Nontuberculous mycobacterial infections in solid organ transplant candidates and recipients
- Aruna Subramanian, MD
Aruna Subramanian, MD
- Clinical Associate Professor of Medicine
- Stanford University School of Medicine
Nontuberculous mycobacteria (NTM) are ubiquitous in the environment, and more than 125 species have been identified . Solid organ transplant recipients have an increased risk for infection with NTM due to depressed cell-mediated immunity. Although NTM infection rates are low compared with other types of infection, when NTM infections occur in transplant recipients, they cause significant morbidity and mortality, due in part to difficulties in disease recognition, delayed diagnosis, and complex drug interactions [2-4].
This topic reviews NTM infections in solid organ transplant recipients. Tuberculosis and the evaluation, treatment, and prophylaxis of infection in solid organ transplant recipients, as well as bacterial, viral, and fungal infections in lung transplant recipients, are reviewed separately. (See "Tuberculosis in solid organ transplant candidates and recipients" and "Evaluation for infection before solid organ transplantation" and "Infection in the solid organ transplant recipient" and "Prophylaxis of infections in solid organ transplantation" and "Bacterial infections following lung transplantation" and "Clinical manifestations, diagnosis, and treatment of cytomegalovirus infection in lung transplant recipients" and "Prevention of cytomegalovirus infection in lung transplant recipients" and "Fungal infections following lung transplantation".)
Most nontuberculous mycobacterial (NTM) species have been found in soil or water and are not known to be transmitted from animal to human or human to human . However, an outbreak of Mycobacterium abscessus in a lung transplant and cystic fibrosis center may have involved person-to-person transmission . In tuberculosis (TB)-nonendemic countries, NTM are more common etiologic agents of disease in solid organ transplant recipients than TB . Solid organ transplant recipients have an increased risk for infection with NTM due to depressed cell-mediated immunity, but NTM infections are nevertheless rare in this population.
The slowly growing mycobacteria M. avium and M. intracellulare (together known as Mycobacterium avium complex [MAC]) are the most common NTM species to cause infection in the United States and are the most common species isolated after solid organ transplantation [5,7]. The other NTM species that are known to cause disease in solid organ transplant recipients include the slowly growing species M. kansasii, M. haemophilum, and M. marinum, along with the rapidly growing species M. fortuitum, M. chelonae, and M. abscessus (table 1) [2,4]. (See "Epidemiology of nontuberculous mycobacterial infections".)
In solid organ transplant recipients, the median onset of NTM infection is usually a year or more after transplantation [4,7,8]. Heart and lung transplant recipients have the highest rates of infection, ranging from 0.2 to 2.8 percent and 0.5 to 8.0 percent, respectively [4,7]. By contrast, rates of NTM infection in renal transplant recipients range from 0.16 to 0.38 percent, and, in one series of liver transplant recipients, the rate was 0.04 percent [2,4].
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