RESUMO
BACKGROUND: A nephrologist with expertise in ultrasonography noticed that patients with longstanding renal grafts had smaller spleens than subjects undergoing initial post-transplantation imaging. This putative finding prompted us to pursue a further investigation into splenic function based on Doppler ultrasound and hematologic parameters. METHODS: We enrolled 47 patients with functioning long-standing kidney grafts, measuring longitudinal diameter of the spleen, hilar and intrasplenic peak systolic velocities (PSV), and hilar and intrasplenic resistivity indices of the splenic artery as well as mean arterial blood pressure (MAP). Giemsa-stained peripheral blood smears were examined for the presence of Howell-Jolly bodies (HJBs) using light microscopy. The patients were then divided into HJB present (HJ(+)) or absent (HJ(-)) groups for further comparison. RESULTS: The overall mean age of 21 females and 26 males was 47.8 ± 12.0 years, and the mean time after transplantation was 2750 ± 1818 days (range, 208-6446). HJBs were detected in 23/47 patients (48.9%). The intrasplenic artery PSV was significantly lower and MAP higher in the HJ(+) group (P < .05). There was no difference in spleen size between the groups. DISCUSSION: HJBs in peripheral blood red cells, an indicator of hyposplenism, was associated with reduced intrasplenic artery PSV, suggesting dysfunction, which may play a role in the known vulnerability of renal transplant recipients to infections.
Assuntos
Síndromes de Imunodeficiência/diagnóstico , Transplante de Rim , Baço/anormalidades , Adulto , Inclusões Eritrocíticas/patologia , Feminino , Humanos , Síndromes de Imunodeficiência/patologia , Síndromes de Imunodeficiência/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doenças da Imunodeficiência Primária , Baço/patologia , Baço/fisiopatologiaRESUMO
Staphylococcus aureus is the main causal pathogen of infective endocarditis (IE), which may have distinct origins, namely, community, nosocomial, or non-nosocomial healthcare-associated (NNHCA). We report the first case of NNHCA-IE caused by methicillin-resistant S. aureus strain USA400/SCCmec IV in which the combination therapy of rifampin and vancomycin had a favorable outcome for the patient.
Assuntos
Endocardite/diagnóstico , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/diagnóstico , Adulto , Antibacterianos/administração & dosagem , Brasil , Ecocardiografia Transesofagiana , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Endocardite/patologia , Genótipo , Instalações de Saúde , Humanos , Masculino , Tipagem Molecular , Rifampina/administração & dosagem , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologia , Resultado do Tratamento , Vancomicina/administração & dosagemRESUMO
The objective of this study was to evaluate the association between previous hepatitis C virus (HCV) infection and the occurrence of posttransplant diabetes mellitus (PTDM) among patients undergoing kidney transplants using tacrolimus (FK). From August 1999 to January 2003, 66 patients (36.4 +/- 15.5 years) underwent kidney transplantation using an immunosuppressive regimen of tacrolimus, mycophenolate mofetil, or azathioprine and steroids. Thirty-four patients (52%) received kidneys from living donors and 32 (48%) from cadaveric donors. The diagnosis of diabetes mellitus was established after two consecutive ambulatory measurements of fasting glycemia > or = 126 mg/dL. Thirty-five percent of the patients (23/66) were HCV+ and 65% (43/66) HCV-. Of the 66 patients, 33% (22) developed PTDM, 19 (82%) from the HCV+ group and only 3 (7%) from the HCV- group. Among those who developed PDTM, the diagnosis was established in the first 2 posttransplant months in most cases (68.2%). The results showed a significant association between HCV and PTDM (P < or = .0001). In this group of patients HCV infection was strongly associated with the development of PTDM. Therefore, additional care is required regarding the immunosuppressive regimen among patients with chronic HCV infection.