The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical characteristics and the usefulness of the QuantiFERON-TB Gold In-Tube test in hematologic patients with hepatic or splenic lesions

  • Kwon, Jae-Cheol (Division of Infectious Diseases, Department of Internal Medicine, National Health Insurance Corporation Ilsan Hospital) ;
  • Kim, Si-Hyun (Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine) ;
  • Park, Sun Hee (Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Choi, Su-Mi (Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Dong-Gun (Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Choi, Jung-Hyun (Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Yoo, Jin-Hong (Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Yoo-Jin (Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Seok (Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, Hee-Je (Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Cho, Seok-Goo (Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Jong-Wook (Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Min, Woo-Sung (Hematopoietic Stem Cell Transplantation Center, Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • Published : 2013.03.01
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Abstract

Background/Aims: Hepatic or splenic lesions in hematologic patients are not defined well because they are not easy to evaluate due to limitations of invasive procedures. Management typically depends on the clinical diagnosis with few microbiological data. Methods: We reviewed the medical records of consecutive hematologic patients with hepatic or splenic lesions in the infectious diseases unit from April 2009 to December 2010 at the Catholic Hematopoietic Stem Cell Transplantation Center in Korea. Results: Twenty-six patients were identified. Their mean age was $46.0{\pm}14.7$ years, and 16 (61.5%) were male. Underlying diseases were acute myelogenous leukemia (n = 15, 57.7%) and myelodysplastic syndrome (n = 6, 23.1%). Among the nine nontuberculous infectious lesions, two bacterial, six fungal, and one combined infection were identified. The numbers of confirmed, probable, and possible tuberculosis (TB) cases were one, three, and four, respectively. Two patients had concurrent pulmonary TB. QuantiFERON-TB Gold In-Tube (QFT-GIT, Cellestis Ltd.) was positive in seven cases, among which six were diagnosed with TB. The sensitivity and specificity of QFT-GIT were 75% and 81.3%. Nine (34.6%) were defined as noninfectious causes. Conclusions: Causes of hepatic or splenic lesion in hematologic patients were diverse including TB, non-TB organisms, and noninfectious origins. TB should be considered for patients not responding to antibacterial or antifungal drugs, even in the absence of direct microbiological evidence. QFT-GIT may be useful for a differential diagnosis of hepatosplenic lesions in hematologic patients.

Keywords

References

  1. Sherman JD, Robbins SL. Changing trends in the casuistics of hepatic abscess. Am J Med 1960;28:943-950. https://doi.org/10.1016/0002-9343(60)90203-5
  2. Yoo HM, Kim WH, Shin SK, Chun WH, Kang JK, Park IS. The changing patterns of liver abscess during the past 20 years: a study of 482 cases. Yonsei Med J 1993;34:340-351. https://doi.org/10.3349/ymj.1993.34.4.340
  3. Lipsett PA, Huang CJ, Lillemoe KD, Cameron JL, Pitt HA. Fungal hepatic abscesses: characterization and management. J Gastrointest Surg 1997;1:78-84. https://doi.org/10.1007/s11605-006-0013-y
  4. Chen CY, Chen YC, Tang JL, et al. Hepatosplenic fungal infection in patients with acute leukemia in Taiwan: incidence, treatment, and prognosis. Ann Hematol 2003;82:93-97. https://doi.org/10.1007/s00277-002-0588-7
  5. World Health Organization. Global tuberculosis control 2010 [Internet]. Geneva (CH): World Health Organization, c2010 [cited 2011 Aug 22]. Available from: http://www.who.int/tb/publications/global_report/2010/en/index.html.
  6. Mazurek GH, Jereb J, Vernon A, et al. Updated guidelines for using interferon gamma release assays to detect Mycobacterium tuberculosis infection: United States, 2010. MMWR Recomm Rep 2010;59(RR-5):1-25.
  7. Kim SH, Choi SJ, Kim HB, Kim NJ, Oh MD, Choe KW. Diagnostic usefulness of a T-cell based assay for extrapulmonary tuberculosis. Arch Intern Med 2007;167:2255-2259. https://doi.org/10.1001/archinte.167.20.2255
  8. Song KH, Jeon JH, Park WB, et al. Usefulness of the whole-blood interferon-gamma release assay for diagnosis of extrapulmonary tuberculosis. Diagn Microbiol Infect Dis 2009;63:182-187. https://doi.org/10.1016/j.diagmicrobio.2008.10.013
  9. Ak O, Dabak G, Ozer S, Saygi A, Dabak R. The evaluation of the Quantiferon-TB gold test in pulmonary and extrapulmonary tuberculosis. Jpn J Infect Dis 2009;62:149-151.
  10. De Pauw B, Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813-1821. https://doi.org/10.1086/588660
  11. Liebeschuetz S, Bamber S, Ewer K, Deeks J, Pathan AA, Lalvani A. Diagnosis of tuberculosis in South African children with a T-cell-based assay: a prospective cohort study. Lancet 2004;364:2196-2203. https://doi.org/10.1016/S0140-6736(04)17592-2
  12. Segal BH, Herbrecht R, Stevens DA, et al. Defining responses to therapy and study outcomes in clinical trials of invasive fungal diseases: Mycoses Study Group and European Organization for Research and Treatment of Cancer consensus criteria. Clin Infect Dis 2008;47:674-683. https://doi.org/10.1086/590566
  13. Pang TC, Fung T, Samra J, Hugh TJ, Smith RC. Pyogenic liver abscess: an audit of 10 years' experience. World J Gastroenterol 2011;17:1622-1630. https://doi.org/10.3748/wjg.v17.i12.1622
  14. Wie SH, Chang UI, Kim JD, et al. Clinical features of 141 cases of pyogenic liver abscess over a 10-year period and antibiotic sensitivity to the causative organisms. Infect Chemother 2008;40:199-206. https://doi.org/10.3947/ic.2008.40.4.199
  15. Marcus SG, Walsh TJ, Pizzo PA, Danforth DN Jr. Hepatic abscess in cancer patients: characterization and management. Arch Surg 1993;128:1358-1364. https://doi.org/10.1001/archsurg.1993.01420240066012
  16. Sallah S, Semelka RC, Wehbie R, Sallah W, Nguyen NP, Vos P. Hepatosplenic candidiasis in patients with acute leukaemia. Br J Haematol 1999;106:697-701. https://doi.org/10.1046/j.1365-2141.1999.01592.x
  17. Hong KW, Kwon JC, Chun HJ, Lee DG, Kim HJ, Min WS. Liver abscess by Aspergillus and Enterococcus faecium in a patient with acute myeloid leukemia: a case report and literature review. Infect Chemother 2011;43:377-381. https://doi.org/10.3947/ic.2011.43.4.377
  18. Huang CJ, Pitt HA, Lipsett PA, et al. Pyogenic hepatic abscess: changing trends over 42 years. Ann Surg 1996;223:600-607. https://doi.org/10.1097/00000658-199605000-00016
  19. Llenas-Garcia J, Fernandez-Ruiz M, Caurcel L, EnguitaValls A, Vila-Santos J, Guerra-Vales JM. Splenic abscess: a review of 22 cases in a single institution. Eur J Intern Med 2009;20:537-539. https://doi.org/10.1016/j.ejim.2009.04.009
  20. Chen HC, Chao YC, Shyu RY, Hsieh TY. Isolated tuberculous liver abscesses with multiple hyperechoic masses on ultrasound: a case report and review of the literature. Liver Int 2003;23:346-350. https://doi.org/10.1034/j.1478-3231.2003.00861.x
  21. Chong VH. Hepatobiliary tuberculosis: a review of presentations and outcomes. South Med J 2008;101:356-361. https://doi.org/10.1097/SMJ.0b013e318164ddbb
  22. Zayer S, Koberstein B, Pohle T. Hepatic lesions in an elderly woman: cancer isn't always the answer. Z Gastroenterol 2011;49:39-41. https://doi.org/10.1055/s-0029-1245695
  23. Kim YK, Uh Y, Lee NS, Cho MY, Eom M, Kim HY. Whole-blood interferon-gamma release assay for diagnosis of tuberculous lymphadenitis. Tohoku J Exp Med 2011;224:189-193. https://doi.org/10.1620/tjem.224.189
  24. Kim SH, Cho OH, Park SJ, et al. Rapid diagnosis of tuberculous meningitis by T cell-based assays on peripheral blood and cerebrospinal f luid mononuclear cells. Clin Infect Dis 2010;50:1349-1358. https://doi.org/10.1086/652142

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