Imaging spectrum of pulmonary infections in renal transplant patients

Abstract

In the post renal transplant setting, pulmonary infections comprise an important set of complications. Microbiological diagnosis although specific is often delayed and insensitive. Radiography is the most common and first imaging test for which patient is referred, however it is relatively insensitive. HRCT is a very useful imaging tool in the scenario where radiography is negative or inconclusive and high clinical suspicion for infection is present. HRCT features vary among the various pathogens and also depend on the level of immunocompromise. Certain HRCT findings are characteristic for specific pathogens and may help narrow diagnosis. In this review article , we will summarize the imaging findings of various pulmonary infections encountered in post renal transplant patients.

Keywords

High resolution computed tomography - immunocompromised - peritransplant - pneumonia - renal transplant

Publication History

Received: 18 September 2019

Accepted: 06 July 2020

Article published online:
19 July 2021

• References

• 1 Rosenow EC, Wilson WR, Cockerill FR. Pulmonary disease in the immunocompromised host. 1. Mayo Clin Proc 1985; 60: 473-87
• 2 Wang X, Wang Y, Zhu Q, Guo G, Yuan H. Pulmonary infection in the renal transplant recipients: Analysis of the radiologic manifestations. Radiol Infect Dis 2014; 1: 3-6
• 3 Gulati M, Kaur R, Jha V, Venkataramu NK, Gupta D, Suri S. High-resolution CT in renal transplant patients with suspected pulmonary infections. Acta Radiol 2001; 41: 237-41
• 4 John GT, Shankar V, Abraham AM, Mukundan U, Thomas PP, Jacob CK. Risk factors for post-transplant tuberculosis. Kidney Int 2001; 60: 1148-53
• 5 Singh N, Paterson DL. Mycobacterium tuberculosis infection in solid-organ transplant recipients: Impact and implications for management. Clin Infect Dis 1998; 27: 1266-77
• 6 Unger JD, Rose HD, Unger GF. Gram-negative pneumonia. Radiology 1973; 107: 283-91
• 7 Rozenshtein A, Hao F, Starc MT, Pearson GDN. Radiographic appearance of pulmonary tuberculosis: Dogma disproved. AJR Am J Roentgenol 2015; 204: 974-8
• 8 Sundaram M, Adhikary SD, John GT, Kekre NS. Tuberculosis in renal transplant recipients. Indian J Urol 2008; 24: 396-400
• 9 Pereira M, Gazzoni FF, Marchiori E, Irion K, Moreira J, Giacomelli IL. et al. High-resolution CT findings of pulmonary Mycobacterium tuberculosis infection in renal transplant recipients. Br J Radiol 2016; 89: 20150686
• 10 Leung AN. Pulmonary tuberculosis: The essentials. Radiology 1999; 210: 307-22
• 11 Lal H, Asmita Mangla L, Prasad R, Gautam M, Nath A. Imaging features of pulmonary infection in post renal transplant recipients: A review. Indian J Transplant 2017; 11: 13
• 12 Chang G-C, Wu C-L, Pan S-H, Yang T-Y, Chin C-S, Yang Y-C. et al. The diagnosis of pneumonia in renal transplant recipients using invasive and noninvasive procedures. Chest 2004; 125: 541-7
• 13 Minero MV, Marín M, Cercenado E, Rabadán PM, Bouza E, Muñoz P. Nocardiosis at the turn of the century. Medicine (Baltimore) 2009; 88: 250-61
• 14 Franquet T, Müller NL, Giménez A, Domingo P, Plaza V, Bordes R. Semiinvasive pulmonary aspergillosis in chronic obstructive pulmonary disease. Am J Roentgenol 2000; 174: 51-6
• 15 Singh N, Husain S. AST infectious diseases community of practice. Invasive aspergillosis in solid organ transplant recipients. Am J Transplant 2009; 9 Suppl (04) S180-191
• 16 Pinto PS. The CT halo sign. Radiology 2004; 230: 109-10
• 17 Logan PM, Primack SL, Miller RR, Müller NL. Invasive aspergillosis of the airways: Radiographic, CT, and pathologic findings. Radiology 1994; 193: 383-8
• 18 Amr S, Sheikh S, Amir A. Fungal Infection in renal transplant patients. Medical Myocology: Current trends & future prospects 2015. Taylor & Francis group, LLC; 0 2015: 110-146
• 19 Song Y, Qiao J, Giovanni G, Liu G, Yang H, Wu J. et al. Mucormycosis in renal transplant recipients: Review of 174 reported cases. BMC Infect Dis 2017; 17: 283
• 20 Franquet T, Müller NL, Giménez A, Martínez S, Madrid M, Domingo P. Infectious pulmonary nodules in immunocompromised patients: Usefulness of computed tomography in predicting their etiology. J Comput Assist Tomogr 2003; 27: 461-8
• 21 Boiselle PM, Tocino I, Hooley RJ, Pumerantz AS, Selwyn PA, Neklesa VP. et al. Chest radiograph interpretation of Pneumocystis carinii pneumonia, bacterial pneumonia, and pulmonary tuberculosis in HIV-positive patients: Accuracy, distinguishing features, and mimics. J Thorac Imaging 1997; 12: 47-53
• 22 Roux A, Gonzalez F, Roux M, Mehrad M, Menotti J, Zahar J-R. et al. Update on pulmonary Pneumocystis jirovecii infection in non-HIV patients. Med Mal Infect 2014; 44: 185-98
• 23 Vogel MN, Brodoefel H, Hierl T, Beck R, Bethge WA, Claussen CD. et al. Differences and similarities of cytomegalovirus and pneumocystis pneumonia in HIV-negative immunocompromised patients thin section CT morphology in the early phase of the disease. Br J Radiol 2007; 80: 516-23
• 24 Bretlau T. Grainger & Allison’s diagnostic radiology. 6th ed. Acta Radiol. 2015. 56. NP53-NP53
• 25 Vogel MN, Vatlach M, Weissgerber P, Goeppert B, Claussen CD, Hetzel J. et al. HRCT-features of Pneumocystis jiroveci pneumonia and their evolution before and after treatment in non-HIV immunocompromised patients. Eur J Radiol 2012; 81: 1315-20
• 26 Kotloff RM, Ahya VN, Crawford SW. Pulmonary complications of solid organ and hematopoietic stem cell transplantation. Am J Respir Crit Care Med 2004; 170: 22-48
• 27 Franquet T, Lee KS, Müller NL. Thin-section CT findings in 32 immunocompromised patients with cytomegalovirus pneumonia who do not have AIDS. Am J Roentgenol 2003; 181: 1059-63
• 28 Horger MS, Pfannenberg C, Einsele H, Beck R, Hebart H, Lengerke C. et al. Cytomegalovirus pneumonia after stem cell transplantation: Correlation of CT findings with clinical outcome in 30 patients. AJR Am J Roentgenol 2006; 187: W636-43
• 29 Wendt CH. Community respiratory viruses: Organ transplant recipients. Am J Med 1997; 102: 31-6 discussion 42-3
• 30 Ison MG. Respiratory viral infections in transplant recipients. Antivir Ther 2007; 12: 627-38
• 31 Gandhi S, Kute V, Patel K, Sutariya H, Pandya V. Role of high resolution computed tomography of chest in posttransplant pulmonary infection. Indian J Transplant 2017; 11: 49-54
• 32 Ariza-Heredia EJ, Fishman JE, Cleary T, Smith L, Razonable RR, Abbo L. Clinical and radiological features of respiratory syncytial virus in solid organ transplant recipients: A single-center experience. Transpl Infect Dis 2012; 14: 64-71
• 33 Kim EA, Lee KS, Primack SL, Yoon HK, Byun HS, Kim TS. et al. Viral pneumonias in adults: Radiologic and pathologic findings. Radiographics 2002; 22 (01) S137-49
• 34 Choo HJ, Kim KI, Lee KN. High-resolution CT findings of varicella-zoster pneumonia. J Korean Radiol Soc 2003; 49: 469-73
• 35 Nair V, Jandovitz N, Hirsch JS, Nair G, Abate M, Bhaskaran M. et al. COVID-19 in kidney transplant recipients. Am J Transplant 2020; 20 (07) 1819-1825
• 36 Oh YW, Effmann EL, Godwin JD. Pulmonary infections in immunocompromised hosts: The importance of correlating the conventional radiologic appearance with the clinical setting. Radiology 2000; 217: 647-56