Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 69
Filtrar
Más filtros

Banco de datos
País/Región como asunto
Tipo del documento
Intervalo de año de publicación
1.
N Engl J Med ; 383(19): 1827-1837, 2020 11 05.
Artículo en Inglés | MEDLINE | ID: mdl-32459919

RESUMEN

BACKGROUND: Remdesivir is an RNA polymerase inhibitor with potent antiviral activity in vitro and efficacy in animal models of coronavirus disease 2019 (Covid-19). METHODS: We conducted a randomized, open-label, phase 3 trial involving hospitalized patients with confirmed SARS-CoV-2 infection, oxygen saturation of 94% or less while they were breathing ambient air, and radiologic evidence of pneumonia. Patients were randomly assigned in a 1:1 ratio to receive intravenous remdesivir for either 5 days or 10 days. All patients received 200 mg of remdesivir on day 1 and 100 mg once daily on subsequent days. The primary end point was clinical status on day 14, assessed on a 7-point ordinal scale. RESULTS: In total, 397 patients underwent randomization and began treatment (200 patients for 5 days and 197 for 10 days). The median duration of treatment was 5 days (interquartile range, 5 to 5) in the 5-day group and 9 days (interquartile range, 5 to 10) in the 10-day group. At baseline, patients randomly assigned to the 10-day group had significantly worse clinical status than those assigned to the 5-day group (P = 0.02). By day 14, a clinical improvement of 2 points or more on the ordinal scale occurred in 64% of patients in the 5-day group and in 54% in the 10-day group. After adjustment for baseline clinical status, patients in the 10-day group had a distribution in clinical status at day 14 that was similar to that among patients in the 5-day group (P = 0.14). The most common adverse events were nausea (9% of patients), worsening respiratory failure (8%), elevated alanine aminotransferase level (7%), and constipation (7%). CONCLUSIONS: In patients with severe Covid-19 not requiring mechanical ventilation, our trial did not show a significant difference between a 5-day course and a 10-day course of remdesivir. With no placebo control, however, the magnitude of benefit cannot be determined. (Funded by Gilead Sciences; GS-US-540-5773 ClinicalTrials.gov number, NCT04292899.).


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Antivirales/administración & dosificación , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Adenosina Monofosfato/administración & dosificación , Adenosina Monofosfato/efectos adversos , Adulto , Anciano , Alanina/administración & dosificación , Alanina/efectos adversos , Antivirales/efectos adversos , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Esquema de Medicación , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/terapia , SARS-CoV-2 , Resultado del Tratamiento , Tratamiento Farmacológico de COVID-19
2.
Clin Infect Dis ; 75(11): 1883-1892, 2022 11 30.
Artículo en Inglés | MEDLINE | ID: mdl-35446944

RESUMEN

BACKGROUND: Favipiravir, an oral, RNA-dependent RNA polymerase inhibitor, has in vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite limited data, favipiravir is administered to patients with coronavirus disease 2019 (COVID-19) in several countries. METHODS: We conducted a phase 2, double-blind, randomized controlled outpatient trial of favipiravir in asymptomatic or mildly symptomatic adults with a positive SARS-CoV-2 reverse-transcription polymerase chain reaction assay (RT-PCR) within 72 hours of enrollment. Participants were randomized to receive placebo or favipiravir (1800 mg twice daily [BID] day 1, 800 mg BID days 2-10). The primary outcome was SARS-CoV-2 shedding cessation in a modified intention-to-treat (mITT) cohort of participants with positive enrollment RT-PCRs. Using SARS-CoV-2 amplicon-based sequencing, we assessed favipiravir's impact on mutagenesis. RESULTS: We randomized 149 participants with 116 included in the mITT cohort. The participants' mean age was 43 years (standard deviation, 12.5 years) and 57 (49%) were women. We found no difference in time to shedding cessation overall (hazard ratio [HR], 0.76 favoring placebo [95% confidence interval {CI}, .48-1.20]) or in subgroups (age, sex, high-risk comorbidities, seropositivity, or symptom duration at enrollment). We detected no difference in time to symptom resolution (initial: HR, 0.84 [95% CI, .54-1.29]; sustained: HR, 0.87 [95% CI, .52-1.45]) and no difference in transition mutation accumulation in the viral genome during treatment. CONCLUSIONS: Our data do not support favipiravir at commonly used doses in outpatients with uncomplicated COVID-19. Further research is needed to ascertain if higher favipiravir doses are effective and safe for patients with COVID-19. CLINICAL TRIALS REGISTRATION: NCT04346628.


Asunto(s)
Tratamiento Farmacológico de COVID-19 , Adulto , Humanos , Femenino , Masculino , SARS-CoV-2 , Pacientes Ambulatorios , Antivirales , Método Doble Ciego , Resultado del Tratamiento
3.
Transfusion ; 62(1): 28-36, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34677830

RESUMEN

BACKGROUND: The reported incidence of adverse reactions following Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) transfusion has generally been lower than expected based on the incidence of transfusion reactions that have been observed in studies of conventional plasma transfusion. This raises the concern for under-reporting of adverse events in studies of CCP that rely on passive surveillance strategies. MATERIALS AND METHODS: Our institution implemented a protocol to actively identify possible adverse reactions to CCP transfusion. In addition, we retrospectively reviewed the charts of inpatients who received CCP at Stanford Hospital between May 13, 2020 and January 31, 2021. We determined the incidence of adverse events following CCP transfusion. RESULTS: A total of 49 patients received CCP. Seven patients (14%) had an increased supplemental oxygen requirement within 4 h of transfusion completion, including one patient who was intubated during the transfusion. An additional 11 patients (total of 18, 37%) had increased oxygen requirements within 24 h of transfusion, including 3 patients who were intubated. Six patients (12%) fulfilled criteria for transfusion-associated circulatory overload (TACO). CONCLUSION: Using an active surveillance strategy, we commonly observed adverse events following the transfusion of CCP to hospitalized patients. It was not possible to definitively determine whether or not these adverse events are related to CCP transfusion. TACO was likely over-diagnosed given overlap with the manifestations of COVID-19. Nevertheless, these results suggest that the potential adverse effects of CCP transfusion may be underestimated by reports from passive surveillance studies.


Asunto(s)
Transfusión de Componentes Sanguíneos/efectos adversos , COVID-19/terapia , Humanos , Inmunización Pasiva/efectos adversos , Oxígeno , Plasma , Estudios Retrospectivos , Resultado del Tratamiento , Sueroterapia para COVID-19
4.
Curr Opin Organ Transplant ; 27(4): 263-268, 2022 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-36354252

RESUMEN

PURPOSE OF REVIEW: Infective endocarditis remains an uncommon disease with significant morbidity and mortality. In the last two decades, progress has been made describing the unique aspects of infective endocarditis in solid organ transplant (SOT) recipients. RECENT FINDINGS: Incidence of infective endocarditis in SOT is higher when compared with the general population. End-stage organ dysfunction, diabetes mellitus, older age, and prior intravenous lines have been identified as risk factors predisposing to infective endocarditis in SOT. Staphylococci and enterococci represent the most frequently isolated pathogens, whereas fungi are rarely isolated. Median time from transplantation to diagnosis ranges from 33 to 66 months. Nosocomial acquisition and mural endocarditis are more common in SOT recipients with infective endocarditis. Procurement of organs from patients with infective endocarditis might be well tolerated so long as close monitoring and targeted antibiotics are given. Selected patients might benefit from heart transplantation as definitive or salvage therapy for infective endocarditis. Outcomes of infective endocarditis in SOT recipients compared with the general population might be similar; however, patient survival and graft function are reduced when recipients suffer from infective endocarditis. SUMMARY: Infective endocarditis although rare can affect donors and recipients involved in the SOT process. Recognition of the unique characteristics in the presentation, prevention, medical, and surgical therapy of this disease is essential in order to minimize adverse outcomes.


Asunto(s)
Endocarditis Bacteriana , Endocarditis , Trasplante de Órganos , Humanos , Trasplante de Órganos/efectos adversos , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/microbiología , Endocarditis/diagnóstico , Endocarditis/etiología , Endocarditis/terapia , Receptores de Trasplantes , Factores de Riesgo
5.
Clin Infect Dis ; 73(3): e826-e829, 2021 08 02.
Artículo en Inglés | MEDLINE | ID: mdl-33624010

RESUMEN

To assess the prevalence of persistent functional impairment after coronavirus disease (COVID-19), we assessed 118 individuals 3-4 months after their initial COVID-19 diagnosis with a symptom survey, work productivity and activity index questionnaire, and 6-minute walk test. We found significant persistent symptoms and functional impairment, even in non-hospitalized patients with COVID-19.


Asunto(s)
COVID-19 , Pandemias , Prueba de COVID-19 , Humanos , SARS-CoV-2 , Encuestas y Cuestionarios
6.
Clin Infect Dis ; 73(9): 1677-1684, 2021 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-33606010

RESUMEN

BACKGROUND: Invasive fungal infection (IFI) is a growing cause of morbidity and mortality in oncology and transplant patients. Diagnosis of IFI is often delayed due to need for invasive biopsy and low sensitivity of conventional diagnostic methods. Fungal cell-free DNA (cfDNA) detection in plasma is a novel testing modality for the noninvasive diagnosis of IFI. METHODS: A novel bioinformatic pipeline was created to interrogate fungal genomes and identify multicopy sequences for cfDNA polymerase chain reaction (PCR) targeting. A real-time PCR panel was developed for 12 genera and species most commonly causing IFI. Sensitivity and specificity of the fungal PCR panel were determined using plasma samples from patients with IFI and non-IFI controls. Clinical impact of the fungal PCR panel was evaluated prospectively based on the treating team's interpretation of the results. RESULTS: Overall, the sensitivity and specificity were 56.5% (65/115; 95% confidence interval [CI], 47.4-65.2) and 99.5% (2064/2075; 95% CI, 99.0-99.7), respectively. In the subset of patients with an optimized plasma volume (2 mL), sensitivity was 69.6% (48/69; 95% CI, 57.9-79.2). Sensitivity was 91.7% (11/12; 95% CI, 62.5-100) for detection of Mucorales agents, 56.3% (9/16; 95% CI, 33.2-76.9) for Aspergillus species, and 84.6% (11/13; 95% CI, 56.5-96.9) for Candida albicans. In a prospective evaluation of 226 patients with suspected IFI, cfDNA testing was positive in 47 (20.8%) patients and resulted in a positive impact on clinical management in 20 of 47 (42.6%). CONCLUSIONS: The fungal cfDNA PCR panel offers a noninvasive approach to early diagnosis of IFI, providing actionable results for personalized care.


Asunto(s)
Ácidos Nucleicos Libres de Células , Infecciones Fúngicas Invasoras , Micosis , Candida albicans , ADN de Hongos/genética , Humanos , Infecciones Fúngicas Invasoras/diagnóstico , Micosis/diagnóstico , Reacción en Cadena en Tiempo Real de la Polimerasa
7.
Emerg Infect Dis ; 27(10): 2734-2736, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34545802

RESUMEN

Prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) prevents Pneumocystis jirovecii pneumonia and nocardiosis in immunocompromised patients but sometimes is avoided because of purported allergies or side effects. Of 25 immunocompromised patients receiving alternative prophylaxis in whom nocardiosis developed, 16 subsequently tolerated TMP/SMX treatment. Clinicians should consider TMP/SMX allergy evaluation and rechallenging to assess patient tolerance.


Asunto(s)
Nocardiosis , Pneumocystis carinii , Pneumocystis , Neumonía por Pneumocystis , Humanos , Huésped Inmunocomprometido , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardiosis/prevención & control , Neumonía por Pneumocystis/tratamiento farmacológico , Neumonía por Pneumocystis/prevención & control , Estudios Retrospectivos
8.
Emerg Infect Dis ; 27(10): 2720-2723, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34296992

RESUMEN

We report persistent severe acute respiratory syndrome coronavirus 2 infection in a patient with HIV/AIDS; the virus developed spike N terminal domain and receptor binding domain neutralization resistance mutations. Our findings suggest that immunocompromised patients can harbor emerging variants of severe acute respiratory syndrome coronavirus 2.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , COVID-19 , Humanos , Mutación , Unión Proteica , SARS-CoV-2 , Glicoproteína de la Espiga del Coronavirus/genética
9.
Am J Transplant ; 21(4): 1564-1575, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-32949093

RESUMEN

Desensitization has enabled incompatible living donor kidney transplantation (ILDKT) across HLA/ABO barriers, but added immunomodulation might put patients at increased risk of infections. We studied 475 recipients from our center from 2010 to 2015, categorized by desensitization intensity: none/compatible (n = 260), low (0-4 plasmaphereses, n = 47), moderate (5-9, n = 74), and high (≥10, n = 94). The 1-year cumulative incidence of infection was 50.1%, 49.8%, 66.0%, and 73.5% for recipients who received none, low, moderate, and high-intensity desensitization (P < .001). The most common infections were UTI (33.5% of ILDKT vs. 21.5% compatible), opportunistic (21.9% vs. 10.8%), and bloodstream (19.1% vs. 5.4%) (P < .001). In weighted models, a trend toward increased risk was seen in low (wIRR = 0.77 1.402.56 ,P = .3) and moderately (wIRR = 0.88 1.352.06 ,P = .2) desensitized recipients, with a statistically significant 2.22-fold (wIRR = 1.33 2.223.72 ,P = .002) increased risk in highly desensitized recipients. Recipients with ≥4 infections were at higher risk of prolonged hospitalization (wIRR = 2.62 3.574.88 , P < .001) and death-censored graft loss (wHR = 1.15 4.0113.95 ,P = .03). Post-KT infections are more common in desensitized ILDKT recipients. A subset of highly desensitized patients is at ultra-high risk for infections. Strategies should be designed to protect patients from the morbidity of recurrent infections, and to extend the survival benefit of ILDKT across the spectrum of recipients.


Asunto(s)
Trasplante de Riñón , Sistema del Grupo Sanguíneo ABO , Incompatibilidad de Grupos Sanguíneos , Rechazo de Injerto/epidemiología , Rechazo de Injerto/etiología , Supervivencia de Injerto , Humanos , Trasplante de Riñón/efectos adversos , Donadores Vivos , Receptores de Trasplantes
10.
Emerg Infect Dis ; 26(8): 1679-1685, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32407284

RESUMEN

Limited data are available on the clinical presentation and outcomes of coronavirus disease (COVID-19) patients in the United States hospitalized under normal-caseload or nonsurge conditions. We retrospectively studied 72 consecutive adult patients hospitalized with COVID-19 in 2 hospitals in the San Francisco Bay area, California, USA, during March 13-April 11, 2020. The death rate for all hospitalized COVID-19 patients was 8.3%, and median length of hospitalization was 7.5 days. Of the 21 (29% of total) intensive care unit patients, 3 (14.3% died); median length of intensive care unit stay was 12 days. Of the 72 patients, 43 (59.7%) had underlying cardiovascular disease and 19 (26.4%) had underlying pulmonary disease. In this study, death rates were lower than those reported from regions of the United States experiencing a high volume of COVID-19 patients.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus/epidemiología , Hiperlipidemias/epidemiología , Hipertensión/epidemiología , Pandemias , Neumonía Viral/epidemiología , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Anciano , Anciano de 80 o más Años , Alanina/análogos & derivados , Alanina/uso terapéutico , Asma/epidemiología , Asma/fisiopatología , Azitromicina/uso terapéutico , COVID-19 , Prueba de COVID-19 , California/epidemiología , Técnicas de Laboratorio Clínico/métodos , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/mortalidad , Diabetes Mellitus/fisiopatología , Femenino , Humanos , Hiperlipidemias/fisiopatología , Hipertensión/fisiopatología , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Neumonía Viral/diagnóstico , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Tomografía Computarizada por Rayos X
11.
Artículo en Inglés | MEDLINE | ID: mdl-31964789

RESUMEN

Clostridioides difficile infection (CDI) is a health care-associated infection associated with significant morbidity and cost, with highly varied risk across populations. More effective, risk-based prevention strategies are needed. Here, we investigate risk factors for hospital-associated CDI in a large integrated health system. In a retrospective cohort of all adult admissions to 21 Intermountain Healthcare hospitals from 2006 to 2012, we identified all symptomatic (i) hospital-onset and (ii) health care-facility-associated, community-onset CDI. We then evaluated the risk associated with antibiotic exposure, including that of specific agents, using multivariable logistic regression. A total of 2,356 cases of CDI among 506,068 admissions were identified (incidence, 46.6 per 10,000). Prior antibiotic use was the dominant risk factor, where for every antibiotic day of therapy prior to the index admission, the odds of subsequent CDI increased by 12.8% (95% confidence interval [CI], 12.2 to 13.4%; P < 0.0001). This was a much stronger association than was inpatient antibiotic exposure (odds ratio [OR], 1.007 [95% CI, 1.005 to 1.009]; P < 0.0001). The highest-risk antibiotics included second-generation and later cephalosporins (especially oral), carbapenems, fluoroquinolones, and clindamycin, while doxycycline and daptomycin were associated with a lower CDI risk. We concluded that cumulative antibiotic exposure prior to admission is the greatest contributor to the risk of subsequent CDI. Most classes of antibiotics carry some risk, which varies by drug and route. This information may be useful for antimicrobial stewardship efforts.


Asunto(s)
Adaptación Fisiológica/efectos de los fármacos , Antibacterianos/efectos adversos , Programas de Optimización del Uso de los Antimicrobianos , Clostridioides difficile/efectos de los fármacos , Infecciones por Clostridium/tratamiento farmacológico , Infección Hospitalaria/microbiología , Adaptación Fisiológica/genética , Antibacterianos/uso terapéutico , Carbapenémicos/efectos adversos , Carbapenémicos/uso terapéutico , Cefalosporinas/efectos adversos , Cefalosporinas/uso terapéutico , Clindamicina/efectos adversos , Clindamicina/uso terapéutico , Clostridioides difficile/genética , Infección Hospitalaria/inducido químicamente , Infección Hospitalaria/tratamiento farmacológico , Daptomicina/efectos adversos , Daptomicina/uso terapéutico , Doxiciclina/efectos adversos , Doxiciclina/uso terapéutico , Farmacorresistencia Bacteriana/genética , Femenino , Fluoroquinolonas/efectos adversos , Fluoroquinolonas/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
12.
Transpl Infect Dis ; 22(6): e13365, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32533741

RESUMEN

Advances in solid organ transplantation have improved the survival of end-stage organ disease at the expense of an increased risk for opportunistic infections. Unusual clinical presentations and the possibility of concurrent infections make diagnosing invasive fungal infection (IFI) more difficult. Here, we present a case of simultaneous vertebral infection caused by Coccidioides immitis-posadasii and subcutaneous phaeohyphomycosis due to Nigrograna mackinnonii in a kidney transplant recipient. The diagnosis of both infections required invasive procedures to obtain tissue and a high index of suspicion that more than one IFI could be present. A multidisciplinary team approach for the management of immunocompromised patients with suspected or diagnosed IFI is warranted.


Asunto(s)
Coccidioidomicosis/diagnóstico , Coinfección/diagnóstico , Coinfección/microbiología , Trasplante de Riñón/efectos adversos , Feohifomicosis/diagnóstico , Antifúngicos/uso terapéutico , Ascomicetos/aislamiento & purificación , Biopsia/métodos , Coccidioides/aislamiento & purificación , Coccidioidomicosis/tratamiento farmacológico , Coccidioidomicosis/microbiología , Coinfección/tratamiento farmacológico , Humanos , Huésped Inmunocomprometido , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/microbiología , Feohifomicosis/tratamiento farmacológico , Feohifomicosis/microbiología , Reacción en Cadena de la Polimerasa/métodos , Resultado del Tratamiento
13.
J Infect Dis ; 220(3): 370-376, 2019 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-30869132

RESUMEN

BACKGROUND: BK virus (BKV) is a significant cause of nephropathy in kidney transplantation. The goal of this study was to characterize the course and source of BKV in kidney transplant recipients. METHODS: We prospectively collected pretransplant plasma and urine samples from living and deceased kidney donors and performed BKV polymerase chain reaction (PCR) and immunoglobulin G (IgG) testing on pretransplant and serially collected posttransplant samples in kidney transplant recipients. RESULTS: Among deceased donors, 8.1% (17/208) had detectable BKV DNA in urine prior to organ procurement. BK viruria was observed in 15.4% (6/39) of living donors and 8.5% (4/47) of deceased donors of recipients at our institution (P = .50). BKV VP1 sequencing revealed identical virus between donor-recipient pairs to suggest donor transmission of virus. Recipients of BK viruric donors were more likely to develop BK viruria (66.6% vs 7.8%; P < .001) and viremia (66.6% vs 8.9%; P < .001) with a shorter time to onset (log-rank test, P < .001). Though donor BKV IgG titers were higher in recipients who developed BK viremia, pretransplant donor, recipient, and combined donor/recipient serology status was not associated with BK viremia (P = .31, P = .75, and P = .51, respectively). CONCLUSIONS: Donor BK viruria is associated with early BK viruria and viremia in kidney transplant recipients. BKV PCR testing of donor urine may be useful in identifying recipients at risk for BKV complications.


Asunto(s)
Virus BK/aislamiento & purificación , Enfermedades Renales/virología , Trasplante de Riñón/efectos adversos , Infecciones por Polyomavirus/virología , Infecciones Tumorales por Virus/virología , Adulto , Femenino , Humanos , Inmunoglobulina G/sangre , Riñón/virología , Enfermedades Renales/sangre , Enfermedades Renales/orina , Donadores Vivos , Masculino , Persona de Mediana Edad , Infecciones por Polyomavirus/sangre , Infecciones por Polyomavirus/orina , Estudios Prospectivos , Receptores de Trasplantes , Infecciones Tumorales por Virus/sangre , Infecciones Tumorales por Virus/orina , Viremia/sangre , Viremia/orina , Viremia/virología
14.
Am J Transplant ; 19(5): 1380-1387, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30378723

RESUMEN

In the context of organ shortage, the opioid epidemic, and effective direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV), more HCV-infected donor organs may be used for liver transplantation. Current data regarding outcomes after donor-derived HCV in previously non-viremic liver transplant recipients are limited. Clinical data for adult liver transplant recipients with donor-derived HCV infection from March 2017 to January 2018 at our institution were extracted from the medical record. Ten patients received livers from donors known to be infected with HCV based on positive nucleic acid testing. Seven had a prior diagnosis of HCV and were treated before liver transplantation. All recipients were non-viremic at the time of transplantation. All 10 recipients derived hepatitis C infection from their donor and achieved sustained virologic response at 12 weeks posttreatment with DAA-based regimens, with a median time from transplant to treatment initiation of 43 days (IQR 20-59). There have been no instances of graft loss or death, with median follow-up of 380 days (IQR 263-434) posttransplant. Transplantation of HCV-viremic livers into non-viremic recipients results in acceptable short-term outcomes. Such strategies may be used to expand the donor pool and increase access to liver transplantation.


Asunto(s)
Hepatitis C/complicaciones , Trasplante de Hígado/métodos , Complicaciones Posoperatorias , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/normas , Receptores de Trasplantes/estadística & datos numéricos , Viremia/complicaciones , Adulto , Anciano , Antivirales/uso terapéutico , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Hepacivirus/efectos de los fármacos , Hepacivirus/aislamiento & purificación , Hepatitis C/tratamiento farmacológico , Hepatitis C/transmisión , Hepatitis C/virología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Viremia/tratamiento farmacológico , Viremia/transmisión , Viremia/virología
15.
Clin Transplant ; 33(9): e13513, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-30817030

RESUMEN

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of tuberculosis in the pre- and post-transplant period. The challenges of screening for both latent and active TB in the setting of transplantation are reviewed. The use of interferon gamma release assays for detection of latent tuberculosis is discussed and compared to tuberculin skin testing. Given the limitations of both testing modality, it is important to consider exposure history and chest imaging. The clinical manifestations of active tuberculosis in transplantation are covered. New recommendations for treatment of latent tuberculosis and active tuberculosis are included.


Asunto(s)
Antibacterianos/uso terapéutico , Mycobacterium tuberculosis/aislamiento & purificación , Trasplante de Órganos/efectos adversos , Guías de Práctica Clínica como Asunto/normas , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Humanos , Sociedades Médicas , Receptores de Trasplantes , Tuberculosis/etiología
16.
Transpl Infect Dis ; 21(4): e13118, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31111613

RESUMEN

Treatment of symptomatic candiduria is notoriously challenging because of the limited repository of antifungals that achieve adequate urinary concentrations. Fluconazole, amphotericin B-based products, and flucytosine are established treatment options for most Candida species. Candida krusei exhibits intrinsic resistance to fluconazole and decreased susceptibility to amphotericin B and flucytosine. In transplant patients, both amphotericin B-based products and flucytosine are less desirable because of their toxicities. Other triazole antifungals are unappealing because they do not achieve adequate urinary concentrations, have multiple toxicities, and interact with transplant-related immunosuppressive medications. Echinocandins are well-tolerated but have been traditionally deferred in the treatment of symptomatic funguria because of their poor urinary concentrations but there is a small but emerging body of literature supporting their use. Here, we present a case of successful eradication of chronic symptomatic C krusei urinary tract infection with micafungin 150 milligrams daily in a liver and kidney transplant recipient, and we review the literature on treatment of symptomatic candiduria.


Asunto(s)
Antifúngicos/uso terapéutico , Candidiasis/tratamiento farmacológico , Trasplante de Riñón/efectos adversos , Trasplante de Hígado/efectos adversos , Micafungina/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Candida/efectos de los fármacos , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Receptores de Trasplantes , Resultado del Tratamiento
17.
Transpl Infect Dis ; 21(1): e12998, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30203504

RESUMEN

We present a case of cytomegalovirus (CMV) native kidney nephritis and prostatitis in a CMV D+/R- kidney transplant recipient who had completed six months of CMV prophylaxis four weeks prior to the diagnosis of genitourinary CMV disease. The patient had a history of benign prostatic hypertrophy and urinary retention that required self-catheterization to relieve high post-voiding residual volumes. At 7 months post-transplant, he was found to have a urinary tract infection, moderate hydronephrosis of the transplanted kidney, and severe hydroureteronephrosis of the native left kidney and ureter, and underwent native left nephrectomy and transurethral resection of the prostate. Histopathologic examination of kidney and prostate tissue revealed CMV inclusions consistent with invasive CMV disease. This case highlights that CMV may extend beyond the kidney allograft to involve other parts of the genitourinary tract, including the native kidneys and prostate. Furthermore, we highlight the tissue-specific risk factors that preceded CMV tissue invasion. In addition to concurrent diagnoses, health care providers should have a low threshold for considering late-onset CMV disease in high-risk solid organ transplant recipients presenting with signs and symptoms of genitourinary tract pathology.


Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Citomegalovirus/aislamiento & purificación , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Nefritis/diagnóstico , Prostatitis/diagnóstico , Aloinjertos/virología , Profilaxis Antibiótica/métodos , Antivirales/uso terapéutico , Biopsia , Infecciones por Citomegalovirus/patología , Infecciones por Citomegalovirus/prevención & control , Infecciones por Citomegalovirus/virología , Humanos , Riñón/patología , Riñón/virología , Masculino , Persona de Mediana Edad , Nefritis/microbiología , Nefritis/patología , Próstata/patología , Próstata/virología , Prostatitis/patología , Prostatitis/virología , Receptores de Trasplantes , Resultado del Tratamiento
20.
Sci Technol Adv Mater ; 16(3): 033504, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27877785

RESUMEN

Cardiovascular disease claims millions of lives every year throughout the world. Biomaterials are used widely for the treatment of this fatal disease. With the advent of nanotechnology, the use of nanocomposites has become almost inevitable in the field of biomaterials. The versatile properties of nanocomposites, such as improved durability and biocompatibility, make them an ideal choice for various biomedical applications. Among the various nanocomposites, polyhedral oligomeric silsesquioxane-poly(carbonate-urea)urethane, bacterial cellulose with polyvinyl alcohol, carbon nanotubes, graphene oxide and nano-hydroxyapatite nanocomposites have gained popularity as putative choices for biomaterials in cardiovascular applications owing to their superior properties. In this review, various studies performed utilizing these nanocomposites for improving the mechanical strength, anti-calcification potential and hemocompatibility of heart valves are reviewed and summarized. The primary motive of this work is to shed light on the emerging nanocomposites for heart valve applications. Furthermore, we aim to promote the prospects of these nanocomposites in the campaign against cardiovascular diseases.

SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA