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1.
Clinics (Sao Paulo) ; 74: e941, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30942282

RESUMO

Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ transplantation (SOT) in the past. However, HIV management has improved since highly active antiretroviral therapy (HAART) became available in 1996, and the long-term survival of patients living with HIV has led many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection.Based on the available data in the medical literature and the cumulative experience of transplantation in HIV-positive patients at our hospital, the aim of the present article is to outline the criteria for transplantation in HIV-positive patients as recommended by the Immunocompromised Host Committee of the Hospital das Clínicas of the University of São Paulo.


Assuntos
Infecções por HIV/cirurgia , Hospitais Universitários/normas , Transplante de Órgãos/normas , Brasil , Humanos , Seleção de Pacientes , Transplantados
2.
Clinics ; 74: e941, 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-989634

RESUMO

Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ transplantation (SOT) in the past. However, HIV management has improved since highly active antiretroviral therapy (HAART) became available in 1996, and the long-term survival of patients living with HIV has led many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection. Based on the available data in the medical literature and the cumulative experience of transplantation in HIV-positive patients at our hospital, the aim of the present article is to outline the criteria for transplantation in HIV-positive patients as recommended by the Immunocompromised Host Committee of the Hospital das Clínicas of the University of São Paulo.

3.
Hepatology ; 2018 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-30218577

RESUMO

A previously healthy 27-year-old female had 3 days of fever (40°C), headache, and myalgia. She had not been previously vaccinated for YF. Initial workup revealed 2,150 leukocytes/mm3 , 83,000 platelets/mm3 , AST 8462U/L and ALT 5249U/L (Figure 1). She was icteric with a heart rate of 60 bpm. The following day, a generalized seizure led to intubation, and renal failure led to hemodialysis. Transcranial doppler ultrasound showed signs of intracranial hypertension, cranial CT scan showed diffuse hypoattenuation and loss of grey-white differentiation; abdominal doppler ultrasound, and echocardiogram were normal. This article is protected by copyright. All rights reserved.

4.
Clinics (Sao Paulo) ; 73: e344, 2018 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-30020340

RESUMO

OBJECTIVES: Patients receiving treatment for tuberculosis are at risk of developing acute liver failure due to the hepatotoxicity of antitubercular drugs. We aimed to describe our experience with liver transplantation from deceased donors in this situation. METHODS: We identified patients undergoing transplantation for acute liver failure due to antitubercular drugs in our prospectively maintained database. RESULTS: Of 81 patients undergoing transplantation for acute liver failure, 8 cases were attributed to antitubercular drugs during the period of 2006-2016. Regarding the time of tuberculosis treatment until the onset of jaundice, patients were on antitubercular drugs for a mean of 64.7 days (21-155 days). The model for end-stage liver disease (MELD) score of patients ranged from 32 to 47 (median 38), and seven patients underwent transplantation under vasopressors. The 1-year survival was 50%. Three patients died during the week following transplantation due to septic shock (including a patient with acute liver failure due to hepatic/disseminated tuberculosis), and the remaining patient died 2 months after transplantation due to pulmonary infection. There were 2 cases of mild rejection and 1 case of moderate rejection. Of the surviving patients, all were considered cured of tuberculosis after alternative drugs were given. CONCLUSION: Patients arrived very sick and displayed poor survival after deceased donor transplantation.


Assuntos
Antituberculosos/efeitos adversos , Falência Hepática Aguda/induzido quimicamente , Falência Hepática Aguda/cirurgia , Transplante de Fígado/métodos , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Encefalopatias/etiologia , Feminino , Humanos , Icterícia/etiologia , Falência Hepática Aguda/mortalidade , Transplante de Fígado/mortalidade , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Tuberculose/complicações , Adulto Jovem
5.
Clinics ; 73: e344, 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-952814

RESUMO

OBJECTIVES: Patients receiving treatment for tuberculosis are at risk of developing acute liver failure due to the hepatotoxicity of antitubercular drugs. We aimed to describe our experience with liver transplantation from deceased donors in this situation. METHODS: We identified patients undergoing transplantation for acute liver failure due to antitubercular drugs in our prospectively maintained database. RESULTS: Of 81 patients undergoing transplantation for acute liver failure, 8 cases were attributed to antitubercular drugs during the period of 2006-2016. Regarding the time of tuberculosis treatment until the onset of jaundice, patients were on antitubercular drugs for a mean of 64.7 days (21-155 days). The model for end-stage liver disease (MELD) score of patients ranged from 32 to 47 (median 38), and seven patients underwent transplantation under vasopressors. The 1-year survival was 50%. Three patients died during the week following transplantation due to septic shock (including a patient with acute liver failure due to hepatic/disseminated tuberculosis), and the remaining patient died 2 months after transplantation due to pulmonary infection. There were 2 cases of mild rejection and 1 case of moderate rejection. Of the surviving patients, all were considered cured of tuberculosis after alternative drugs were given. CONCLUSION: Patients arrived very sick and displayed poor survival after deceased donor transplantation.

6.
J Bras Nefrol ; 39(3): 341-344, 2017 Jul-Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29044345

RESUMO

Granulicatella and Abiotrophia are genera of fastidious Gram-positive cocci commensal of the oral, genitourinary, and intestinal flora. We report the first case of infective endocarditis caused by Granulicatella sp. in a kidney transplant recipient. A 67-year-old male kidney transplant recipient was admitted to the hospital for investigation of fever, abdominal pain, and diarrhea. On physical examination, he was dehydrated. Laboratory tests identified impaired renal function (creatinine level of 15.5 mg/dl; reference, 3.0 mg/dl), metabolic acidosis, and electrolyte disturbances. Cryptosporidium sp. was identified as the cause of the diarrhea, and the infection was treated with nitazoxanide. On admission, cultures of blood, urine, and stool samples were negative. Echocardiography results were normal. Despite the antimicrobial treatment, the fever persisted. A transthoracic echocardiogram revealed infective endocarditis of the mitral valve, and Granulicatella spp. were isolated in blood cultures. Although the patient was treated with penicillin and amikacin, he evolved to septic shock of pulmonary origin and died. Infective endocarditis caused by Granulicatella sp. should be suspected in cases of culture-negative endocarditis.


Assuntos
Carnobacteriaceae , Endocardite Bacteriana , Infecções por Bactérias Gram-Positivas , Transplante de Rim , Complicações Pós-Operatórias , Idoso , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Evolução Fatal , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico
7.
J. bras. nefrol ; 39(3): 341-344, July-Sept. 2017. graf
Artigo em Inglês | LILACS-Express | ID: biblio-893776

RESUMO

Abstract Granulicatella and Abiotrophia are genera of fastidious Gram-positive cocci commensal of the oral, genitourinary, and intestinal flora. We report the first case of infective endocarditis caused by Granulicatella sp. in a kidney transplant recipient. A 67-year-old male kidney transplant recipient was admitted to the hospital for investigation of fever, abdominal pain, and diarrhea. On physical examination, he was dehydrated. Laboratory tests identified impaired renal function (creatinine level of 15.5 mg/dl; reference, 3.0 mg/dl), metabolic acidosis, and electrolyte disturbances. Cryptosporidium sp. was identified as the cause of the diarrhea, and the infection was treated with nitazoxanide. On admission, cultures of blood, urine, and stool samples were negative. Echocardiography results were normal. Despite the antimicrobial treatment, the fever persisted. A transthoracic echocardiogram revealed infective endocarditis of the mitral valve, and Granulicatella spp. were isolated in blood cultures. Although the patient was treated with penicillin and amikacin, he evolved to septic shock of pulmonary origin and died. Infective endocarditis caused by Granulicatella sp. should be suspected in cases of culture-negative endocarditis.


Resumo Granulicatella e Abiotrophia são gêneros de cocos gram-positivos fastidiosos comensais das floras oral, genitourinária e intestinal. Relatamos o primeiro caso de endocardite infecciosa por Granulicatella sp. em paciente transplantado renal. Paciente do sexo masculino, 67 anos, foi admitido no hospital para investigação de febre, dor abdominal e diarreia. Ao exame físico encontrava-se desidratado. Exames laboratoriais identificaram piora de função renal (creatinina: 15,5mg/dL - níveis basais: 3mg/dL), acidose metabólica e distúrbios eletrolíticos. Cryptosporidium sp foi identificado como causa da diarréia e tal germe foi tratado com nitazoxanida. À admissão, hemoculturas, urocultura e coprocultura negativas além de ecocardiograma normal. A despeito do tratamento antimicrobiano, paciente persistiu febril. Um ecocardiograma transtorácico posterior foi realizado, revelando endocardite em válvula mitral, sendo então identificada em hemocultura Granulicatella sp. Apesar do tratamento com penicilina e amicacina, o paciente evoluiu com quadro de choque séptico de foco pulmonar e óbito. Endocardite infecciosa por Granulicatela sp. deve ser suspeitada em casos de endocardite com hemoculturas negativas.

8.
World J Gastroenterol ; 22(18): 4547-58, 2016 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-27182164

RESUMO

AIM: To identify risk factors associated with survival in patients retransplanted for hepatitis C virus (HCV) recurrence and to apply a survival score to this population. METHODS: We retrospectively identified 108 patients retransplanted for HCV recurrence in eight European liver transplantation centers (seven in France, one in Spain). Data collection comprised clinical and laboratory variables, including virological and antiviral treatment data. We then analyzed the factors associated with survival in this population. A recently published score that predicts survival in retransplantation in patients with hepatitis C was applied. Because there are currently no uniform recommendations regarding selection of the best candidates for retransplantation in this setting, we also described the clinical characteristics of 164 patients not retransplanted, with F3, F4, or fibrosing cholestatic hepatitis (FCH) post-first graft presenting with hepatic decompensation. RESULTS: Overall retransplantation patient survival rates were 55%, 47%, and 43% at 3, 5, and 10 years, respectively. Patients who were retransplanted for advanced cirrhosis had survival rates of 59%, 52%, and 49% at 3, 5, and 10 years, while those retransplanted for FCH had survival rates of 34%, 29%, and 11%, respectively. Under multivariate analysis, and adjusting for the center effect and the occurrence of FCH, factors associated with better survival after retransplantation were: negative HCV viremia before retransplantation, antiviral therapy after retransplantation, non-genotype 1, a Model for End-stage Liver Disease (MELD) score < 25 when replaced on the waiting list, and a retransplantation donor age < 60 years. Although the numbers were small, in the context of the new antivirals era, we showed that outcomes in patients who underwent retransplantation with undetectable HCV viremia did not depend on donor age and MELD score. The Andrés score was applied to 102 patients for whom all score variables were available, producing a mean score of 43.4 (SD = 6.6). Survival rates after the date of the first decompensation post-first liver transplantation (LT1) in the liver retransplantation (reLT) group (94 patients decompensated) at 3, 5, and 10 years were 62%, 59%, and 51%, respectively, among 78 retransplanted individuals with advanced cirrhosis, and 42%, 32%, and 16% among 16 retransplanted individuals with FCH. In the non-reLT group with hepatic decompensation, survival rates were 27%, 18%, and 9% at 3, 5, and 10 years, respectively (P < 0.0001). Compared with non-retransplanted patients, retransplanted patients were younger at LT1 (mean age 48 ± 8 years compared to 53 ± 9 years in the no reLT group, P < 0.0001), less likely to have human immunodeficiency virus (HIV) co-infection (4% vs 14% among no reLT patients, P = 0.005), more likely to have received corticosteroid bolus therapy after LT1 (25% in reLT vs 12% in the no reLT group, P = 0.01), and more likely to have presented with sustained virological response (SVR) after the first transplantation (20% in the reLT group vs 7% in the no reLT group, P = 0.028). CONCLUSION: Antiviral therapy before and after retransplantation had a substantial impact on survival in the context of retransplantation for HCV recurrence, and with the new direct-acting antivirals now available, outcomes should be even better in the future.


Assuntos
Técnicas de Apoio para a Decisão , Hepacivirus/patogenicidade , Hepatite C/cirurgia , Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Ativação Viral , Adolescente , Adulto , Idoso , Antivirais/uso terapêutico , Feminino , França , Hepatite C/diagnóstico , Hepatite C/mortalidade , Hepatite C/virologia , Humanos , Estimativa de Kaplan-Meier , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Cirrose Hepática/virologia , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Recidiva , Reoperação , Estudos Retrospectivos , Fatores de Risco , Espanha , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Mem Inst Oswaldo Cruz ; 110(1): 2017 Apr, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25742264

RESUMO

Histology is the gold standard for diagnosing acute rejection and hepatitis C recurrence after liver transplantation. However, differential diagnosis between the two can be difficult. We evaluated the role of C4d staining and quantification of hepatitis C virus (HCV) RNA levels in liver tissue. This was a retrospective study of 98 liver biopsy samples divided into four groups by histological diagnosis: acute rejection in patients undergoing liver transplant for hepatitis C (RejHCV+), HCV recurrence in patients undergoing liver transplant for hepatitis C (HCVTx+), acute rejection in patients undergoing liver transplant for reasons other than hepatitis C and chronic hepatitis C not transplanted (HCVTx-). All samples were submitted for immunohistochemical staining for C4d and HCV RNA quantification. Immunoexpression of C4d was observed in the portal vessels and was highest in the HCVTx- group. There was no difference in C4d expression between the RejHCV+ and HCVTx+ groups. However, tissue HCV RNA levels were higher in the HCVTx+ group samples than in the RejHCV+ group samples. Additionally, there was a significant correlation between tissue and serum levels of HCV RNA. The quantification of HCV RNA in liver tissue might prove to be an efficient diagnostic test for the recurrence of HCV infection.


Assuntos
Complemento C4b/análise , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/virologia , Hepacivirus/isolamento & purificação , Hepatite C/imunologia , Hepatite C/virologia , Transplante de Fígado , Fragmentos de Peptídeos/análise , RNA Viral/isolamento & purificação , Adolescente , Adulto , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Rejeição de Enxerto/patologia , Hepacivirus/genética , Hepatite C/patologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
10.
Mem. Inst. Oswaldo Cruz ; 110(1): 56-64, 03/02/2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-741619

RESUMO

Histology is the gold standard for diagnosing acute rejection and hepatitis C recurrence after liver transplantation. However, differential diagnosis between the two can be difficult. We evaluated the role of C4d staining and quantification of hepatitis C virus (HCV) RNA levels in liver tissue. This was a retrospective study of 98 liver biopsy samples divided into four groups by histological diagnosis: acute rejection in patients undergoing liver transplant for hepatitis C (RejHCV+), HCV recurrence in patients undergoing liver transplant for hepatitis C (HCVTx+), acute rejection in patients undergoing liver transplant for reasons other than hepatitis C and chronic hepatitis C not transplanted (HCVTx-). All samples were submitted for immunohistochemical staining for C4d and HCV RNA quantification. Immunoexpression of C4d was observed in the portal vessels and was highest in the HCVTx- group. There was no difference in C4d expression between the RejHCV+ and HCVTx+ groups. However, tissue HCV RNA levels were higher in the HCVTx+ group samples than in the RejHCV+ group samples. Additionally, there was a significant correlation between tissue and serum levels of HCV RNA. The quantification of HCV RNA in liver tissue might prove to be an efficient diagnostic test for the recurrence of HCV infection.


Assuntos
Animais , Humanos , Camundongos , Anexina A1/farmacologia , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Neutrófilos/citologia , Neutrófilos/imunologia , Apoptose , Actinas/metabolismo , Anexina A1/deficiência , Anexina A1/genética , Anexina A1/imunologia , Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , AMP Cíclico/metabolismo , Dexametasona/farmacologia , Técnicas In Vitro , /biossíntese , Camundongos Knockout , Macrófagos/metabolismo , Peptídeos , Fagocitose/efeitos dos fármacos , Fator de Crescimento Transformador beta/biossíntese
11.
World J Gastroenterol ; 20(18): 5363-74, 2014 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-24833866

RESUMO

Since 1963, when the first human liver transplantation (LT) was performed by Thomas Starzl, the world has witnessed 50 years of development in surgical techniques, immunosuppression, organ allocation, donor selection, and the indications and contraindications for LT. This has led to the mainstream, well-established procedure that has saved innumerable lives worldwide. Today, there are hundreds of liver transplant centres in over 80 countries. This review aims to describe the main aspects of LT regarding the progressive changes that have occurred over the years. We herein review historical aspects since the first experimental studies and the first attempts at human transplantation. We also provide an overview of immunosuppressive agents and their potential side effects, the evolution of the indications and contraindications of LT, the evolution of survival according to different time periods, and the evolution of methods of organ allocation.


Assuntos
Hepatopatias/cirurgia , Transplante de Fígado , Animais , Sobrevivência de Enxerto , História do Século XX , História do Século XXI , Humanos , Imunossupressores/uso terapêutico , Hepatopatias/diagnóstico , Hepatopatias/história , Hepatopatias/mortalidade , Transplante de Fígado/efeitos adversos , Transplante de Fígado/história , Transplante de Fígado/mortalidade , Seleção de Pacientes , Fatores de Risco , Fatores de Tempo , Doadores de Tecidos/provisão & distribução , Resultado do Tratamento , Listas de Espera
14.
Braz. j. infect. dis ; 17(1): 41-47, Jan.-Feb. 2013. ilus, tab
Artigo em Inglês | LILACS | ID: lil-665773

RESUMO

OBJECTIVES: To assess the virologic and immunological response of darunavir/ritonavir plus optimized background therapy in highly antiretroviral-experienced HIV-infected patients in Brazil. METHODS: Prospective cohort study carried out in a tertiary center in Sao Paulo, Brazil. Three-class antiretroviral-experienced patients with confirmed virologic failure began darunavir/ritonavir plus optimized background therapy (nucleoside/tide reverse transcriptase inhibitors ± raltegravir ± enfuvirtide ± maraviroc) after performing a genotypic resistance assay. Clinical evaluation and laboratory tests were collected at baseline and at weeks 12, 24, and 48. Multivariate analysis was performed to identify predictors of virologic response at 48 weeks. RESULTS: Ninety-two patients were included. The median of darunavir resistant mutation was 1 (range 0-6). The median genotypic sensitivity score in the optimized background therapy was 2 (interquartile range 1-2). At week 48, 83% (95% CI: 75-90%) had an HIV RNA level <50 copies/mL and the median CD4 cell count was 301 (interquartile range 224-445) cells/mm³. Baseline HIV RNA >100 000 copies/mL was inversely associated with virologic success at week 48 (HR: 0.22, 95% CI: 0.06-0.85, p = 0.028). CONCLUSIONS: Darunavir/ritonavir plus optimized background therapy was a highly effective salvage regimen under clinical routine conditions in a referral center in Brazil, which is similar to the reported in high-income countries.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral/genética , Infecções por HIV/tratamento farmacológico , HIV-1 , Mutação/genética , Ritonavir/uso terapêutico , Sulfonamidas/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Brasil , Estudos de Coortes , Quimioterapia Combinada/métodos , Genótipo , Infecções por HIV/virologia , HIV-1 , Estudos Prospectivos , Fatores de Tempo , Carga Viral
15.
Braz J Infect Dis ; 17(1): 41-7, 2013 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23294644

RESUMO

OBJECTIVES: To assess the virologic and immunological response of darunavir/ritonavir plus optimized background therapy in highly antiretroviral-experienced HIV-infected patients in Brazil. METHODS: Prospective cohort study carried out in a tertiary center in Sao Paulo, Brazil. Three-class antiretroviral-experienced patients with confirmed virologic failure began darunavir/ritonavir plus optimized background therapy (nucleoside/tide reverse transcriptase inhibitors ± raltegravir ± enfuvirtide ± maraviroc) after performing a genotypic resistance assay. Clinical evaluation and laboratory tests were collected at baseline and at weeks 12, 24, and 48. Multivariate analysis was performed to identify predictors of virologic response at 48 weeks. RESULTS: Ninety-two patients were included. The median of darunavir resistant mutation was 1 (range 0-6). The median genotypic sensitivity score in the optimized background therapy was 2 (interquartile range 1-2). At week 48, 83% (95% CI: 75-90%) had an HIV RNA level <50 copies/mL and the median CD4 cell count was 301 (interquartile range 224-445) cells/mm(3). Baseline HIV RNA >100000 copies/mL was inversely associated with virologic success at week 48 (HR: 0.22, 95% CI: 0.06-0.85, p=0.028). CONCLUSIONS: Darunavir/ritonavir plus optimized background therapy was a highly effective salvage regimen under clinical routine conditions in a referral center in Brazil, which is similar to the reported in high-income countries.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral/genética , Infecções por HIV/tratamento farmacológico , HIV-1/genética , Mutação/genética , Ritonavir/uso terapêutico , Sulfonamidas/uso terapêutico , Adulto , Terapia Antirretroviral de Alta Atividade , Brasil , Contagem de Linfócito CD4 , Estudos de Coortes , Darunavir , Quimioterapia Combinada/métodos , Feminino , Genótipo , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Carga Viral
16.
Clin Transplant ; 24(6): 735-46, 2010 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20438579

RESUMO

INTRODUCTION: After liver transplant (LT) from Anti-HBc+/HBsAg- donors into HBsAg- recipients, transmission of hepatitis B virus (HBV) may occur (de novo HBV infection). This study analyzes the incidence of de novo HBV infection in HBsAg- recipients of Anti-HBc+/HBsAg- LT with respect to: (i) the recipients' HBV serology and (ii) the type of preventive therapy adopted. METHODS: A systematic review of the literature using the electronic database Medline. RESULTS: Five hundred and fifty-two LT in 36 articles were selected. Lamivudine, Hepatitis B immune globulin (HBIG), revaccination, and combined therapies were employed in multiple strategies as preventive interventions. Naïve recipients had a high risk of de novo HBV infection, with smaller incidences when HBIG and lamivudine were used, either alone or in association. Vaccinated recipients or those with isolated hepatitis B core antibodies (Anti-HBc) and previous HBV infection had lower risks of viral transmission, additionally reduced by any prophylaxis adoption. DISCUSSION: LT from Anti-HBc+/HBsAg- donors into HBsAg- recipients is apparently safe, as long as the recipient is vaccinated or presents an isolated Anti-HBc or previous HBV infection and some prophylaxis is employed. Currently lamivudine seems the best alternative; other nucleoside analogs and revaccination strategies should be considered in future studies. Follow-up and preventive therapies should be maintained for five yr or preferably throughout the recipients' life span.


Assuntos
Anticorpos Anti-Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/imunologia , Hepatite B/imunologia , Transplante de Fígado/imunologia , Hepatite B/prevenção & controle , Hepatite B/transmissão , Humanos , Doadores de Tecidos
17.
Scand J Infect Dis ; 39(8): 728-30, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17654352

RESUMO

Cat-scratch disease, primarily caused by Bartonella henselae, typically presents with regional adenopathy, and the role of antibiotics in the treatment is debatable. We present a report of B. henselae infection transmitted by the same kitten to 4 different individuals, each with different clinical characteristics, treatment, and evolution.


Assuntos
Bartonella henselae/efeitos dos fármacos , Doença da Arranhadura de Gato/transmissão , Adolescente , Adulto , Animais , Antibacterianos/efeitos adversos , Bartonella henselae/imunologia , Bartonella henselae/patogenicidade , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/diagnóstico , Doença da Arranhadura de Gato/tratamento farmacológico , Gatos , Relações Familiares , Feminino , Humanos , Doenças Linfáticas/etiologia , Doenças Linfáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Testes Sorológicos
18.
Braz J Infect Dis ; 10(2): 132-8, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16878265

RESUMO

Mycophenolate mofetil (MMF) is currently used for prophylaxis of acute rejection in solid organ transplantation. There have been diverging reports regarding an association between MMF and the risk of cytomegalovirus (CMV) infection. We reviewed the main published studies in an attempt to clarify the association between the use of MMF and the risk, frequency and severity of CMV infections. In a search of the Medline database with the terms "mycophenolate" and "cytomegalovir*", 42 articles were found to be relevant; among these, 29 articles were thoroughly analyzed. The first studies on MMF in renal transplantation already showed a tendency towards an association between this drug and the occurrence of CMV disease. Further studies were designed specifically to study this association; with the conclusion that an immunosuppressive regimen containing MMF increases the likelihood of CMV disease. Most studies were performed with kidney transplant recipients. We conclude that the use of MMF apparently increases the incidence of CMV disease in renal transplant patients; however, further studies are needed to confirm this association.


Assuntos
Infecções por Citomegalovirus/induzido quimicamente , Imunossupressores/efeitos adversos , Transplante de Rim , Transplante de Fígado , Ácido Micofenólico/análogos & derivados , Infecções por Citomegalovirus/epidemiologia , Rejeição de Enxerto/prevenção & controle , Humanos , Incidência , Ácido Micofenólico/efeitos adversos , Fatores de Risco , Índice de Gravidade de Doença
19.
Braz. j. infect. dis ; 10(2): 132-138, Apr. 2006. tab
Artigo em Inglês | LILACS | ID: lil-431986

RESUMO

Mycophenolate mofetil (MMF) is currently used for prophylaxis of acute rejection in solid organ transplantation. There have been diverging reports regarding an association between MMF and the risk of cytomegalovirus (CMV) infection. We reviewed the main published studies in an attempt to clarify the association between the use of MMF and the risk, frequency and severity of CMV infections. In a search of the Medline database with the terms "mycophenolate" and "cytomegalovir*", 42 articles were found to be relevant; among these, 29 articles were thoroughly analyzed. The first studies on MMF in renal transplantation already showed a tendency towards an association between this drug and the occurrence of CMV disease. Further studies were designed specifically to study this association; with the conclusion that an immunosuppressive regimen containing MMF increases the likelihood of CMV disease. Most studies were performed with kidney transplant recipients. We conclude that the use of MMF apparently increases the incidence of CMV disease in renal transplant patients; however, further studies are needed to confirm this association.


Assuntos
Humanos , Infecções por Citomegalovirus/induzido quimicamente , Imunossupressores/efeitos adversos , Transplante de Rim , Transplante de Fígado , Ácido Micofenólico/análogos & derivados , Infecções por Citomegalovirus/epidemiologia , Rejeição de Enxerto/prevenção & controle , Incidência , Ácido Micofenólico/efeitos adversos , Fatores de Risco , Índice de Gravidade de Doença
20.
Rev Hosp Clin Fac Med Sao Paulo ; 58(4): 207-14, 2003 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-14534673

RESUMO

UNLABELLED: Considering the relevance of AIDS/tuberculosis comorbidity worldwide, especially in Brazil, this study was developed to describe the clinical and epidemiological features of the comorbid cases identified from 1989 to 1997 by the epidemiology service of the Hospital das Clínicas of the Universidade de São Paulo. METHODS: Databases containing information on all identified AIDS/tuberculosis cases cared for at the hospital were used to gather information on comorbid cases. RESULTS: During the period, 559 patients were identified as presenting with AIDS/tuberculosis comorbidity. Risk behavior for AIDS was primarily heterosexual contact (38.9%), followed by intravenous drug use (29.3%) and homosexual/bisexual contact (23.2%). Regarding clinical features, there were higher rates of extrapulmonary tuberculosis when compared to tuberculosis without comorbidity. There was an increase in reporting of AIDS by ambulatory units during the period. Epidemiologically, there was a decrease in the male/female ratio, a predominance in the 20 to 39 year-old age group, and a majority of individuals who had less than 8 years of schooling and had low professional qualifications. CONCLUSIONS: High rates of AIDS/tuberculosis cases at our hospital indicate the need for better attention towards early detection of tuberculosis, especially in its extrapulmonary form. Since the population that attends this hospital tends to be of a lower socioeconomic status, better management of AIDS and tuberculosis is required to increase the rates of treatment adherence and thus lower the social costs.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Tuberculose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Criança , Pré-Escolar , Comorbidade , Escolaridade , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo
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