結核病會透過器官移植傳染


  March 18, 2008(亞特蘭大訊)-根據一項發表於2008國際新興感染疾病會議的研究,從瀰漫性肺結核(TB)捐贈者移植的器官,會造成疾病傳播至二到三位的受贈者。
  
  根據Emily Piercefield醫師表示,這些發現代表由基因型比對捐贈者與受贈者來確認第一個透過器官移植感染TB的案例;他是俄克拉荷馬州健康部門急性疾病服務官員。
  
  這項研究中的捐贈者有無家可歸與酗酒的病史,且因為大腦血管炎住院;他過去沒有已知的TB病史,且過去的結核菌素檢驗是陰性的。
  
  捐贈者的肝臟與兩個腎臟被移植到三位受贈者身上,其中一位腎臟受贈者在移植後死亡,且其他腎臟受贈者發生了瀰漫性TB感染;該TB基因型與捐贈者的相符,接受肝臟捐贈者病患沒有發生TB的證據。
  
  Piercefield醫師向Medscape感染疾病表示,臨床醫師在照護器官移植病患時,應該維持對TB的高度警戒心;確認潛在器官捐贈者罹患TB的危險因子,應該促成排除器官捐贈者結核病的進一步研究。
  
  喬治亞州亞特蘭大疾病控制與預防中心(CDC)血液、器官與其他組織安全性辦公室主任的Matthew Kuehnert醫師,他也參與這項研究,他說器官移植接受者通常是免疫功能不全的,且因此,病徵與症狀將可能是猛烈且非典型的;對於肺臟移植病患,TB的典型證據,例如咳嗽,可能是明顯的,但對於其他器官移植病患,例如腎臟移植,病患可能僅只有發燒與骨髓功能異常。他附帶表示,骨髓切片可能可以確認分支結核桿菌的感染。
  
  Kuehnert醫師表示,一項稱為移植傳染疾病追蹤網絡的監視系統由CDC器官分享整合網絡、以及其他幫助確認器官移植病患傳染疾病的組織發展。
  
  安大略渥太華醫院感染疾病部門的Gregory Rose醫師表示,證據支持器官移植作為疾病傳播的路徑從依情況而定的(例如在移植後數月後才發生TB)到根深蒂固的,例如兩位受贈者同樣接受一位捐贈者的器官,且都得到以基因型確認的分支結核桿菌,過去已經有兩個報告(從兩位捐贈者得到器官的四位受贈者)。
  
  他向Medscape感染疾病表示,目前這項報告透過提供捐贈者的TB基因型類型與受贈者相同的證據,包含TB可能從一個移植的器官傳播的強烈證據。
  
  Rose醫師附帶表示,某些檢驗,例如結核桿菌培養,可能要在移植後數週才有培養結果;這並不代表移植應該延遲或是取消,但這卻代表受贈者移植照護團隊需要有可以快速連絡捐贈者是否罹患TB相關資訊的機制。
  
  這項研究由俄克拉荷馬州立健康部門、德州健康照護部門與CDC進行與贊助;作者表示這些研究結果與結論並未正式地由CDC發出,且將不會被解釋為代表任何官方的判斷或是政策;作者與評論者表示沒有相關資金上的關係。

Tuberculosis Transmitted Throu

By Emma Hitt, PhD
Medscape Medical News

March 18, 2008 (Atlanta) — Organs transplanted from a donor with disseminated tuberculosis (TB) resulted in disease transmission to 2 of 3 organ recipients, according to a study presented here at the International Conference on Emerging Infectious Diseases 2008.

These findings represent the first TB transmission through transplantation documented by matching genotype isolates of donor and recipients, according to Emily Piercefield, MD, DVM, EIS, officer with the Acute Disease Service for the Oklahoma State Department of Health..

The donor in the study had a history of homelessness and alcohol use and was hospitalized for cerebral vasculitis. He had no known history of TB, and previous tuberculin skin tests had been negative.

The donor's liver and 2 kidneys were transplanted to 3 recipients. One of the kidney recipients died after receiving the transplant, and the other kidney recipient developed disseminated TB. The TB genotype matched that of the donor. No evidence of TB was found in the patient receiving the liver transplant.

"Clinicians should maintain a high index of suspicion for TB when caring for transplant recipients," Dr. Piercefield told Medscape Infectious Diseases. "Identification of risk factors for TB in a potential donor should prompt further investigation to exclude the presence of tuberculosis in that donor candidate," she said.

Matthew Kuehnert, MD, director of the Office of Blood, Organ, and other Tissue Safety, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, who participated in the investigation, noted that recipients of transplants are often immunosuppressed, and therefore, "signs and symptoms can be vague and atypical. For lung transplant patients, classic evidence of TB, such as a cough, may be evident, but for recipients of other organs, such as the kidneys, the patient may only have fever and bone marrow dysfunction," he said. "A bone marrow biopsy may enable identification of Mycobacterium tuberculosis," he added. 

A surveillance system called the Transplantation Transmission Sentinel Network is being developed by the United Network for Organ Sharing, the CDC, and other organizations to aid in the recognition of transmitted disease in recipients, Dr. Kuehnert noted.

"Evidence supporting transplantation as the route of transmission ranges from circumstantial (ie, development of TB in the transplanted organ within a few months of transplantation) to well-established (ie, 2 recipients of a single donor's organs both developing disease through genotypically identical M tuberculosis, of which there have been 2 previous reports [4 prior recipients from 2 donors])," said Gregory Rose, MD, from the Division of Infectious Diseases, Ottawa Hospital, Ontario.

"The current report adds to this literature by providing evidence that the TB strain in the recipients was genotypically identical to that in the donor and contains the strongest evidence to date that TB may be transmitted through a transplanted organ," he told Medscape Infectious Diseases.

Dr. Rose added that some tests, such as mycobacterial cultures, may not be reported until weeks after the transplantation. "This does not mean the transplant should be delayed or cancelled, but [it] does indicate the need for a mechanism for rapid communication of donor TB status to the recipient's transplant care team."

The investigation was conducted and funded by the Oklahoma State Department of Health, the Texas Department of State Health Services, and the CDC. The authors state that the findings and conclusions have not been formally disseminated by the CDC and should not be construed to represent any agency determination or policy. The authors and commentators have disclosed no relevant financial relationships.

International Conference on Emerging Infectious Diseases 2008: Slide Session J3. Presented March 18, 2007.

    
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