RESUMEN
Immune-mediated renal diseases are a diverse group of disorders caused by antibody, complement, or cell-mediated autosensitization. Although these diseases predispose to infection on their own, a growing array of traditional and newer, more targeted immunosuppressant medications are used to treat these diseases. By understanding their mechanisms of action and the infections associated with suppression of each arm of the immune system, nephrologists can better anticipate these risks and effectively prevent and recognize opportunistic infections. Focusing specifically on nonkidney transplant recipients, this review discusses the infections that can be associated with each of the commonly used immunosuppressants by nephrologists and suggest interventions to prevent infectious complications in patients with immune-mediated renal disease.
RESUMEN
Solid organ transplant recipients require ongoing immunosuppression to prevent acute rejection, which puts them at risk of opportunistic infections. Viral infections are particularly challenging to prevent and treat as many establish latency and thus cannot be eliminated, whereas targets for small molecule antiviral medications are limited. Resistance to antivirals and unacceptable toxicity also complicate treatment. Virus-specific T cell therapies aim to restore host-specific immunity to opportunistic viruses that is lacking due to ongoing immunosuppressive therapy. This minireview will provide a state-of-the-art update of the current virus-specific T cell pipeline and translational research that is likely to lead to further treatment options for viral infections in solid organ transplant recipients.
Asunto(s)
Trasplante de Órganos , Linfocitos T , Receptores de Trasplantes , Virosis , Humanos , Trasplante de Órganos/efectos adversos , Virosis/inmunología , Virosis/etiología , Virosis/terapia , Linfocitos T/inmunología , Rechazo de Injerto/prevención & control , Rechazo de Injerto/etiología , Rechazo de Injerto/inmunologíaRESUMEN
Cell cytotoxicity neutralization assay (CCNA) is considered to be a gold standard to diagnose Clostridioides difficile infections. We performed CCNA on 77 consecutive admission screening rectal swabs from asymptomatic toxigenic C. difficile carriers. Thirty-nine percent of specimens from asymptomatic carriers were positive. Thus, CCNA specificity may be lower than previously thought.
RESUMEN
OBJECTIVES: Differentiating cellulitis from pseudocellulitis is challenging, and misdiagnosis leads to unnecessary antimicrobial use and increased healthcare expenditure. Clinical diagnosis remains the criterion standard and may involve expert consultation. Our objective was to evaluate the usefulness of a handheld infrared thermometer to improve diagnostic certainty in cases of suspected cellulitis. METHODS: We conducted a cross-sectional study from August 2018 to January 2020 at a tertiary-care hospital in Montreal, Canada. We enrolled adult patients with suspected limb cellulitis. Using the infrared thermometer, we compared the average temperature of the affected area with that of the contralateral limb, and we used Youden's method to determine the optimal temperature difference which best differentiated cellulitis from pseudocellulitis as determined by an independent and blinded infectious diseases specialist. We used bootstrapping to estimate 95% confidence intervals for the sensitivity, specificity, and area under the receiver operating curve. RESULTS: Of 65 patients screened for enrolment, 52 patients were recruited (median age: 64 years, IQR 52-76); 39 of these were diagnosed with cellulitis and 13 were not. The mean temperature difference between affected and unaffected limbs was 2.6°C (95%CI 2.1-3.1°C) for patients with cellulitis and 0.4°C (95%CI -1.2°C to 2.1°C) for patients without (p < 0.001). An average temperature difference between limbs of 0.8°C or more was 95% sensitive (95%CI 74-100%) and 69% specific (95%CI 44-95%) for the diagnosis of cellulitis (c-statistic 0.82). CONCLUSIONS: In this proof-of-concept single-centre study, a handheld infrared thermometer was a useful aid to differentiate cellulitis from pseudocellulitis.
Asunto(s)
Celulitis (Flemón) , Termómetros , Anciano , Antibacterianos/uso terapéutico , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/tratamiento farmacológico , Estudios Transversales , Humanos , Persona de Mediana EdadAsunto(s)
Anemia/terapia , Incompatibilidad de Grupos Sanguíneos/orina , Transfusión de Eritrocitos/efectos adversos , Reacción a la Transfusión/orina , Dolor Abdominal/etiología , Adulto , Anemia/diagnóstico , Incompatibilidad de Grupos Sanguíneos/complicaciones , Incompatibilidad de Grupos Sanguíneos/diagnóstico , Bradicardia/etiología , Servicio de Urgencia en Hospital , Fatiga/etiología , Femenino , Fluidoterapia , Cefalea/etiología , Humanos , Hipertensión/etiología , Hierro/uso terapéutico , Náusea/etiología , Readmisión del Paciente , Reacción a la Transfusión/complicaciones , Reacción a la Transfusión/diagnóstico , Reacción a la Transfusión/terapia , Vitamina B 12/uso terapéutico , Deficiencia de Vitamina B 12/diagnóstico , Deficiencia de Vitamina B 12/terapia , Complejo Vitamínico B/uso terapéuticoRESUMEN
BACKGROUND: Acute invasive fungal infections of the head and neck secondary to tyrosine kinase inhibitors are rare and potentially life-threatening events. CASE PRESENTATION: We report a case of mucormycosis of the thyroid gland in a patient known for chronic lymphocytic leukemia receiving ibrutinib who presented with a rapidly growing thyroid nodule and dysphonia. An acute invasive fungal infection was identified on a core needle biopsy; mucormycosis was confirmed on culture. The patient was successfully treated with surgical debridement and long-term antifungal therapy. CONCLUSION: Patients on ibrutinib may be at risk of acute invasive fungal infections of the head and neck.
Asunto(s)
Agammaglobulinemia Tirosina Quinasa/antagonistas & inhibidores , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Mucormicosis/etiología , Pirazoles/efectos adversos , Pirimidinas/efectos adversos , Nódulo Tiroideo/etiología , Adenina/análogos & derivados , Anciano , Cunninghamella/aislamiento & purificación , Humanos , Huésped Inmunocomprometido , Leucemia Linfocítica Crónica de Células B/complicaciones , Masculino , Piperidinas , Pirazoles/uso terapéutico , Pirimidinas/uso terapéutico , Nódulo Tiroideo/microbiología , Nódulo Tiroideo/patologíaRESUMEN
PURPOSE OF REVIEW: Traveller's diarrhea, though not life-threatening. is often a vexing problem, which impacts overall function of the traveller while on holiday. Increasing data is available regarding molecular diagnostic techniques, which may help obtain an early etiologic diagnosis. Use of antibiotics for traveller's diarrhea is controversial in this era of multidrug resistance and microbiome disruption. RECENT FINDINGS: Travel to the tropics promotes gut colonization with drug-resistant bacteria and this risk increases after treatment with antibiotics, leading to potential ecological impacts in the country of residence. SUMMARY: Traveller's diarrhea is common and can impact a traveller's itinerary leading to significant inconvenience, and occasional longer term sequelae. Though bacterial causes predominate, recommended treatment is conservative in mild-to-moderate cases. Molecular techniques for early diagnosis of traveller's diarrhea may help with appropriate management. Treatment with antibiotics is sometimes required but is associated with gut colonization by multidrug-resistant bacteria.