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Tuberculosis in immunosuppressed patients

J W Millar, N W Horne

    Lancet (London, England)
    |June 2, 1979
    PubMed
    Summary
    This summary is machine-generated.

    Tuberculosis can develop in patients on long-term immunosuppressive therapy, often with delayed diagnosis due to suppressed symptoms. Vigilant monitoring and proactive investigation are crucial for early detection and improved outcomes in these vulnerable patients.

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    Area of Science:

    • Immunology
    • Infectious Diseases
    • Pulmonology

    Background:

    • Long-term immunosuppressive therapy is used for various conditions.
    • Corticosteroids, particularly prednisolone, are frequently used in immunosuppressive regimens.
    • Immunosuppression can increase the risk of opportunistic infections like tuberculosis.

    Purpose of the Study:

    • To describe cases of tuberculosis in patients receiving long-term immunosuppressive therapy.
    • To highlight diagnostic challenges and outcomes in this patient population.
    • To emphasize the need for specific management strategies.

    Main Methods:

    • Retrospective case series of 11 patients.
    • Review of patient data including immunosuppressive drug regimens, clinical presentation, diagnosis, and outcomes.

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  • Analysis of diagnostic delays and treatment responses.

    • Main Results:

    • 11 patients developed tuberculosis during immunosuppressive therapy, primarily with high-dose corticosteroids.
    • Diagnosis was delayed in all cases due to masked symptoms.
    • Mortality was significant (4 deaths), with 3 directly due to tuberculosis.
    • Survivors had varying severity, from critical illness to advanced pulmonary disease with miliary spread.

    Conclusions:

    • A high index of suspicion for tuberculosis is essential in patients on long-term immunosuppressive therapy.
    • Regular clinical and radiological monitoring is recommended.
    • Pre-treatment investigation and potential chemoprophylaxis should be considered for patients initiating immunosuppressive therapy, especially with prednisolone.