Tuberculosis-Associated Hemophagocytic Lymphohistiocytosis: Diagnostic Challenges and Determinants of Outcome

被引:6
作者
Kurver, Lisa [1 ,2 ]
Seers, Timothy [3 ]
van Dorp, Suzanne [4 ]
van Crevel, Reinout [1 ,2 ]
Pollara, Gabriele [3 ,5 ]
van Laarhoven, Arjan [1 ,2 ]
机构
[1] Radboud Univ Nijmegen Med Ctr, Dept Internal Med, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands
[2] Radboud Univ Nijmegen Med Ctr, Radboud Ctr Infect Dis, Nijmegen, Netherlands
[3] Univ Coll London Hosp NHS Fdn Trust, Hosp Trop Dis, London, England
[4] Radboud Univ Nijmegen Med Ctr, Dept Hematol, Nijmegen, Netherlands
[5] UCL, Div Infect & Immun, Cruciform Bldg,Gower St, London WC1E 6BT, England
来源
OPEN FORUM INFECTIOUS DISEASES | 2024年 / 11卷 / 04期
关键词
anergy; bone marrow; hemophagocytic lymphohistiocytosis; mortality; tuberculosis; BONE-MARROW; PATHOGENESIS; CELLS;
D O I
10.1093/ofid/ofad697
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background Tuberculosis (TB) can induce secondary hemophagocytic lymphohistiocytosis (HLH), a severe inflammatory syndrome with high mortality. We integrated all published reports of adult HIV-negative TB-associated HLH (TB-HLH) to define clinical characteristics, diagnostic strategies, and therapeutic approaches associated with improved survival. Methods PubMed, Embase, and Global Index Medicus were searched for eligible records. TB-HLH cases were categorized into (1) patients with a confirmed TB diagnosis receiving antituberculosis treatment while developing HLH and (2) patients presenting with HLH of unknown cause later diagnosed with TB. We used a logistic regression model to define clinical and diagnostic parameters associated with survival. Results We identified 115 individual cases, 45 (39.1%) from countries with low TB incidence (<10/100 000 per year). When compared with patients with HLH and known TB (n = 21), patients with HLH of unknown cause (n = 94) more often had extrapulmonary TB (66.7% vs 88.3%), while the opposite was true for pulmonary disease (91.5% vs 59.6%). Overall, Mycobacterium tuberculosis was identified in the bone marrow in 78.4% of patients for whom examination was reported (n = 74). Only 10.5% (4/38) of patients tested had a positive result upon a tuberculin skin test or interferon-gamma release assay. In-hospital mortality was 28.1% (27/96) in those treated for TB and 100% (18/18) in those who did not receive antituberculosis treatment (P < .001). Conclusions Tuberculosis should be considered a cause of unexplained HLH. TB-HLH is likely underreported, and the diagnostic workup of patients with HLH should include bone marrow investigations for evidence of Mycobacerium tuberculosis. Prompt initiation of antituberculosis treatment likely improves survival in TB-HLH.
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页数:9
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