Diagnostic delay and mortality of active tuberculosis in patients after kidney transplantation in a tertiary care hospital in China

<div><p>TB infection in patients after kidney transplantation remains a concern in a successful long-term outcome. This retrospective, descriptive study was performed on tuberculosis infection after kidney transplantation in the Department of Infectious Disease of the First Affiliated Hospital of Zhejiang University, a tertiary care hospital in China, from January 2011 to April 2017, with the aim to explain the clinical features of active tuberculosis after kidney transplantation and explore the correlated factors for diagnostic delay and mortality. It included 48 cases. All these cases were followed up for at least 12 months after anti-tuberculosis therapy, except the ones who died during this period. The median time of transplantation to active tuberculosis of these 48 patients was about 5.4 years. The time from a first hospital visit to the diagnosis (diagnostic delay) of 12 (25%) cases was more than 30 days. The correlated factors for the diagnostic delay more than 30 days were a fever for more than 2 weeks and antibiotic use for more than 2 weeks. Nine (18.8%) cases died during the anti-tuberculosis therapy or following-up period due to TB relapse. The risk factors for mortality were severe complications, such as encephaledema, severe pneumonia, intestinal perforation, liver function failure, and the following multiple-organ failure. In conclusion, the possibility of tuberculosis infection should be carefully assessed and sometimes diagnostic anti-tuberculosis therapy may be required for patients who had a fever for more than 2 weeks or used antibiotics for more than 2 weeks after kidney transplantation. Severe complications and the following multiple-organ failure might increase the mortality among these patients.</p></div

Related factors for diagnostic delay (≥30 days).

<p>Related factors for diagnostic delay (≥30 days).</p

Demographic and clinical characteristics of 48 patients with active tuberculosis after transplantation.

<p>Demographic and clinical characteristics of 48 patients with active tuberculosis after transplantation.</p

Risk factors for death during anti-tuberculosis therapy.

<p>Risk factors for death during anti-tuberculosis therapy.</p

Clinical diagnosis of 48 patients with active tuberculosis after transplantations.

<p>Clinical diagnosis of 48 patients with active tuberculosis after transplantations.</p

<i>V</i>. <i>vulnificus</i> infection that presented as swelling, Hemorrhagic bulla and phlegmon are observed on the right hand.

<p><i>V</i>. <i>vulnificus</i> infection that presented as swelling, Hemorrhagic bulla and phlegmon are observed on the right hand.</p

Seasonal distribution of <i>V</i>. <i>vulnificus</i> infections at the First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.

<p>Seasonal distribution of <i>V</i>. <i>vulnificus</i> infections at the First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.</p

Laboratory results measured between survivors group and deaths group.

<p>Note: ULN, the upper limit of normal. At our hospital, the normal range for ALT was 5–40 U/L, the normal range for AST was 5–37 U/L, the normal range for serum creatinine was 40–108 μmol/L, and the normal range for urea nitrogen was 1.7–8.3 mmol/L.</p><p>Laboratory results measured between survivors group and deaths group.</p

Treatment strategies and clinical outcomes.

<p>Treatment strategies and clinical outcomes.</p

Correlations between Clinical Features and Mortality in Patients with <i>Vibrio vulnificus</i> Infection

<div><p><i>Vibrio vulnificus</i> is a common gram-negative bacterium, which might cause morbidity and mortality in patients following consumption of seafood or exposure to seawater in Southeast China. We retrospectively analyzed clinical data of patients with laboratory confirmed <i>V</i>. <i>vulnificus</i> infection. Twenty one patients were divided into a survival group and a non-surviving (or death) group according to their clinical outcome. Clinical data and measurements were statistically analyzed. Four patients (19.05%) died and five patients gave positive cultures from bile fluid, and 16 other patients gave positive culture from blood or blisters. Ten patients (47.62%) had an underlying liver disease and marine-related events were found in sixteen patients (76.2%). Patients with heavy drinking habits might be at increased mortality (p = 0.028). Clinical manifestations of cellulitis (47.6%), septic shock (42.9%) and multiple organ failure (28.6%) were statistically significant when comparing survivors and non-survivors (p = 0.035, p = 0.021 and p = 0.003, respectively). The laboratory results, including hemoglobin < 9.0 g/L (p = 0.012), platelets < 2.0×10⁹ /L, prothrombin time activity (PTA) <20%, decreased serum creatinine and increased urea nitrogen were statistically significant (p = 0.012, p = 0.003, p = 0.028 and p = 0.028, respectively). Patients may be at a higher risk of mortality under situations where they have a history of habitual heavy alcoholic drink consumption (p = 0.028, OR = 22.5, 95%CI 1.5–335.3), accompanied with cellulitis, shock, multiple organ failure, and laboratory examinations that are complicated by decreased platelets, hemoglobin and significantly prolonged prothrombin time (PT).</p></div