Am. J. Respir. Crit. Care Med.,
Volume 158, Number 4, October 1998, 1173-1177
Risk Factors for Pulmonary Tuberculosis in
Bone Marrow Transplant Recipients
MARY S. M.
IP,
K. Y.
YUEN,
PATRICK C. Y.
WOO,
W. K.
LUK,
KENNETH W. T.
TSANG,
W. K.
LAM,
and
RAYMOND H. S.
LIANG
Department of Medicine and Department of Microbiology, University of Hong Kong, Queen Mary Hospital, Hong Kong
Little is known about the profile of infection with Mycobacterium tuberculosis in bone marrow transplant (BMT) recipients. Of five BMT series with a total of more than 5,000 patients, only 10 cases of
M. tuberculosis infection were described, with an overall incidence of 0.19%. We have conducted a
prospective evaluation of 183 consecutive BMT recipients, and 10 patients were found to develop
pulmonary tuberculosis post-BMT, yielding an incidence of 5.5%. We described the clinical features
of these 10 patients, and analyzed the risk factors for development of tuberculosis using age- and sex-matched case control subjects who did not develop the disease. The median age of the 10 patients
who developed tuberculosis was 29 yr (range, 17 to 40 yr). The median time for onset of symptoms was 150 d (range, 23 to 550 d), mainly presenting with fever and cough, with infiltrates on chest radiograph. Respiratory tract specimens, mostly sputum, yielded positive smears for acid-fast bacilli in
three and positive M. tuberculosis culture in eight, whereas lung tissue histology was the first diagnostic test in two patients. Treatment with standard antituberculosis drugs for a longer duration was
highly effective, with no excessive side effects. Risk factors identified for development of tuberculosis included allogeneic BMT (p < 0.05, relative risk [RR] = 23.7), total body irradiation (p < 0.05, RR = 4.9), and chronic graft-versus-host disease (GVHD) (p < 0.05, RR = 3.6). It is postulated that chronic GVHD predisposed to development of tuberculosis mainly via disruption of host reconstitution of immune defenses against M. tuberculosis.
