Candidíase em pacientes transplantados renais / Candidiasis in kidney transplant patients

O objetivo do trabalho foi verificar a prevalência de candidíase em transplantados renais. Foram avaliados os prontuários dos pacientes transplantados no Hospital das Clínicas de Ribeirão Preto de fevereiro de 1968 a fevereiro de 1995. Nesse período foram transplantados 620 pacientes. Destes, 87 apresentaram 107 episódios de candidíase. Locais mais acometidos: trato urinário com 55 episódios, trato respiratório com 28, e trato gastrointestinal com 16. O agente etiológico mais freqüente foi C. albicans com 65 casos seguido de C. tropicalis com 12 e C. glabrata com 11 casos. As infecções do trato urinário mostraram incidência maior (61,7%) nos primeiros 6 meses. A maioria se apresentou clínicamente como infecção bacteriana. No trato respiratório, as infecções foram caracterizadas por recuperação do agente no escarro. No trato gastrointestinal, 9/16 episódios foram esofágicos, com epigastralgia, dor retroesternal, às vezes acompanhados de candidíase oral ou odinofagia. Nos outros episódios o agente foi recuperado nas fezes com quadro clínico de gastroenterite. Nas infecções dos tratos urinário e respiratório, houve associação da candidíase com antibioticoterapia prévia (76% e 67% respectivamente), além de infecções bacterianas concomitantes (34% e 64% respectivamente). As infecções por Candida sp tiveram prevalência geral em torno de 14,5%. A localização predominante foi no trato urinário e, em seguida, nos tratos respiratório e gastrointestinal, apresentando alto índice de associação com antibioticoterapia prévia e infecções bacterianas.

The medical records of 620 patients submitted to renal transplant from February 1968 to February 1995 were surveyed for Candida infection. Of these, 87 presented 107 episodes of candidiasis. In 42.9% the infection appeared up to 6 months after the transplant. The most frequent involved sites were: urinary tract, respiratory tract, and gastrointestinal tract. The most frequent etiological agents were: C. albicans, C. tropicalis and C. glabrata. Most urinary tract infections occurred in the first 6 months (61.7%) and manifested clinically as a bacterial infection. In the respiratory tract infections were characterized by isolation of the agent in sputum. In the gastrointestinal infections, 9/16 episodes were esophageal. There were 3 deaths directly related to Candidiasis (one pulmonary and 2 disseminated cases). In the urinary tract, and respiratory tract infections there was association of candidiasis with previous antibiotic treatment (76% and 67%, respectively), and with concomitant bacterial infections (34% and 64%, respectively). The overall prevalence of Candida infections was 14.5%. The predominant location was in the urinary tract (51.0%), followed by the respiratory (26.0%) and gastrointestinal tract (15.0%), with a high rate of association with previous antibiotic treatment and bacterial infections.

Use of ciprofloxacin as a prophylactic agent in urinary tract infections in renal transplant recipients.

The most common form of bacterial infection in renal transplant recipients is urinary tract infection (UTI), and some studies have shown that prophylaxis can reduce this incidence. In the present investigation we evaluated 80 patients submitted to renal transplantation at the Renal Transplant Unit of the University Hospital of Ribeirao Preto, SP. The study was prospective, double blind and randomized. The patients were divided into two groups, one receiving placebo and the other ciprofloxacin at the dose of 250 mg twice a day for the first 10 d and 250 mg/d for 6 months after transplantation. Of the 41 patients who received ciprofloxacin 28 completed the study, and of the 39 patients who received placebo 30 completed the study. The largest number of UTI occurred in the placebo group, with a significant difference from the ciprofloxacin group during the first month after surgery (p < 0.05). In the group treated with ciprofloxacin, only 6/40 patients (15%) developed UTI, as opposed to 19/39 (48.7%) for the placebo group. The total number of infectious episodes was higher in the placebo group (26) than in the ciprofloxacin group (12). The medication was well tolerated throughout the study period.

[Candidiasis in kidney transplant patients]. / Candidíase em pacientes transplantados renais.

The medical records of 620 patients submitted to renal transplant from February 1968 to February 1995 were surveyed for Candida infection. Of these, 87 presented 107 episodes of candidiasis. In 42.9% the infection appeared up to 6 months after the transplant. The most frequent involved sites were: urinary tract, respiratory tract, and gastrointestinal tract. The most frequent etiological agents were: C. albicans, C. tropicalis and C. glabrata. Most urinary tract infections occurred in the first 6 months (61.7%) and manifested clinically as a bacterial infection. In the respiratory tract infections were characterized by isolation of the agent in sputum. In the gastrointestinal infections, 9/16 episodes were esophageal. There were 3 deaths directly related to Candidiasis (one pulmonary and 2 disseminated cases). In the urinary tract, and respiratory tract infections there was association of candidiasis with previous antibiotic treatment (76% and 67%, respectively), and with concomitant bacterial infections (34% and 64%, respectively). The overall prevalence of Candida infections was 14.5%. The predominant location was in the urinary tract (51.0%), followed by the respiratory (26.0%) and gastrointestinal tract (15.0%), with a high rate of association with previous antibiotic treatment and bacterial infections.

Hepatitis B virus infection in hemodialysis units: clinical features, epidemiological markers and general control measures.

1. A total of 140 patients and 41 staff members were submitted to periodic testing for HBsAg from January 1979 to December 1984 at the Hemodialysis Unit of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo. Twenty-two HBsAg-positive subjects were detected during this period, 15 of whom had acquired the hepatitis B virus (HBV) in the Unit (10 patients and 5 staff-members). 2. HBV prevalence was not uniform throughout the period of study, with an increase of hepatitis B cases occurring after September 1981 and reaching epidemic proportions which lasted until January 1983. 3. Among the preventive measures adopted, epidemiological alert, grouping patients and workers according to susceptibility or immunity to the infection, and setting up a separate area for the dialysis of infected patients appeared to be most important. 4. The use of HBV subtyping as an epidemiological marker permitted us to demonstrate that HBV was introduced into the Unit by chronic carrier patients and spread internally through the probable contamination of equipment and unit environment.