ABSTRACT
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.
Subject(s)
Chagas Cardiomyopathy , Chagas Disease , Heart Transplantation , Organ Transplantation , Humans , Prospective Studies , Tissue and Organ Procurement , Trypanosoma cruziABSTRACT
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.
Subject(s)
Antifungal Agents/therapeutic use , Graft Rejection/therapy , Immunosuppressive Agents/therapeutic use , Kidney Transplantation/adverse effects , Lung Diseases, Fungal/diagnosis , Paracoccidioides/pathogenicity , Paracoccidioidomycosis/diagnosis , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antifungal Agents/administration & dosage , Bronchoalveolar Lavage , Bronchoalveolar Lavage Fluid/microbiology , Bronchoscopy , Female , Graft Rejection/immunology , Humans , Imipenem/administration & dosage , Imipenem/therapeutic use , Immunity, Humoral , Immunosuppression Therapy/methods , Immunosuppressive Agents/administration & dosage , Itraconazole/administration & dosage , Kidney Failure, Chronic/surgery , Latin America , Lung Diseases, Fungal/complications , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology , Methylprednisolone/administration & dosage , Methylprednisolone/therapeutic use , Middle Aged , Paracoccidioides/isolation & purification , Paracoccidioidomycosis/complications , Paracoccidioidomycosis/drug therapy , Paracoccidioidomycosis/microbiology , Plasmapheresis , Respiration, Artificial , Tomography, X-Ray Computed , Vancomycin/administration & dosage , Vancomycin/therapeutic useABSTRACT
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.
