RESUMEN
Kidney transplant recipients develop atypical infections in their epidemiology, presentation and outcome. Among these, meningitis and meningoencephalitis require urgent and adapted anti-infectious therapy, but published data is scarce in KTRs. The aim of this study was to describe their epidemiology, presentation and outcome, in order to improve their diagnostic and management. We performed a retrospective, multicentric cohort study in 15 French hospitals that included all 199 cases of M/ME in KTRs between 2007 and 2018 (0.9 case per 1,000 KTRs annually). Epidemiology was different from that in the general population: 20% were due to Cryptococcus neoformans, 13.5% to varicella-zoster virus, 5.5% to Mycobacterium tuberculosis, and 4.5% to Enterobacteria (half of which produced extended spectrum beta-lactamases), and 5% were Post Transplant Lymphoproliferative Disorders. Microorganisms causing M/ME in the general population were infrequent (2%, for Streptococcus pneumoniae) or absent (Neisseria meningitidis). M/ME caused by Enterobacteria, Staphylococci or filamentous fungi were associated with high and early mortality (50%-70% at 1 year). Graft survival was not associated with the etiology of M/ME, nor was impacted by immunosuppression reduction. Based on these results, we suggest international studies to adapt guidelines in order to improve the diagnosis and the probabilistic treatment of M/ME in SOTRs.
Asunto(s)
Encefalitis , Trasplante de Riñón , Meningitis , Humanos , Estudios Retrospectivos , Estudios de Cohortes , Trasplante de Riñón/efectos adversos , Meningitis/complicaciones , Meningitis/diagnóstico , Encefalitis/diagnóstico , Encefalitis/epidemiología , Encefalitis/etiologíaRESUMEN
ABO compatibility rules in kidney transplantation have been deeply modified with the possibility of ABO-incompatible transplantation. The recipient has to be prepared in the days preceding surgery with an objective of ABO antibody titers of 1/8 or less. This is obtained through a procedure including antibody removal, rituximab and IV immunoglobulins alone or in association according to the initial titer. All ABO combinations are possible. Due to the preparation of the recipient, living related transplantation has been first carried out but ABO-incompatible transplantation from a deceased donor is becoming common practice in some countries (A2 or A2B donor to a B recipient). Lower uncensored graft survival has been reported by some studies but not when ABO-incompatible kidney transplantations were compared with matched ABO-compatible ones. The infectious risk in the perioperative period, consequence of higher immunosuppression, raises concern. The interlaboratory variability in hemagglutination anti-A/B assays remains an important question among cohort studies which leads to development of new tests. ABO-incompatible transplantation is associated with a rare process, accommodation, that is well known in xenotransplantation and according to which, the transplant is protected against the consequences of ABO antibody binding. In human kidney ABO-incompatible transplantation, few studies are available but suggest that this protection against the post-transplant antibody rebound might be mediated by the expression of anti-complement molecules by endothelial cells.
Asunto(s)
Sistema del Grupo Sanguíneo ABO/inmunología , Histocompatibilidad , Trasplante de Riñón , Sistema del Grupo Sanguíneo ABO/sangre , Sistema del Grupo Sanguíneo ABO/genética , Incompatibilidad de Grupos Sanguíneos/inmunología , Tipificación y Pruebas Cruzadas Sanguíneas/normas , Francia , Frecuencia de los Genes , Rechazo de Injerto/inmunología , Supervivencia de Injerto , Humanos , Terapia de Inmunosupresión , Trasplante de Riñón/normas , Guías de Práctica Clínica como Asunto , Donantes de Tejidos , Listas de EsperaRESUMEN
On April 2009, a new swine-origin A(H1N1) influenza virus, A(H1N1)v, was identified in the United States. Today (June 12, 2009), more than 29,000 cases have been reported in the world, and 73 in France. This is the first report of secondary transmission in France. The three patients presented with common influenza signs including cough, fever, and sore throat. The incubation period could last from two to four days; it should be kept in mind that the first international data mentioned one to seven days. The buildup and maintenance of an infectious focus involve secondary transmissions.
Asunto(s)
Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/transmisión , Adulto , Femenino , Francia , Humanos , Gripe Humana/diagnóstico , Gripe Humana/tratamiento farmacológico , Masculino , Persona de Mediana EdadRESUMEN
Our purpose is to assess the question of the definition of hepatitis B virus pre-C-C mutant-chronic infection, according to the level of the viral load at the era of very sensitive techniques of quantification of HBV DNA.
Asunto(s)
ADN Viral/aislamiento & purificación , Virus de la Hepatitis B/aislamiento & purificación , Hepatitis B Crónica/diagnóstico , ARN Viral/aislamiento & purificación , ADN Viral/sangre , ADN Viral/genética , Virus de la Hepatitis B/genética , Humanos , Mutación , ARN Viral/sangre , ARN Viral/genética , Sensibilidad y Especificidad , Carga ViralRESUMEN
INTRODUCTION: Acute retinal necrosis syndrome (ARN syndrome) is a rare viral disease with a poor prognosis in most cases. It is characterized by substantial ocular inflammation with progressive retinal necrosis, occlusive vasculitis and sometimes extraocular features. CASE REPORT: We report the case of a 62-year-old woman who was referred for a suspicion of a stroke. Ophthalmological examination revealed a profound bilateral visual loss due to extensive retinal necrosis. The patient was immediately treated with antiherpetic drugs. ARN syndrome with meningoencephalitis caused by herpes simplex virus type 2 was confirmed by PCR studies performed on aqueous humor and cerebrospinal fluid. Herpes simplex virus 2 (IgG+ , IgM-) was probably reactivated after intrathecal injection of steroids because of pain associated with narrowing of the lumbar vertebral canal. The patient was treated with intravenous Acyclovir for 3 weeks. After 4 months, both retinas were detached. DISCUSSION AND CONCLUSION: ARN syndrome caused by herpes simplex virus 2 most often occurs after reactivation of the latent virus in patients with a neurological medical history or congenital infection. Antiviral treatment must begin early to decrease risks of bilateralization and complications.
Asunto(s)
Errores Diagnósticos , Encefalitis por Herpes Simple/complicaciones , Herpesvirus Humano 2/aislamiento & purificación , Síndrome de Necrosis Retiniana Aguda/etiología , Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Humor Acuoso/virología , Líquido Cefalorraquídeo/virología , ADN Viral/análisis , Dexametasona/administración & dosificación , Dexametasona/uso terapéutico , Quimioterapia Combinada , Encefalitis por Herpes Simple/tratamiento farmacológico , Encefalitis por Herpes Simple/virología , Femenino , Ganciclovir/uso terapéutico , Hemiplejía/etiología , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Desprendimiento de Retina/etiología , Síndrome de Necrosis Retiniana Aguda/diagnóstico , Síndrome de Necrosis Retiniana Aguda/tratamiento farmacológico , Síndrome de Necrosis Retiniana Aguda/virología , Accidente Cerebrovascular/diagnóstico , Incontinencia Urinaria/etiología , Activación ViralRESUMEN
Myelodysplastic syndromes (MDS) are clonal disorders of pluripotent hematopoietic stem cells. MDS occur predominantly over the age of 60 years. The diagnosis of MDS is based on the examination of both blood films and bone marrow aspirate. Diseases such as vitamin B12 and/or folate deficiency, or cytotoxic therapy leading to a marrow dysplasia should be ruled out. Five subtypes are described in the FAB classification : refractory anaemia or refractory cytopenia, refractory sideroblastic anaemia, refractory anaemia with excess of blasts, refractory anaemia with excess of blasts in transformation, chronic myelomonocytic leukaemia. This FAB classification is based on a small number of parameters: percentage of blood and marrow blasts, percentage of ringed sideroblasts and blood monocytes. The anaemia is typically normo- or macrocytic, non regenerative, and in half cases is associated with neutropenia and/or thrombocytopenia. During blood film examination, cell abnormalities have to be notified, i.e. anisocytosis, poikilocytosis of red cells, morphological abnormalities of neutrophils including hypogranulation, hypolobulation, abnormal large platelets. The prognostic and the treatment of MDS depend on the subtype of the FAB classification, the patient's age, the percentage of marrow blasts, the importance of cytopenia, the presence or not of cytogenetic abnormalities and the existence or not of HLA-identical donor.