title: A low incidence of nontuberculous mycobacterial infections in pediatric hematopoietic stem cell transplantation recipients.
abstract: Hematopoietic stem cell transplantation (HSCT) is being used to treat a wide spectrum of clinical disorders but opportunistic infection remains an important factor determining outcomes for these patients. Nontuberculous mycobacterial (NTM) infections are being reported more frequently in HSCT recipients and the incidence of NTM infections in adult recipients is reported to be 0.4%-4.9%. However, the incidence and severity of NTM infections are less well described in pediatric HSCT recipients. Centers for Disease Control and Prevention guidelines were used to define definite and probable NTM infection among 132 children undergoing 169 HSCT between January 2000 and December 2004 at our institution. NTM infection was diagnosed in 5 of 132 pediatric recipients (3.8%). There were no NTM infections diagnosed in the autologous HSCT recipients and the incidence of NTM in allogeneic HSCT recipients was 6.4% (95% confidence interval, 0.8-11.9). The mean age of the HSCT recipients who developed NTM infections was 8 years (range, 2-19 years); 3 were male and 2 were female. Four conditioning regimens included alemtuzumab and 3 had antithymocyte globulin. Of the 5 patients with NTM infections, 2 met the criteria for definite infection and 3 for probable infection. Of the 2 patients with definite NTM infection, 1 had disseminated disease with Mycobacterium avium complex and the other had Mycobacterium chelonae catheter-related bloodstream infection. The probable NTM infections were 1 skin infection with Mycobacterium kansasii and 2 lower respiratory tract infections with M avium complex. Median time to NTM infection was 115 days (range, 14-269 days) after HSCT. Two patients had graft-versus-host disease at the time of NTM infection. All 5 patients received 3-4 antimycobacterial drugs and all NTM infections resolved. In summary, the incidence of NTM infection in pediatric HSCT recipients appears similar to that described in adult HSCT recipients and the outcome appears to be excellent with the proper antibiotic therapy. The increased use of anti-T cell antibodies appears to be associated with an increased risk of NTM infections in pediatric HSCT recipients. Multicenter studies are needed to identify the risk factors, early diagnostic criteria, and optimal therapy.
authors.affiliation: Department of Pediatrics, Columbia University, New York, New York 10032, USA.
authors.forename: Elif
authors.initials: E
authors.lastname: Unal
authors.forename: Catherine
authors.initials: C
authors.lastname: Yen
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
authors.forename: Diane
authors.initials: D
authors.lastname: George
authors.forename: Phyllis
authors.initials: P
authors.lastname: Della-Latta
authors.forename: Carmella
authors.initials: C
authors.lastname: van de Ven
authors.forename: Erin
authors.initials: E
authors.lastname: Morris
authors.forename: M Brigid
authors.initials: MB
authors.lastname: Bradley
authors.forename: Gustavo
authors.initials: G
authors.lastname: Del Toro
authors.forename: James
authors.initials: J
authors.lastname: Garvin
authors.forename: Monica
authors.initials: M
authors.lastname: Bhatia
authors.forename: Joseph
authors.initials: J
authors.lastname: Schwartz
authors.forename: Prakash
authors.initials: P
authors.lastname: Satwani
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Roman
authors.forename: Erin
authors.initials: E
authors.lastname: Cooney
authors.forename: Karen
authors.initials: K
authors.lastname: Wolownik
authors.forename: Ria
authors.initials: R
authors.lastname: Hawks
authors.forename: Sandra
authors.initials: S
authors.lastname: Foley
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
mesh_terms: D000293:Adolescent; D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000009:adverse effects; D000961:Antilymphocyte Serum / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D009164:Mycobacterium Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D009894:Opportunistic Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab