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      Active Mycobacterium tuberculosis infection at a comprehensive cancer center, 2006–2014

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          Abstract

          Background

          Morbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer.

          Methods

          We retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014.

          Results

          A total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Thirty-two (62%) patients had underlying cancer, while 20 (38%) patients did not have cancer but were referred to the institution because of suspicion of underlying malignancy. Among patients with cancer, 18 (56%) had solid tumors; 8 (25%) had active hematologic malignancies; and 6 (19%) had undergone hematopoietic-cell transplantation (HCT). Patients with and without cancer were overall similar with the exception of median age (61 years in cancer patients compared to 53 years in noncancer patients). Pulmonary disease was identified in 32 (62%) patients, extrapulmonary disease in 10 (19%) patients, and disseminated disease in 10 (19%) patients. Chemotherapy was delayed in 53% of patients who were to receive such treatment. Eleven patients (all of whom had cancer) died; 3 of these deaths were attributable to Mtb infection.

          Conclusions

          Although not common, tuberculosis remains an important infection in patients with cancer. Approximately one-third of patients were referred to our institution for suspicion of cancer but were ultimately diagnosed with active Mtb infection rather than malignancy.

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          Most cited references13

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          Clinical practice. Latent tuberculosis infection in the United States.

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            Risk of Active Tuberculosis in Patients with Cancer: A Systematic Review and Meta-Analysis.

            Cancer is a known risk factor for developing active tuberculosis (TB). We determined the incidence and relative risk of active TB in cancer patients compared to the general population.
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              The risk of tuberculosis in patients with cancer.

              Current US guidelines for the management of latent tuberculosis infection in cancer patients are based on studies from 1970s, yet much about cancer care has changed in the interim. In a review of our experience during the past 25 years, we found that incidence of tuberculosis varied significantly according to country of birth and cancer type. Foreign-born patients with underlying hematologic neoplasm had a tuberculosis rate 50-100 times higher than US-born patients, whereas US-born patients with an underlying solid tumor had the same tuberculosis rate as US-born persons without cancer. These findings may help guide the management of latent tuberculosis infection in persons with cancer.
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                Author and article information

                Contributors
                jkmeid46@gmail.com
                pakulkar@bcm.edu
                marjorie.batista@accamargo.org.br
                firaselchaer@umm.edu
                medamrita@gmail.com
                eariza@mdanderson.org
                vmulanov@mdanderson.org
                713-745-1116 , rfchemaly@mdanderson.org
                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                6 November 2019
                6 November 2019
                2019
                : 19
                : 934
                Affiliations
                [1 ]ISNI 0000 0001 2291 4776, GRID grid.240145.6, Department of Infectious Diseases, Infection Control, and Employee Health, , The University of Texas MD Anderson Cancer Center, ; Houston, TX USA
                [2 ]ISNI 0000 0001 2160 926X, GRID grid.39382.33, Infectious Diseases Section, Department of Medicine, , Baylor College of Medicine, ; Houston, TX USA
                [3 ]ISNI 0000 0004 0420 5521, GRID grid.413890.7, Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, ; Houston, TX USA
                [4 ]ISNI 0000 0004 0434 0002, GRID grid.413036.3, University of Maryland Greenebaum Comprehensive Cancer Center Baltimore, ; Baltimore, MD USA
                Article
                4586
                10.1186/s12879-019-4586-y
                6836382
                31694567
                1d0d2bcc-89f8-4998-89bb-4831863c59b0
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 April 2019
                : 21 October 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Infectious disease & Microbiology
                tuberculosis,stem cell transplantation,leukemia,cancer,pulmonary,death

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