Molecular detection and identification of spotted fever group rickettsiae in ticks collected from horses in Cuba.

Spotted fever group (SFG) rickettsiae are obligatory intracellular bacteria that cause disease in humans and other animals. Ixodid ticks are the principal vectors of SFG rickettsiae. The present study aimed to determine the prevalence and species identity of SFG rickettsiae in ticks and horses from urban and rural areas of western Cuba using PCR assays. Tick samples, collected from 79 horses, consisted of 14 Amblyomma mixtum adults, 111 Dermacentor nitens adults and 19 pools of D. nitens nymphs (2-5 individuals/pool). The PCR results revealed the presence of Rickettsia spp. in 64% of the A. mixtum adults, 16% of the D. nitens adults, and 11% of the pooled samples of D. nitens nymphs. In contrast, Rickettsia spp. was not detected in any of the 200 horse blood samples included in this study. DNA sequence data of the rickettsial 17 kDa antigen gene showed that Rickettsia amblyommatis was present in A. mixtum; and Rickettsia felis in D. nitens. This is the first report of R. felis in D. nitens in Cuba. The present study extends our knowledge of the potential vector spectrum and distribution of SFG rickettsiae pathogens in western Cuba.

High frequency of gram-negative bacilli harboring blaKPC-2 in the different stages of wastewater treatment plant: A successful mechanism of resistance to carbapenems outside the hospital settings.

Wastewater treatment plants (WWTPs) are considered to be a reservoir and a source of bacterial resistance. Worryingly, the presence of carbapenem-resistant Gram-negative bacilli (CRGNB) in WWTPs has recently been reported, but there are still many research gaps regarding its emergence and impact. The distribution of CRGNB in the different stages of a WWTP in Colombia and the relationship between the physicochemical factors involved with their presence are described in this paper. Additionally, given the impact on public health, the CRGNB detected were compared with isolates previously found in hospital patients. Residual water samples were taken from five different stages of a WWTP between January and July 2017. A total of 390 GNB were isolated, and a significant frequency of CRGNB harboring blaKPC-2 (38.2%, n = 149/390) was detected, of which 57% were Enterobacteriaceae, 41.6% Aeromonadaceae, and 1.3% Pseudomonadaceae. The Enterobacteriaceae were more frequent in the raw effluent compared to the Aeromonadaceae, which in turn were more prevalent in the recycled activated sludge and final effluent. Environmental variables such as pH, oxygen, chemical oxygen demand, and temperature were significantly correlated with the quantification of carbapenem-resistant Enterobacteriaceae (CRE) at specific points in the WWTP. Interestingly, isolated K. pneumoniae harboring blaKPC-2 from the WWTPs were diverse and did not relate genetically to the hospital strains with which they were compared. In conclusion, these results confirm the worrying scenario of the dissemination and persistence of emerging contaminants such as CRGNB harboring blaKPC-2, and reinforce the need to establish strategies aimed at containing this problem using multifocal interventions.

High clonal diversity of multidrug-resistant and extended spectrum beta-lactamase-producing Escherichia coli in a wastewater treatment plant.

Increasing beta-lactam resistance has led to the exploration of different places, such as wastewater treatment plants (WWTPs) which have been considered to be reservoirs and sources of bacterial resistance. This work aims to determine the presence of beta-lactamase-producing-Enterobacteriaceae in different points of a WWTP in Colombia. Six samplings were carried out in 2017 in the raw influent, aeration tanks, recycled sludge and final effluent of a WWTP. The beta-lactamase-producing-Enterobacteriaceae were detected and identified using phenotypic and molecular methods. Of the 353 isolates included, 28.3% corresponded to enterobacteria. The most frequent microorganisms were Escherichia coli (83%), Citrobacter freundii (11%) and Enterobacter cloacae complex (4%). The 97% of enterobacteriaceae had at least one beta-lactamase, and the most prevalent were the blaTEM (43.8%) and blaCTX-M-1group (35.8%) which were detected specially in recycled sludge and final effluent sample points. High percentage of multidrug resistance (to beta-lactams and non-beta-lactam antibiotics) was detected in E. coli (63.2%). Additionally, the typing by PFGE and MLST showed high genotypic diversity and the presence of the successful ST131 clone, globally spread. This work highlights the strong role of E. coli as a vector for the dissemination of resistance and the beta-lactamases in aquatic environments.

Polyparasitism and zoonotic parasites in dogs from a rural area of the Argentine Chaco.

Dogs play an important role as reservoirs and hosts of multiple pathogens shared with humans and wildlife, which contribute significantly to the global burden of disease. Here, we assessed the occurrence of a broad range of zoonotic and non-zoonotic parasites in dogs from a rural area in the humid Chaco; determined the occurrence of polyparasitism; and explored its association with selected risk factors. In total, 212 dogs were examined serologically to determine Trypanosoma cruzi infection and 152 of them also were examined for Ehrlichia canis, Borrelia bugderfori, Anaplasma phagocitophylum, Dirofilaria immitis and Toxoplasma gondii. Fecal samples from 85 dogs were examined for intestinal parasites. Seventeen parasite species were seen, 77% of which are zoonotic. The most prevalent parasites were Ancylostoma caninum (68.2%), T. gondii (55.3%, first report for dogs in Argentina), Giardia sp. (25.9%), Cryptosporidium sp. (20.0%), T. cruzi (16.5%), trematodes (15.3%) and Toxocara canis (14.1%). Polyparasitism was found in 96% of the dogs, with up to six parasite species in a single dog, and was significantly associated with age of dog but not with host body condition or sex. The most frequent pair of parasites found together were T. gondii-A. caninum (46%), A. caninum-T. cruzi (34%) and T. gondii-T. cruzi (27%). The prevalence of anemia and leukocytosis was significantly higher in dogs showing the worst body condition. Our findings likely reflect structural poverty, poor sanitation and lack of a safe water supply. Importantly, many of the prevalent parasites seen are threats to human health. 243 words.

Antifungal activity of tyrosol and farnesol used in combination against Candida species in the planktonic state or forming biofilms.

AIM: This study examined the antifungal activity of the combination of tyrosol and farnesol against Candida albicans and Candida glabrata in the planktonic state or forming biofilms. METHODS AND RESULTS: The effect of drug association against Candida planktonic cells was assessed by the fractional inhibitory concentration index. Mono- and dual-species biofilms were developed during 24 h and then treated with the compounds for 3 days, with two daily treatments of 1 min each. After, the total biomass, metabolic activity and the number of cultivable cells were quantified. Planktonic cells of the two species showed a similar susceptibility to the drug combination, however, a synergistic effect was only verified for C. glabrata. Regarding biofilm susceptibility, significant reductions in C. glabrata biomass, metabolism of C. albicans and mixed biofilms, and cultivable cells of single biofilms were verified for the drug combination, indicating an additive effect. For all other experiments, the effects were classified as indifferent. CONCLUSION: The combined use of tyrosol and farnesol was advantageous for some of the analysed parameters against Candida species. SIGNIFICANCE AND IMPACT OF THE STUDY: These findings may contribute to the development of oral care products containing tyrosol and farnesol to combat oral infections caused by Candida species.

Differential effects of the combination of tyrosol with chlorhexidine gluconate on oral biofilms.

OBJECTIVE: This study assessed the effect of tyrosol and chlorhexidine gluconate in combination against Candida albicans, Candida glabrata, and Streptococcus mutans in the planktonic state or forming biofilms in vitro. MATERIALS AND METHODS: Checkerboard assays were performed for determination of minimum inhibitory concentration. Biofilms were cultivated during 24 h on specimens of acrylic resin and hydroxyapatite and treated with the drugs alone or in combination twice a day for 1 min, during 3 days. The antibiofilm effect was determined by quantification of the metabolic activity and cultivable cells. The drug combination was also applied on C. albicans to investigate its action on the number of hyphae. Data were statistically examined by two-way ANOVA and Holm-Sidak test (P < 0.05). RESULTS: The effect of drug combination on planktonic cells was classified as antagonistic for C. albicans and indifferent for the other strains. Also, the drugs were ineffective against the tested biofilms. However, the drug combination showed a synergistic effect in reducing the number of hyphae by C. albicans. CONCLUSION: The combination of tyrosol with chlorhexidine gluconate was only effective in reducing the number of hyphae by C. albicans, a relevant virulence factor of this species.

Serious fungal infections in Ecuador.

There is a dearth of data from Ecuador on the burden of life-threatening fungal disease entities; therefore, we estimated the burden of serious fungal infections in Ecuador based on the populations at risk and available epidemiological databases and publications. A full literature search was done to identify all epidemiology papers reporting fungal infection rates. WHO, ONU-AIDS, Index Mundi, Global Asthma Report, Globocan, and national data [Instituto Nacional de Estadística y Censos (INEC), Ministerio de Salud Pública (MSP), Sociedad de Lucha Contra el Cáncer (SOLCA), Instituto Nacional de Donación y Trasplante de Órganos, Tejidos y Células (INDOT)] were reviewed. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology by LIFE. Ecuador has a variety of climates from the cold of the Andes through temperate to humid hot weather at the coast and in the Amazon basin. Ecuador has a population of 15,223,680 people and an average life expectancy of 76 years. The median estimate of the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) population at risk for fungal disease (<200 CD4 cell counts) is ∼10,000, with a rate of 11.1% (1100) of histoplasma, 7% (700) of cryptococcal meningitis, and 11% (1070) of Pneumocystis pneumonia. The burden of candidemia is 1037. Recurrent Candida vaginitis (≥4 episodes per year) affects 307,593 women aged 15-50 years. Chronic pulmonary aspergillosis probably affects ∼476 patients following tuberculosis (TB). Invasive aspergillosis is estimated to affect 748 patients (∼5.5/100,000). In addition, allergic bronchopulmonary aspergillosis (ABPA) in asthma and severe asthma with fungal sensitization (SAFS) were estimated to affect 26,642 and 45,013 people, respectively. Our estimates indicate that 433,856 (3%) of the population in Ecuador is affected by serious fungal infection.

Saberes locales campesinos sobre el alimento: aportes a la soberanía y la salud mental comunitaria / Local peasant knowledge about food: contributions to sovereignty and collective mental health

Introducción: Los trabajos sobre violencia política, salud mental y vida cotidiana realizados en alianza entre la academia y una organización campesina en Antioquia, han llevado a posicionar la soberanía alimentaria como un asunto central en procesos de recuperación y reparación colectiva, en un contexto donde se amalgama el sufrimiento, la precarización del modo de vida campesino y la deuda histórica de una reforma agraria inacabada Objetivo: Explorar los procesos salutogénicos que emergen de las acciones reflexivas emprendidas por un grupo de mujeres campesinas a partir de su participación en una experiencia de Investigación Acción Participativa (IAP) y sus aportes a la soberanía alimentaria local. Metodología: Estudio cualitativo que recoge elementos de la IAP, desarrollado en Argelia, Oriente antioqueño, a través de entrevistas semiestructuradas, grupos focales, observación participante y ejercicios de cartografía social, además de acciones de incidencia local Resultados: Se describen los productos derivados del proceso de investigar-actuar-participar tales como la consolidación de un equipo local de investigación y tres acciones de incidencia en la vida local: inventario de semillas nativas y criollas, vivero comunitario, feria campesina y festival gastronómico. Conclusiones: 1) El alimento adquiere una connotación política y trasciende lo nutricional funcional. 2) Los saberes locales de subsistencia/resistencia generan soberanía 3) Las redes sociales sobre las que se soportan los saberes, y los saberes mismos, son recursos sociales de salud. 4) Es necesario problematizar las medidas técnicas convencionales en el campo de la salud mental y ubicar su campo de acción en el terreno de las relaciones microsociales.

Introduction: TApproaches on political violence, mental health and daily life conducted in partnership between the academy and a peasant organization in Antioquia, have positioned food sovereignty as a central issue in processes of repair and collective recovery. In a context where suffering, precariousness of the peasant mode of life and historical debts caused by an unfinished land administration reform, remain being key elements of the conflict. Objectives: To explore salutogenic processes that emerge from the reflections made by a group of rural women, based on their active participation in a research experience and their contributions to local food sovereignty. Methodology: Qualitative study which includes elements of the IAP, developed in Algeria, eastern Antioquia, through semi-structured interviews, focus groups, participant observation and social mapping exercises. Besides, local advocacy actions were assessed. Results: Inventory of native and creole seeds, community garden center, country fair and food festival are described as resulting products from the process of research-actionparticipation where the consolidation of a local research team and actions of incidence in rural life are exposed. Conclusions: 1) Food acquires a political connotation and transcends functional nutrition. 2) Local knowledge of subsistence or resistance generates sovereignty 3) Social networks on which knowledge is supported, and knowledge itself, are social health resources. 4) It is necessary to problematize the conventional technical measures in the field of mental health and to determine its scope in the field of micro-social relationships.

Activity of tyrosol against single and mixed-species oral biofilms.

AIM: This study aimed to evaluate the effect of tyrosol on the formation of single and mixed biofilms of Candida albicans ATCC 10231, Candida glabrata ATCC 90030 and Streptococcus mutans ATCC 25175 formed on acrylic resin (AR) and hydroxyapatite (HA) surfaces. METHODS AND RESULTS: Single and mixed biofilms were formed on AR and HA in the presence of tyrosol at 50, 100 and 200 mmol l(-1), during 48 h. Next, antimicrobial activity was assessed through metabolic activity (XTT reduction assay) and the number of colony-forming units (CFUs). Scanning electron microscopy observations were performed in order to analyse biofilm structure. Tyrosol, mainly at 200 mmol l(-1), significantly decreased the metabolic activity and number of CFUs for all single and mixed-species biofilms formed on both surfaces. SEM images suggested cell damage caused by tyrosol. CONCLUSION: Tyrosol showed inhibitory effects against biofilms formed by important oral pathogens. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study showing the antibiofilm effect of tyrosol on Candida species and Strep. mutans in single and mixed cultures. These results may be useful in the development of topical therapies focused on preventing biofilm-associated oral diseases, such as denture stomatitis and dental caries.

[Intrarenal smooth muscle: histology of a complex urodymamic machine]. / Músculo liso intrarrenal: histología de una compleja máquina urodinámica.

OBJECTIVE: To know better the microscopic arrangement of the bundles of smooth muscle in the human renal parenchyma, their distribution and anatomical relationships, trying to make a reconstruction of this muscular system. METHODS: Five adult human kidneys and one fetal kidney were processed "in toto" with cross sections every 300µm. In the histological sections we identify the smooth muscle fibers trying to determine its insertion, course and anatomical relationship with other structures of the kidney tissue. RESULTS: There are bundles of smooth muscle fibers of variable thickness parallel to the edges of the medullary pyramids, bundles that surrounding the medulla in a spiral course, and bundles that accompany arcuate vessels, the latter being the most abundant and easy to identify. These groups of muscle fibers do not have a precise or constant insertion site, their periodicity is not homogeneous and they are not a direct extension of the muscle of the renal pelvis, although some bundles are in contact with it. There are also unusual and inconstant small muscle fibers no associated to vessels in the interstitium of the cortex and, exceptionally, in the medulla. CONCLUSION: There is a complex microscopic system of smooth muscle fibers that partially surround the renal medulla and are related to renal pelvic muscles without a direct continuity with them. Although this small muscular system is under-recognized, could be very important in urodynamics.

[Detection of renin in chromophobe renal cell carcinomas]. / Detección de renina en carcinomas cromófobos de células renales.

AIM: To evaluate frequency of renin detection in chromophobe renal cell carcinoma, and if this expression was associated to systemic high blood pressure. MATERIAL AND METHODS: A descriptive retrospective study. All the cases with confirmed diagnosis of chromophobe carcinoma and resected between 1990 and 2004 were included in our study: 31 cases from 31 patients. Immunohistochemistry was carried out on sections from the paraffin-embedded tissue using a monoclonal antiserum. Patient blood pressure before and after neoplasm resection was registered from clinical histories. We compared frequencies of hypertension in cases with and without expression of renin (Fisher's text or chi(2) as appropriate) and evolution of HTA after tumour resection. RESULTS: We found that 10 of 31 tumors (32.3%) contained immunoreactivity for renin; this staining was diffuse in 6 cases and focal in the other 4. Systemic hypertension was detected in 6 of 10 (60.0%) patients with renin expression and in 6 of 21 (28.6%) patients without renin immunolabeling (p=0.13). After tumor resection none patient with renin expression and high blood pressure showed remission of the hypertension. CONCLUSION: Renin is frequently expressed in chromophobe renal cell carcinoma, but this renin appears clinically inactive. More studies will be necessary to know implications of this feature on clinical presentation, diagnosis or pathogenesis.

C4D immunostaining in surveillance endomyocardial biopsies from well-functioning heart allografts.

OBJECTIVE: The meaning of biopsy C4d detection in heart allografts without dysfunction or morphologic changes suggesting antibody-mediated rejection (AMR) is not clear. The aim of this study was to search for an association between C4d detection in allograft biopsies of well-functioning hearts without changes suggestive of AMR, and clinical outcomes. METHODS: Endomyocardial protocol biopsies from 44 heart transplant patients with well-functioning grafts and without changes suggesting AMR were performed at 1 month and 1 year after transplantation and analyze the presence of C4d deposition using immunohistochemistry. Two-year follow-up was based on clinical parameters and echocardiographic information. Heart graft function was categorized as good vs. poor. The presence of C4d, using diverse schemes to graduate the extension of the deposition, was correlated with clinical graft outcomes. RESULTS: C4d deposition was observed in the capillary walls of 33 biopsies (37.5%; n = 25 patients; 56.8%). No biopsy had diffuse (>50%) immunostaining. Six patients presented with multifocal capillary C4d immunostaining in at least 1 biopsy. Capillary positivity for C4d (if focal or multifocal) showed no statistical association with cellular rejection or graft function. Perimyocytic C4d detection was neither associated with rejection nor graft outcome. CONCLUSION: Our work failed to demonstrate an association between C4d detection in protocol biopsies of heart grafts and clinical outcomes. The clinical utility of C4d staining in solid organ transplantation may vary by organ. Our results suggest that C4d did not have clinical utility in surveillance biopsies of well-functioning heart grafts without morphological changes suggesting AMR.

Gastrectomía en manga laparoscópica para el tratamiento de la obesidad mórbida / Laparoscopic sleeve gastrectomy for the treatment of morbid obesity

La obesidad es el resultado de un desbalance entre la ingesta calórica y el gasto energético. La obesidad mórbida incluye pacientes con índice de masa corporal mayor a 35 con co-morbilidades asociadas o con índices mayores de 40 sin co-morbilidades. Estos pacientes no logran pérdidas del exceso de peso sostenido cuando lo intentan a través de tratamiento médico, por ello el tratamiento quirúrgico es la única opción que permite la pérdida de peso efectiva a largo plazo. La gastrectomía en manga permite resecar la porción donde predomina la producción de grelina: hormona orexígena involucrada en la regulación del apetito, proporcionando un efecto adicional al restrictivo derivado de la disminución del volumen gástrico. Se incluyeron 11 pacientes en el trabajo 36 por ciento hombres y 64 por ciento mujeres. El IMC promedio fue de 42 kg/m2, las morbilidades la padecían el 54 por ciento de los pacientes y las más frecuentes fueron dislipidemia e hipertensión, tiempo operatorio promedio fue de 90 min, hubo una sola complicación mayor que ameritó conversión y la evolución posoperatoria fue estupenda con pérdidas del exceso de peso de 66 por ciento y disminución del IMC de 25 por ciento en promedio a los seis meses, con mejoría del 100 por ciento de las morbilidades. La gastrectomía en manga es un procedimiento efectivo, sencillo, reproducible, con escasa morbilidad que mantiene la fisiología del vaciamiento gástrico con la adición de la influencia hormonal a través de la disminución de la producción de grelina y otros mecanismos hormonales que participan en la regulación del apetito y la saciedad.

The obesity is the result of a trouble between the caloric ingestion and the energetic expense. The morbid obesity includes patients with index of corporal bigger mass than 35 with associate co-morbidities or with major indexes of 40 without co-morbidities. These patients do not achieve losses of the supported overweight when they try it across medical treatment, for it the surgical treatment is the unique option that allows the effective long-term loss of weight. The gastrectomía in sleeve allows to resect the portion where it predominates over the production of ghrelina: orexígen hormone involved in the regulation of the appetite, providing an additional effect to the restrictive derivative of the decrease of the gastric volume. 11 patients included in the clinical trial 36 percent men and 64 percent women. The average IMC was of 42 kg/m2, the morbidities were suffering 54 percent of the patients and the most frequent were dislipidemia and hypertension, operative average time was 90 minutes, there was an alone major complication that deserved conversion and the evolution post operative was marvellous with losses of the overweight of 66 percent and decrease of the IMC of 25 percent in average to six months, with improvement of 100 percent of the morbidities. The gastrectomía in sleeve is an effective, simple, reproducible procedure, with scanty morbidity that supports the physiology of the gastric voidance with the addition of the hormonal influence across the decrease of the production of grelina and other hormonal mechanisms that take part in the regulation of the appetite and the satiety.

[Expression of nephrin, podocin and a-actinine-4 in renal tissue of patients with proteinuria]. / Expresión de nefrina, podocina y alpha-actinina-4 en tejido renal de pacientes con proteinuria.

INTRODUCTION: Slit diaphragm and/or podocyte's cytoskeleton alterations are related to proteinuria and nephrotic syndrome. In our population, focal and segmental glomerulosclerosis causing nephrotic syndrome is the more frequent biopsy demonstrated glomerulopathy. Our aim was search for alterations in some slit diaphragm-associated proteins in patients with nephrotic range proteinuria. METHODS: Renal tissue from 40 patients with nephrotic range proteinuria, 10 patients with non-nephrotic proteinuria, 3 with isolated hematuria, and 10 samples of normal renal tissue (deceased donors) were studied, by indirect immunofluorescence, for expression of nephrin, podocin, and alpha-actinin-4. RESULTS: Expression of these proteins was lineal, homogeneous, in the glomerular capillary walls in normal renal tissue and in patients with isolated hematuria. In nephrotic proteinuria this normal appearance was altered and immunostaining showed a fine granular appearance. In 18 cases (45%) of patients with nephrotic proteinuria and 3 cases (30%) of patients with non-nephrotic proteinuria there was loss of at least one of these proteins (p = 0.49). These alterations were found in the diverse glomerulopathies more frequently causing nephrotic syndrome. CONCLUSIONS: In nephrotic range proteinuria redistribution or loss of expression of slit diaphragm-associated proteins is very frequent. In many of our cases this fact could be more a consequence than a cause of proteinuria. These alterations can be also evidenced in patients with non-nephrotic proteinuria.

[Ureterostomy cytomegalovirus infection presenting as stoma ulceration in a kidney allograft receptor: a case report]. / Ureteritis por citomegalovirus en receptor de trasplante renal. Informe de un caso con presentación inusual.

Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients, but urinary tract involvement has been rare. Only a few cases of symptomatic ureteritis have been reported in renal transplant recipients. In previous reports the presentation of CMV ureteritis is obstructive nephropathy, often in the absence of systemic illness, or rarely it may also mimic allograft rejection with minimal obstructive symptoms. We describe an additional case of CMV ureteritis in a patient with cutaneous ureterostomy. The unusual clinical presentation with urinary infection symptoms and ureterostomy stoma ulceration constitute a very particular presentation. The increasing report cases with CMV ureteritis suggest an increase of this post-transplant complication.

Histologic assessment of donor kidneys and graft outcome: multivariate analyses.

UNLABELLED: We performed a multivariate analysis to evaluate the importance of histologic parameters in donor kidney biopsies as predictors of graft outcome. METHODS: Wedge protocol biopsies from a single center were analyzed for glomerulosclerosis (GS), interstitial fibrosis (IF), tubular atrophy (TA), arteriosclerosis (AS), and arteriolar hyalinosis (AH). Alterations were quantified as percentage (GS, IF) or semiquantified according to Banff criteria (IF, TA, AS, AH). We calculated creatinine clearance (CrCl) at 1, 2, and 3 years posttransplant. Donor data included age, gender, and type: non-heart-beating donor or brain dead donors. Recipient data included age, gender, cold ischemia time, number of HLA mismatches, peak level of the panel reactive antibody (PRA), number of acute rejection episodes (ARE), and presence or absence of cytomegalovirus (CMV) disease. Univariate and multivariate analyses were performed. Follow-up range was 1 to 4.2 years. RESULTS: GS, IF, TA, and AH were associated with graft survival in the multivariate analysis. The histologic parameters were associated with CrCl at several posttransplant time intervals, but the significance of association was lost in the multivariate analysis. Donor age showed a better correlation with graft function. In the univariate analyses adjusting for donor age, only IF and AH were associated with graft function. CONCLUSIONS: Histologic parameters showed a modest association with graft function. In our study, donor age is the better predictor of graft function. IF and AH may be similar to or better than GS as predictors of graft outcome.

Detection of amastigotes of Trypanosoma cruzi in a kidney graft with acute dysfunction.

We described a case of allograft kidney dysfunction associated with renal parenchymal infection with amastigotes of Trypanosoma cruzi. The patient was diagnosed as being chronically infected prior to transplantation. The infection was probably acquired by blood transfusion. He could not complete antiparasitic treatment due to drug toxicity. He was transplanted from a cadaver who showed a negative test for Chagas' disease. One year after transplantation the serum creatinine progressively increased. Histological examination of renal biopsy revealed intracytoplasmic amastigotes of T cruzi. No evidence of other specific alterations in the graft was detected. It was unknown whether graft dysfunction was only due to parasitic infection. The present case confirmed that T cruzi can infect kidney grafts and that immunosuppression in kidney transplantation is potentially a cause of dissemination of Chagas' disease.