201
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Morales JM, Campistol JM, Dominguez-Gil B. Hepatitis C virus infection and kidney transplantation. Semin Nephrol 2002. [DOI: 10.1053/snep.2002.33677] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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202
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205
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Delarocque-Astagneau E, Baffoy N, Thiers V, Simon N, de Valk H, Laperche S, Couroucé AM, Astagneau P, Buisson C, Desenclos JC. Outbreak of hepatitis C virus infection in a hemodialysis unit: potential transmission by the hemodialysis machine? Infect Control Hosp Epidemiol 2002; 23:328-34. [PMID: 12083237 DOI: 10.1086/502060] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To identify the routes of transmission during an outbreak of infection with hepatitis C virus (HCV) genotype 2a/2c in a hemodialysis unit. DESIGN A matched case-control study was conducted to identify risk factors for HCV seroconversion. Direct observation and staff interviews were conducted to assess infection control practices. Molecular methods were used in a comparison of HCV infecting isolates from the case-patients and from patients infected with the 2a/2c genotype before admission to the unit. SETTING A hemodialysis unit treating an average of 90 patients. PATIENTS A case-patient was defined as a patient receiving hemodialysis with a seroconversion for HCV genotype 2a/2c between January 1994 and July 1997 who had received dialysis in the unit during the 3 months before the onset of disease. For each case-patient, 3 control-patients were randomly selected among all susceptible patients treated in the unit during the presumed contamination period of the case-patient. RESULTS HCV seroconversion was associated with the number of hemodialysis sessions undergone on a machine shared with (odds ratio [OR] per additional session, 1.3; 95% confidence interval [CI95], 0.9 to 1.8) or in the same room as (OR per additional session, 1.1; CI95, 1.0 to 1.2) a patient who was anti-HCV (genotype 2a/2c) positive. We observed several breaches in infection control procedures. Wetting of transducer protectors in the external pressure tubing sets with patient blood reflux was observed, leading to a potential contamination by blood of the pressure-sensing port of the machine, which is not accessible to routine disinfection. The molecular analysis of HCV infecting isolates identified among the case-patients revealed two groups of identical isolates similar to those of two patients infected before admission to the unit. CONCLUSIONS The results suggest patient-to-patient transmission of HCV by breaches in infection control practices and possible contamination of the machine. No additional cases have occurred since the reinforcement of infection control procedures and the use of a second transducer protector.
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206
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Bloom RD, Rao V, Weng F, Grossman RA, Cohen D, Mange KC. Association of hepatitis C with posttransplant diabetes in renal transplant patients on tacrolimus. J Am Soc Nephrol 2002; 13:1374-80. [PMID: 11961026 DOI: 10.1097/01.asn.0000012382.97168.e0] [Citation(s) in RCA: 215] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Posttransplant diabetes mellitus (PTDM) remains a common complication of immunosuppression. Although multiple risk factors have been implicated, none have been clearly identified as predisposing to the increased PTDM frequency observed in patients on tacrolimus. Hepatitis C virus (HCV) has been associated with diabetes and is a significant renal transplant comorbidity. In this study, records of 427 kidney recipients who had no known diabetes before transplantation were retrospectively examined. A multivariate logistic regression model was fit with covariates that had unadjusted relationships with PTDM to examine the independent relationship of HCV and the odds of development of PTDM by 12 mo posttransplant. A potential interaction between HCV and the use of tacrolimus as maintenance therapy on the odds of the development of PTDM was examined. Overall, PTDM occurred more frequently in HCV(+) than HCV(-) patients (39.4% versus 9.8%; P = 0.0005). By multivariate logistic regression, HCV (adjusted odds ratio [OR], 5.58; 95% confidence interval [CI], 2.63 to 11.83; P = 0.0001), weight at transplantation (adjusted OR 1.028; 95% CI, 1.00 to 1.05; P = 0.001), and tacrolimus (adjusted OR, 2.85; 95% CI, 1.01 to 5.28; P = 0.047) were associated with PTDM. A significant interaction (P = 0.0001) was detected between HCV status and tacrolimus use for the odds of PTDM. Among the HCV(+) cohort, PTDM occurred more often in tacrolimus-treated than cyclosporine A-treated patients (57.8% versus 7.7%; P < 0.0001). PTDM rates in HCV(-) patients were similar between the two calcineurin inhibitors (10.0% versus 9.4%; P = 0.521, tacrolimus versus cyclosporine A). In conclusion, HCV is strongly associated with PTDM in renal transplant recipients and appears to account for the increased diabetogenicity observed with tacrolimus.
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Affiliation(s)
- Roy D Bloom
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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207
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Ratge D, Scheiblhuber B, Landt O, Berg J, Knabbe C. Two-round rapid-cycle RT-PCR in single closed capillaries increases the sensitivity of HCV RNA detection and avoids amplicon carry-over. J Clin Virol 2002; 24:161-72. [PMID: 11856617 DOI: 10.1016/s1386-6532(01)00244-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND For the detection of hepatitis C virus (HCV) specific nucleic acids the polymerase chain reaction (PCR) is widely used. Rapid-cycle PCR is performed in glass capillaries with the LightCycler instrument and allows PCR including product analysis to be performed within a closed system in about 1 h. Thus, rapid-cycle PCR appears especially suitable for routine diagnostic applications. However, the volume of the PCR vessel is restricted to about 20 microl, which may limit the sensitivity of the PCR. To increase its sensitivity two-round or nested primer PCR protocols have been developed. In rapid-cycle PCR first-round PCR products are usually collected from the capillaries by centrifugation, a procedure prone to cross-contamination. OBJECTIVES Development of a two-round rapid-cycle reverse transcription-polymerase chain reaction (RT-PCR) in single closed LightCycler capillaries for the sensitive detection of HCV RNA in serum or plasma. STUDY DESIGN A set of two pairs of nested primers was selected. The first-round RT-PCR reaction mixture was separated from the second-round PCR mixture by silicone oil. Reverse transcription followed by the first-round PCR was performed. Then, the second-round mixture was combined with first-round products by a centrifugation step followed by second round PCR during which fluorescence intensities were recorded and used for quantification. RESULTS To establish the sensitivity of this novel assay a serial dilution of HCV reference standard was used. In plasma samples about 100 IU/ml HCV were consistently detected using the high pure viral RNA kit for nucleic acid purification. This detection limit was found to be about 20 fold increased compared with single-round RT-PCR and corresponded to 3.4 IU of HCV per capillary. Using a panel of HCV genotype standards the novel assay exhibited similar sensitivity for all HCV genotypes. The applicability for clinical routine testing was demonstrated by examining 156 clinical samples. CONCLUSION Two-round RT-PCR with the LightCycler instrument using a single closed capillary throughout the procedure was found ideally suited for rapid (100 min), accurate and sensitive molecular diagnosis of active HCV infections. Since the capillaries remained closed during the procedure carry-over contamination was precluded.
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Affiliation(s)
- D Ratge
- Institute of Clinical Pathology, Robert Bosch Hospital, Auerbachstrasse 110, D-70376 Stuttgart, Germany.
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208
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Almroth G, Ekermo B, Månsson AS, Svensson G, Widell A. Detection and prevention of hepatitis C in dialysis patients and renal transplant recipients. A long-term follow up (1989-January 1997). J Intern Med 2002; 251:119-28. [PMID: 11905587 DOI: 10.1046/j.1365-2796.2002.00938.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hepatitis C is frequent problem in dialysis wards. DESIGN A long time (1989-97) follow up of hepatitis C virus (HCV) infection in a Swedish nephrology unit was performed with anti-HCV screening, confirmatory antibody tests, viral RNA detection and molecular characterization. Case histories were reviewed with focus, onset of infection, liver morbidity and mortality. RESULTS In October 1991, 10% (19 of 184) of the patients in the unit (haemodialysis-, peritoneal dialysis and transplanted patients) were verified or suspected HCV carriers, whilst the number at the end of 1996 was 8%, (13 of 157). Most patients were infected before 1991 but only in one case from a known HCV-infected blood donor. No new HCV infections associated with haemodialysis occurred during the study period. A total of 13 of 24 viremic patients had HCV genotype 2b, a pattern suggesting nosocomial transmission. This was further supported by phylogenetic analysis of HCV viral isolates in seven. HCV viremia was also common in patients with an incomplete anti-HCV antibody pattern as 8 of the 12 indeterminant sera were HCV-RNA positive. CONCLUSIONS Awareness, prevention, identification of infected patients and donor testing limited transmission. Indeterminant recombinant immunoblot assays (RIBA)-results should be regarded with caution as a result of the relative immunodeficiency in uremic patients. Our data indicate nosocomial transmission in several patients.
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Affiliation(s)
- G Almroth
- Department of Nephrology, University Hospital of Linköping, Sweden.
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209
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Fong TL, Bunnapradist S, Jordan SC, Cho YW. Impact of hepatitis B core antibody status on outcomes of cadaveric renal transplantation: analysis of United network of organ sharing database between 1994 and 1999. Transplantation 2002; 73:85-9. [PMID: 11792984 DOI: 10.1097/00007890-200201150-00016] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Organ shortage continues to be a major problem in transplantation. The use of organs from marginal donors who are hepatitis B surface antigen (HBsAg) negative and hepatitis B core antibody (anti-HBc Ab) reactive (+), could increase the donor pool substantially. Little information is available about the effects of anti-HBc Ab (+) donor status on viral transmission, and graft and patient survival. To address these issues, an analysis was performed using the United Network of Organ Sharing cadaveric kidney transplant database between 1994 to 1999. METHODS All cadaveric kidney transplants performed between 1994 to 1999 with negative HBsAg serology were evaluated. Viral transmission, and graft and patient outcomes were measured. The analysis included follow-up information in the United Network of Organ Sharing database through September 2000. A multivariate analysis was performed, using known confounding factors that may affect the outcomes in donors and recipients who were designated as (+) or (-) (D+/R+, ++D+/R-, D-/R-, and D-/R+) according to their anti-HBc Ab status. RESULTS Univariate analyses showed that graft and patient survival rates were statistically significantly lower in D+/R- compared with those who were D-/R-. However, multivariate regression analyses showed that neither donor nor recipient anti-HBc Ab status influenced the risk of graft failure or patient death after adjustment for other factors. Anti-HBc Ab (+) kidneys resulted in a higher incidence of anti-HBc antibody seroconversion but this was not associated with a higher incidence of HBsAg detection. CONCLUSION We conclude that renal allografts from anti-HBc Ab (+) donors should be considered for transplant especially in successfully immunized recipients.
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Affiliation(s)
- Tse-Ling Fong
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, 2011 Zonal Avenue HMR 101, Los Angeles CA 90033, USA
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210
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Valtuille R, Frankel F, Gómez F, Moretto H, Fay F, Rendo P, Lef L, Fernández J. The role of transfusion-transmitted virus in patients undergoing hemodialysis. J Clin Gastroenterol 2002; 34:86-8. [PMID: 11743253 DOI: 10.1097/00004836-200201000-00017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
GOALS To study transfusion-transmitted virus (TTV) infection in 75 patients on hemodialysis and examine its relationship with age, sex, duration of dialysis, history of transfusion, and chronic elevation of alanine aminotransferase (ALT) levels. STUDY Serum TTV was analyzed by polymerase chain reaction (PCR), TTV genotypes by restriction fragment length polymorphism, and hepatitis C virus (HCV) RNA by PCR. RESULTS Transfusion-transmitted virus was detected in 32 patients (42.7%). Transfusion-transmitted virus genotypes were as follows: G1 in 16 patients; G2, 3; G3, 1; G4, 2; G2-G5, 6; and unclassified, 4. Mean duration of dialysis was 37 +/- 32 months for TTV-positive patients and 43 +/- 37 months for TTV-negative patients (not significant). Twenty-seven (84%) TTV-positive patients and 27 (63%) TTV-negative patients had a history of transfusions ( p = 0.04). Chronic ALT elevation was observed in 9 patients; 5 of them were TTV-positive (16%) and 4 were TTV-negative (9%) (not significant). Four (40%) HCV RNA-positive patients and 5 (8%) HCV RNA-negative patients had chronic ALT elevation ( p = 0.003). Three TTV-positive patients with chronic ALT elevation were also infected with HCV. The two patients with isolated TTV infection did not have another clinical feature to explain their ALT elevation. CONCLUSIONS Transfusion-transmitted virus had a high prevalence in the patients on hemodialysis; genotype G1 accounts for half of the cases. Transfusion-transmitted virus infection depends on the transfusional antecedent but not on the duration of dialysis. Chronic ALT elevation is significantly associated with HCV infection but not TTV infection. However, TTV could be a causative agent of chronic ALT elevation in some patients.
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Affiliation(s)
- Rodolfo Valtuille
- RTC, Monte Grande, CDM, Bio Sidus, Department of Clinical Research, Buenos Aires, Argentina
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211
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Bourlière M, Barberin JM, Rotily M, Guagliardo V, Portal I, Lecomte L, Benali S, Boustière C, Perrier H, Jullien M, Lambot G, Loyer R, LeBars O, Daniel R, Khiri H, Halfon P. Epidemiological changes in hepatitis C virus genotypes in France: evidence in intravenous drug users. J Viral Hepat 2002; 9:62-70. [PMID: 11851904 DOI: 10.1046/j.1365-2893.2002.00319.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hepatitis C virus (HCV) genotypes are distributed differently depending on geography and route of infection. We characterized the distribution of genotypes in a large cohort of patients with chronic hepatitis C in the South-east of France and evaluated the relative prevalence according to time of acquisition. One thousand, one hundred-and-eighty-three patients who were anti-HCV-positive were studied. HCV genotype distribution has changed significantly from the 1960s to 2000. The prevalence of genotype 1b decreased from 47% before 1978 to 18.8% in the 1990s while the prevalence of genotype 1a and 3a increased during the same period from 18% and 15.3% to 28.8% and 26.3%, respectively. The logistic regression model showed that genotype 1a was significantly more common in patients infected through intravenous drug injection odds ratio ((OR): 2.08, P < 0.01) and after 1990 (OR: 1.98, P < 0.05). Genotype 1b was significantly less frequent in patients infected through intravenous drug injection (OR: 0.17, P < 0.001) and has decreased since 1978 (OR: 0.27, P < 0.001). Genotype 3a was independently associated with intravenous drug injection (OR: 6.1, P < 0.001) and tattooing (OR: 8.01, P < 0.001) and was more frequent in the 1979-90 period (OR: 2.05 and 1.74, P < 0.001 and P < 0.05). Our results show a modification of HCV genotypes distribution over the last four decades due to an increase of intravenous drug use (IVDU) contamination and an evolution of HCV genotypes distribution only in IVDU population characterized by a decrease of genotype 1b, an increase of genotype 3a from 1970 to 1990 and a higher increase of genotype 1a which is currently the predominant genotype in our population.
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Affiliation(s)
- M Bourlière
- Department of Gastroenterology and Liver Unit, Hôpital Saint Joseph, France.
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212
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Braun WE, Yadlapalli NG. The spectrum of long-term renal transplantation: Outcomes, complications, and clinical studies. Transplant Rev (Orlando) 2002. [DOI: 10.1053/trre.2002.28889] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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213
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Gokal R. Peritoneal Dialysis in the 21st Century: An Analysis of Current Problems and Future Developments. J Am Soc Nephrol 2002. [DOI: 10.1681/asn.v13suppl_1s104] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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214
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Abstract
With the success of organ transplantation, liver disease has emerged as an important cause of morbidity and mortality of renal transplant (RT) recipients. Numerous studies performed during the 1990s have shown that hepatitis C virus (HCV) infection is the leading cause of chronic liver disease among RT recipients. The transmission of HCV by renal transplantation of a kidney from an HCV-infected organ donor has been shown unequivocally. Liver biopsy is essential in the evaluation of liver disease of RT recipients, and histological studies have shown that HCV-related liver disease after renal transplantation is progressive. The outcome of HCV-related liver disease is probably more aggressive in RT recipients than immunocompetent individuals. Various factors can affect the progression of HCV in the RT population: coinfection with hepatitis B virus, time of HCV acquisition, type of immunosuppressive treatment, and concomitant alcohol abuse. The role of virological features of HCV remains unclear. The natural history of HCV infection after renal transplantation is under evaluation; however, recent surveys with long follow-ups have documented adverse effects of HCV infection on patient and graft survival in RT recipients. Use of renal grafts from HCV-infected donors in recipients with HCV infection does not appear to result in a greater burden of liver disease, at least for a short period. The association between HCV and de novo or recurrent glomerulonephritis after RT has been hypothesized and is an area of avid research. Reported studies do not support interferon (IFN) treatment for RT recipients with chronic hepatitis C because of the frequent occurrence of graft failure, and information on the use of other types of IFN or combined therapy (IFN plus ribavirin or amantadine) is not yet available in the RT population.
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Affiliation(s)
- F Fabrizi
- Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS, Milano, Italy
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215
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Abstract
Hepatitis C is the most common cause of liver disease in the dialysis patient. The prevalence of chronic hepatitis C determined by anti-HCV testing in this population ranges from 6% to 38%. Using second generation EIA assays, the prevalence of anti-HCV among patients participating in the 1997 National Surveillance of Dialysis Associated Diseases in the United States was 9.3%. Polymerase chain reaction testing for HCV RNA has shown that the prevalence of HCV infection can be as high as 20% to 30% of dialysis patients. The causes and source of infection in patients with chronic renal failure on hemodialysis are multiple. Before the introduction of routine screening of blood donors for anti-HCV, blood transfusions were an important risk factor for acquisition of hepatitis C. Other potential sources of infection include exposure to contaminated equipment and nosocomial routes such as patient-to-patient exposure. The risk of infection appears to correlate with the duration of hemodialysis and the number of transfusions. Interestingly, dialysate and buffers have been shown to be virus free even when used in hepatitis C infected patients. The natural history of chronic hepatitis C infection in patients with renal failure is not well characterized. Although persistent elevations in ALT levels occur in 12% to 50% of dialysis patients, the frequency of persistently normal ALT levels in HCV-infected dialysis patients appears to be higher than in HCV-infected patients without renal failure. Overt liver disease and liver failure rarely occur. The degree of inflammation in liver biopsies of renal failure patients is usually mild. Thus, progressive liver disease may be less common in patients with advanced renal disease but further studies are required to assess the true impact of hepatitis C infection in this high risk population. The impact of hepatitis C infection on morbidity and mortality of patients with end-stage renal disease remains poorly defined. Initial studies have failed to show a significant increase in mortality among HCV-infected hemodialysis or renal transplant patients within the first 5 years following transplantation. In contrast, recent studies with extended follow-up of renal transplant recipients suggest that hepatitis C infection may affect patient and graft survival during the second decade. Further studies are required to identify the mechanisms of infection of patients with end-stage renal disease and to define better treatment strategies for these patients before and after kidney transplantation.
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Affiliation(s)
- S L Zacks
- Division of Digestive Diseases and Nutrition, University of North Carolina at Chapel Hill, North Carolina, USA
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216
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Abstract
Patients with chronic renal failure are predisposed to infections. Infections in end-stage renal disease patients are caused by immunosuppressive effects of uremia. Patients with renal failure on dialysis have impaired host defenses and may develop infections related to vascular access. This article reviews the infectious complications related to chronic renal failure in dialysis.
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Affiliation(s)
- V R Minnaganti
- State University of New York School of Medicine, Stony Brook, New York, USA
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217
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Petrosillo N, Gilli P, Serraino D, Dentico P, Mele A, Ragni P, Puro V, Casalino C, Ippolito G. Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis 2001; 37:1004-10. [PMID: 11325683 DOI: 10.1016/s0272-6386(05)80017-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To assess hepatitis C virus (HCV) incidence rates and identify determinants of infection among hemodialysis patients, a multicenter study was conducted in 58 units in ITALY: An initial seroprevalence survey was conducted among 3,492 patients already on hemodialysis therapy as of January 1997 and among an additional 434 patients who began dialysis up to January 1998. HCV antibodies were assessed by third-generation enzyme immunoassays. Patients testing seronegative at baseline were enrolled into a 1-year incidence study with serological follow-up at 6 and 12 months. For patients who seroconverted, an HCV RNA assay was performed on stored baseline samples to confirm new infection. A nested case-control study was subsequently performed to investigate potential risk factors. For each incident case, three controls negative for both HCV antibodies and HCV RNA were randomly selected. At enrollment, HCV seroprevalence was 30.0%. During follow-up, 23 new HCV cases were documented, with a cumulative incidence of 9.5 cases/1,000 patient-years. By logistic regression analysis, an increased risk for HCV infection emerged for patients attending the dialysis units with a high prevalence of HCV-infected patients at baseline (odds ratio [OR], 4.6) and for those attending units with a low personnel-patient ratio (OR, 5.4). Among extradialysis factors, a history of surgical intervention in the previous 6 months (OR, 16.7) significantly increased HCV risk. These findings suggest that the combination of understaffing and a high level of infected patients in the dialysis setting increases the risk for HCV nosocomial transmission. This is likely related to an increased likelihood for breaks in infection control measures.
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Affiliation(s)
- N Petrosillo
- National Institute for Infectious Diseases, IRCCS Lazzaro Spallanzani.
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218
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Weber DJ, Rutala WA. The emerging nosocomial pathogens Cryptosporidium, Escherichia coli O157:H7, Helicobacter pylori, and hepatitis C: epidemiology, environmental survival, efficacy of disinfection, and control measures. Infect Control Hosp Epidemiol 2001; 22:306-15. [PMID: 11428444 DOI: 10.1086/501907] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
New and emerging infectious diseases pose a threat to public health and may be responsible for nosocomial outbreaks. Cryptosporidium parvum and Escherichia coli are gastrointestinal pathogens that have caused nosocomial infections via person-to-person transmission, environmental contamination, or contaminated water or food. Helicobacter pylori has been transmitted via inadequately disinfected endoscopes. Finally, hepatitis C may be acquired by healthcare personnel by percutaneous or mucous membrane exposure to blood or between patients by use of contaminated blood products or via environmental contamination. Rigorous adherence to Standard Precautions, Contact Precautions for patients with infectious diarrhea, disinfection of environmental surfaces, and appropriate disinfection of endoscopes are adequate to prevent nosocomial acquisition of these pathogens.
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Affiliation(s)
- D J Weber
- Department of Medicine, University of North Carolina at Chapel Hill, 27599-7030, USA
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219
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220
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Mas V, Alvarellos T, Chiurchiu C, Camps D, Massari P, de Boccardo G. Hepatitis C virus infection after renal transplantation: viral load and outcome. Transplant Proc 2001; 33:1791-3. [PMID: 11267514 DOI: 10.1016/s0041-1345(00)02682-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- V Mas
- Molecular Diagnostic Lab, Hospital Privado, Córdoba, Argentina
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221
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Mosconi G, Scolari MP, Morelli C, Nardo B, Bertuzzi V, De Pascalis A, Donati G, Zambianchi L, Buscaroli A, Stefoni S. Renal transplantation and HCV hepatitis: a longitudinal study. Transplant Proc 2001; 33:1185. [PMID: 11267249 DOI: 10.1016/s0041-1345(00)02377-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G Mosconi
- Unit of Nephrology, Dialysis and Renal Transplantation, St. Orsola University Hospital, Bologna, Italy
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222
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Noiri E, Nakao A, Oya A, Fujita T, Kimura S. Hepatitis C virus in blood and dialysate in hemodialysis. Am J Kidney Dis 2001; 37:38-42. [PMID: 11136165 DOI: 10.1053/ajkd.2001.20630] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The prevalence of hepatitis C virus (HCV) positivity among hemodialysis patients remains high compared with that of the healthy population, and thus the issue of safety and environmental protection must be addressed. The purpose of this study is to evaluate the dynamics of prehemodialysis and posthemodialysis blood HCV levels and HCV escape to spent dialysate. Because heparin has an inhibitory effect on the reverse-transcription polymerase chain reaction (RT-PCR) assay, a serine protease inhibitor (nafamostat mesilate) was used as the anticoagulant for hemodialysis. High-flux polysulfone membrane dialyzers were used; dialyzer reuse was not performed. Multicyclic RT-PCR was performed for the quantitative detection of HCV. To elucidate HCV escape to spent dialysate, a portion of total spent dialysate was continuously extracted in a sterile fashion using a minutely adjusted syringe pump. No HCV extravasation to spent dialysate was found, although HCV copy numbers were reduced to a statistically significant level in postdialysis blood compared with predialysis levels (P: < 0.05; n = 20). The need to establish standards for risk management in dialysis centers is evident. The data obtained in this study strongly suggest that to minimize the risk for HCV transmission, lower transmembrane pressure (TMP) should be used in the hemodialysis of HCV-positive patients, with fresh polysulfone dialyzers and dialysis settings of 180 to 250 mL/min for blood flow, 500 mL/min for dialysate flow, and less than 18.72 mm Hg for TMP.
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Affiliation(s)
- E Noiri
- Departments of Nephrology and Endocrinology and Infectious Disease and Hemodiafiltration Unit, University of Tokyo, Japan.
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223
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Wang NS, Liao LT, Zhu YJ, Pan W, Fang F. Follow-up study of hepatitis C virus infection in uremic patients on maintenance hemodialysis for 30 months. World J Gastroenterol 2000; 6:888-892. [PMID: 11819715 PMCID: PMC4728281 DOI: 10.3748/wjg.v6.i6.888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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224
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Sarmento A, Freitas F, Tavares AP, Machado D. Organ donor viral screening and its implications in transplantation; an overview. Transplant Proc 2000; 32:2571-6. [PMID: 11134713 DOI: 10.1016/s0041-1345(00)01793-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- A Sarmento
- Infectious Diseases Unit, Hospital Pedro Hispano, Therapeutics and Clinical Pharmacology of Porto Medical School, Porto, Portugal
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225
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Mokrzycki MH, Schröppel B, Gersdorff GVON, Rush H, Zdunek MP, Feingold R. Tunneled-cuffed catheter associated infections in hemodialysis patients who are seropositive for the human immunodeficiency virus. J Am Soc Nephrol 2000; 11:2122-2127. [PMID: 11053489 DOI: 10.1681/asn.v11112122] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Infection rates in tunneled-cuffed catheters (TCC) are reported to be higher in immunocompromised patients. The purpose of this study was to evaluate TCC-associated infection rates in patients with HIV infection (HIV+). Data were collected in 40 HIV + patients and 41 controls (C), and in 118 TCC (HIV+, 58; C, 60) for 28,146 catheter days (HIV+, 16,227; C, 11,919). There were no significant differences in the TCC bacteremia rates (HIV+, 2.23 versus C, 2.53 per 1000 TCC days, P: = NS) or in the TCC exit site infection rates (HIV+, 2.20 versus C, 2.24 per 1000 TCC days, P: = NS) between the groups. The number of TCC removed due to infection was also similar, (HIV+ versus C: 17 versus 15%, P: = NS). In the HIV+ group, the association of hepatitis B surface antigenemia with TCC exit site infection was dependent on the history of injection drug use. Black race was a significant risk factor for higher TCC exit site infection rates, whereas prophylactic antibiotic use and high CD4 count were significantly associated with lower TCC exit site infection rates. None of the factors significantly predicted bacteremia rate in either group (HIV+ or C). In comparison to controls, HIV+ patients had a fivefold increased risk of having a Gramnegative organism (P: = 0.02) and a sevenfold increased risk of a fungal isolate (P: = 0.08), although the latter finding was not statistically significant. HIV infection is not a significant risk factor for TCC-associated infection but is associated with a higher prevalence of Gram-negative and fungal species.
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Affiliation(s)
- Michele H Mokrzycki
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
- Departments of Medicine, Jacobi Medical Center, Bronx, New York
- Montefiore Medical Center, Bronx, New York
| | - Bernd Schröppel
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
- Departments of Medicine, Jacobi Medical Center, Bronx, New York
| | - Gero VON Gersdorff
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
- Departments of Medicine, Jacobi Medical Center, Bronx, New York
| | - Heather Rush
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
- Montefiore Medical Center, Bronx, New York
| | - Miroslaw P Zdunek
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
- Montefiore Medical Center, Bronx, New York
| | - Robert Feingold
- Division of Nephrology, Albert Einstein College of Medicine, Bronx, New York
- Montefiore Medical Center, Bronx, New York
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226
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Campo N, Brizzolara R, Sinelli N, Torre F, Russo R, Deferrari G, Picciotto A. TT virus infection in haemodialysis patients. Nephrol Dial Transplant 2000; 15:1823-6. [PMID: 11071972 DOI: 10.1093/ndt/15.11.1823] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The recent discovery of a new parenterally transmitted DNA virus called TT virus (TTV) led us to investigate its prevalence in haemodialysis patients, a high-risk group for blood-borne infection, and to evaluate its role in liver disease. Moreover, we compared the TTV prevalence with the prevalence of other hepatitis virus coinfections. METHODS Serum samples of 78 patients on maintenance haemodialysis were tested for TTV-DNA, hepatitis G virus (HGV)-RNA, anti-E2, anti-hepatitis C virus (HCV) and HCV-RNA. TTV-DNA was detected by semi-nested PCR using the primers from open reading frame 1 (ORF). HGV-RNA was detected by PCR using specific primers for the NS3 and the 5'-UTR genome regions while anti-E2 were checked by an enzyme immunological test. Anti-HCV was tested by the second generation Chiron RIBA HCV test system. HCV-RNA was evaluated by nested PCR with primers directed to the highly conserved 5' non-coding region of the HCV genome. RESULTS TTV prevalence in our patients was 19% (15/78) while the prevalence of HCV and HGV infection proved to be 20 and 15.4%, respectively. Among TTV positive patients HGV co-infection was present in five cases (33%), HCV in six cases (39.9%), while HBV co-infection was not present in any of the patients. Only three patients proved positive for all three viruses. ALT levels were normal in most cases (13/15; 86%). In particular, patients with TTV infection alone showed normal ALT levels and HCV coinfection was found in the two patients with moderate ALT increases. CONCLUSIONS TTV prevalence in haemodialysed patients is significant though the real clinical impact is still unclear. However, we must keep in mind that the epidemiological relevance of TTV infection is probably underestimated due to the impossibility in detecting the corresponding antibody.
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Affiliation(s)
- N Campo
- Department of Internal Medicine, Gastroenterology Unit, University of Genoa, Genoa, Italy
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227
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Natov SN, Pereira BJ. Routine serologic testing for hepatitis C virus infection should be instituted among dialysis patients. Semin Dial 2000; 13:393-8. [PMID: 11130264 DOI: 10.1046/j.1525-139x.2000.00108.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since the cloning of hepatitis C virus (HCV), a number of serologic and virologic tests for detecting infections with this virus have been made available for clinical practice. This led to the recognition of HCV as a major health hazard in hemodialysis (HD) centers. Yet the nephrology community has not been offered explicit recommendations about routine serologic testing for HCV of dialysis patients and consequently has remained unclear and divided about the utility of this testing. This review presents evidence in support of instituting routine serologic testing for HCV among dialysis patients. It concludes that because of the peculiar features of HCV infection in HD patients, serologic testing for HCV is the only means for unequivocal diagnosis of hepatitis C and an irreplaceable instrument for monitoring the incidence and the prevalence of the infection in this population. Serologic surveillance for HCV infection is crucial for identifying the association of new cases of HCV infection with potential risk factors for HCV transmission, particularly nosocomial, that can be modified in a way to prevent further dissemination of the virus. Data collected from routine serologic testing for HCV will undoubtedly improve our understanding of the epidemiology of HCV in the dialysis population and will provide a strong foundation for developing preventive measures and infection control strategies that are highly effective in controlling HCV infection. Routine serologic testing for HCV is also of direct benefit to the individual patient since establishing the HCV serologic status of each patient is important for optimizing patient care.
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Affiliation(s)
- S N Natov
- Division of Nephrology, New England Medical Center, Boston, Massachusetts 02111, USA
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228
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Angelico M, Morosetti M, Passalacqua S, Chiappini MG, Botta S, Ombres D, Splendiani G, Casciani CU. Low levels of hepatitis C virus RNA in blood of infected patients under maintenance haemodialysis with high-biocompatibility, high-permeability filters. Dig Liver Dis 2000; 32:724-8. [PMID: 11142584 DOI: 10.1016/s1590-8658(00)80337-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients undergoing maintenance haemodialysis are often infected with hepatitis C virus, yet the clinical course of liver disease is usually mild. We investigated whether the hepatitis C virus viral load is influenced by the haemodialytic procedure and the type of dialyser. METHODS Hepatitis C virus-RNA levels were measured using a quantitative polymerase chain reaction assay in predialysis blood from 51 hepatitis C virus-infected patients dialysed with different membranes. Paired pre- and post-dialysis measurements were also obtained in 18 patients. RESULTS Patients dialysed using cuprammonium-regenerated cellulose membranes with low (cuprofan) or intermediate (cellulose acetate or diacetate) biocompatibility had higher pre-dialysis hepatitis C virus-RNA levels (p<0.05] compared to those dialysed with synthetic high-biocompatibility, high-permeability polymeric membranes (polyacrylonitrile, polysulfone, polymethylmethacrylate or polycarbonate). Hepatitis C virus-RNA levels were unrelated to the duration of haemodialysis and the presence of abnormal transaminases. A significant reduction (p=0. 04) of serum hepatitis C virus-RNA levels was observed after a single haemodialysis, particularly in patients with high pre-dialysis viral load. Patients with low pre-dialysis hepatitis C virus-RNA levels (<2. 5 x 10(3) copies/ml) exhibited only minimal changes following the procedure. Four patients with medium-high basal viral load switched from a low-biocompatibility/low-permeability to a high-biocompatibility/high permeability filter had a marked reduction of viraemia after three weeks, in one case followed by a new increase after return to the original filter. CONCLUSIONS Haemodialysis with high-biocompatibility/high-permeability filters in hepatitis C virus-infected patients is associated with low blood levels of hepatitis C virus-RNA. This finding may be of clinical relevance, especially in patients listed for kidney transplantation.
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Affiliation(s)
- M Angelico
- Department of Public Health and Chairs of Surgery, Tor Vergata University, Rome, Italy.
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229
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Delmonico FL. Cadaver donor screening for infectious agents in solid organ transplantation. Clin Infect Dis 2000; 31:781-6. [PMID: 11017830 DOI: 10.1086/314000] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2000] [Revised: 06/21/2000] [Indexed: 01/24/2023] Open
Abstract
The transmission of infection by a cadaver donor organ can result not only in loss of the allograft but also in death of the immunosuppressed recipient. Despite the shortage of cadaver organ donors, every donor must be evaluated thoroughly for the potential transmission of infectious disease, because the consequences of the organ donor events can have a profound effect on the transplant outcome. This review summarizes current knowledge about serological screening of organ donors to determine the suitability of organs from cadaver donors for transplantation.
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Affiliation(s)
- F L Delmonico
- New England Organ Bank and Harvard Medical School, Newton, MA, USA. francis_delmonico @neob.com
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230
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Abstract
In the latter half of the 20th century, HCV emerged as the most common cause of chronic liver disease, and will likely remain so. Since its initial discovery in 1989, rapid progress has been made in our understanding of the virology, epidemiology, natural history, diagnosis, and treatment of HCV. Over the next few decades, as further advancements are made, superior treatment options will become available.
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Affiliation(s)
- C P Cheney
- Harvard Medical School, Division of Gastroenterology, Boston, Massachusetts, USA
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231
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Abstract
Exposure to blood-borne pathogens poses a serious risk to health care workers (HCWs). We review the risk and management of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections in HCWs and also discuss current methods for preventing exposures and recommendations for postexposure prophylaxis. In the health care setting, blood-borne pathogen transmission occurs predominantly by percutaneous or mucosal exposure of workers to the blood or body fluids of infected patients. Prospective studies of HCWs have estimated that the average risk for HIV transmission after a percutaneous exposure is approximately 0.3%, the risk of HBV transmission is 6 to 30%, and the risk of HCV transmission is approximately 1.8%. To minimize the risk of blood-borne pathogen transmission from HCWs to patients, all HCWs should adhere to standard precautions, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments. Employers should have in place a system that includes written protocols for prompt reporting, evaluation, counseling, treatment, and follow-up of occupational exposures that may place a worker at risk of blood-borne pathogen infection. A sustained commitment to the occupational health of all HCWs will ensure maximum protection for HCWs and patients and the availability of optimal medical care for all who need it.
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232
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Mandal AK, Kraus ES, Samaniego M, Rai R, Humphreys SL, Ratner LE, Maley WR, Burdick JF. Shorter waiting times for hepatitis C virus seropositive recipients of cadaveric renal allografts from hepatitis C virus seropositive donors. Clin Transplant 2000; 14:391-6. [PMID: 10946777 DOI: 10.1034/j.1399-0012.2000.14040602.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The purposes of this study were: 1) to analyze the early results of cadaveric renal transplantation from either hepatitis C virus seropositive (HCV+ ) or hepatitis C virus seronegative (HCV-) donors into HCV + recipients; and 2) to determine whether HCV+ patients with end-stage renal disease (ESRD) might benefit from receiving renal allografts from HCV + donors. METHODS From January 1997 to June 1999, 28 patients with ESRD and HCV infection underwent 29 cadaveric renal transplants. The data were reviewed retrospectively. Nineteen of the renal transplants were performed with allografts obtained from 15 HCV + donors and 10 with allografts obtained from 10 HCV- donors. The median follow-up was 16.2 months, with an average of 15.4+/-2 months. RESULTS Recipients of HCV + renal allografts had shorter waiting times for transplantation. On average, patients who received a kidney from HCV + donors were transplanted 9+/-3 months after being placed on the transplant list, compared to 29+/-3 months for patients who received a kidney from a HCV- donor. Shorter waiting times were noted in every blood type group. There were no significant differences in rejection episodes, infectious complications, renal function, liver function, graft survival, or patient survival. CONCLUSIONS The use of renal allografts from HCV + donors for HCV + recipients shortens the waiting time for these patients, with no short-term differences in renal and liver function, graft loss, or patient survival.
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Affiliation(s)
- A K Mandal
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287-8611, USA
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233
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Martín J, de Sequera P, Quiroga JA, Rico M, Fernández M, Arocena C, Caramelo C, Carreño V. Role of haemodialysis and hepatitis c virus infection in spontaneous and induced cytokine production of patients with chronic renal disease. Cytokine 2000; 12:1248-52. [PMID: 10930306 DOI: 10.1006/cyto.2000.0701] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cytokines modulate general and virus infection-related host immune responses. We have investigated cytokine responses in chronic renal disease patients with regard to haemodialysis and hepatitis C virus (HCV) infection. Compared with healthy subjects with normal renal function (n=15), non-dialyzed/renal disease individuals without HCV infection (n=11) showed increased production of tumour necrosis factor (TNF)-alpha, interleukin (IL-)6, IL-10, interferon (IFN-)gamma and IL-12 by blood mononuclear cells (P<0.05). These inflammatory cytokine responses were abolished in haemodialysis patients (n=37;P<0.05), except for IL-12. This hyporesponsiveness in haemodialysis patients was more evident in stimulatory conditions, as shown by the consistent inhibition of IFN-gamma production, and the failure of exogenous IFN-gamma to prime for IL-12 inducibility (P<0.01). The disturbed cytokine response appeared to focus in the T-helper lymphocyte phenotype 1 (Th(1)) because the stimulation of IL-6 and IL-10 (Th(2)phenotype cytokines) was not impaired. The pattern of response was similar among haemodialysis patients with (n=24) or without (n=13) HCV infection. However, HCV-positive haemodialysis patients had a blunted TNF-alpha response (P<0.05) and failed to increase the stimulated IFN-gamma and IL-12 production (P<0.01) compared with chronic hepatitis C patients without renal disease (n=25). On the contrary, IL-10 stimulation was higher in HCV-positive haemodialysis patients (P<0.01). These results disclose the presence in haemodialysis patients of markedly abnormal general and HCV infection-related cytokine responses; the inhibitory alterations appear to affect predominantly the stimulated responses via the Th(1)subset and its relationship with monocyte response with possible pathogenic and therapeutic implications.
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Affiliation(s)
- J Martín
- Department of Hepatology, Fundación Jiménez Díaz, Madrid, Spain
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234
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Baid S, Cosimi AB, Tolkoff-Rubin N, Colvin RB, Williams WW, Pascual M. Renal disease associated with hepatitis C infection after kidney and liver transplantation. Transplantation 2000; 70:255-61. [PMID: 10933143 DOI: 10.1097/00007890-200007270-00001] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- S Baid
- Department of Medicine, Massachusetts General Hospital, Boston 02114, USA
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235
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Affiliation(s)
- José M Morales
- Renal Transplant Unit, Nephrology Department, Hospital Universitario 12 de Octubre, Madrid and Renal Transplant Unit, Hospital Clinic, Barcelona, Spain
| | - Josep M Campistol
- Renal Transplant Unit, Nephrology Department, Hospital Universitario 12 de Octubre, Madrid and Renal Transplant Unit, Hospital Clinic, Barcelona, Spain
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236
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Beltrami EM, Williams IT, Shapiro CN, Chamberland ME. Risk and management of blood-borne infections in health care workers. Clin Microbiol Rev 2000; 13:385-407. [PMID: 10885983 PMCID: PMC88939 DOI: 10.1128/cmr.13.3.385] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Exposure to blood-borne pathogens poses a serious risk to health care workers (HCWs). We review the risk and management of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections in HCWs and also discuss current methods for preventing exposures and recommendations for postexposure prophylaxis. In the health care setting, blood-borne pathogen transmission occurs predominantly by percutaneous or mucosal exposure of workers to the blood or body fluids of infected patients. Prospective studies of HCWs have estimated that the average risk for HIV transmission after a percutaneous exposure is approximately 0.3%, the risk of HBV transmission is 6 to 30%, and the risk of HCV transmission is approximately 1.8%. To minimize the risk of blood-borne pathogen transmission from HCWs to patients, all HCWs should adhere to standard precautions, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments. Employers should have in place a system that includes written protocols for prompt reporting, evaluation, counseling, treatment, and follow-up of occupational exposures that may place a worker at risk of blood-borne pathogen infection. A sustained commitment to the occupational health of all HCWs will ensure maximum protection for HCWs and patients and the availability of optimal medical care for all who need it.
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Affiliation(s)
- E M Beltrami
- HIV Infections Branch, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia 30333, USA.
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237
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238
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Garinis G, Patrinos GP, Menounos P, Spanakis N, Gorgoulis VG, Theodorou V, Ioannidis T, Karameris A, Valis D. Evaluation of a Minipool Reverse Transcription-PCR Screening Method for the Detection of Hepatitis C Virus Infection in Hemodialysis Patients. Clin Chem 2000. [DOI: 10.1093/clinchem/46.4.582d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- George Garinis
- MEDICANALYSIS Institute of Molecular Biology Applications, GR-15121 Athens, Greece
| | - George P Patrinos
- Nursing Military Academy, Laboratory of Research, GR-16201 Athens, Greece
| | - Panayotis Menounos
- Nursing Military Academy, Laboratory of Research, GR-16201 Athens, Greece
| | - Nikos Spanakis
- MEDICANALYSIS Institute of Molecular Biology Applications, GR-15121 Athens, Greece
| | - Vassilis G Gorgoulis
- University of Athens, School of Medicine, Laboratory of Histology, and Embryology, GR-11527 Athens, Greece
| | - Vassilis Theodorou
- MEDICANALYSIS Institute of Molecular Biology Applications, GR-15121 Athens, Greece
| | - Thomas Ioannidis
- MEDICANALYSIS Institute of Molecular Biology Applications, GR-15121 Athens, Greece
| | - Andreas Karameris
- “401” General Army Hospital, Department of Pathology, GR-11525 Athens, Greece
| | - Dimitrios Valis
- MEDICANALYSIS Institute of Molecular Biology Applications, GR-15121 Athens, Greece
- “HYGEIA” Therapeutic Center, Unit of Nephrology, GR-15123 Athens, Greece
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239
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Tanphaichitr NT, Brennan DC. Infectious complications in renal transplant recipients. ADVANCES IN RENAL REPLACEMENT THERAPY 2000; 7:131-46. [PMID: 10782731 DOI: 10.1053/rr.2000.5270] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infectious complications present major challenges to physicians caring for renal transplant recipients. The high rate of infection reflects the net state of immunosuppression associated with end-stage renal disease, transplantation, donor and environmental exposure. An understanding of the factors that affect the patients' overall state of immunosuppression is essential to prevent and treat infectious complications, which may lead to significant morbidity, graft dysfunction, or mortality. Familiarity with the various pathogens, clinical presentation, diagnostic options, treatment, and prophylaxis is important to care for renal transplant patients. The authors present their approach, based on review of current literature, to these issues.
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Affiliation(s)
- N T Tanphaichitr
- Department of Medicine at Washington University School of Medicine, St Louis, MO, USA
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240
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Abstract
Nosocomial transmission of hepatitis C virus (HCV) may occur in a variety of circumstances. This problem is best characterised in haemodialysis units. In this setting, molecular analysis of viral isolates indicates that patient to patient is the most frequent mode of HCV transmission. Spreading of HCV is mainly related to non-strict observance of universal precautionary measures, which are an efficient and, possibly, sufficient means for prevention. Epidemics or single instances of patient-to-patient transmission have only occasionally been reported in hospital settings other than haemodialysis units, and, again, non-observance of universal precautionary measures, or inadequate cleaning or disinfecting of medical instruments was involved. Transmission from an infected surgeon to patients has been reported, but infection from doctors to patients seems to be exceptional. Thus, although prospective studies have not been performed, nosocomial transmission of HCV unrelated to haemodialysis appears to be an infrequent and preventable event.
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Affiliation(s)
- J M Sánchez-Tapias
- Liver Unit, IMD Hospital Clinic, IDIBAPS, University of Barcelona, Spain.
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241
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17 Hepatitis C and renal disease. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s1874-5326(00)80021-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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242
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Affiliation(s)
- J M Morales
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
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243
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Natov SN, Lau JY, Ruthazer R, Schmid CH, Levey AS, Pereira BJ. Hepatitis C virus genotype does not affect patient survival among renal transplant candidates. The New England Organ Bank Hepatitis C Study Group. Kidney Int 1999; 56:700-6. [PMID: 10432411 DOI: 10.1046/j.1523-1755.1999.00594.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) are at increased risk for infection with different hepatitis C virus (HCV) genotypes and multiple genotype infections. However, to date, the effect of the type and number of infecting HCV genotypes on survival among ESRD patients has not been carefully examined, and this was the objective of this study. METHODS Sera from patients on the renal transplant waiting list at the New England Organ Bank between November 1986 and June 1990 were tested for anti-HCV using a third-generation enzyme-linked immunosorbent assay. All anti-HCV-positive serum samples were tested for HCV RNA by reverse transcriptase "nested" polymerase chain reaction (PCR) with primers derived from the highly conserved 5'UTR region of the HCV genome. HCV genotypes were determined by restriction fragment length polymorphism of the 5'UTR PCR product. The duration of follow-up was calculated from the date of the first available serum specimen until death, loss to follow-up, or December 31, 1995, whichever occurred earlier. Two separate multivariate models were constructed: one to examine the impact of HCV genotype on mortality and the other to examine the impact of the single versus mixed infection on mortality. In both models, the independent variables were HCV genotype and transplantation. The HCV genotype was treated as a time-independent (baseline) variable. Transplantation was treated as a time-dependent variable in which the status changed after transplantation. RESULTS HCV RNA was detected by PCR in 224 patients (81%) in whom sera were available. Complete clinical data on baseline covariates, subsequent transplantation, and mortality were available in 180 patients (80%), and these patients constituted the final study cohort. HCV genotypes 1a and 1b were the two most common genotypes encountered and were found in 60 and 24% of the patients, respectively. One hundred and sixty-two (90%) patients were infected with a single HCV single genotype, 16 patients (9%) with two genotypes, and two patients (1%) with three genotypes. Among the 180 patients in the final study cohort, 86 (48%) underwent transplantation, and 66 (37%) patients died during follow-up. Compared with patients infected with HCV genotype 1a, the relative risk (RR) of death from all causes was not significantly increased among patients infected with genotype 1b (RR = 1.02, 95% CI, 0.55 to 1.89) or other genotypes (RR = 1.08, 95% CI, 0.50 to 2.30). Likewise, compared with patients with a single infection, the RR of death among patients with mixed infection (RR = 1.18, 95% CI, 0.52 to 2.66) was not significantly increased. CONCLUSIONS The results of this study suggest that the type and number of HCV genotypes may not have a significant impact on survival among ESRD patients.
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Affiliation(s)
- S N Natov
- Division of Nephrology, New England Medical Center Box #391, Boston, Massachusetts 02111, USA.
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244
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Validation of self-reported transfusion histories in renal dialysis patients. Canadian Journal of Public Health 1999. [PMID: 10401173 DOI: 10.1007/bf03404507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this analysis was to assess the validity of self-reported transfusion histories in dialysis patients. Using data from a cross-sectional study of a dialysis population being investigated for hepatitis C virus (HCV) infection, the correspondence between self-reported transfusion history and transfusion records was explored. Demographic data and dialysis histories were examined in relation to the accuracy of self-reports. Overall, the questionnaire data and the blood bank records agreed for 89% of participants. The Kappa statistic was 0.72 (95% CI: 0.61, 0.83) indicating an acceptable level of agreement. The effect of non-differential exposure misclassification on the risk estimates for transfusion history as a determinant of HCV infection is demonstrated. Exploring the discrepancies between self-reports and documented transfusion histories underlines the need to communicate clearly medical interventions in chronically ill patients. Additionally, it suggests that studies into transfusion-acquired blood-borne pathogens should use all available information sources to establish exposure.
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245
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Thorn K. Hepatitis C: the lurking dragon. THE CASE MANAGER 1999; 10:55-62. [PMID: 11094970 DOI: 10.1016/s1061-9259(99)80133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Hepatitis C virus (HCV) is the most common chronic blood-borne infection in the United States. An estimated 3.9 million Americans (1.4%) are infected with HCV. The 10th leading cause of death in U.S. adults is chronic liver disease (CLD), which accounts for 25,000 deaths annually. Approximately 40% of all CLD is related to HCV, causing 8000 to 10,000 deaths annually. In addition, approximately 60% of people with HIV are believed to be coinfected with HCV, which hastens their progression to AIDS.
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Affiliation(s)
- K Thorn
- Thorn and Associates, Canoga Park, Calif., USA
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246
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Younossi ZM, Braun WE, Protiva DA, Gifford RW, Straffon RA. Chronic viral hepatitis in renal transplant recipients with allografts functioning for more than 20 years. Transplantation 1999; 67:272-5. [PMID: 10075593 DOI: 10.1097/00007890-199901270-00015] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of infection with hepatotropic viruses (hepatitis B virus [HBV] and hepatitis C virus [HCV]) on morbidity and mortality, and allograft function in renal transplant recipients with allografts functioning for >20 years is not known. METHODS AND RESULTS Seventy-nine of 511 renal transplants performed at the Cleveland Clinic Foundation from January 1963 to January 1978 are known to have functioned for at least 20 years (level 5A). Fifty-four of these patients had hepatitis testing updated after their 19th year of transplantation. Fifteen patients had evidence of ongoing viral infection: persistent hepatitis B surface antigen in three (6%), HCV antibody (enzyme-linked immunosorbent assay II supplemented by recombinant immunoblot assay) in 11 (20%), and both viruses in one (2%). Of the 10 surviving patients, 8 were tested further for viral replication. HCV RNA (polymerase chain reaction; Amplicore) was positive in 6/7 (86%), and HBV DNA (hybridization) was positive in 1/2 (50%). An elevated alanine aminotransferase (>35 U/L) was present in all hepatitis patients, alpha-fetoprotein >10 ng/ml in 2/8 (25%), and cryoglobulins >50 microg/ml in 3/6 (50%) infected with HCV. No hepatocellular carcinoma was detected by hepatic ultrasound. In patients with chronic viral hepatitis, probable cirrhosis developed in 20% (3/15) compared to one patient in the group without hepatitis, but there was no mortality from liver failure in either group. Diabetes mellitus was significantly more common in those with than without hepatitis (11/15 vs. 10/39; P=0.002), but severe infection was not (9/15 vs. 15/39). Five hepatitis patients (33%) have died of non-hepatic causes (one from meningitis, one from unknown cause, and three from coronary heart disease [CHD] vs. only two individuals without hepatitis [5%]; P= 0.014). Although the more frequent occurrence of CHD among those with hepatitis was not significant (7/15 vs. 8/39; P=0.09), CHD as a cause of death in those with HCV was significantly increased (P=0.03). CONCLUSIONS Twenty-year renal transplant recipients infected with hepatotropic viruses (HBV and HCV) have a high rate of active viral replication (88%), a greater frequency of diabetes (P=0.01), and a higher overall mortality (P=0.014).
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Affiliation(s)
- Z M Younossi
- Department of Gastroenterology, Cleveland Clinic Foundation, Ohio 44195, USA.
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248
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Baid S, Pascual M, Williams WW, Tolkoff-Rubin N, Johnson SM, Collins B, Chung RT, Delmonico FL, Cosimi AB, Colvin RB. Renal thrombotic microangiopathy associated with anticardiolipin antibodies in hepatitis C-positive renal allograft recipients. J Am Soc Nephrol 1999; 10:146-53. [PMID: 9890320 DOI: 10.1681/asn.v101146] [Citation(s) in RCA: 123] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hepatitis C virus (HCV) infection has been associated with de novo or recurrent membranoproliferative glomerulonephritis and acute transplant glomerulopathy in transplanted kidneys. Recently, anticardiolipin antibodies (ACA) have been linked with chronic HCV infection. A few reports have suggested an association between ACA and renal allograft thrombosis. This study examines the clinical and pathologic features of HCV-positive renal allograft recipients at our institution. From 1990 to 1996, 379 kidney transplants were performed. We identified 18 recipients (4.8%) with HCV-positive serology pretransplant. Determination of IgG and IgM ACA was performed by enzyme-linked immunosorbent assay, using pretransplant sera. Among the 18 patients, five patients presented with biopsy-proven de novo renal thrombotic microangiopathy (RTMA), occurring 5 to 120 d (median, 14 d) after transplant. No differences in pretransplant characteristics were observed between patients with (n = 5) or without (n = 13) RTMA. All five patients had a positive ACA test (either IgG or IgM titer > 2 SD above normal), compared with only one of 13 patients without RTMA. The mean value for IgG ACA was significantly higher in the RTMA patients than in patients without RTMA (22.9 +/- 14.1 versus 6.9 +/- 4.9 IgG phospholipid units, P = 0.02); however, there were no significant differences in IgM ACA titers. Rheumatoid factor and complement C4 levels were normal in pretransplant sera of patients with RTMA. Patients with RTMA had their cyclosporine withdrawn (four of five) or the dose was decreased (one of five), and one of five underwent plasmapheresis. Four of five patients died within 5 yr after transplant, compared with no deaths in the other 13 patients. Finally, as a control group, seven HCV-negative renal allograft recipients who presented with RTMA/hemolytic uremic syndrome during the same time period were found to have normal ACA values (IgG or IgM). RTMA associated with ACA in HCV-positive renal allograft recipients may represent a new clinical entity. The occurrence of this syndrome may have deleterious consequences for patient and graft survival.
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Affiliation(s)
- S Baid
- Renal Unit, Massachusetts General Hospital, Boston 02114, USA
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249
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Abstract
Patients on chronic dialysis are at increased risk of acquiring parenterally transmitted hepatitis viruses from blood product transfusions or nosocomial transmission in hemodialysis units, and biochemical abnormalities in liver function are seen in 10-44% of patients on chronic hemodialysis. In the past, hepatitis B virus (HBV) was the major cause of parenterally transmitted viral hepatitis in dialysis patients, and the remaining cases were attributed to non-A, non-B hepatitis (NANBH). The discovery of the hepatitis C virus (HCV) has shed light on the cause and clinical course of NANBH in patients on dialysis. The current debate is focused on strategies to reduce the transmission of HCV among dialysis patients and to lessen the consequences of liver disease among patients already infected.
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Affiliation(s)
- B J Pereira
- Division of Nephrology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA
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250
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Glicklich D, Thung SN, Kapoian T, Tellis V, Reinus JF. Comparison of clinical features and liver histology in hepatitis C-positive dialysis patients and renal transplant recipients. Am J Gastroenterol 1999; 94:159-63. [PMID: 9934748 DOI: 10.1111/j.1572-0241.1999.00788.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Liver biopsies in hepatitis C virus (HCV)-positive end stage renal disease (ESRD) patients before or after renal transplantation were compared to study the effect of transplant-related immunosuppression. METHODS In this prospective study all patients on the active transplant list and all patients with functioning renal transplants at our hospital were tested for HCV antibody (ELISA-2) over a 30-month period. HCV infection was confirmed by polymerase chain reaction in most patients. All HCV-positive patients were asked to undergo liver biopsy without regard to serum transaminase levels. Patients were interviewed, examined, and had detailed chart review. By protocol, liver histology was evaluated according to stage and inflammatory activity in a blinded fashion. RESULTS There were 129 HCV-antibody-positive patients, of 795 tested. Sixty-seven agreed to liver biopsy. Of these, 22 patients had never been transplanted and 45 had received transplants. Mean transplant duration before biopsy was 41.2 months (range, 1-204 months). Transplant patients had significantly longer duration of ESRD and estimated duration of HCV infection than patients not transplanted. Dialysis patients had significantly more portal inflammatory activity and lymphoid follicles on biopsy whereas transplant patients had more piecemeal necrosis and steatosis. However, the total histological activity score and stage were similar between groups. Multivariate analysis confirmed the association between transplant and steatosis. But independent variables including transplant duration, HCV infection duration, and ESRD duration were not correlated with histological findings. CONCLUSION Renal transplantation may not be associated with an increased risk of progressive liver disease in HCV-positive patients, compared with ESRD patients receiving chronic dialysis. Long-term studies with serial liver biopsies are needed to resolve this issue.
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Affiliation(s)
- D Glicklich
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467-2490, USA
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