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Diagnostic Delay and Associated Clinical Features of Tuberculosis among Adult Patients with Acute Myeloid Leukemia in Doha, Qatar

DOI: 10.4236/jtr.2018.61005, PP. 49-62

Keywords: Tuberculosis, Acute Myeloid Leukemia, Neutropenia

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Abstract:

Background: Tuberculosis is currently the world’s leading cause of death arising from a single infectious condition. While T cell mediated immunity is recognized to have a major contribution to tuberculosis activation, the present investigation confirmed that TB was more prevalent among patients with acute myeloid rather than lymphoid leukemia and such association was frequently overlooked. The primary objective of this study is to estimate the diagnostic delay of tuberculosis among patients with acute myeloid leukemia (AML) and compare it to the general population in Qatar. Secondary objective is to study the clinical and epidemiologic characteristics of tuberculosis in patients with AML. Methods: This is a retrospective study of tuberculosis cases diagnosed in subjects with AML during the period from January 2008 till December 2016. Results: Among 215 subjects with AML identified during the study period, 12 (5.58%) received the diagnosis of tuberculosis. The estimated incidence of tuberculosis among AML cases was 7.14 cases per 1000 per year. The mean delay in diagnosis of tuberculosis was 64.2 days (95% CI: 26.8 - 101.5) and the median was 45 days (interquartile range; Q1 - Q3, 29.5 - 97.5). Prolonged fever was the most common presentation (100% of cases). Parenchymal lung involvement was the most common radiologic abnormality (83.3% of cases). Three patients (25%) died and 8 patients completed 9 to 12 months of anti-tuberculous treatment with clinical and radiological remission. Conclusion: Infections caused by Mycobacterium tuberculosis are not uncommon in patients with AML especially in patients from tuberculosis endemic regions. It constitutes a diagnostic challenge so high index of suspicion is of paramount importance.

References

[1]  World Health Organization. Global Tuberculosis Report 2012.
[2]  Giovanni, D., Michela, S. and Giovanni, F. (2013) The Biology of Mycobacterium tuberculosis Infection. Mediterranean Journal of Hematology and Infectious Diseases, 5, e2013070.
[3]  World Health Organization (2009) Global Tuberculosis Control: Surveillance, Planning and Financing. WHO/HTM/ TB/2009.411, WHO, Geneva.
[4]  Dye, C., Scheele, S., Dolin, P., Pathania, V. and Raviglione, M.C. (1999) Consensus Statement. Global Burden of Tuberculosis: Estimated Incidence, Prevalence, and Mortality by Country. WHO Global Surveillance and Monitoring Project. JAMA, 282, 677-686.
https://doi.org/10.1001/jama.282.7.677
[5]  Wells, C.D., Cegielski, J.P., Nelson, L.J., et al. (2007) HIV Infection and Multidrug-Resistant Tuberculosis—The Perfec Storm. Journal of Infectious Diseases, 196, S86-S107.
https://doi.org/10.1086/518665
[6]  Al-Anazi, K., Aljasser, A. and Evans, D.A. (2007) Infections Caused by Mycobacterium tuberculosis in Patients with Hematological Disorders and in Recipients of Hematopoietic Stem Cell Transplant, a Twelve Year Retrospective Study. Annals of Clinical Microbiology and Antimicrobials, 6, 16.
https://doi.org/10.1186/1476-0711-6-16
[7]  Zumla, A., Raviglione, M., Hafner, R. and von Reyn, C.F. (2013) Tuberculosis. The New England Journal of Medicine, 368, 745-755.
https://doi.org/10.1056/NEJMra1200894
[8]  Fu, L.M. (2003) The Potential of Human Neutrophil Peptides in Tuberculosis Therapy. International Journal of Tuberculosis and Lung Disease, 7, 1027-1032.
[9]  Martineau, A.R., Newton, S.M., Wilkinson, K.A., et al. (2007) Neutrophil-Mediated Innate Immune Resistance to Mycobacteria. Journal of Clinical Investigation, 117, 1988-1994.
https://doi.org/10.1172/JCI31097
[10]  Nauseef, W.M. and Borregaard, N. (2014) Neutrophils at Work. Nature Immunology, 15, 602-611.
https://doi.org/10.1038/ni.2921
[11]  Mayadas, T.N., Cullere, X. and Lowell, C.A. (2014) The Multifaceted Functions of Neutrophils. Annual Review of Pathology: Mechanisms of Disease, 9, 181-218.
https://doi.org/10.1146/annurev-pathol-020712-164023
[12]  Kaplan, M.H., Armstrong, D. and Rosen, P. (1974) Tuberculosis Complicating Neoplastic Disease. A Review of 201 Cases. Cancer, 33, 850-858.
https://doi.org/10.1002/1097-0142(197403)33:3<850::AID-CNCR2820330334>3.0.CO;2-H
[13]  Feld, R., Bodey, G.P. and Groschel, D. (1976) Mycobacteriosis in Patients with Malignant Disease. Archives of Internal Medicine, 136, 67-70.
https://doi.org/10.1001/archinte.1976.03630010051009
[14]  Mishra, P., Kumar, R., Mahapatra, M., et al. (2006) Tuberculosis in Acute Leukemia: A Clinico-Hematological Profile. Hematology, 11, 335-340.
https://doi.org/10.1080/10245330600915818
[15]  Gupta, A., Singh, M., Singh, H., et al. (2010) Infections in Acute Myeloid Leukemia: An Analysis of 382 Febrile Episodes. Medical Oncology, 27, 1037-1045.
https://doi.org/10.1007/s12032-009-9330-9
[16]  Advani, S.H. and Banavali, S.D. (1989) Pattern of Infection in Hematologic Malignancies: An Indian Experience. Reviews of Infectious Diseases, 11, S1621-S1628.
https://doi.org/10.1093/clinids/11.Supplement_7.S1621
[17]  Srivastava, V.M., Krishnaswami, H., Srivastava, A., Dennison, D. and Chandy, M. (1996) Infections in Haematological Malignancies: An Autopsy Study of 72 Cases. Transactions of the Royal Society of Tropical Medicine and Hygiene, 90, 406-408.
[18]  Cardona, P.J. (2009) A Dynamic Reinfection Hypothesis of Latent Tuberculosis Infection. Infection, 37, 80-86.
https://doi.org/10.1007/s15010-008-8087-y
[19]  Barrios-Payán, J., Saqui-Salces, M., Jeyanathan, M., et al. (2012) Extrapulmonary Locations of Mycobacterium tuberculosis DNA during Latent Infection. Journal of Infectious Diseases, 206, 1194-1205.
https://doi.org/10.1093/infdis/jis381
[20]  Pai, M., Denkinger, C.M., Kik, S.V. et al. (2014) Gamma Interferon Release Assays for Detection of Mycobacterium tuberculosis Infection. Clinical Microbiology Reviews, 27, 3-20.
https://doi.org/10.1128/CMR.00034-13
[21]  Al-Suwaidi, Z. (2015) Tuberculosis in Qatar. International Journal of Mycobacteriology, 4, 124.
https://doi.org/10.1016/j.ijmyco.2014.10.052
[22]  Libshitz, H.I., Pannu, H.K., Elting, L.S. and Cooksley, C.D. (1997) Tuberculosis in Cancer Patients: An Update. Journal of Thoracic Imaging, 12, 41-46.
https://doi.org/10.1097/00005382-199701000-00006
[23]  de la Cámara, R., Martino, R., Granados, E., et al. (2000) Tuberculosis after Hematopoietic Stem Cell Transplantation: Incidence, Clinical Characteristics and Outcome. Bone Marrow Transplantation, 26, 291-298.
https://doi.org/10.1038/sj.bmt.1702506
[24]  Kamboj, M. and Sepkowitz, K.A. (2006) The Risk of Tuberculosis in Patients with Cancer. Clinical Infectious Diseases, 42, 1592-1595.
[25]  Stefan, D.C., Kruis, A.L., Schaaf, H.S. and Wessels, G. (2008) Tuberculosis in Oncology Patients. Annals of Tropical Paediatrics, 28, 111-116.
https://doi.org/10.1179/146532808X302125
[26]  Chen, C.Y., Sheng, W.H., Cheng, A., et al. (2011) Clinical Characteristics and Outcomes of Mycobacterium tuberculosis Disease in Adult Patients with Hematological Malignancies. BMC Infectious Diseases, 11, 324.
https://doi.org/10.1186/1471-2334-11-324
[27]  Wu, C.Y., Hu, H.Y., Pu, C.Y., et al. (2011) Aerodigestive Tract, Lung and Haematological Cancers Are Risk Factors for Tuberculosis: An 8-Year Population-Based Study. International Journal of Tuberculosis and Lung Disease, 15, 125-130.
[28]  Ibrahim, W.H., Alousi, F.H., Al-Khal, A., Bener, A., AlSalman, A., Aamer, A., Khaled, A. and Raza, T. (2016) Diagnostic Delay among Adults with Pulmonary Tuberculosis in a High Gross Domestic Product per Capita Country: Reasons and Magnitude of the Problem. International Journal of Preventive Medicine, 7, 116.
https://doi.org/10.4103/2008-7802.193091
[29]  Vorster, M., Sathekge, M.M. and Bomanji, J. (2014) Advances in Imaging of Tuberculosis: The Role of 18F-FDG PET and PET/CT. Current Opinion in Pulmonary Medicine, 20, 287-293.
https://doi.org/10.1097/MCP.0000000000000043
[30]  Skoura, E., Zumla, A. and Bomanji, J. (2015) Imaging in Tuberculosis. International Journal of Infectious Diseases, 32, 87-93.
https://doi.org/10.1016/j.ijid.2014.12.007
[31]  Omri, H.E., Hascs, I. Z., Taha, R., et al. (2015) Tubercular Meningitis and Lymphadenitis Mimicking a Relapse of Burkitt’s Lymphoma on 18F-FDG-PET/CT: A Case Report. Case Reports in Oncology, 8, 226-232.
https://doi.org/10.1159/000430768
[32]  Anibarro, L. and Pena, A. (2014) Tuberculosis in Patients with Haematological Malignancies. Mediterranean Journal of Hematology and Infectious Diseases, 6, e2014026.
https://doi.org/10.4084/mjhid.2014.026
[33]  Kwon, J.C., Kim, S.H., Park, S.H., et al. (2013) Clinical Characteristics and the Usefulness of the QuantiFERON-TB Gold In-Tube test in Hematologic Patients with Hepatic or Splenic Lesions. The Korean Journal of Internal Medicine, 28, 187-196.
https://doi.org/10.3904/kjim.2013.28.2.187
[34]  Silva, F.A., Matos, J.O., de, Q.M.F.C. and Nucci, M. (2005) Risk Factors for and Attributable Mortality from Tuberculosis in Patients with Hematologic Malignancies. Haematologica, 90, 1110-1115.
[35]  Andreu, J., Caceres, J., Pallisa, E. and Martinez-Rodriguez, M. (2004) Radiological Manifestations of Pulmonary Tuberculosis. European Journal of Radiology, 51, 139-149.
https://doi.org/10.1016/j.ejrad.2004.03.009

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