR, Razonable RR. Mycobacterium tuberculosis after solid organ transplantation: A review of more than 2000 cases. Clin Transplant 2018; 32:e13259. [PMID: 29656530 DOI: 10.1111/ctr.13259] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mycobacterium tuberculosis (TB) is a common pathogen worldwide, and it may cause significant infection after solid organ transplantation (SOT). We reviewed all reported TB cases to provide an update on its epidemiology, clinical presentation, management, and outcome after SOT. METHODS MEDLINE, EMBASE, and OVID were reviewed from January 1, 1998, to December 31, 2016, using keywords tuberculosis and solid organ transplant or transplantation. RESULTS There were 187 publications reporting 2082 cases of TB among kidney (n = 1719), liver (n = 253), heart (n = 77), lung (n = 25), and kidney-pancreas (n = 8) recipients. Among cohort studies, the median incidence was 2.37% (range, 0.05%-13.27%) overall. Most TB disease was considered reactivation of latent infection, occurring beyond the first year after SOT. Early-onset cases were seen among donor-derived TB cases. Fever was the most common symptom. Radiologic findings were highly variable. Extrapulmonary and disseminated TB occurred 29.84% and 15.96%, respectively. Multidrug-resistant TB was rare. Treatment using 4 or 5 drugs was commonly associated with hepatotoxicity and graft dysfunction. All-cause mortality was 18.84%. CONCLUSIONS This large review highlights the complexity of TB after SOT. Reactivation TB, donor-transmitted infection, extrapulmonary involvement, and disseminated disease are common occurrences. Treatment of TB is commonly associated with hepatotoxicity and graft dysfunction.
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Affiliation(s)
- Cybele Lara R Abad
- Section of Infectious Diseases, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Raymund R Razonable
- Division of Infectious Diseases, Department of Medicine, The William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine and Sciences, Rochester, MN, USA
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8
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Moon HH, Park SY, Kim JM, Park JB, Kwon CHD, Peck KR, Kim SJ, Lee SK, Joh JW. Isoniazid Prophylaxis for Latent Tuberculosis Infections in Liver Transplant Recipients in a Tuberculosis-Endemic Area. Ann Transplant 2017; 22:338-345. [PMID: 28579606 PMCID: PMC6248040 DOI: 10.12659/aot.902989] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Isoniazid (INH) prophylaxis (Px) has good efficacy for preventing tuberculosis (TB) in the general population. However, its use for the treatment of latent TB infections (LTBI) in liver transplant (LT) recipients is challenging because little is known about INH-induced hepatotoxicity in graft recipients. We evaluated the efficacy and safety of INH Px in LT recipients. Material/Methods From March 2008 to December 2012, we retrospectively reviewed data on 277 patients who received LT at a single center. We examined the results of tuberculin skin tests and interferon-γ release assays, use of INH, INH-induced hepatotoxicity, and post-LT TB occurrence. Results Among 277 recipients, 7 cases of post-transplant TB were detected (2.52%). Seventeen patients received post-transplant INH Px. Among INH Px recipients, post-LT TB infection did not occur. Hepatotoxicity after INH Px was significantly lower in the patients who received INH Px at an aspartate aminotransferase (AST) level that was less than 50 U/L than in those who received INH Px at an AST level that was more than 50 U/L (P=0.046, 0.002). Conclusions INH is likely to be effective for preventing post-LT TB recurrence in LTBI. However, because of INH-induced hepatotoxicity, it is better to avoid using it in the early post-LT period and to wait to initiate INH Px until liver function is stable in LT recipients.
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Affiliation(s)
- Hyung Hwan Moon
- Department of Surgery, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, South Korea
| | - So Yeon Park
- Division of Infectious Diseases, Department of Medicine, Hallym University Medical Center, Hallym University School of Medicine, Seoul, South Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-Joo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Suk-Koo Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Georgia and the South Sandwich Islands
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Barbouch S, Hajji M, Helal I, Ounissi M, Bacha MM, Ben Hamida F, Abderrahim E, Ben Abdallah T. Tuberculosis After Renal Transplant. EXP CLIN TRANSPLANT 2017; 15:200-203. [PMID: 28260468 DOI: 10.6002/ect.mesot2016.p79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tuberculosis is one of the leading infections after renal transplant, particularly in developing countries where the incidence and prevalence in the general population are high. Diagnosis requires bacteriologic and histologic confirmation. Interactions among the antitubercular drugs and the immunosuppressive agents have to be considered while prescribing, and surveillance for adverse effects is required. Although rare, case reports are available on extrapulmonary tuberculosis in allograft recipients. Here, we present a 25-year-old kidney transplant recipient who was diagnosed with lymph node tuberculosis under uncommon circumstances but who had a good outcome. This case report illustrates the difficulties in diagnosis of tuberculosis, changes in therapeutic protocols, and prognostic factors and highlights the effects of infectious complications with immunosuppressive therapy in this particular patient population.
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Affiliation(s)
- Samia Barbouch
- Nephrology Department, Laboratory of Renal Pathology and Laboratory of Kidney Transplantation Immunology and Immunopathology, Charles Nicolle Hospital, Tunis, Tunisia
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Meinerz G, da Silva C, Goldani J, Garcia V, Keitel E. Epidemiology of tuberculosis after kidney transplantation in a developing country. Transpl Infect Dis 2016; 18:176-82. [DOI: 10.1111/tid.12501] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/24/2015] [Accepted: 11/22/2015] [Indexed: 01/30/2023]
Affiliation(s)
- G. Meinerz
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
| | - C.K. da Silva
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
| | - J.C. Goldani
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
| | - V.D. Garcia
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
| | - E. Keitel
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
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Pereira M, Gazzoni FF, Marchiori E, Irion K, Moreira J, Giacomelli IL, Pasqualotto A, Hochhegger B. High-resolution CT findings of pulmonary Mycobacterium tuberculosis infection in renal transplant recipients. Br J Radiol 2015; 89:20150686. [PMID: 26607644 DOI: 10.1259/bjr.20150686] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Renal transplantation recipients are at increased risk of Mycobacterium tuberculosis infection because of immunosuppression. The aim of this study was to assess high-resolution CT (HRCT) findings in renal transplantation recipients diagnosed with pulmonary tuberculosis (TB). METHODS We reviewed HRCT findings from patients diagnosed with pulmonary TB, established by M. tuberculosis detection in bronchoalveolar lavage, sputum or biopsy sample. Two observers independently reviewed HRCT images and reached consensus decisions on the presence and distribution of: (i) miliary nodules, (ii) cavitation and centrilobular tree-in-bud nodules, (iii) ground-glass attenuation and consolidation, (iv) mediastinal lymph node enlargement and (v) pleural effusion. RESULTS The sample comprised 40 patients [26 males, 14 females; median age, 45 years (range, 12-69 years)]. The main HRCT pattern was miliary nodules (40%), followed by cavitation and centrilobular tree-in-bud nodules (22.5%), ground-glass attenuation and consolidation (15%), mediastinal lymph node enlargement (12.5%) and pleural effusion (10%). The distribution of findings in patients with miliary nodules was random. In patients with cavitation and centrilobular tree-in-bud nodules, 66.6% of abnormalities were found in the upper lobes. Pleural effusion was unilateral in 75% of cases. The overall mortality rate was 27.5%. This rate was 50% in patients with miliary nodules, and 72.6% of all deaths occurred in this group. Thus, mortality was increased significantly in patients with miliary nodules (p < 0.05). CONCLUSION The main HRCT finding in renal transplantation recipients with pulmonary TB was miliary nodules, followed by cavitation and centrilobular tree-in-bud nodules. Miliary nodules were associated with a worse prognosis in these patients. ADVANCES IN KNOWLEDGE We report the first series on HRCT findings of microbiologically confirmed pulmonary TB exclusively in renal transplantation recipients. The main HRCT finding was miliary nodules, and mortality was increased significantly in these patients.
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Affiliation(s)
- Marisa Pereira
- 1 Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fernando F Gazzoni
- 2 Labimed-Medical Imaging Research Lab, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)/Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Edson Marchiori
- 3 Radiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Klaus Irion
- 4 Radiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Jose Moreira
- 1 Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Irai L Giacomelli
- 2 Labimed-Medical Imaging Research Lab, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)/Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Alessandro Pasqualotto
- 2 Labimed-Medical Imaging Research Lab, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)/Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Bruno Hochhegger
- 2 Labimed-Medical Imaging Research Lab, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)/Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
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Dave K, Gandhi B, Kalthoonical V. Uncommon presentation of tuberculosis in a renal allograft recipient. INDIAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.1016/j.ijt.2015.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Benito N, García-Vázquez E, Horcajada JP, González J, Oppenheimer F, Cofán F, Ricart MJ, Rimola A, Navasa M, Rovira M, Roig E, Pérez-Villa F, Cervera C, Moreno A. Clinical features and outcomes of tuberculosis in transplant recipients as compared with the general population: a retrospective matched cohort study. Clin Microbiol Infect 2015; 21:651-8. [PMID: 25882369 DOI: 10.1016/j.cmi.2015.03.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/28/2015] [Accepted: 03/21/2015] [Indexed: 02/08/2023]
Abstract
There are no previous studies comparing tuberculosis in transplant recipients (TRs) with other hosts. We compared the characteristics and outcomes of tuberculosis in TRs and patients from the general population. Twenty-two TRs who developed tuberculosis from 1996 through 2010 at a tertiary hospital were included. Each TR was matched by age, gender and year of diagnosis with four controls selected from among non-TR non-human immunodeficiency virus patients with tuberculosis. TRs (21 patients, 96%) had more factors predisposing to tuberculosis than non-TRs (33, 38%) (p <0.001). Pulmonary tuberculosis was more common in non-TRs (77 (88%) vs. 12 TRs (55%); p 0.001); disseminated tuberculosis was more frequent in TRs (five (23%) vs. four non-TRs (5%); p 0.005). Time from clinical suspicion of tuberculosis to definitive diagnosis was longer in TRs (median of 14 days) than in non-TRs (median of 0 days) (p <0.001), and invasive procedures were more often required (12 (55%) TRs and 15 (17%) non-TRs, respectively; p 0.001). Tuberculosis was diagnosed post-mortem in three TRs (14%) and in no non-TRs (p <0.001). Rates of toxicity associated with antituberculous therapy were 38% in TRs (six patients) and 10% (seven patients) in non-TRs (p 0.014). Tuberculosis-related mortality rates in TRs and non-TRs were 18% and 6%, respectively (p 0.057). The adjusted Cox regression analysis showed that the only predictor of tuberculosis-related mortality was a higher number of organs with tuberculosis involvement (adjusted hazard ratio 8.6; 95% CI 1.2-63). In conclusion, manifestations of tuberculosis in TRs differ from those in normal hosts. Post-transplant tuberculosis resists timely diagnosis, and is associated with a higher risk of death before a diagnosis can be made.
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Affiliation(s)
- N Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
| | - E García-Vázquez
- Infectious Diseases Service, Hospital Clínico Universitario Virgen de la Arrixaca. University of Murcia, Murcia, Spain
| | - J P Horcajada
- Infectious Diseases Service, Parc de Salut Mar. Universitat Pompeu Fabra, Barcelona, Spain
| | - J González
- Microbiology Service, Hospital Clínic Universitari - Institut d'Investigacions Biomèdicas Agust Pí y Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - F Oppenheimer
- Renal Transplant Unit, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - F Cofán
- Renal Transplant Unit, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - M J Ricart
- Renal Transplant Unit, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - A Rimola
- Liver Unit, Hospital Clínic Universitari - IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M Navasa
- Liver Unit, Hospital Clínic Universitari - IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - M Rovira
- Haematology Service, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - E Roig
- Cardiology Service, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Pérez-Villa
- Cardiology Service, Hospital Clínic Universitari - IDIBAPS, University of Barcelona Institut d'Investigacions Biomèdicas Agust Pí y Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Cervera
- Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
| | - A Moreno
- Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Clínic Universitari - IDIBAPS. University of Barcelona, Barcelona, Spain
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Hekimoglu K, Tezcan S, Coskun M, Dogrul M, Moray G, Haberal M. MDCT Evaluation of Early Pulmonary Infection Types After Liver Transplantation. Transplant Proc 2015; 47:473-7. [DOI: 10.1016/j.transproceed.2014.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 11/17/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022]
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Outcome of latent tuberculosis infection in solid organ transplant recipients over a 10-year period. Transplantation 2015; 98:671-5. [PMID: 24825525 DOI: 10.1097/tp.0000000000000133] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Screening and therapy of latent tuberculosis infection (LTBI) is recommended in solid organ transplant (SOT). However, there are limited data on the tolerability of LTBI therapy pretransplant and posttransplant. We studied the tolerability of LTBI therapy and effectiveness of a centralized LTBI treatment program in a low-risk population. METHODS Provincial TB and transplant databases were retrospectively reviewed for LTBI therapy referrals in SOT candidates and recipients over a 10-year period. Using univariate logistic regression, we examined factors associated with failure to complete therapy and followed patients for active TB. RESULTS From 2001 to 2010, 200/461 SOT candidates referred to the TB program (43.4%) were eligible for therapy for LTBI. Eleven patients refused therapy. The remaining patients (n=189) were initially prescribed isoniazid (73%), rifampin (12.7%), or another regimen (14.3%). Adequate LTBI therapy occurred in 122 (64.5%). Patients who were liver transplant candidates or recipients were less likely to complete therapy than nonliver transplant patients (OR, 0.20; P<0.001) as were patients treated in the posttransplant phase (OR, 0.47; P=0.034). Liver enzyme elevation led to discontinuation of therapy more often in liver transplant candidates and recipients (OR, 10.48; P<0.001) and posttransplant treatment (OR, 3.50; P=0.019). In 599.4 patient-years of follow-up posttransplant (mean, 4.9 year/patient), there were no cases of active TB. CONCLUSION A centralized referral program for LTBI therapy in transplant candidates is effective to prevent TB reactivation posttransplant. A significant proportion of liver transplant candidates and recipients do not tolerate standard LTBI therapy. Alternative therapies for these patients should be evaluated.
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Abidi K, Jellouli M, Hammi Y, Gargah T. Tuberculosis following kidney transplantation: report of paediatric case. Pan Afr Med J 2015; 22:302. [PMID: 26966498 PMCID: PMC4769046 DOI: 10.11604/pamj.2015.22.302.7882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/12/2015] [Indexed: 12/02/2022] Open
Abstract
Recipients of solid organ transplantation are, because of immunosuppressive therapy, at high risk to develop opportunistic infections including tuberculosis (TB). The incidence, clinical manifestations, and optimal diagnostic tests of this disease in this population have not been adequately defined. In this paper, we report a case of 13 year-old boy who developed pulmonary tuberculosis following a second renal transplantation from a deceased donor. The described case points diagnostic difficulties of the tuberculosis disease which are due to insidious and non specific clinical presentation. Also, the treatment is delicate because interaction between immunosuppressive drugs and antituberculosis drugs.
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Affiliation(s)
- Kamel Abidi
- Pediatric Nephrology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Manel Jellouli
- Pediatric Nephrology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Yousra Hammi
- Pediatric Nephrology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Tahar Gargah
- Pediatric Nephrology Department, Charles Nicolle Hospital, Tunis, Tunisia
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Ulloa J, Parekh J, Hope C, Roll G. Case Report of Intestinal Tuberculosis 6 Years After Simultaneous Pancreas and Kidney Transplant. Transplant Proc 2014; 46:2450-2. [DOI: 10.1016/j.transproceed.2014.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/12/2014] [Indexed: 11/26/2022]
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Regmi A, Singh P, Harford A. A Case of Multidrug-Resistant Monoarticular Joint Tuberculosis in a Renal Transplant Recipient. Transplant Proc 2014; 46:274-7. [DOI: 10.1016/j.transproceed.2013.07.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 07/24/2013] [Indexed: 02/04/2023]
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Mycobacterium tuberculosis infection following kidney transplantation. BIOMED RESEARCH INTERNATIONAL 2013; 2013:347103. [PMID: 24222903 PMCID: PMC3816022 DOI: 10.1155/2013/347103] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 06/19/2013] [Indexed: 11/20/2022]
Abstract
Introduction and Aims. Post-transplant tuberculosis (TB) is a problem in successful long-term outcome of renal transplantation recipients. Our objective was to describe the pattern and risk factors of TB infection and the prognosis in our transplant recipients. Patients and Methods. 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. Results. 16 patients (3,2%) developed post-transplant TB with a mean age of 32,5 ± 12,7 (range: 13–60) years and a mean post-transplant period of 36,6months (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%). 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. Recurrences were observed in 4 cases after early stop of treatment. Two patients (12.5%) died. Conclusion. Extra pulmonary and disseminated tuberculosis were observed in third of our patients. More than 9months of treatment may be necessary to prevent recurrence.
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Wu TJ, Chiang WF, Wu ST, Lin SH. Tuberculous Sacroiliitis in a Renal Transplant Recipient: A Case Report. Transplant Proc 2013; 45:2798-800. [DOI: 10.1016/j.transproceed.2012.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 11/18/2012] [Accepted: 12/30/2012] [Indexed: 10/26/2022]
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Marques IDB, Azevedo LS, Pierrotti LC, Caires RA, Sato VAH, Carmo LPF, Ferreira GF, Gamba C, de Paula FJ, Nahas WC, David-Neto E. Clinical features and outcomes of tuberculosis in kidney transplant recipients in Brazil: a report of the last decade. Clin Transplant 2013; 27:E169-76. [DOI: 10.1111/ctr.12077] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 02/04/2023]
Affiliation(s)
- Igor D. B. Marques
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Luiz S. Azevedo
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Lígia C. Pierrotti
- Department of Infectious Diseases; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Renato A. Caires
- Division of Nephrology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Víctor A. H. Sato
- Division of Nephrology; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Lilian P. F. Carmo
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Gustavo F. Ferreira
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Cristiano Gamba
- Department of Infectious Diseases; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Flávio J. de Paula
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - William C. Nahas
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
| | - Elias David-Neto
- Renal Transplant Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo; Brazil
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Kupeli E, Ulubay G, Colak T, Ozdemirel TS, Ozyurek BA, Akcay S, Haberal M. Pulmonary complications in renal recipients after transplantation. Transplant Proc 2011; 43:551-3. [PMID: 21440758 DOI: 10.1016/j.transproceed.2011.01.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Renal transplantation is the most common type of solid organ transplantation. Recipients are susceptible to a variety of pulmonary complications, in particular during intense immunosuppression therapy. OBJECTIVE To evaluate pulmonary complications during the first year after renal transplantation. MATERIALS AND METHODS Medical records were reviewed retrospectively for all patients who underwent renal transplantation between 2007 and 2010. Data pertinent to pulmonary complications were obtained including patient demographics, findings at chest radiography and pulmonary function testing, concentrations of C-reactive protein and albumin, and white blood cell count. RESULTS The study included 136 patients (71.3% men), with mean (SD) age of 36.3 (12.2) years. The most frequently prescribed immunosuppression therapy included prednisolone plus cyclosporine, tacrolimus, or rapamycin. Fifteen patients developed complications during the first year after surgery including respiratory infections in 12 (80%), namely, bacterial pneumonia in 10 (66.6%), and tuberculosis (caused by Mycobacterium tuberculosis) in 2 (33.3%). Pneumonia developed within the first 5 months after transplantation in 6 patients, and tuberculosis after the third month. Microbiologic agents were detected in 3 of the 6 patients (20%), and empyema, postoperative atelectasis, and pulmonary embolism, respectively, in the other 3 patients. No association was observed between complications and baseline pulmonary function test results. C-reactive protein concentration was significantly increased in patients with pulmonary complications. No invasive procedures were performed to diagnose complications, all of which resolved with appropriate treatment. CONCLUSION Pulmonary infections are a primary complication in renal transplant recipients, and are observed most frequently in the first 6 months after surgery. Immunosuppression therapy is the most likely cause of these complications, and rigorous monitoring of drug concentrations is essential. An invasive diagnostic approach may not always be necessary to determine the early specific therapy.
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Affiliation(s)
- E Kupeli
- Department of Pulmonary Diseases, Baskent University School of Medicine, Ankara, Turkey.
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Hoyo I, Linares L, Cervera C, Almela M, Marcos MA, Sanclemente G, Cofán F, Ricart MJ, Moreno A. Epidemiology of pneumonia in kidney transplantation. Transplant Proc 2011; 42:2938-40. [PMID: 20970576 DOI: 10.1016/j.transproceed.2010.07.082] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pneumonia remains an important cause of morbidity among solid organ transplant recipients. METHODS We prospectively evaluated all renal transplant patients at our center from July 2003 to December 2008 who had pneumonia that required hospitalization. We gathered data regarding underlying diseases as well as pretransplant, transplant, and posttransplant characteristics. Pneumonia defined according to the Centers for Disease Control and Prevention criteria was classified depending on its origin as community acquired or nosocomial. In all patients, microbiologic samples of respiratory secretions and blood were collected at the physician's discretion. The indication to perform a fiberoptic bronchoscopy was the presence of multiple, bilateral, or diffuse pulmonary infiltrates or the absence of a clinical or radiologic response after 3 days of antimicrobial therapy. RESULTS Among 610 kidney transplant recipients, we diagnosed 60 episodes of pneumonia in 54 patients (8.8%), of which 23 had a nosocomial origin (38%) and 37 community acquired (62%). Bacterial infection was the most frequent etiology (44%), followed by fungal in 4 (7%) and viral in 2 (3.5%). The most commonly isolated microorganism in nosocomial pneumonia was Pseudomonas aeruginosa (26%, among which 50% was multidrug resistant). In 34% there was no microbiologic isolation. The most common pathogen among community-acquired pneumonias was Strepococcus pneumoniae (11%). In 54% of cases there was no microbiologic confirmation of disease. The overall accuracy of bronchoalveolar lavage was 72%. A total of 21 patients with pneumonia (35%) were admitted to the intensive care unit; of these, 14 had a nosocomial origin (60%) and 9 (15%) died due to the infection (8 [88%] of whom had nosocomial pneumonia; P=.001). CONCLUSIONS Our data confirmed that nosocomial pulmonary infections are associated with considerable morbidity and mortality in renal transplant recipients. The performance of invasive procedures is useful for the diagnosis of pneumonia.
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Affiliation(s)
- I Hoyo
- Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Orcau À, Caylà JA, Martínez JA. Present epidemiology of tuberculosis. Prevention and control programs. Enferm Infecc Microbiol Clin 2011; 29 Suppl 1:2-7. [DOI: 10.1016/s0213-005x(11)70011-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kupeli E, Akcay S, Ulubay G, Ozyurek B, Ozdemirel T, Haberal M. Diagnostic Utility of Flexible Bronchoscopy in Recipients of Solid Organ Transplants. Transplant Proc 2011; 43:543-6. [DOI: 10.1016/j.transproceed.2011.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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