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Nasir N, Sarfaraz S, Khanum I, Ansari T, Nasim A, Dodani SK, Luxmi S. Tuberculosis in Solid Organ Transplantation: Insights from TB Endemic Areas. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00756-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Tuberculous appendicitis is a rare extrapulmonary manifestation of tuberculosis without clear summarization or consensus on its management. DATA SOURCES Case reports were gathered from several online literature databases by searching terms "tuberculosis", "tuberculous", and "appendicitis".Report eligibility criteria: Cases of appendicitis due to M. tuberculosis identified on operative histology. Exclusion criteria: appendicitis caused by a mycobacterium other than M. tuberculosis, and appendiceal tuberculosis identified incidentally during procedures for other reasons. RESULTS Thirty four patients were identified. Twenty five patients presented with acute right lower quadrant abdominal pain. Eleven patients described chronic symptoms of tuberculosis (cough, night sweats, or weakness/fatigue). Four patients had a known diagnosis of TB. Seven of 24 cases reported peri-operative chest imaging which demonstrated pulmonary lesions. AFB were present in tissue or fluid samples of 6 patients, and negative in 15 patients. All patients underwent pharmacotherapy on a WHO-recommended anti-tuberculous treatment (ATT) with RIPE or an alternative. The average duration of treatment was 7.2 ± 1.7 months. LIMITATIONS Data was gathered from case reports without complete uniformity in diagnostic work-up. The potential for larger scale study is limited due to disease rarity. CONCLUSIONS Tuberculous appendicitis cannot be diagnosed prior to histologic evaluation. Several data points may suggest the disease on a clinician's differential diagnosis if they present with a combination of the following: born in a country with endemic tuberculosis; chronic cough, weakness/fatigue, or nausea prior to onset of abdominal pain; pulmonary lesions on chest X-ray; white studding of the mesentery or peritoneum in a young patient; positive AFB stain of abdominal fluid or peritoneal tissue.
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Affiliation(s)
- Grant Hubbard
- Western Reserve Hospital, Department of Surgery, 1900 23rd St, Cuyahoga Falls, OH 44223, USA
| | - Walter Chlysta
- Western Reserve Hospital, Department of Surgery, 1900 23rd St, Cuyahoga Falls, OH 44223, USA
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Giacomelli IL, Schuhmacher Neto R, Marchiori E, Pereira M, Hochhegger B. Chest X-ray and chest CT findings in patients diagnosed with pulmonary tuberculosis following solid organ transplantation: a systematic review. ACTA ACUST UNITED AC 2019; 44:161-166. [PMID: 29791554 PMCID: PMC6044660 DOI: 10.1590/s1806-37562017000000459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/02/2018] [Indexed: 11/21/2022]
Abstract
The objective of this systematic review was to select articles including chest X-ray or chest CT findings in patients who developed pulmonary tuberculosis following solid organ transplantation (lung, kidney, or liver). The following search terms were used: "tuberculosis"; "transplants"; "transplantation"; "mycobacterium"; and "lung". The databases used in this review were PubMed and the Brazilian Biblioteca Virtual em Saúde (Virtual Health Library). We selected articles in English, Portuguese, or Spanish, regardless of the year of publication, that met the selection criteria in their title, abstract, or body of text. Articles with no data on chest CT or chest X-ray findings were excluded, as were those not related to solid organ transplantation or pulmonary tuberculosis. We selected 29 articles involving a collective total of 219 patients. The largest samples were in studies conducted in Brazil and South Korea (78 and 35 patients, respectively). The imaging findings were subdivided into five common patterns. The imaging findings varied depending on the transplanted organ in these patients. In liver and lung transplant recipients, the most common pattern was the classic one for pulmonary tuberculosis (cavitation and "tree-in-bud" nodules), which is similar to the findings for pulmonary tuberculosis in the general population. The proportion of cases showing a miliary pattern and lymph node enlargement, which is most similar to the pattern seen in patients coinfected with tuberculosis and HIV, was highest among the kidney transplant recipients. Further studies evaluating clinical data, such as immunosuppression regimens, are needed in order to improve understanding of the distribution of these imaging patterns in this population.
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Affiliation(s)
- Irai Luis Giacomelli
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marisa Pereira
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - Bruno Hochhegger
- Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
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Ardalan MR. Global scientific vision with local vigilance: renal transplantation in developing countries. Nephrourol Mon 2015; 7:e22653. [PMID: 25738120 PMCID: PMC4330688 DOI: 10.5812/numonthly.22653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 08/30/2014] [Accepted: 09/13/2014] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Renal Transplantation is the most effective treatment for patients with end-stage renal disease, which is fortunately available in the developing countries, even for poor people. Nonetheless, the way forward should be the implementation of advanced science of transplantation, allograft monitoring abilities, knowledge about the epidemiology of renal disease in any specific region, awareness about the influence of ethenic and genetic factors immunosuppressant bioavailability, and post-transplant complications all strongly affecting the patients and allograft survival. EVIDENCE ACQUISITIONS In this process we searched mainly in PubMed, Web of Science and Google Scholar data bases for key words of renal allograft monitoring, post-transplant infections, renal/kidney transplantation and Iran. We followed the cross articles to follow our main idea to find a connection between modern advancement in renal allograft monitoring and our practice in developing countries. Another focus was on the special infectious and non-infection complication that do exist in specific region and need specific considerations. RESULTS Implementation of modern techniques of immune monitoring, allograft function, awareness about the specific infectious and non-infectious disease in each region improves the quality of renal transplantation. CONCLUSIONS We need to combine the advance scientific vision with local vigilance to achieve the best outcome in renal allograft recipients.
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Affiliation(s)
- Mohammad Reza Ardalan
- Chronic Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Ardalan MR. Tabriz nephro-educational courses; A global scientific vision with local vigilance. J Renal Inj Prev 2014; 3:7-8. [PMID: 25436221 PMCID: PMC4206040 DOI: 10.12861/jrip.2014.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 11/29/2013] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mohammad-Reza Ardalan
- Chronic Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Moniri A, Marjani M, Tabarsi P, Baghaei P, Dorudinia A, Masjedi MR. Multidrug-resistant tubercular appendicitis: Report of a case. Int J Mycobacteriol 2013; 2:227-9. [PMID: 26786127 DOI: 10.1016/j.ijmyco.2013.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 07/17/2013] [Accepted: 07/17/2013] [Indexed: 11/26/2022] Open
Abstract
Acute tubercular appendicitis has remained a rare disease despite frequent cases of tuberculosis. The following study reports a patient with multidrug-resistant (MDR) pulmonary tuberculosis that developed acute appendicitis. Histopathology of the appendix was compatible with tuberculosis. The patient had a good outcome after surgery and medical therapy.
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Affiliation(s)
- Afshin Moniri
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atosa Dorudinia
- Pediatric Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Masjedi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Affiliation(s)
- Mohammad-Reza Ardalan
- Chronic Kidney Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Azevedo P, Freitas C, Silva H, Aguiar P, Farrajota P, Almeida M, Pedroso S, Martins LS, Dias L, Vizcaíno JR, Castro Henriques A, Cabrita A. A case series of gastrointestinal tuberculosis in renal transplant patients. Case Rep Nephrol 2013; 2013:213273. [PMID: 24558621 PMCID: PMC3914201 DOI: 10.1155/2013/213273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 01/26/2013] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach.
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Affiliation(s)
- Pedro Azevedo
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Cristina Freitas
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Hugo Silva
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Pedro Aguiar
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Pedro Farrajota
- Department of Pathology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Manuela Almeida
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Sofia Pedroso
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - La Salete Martins
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - Leonídio Dias
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - José Ramón Vizcaíno
- Department of Pathology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - António Castro Henriques
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
| | - António Cabrita
- Department of Nephrology, Centro Hospitalar do Porto, Santo António Hospital, 4099-001 Porto, Portugal
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Ardalan M. Rare presentations of cytomegalovirus infection in renal allograft recipients. Nephrourol Mon 2012; 4:431-6. [PMID: 23573461 PMCID: PMC3614274 DOI: 10.5812/numonthly.1844] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 07/19/2011] [Accepted: 07/27/2011] [Indexed: 01/15/2023] Open
Abstract
Cytomegalovirus is the most common viral infection after kidney transplantation. Clinical presentations of cytomegalovirus infection range from asymptomatic infection to organ-specific involvement. Most symptomatic infections manifest as fever and cytopenia. The gastrointestinal tract is the most common site of tissue-invasive infection, often presenting as diarrhea or gastrointestinal bleeding. Gastrointestinal obstruction, perforation, thrombosis of large gastrointestinal veins, splenic artery thrombosis, and pancreatitis are rare gastrointestinal presentations of cytomegalovirus infection. Renal-allograft ureteral stricture and skin involvement are other rare presentations of cytomegalovirus infection. hemophagocytic syndrome, thrombotic microangiopathy, adrenal insufficiency, and renal allograft artery stenosis are other rare symptoms of cytomegalovirus infection.
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Affiliation(s)
- Mohammadreza Ardalan
- Department of Nephrology, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Mario Negri Institute of Pharmacological Research, Bergamo, Italy
- Corresponding author: Mohammadreza Ardalan, Department of nephrology, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel.: +98-4113344339, Fax: +98-4113344280, E-mail:
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Etemadi J, Shoja MM, Ghabili K, Talebi M, Namdar H, Mirnour R. Multiple etiologies of axonal sensory motor polyneuropathy in a renal transplant recipient: a case report. J Med Case Rep 2011; 5:530. [PMID: 22032472 PMCID: PMC3223516 DOI: 10.1186/1752-1947-5-530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 10/27/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Neurological complications leading to morbidity and mortality are not frequent in renal transplant recipients. Here, we report a renal transplant recipient who presented with diminished strength in his limbs probably due to multiple etiologies of axonal sensorimotor polyneuropathy, which resolved with intravenous immunoglobulin. CASE PRESENTATION A 49-year-old Iranian male renal transplant recipient with previous history of autosomal dominant polycystic kidney disease presented with diminished strength in his limbs one month after surgery. Our patient was on cyclosporine A, mycophenolate mofetil and prednisone. Although a detected hypophosphatemia was corrected with supplemental phosphate, the loss of strength was still slowly progressive and diffuse muscular atrophy was remarkable in his trunk, upper limb and pelvic girdle. Meanwhile, his cranial nerves were intact. Post-transplant diabetes mellitus was diagnosed and insulin therapy was initiated. In addition, as a high serum cyclosporine level was detected, the dose of cyclosporine was reduced. Our patient was also put on intravenous ganciclovir due to positive serum cytomegalovirus immunoglobulin M antibody. Despite the reduction of oral cyclosporine dose along with medical therapy for the cytomegalovirus infection and diabetes mellitus, his muscular weakness and atrophy did not improve. One week after administration of intravenous immunoglobulin, a significant improvement was noted in his muscular weakness. CONCLUSION A remarkable response to intravenous immunoglobulin is compatible with an immunological basis for the present condition (post-transplant polyneuropathy). In cases of post-transplant polyneuropathy with a high clinical suspicion of immunological origin, administration of intravenous immunoglobulin may be recommended.
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Affiliation(s)
- Jalal Etemadi
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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