Tuberculosis in renal transplant patients

Detalhes bibliográficos
Autor(a) principal: Paula, Flávio Jota de
Data de Publicação: 1987
Outros Autores: Azevedo, Luiz Sérgio, Saldanha, Luiz Balthazar, Ianhez, Luiz Estevam, Sabbaga, Emil
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista do Instituto de Medicina Tropical de São Paulo
Texto Completo: https://www.revistas.usp.br/rimtsp/article/view/28530
Resumo: Tuberculosis (TB) was diagnosed in 25 of 466 patients who underwent renal transplant over a period of 15 years. TB developed from 1 month to 9 years post-transplant. In 56% of the cases the onset was within the first post-transplant year. TB affected several isolated or combined organs. Pulmonary involvement was present in 76% of cases, either as isolated pleuro-pulmonary (56%) or associated with other sites (20%). The non-pulmonary sites were: skin, joints, tests, urinary tract, central nervous system and lymphonodules. The diagnosis was confirmed by biopsy in 64% of the cases, by identification of tubercle bacilli in 24% and only at necropsy in 12% Biopsy specimens could be classified in three histological forms: exudative, that occurred in early onset and more severe cases granulomatous in late onset and benign cases; and mixed in intermediate cases. Azathioprine dosages were similar along post-transplant time periods in TB patients and in the control groups; and in TB patients who were cured and who died. The number of steroid treated rejection crises was greater in TB than in the control group. Prednisone doses were higher and the number of rejection crises was greater in TB patients who died than in those who were cured. Fifteen patients were cured and ten died, two of them of causes unrelated to TB. Six of the eight TB-related deaths occurred in the first 6 post-transplant months. The outcome was poor in patients in whom TB arose early in post-transplant period and where the exudative or mixed forms were present; whereas the prognosis was good in patients with late onset and granulomatous form of TB. In one patient TB was transmitted by the allograft.
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spelling Tuberculosis in renal transplant patients Tuberculose em pacientes transplantados renais TuberculosisKidney transplantationInfectionImmunosuppression Tuberculosis (TB) was diagnosed in 25 of 466 patients who underwent renal transplant over a period of 15 years. TB developed from 1 month to 9 years post-transplant. In 56% of the cases the onset was within the first post-transplant year. TB affected several isolated or combined organs. Pulmonary involvement was present in 76% of cases, either as isolated pleuro-pulmonary (56%) or associated with other sites (20%). The non-pulmonary sites were: skin, joints, tests, urinary tract, central nervous system and lymphonodules. The diagnosis was confirmed by biopsy in 64% of the cases, by identification of tubercle bacilli in 24% and only at necropsy in 12% Biopsy specimens could be classified in three histological forms: exudative, that occurred in early onset and more severe cases granulomatous in late onset and benign cases; and mixed in intermediate cases. Azathioprine dosages were similar along post-transplant time periods in TB patients and in the control groups; and in TB patients who were cured and who died. The number of steroid treated rejection crises was greater in TB than in the control group. Prednisone doses were higher and the number of rejection crises was greater in TB patients who died than in those who were cured. Fifteen patients were cured and ten died, two of them of causes unrelated to TB. Six of the eight TB-related deaths occurred in the first 6 post-transplant months. The outcome was poor in patients in whom TB arose early in post-transplant period and where the exudative or mixed forms were present; whereas the prognosis was good in patients with late onset and granulomatous form of TB. In one patient TB was transmitted by the allograft. Tuberculose (TB) foi diagnosticada em 25 de 466 pacientes submetidos a transplante renal. A TB surgiu entre 1 mês e 9 anos pós-transplante. O pulmão foi acometido em 76% dos casos, isoladamente (56%), ou associado a outras localizações (20%). Os outros órgãos envolvidos foram: pele, articulações, testículos, trato urinário, sistema nervoso central e linfonodos. O diagnóstico foi confirmado por biópsia em 64% dos casos, pela identificação do bacilo em 24% e apenas à necrópsia em 12%. Três formas histológicas foram identificadas: exudativa (nos casos de aparecimento precoce e de maior gravidade) granulomatosa (naqueles benignos e de aparecimento tardio) e mista (naqueles intermediários). As doses de azatioprina foram constantes ao longo do período pós-transplante, tanto no grupo tuberculoso como no controle, bem como nos pacientes tuberculosos que faleceram e que se curaram. O número de crises de rejeição tratadas foi maior no grupo TB do que no grupo controle. As doses de prednisona e o número de crises de rejeição foram maiores nos pacientes tuberculosos que faleceram do que naqueles que sobreviveram. Quinze pacientes se curaram e 10 faleceram, oito de causas relacionadas à TB, Seis destes óbitos ocorreram nos 6 primeiros meses pós-transplante. Em um paciente a TB foi transmitida pelo enxerto. Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo1987-10-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/rimtsp/article/view/28530Revista do Instituto de Medicina Tropical de São Paulo; Vol. 29 No. 5 (1987); 268-275 Revista do Instituto de Medicina Tropical de São Paulo; Vol. 29 Núm. 5 (1987); 268-275 Revista do Instituto de Medicina Tropical de São Paulo; v. 29 n. 5 (1987); 268-275 1678-99460036-4665reponame:Revista do Instituto de Medicina Tropical de São Pauloinstname:Instituto de Medicina Tropical (IMT)instacron:IMTenghttps://www.revistas.usp.br/rimtsp/article/view/28530/30383Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Pauloinfo:eu-repo/semantics/openAccessPaula, Flávio Jota deAzevedo, Luiz SérgioSaldanha, Luiz BalthazarIanhez, Luiz EstevamSabbaga, Emil2012-07-02T00:58:02Zoai:revistas.usp.br:article/28530Revistahttp://www.revistas.usp.br/rimtsp/indexPUBhttps://www.revistas.usp.br/rimtsp/oai||revimtsp@usp.br1678-99460036-4665opendoar:2022-12-13T16:50:15.733566Revista do Instituto de Medicina Tropical de São Paulo - Instituto de Medicina Tropical (IMT)true
dc.title.none.fl_str_mv Tuberculosis in renal transplant patients
Tuberculose em pacientes transplantados renais
title Tuberculosis in renal transplant patients
spellingShingle Tuberculosis in renal transplant patients
Paula, Flávio Jota de
Tuberculosis
Kidney transplantation
Infection
Immunosuppression
title_short Tuberculosis in renal transplant patients
title_full Tuberculosis in renal transplant patients
title_fullStr Tuberculosis in renal transplant patients
title_full_unstemmed Tuberculosis in renal transplant patients
title_sort Tuberculosis in renal transplant patients
author Paula, Flávio Jota de
author_facet Paula, Flávio Jota de
Azevedo, Luiz Sérgio
Saldanha, Luiz Balthazar
Ianhez, Luiz Estevam
Sabbaga, Emil
author_role author
author2 Azevedo, Luiz Sérgio
Saldanha, Luiz Balthazar
Ianhez, Luiz Estevam
Sabbaga, Emil
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Paula, Flávio Jota de
Azevedo, Luiz Sérgio
Saldanha, Luiz Balthazar
Ianhez, Luiz Estevam
Sabbaga, Emil
dc.subject.por.fl_str_mv Tuberculosis
Kidney transplantation
Infection
Immunosuppression
topic Tuberculosis
Kidney transplantation
Infection
Immunosuppression
description Tuberculosis (TB) was diagnosed in 25 of 466 patients who underwent renal transplant over a period of 15 years. TB developed from 1 month to 9 years post-transplant. In 56% of the cases the onset was within the first post-transplant year. TB affected several isolated or combined organs. Pulmonary involvement was present in 76% of cases, either as isolated pleuro-pulmonary (56%) or associated with other sites (20%). The non-pulmonary sites were: skin, joints, tests, urinary tract, central nervous system and lymphonodules. The diagnosis was confirmed by biopsy in 64% of the cases, by identification of tubercle bacilli in 24% and only at necropsy in 12% Biopsy specimens could be classified in three histological forms: exudative, that occurred in early onset and more severe cases granulomatous in late onset and benign cases; and mixed in intermediate cases. Azathioprine dosages were similar along post-transplant time periods in TB patients and in the control groups; and in TB patients who were cured and who died. The number of steroid treated rejection crises was greater in TB than in the control group. Prednisone doses were higher and the number of rejection crises was greater in TB patients who died than in those who were cured. Fifteen patients were cured and ten died, two of them of causes unrelated to TB. Six of the eight TB-related deaths occurred in the first 6 post-transplant months. The outcome was poor in patients in whom TB arose early in post-transplant period and where the exudative or mixed forms were present; whereas the prognosis was good in patients with late onset and granulomatous form of TB. In one patient TB was transmitted by the allograft.
publishDate 1987
dc.date.none.fl_str_mv 1987-10-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://www.revistas.usp.br/rimtsp/article/view/28530
url https://www.revistas.usp.br/rimtsp/article/view/28530
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv https://www.revistas.usp.br/rimtsp/article/view/28530/30383
dc.rights.driver.fl_str_mv Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Paulo
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Paulo
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo
publisher.none.fl_str_mv Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo
dc.source.none.fl_str_mv Revista do Instituto de Medicina Tropical de São Paulo; Vol. 29 No. 5 (1987); 268-275
Revista do Instituto de Medicina Tropical de São Paulo; Vol. 29 Núm. 5 (1987); 268-275
Revista do Instituto de Medicina Tropical de São Paulo; v. 29 n. 5 (1987); 268-275
1678-9946
0036-4665
reponame:Revista do Instituto de Medicina Tropical de São Paulo
instname:Instituto de Medicina Tropical (IMT)
instacron:IMT
instname_str Instituto de Medicina Tropical (IMT)
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reponame_str Revista do Instituto de Medicina Tropical de São Paulo
collection Revista do Instituto de Medicina Tropical de São Paulo
repository.name.fl_str_mv Revista do Instituto de Medicina Tropical de São Paulo - Instituto de Medicina Tropical (IMT)
repository.mail.fl_str_mv ||revimtsp@usp.br
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