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Schmitz J, Kracht J, Evert K, Wenzel JJ, Schemmerer M, Lehmann U, Panning M, Pape L, Pohl M, Bräsen JH. Hepatitis E virus infection of transplanted kidneys. Am J Transplant 2024; 24:491-497. [PMID: 38072120 DOI: 10.1016/j.ajt.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/02/2023] [Accepted: 11/30/2023] [Indexed: 12/29/2023]
Abstract
Immunocompromised patients are at risk of chronic hepatitis E (HEV) infection. Recurrent T cell and borderline rejections in a pediatric patient with high HEV copy numbers led us to study HEV infection within renal transplants. To investigate the frequency of renal HEV infection in transplanted patients, 15 samples from patients with contemporaneous diagnoses of HEV infection were identified at our center. Ten samples had sufficient residual paraffin tissue for immunofluorescence (IF) and RNA-fluorescence-in-situ-hybridization (RNA-FISH). The biopsy of the pediatric index patient was additionally sufficient for tissue polymerase chain reaction and electron microscopy. HEV RNA was detected in paraffin tissue of the index patient by tissue polymerase chain reaction. Subsequently, HEV infection was localized in tubular epithelial cells by IF, RNA-FISH, and electron microscopy. One additional biopsy from an adult was positive for HEV by RNA-FISH and IF. Focal IF positivity for HEV peptide was observed in 7 additional allografts. Ribavirin therapy was not successful in the pediatric index patient; after relapse, ribavirin is still administered. In the second patient, successful elimination of HEV was achieved after short-course ribavirin therapy. HEV infection is an important differential diagnosis for T cell rejection within transplanted kidneys. Immunostaining of HEV peptide does not necessarily prove acute infection. RNA-FISH seems to be a reliable method to localize HEV.
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Affiliation(s)
- Jessica Schmitz
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Julia Kracht
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Jürgen J Wenzel
- National Consultant Laboratory for HAV and HEV, Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
| | - Mathias Schemmerer
- National Consultant Laboratory for HAV and HEV, Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Germany
| | - Ulrich Lehmann
- Molecular Pathology, Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Marcus Panning
- Institute of Virology, University Clinics Freiburg, Freiburg, Germany
| | - Lars Pape
- Department of Pediatrics II, University Hospital of Essen, Essen, Germany
| | - Martin Pohl
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jan Hinrich Bräsen
- Nephropathology Unit, Institute of Pathology, Hannover Medical School, Hannover, Germany.
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Liang X, Xu Y, Zhang Y, Feng X, Wang Y, Zhao C, Cao Y. An effective treatment for diabetic foot necrosis with traditional Chinese and Western medicine: a case report. J Wound Care 2024; 33:22-27. [PMID: 38197281 DOI: 10.12968/jowc.2024.33.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Patients with diabetes who undergo a kidney transplant are at a great risk of undergoing amputations, usually associated with severe infection and necrosis. The treatment of severe diabetic foot necrosis is challenging in clinic, and the function of the limb is often hugely compromised. A 74-year-old male who had been diagnosed with severe post-renal transplant diabetic foot necrosis refused the option of below-knee amputation from previous surgeons, and requested to keep his left foot. The patient was treated with integrated traditional Chinese medicine (TCM) and Western medicine, with positive results. TCM therapeutic principles included 'clearing heat, removing toxicity, regulating Qi, resolving dampness, activating stagnant blood and nourishing yin as well as tonifying Qi and blood'. Treatment with Western medicine included wound debridement, internal fixation or joint fusion, and use of insulin, antibiotics and vasodilators. The patient was treated with a staged and diverse approach (i.e., a combination of TCM and Western medicine, surgical management and education for diabetic foot care), which ultimately helped the patient achieve limb salvage and regain normal function. A combination therapy of Western medicine and TCM may be a promising approach to heal diabetic foot ulcers.
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Affiliation(s)
- Xinyu Liang
- Department of Peripheral Vascular, Shanghai TCM-Integrated Hospital, Shanghai, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongcheng Xu
- Department of Peripheral Vascular, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Yaxu Zhang
- Department of Peripheral Vascular, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Xia Feng
- Department of Peripheral Vascular, Shanghai TCM-Integrated Hospital, Shanghai, China
| | - Yuzhen Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Cheng Zhao
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yemin Cao
- Department of Peripheral Vascular, Shanghai TCM-Integrated Hospital, Shanghai, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Cleto-Yamane TL, Rodrigues-Santos G, de Magalhães-Barbosa MC, Moura PG, Vasconcelos RD, Gouveia JLS, de Oliveira AL, Ferreira FC, Shalders AL, de Oliveira MBG, Lima-Setta F, da Cunha AJLA, Prata-Barbosa A. Screening of COVID-19 in outpatient children with cancer or solid organ transplantation: preliminary report. Eur J Pediatr 2021; 180:3237-3241. [PMID: 33768332 PMCID: PMC7994062 DOI: 10.1007/s00431-021-04044-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/10/2021] [Accepted: 03/21/2021] [Indexed: 12/22/2022]
Abstract
Clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pediatric immunosuppressed patients is unknown. Emerging data describe a milder or asymptomatic course in children compared with adults in this scenario. We present the seroprevalence and clinical features of coronavirus disease 2019 in a prospective cohort of 114 immunosuppressed children and adolescents from three groups: kidney transplantation, liver transplantation, and cancer patients. Among the thirty-five (30.7%) patients who had a positive serological test for SARS-CoV-2, 77% did not report previous symptoms and none of them developed any complications of coronavirus disease 2019 (COVID-19) after 30 or more days of follow-up. Among those who were symptomatic, diarrhea, fever, and cough were the most common findings.Conclusion: Seroprevalence of SARS-CoV-2 infection is high among immunosuppressed children and adolescents. COVID-19 has a mild or asymptomatic course in most of these patients. What is Known: • The number of immunosuppressed patients with coronavirus disease 2019 is increasing. • Viral infections have the potential for greater severity in immunocompromised children. What is New: • Seroprevalence for severe acute respiratory syndrome coronavirus 2 in immunocompromised pediatric patients was 31%. • A quarter of the serology-positive patients reported mild symptoms and none of them developed multisystem inflammatory syndrome in children associated with coronavirus disease 2019.
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Affiliation(s)
- Thaís Lira Cleto-Yamane
- Department of Kidney Transplant, Hospital Estadual da Criança, Rua Luiz Beltrão, 147, Vila Valqueire, Rio de Janeiro, RJ, 21330-320, Brazil. .,Department of Nephrology, Hospital Universitario Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Gustavo Rodrigues-Santos
- grid.472984.4Department of Pediatrics, Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ Brazil
| | | | | | | | - Jaqueline Leal Santos Gouveia
- Department of Kidney Transplant, Hospital Estadual da Criança, Rua Luiz Beltrão, 147, Vila Valqueire, Rio de Janeiro, RJ 21330-320 Brazil ,grid.414552.30000 0004 0417 9466Department of Pediatric Nephrology, Hospital Federal de Bonsucesso, Rio de Janeiro, RJ Brazil
| | - Anne Louise de Oliveira
- Department of Kidney Transplant, Hospital Estadual da Criança, Rua Luiz Beltrão, 147, Vila Valqueire, Rio de Janeiro, RJ 21330-320 Brazil ,grid.414552.30000 0004 0417 9466Department of Pediatric Nephrology, Hospital Federal de Bonsucesso, Rio de Janeiro, RJ Brazil
| | | | | | | | - Fernanda Lima-Setta
- grid.472984.4Department of Pediatrics, Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ Brazil
| | - Antonio José Ledo Alves da Cunha
- grid.472984.4Department of Pediatrics, Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ Brazil ,grid.8536.80000 0001 2294 473XUniversidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
| | - Arnaldo Prata-Barbosa
- grid.472984.4Department of Pediatrics, Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ Brazil ,grid.8536.80000 0001 2294 473XUniversidade Federal do Rio de Janeiro, Rio de Janeiro, RJ Brazil
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Raposo JV, Alves ADR, Dos Santos da Silva A, Dos Santos DC, Melgaço JG, Moreira OC, Pinto MA, de Paula VS. Multiplex qPCR facilitates identification of betaherpesviruses in patients with acute liver failure of unknown etiology. BMC Infect Dis 2019; 19:773. [PMID: 31484497 PMCID: PMC6727340 DOI: 10.1186/s12879-019-4309-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background The etiology of acute liver failure (ALF) is often unknown and reported to be associated with herpesviruses in a number of cases. In this study, we examined for betaherpesviruses infections in patients with ALF of unknown etiology using a multiplex qPCR to Betaherpesviruses subfamily. Methods Liver explant and serum samples from 27 patients with ALF of unknown etiology were analyzed with the aid of multiplex qPCR to identify betaherpesviruses. All positive samples were sequenced to confirm herpes infection and liver enzyme levels evaluated. Results Betaherpesviruses infection was effectively detected using multiplex qPCR. Six (22%) HHV-6, one (3%) HCMV and two (7%) dual infections (one with HHV-7/HHV-6, and the other with HHV-7/ HCMV). Interestingly, HHV-7 was only detected in the presence of other betaherpesviruses. Sequencing information confirmed betaherpesviruses infection. High hepatic enzyme levels and INR values> 1.5 were determined in all betaherpesvirus-positive patients. Conclusions Multiplex qPCR facilitated efficient quantification, indicating that differentiation between betaherpesviruses is possible with the sole use of real-time PCR. Liver explant and serum samples were positive for some betaherpesviruses, and coinfection of HHV-7 with HHV-6 and HCMV was additionally detected. Based on these results, we propose that ALF patients should be screened for the presence of betaherpesviruses.
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Affiliation(s)
- Jéssica Vasques Raposo
- Laboratory of Molecular Virology, Oswaldo Cruz Institute / Fiocruz, Rio de Janeiro, Brazil
| | - Arthur Daniel Rocha Alves
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute / Fiocruz, Rio de Janeiro, Brazil
| | | | | | - Juliana Gil Melgaço
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute / Fiocruz, Rio de Janeiro, Brazil
| | - Otacílio C Moreira
- Laboratory of Molecular Biology and Endemic Diseases, Oswaldo Cruz Institute / Fiocruz, Rio de Janeiro, Brazil
| | - Marcelo Alves Pinto
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute / Fiocruz, Rio de Janeiro, Brazil
| | - Vanessa Salete de Paula
- Laboratory of Molecular Virology, Oswaldo Cruz Institute / Fiocruz, Rio de Janeiro, Brazil. .,Oswaldo Cruz Foundation, IOC - Av. Brasil 4365-Manguinhos, Pav. Helio e Peggy Pereira B10, Rio de Janeiro, 21040-360, Brazil.
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