Mycobacterial infections in solid organ transplant recipients.

Mycobacterial infections represent a growing challenge for solid organ transplant recipients (SOT). The adverse effects of tuberculosis (TB) therapy present a major difficulty, due to the interactions with immunosuppressive drugs and direct drug toxicity. While TB may be donor-transmitted or community-acquired, it usually develops at a latent infection site in the recipient. Pre-transplant prevention efforts will improve transplant outcomes and avoid the complications associated with post-transplant diagnosis and treatment. The present review and consensus manuscript is based on the updated published information and expert recommendations. The current data about epidemiology, diagnosis, new regimens for the treatment of latent TB infection (LTBI), the experience with rifamycins for the treatment of active TB in the post-transplant period and the experience with isoniazid for LTBI in the liver transplant population, are also reviewed. We attempt to provide useful recommendations for each transplant period and problem concerning mycobacterial infections in SOT recipients.

Feasibility of the T-SPOT.TB assay for the immunodiagnosis of smear-positive pulmonary tuberculosis using induced sputum.

Diagnosis of active tuberculosis (TB) remains a challenge. In this a preliminary proof-of-concept study seeking to determine the feasibility of using cells from induced sputum for the immunodiagnosis of pulmonary TB (PTB) in smear-positive cases, a total of 75 subjects with PTB (n = 31) and healthy controls (n = 44) underwent the blood T-SPOT(R).TB test. T-SPOT.TB in induced sputum samples was performed in 29 of 31 TB and 14/44 healthy subjects. Induced sputum T-SPOT.TB results were indeterminate in 72.6% of TB and 100% of healthy subjects. The T-SPOT.TB test in induced sputum samples does not seem a feasible method for diagnosing PTB and needs improvement.