RESUMO
BACKGROUND: There is no specific antiviral treatment for parvovirus B19 (PVB19) infection. OBJECTIVE: The objective of this study was to study the treatment and outcome of PVB19 infection in kidney transplant recipients (KTR) at our institution, and cases published in the medical literature. METHODS: We conducted a retrospective review of PVB19 infection in KTR at an academic medical center over a 16-year period and summarized the data on its treatment and outcome in 120 KTR in the medical literature. RESULTS: In our cohort of eight patients, the median time to the onset of PVB19 disease was 7.2 weeks after transplantation. All patients had severe aregenerative anemia (mean hemoglobin (Hb) of 6.2 ± 1.0 g/dl); all were treated with a reduction in their immunosuppressive regimen and the administration of single-dose intravenous immunoglobulin (IVIG) (mean total dosage of 0.87 ± 0.38 g/kg). The median time to anemia improvement (Hb >10 g/dl) was 3-week post-treatment. No recurrences were documented during follow-up (median 25 months). Among 128 patients (including our cohort of 8 and 120 reported in literature), therapeutic strategies included: 43% IVIG alone, 39% IVIG and reduced immunosuppression, 9% reduction of immunosuppression, and 9% conservative therapy. Clinical relapses were observed in 35% of 71 reported cases. CONCLUSIONS: In KTR, decreasing immunosuppression and the administration of low-dose immunoglobulin seem to be not worse than the standard dose in PVB19 infection.
Assuntos
Eritema Infeccioso/terapia , Imunoglobulinas Intravenosas/administração & dosagem , Imunossupressores/administração & dosagem , Transplante de Rim/métodos , Centros Médicos Acadêmicos , Adulto , Eritema Infeccioso/etiologia , Feminino , Seguimentos , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Abstract Background There is no specific antiviral treatment for parvovirus B19 (PVB19) infection. Objective The objective of this study was to study the treatment and outcome of PVB19 infection in kidney transplant recipients (KTR) at our institution, and cases published in the medical literature. Methods We conducted a retrospective review of PVB19 infection in KTR at an academic medical center over a 16-year period and summarized the data on its treatment and outcome in 120 KTR in the medical literature. Results In our cohort of eight patients, the median time to the onset of PVB19 disease was 7.2 weeks after transplantation. All patients had severe aregenerative anemia (mean hemoglobin (Hb) of 6.2 ± 1.0 g/dl); all were treated with a reduction in their immunosuppressive regimen and the administration of single-dose intravenous immunoglobulin (IVIG) (mean total dosage of 0.87 ± 0.38 g/kg). The median time to anemia improvement (Hb >10 g/dl) was 3-week post-treatment. No recurrences were documented during follow-up (median 25 months). Among 128 patients (including our cohort of 8 and 120 reported in literature), therapeutic strategies included: 43% IVIG alone, 39% IVIG and reduced immunosuppression, 9% reduction of immunosuppression, and 9% conservative therapy. Clinical relapses were observed in 35% of 71 reported cases. Conclusions In KTR, decreasing immunosuppression and the administration of low-dose immunoglobulin seem to be not worse than the standard dose in PVB19 infection.
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Transplante de Rim/métodos , Imunoglobulinas Intravenosas/administração & dosagem , Eritema Infeccioso/terapia , Imunossupressores/administração & dosagem , Recidiva , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Eritema Infeccioso/etiologia , Centros Médicos AcadêmicosRESUMO
Primary laryngeal aspergillosis is a rare condition. Only a few cases have been reported in the past years. Most of them have been reported in healthy patients or with a mild immunocompromised state. We report a case of primary laryngeal aspergillosis in a solid organ transplant recipient (SOT), an infection not previously described in this population; we reviewed the published literature in all populations.
Assuntos
Aspergilose/diagnóstico , Aspergillus fumigatus/isolamento & purificação , Hospedeiro Imunocomprometido , Transplante de Rim/efeitos adversos , Laringe/microbiologia , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/imunologia , Aspergilose/microbiologia , Biópsia , Rejeição de Enxerto/prevenção & controle , Humanos , Terapia de Imunossupressão/efeitos adversos , Falência Renal Crônica/cirurgia , Laringoscopia , Laringe/diagnóstico por imagem , Laringe/patologia , Masculino , Pessoa de Meia-IdadeAssuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Falência Renal Crônica/terapia , Nefrite Lúpica/complicações , Infecções por Mycobacterium/microbiologia , Trombose/microbiologia , Adulto , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/microbiologia , Tronco Braquiocefálico/patologia , Tronco Braquiocefálico/cirurgia , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/microbiologia , Veias Braquiocefálicas/patologia , Veias Braquiocefálicas/cirurgia , Feminino , Humanos , Falência Renal Crônica/etiologia , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium/patologia , Diálise Renal/efeitos adversos , Staphylococcus epidermidis/isolamento & purificação , Trombose/diagnóstico por imagem , Trombose/patologia , Ultrassonografia Doppler em CoresRESUMO
Electrolyte and acid-base disturbances are frequent in patients with end-stage liver disease; the underlying physiopathological mechanisms are often complex and represent a diagnostic and therapeutic challenge to the physician. Usually, these disorders do not develop in compensated cirrhotic patients, but with the onset of the classic complications of cirrhosis such as ascites, renal failure, spontaneous bacterial peritonitis and variceal bleeding, multiple electrolyte, and acid-base disturbances emerge. Hyponatremia parallels ascites formation and is a well-known trigger of hepatic encephalopathy; its management in this particular population poses a risky challenge due to the high susceptibility of cirrhotic patients to osmotic demyelination. Hypokalemia is common in the setting of cirrhosis: multiple potassium wasting mechanisms both inherent to the disease and resulting from its management make these patients particularly susceptible to potassium depletion even in the setting of normokalemia. Acid-base disturbances range from classical respiratory alkalosis to high anion gap metabolic acidosis, almost comprising the full acid-base spectrum. Because most electrolyte and acid-base disturbances are managed in terms of their underlying trigger factors, a systematic physiopathological approach to their diagnosis and treatment is required.
Assuntos
Desequilíbrio Ácido-Base/fisiopatologia , Doença Hepática Terminal/fisiopatologia , Desequilíbrio Hidroeletrolítico/fisiopatologia , Desequilíbrio Ácido-Base/etiologia , Alcalose/etiologia , Alcalose/fisiopatologia , Progressão da Doença , Doença Hepática Terminal/complicações , Humanos , Hipopotassemia/etiologia , Hipopotassemia/fisiopatologia , Hiponatremia/etiologia , Hiponatremia/fisiopatologia , Desequilíbrio Hidroeletrolítico/etiologiaRESUMO
BACKGROUND: Renal thrombotic microangiopathy (TMA) may be associated with lupus nephritis. Its relationship to other disease factors and its specific effect on prognosis are not precisely known. Evidence regarding these aspects is controversial, and information focusing on kidney-limited TMA in systemic lupus erythematosus (SLE) patients is scarce. OBJECTIVES: The aims of this study were to identify risk factors for renal TMA in patients with lupus nephritis and to determine its impact on clinical outcomes. METHODS: A case-control study was performed. We studied 245 renal biopsies from SLE patients. We included patients with renal TMA, as well as control subjects adjusted for glomerulonephritis class, estimated glomerular filtration rate, activity and chronicity indices, and follow-up time. Serological and clinical features were measured at the time of the biopsy and during follow-up. RESULTS: Twenty-three patients with renal TMA and 21 control subjects were included. There were no differences in Systemic Lupus Erythematosus Disease Activity Index score, end-stage renal disease, or mortality between groups during follow-up. After multivariate analysis, lymphopenia (odds ratio, 10.69; 95% CI, 1.35-84.74) and anti-Ro antibody positivity (odds ratio, 8.96; 95% CI, 1.49-53.57) remained significantly associated with renal TMA. CONCLUSIONS: Lymphopenia and anti-Ro positivity are independent risk factors for renal TMA in SLE patients. This increased risk could be a consequence of the potential role of these factors in endothelial dysfunction and damage. Outcomes were similar for patients with the same estimated glomerular filtration rate and biopsy characteristics, regardless of the presence of TMA.