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1.
Viruses ; 16(7)2024 Jul 02.
Article in English | MEDLINE | ID: mdl-39066229

ABSTRACT

Pediatric solid organ transplant (SOT) recipients face a challenging balance between immunosuppression and graft rejection. While Epstein-Barr Virus (EBV) and cytomegalovirus (HCMV) are known contributors to post-transplant lymphoproliferative disease and graft rejection, respectively, the roles of herpesvirus 6 and 7 (HHV6 and HHV7) and the impact of these herpesviruses on cytokine levels remain unclear, leading to gaps in clinical practice. In this associative study, we measured 17 cytokines using a Bio-Plex assay in a meticulously curated plasma sample pool (N = 158) from pediatric kidney and liver transplant recipients over a one-year follow-up period. The samples included virus-negative and virus-positive cases, either individually or in combination, along with episodes of graft rejection. We observed that the elevation of IL-4, IL-8, and IL-10 correlated with graft rejection. These cytokines were elevated in samples where HCMV or HHV6 were detected alone or where EBV and HHV7 were co-detected. Interestingly, latent EBV, when detected independently, exhibited an immunomodulatory effect by downregulating cytokine levels. However, in co-detection scenarios with ß-herpesviruses, EBV transitioned to a lytic state, also associating with heightened cytokinemia and graft rejection. These findings highlight the complex interactions between the immune response and herpesviruses in transplant recipients. The study advocates for enhanced monitoring of not only EBV and HCMV but also HHV6 and HHV7, providing valuable insights for improved risk assessment and targeted interventions in pediatric SOT recipients.


Subject(s)
Cytokines , Cytomegalovirus , Graft Rejection , Herpesvirus 6, Human , Herpesvirus 7, Human , Kidney Transplantation , Liver Transplantation , Humans , Kidney Transplantation/adverse effects , Cytokines/blood , Cytokines/metabolism , Child , Herpesvirus 6, Human/immunology , Male , Female , Child, Preschool , Liver Transplantation/adverse effects , Cytomegalovirus/immunology , Graft Rejection/virology , Graft Rejection/immunology , Herpesvirus 4, Human/immunology , Adolescent , Infant , Herpesviridae Infections/virology , Herpesviridae Infections/immunology , Transplant Recipients , Epstein-Barr Virus Infections/virology , Epstein-Barr Virus Infections/immunology , Cytomegalovirus Infections/virology , Cytomegalovirus Infections/immunology , Herpesviridae
2.
Parasite Immunol ; 46(7): e13059, 2024 Jul.
Article in English | MEDLINE | ID: mdl-39039790

ABSTRACT

Immunosuppressed patients, particularly transplant recipients, can develop severe strongyloidiasis. This study aimed to detect anti-Strongyloides IgG antibodies in a panel of sera from liver transplant patients. Two techniques were used: ELISA as the initial screening test and Western blotting as a confirmatory test. ELISA reactivity of 10.9% (32/294) was observed. The 40-30 kDa fraction was recognised in 93.7% (30/32) of the patients, resulting in a positivity rate of 10.2%. These data highlight the importance of serological screening for Strongyloides stercoralis infection in liver transplant recipients.


Subject(s)
Antibodies, Helminth , Enzyme-Linked Immunosorbent Assay , Immunoglobulin G , Liver Transplantation , Strongyloides stercoralis , Strongyloidiasis , Transplant Recipients , Humans , Strongyloidiasis/diagnosis , Strongyloidiasis/immunology , Strongyloidiasis/blood , Antibodies, Helminth/blood , Animals , Strongyloides stercoralis/immunology , Immunoglobulin G/blood , Blotting, Western , Male , Mass Screening/methods , Middle Aged , Female , Adult , Neglected Diseases/diagnosis , Neglected Diseases/epidemiology , Neglected Diseases/immunology , Immunocompromised Host , Aged
3.
Transpl Int ; 37: 12469, 2024.
Article in English | MEDLINE | ID: mdl-38952482

ABSTRACT

Solid organ transplant (SOT) recipients are particularly susceptible to infections caused by multidrug-resistant organisms (MDRO) and are often the first to be affected by an emerging resistant pathogen. Unfortunately, their prevalence and impact on morbidity and mortality according to the type of graft is not systematically reported from high-as well as from low and middle-income countries (HIC and LMIC). Thus, epidemiology on MDRO in SOT recipients could be subjected to reporting bias. In addition, screening practices and diagnostic resources may vary between countries, as well as the availability of new drugs. In this review, we aimed to depict the burden of main Gram-negative MDRO in SOT patients across HIC and LMIC and to provide an overview of current diagnostic and therapeutic resources.


Subject(s)
Drug Resistance, Multiple, Bacterial , Organ Transplantation , Humans , Organ Transplantation/adverse effects , Transplant Recipients , Anti-Bacterial Agents/therapeutic use , Prevalence , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/epidemiology , Developing Countries
4.
Mycopathologia ; 189(3): 43, 2024 May 06.
Article in English | MEDLINE | ID: mdl-38709328

ABSTRACT

During an epidemiological survey, a potential novel species within the basidiomycetous yeast genus Trichosporon was observed. The clinical strain was obtained from a urine sample taken from a Brazilian kidney transplant recipient. The strain was molecularly identified using the intergenic spacer (IGS1) ribosomal DNA locus and a subsequent phylogenetic analysis showed that multiple strains that were previously reported by other studies shared an identical IGS1-genotype most closely related to that of Trichosporon inkin. However, none of these studies provided an in-depth characterization of the involved strains to describe it as a new taxon. Here, we present the novel clinically relevant yeast for which we propose the name Trichosporon austroamericanum sp. nov. (holotype CBS H-24937). T. austroamericanum can be distinguished from other siblings in the genus Trichosporon using morphological, physiological, and phylogenetic characters.


Subject(s)
DNA, Fungal , DNA, Ribosomal Spacer , Phylogeny , Sequence Analysis, DNA , Transplant Recipients , Trichosporon , Trichosporonosis , Trichosporon/classification , Trichosporon/genetics , Trichosporon/isolation & purification , DNA, Ribosomal Spacer/genetics , DNA, Ribosomal Spacer/chemistry , DNA, Fungal/genetics , Humans , Brazil , Trichosporonosis/microbiology , Cluster Analysis , Mycological Typing Techniques , Kidney Transplantation , Microscopy , Genotype
5.
Transplant Proc ; 56(5): 1048-1051, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38760299

ABSTRACT

BACKGROUND: COVID-19, caused by SARS-CoV-2, was responsible for higher morbidity and mortality in renal transplant recipients (RTx). The objective of the study was to evaluate the impact of COVID-19 infection on RTx in a single center in Brazil. METHODS: A cohort of 135 RTx was evaluated between December 2019 and June 202l, and demographics, clinical, and laboratory profiles were analyzed from deceased donors with COVID-19. RESULTS: Diabetic and RTx from extended criterion donors presented more frequently the severe form of the disease. Serum creatinine (sCr) after 3 months of diagnosis of COVID-19 varied according to the severity of infection. The lethality rate was higher in the group with severe symptoms (65%) compared with those with mild infection (1.5%). CONCLUSION: The increase in sCr was associated with disease severity. The lethality rate for COVID-19 was 26.6%. These rates are 10-20 times higher than those reported in the general population and suggest that rigorous observation, early diagnosis, and disease prevention measures are crucial in RTx.


Subject(s)
COVID-19 , Kidney Transplantation , Humans , COVID-19/epidemiology , COVID-19/mortality , COVID-19/diagnosis , Kidney Transplantation/adverse effects , Male , Middle Aged , Female , Brazil/epidemiology , Adult , Transplant Recipients/statistics & numerical data , SARS-CoV-2 , Creatinine/blood , Severity of Illness Index , Aged , Retrospective Studies
6.
Transplant Proc ; 56(5): 1112-1114, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38762404

ABSTRACT

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has been a global reality for longer than 3 years. Serologic studies have great importance for understanding the virus's behavior in populations, as it can suggest the status of the epidemic in a community. This cross-sectional study aimed to analyze the serologic profile for COVID-19 in patients before and after pediatric heart transplantation. METHODS: Serology data on IgG and IgM antibodies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were collected in patients of the Pediatric Cardiology and Congenital Heart Diseases unit of a Brazilian hospital between January and August 2022. A total of 174 patients were recruited, including 28 on the transplantation waiting list and 146 heart transplant recipients. Information for each patient, including demographics (age, sex, state of origin), type of heart disease (congenital or acquired), and time after transplantation, was analyzed. RESULTS: Overall, 72 patients had a positive serology for anti-N antibodies (48.0%), including 62 heart transplant recipients and 10 patients on the transplantation waiting list, The positivity rates in these 2 groups were 48.1% and 47.6%, respectively. Positivity rates for previously infected individuals were 62.5% and 62.1%, respectively. CONCLUSIONS: Approximately one-half of our study sample had IgM or IgG antibodies against the SARS-CoV-2 virus. Serologic studies on the duration and level of protection provided by these antibodies are relevant public health tools for health promotion of vulnerable groups and can be useful for future studies on antibody behavior.


Subject(s)
Antibodies, Viral , COVID-19 , Heart Transplantation , SARS-CoV-2 , Waiting Lists , Humans , COVID-19/epidemiology , COVID-19/immunology , COVID-19/blood , Male , Female , Child , Cross-Sectional Studies , SARS-CoV-2/immunology , Child, Preschool , Antibodies, Viral/blood , Adolescent , Brazil/epidemiology , Infant , Immunoglobulin G/blood , Immunoglobulin M/blood , Transplant Recipients/statistics & numerical data , COVID-19 Serological Testing
8.
Transpl Infect Dis ; 26(4): e14274, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38576133

ABSTRACT

BACKGROUND: Hematopoietic stem cell transplant (HSCT) recipients are among patients with highest risk of adverse coronavirus disease 2019 (COVID-19) outcomes. OBJECTIVE: We compared clinical outcomes in post-HSCT patients with COVID-19 before and during the Omicron period. STUDY DESIGN: This was a retrospective study including patients post-HSCT with severe acute respiratory syndrome coronavirus 2 infection from April 2020 to March 2023 at Instituto Nacional de Cancerología, Mexico City. We describe their clinical characteristics and report the variables associated with severe clinical disease, hospitalization, and death. RESULTS: Fifty-three patients were included; 31 (58.5%) from the pre-Omicron period and 22 (41.5%) from the Omicron period. Median age was 42-years old (interquartile range 26-53), and 31 patients (59%) were men. Only four patients (16%) had received a vaccine prior to COVID-19 diagnosis in the pre-Omicron period versus 20 (91%) in the Omicron period (p < 0.001). COVID-19 severe cases were more common before Omicron: seven patients (23%) versus two patients (9%). Only one patient (3%) received an antiviral in the pre-Omicron period compared to 11 patients (50%) during the Omicron period (p < 0.01). COVID-19-associated mortality was almost double in the pre-Omicron period (16% vs. 9%, p = 0.6). CONCLUSIONS: This study reports patients with a high proportion of severe outcomes during the first 2 years of the pandemic. Outcomes improved during Omicron with better access to vaccines and antivirals and no in-hospital cases. Variables associated with worse outcomes were similar to other reports. Strengthening infection control measures in the hospital and better access to preventive strategies and therapeutic options are mandatory in these high-risk patients.


Subject(s)
COVID-19 , Hematopoietic Stem Cell Transplantation , SARS-CoV-2 , Humans , COVID-19/epidemiology , COVID-19/mortality , COVID-19/prevention & control , Male , Mexico/epidemiology , Hematopoietic Stem Cell Transplantation/adverse effects , Adult , Middle Aged , Female , Retrospective Studies , Hospitalization/statistics & numerical data , Transplant Recipients/statistics & numerical data , COVID-19 Vaccines/administration & dosage
9.
Value Health Reg Issues ; 42: 100983, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38663057

ABSTRACT

OBJECTIVES: To evaluate cost-effective pharmacological treatment in adult kidney transplant recipients from the perspective of the Colombian health system. METHODS: A decision tree model for the induction phase and a Markov model for the maintenance phase were built. A review of the clinical literature was conducted to extract probabilities, and the life-years were used as the outcome. Costs were calculated using the administrative databases. The evaluating treatment schemes are organized by groups of evidence with direct comparisons. RESULTS: In the induction phase, anti-thymocyte immunoglobulin+ methylprednisolone is dominant, more effective, and less expensive, compared with basiliximab+methylprednisolone. In the maintenance phase, azathioprine (AZA) is dominant in contrast to mycophenolate mofetil (MFM) both with cyclosporine (CIC)+ corticosteroids (CE); CIC is dominant relative to sirolimus (SIR) and tacrolimus (TAC) (both with MFM+CE or AZA+CE), and TAC is dominant compared with SIR (in addition with MFM+CE or mycophenolate sodium [MFS]+CE); MFM is dominant in relation to MFS and everolimus, and SIR is more effective MFM but it does not exceed the threshold (in sum with TAC+CE); MFS and MFM are dominant relative to everolimus, and SIR is more effective than MFM, but it does not exceed the threshold (in addiction with CIC+CE); MFM is dominant in relation to TAC (in sum with SIR+CE), and CIC+AZA+CE is dominant in relation to TAC+MFM+CE. CONCLUSIONS: The base-case results for all evidence groups are consistent with the different sensitivity analyses.


Subject(s)
Immunosuppressive Agents , Kidney Transplantation , Adult , Humans , Adrenal Cortex Hormones/therapeutic use , Adrenal Cortex Hormones/economics , Azathioprine/therapeutic use , Azathioprine/economics , Colombia , Cost-Effectiveness Analysis , Cyclosporine/therapeutic use , Cyclosporine/economics , Decision Trees , Graft Rejection/prevention & control , Graft Rejection/economics , Immunosuppressive Agents/economics , Immunosuppressive Agents/therapeutic use , Kidney Transplantation/economics , Markov Chains , Mycophenolic Acid/therapeutic use , Mycophenolic Acid/economics , Sirolimus/therapeutic use , Sirolimus/economics , Tacrolimus/economics , Tacrolimus/therapeutic use , Transplant Recipients/statistics & numerical data
10.
Braz J Infect Dis ; 28(2): 103742, 2024.
Article in English | MEDLINE | ID: mdl-38670166

ABSTRACT

A substantial number of zoonotic diseases are caused by viral pathogens, representing a significant menace to public health, particularly to susceptible populations, such as pregnant women, the elderly, and immunocompromised individuals. Individuals who have undergone solid organ transplantation frequently experience immunosuppression, to prevent organ rejection, and, thus are more prone to opportunistic infections. Furthermore, the reactivation of dormant viruses can threaten transplant recipients and organ viability. This mini-review examines the up-to-date literature covering potential zoonotic and organ rejection-relevant viruses in solid organ transplant recipients. A comprehensive list of viruses with zoonotic potential is highlighted and the most important clinical outcomes in patients undergoing transplantation are described. Moreover, this mini-review calls attention to complex multifactorial events predisposing viral coinfections and the need for continuous health surveillance and research to understand better viral pathogens' transmission and pathophysiology dynamics in transplanted individuals.


Subject(s)
Immunocompromised Host , Organ Transplantation , Transplant Recipients , Humans , Organ Transplantation/adverse effects , Animals , Virus Diseases/transmission , Virus Diseases/virology , Disease Susceptibility , Zoonoses/transmission , Zoonoses/virology , Viral Zoonoses/transmission , Viral Zoonoses/virology , Risk Factors
11.
Pediatr Transplant ; 28(3): e14713, 2024 May.
Article in English | MEDLINE | ID: mdl-38553819

ABSTRACT

BACKGROUND: This study aimed to compare the efficacy and safety of basiliximab (BAS) versus a single dose of anti-thymocyte globulin (r-ATG) induction therapy in pediatric kidney transplant recipients (KTRs). METHODS: This single-center retrospective comparative cohort study included all pediatric KTRs from May 2013 to April 2018 and followed up to 12 months. In the first period, all recipients received BAS, while from May 2016, a single 3 mg/kg dose of r-ATG was instituted. Maintenance therapy consisted of a calcineurin inhibitor plus prednisone plus azathioprine or mycophenolate. RESULTS: A total of 227 patients were included (BAS, n = 113; r-ATG, n = 114). The main combination of immunosuppressive drugs was tacrolimus, prednisone, and azathioprine in both groups (87% vs. 88%, p = .718). Patients receiving r-ATG showed superior survival-free of the composite endpoint (acute rejection, graft loss, or death; 76% vs. 61%, p = .003; HR 2.08, 1.29-3.34, p = .003) and lower incidence of biopsy-proven acute rejection (10% vs. 21%, p = .015). There was no difference in the overall incidence of CMV infection (33% vs. 37%, p = .457), PTLD (1% vs. 3%, p = .309), 30-day hospital readmissions (24% vs. 23%, p = .847), and kidney function at 12 months (86 ± 29 vs. 84 ± 30 mL/min/1.73m2, p = .614). CONCLUSIONS: These data suggest that induction therapy with a single 3 mg/kg dose of r-ATG is associated with higher efficacy for preventing acute rejection and similar safety profile compared to BAS.


Subject(s)
Antilymphocyte Serum , Kidney Transplantation , Humans , Child , Basiliximab/therapeutic use , Antilymphocyte Serum/therapeutic use , Antibodies, Monoclonal/therapeutic use , Prednisone/therapeutic use , Retrospective Studies , Cohort Studies , Azathioprine , Induction Chemotherapy , Graft Rejection/prevention & control , Graft Rejection/epidemiology , Immunosuppressive Agents/therapeutic use , Recombinant Fusion Proteins/therapeutic use , Transplant Recipients
12.
PLoS One ; 19(3): e0301198, 2024.
Article in English | MEDLINE | ID: mdl-38547193

ABSTRACT

BACKGROUND AND AIMS: COVID-19 vaccination has proved to be effective to prevent symptomatic infection and severe disease even in immunocompromised patients including liver transplant patients. We aim to assess the impact of COVID-19 vaccination on the mortality and development of severe and critical disease in our center. METHODS: A retrospective cohort study of LT patients in a reference center between March 2020 and February 2022. Demographic data, cirrhosis etiology, time on liver transplantation, immunosuppressive therapies, and vaccination status were recorded at the time of diagnosis. Primary outcome was death due to COVID-19, and secondary outcomes included the development of severe COVID-19 and intensive care unit (ICU) requirement. RESULTS: 153 of 324 LT recipients developed COVID-19, in whom the main causes of cirrhosis were HCV infection and metabolic-associated fatty liver disease. The vaccines used were BNT162b2 (48.6%), ChAdOx1 nCoV-19 (21.6%), mRNA-1273 vaccine (1.4%), Sputnik V (14.9%), Ad5-nCoV-S (4.1%) and CoronaVac (9.5%). Case fatality and ICU requirement risk were similar among vaccinated and unvaccinated LT patients (adjusted relative case fatality for vaccinated versus unvaccinated of 0.68, 95% CI 0.14-3.24, p = 0.62; adjusted relative risk [aRR] for ICU requirement of 0.45, 95% CI 0.11-1.88, p = 0.27). Nonetheless, vaccination was associated with a lower risk of severe disease (aRR for severe disease of 0.32, 95% CI 0.14-0.71, p = 0.005). CONCLUSIONS: Vaccination reduces the risk of severe COVID-19 in LT patients, regardless of the scheme used. Vaccination should be encouraged for all.


Subject(s)
COVID-19 Vaccines , COVID-19 , Liver Transplantation , Humans , 2019-nCoV Vaccine mRNA-1273 , BNT162 Vaccine , ChAdOx1 nCoV-19 , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , Liver Cirrhosis , Mexico/epidemiology , Retrospective Studies , Transplant Recipients , Vaccination
13.
Rev. cuba. med. mil ; 53(1)mar. 2024. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1569889

ABSTRACT

Introducción: La fiebre es un marcador de enfermedades infecciosas e inflamatorias que se da por una respuesta inmune innata y por diferentes mediaciones entre marcadores moleculares. En el paciente inmunodeprimido, uno o varios mecanismos inmunológicos pueden estar alterados, debido a que la respuesta inmune puede estar deprimida y la fiebre puede denotar un estado patológico grave subyacente. Se realizó una búsqueda exploratoria en las bases de datos PubMed/Medline, Scopus y Scielo entre septiembre y octubre de 2022. Se incluyeron los términos fiebre, pacientes inmunodeprimidos, tratamiento y sistema inmune. Se seleccionaron 41 artículos científicos con diferentes diseños epidemiológicos. Objetivo: Describir aspectos relacionados con la fisiopatología de la fiebre, el tratamiento de la presencia de fiebre en pacientes con virus de inmunodeficiencia humana y síndrome de inmunodeficiencia adquirida, así como también en pacientes receptores de trasplantes de órgano sólido y de trasplantes hematopoyéticos, pacientes neutropénicos y pacientes tratados con corticosteroides y terapia biológica. Desarrollo: El tratamiento del paciente inmunodeprimido con fiebre incluye aspectos fundamentales como una adecuada anamnesis y examen físico, además de pruebas diagnósticas orientadas para establecer la causa de la fiebre. En estos pacientes, las infecciones juegan un papel protagónico y su intervención temprana es fundamental para impactar en la morbimortalidad. Conclusiones: El paciente inmunodeprimido con presencia de fiebre presenta un panorama desafiante para su manejo médico integral. Entre otros aspectos es relevante considerar el tipo y tiempo de inmunosupresión, así como los factores de riesgo, con el fin de orientar los diagnósticos y tratamientos(AU)


Introduction: Fever is a marker of infectious and inflammatory diseases that is caused by an innate immune response and by different mediations between molecular markers. In the immunocompromised patient, one or more immunological mechanisms may be altered because the immune response may be compromised, and fever may denote a serious underlying disease state. An exploratory search was conducted in the PubMed/Medline, Scopus, and Scielo databases between September and October 2022. The terms fever immunocompromised patients, treatment, and immune system. A total of 41 scientific articles with different epidemiological designs were selected. Objective: To describe aspects related to the pathophysiology of fever, management of the presence of fever in patients with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome, as well as in patients who have received solid organ transplants and hematopoietic transplants, neutropenic patients and patients treated with corticosteroids and biological therapy. Developing: The approach to the immunocompromised patient with fever includes fundamental aspects such as an adequate history and physical examination, as well as diagnostic tests aimed at establishing the cause of the fever. In these patients, infections play a leading role and early intervention is essential to impact morbidity and mortality. Conclusions: The immunocompromised patient with the presence of fever presents a challenging panorama for his/her comprehensive medical approach. Among other aspects, it is relevant to consider the type and duration of immunosuppression, as well as the risk factors, to guide diagnoses and treatments(AU)


Subject(s)
Humans , Risk Factors , Acquired Immunodeficiency Syndrome , Immunocompromised Host , Fever/etiology , Fever/physiopathology , Fever/therapy , Transplant Recipients , Immunity , Immunity, Innate , Patients , Biological Therapy/methods , Organ Transplantation , Adrenal Cortex Hormones/therapeutic use , Febrile Neutropenia/complications
14.
Transpl Infect Dis ; 26(3): e14269, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38501790

ABSTRACT

Histoplasmosis is an expected endemic mycosis in solid organ transplant recipients and occurs as a primary infection, reactivation, or, rarely, acquired from an infected allograft. Reactivation is favored by maintenance immunosuppression or anti-rejection therapy, which facilitates the appearance of disseminated forms as well as unusual presentations. We present the case of a 66-year-old woman with isolated tenosynovitis due to Histoplasma capsulatum 25 years after a kidney transplant.


Subject(s)
Histoplasma , Histoplasmosis , Kidney Transplantation , Tenosynovitis , Humans , Kidney Transplantation/adverse effects , Histoplasmosis/diagnosis , Histoplasmosis/drug therapy , Histoplasmosis/microbiology , Histoplasma/isolation & purification , Female , Aged , Tenosynovitis/microbiology , Tenosynovitis/drug therapy , Antifungal Agents/therapeutic use , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Transplant Recipients
15.
Viruses ; 16(3)2024 03 11.
Article in English | MEDLINE | ID: mdl-38543797

ABSTRACT

Torque Teno Virus (TTV) is a nonpathogenic and ubiquitous ssDNA virus, a member of the Anelloviridae family. TTV has been postulated as a biomarker in transplant patients. This study aimed to determine the TTV species diversity and variability in renal transplant recipients and to associate species diversity with the corresponding TTV viral load. From 27 recipients, 30 plasma samples were selected. Viral load was determined using two real-time PCR assays, followed by RCA-NGS and ORF1 phylogenetic analysis. The TTV diversity was determined in all samples. Variability was determined in three patients with two sequential samples (pre- and post-transplantation). Most of the samples presented multiple TTV species, up to 15 different species were detected. In the pre-transplant samples (n = 12), the most prevalent species were TTV3 (75%) and TTV13 (75%), and the median number of species per sample was 5 (IQR: 4-7.5). TTV3 was also the most prevalent (56%) in the post-transplant samples (n = 18), and the median number of species was 2 (IQR: 1.8-5.5). No significant correlation between the number of species and viral load was found. The number and type of TTV species showed total variability over time. We report high TTV species diversity in Argentinian recipients, especially in pre-transplant period, with total intra-host variability. However, we found no significant correlation between this high diversity and TTV viral load.


Subject(s)
DNA Virus Infections , Kidney Transplantation , Torque teno virus , Humans , Torque teno virus/genetics , Kidney Transplantation/adverse effects , Phylogeny , Transplant Recipients , Viral Load , DNA, Viral/genetics
16.
Emerg Infect Dis ; 30(3): 613-616, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38407164

ABSTRACT

We report a case of Enterocytozoon bieneusi infection in a pediatric hematopoietic stem cell transplant recipient in Argentina. Spores were visualized in feces using Calcofluor White and modified trichrome stainings. PCR and sequencing identified E. bieneusi genotype D in fecal samples and liver samples, confirming extraintestinal dissemination of the parasite.


Subject(s)
Enterocytozoon , Hematopoietic Stem Cell Transplantation , Humans , Child , Argentina/epidemiology , Enterocytozoon/genetics , Transplant Recipients , Feces , Hematopoietic Stem Cell Transplantation/adverse effects
17.
Transplant Proc ; 56(2): 297-305, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38395659

ABSTRACT

BACKGROUND: To describe and establish the efficacy and safety of Mycophenolate Mofetil (Micoflavin) in patients with de novo renal transplantation during one-year post-transplant follow-up. As secondary objectives, the behavior of mycophenolic acid (MPA) C0 levels in this population, the relationship between MPA levels and renal function of the grafts, the incidence of acute rejection, and the incidence of adverse effects were evaluated. METHODS: A prospective cohort study was conducted on patients who received a first kidney transplant from a deceased donor between March 1, 2021, and February 28, 2022, at the Alma Mater of Antioquia Hospital of the Antioquia's University, in Medellín, Colombia. MPA C0 levels were taken from the patients on days 15, 30, 90, 180, and 360 after the kidney transplantation. RESULTS: Patients presented MPA therapeutic levels in the study. The average of the MPA levels in the population was 2.5 µg/mL, with an IQR of 2.13 to 3.32. There were 5 acute rejections (27%), but none of the patients with acute rejection presented subtherapeutic levels of mycophenolate. No significant relationship was observed between mycophenolic acid levels and rejection (P = .255). The patients who completed the study had no gastrointestinal intolerance to mycophenolate, cytomegalovirus infections, or significant hematological complications. CONCLUSIONS: MMF (Micoflavin) maintained mycophenolic acid levels C0 within the therapeutic range, was well tolerated and without the presence of significant adverse events, and maintained stable renal function throughout the follow-up period in the population studied.


Subject(s)
Kidney Transplantation , Mycophenolic Acid , Humans , Mycophenolic Acid/adverse effects , Kidney Transplantation/adverse effects , Retrospective Studies , Transplant Recipients , Prospective Studies , Colombia , Immunosuppressive Agents/adverse effects , Enzyme Inhibitors , Graft Rejection/epidemiology
18.
J. Health Biol. Sci. (Online) ; 12(1): 1-9, jan.-dez. 2024. tab
Article in Portuguese | LILACS | ID: biblio-1554635

ABSTRACT

Objetivo: analisar o perfil de micro-organismos presentes e resistência destes aos antimicrobianos em uroculturas de pacientes transplantados renais no período de 2021-2022. Métodos: trata-se de um estudo transversal com análise quantitativa dos dados de uroculturas positivas de pacientes transplantados renais, acompanhados no Hospital Geral de Fortaleza entre janeiro de 2021 a dezembro de 2022. Foi empregado um instrumento de pesquisa elaborado, contendo variáveis classificatórias, e os dados foram obtidos por meio de registros das uroculturas existentes no sistema de prontuário eletrônico utilizado pelo hospital. Resultados: das 534 uroculturas solicitadas, 36,7% apresentaram resultado positivo, sendo 60,4% de mulheres com idades entre 20 e 59 anos. A maioria dos casos foram desenvolvidos por pacientes que receberam acompanhamento ambulatorial (56,2%). Os micro-organismos isolados foram, predominantemente, enterobactérias (81,34%), com prevalência de E.coli (69,30%). Os perfis de sensibilidade antimicrobiana variaram, com a resistência da E.coli a antibióticos como ampicilina, ácido nalidíxico, norfloxacino e ciprofloxacino. Conclusões: essas descobertas fornecem informações importantes sobre métodos clínicos específicos, métodos preventivos e melhorias na qualidade de vida dos transplantados renais.


Objective: to analyze the profile of microorganisms present and their resistance to antimicrobials in urocultures of renal transplant patients in 2021-2022. Methods: it is a cross-sectional study with quantitative data analysis from positive urocultures of renal transplant patients accompanied at the General Hospital of Fortaleza between January 2021 and December 2022. An elaborate research instrument containing classification variables was employed, and the data were obtained through records of the urocultures existing in the electronic checkbook system used by the hospital. Results: of the 534 urocultures requested, 36.7% showed a positive result, of which 60.4% were women aged between 20 and 59. Most cases were developed by patients who received outpatient follow-up (56.2%). The isolated microorganisms were predominantly enterobacteria (81.34%), with the prevalence of E.coli (69.30%). Antimicrobial sensitivity profiles varied, with E.coli resistance to antibiotics such as ampicillin, nalidixic acid, norfloxacin, and ciprofloxacin. Conclusion: these findings provide important information about specific clinical methods, preventive methods, and improvements in the quality of life of renal transplant patients.


Subject(s)
Humans , Male , Female , Microbiota , Transplant Recipients , Anti-Infective Agents , Patients , Kidney
19.
Int J Dermatol ; 63(5): 560-564, 2024 May.
Article in English | MEDLINE | ID: mdl-38263692

ABSTRACT

Cutaneous squamous cell carcinoma (cSCC) is the most common skin malignancy in kidney transplant recipients (KTRs) as a result of immunosuppression. A worldwide increase in kidney transplantation justifies the determination of prognostic biomarkers by collecting detailed patient data on metastasis development. This study aims to characterize the clinical, epidemiological, and histopathological profiles of KTRs who developed metastasis of cSCC. We conducted a retrospective single-center study on 18 KTRs and 21 immunocompetent patients (ICs) with metastatic cSCC, using data from 2004 to 2021. ICs were older (median age 70.5 years) than KTRs (median age: 59.5 years). Both groups were predominantly male with Fitzpatrick skin phototype I/II. The primary tumor appeared around 83.5 months post-transplant, usually in sun-exposed areas (61.1%), though some non-exposed areas in ICs (23.8%) contradicted literature findings. KTRs took longer to develop metastasis (median: 11.0 months) compared to ICs (median: 5.5 months). The mean size of the primary tumor was smaller in KTRs (2.50 cm2) compared to ICs (4.55 cm2). The main lymph node chain affected by metastasis was parotid lymph nodes in KTRs (27.8%) and cervical/axillar lymph nodes in ICs (both 19.0%). Both groups exhibited similar primary tumor grades and metastasis evolution, but KTRs had a higher prevalence of lymphovascular invasion. Metastasis of cSCC was more common in males with low skin phototype, in KTRs, particularly on the head and neck. The study suggests a possible link between lymphovascular invasion and metastasis development in KTRs.


Subject(s)
Carcinoma, Squamous Cell , Kidney Transplantation , Lymphatic Metastasis , Skin Neoplasms , Humans , Skin Neoplasms/pathology , Skin Neoplasms/epidemiology , Kidney Transplantation/adverse effects , Male , Middle Aged , Female , Retrospective Studies , Aged , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/secondary , Transplant Recipients/statistics & numerical data , Adult , Immunocompetence , Tumor Burden , Lymph Nodes/pathology , Immunocompromised Host , Sunlight/adverse effects
20.
Transplantation ; 108(4): 963-969, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-37953468

ABSTRACT

BACKGROUND: Omicron variant has been associated with milder cases of COVID-19 among kidney transplant recipients. However, little is known about postacute sequelae, referred to as Long COVID. METHODS: Prospective, single-center cohort study investigating prevalence and risk factors for Long COVID among kidney transplant recipients during the omicron predominance in Brazil. The analysis included adult patients with confirmed SARS-CoV-2 infection between January 5, 2022, and July 18, 2022, were alive, had a functioning kidney transplant 3 mo after symptom onset, and answered a telephonic survey about physical complains of Long COVID. RESULTS: From the 1529 eligible, 602 (39%) patients responded the survey. Sixteen percent reported a previous SARS-CoV-2 infection, and 85% had been fully vaccinated. The prevalence of Long COVID was 52%, with the most common complaints being weakness (46%), myalgia (41%), dizziness (33%), and headache (31%). Among employed patients, 94% were able to resume their normal work activities. In multivariable analysis, female gender (hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.51-3.02; P < 0.0001), previous SARS-CoV-2 infection (HR, 3.55; 95% CI, 1.91-6.60; P < 0.0001), fatigue (HR, 2.32; 95% CI, 1.18-4.55; P = 0.014), myalgia (HR, 1.48; 95% CI, 1.03-2.15; P = 0.036) during the acute phase, and hospitalization because of COVID-19 (HR, 1.71; 95% CI, 1.06-2.76; P = 0.028) were independently associated with Long COVID. CONCLUSIONS: In the "omicron era," Long COVID among kidney transplant recipients exhibited milder characteristics and had a less significant impact on their ability to resume normal life activities. The risk factors for persistent symptoms were similar to those observed in the general population except for the vaccination status, underscoring the importance of closer monitoring in special subgroups.


Subject(s)
COVID-19 , Kidney Transplantation , Adult , Humans , Female , Post-Acute COVID-19 Syndrome , COVID-19/epidemiology , Cohort Studies , Kidney Transplantation/adverse effects , Myalgia , Prospective Studies , SARS-CoV-2 , Transplant Recipients
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