RESUMO
This is a case of a kidney transplant recipient who presented with skin lesions, low-grade fevers, and pancytopenia 2 months after his transplant.
Assuntos
Transplante de Rim , Humanos , Argentina , Transplante de Rim/efeitos adversos , América LatinaRESUMO
BACKGROUND: The best approach to tuberculosis (TB) treatment in transplanted patients is still unknown. Current guidelines are based on evidence either extrapolated from other populations or observational. Rifampin-containing regimens have strong pharmacokinetic interactions with immunosuppressive regimens, with high rates of organ dysfunction and â¼20% mortality. This report describes the results obtained using non-rifampin-containing regimens to treat confirmed TB in adult patients with kidney/kidney-pancreas transplantation. METHODS: Retrospective data analysis from confirmed TB cases in adult kidney/kidney-pancreas transplant recipients (2006-2019), treated "de novo" with non-rifampin-containing regimens. RESULTS: Fifty-seven patients had confirmed TB. Thirty patients were treated "de novo" with non-rifampin-containing regimens. These patients' mean age was 49.24 (±11.50) years. Induction immunosuppression was used in 22 patients. Maintenance immunosuppression was tacrolimus-mycophenolate-steroids in 13 (43%), sirolimus-mycophenolate-steroids in 6 (20%), and other immunosuppressive regimens in 11 (36%). Belatacept was used in four patients. TB localizations: pulmonary 43%; disseminated 23%; extrapulmonary 33%. Twenty-seven (90%) patients completed treatment with isoniazid, ethambutol, and levofloxacin (12 months, 23; 9 months, 3; 6 months, 1); 12 of these patients also received pyrazinamide for the first 2 months and were cured with functioning grafts. One patient (3%) lost the graft while on treatment. Two patients (7%) died while on TB treatment. Median (range) follow-up after completion of TB treatment was 32 (8-150) months. No TB relapses were observed. CONCLUSIONS: Results with non-rifampin-containing TB treatments in this case series were better (in terms of mortality and graft dysfunction) than those previously described with rifampin-containing regimens in transplanted patients.
Assuntos
Transplante de Pâncreas , Tuberculose , Adulto , Humanos , Pessoa de Meia-Idade , Rifampina/uso terapêutico , Transplante de Pâncreas/efeitos adversos , Estudos Retrospectivos , Isoniazida , Imunossupressores/uso terapêutico , Tuberculose/tratamento farmacológico , Rim , Antituberculosos/uso terapêuticoRESUMO
This study analysed Strongyloides stercoralis genetic variability based on a 404 bp region of the cox1 gene from Latin-American samples in a clinical context including epidemiological, diagnosis and follow-up variables. A prospective, descriptive, observational study was conducted to evaluate clinical and parasitological evolution after ivermectin treatment of 41 patients infected with S. stercoralis. Reactivation of the disease was defined both by clinical symptoms appearance and/or direct larvae detection 30 days after treatment or later. We described 10 haplotypes organized in two clusters. Most frequent variants were also described in the Asian continent in human (HP24 and HP93) and canine (HP24) samples. Clinical presentation (intestinal, severe, cutaneous and asymptomatic), immunological status and eosinophil count were not associated with specific haplotypes or clusters. Nevertheless, presence of cluster 1 haplotypes during diagnosis increased the risk of reactivation with an odds ratio (OR) of 7.51 [confidence interval (CI) 95% 1.3844.29, P = 0.026]. In contrast, reactivation probability was 83 times lower if cluster 2 (I152V mutation) was detected (OR = 0.17, CI 95% 0.020.80, P = 0.02). This is the first analysis of S. stercoralis cox1 diversity in the clinical context. Determination of clusters during the diagnosis could facilitate and improve the design of follow-up strategies to prevent severe reactivations of this chronic disease.
Assuntos
Strongyloides stercoralis , Estrongiloidíase , Animais , Cães , Fezes , Humanos , América Latina/epidemiologia , Tipagem Molecular , Estudos Prospectivos , Strongyloides stercoralis/genética , Estrongiloidíase/diagnóstico , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/epidemiologiaRESUMO
Coinfection of SARS-CoV-2 and dengue virus has not been previously reported. We report a confirmed case with favourable outcome, but whether the occurrence of simultaneous infections may alter the usual clinical course of each infection is still unknown.
Assuntos
Coinfecção/diagnóstico , Infecções por Coronavirus/diagnóstico , Dengue/diagnóstico , Pneumonia Viral/diagnóstico , Adulto , Betacoronavirus , COVID-19 , Infecções por Coronavirus/complicações , Dengue/complicações , Vírus da Dengue , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , SARS-CoV-2RESUMO
This review addresses relevant aspects of Chagas disease in the solid organ transplantation setting. This trypanosomiasis was geographically restricted to America, but migration has turned Chagas disease into a global public health concern. Parasite persistence in chronically infected individuals entails the potential of transmission with organ donation and the potential for reactivation under immunosuppression. Prospective monitoring with real-time PCR or direct methods for detection of parasitemia and treatment of documented episodes of transmission/ reactivation (rather than prophylactic treatment) is the recommended approach for managing patients at risk. Chagas disease is an important cause of terminal cardiomyopathy. Clinical results demonstrate that with adequate monitoring and treatment, patients with Chagas cardiomyopathy benefit from heart transplantation, with long-term results even better than patients who underwent heart transplantation due to other conditions. Kidney and liver (and possibly other solid organs) transplantation can be safely performed in chronically infected patients with adequate management. Chronically infected patients are also suitable for organ donation (with the exception of the heart and intestines). Although reactivations and transmissions are observed, serious clinical disease is rare, and they are usually successfully managed with benznidazole or nifurtimox.
Assuntos
Cardiomiopatia Chagásica , Doença de Chagas , Transplante de Coração , Transplante de Órgãos , Humanos , Estudos Prospectivos , Obtenção de Tecidos e Órgãos , Trypanosoma cruziRESUMO
Paracoccidioides brasiliensis is the cause of paracoccidioidomycosis, one of the most important systemic mycoses in Latin America. Human disease has been observed in a limited geographic and ecological niche, and it is attributed to exposure to the fungus in soil. Most primary infections are subclinical, as the infection is contained by the host mainly through cell-mediated immune response. However, as the fungus has the ability to survive in a dormant state for long periods, an impairment of the immune response may lead to reactivation and clinical disease. Surprisingly, paracoccidioidomycosis has rarely been reported in transplanted patients. The aim of this communication is to report a case occurring in a kidney recipient in an acute clinical form immediately after transplantation, and to review the available information on previously reported cases.
Assuntos
Antifúngicos/uso terapêutico , Rejeição de Enxerto/terapia , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Pneumopatias Fúngicas/diagnóstico , Paracoccidioides/patogenicidade , Paracoccidioidomicose/diagnóstico , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Lavagem Broncoalveolar , Líquido da Lavagem Broncoalveolar/microbiologia , Broncoscopia , Feminino , Rejeição de Enxerto/imunologia , Humanos , Imipenem/administração & dosagem , Imipenem/uso terapêutico , Imunidade Humoral , Terapia de Imunossupressão/métodos , Imunossupressores/administração & dosagem , Itraconazol/administração & dosagem , Falência Renal Crônica/cirurgia , América Latina , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/microbiologia , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/complicações , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/microbiologia , Plasmaferese , Respiração Artificial , Tomografia Computadorizada por Raios X , Vancomicina/administração & dosagem , Vancomicina/uso terapêuticoRESUMO
We report a case of hematuria in a pregnant patient caused by right renal vein hypertension, as a result of compression of right renal, the inferior caval and the right gonadal veins because of posterior displacement of the pancreas caused by the presence of the gravid uterus. Hematuria resolved after a cesarean delivery. This condition has not been, to our knowledge, previously described.
Assuntos
Hematúria/etiologia , Hipertensão Renovascular/etiologia , Complicações Cardiovasculares na Gravidez/diagnóstico , Veias Renais/patologia , Adulto , Constrição Patológica , Dilatação Patológica , Feminino , Humanos , Rim/irrigação sanguínea , Imageamento por Ressonância Magnética , Gravidez , Terceiro Trimestre da Gravidez , Fluxo Sanguíneo RegionalRESUMO
Familial Mediterranean fever (FMF) is a genetic disorder characterized by sporadic, acute attacks of fever and serosal inflammation. Typical manifestations are recurrent febrile episodes of acute instauration for brief duration (1 to 4 days) that is associated with severe pain due to serositis at one or more sites. Abdominal crisis occurs in 95% of the patients. Treatment with colchicine is highly effective as preventive treatment, but it is considered to be ineffective for the treatment of established acute attacks. As mentioned, untreated crisis resolves spontaneously in 1 to 4 days. Prolonged, nonresolving crisis of abdominal pain refractory to nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, with fever and elevation of acute phase reactants that resolves after the administration of colchicine, is a clinical presentation undescribed hitherto. The aim of this paper is to report a patient with this distinctively unusual clinical presentation of FMF.