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Disseminated nontuberculous mycobacterial infections after allogeneic hematopoietic stem cell transplantation: a risk-based strategy for early diagnosis

Bone Marrow Transplantation volume 58, pages 956–958 (2023)Cite this article

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Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms and widely distributed in water and soil [1]. In humans, NTM infections can be localized to the lungs, but can also present as lymphadenopathy, skin/soft tissue, or bone infections. Disseminated NTM infections involve multiple organs and occur in severely immunocompromised hosts, e.g., in persons infected with human immunodeficiency virus (HIV) and low CD4 counts, or with primary immunodeficiencies such as GATA2 deficiency. NTM infections after allogeneic hematopoietic stem cell transplantation (allo-HSCT) are rare with an incidence of 1.7–6.4% [2]. The majority of these cases are localized pulmonary infections, while dissemination is reported in only 0.2% of patients. However, incidence of NTM infections is rising after allo-HSCT [2]. Here, we present four cases of disseminated NTM infections according to the American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) definitions [3], occurring in a single center between 2019 and 2022.

An obvious but also controversial explanation for the high incidence of disseminated NTM infections presented here, is the deep T cell suppression due to ex vivo αβ T cell-depleted allo-HSCT. Low CD4 counts are a risk factor for NTM infections after allo-HSCT [4]. Alemtuzumab and anti-thymocyte globulin have been implied to enhance the risk of NTM infections by some investigators [5], while others stated that neither of these treatments nor ex-vivo T cell depletion was a risk factor for NTM infection [2, 6].

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Fig. 1: NTM tissue samples, a risk-based strategy, and clinical characteristics of four patients with disseminated NTM infections.

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Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Author notes

  1. These authors contributed equally: Anke H. W. Bruns, Jurgen Kuball.

Authors and Affiliations

  1. Department of Hematology, University Medical Center, Utrecht, the Netherlands

    Laura G. M. Daenen, Lotte E. van der Wagen, Anna van Rhenen, Moniek A. de Witte & Jurgen Kuball

  2. Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands

    Jan-Tom van der Bruggen & Herman F. Wunderink

  3. Department of Pathology, University Medical Center, Utrecht, the Netherlands

    Roos J. Leguit

  4. Department of Infectious Diseases, University Medical Center, Utrecht, the Netherlands

    Anke H. W. Bruns

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  1. Laura G. M. Daenen
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Contributions

LGMD was responsible for the literature review, updating reference lists, and creating Fig. 1b/c and the Supplementary table. LGMD, AHWB, and JK wrote the report. JTvdB and HFW gave treatment advice and provided feedback on the report. RJL was the pathologist involved, created Fig. 1a and provided feedback on the report. LEvdW, AvR, and MAdW were involved in treating the patients and provided feedback on the report.

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Correspondence to Laura G. M. Daenen.

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Daenen, L.G.M., van der Bruggen, JT., Leguit, R.J. et al. Disseminated nontuberculous mycobacterial infections after allogeneic hematopoietic stem cell transplantation: a risk-based strategy for early diagnosis. Bone Marrow Transplant 58, 956–958 (2023). https://doi.org/10.1038/s41409-023-02011-6

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