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Endemic and opportunistic infections in Brazilian solid organ transplant recipients

BATISTA, M. V.; PIERROTTI, L. C.; ABDALA, E.; CLEMENTE, W. T.; GIRAO, E. S.; ROSA, D. R. T.; IANHEZ, L. E.; BONAZZI, P. R.; LIMA, A. S.; FERNANDES, P. F. C. B. C.; PADUA-NETO, M. V.; BACCHELLA, T.; OLIVEIRA, A. P. P.; VIANA, C. F. G.; FERREIRA, M. S.; SHI
Fonte: WILEY-BLACKWELL Publicador: WILEY-BLACKWELL
Tipo: Artigo de Revista Científica
ENG
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OBJECTIVE To evaluate the frequency and clinical features of endemic and other opportunistic infections in liver or kidney transplant recipients in four transplant centres in different geographical areas of Brazil. METHODS Retrospective analysis of medical and laboratory records of four transplant centres on endemic and other opportunistic infections in liver or kidney transplant recipients. Analyses were performed with spss statistical software. RESULTS From 2001 to 2006, 1046 kidney and 708 liver transplants were registered in all centres. The average age was 42 years. Among 82 (4.7%) cases with infections, the most frequent was tuberculosis (2.0%), followed by systemic protozoal infections (0.7%), toxoplasmosis (0.4%) and visceral leishmaniasis (0.3%). Systemic fungal infections occurred in 0.6%, of which 0.4% were cryptococcosis and 0.2% were histoplasmosis. Dengue was the only systemic viral infection and was registered in two cases (0.1%), of which one was classified as the classic form and the other as dengue haemorrhagic fever. Nocardiosis was described in one case (0.05%). The infectious agents most frequently associated with diarrhoea were Blastocystis sp., Schistosoma mansoni and Strongyloides stercoralis. CONCLUSIONS Opportunistic Infections in transplant patients have a wide spectrum and may vary from asymptomatic to severe infections with high mortality. A better understanding of the epidemiology of endemic pathogens and clinical manifestations can contribute to the establishment of an early diagnosis as well as correct treatment aimed at decreasing morbidity and mortality.

Usefulness of qualitative polymerase chain reaction for Trypanosoma cruzi DNA in endomyocardial biopsy specimens of chagasic heart transplant patients

BENVENUTI, Luiz A.; ROGGERIO, Alessandra; COELHO, Guilherme; FIORELLI, Alfredo I.
Fonte: ELSEVIER SCIENCE INC Publicador: ELSEVIER SCIENCE INC
Tipo: Artigo de Revista Científica
ENG
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BACKGROUND: Chagas` disease reactivation (CDR) after heart transplantation is characterized by relapse of the infectious disease, with direct detection of Trypanosoma cruzi parasites in blood, cerebrospinal fluid, or tissues. CDR affecting the myocardium induces lymphocytic myocarditis and should be distinguished from acute cellular rejection in endomyocardial biopsy (EMB) specimens. METHODS: We performed retrospectively qualitative polymerase chain reaction for T cruzi DNA using 2 sets of primers targeting nuclear DNA (nDNA) or kinetoplast DNA (kDNA) in 61 EMB specimens of 11 chagasic heart transplant recipients who presented with CDR. Thirty-five EMB specimens were obtained up to 6 months before (pre-CDR group) and 26 up to 2 years after the diagnosis of CDR. The control group consisted of 6 chagasic heart transplant recipients with 18 EMB specimens who never experienced CDR. RESULTS: Amplification of kDNA occurred in 8 of 35 (22.9%) EMB specimens of the pre-CDR group, in 5 of 18(27.8%) of the control group, and in 17 of 26(65.4%) EMB specimens obtained after the successful treatment of CDR. Amplification of nDNA occurred in 3 of 35 (8.6%) EMB specimens of the pre-CDR group, 0 of 18 (0%) of the control group, and 6 of 26 (23.1%) EMB specimens obtained after the successful treatment of CDR. CONCLUSIONS: Amplification of kDNA in EMB specimens is not specific for the diagnosis of CDR...

Does mycophenolate mofetil increase the risk of cytomegalovirus infection in solid organ transplant recipients?: A mini-review

Song,Alice Tung Wan; Abdala,Edson; Bonazzi,Patrícia Rodrigues; Bacchella,Telésforo; Machado,Marcel Cerqueira César
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2006 EN
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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.

Invasive aspergillosis in hematopoietic stem cell transplant recipients: a retrospective analysis

Carvalho-Dias,Viviane Maria Hessel; Sola,Caroline Bonamin Santos; Cunha,Clóvis Arns da; Shimakura,Sílvia Emiko; Pasquini,Ricardo; Queiroz-Telles,Flávio de
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2008 EN
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Invasive aspergillosis (IA) currently is an important cause of mortality in subjects undergoing hematopoietic stem cell transplants (HSCT) and is also an important cause of opportunistic respiratory and disseminated infections in other types of immunocompromised patients. We examined the medical records of 24 cases of proven and probable invasive aspergillosis (IA) at the Hospital de Clinicas of the Federal University of Parana, Brazil, from January 1996 to October 2006. During this period occurred a mean of 2.2 cases per year or 3.0 cases per 100 HSTC transplants. There was a significant relationship between structural changes in the bone marrow transplant (BMT) Unit and the occurrence of IA cases (p=0.034, relative risk (RR) = 2.47). Approximately 83% of the patients died due to invasive fungal infection within 60 days of follow up. Some factors tended to be associated with mortality, but these associations were not significant. These included corticosteroid use, neutropenia (<100 cells/mm³) at diagnosis, patients that needed to change antifungal therapy because of toxicity of the initial first-line regimen and disseminated disease. These factors should be monitored in BMT units to help prevent IA. Physicians should be aware of the risk factors for developing invasive fungal infections and try to reduce or eliminate them. However...

Oral care in Brazilian bone marrow transplant centers

Eduardo,Fernanda de Paula; Bezinelli,Letícia Mello; Hamerschlak,Nelson; Andrade,Claudia Toledo; Morelli,Leonardo Raul; Corrêa,Luciana
Fonte: Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular Publicador: Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2011 EN
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BACKGROUND: Oral care is a fundamental procedure for the success of the hematopoietic stem cell transplantation, particularly regarding the control of oral infectious diseases. Information about oral care protocols and the inclusion of dental professionals in transplantation medical staff is poorly known. OBJECTIVE: The aim of this study was to carry out a survey about the protocols of Brazilian dental professionals with regard to oral care of HSCT patients. METHODS: A questionnaire was mailed to 36 Brazilian transplant centers with questions about basic oral care protocols, the indication of specific mouthwashes, antibiotic therapy regimens, laser therapy, and treatment of oral mucositis and graft-versus-host disease. All the respondent centers (n = 12) have dentists as members of the HSCT medical staff. RESULTS: The majority indicate non-alcoholic chlorhexidine (n = 9; 75.0%) and sodium bicarbonate (n = 5; 41.7%) as routine mouthwashes. Laser therapy was frequently indicated (n= 9; 75.0%), mainly in the prevention of oral mucositis and in oral pain control. In the post-transplant period, antibiotic therapy was only indicated for invasive dental treatments (n= 8; 66.7%). Several treatments for graft-versus-host disease were mentioned without a trend towards establishing a standard protocol. CONCLUSION: Basic oral care constitutes regular assessment in the routine treatment of hematopoietic stem cell transplantation patients in Brazilian centers.

Epstein-Barr virus: general factors, virus-related diseases and measurement of viral load after transplant

Gequelin,Luciana Cristina Fagundes; Riediger,Irina N; Nakatani,Sueli M; Biondo,Alexander W; Bonfim,Carmem M
Fonte: Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular Publicador: Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2011 EN
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The Epstein-Barr virus is responsible for infectious mononucleosis syndrome and is also closely associated to several types of cancer. The main complication involving Epstein-Barr virus infection, both in recipients of hematopoietic stem cells and solid organs, is post-transplant lymphoproliferative disease. The importance of this disease has increased interest in the development of laboratory tools to improve post-transplant monitoring and to detect the disease before clinical evolution. Viral load analysis for Epstein-Barr virus through real-time polymerase chain reaction is, at present, the best tool to measure viral load. However, there is not a consensus on which sample type is the best for the test and what is its predictive value for therapeutic interventions.

Successful Treatment of Invasive Aspergillosis in a Heart Transplant Patient

Radovancevic, Branislav; Frazier, O. Howard; Gentry, Layne O.; Okereke, O.U. John; Cooley, Denton A.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /09/1985 EN
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Infection continues to be a major cause of mortality in cardiac transplant patients, and even though there has been significant progress in diagnosing and treating many infectious disease problems, invasive aspergillosis in the transplant patient represents a serious and usually fatal complication. Even with successful early diagnosis, the use of free amphotericin B (a polyene antibiotic) has failed to cure disseminated infection. We report the case of a 46-year-old transplant patient who failed to respond to treatment with free amphotericin B after a 7-day period of treatment for biopsy-proven pulmonary aspergillosis. However, a subsequent substitution of a liposomal form of amphotericin B was used, and the patient responded well to a total dose of 1.5 mg. After 7 months, the patient continues free of infection. This experience suggests that the introduction of liposomal amphotericin B may give new hope for treating an otherwise lethal infection.

Non-myeloablative Allogeneic Hematopoietic Stem Cell Transplant Using Mismatched / Haploidentical Donors: A review

Koh, Liang-Pniu; Chao, Nelson J.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
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Haploidentical hematopoietic stem cell transplantation (HSCT) provides an opportunity for patients to benefit from HCT when a human leukocyte antigen (HLA) genotypically matched sibling is not available. Initial results with the use of mismatched allograft has been disappointing, due to the high incidence of graft-versus-host disease (GVHD), and infectious complications resulting in an unacceptable treatment-related morbidity and mortality. Recent advances with effective T-cell depletion, the use of ‘megadose’ of stem cells and reduced intensity conditioning has significantly decreased the early transplant related mortality and GvHD, while enabling robust and prompt engraftment, and hence enhancing the therapeutic benefits of haploidentical transplantation. However, the cardinal problems related to delayed immune reconstitution causing post-transplant infectious complications and relapse remain, limiting the efficacy of haploidentical transplant.. Preliminary data has demonstrated the great potential in the use of adoptive cellular immunity and selective allodepletion in rapidly reconstituting immunity without GvHD. The encouranging reports from haploidentical transplant using noninherited maternal antigen (NIMA)-mismatched donors or natural killer alloreactive donors may greatly increase the donor availability and open a way to more appropriate donor selection in HLA-haploidentical HSCT. Future challenges remain in determining the safest approach for haploidentical transplant to be performed with minimal risk of GvHD...

Infectious Disease Transmission during Organ and Tissue Transplantation

Greenwald, Melissa A.; Kuehnert, Matthew J.; Fishman, Jay A.
Fonte: Centers for Disease Control and Prevention Publicador: Centers for Disease Control and Prevention
Tipo: Artigo de Revista Científica
Publicado em /08/2012 EN
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Transplantation of organs and tissues (bone, tendon, skin, cornea) will always be associated with some risk for transmission of infectious diseases from donor to recipient. Understanding and minimizing this risk is difficult for many reasons: donor screening processes vary, screening for every infectious organism is not possible, and assessment of recipient health after transplantation to determine possibility of disease transmission is often not adequate. In May 2010, the US Food and Drug Administration held a meeting to address these challenges and establish a research agenda for minimizing these transplant transmission risks. Attendees agreed that the focus should be on standardizing donor screening, compiling disease transmissibility data, monitoring of transplant recipients’ health, and assessing effectiveness of measures to minimize disease transmission. Collaboration and sharing of perspectives, experiences, and resources of all stakeholders in the transplantation process (government, private industry, and health care providers) can improve the safety of organ and tissue transplantation.

Epstein-Barr virus: general factors, virus-related diseases and measurement of viral load after transplant

Gequelin, Luciana Cristina Fagundes; Riediger, Irina N.; Nakatani, Sueli M.; Biondo, Alexander W.; Bonfim, Carmem M.
Fonte: Associação Brasileira de Hematologia e Hemoterapia Publicador: Associação Brasileira de Hematologia e Hemoterapia
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
Relevância na Pesquisa
392.47617%
The Epstein-Barr virus is responsible for infectious mononucleosis syndrome and is also closely associated to several types of cancer. The main complication involving Epstein-Barr virus infection, both in recipients of hematopoietic stem cells and solid organs, is post-transplant lymphoproliferative disease. The importance of this disease has increased interest in the development of laboratory tools to improve post-transplant monitoring and to detect the disease before clinical evolution. Viral load analysis for Epstein-Barr virus through real-time polymerase chain reaction is, at present, the best tool to measure viral load. However, there is not a consensus on which sample type is the best for the test and what is its predictive value for therapeutic interventions.

Design and methodology of the Swiss Transplant Cohort Study (STCS): a comprehensive prospective nationwide long-term follow-up cohort

Koller, Michael T.; van Delden, Christian; Müller, Nicolas J.; Baumann, Philippe; Lovis, Christian; Marti, Hans-Peter; Fehr, Thomas; Binet, Isabelle; De Geest, Sabina; Bucher, Heiner C.; Meylan, Pascal; Pascual, Manuel; Steiger, Jürg
Fonte: Springer Netherlands Publicador: Springer Netherlands
Tipo: Artigo de Revista Científica
EN
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In Switzerland, organ procurement is well organized at the national-level but transplant outcomes have not been systematically monitored so far. Therefore, a novel project, the Swiss Transplant Cohort Study (STCS), was established. The STCS is a prospective multicentre study, designed as a dynamic cohort, which enrolls all solid organ recipients at the national level. The features of the STCS are a flexible patient-case system that allows capturing all transplant scenarios and collection of patient-specific and allograft-specific data. Beyond comprehensive clinical data, specific focus is directed at psychosocial and behavioral factors, infectious disease development, and bio-banking. Between May 2008 and end of 2011, the six Swiss transplant centers recruited 1,677 patients involving 1,721 transplantations, and a total of 1,800 organs implanted in 15 different transplantation scenarios. 10 % of all patients underwent re-transplantation and 3% had a second transplantation, either in the past or during follow-up. 34% of all kidney allografts originated from living donation. Until the end of 2011 we observed 4,385 infection episodes in our patient population. The STCS showed operative capabilities to collect high-quality data and to adequately reflect the complexity of the post-transplantation process. The STCS represents a promising novel project for comparative effectiveness research in transplantation medicine.

Xenotransplantation-associated infectious risk: a WHO consultation

Fishman, Jay A.; Scobie, Linda; Takeuchi, Yasuhiro
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
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Xenotransplantation carries the potential risk of the transmission of infection with the cells or tissues of the graft. The degree of risk is unknown in the absence of clinical trials. The clinical application of xenotransplantation has important implications for infectious disease surveillance, both at the national and international levels. Preclinical data indicate that infectious disease events associated with clinical xenotransplantation from swine, should they occur, will be rare; data in human trials are limited but have demonstrated no transmission of porcine microorganisms including porcine endogenous retrovirus. Xenotransplantation will necessitate the development of surveillance programs to detect known infectious agents and, potentially, previously unknown or unexpected pathogens. The development of surveillance and safety programs for clinical trials in xenotransplantation is guided by a “Precautionary Principle,” with the deployment of appropriate screening procedures and assays for source animals and xenograft recipients even in the absence of data suggesting infectious risk. All assays require training, standardization and validation, and sharing of laboratory methods and expertise to optimize the quality of the surveillance and diagnostic testing. Investigation of suspected xenogeneic infection events (xenosis...

Dengue hemorrhagic fever in a peripheral blood stem cell transplant recipient: the first case report

Visuthranukul, Jirayu; Bunworasate, Udomsak; Lawasut, Panisinee; Suankratay, Chusana
Fonte: PAGEPress Publications Publicador: PAGEPress Publications
Tipo: Artigo de Revista Científica
Publicado em 06/11/2009 EN
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Dengue infection, a mosquito-borne infectious disease in tropical and subtropical areas, has recently become an emerging global disease. The clinical course of dengue infection may be unfavorable in immunocompromised patients. In this report, we present a 16-year old female patient with acute myeloid leukemia who received allogeneic peripheral blood stem cell transplant five months prior to presentation. She was hospitalized at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, due to fever, headache, and myalgia for one day. During hospitalization, she developed capillary leakage syndrome and progressive thrombocytopenia. A diagnosis of dengue hemorrhagic fever was made and confirmed by positive dengue serology and polymerase chain reaction testing. She made a full recovery 14 days after hospitalization. Our case possibly acquired dengue virus from infected mosquitoes while visiting her relatives four days before her present illness. In conclusion, this is the first reported case of dengue hemorrhagic fever in a peripheral blood stem cell transplant recipient. In addition, we review all previous reports of dengue infection in organ transplant recipients.

Allogeneic CD34 selected peripheral stem cell transplant for Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI): rapid haemopoietic and biochemical reconstitution

Alvaro, F.; Toogood, I.; Fletcher, J.; Clements, P.; Rawling, T.; To, B.
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Artigo de Revista Científica
Publicado em //1998 EN
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Severe Maroteaux–Lamy syndrome is usually fatal in teenage or early adult life. Until recently, allogeneic bone marrow transplantation was the only form of enzyme replacement. We report the first successful transplant using CD34 selected, mobilised allogeneic blood cells for an inborn error of metabolism. A busulphan, cyclophosphamide, melphalan and antithymocyte globulin conditioning regimen was used as myeloablative therapy. Allogeneic CD34 selected granulocyte colony-stimulating factor (G-CSF)-mobilised blood cells from a HLA-identical sibling were used for the transplant. Haemopoietic reconstitution occurred on day 10 post-transplant with normal N-acetylgalactosamine-4-sulphatase levels. Infectious and graft-versus-host disease (GVHD) complications were minimal. We suggest that CD34 selected, mobilised allogeneic blood cells are a safe form of enzyme replacement therapy in Maroteaux–Lamy syndrome and should be considered in other metabolic diseases where the benefits of haemopoietic transplantation are proven.

Prevalência de anticorpos anti-herpesvírus humano tipo 8 (HHV-8) em soros de pacientes com insuficiência renal crônica; Prevalence of human herpesvirus-8 (HHV-8) antibodies in serum samples from patients with chronic kidney disease

Magri, Mariana Cavalheiro
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 21/07/2008 PT
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A infecção pelo herpesvírus humano tipo 8 (HHV-8) tem sido associada ao sarcoma de Kaposi (SK) iatrogênico, que acomete pacientes imunossuprimidos e/ou transplantados renais. Em populações consideradas saudáveis, a soroprevalência para o HHV-8 varia de 1% a 8%. O presente trabalho buscou: determinar a prevalência e os títulos de anticorpos anti-HHV-8 em pacientes com insuficiência renal crônica (IRC), submetidos ou não à terapia renal substitutiva (TRS) do Hospital do Rim e Hipertensão e Casa da Diálise da UNIFESP e da Santa Casa de Misericórdia de São Paulo e, comparar os resultados obtidos com outras populações da mesma região geográfica, porém de outras categorias de risco para adquirir doenças infecciosas. Soros de 805 pacientes: 295 em hemodiálise, 54 em diálise peritoneal e 456 em acompanhamento ambulatorial, sem TRS, foram testados quanto à presença de anticorpos anti-HHV-8, de fase latente e lítica da replicação viral, por meio de técnicas de imunofluorescência indireta (IFI) LANA e Lítico, padronizadas na Seção de Imunologia do Instituto Adolfo Lutz. Os resultados obtidos foram analisados em relação a dados clínicos, epidemiológicos e laboratoriais usando o teste do qui-quadrado ou exato de Fisher para as variáveis categóricas e os testes de Mann Whitney ou Kruskal Wallis para as variáveis contínuas. Foi encontrada soropositividade ao HHV-8 em 18...

Agentes infecciosos e inflamação em miocárdio de pacientes com miocardiopatia dilatada; Infectious agents and inflammation in the myocardium of patients with dilated cardiomyopathy

Mangini, Sandrigo
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 03/04/2013 PT
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A insuficiência cardíaca é uma síndrome clínica de alta morbimortalidade e em uma parcela expressiva de casos, sem etiologia definida, o papel de agentes infecciosos tem sido considerado. No entanto, muitas dúvidas existem neste contexto, além de incipiente participação da população nacional em estudos sobre o tema. O objetivo deste estudo foi determinar a frequência de agentes infecciosos pré-estabelecidos e de inflamação, em fragmentos de biopsia endomiocárdica de pacientes com miocardiopatia dilatada idiopática e miocardiopatias de outras etiologias específicas, em comparação a grupo controle sem evidência de cardiopatia. Entre julho de 2008 e agosto de 2011 foram estudados fragmentos de biopsia endomiocárdica de pacientes internados com miocardiopatia dilatada idiopática em avaliação para transplante cardíaco, doadores e corações explantados de diferentes miocardiopatias. Foram definidos 2 grupos: doadores (29 casos) e miocardiopatas (55 casos, incluindo, 32 idiopáticos, 9 chagásicos, 6 isquêmicos e 8 de outras etiologias específicas). Observamos que a inflamação por linfócitos T foi mais intensa nos miocardiopatas em relação aos doadores, não havendo diferença em relação à presença de macrófagos...

Evaluation of the presence of microorganisms in solid-organ preservation solution

Mattana,André Marcelo Colvara; Marra,Alexandre Rodrigues; Machado,Antônia Maria de Oliveira; Lopes Filho,Gaspar de Jesus; Salzedas Netto,Alcides Augusto; Gonzalez,Adriano Miziara
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2011 EN
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OBJECTIVE: To assess the presence of microorganism contamination in the preservation solution for transplant organs (kidney/pancreas). Method: Between August 2007 and March 2008, 136 samples of preservation solution were studied prior to graft implantation. Variables related to the donor and to the presence of microorganisms in the preservation solution of organs were evaluated, after which the contamination was evaluated in relation to the "recipient culture" variable. Univariate and multivariate statistical analyses were performed. RESULTS: The contamination rate of the preservation solution was 27.9%. Coagulase-negative Staphylococcus was the most frequently isolated microorganism. However, highly virulent agents, such as fungi and enterobacteria, were also isolated. In univariate analysis, the variable "donor antibiotic use" was significantly associated to the contamination of the preservation solution. On the other hand, multivariate analysis found statistical significance in "donor antibiotic use" and "donor's infectious complications" variables. CONCLUSIONS: In this study, 27.9% of the preservation solutions of transplant organs were contaminated. Infectious diseases and non-use of antibiotics by the donor were significantly related to the presence of microorganisms in organ preservation solutions. Contamination in organ preservation solutions was not associated with infection in the recipient.

Evaluation of the presence of microorganisms in solid-organ preservation solution

Mattana, André Marcelo Colvara; Marra, Alexandre Rodrigues; Machado, Antônia Maria de Oliveira; Lopes Filho, Gaspar de Jesus; Salzedas Netto, Alcides Augusto; Gonzalez, Adriano Miziara
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: 528-532
ENG
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OBJECTIVE: To assess the presence of microorganism contamination in the preservation solution for transplant organs (kidney/pancreas). Method: Between August 2007 and March 2008, 136 samples of preservation solution were studied prior to graft implantation. Variables related to the donor and to the presence of microorganisms in the preservation solution of organs were evaluated, after which the contamination was evaluated in relation to the recipient culture variable. Univariate and multivariate statistical analyses were performed. RESULTS: The contamination rate of the preservation solution was 27.9%. Coagulase-negative Staphylococcus was the most frequently isolated microorganism. However, highly virulent agents, such as fungi and enterobacteria, were also isolated. In univariate analysis, the variable donor antibiotic use was significantly associated to the contamination of the preservation solution. on the other hand, multivariate analysis found statistical significance in donor antibiotic use and donor's infectious complications variables. CONCLUSIONS: In this study, 27.9% of the preservation solutions of transplant organs were contaminated. Infectious diseases and non-use of antibiotics by the donor were significantly related to the presence of microorganisms in organ preservation solutions. Contamination in organ preservation solutions was not associated with infection in the recipient.

Toxoplasma reactivation after renal transplant – low expression of nitric oxide synthase and a Th2 pattern of immune response

Tuon, Felipe Francisco; Division of Infectious Diseases, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil.; Cordeiro, Daiane Maria; Faculdade Evangélica do Paraná
Fonte: Setor de Ciência da Saúde - Universidade Federal do Paraná Publicador: Setor de Ciência da Saúde - Universidade Federal do Paraná
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Avaliado pelos pares;
Publicado em 09/12/2015 EN
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Background: The mechanism of immunosuppression associated with reactivation of the toxoplasmosis in transplanted patients is known, but the interactions of the human cells and cytokines expression is not well established.Case report: We described a case of toxoplasmosis reactivation in a renal transplanted patient with pneumonitis. The in situ expression of cytokines and cellular phenotypes was evaluated in this case.Results: A Th2 pattern of immune response predominated with strong expression of TGF-beta, TNF-alpha and IL-10. The expression of IL-2 receptor, nitric oxide synthase and IFN-gamma were weak.Conclusion: The reactivation of toxoplasmosis in the lung was associated with a Th2 pattern of immune response and decreased activity of macrophages.

A diagnosis not to forget in a long -term kidney transplant: Pneumocystis pneumonia

Bento,Claudia; Martins,La Salete; Almeida,Manuela; Pedroso,Sofia; Dias,Leonideo; Henriques,Antonio Castro; Cabrita,Antonio
Fonte: Sociedade Portuguesa de Nefrologia Publicador: Sociedade Portuguesa de Nefrologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2014 EN
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Potential aetiologies of infection in kidney transplant patients are diverse, ranging from common community-acquired infectious diseases to uncommon opportunistic infections. Pneumocystis is a wellknown opportunistic fungus that can cause life-threatening pneumonia in kidney transplant patients mostly within the first 6 months post-transplantation. This en tity may occur after one year post-transplant, but the rate is very low. High immunosuppression, cytomegalovirus infection, previous history of acute rejection and poor GFR are risk factors for the occurrence of pneumocystis pneumonia (PCP) in kidney transplant patients. The treatment of choice is high-dose trimethoprim-sulfamethoxazol (TMP-SMX), reduction of immunosuppressive therapy and, in severe cases (defined by PaO2 < 70 mmHg or an arterial-alveolar gradient > 35 mmHg), association with steroids. We report a case of PCP 12.5 years after renal transplant. A 51-yearold male presented to the hospital with a 3-day history of asthenia, fever and genitourinary complains. Despite the initial treatment for cystitis he kept fever (> 38.5°C) and developed dry cough, hypoxaemia and rapidly progressive dyspnea. Physical examination revealed increased respiratory rate, tachycardia...