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Chen HH, Chung CH, Huang N, Tsai TF, Lin IF. Dengue severity in rheumatoid arthritis patients under treatment with disease-modifying antirheumatic drugs. Int J Rheum Dis 2024; 27:e15224. [PMID: 38896108 DOI: 10.1111/1756-185x.15224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/22/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Hsin-Hua Chen
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia Hua Chung
- National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nicole Huang
- National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - I Feng Lin
- National Yang Ming Chiao Tung University, Taipei, Taiwan
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Tan SSX, Ho QY, Thangaraju S, Tan TT, Kee T, Chung SJ. Dengue virus infection among renal transplant recipients in Singapore: a 15-year, single-centre retrospective review. Singapore Med J 2024; 65:235-241. [PMID: 34749495 PMCID: PMC11132622 DOI: 10.11622/smedj.2021167] [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: 05/03/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Dengue is a mosquito-borne viral infection endemic in Singapore. Its impact on renal transplantation is limited to small case series. We aimed to characterise the clinical presentation and outcomes of dengue infection among renal transplant recipients in Singapore. METHODS We conducted a 15-year retrospective review of dengue in renal transplant patients treated at Singapore General Hospital between January 2005 and October 2019. The diagnosis of dengue was made if there were a compatible clinical syndrome and a positive dengue diagnostic assay (dengue non-structural 1 antigen, immunoglobulin M or reverse transcriptase-polymerase chain reaction). RESULTS Of the 31 patients diagnosed with dengue, 18 (58.1%) were deceased donor recipients. The median age was 52 (interquartile range [IQR] 40-61) years; 16 (51.6%) were females. The median time to diagnosis was 99 (IQR 18-169) months from transplant. The most common clinical symptoms were fever (87.1%), myalgia (41.9%), gastrointestinal symptoms (38.7%) and headache (25.8%). Nineteen (61.3%) patients had dengue without warning signs, nine (29.0%) had dengue with warning signs, three (9.7%) had severe dengue and 30 (96.8%) were hospitalised. Seventeen (54.8%) patients had graft dysfunction, 16 (94.1%) of whom had recovery of graft function. One (3.2%) patient required dialysis and subsequently died. There were two cases of donor-derived infections (DDIs) with favourable outcomes. CONCLUSION Our experience with dengue in renal transplant recipients is concordant with published data. Although graft dysfunction is common, it is often transient with favourable outcomes. Outpatient management may be considered for mild infections. Although dengue DDIs are uncommon, more stringent donor screening may be considered in endemic regions.
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Affiliation(s)
| | - Quan Yao Ho
- Department of Renal Medicine, Singapore General Hospital, SingHealth Duke-NUS Transplant Centre, Singapore
| | - Sobhana Thangaraju
- Department of Renal Medicine, Singapore General Hospital, SingHealth Duke-NUS Transplant Centre, Singapore
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Terence Kee
- Department of Renal Medicine, Singapore General Hospital, SingHealth Duke-NUS Transplant Centre, Singapore
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Bezerra KC, Vieira CMAG, de Oliveira-Filho EF, Reis CRS, Oriá RB. Susceptibility of solid organ transplant recipients to viral pathogens with zoonotic potential: A mini-review. Braz J Infect Dis 2024; 28:103742. [PMID: 38670166 PMCID: PMC11078645 DOI: 10.1016/j.bjid.2024.103742] [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: 11/30/2023] [Revised: 02/28/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
A substantial number of zoonotic diseases are caused by viral pathogens, representing a significant menace to public health, particularly to susceptible populations, such as pregnant women, the elderly, and immunocompromised individuals. Individuals who have undergone solid organ transplantation frequently experience immunosuppression, to prevent organ rejection, and, thus are more prone to opportunistic infections. Furthermore, the reactivation of dormant viruses can threaten transplant recipients and organ viability. This mini-review examines the up-to-date literature covering potential zoonotic and organ rejection-relevant viruses in solid organ transplant recipients. A comprehensive list of viruses with zoonotic potential is highlighted and the most important clinical outcomes in patients undergoing transplantation are described. Moreover, this mini-review calls attention to complex multifactorial events predisposing viral coinfections and the need for continuous health surveillance and research to understand better viral pathogens' transmission and pathophysiology dynamics in transplanted individuals.
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Affiliation(s)
- Karine C Bezerra
- Universidade Federal do Ceará, Faculdade de Medicina, Laboratório da Biologia da Cicatrização, Ontogenia e Nutrição de Tecidos, Fortaleza, CE, Brazil
| | - Carlos Meton A G Vieira
- Universidade Federal do Ceará, Faculdade de Medicina, Laboratório da Biologia da Cicatrização, Ontogenia e Nutrição de Tecidos, Fortaleza, CE, Brazil
| | | | - Christian Robson S Reis
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Microbiologia, Recife, PE, Brazil
| | - Reinaldo B Oriá
- Universidade Federal do Ceará, Faculdade de Medicina, Laboratório da Biologia da Cicatrização, Ontogenia e Nutrição de Tecidos, Fortaleza, CE, Brazil.
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Ribeiro C, Turani SAD, Miranda SMC, Souza PAMD, Penido MGMG. Dengue infection in kidney transplant recipients: clinical course and its impact on renal function. J Bras Nefrol 2021; 44:75-83. [PMID: 34590670 PMCID: PMC8943864 DOI: 10.1590/2175-8239-jbn-2021-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Kidney transplant recipients (KTR) are at increased risk for dengue virus (DENV) infection. The aim of this study was to outline the clinical presentation and laboratory profile of DENV infection in KTR and its impact on renal function. Methods: This was a retrospective study of KTR diagnosed with DENV infection. Adult patients who visited Santa Casa de Belo Horizonte Nephrology Center between April and September 2019 were included. Patients who did not sign the Informed Consent were excluded. Data were collected from the database and medical records. The study was approved by the local Institutional Ethics Committee and the Informed Consent was obtained. Results: Nineteen KTR were evaluated. The main signs and symptoms were myalgia, headache/retro-orbital pain, fever, and gastrointestinal symptoms. Two patients had acute cholecystitis without calculus, three experienced pleural and/or pericardial effusion, and one developed acute myocarditis. All patients were under immunosuppression with prednisone, tacrolimus, and mycophenolate, and most were not receiving induction therapy. Temporary suspension/reduction of immunosuppression was required in 58% of patients and leukopenia was the most common reason. Thrombocytopenia was common and 58% of patients developed acute kidney injury. All patients recovered renal function. Conclusions: DENV infection in KTR patients seems to follow a similar course as in the general population. Although there was no control group, we suspect that immunosuppression, preexisting kidney disease or type of donor was not a determining factor in most patients. Transient renal dysfunction was common but reversible. No patient experienced death or graft loss.
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Affiliation(s)
- Claudia Ribeiro
- Santa Casa de Belo Horizonte, Centro de Nefrologia, Belo Horizonte, MG, Brasil
| | | | | | | | - Maria Goretti Moreira Guimarães Penido
- Santa Casa de Belo Horizonte, Centro de Nefrologia, Belo Horizonte, MG, Brasil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brasil
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Cachera L, Adenis A, Dueymes JM, Rochemont D, Guarmit B, Roura R, Meddeb M, Nacher M, Djossou F, Epelboin L. What Is the Part of Tropical Diseases Among Infectious Complications in Renal Transplant Recipients in the Amazon? A 12-Year Multicenter Retrospective Analysis in French Guiana. Transplant Proc 2021; 53:2242-2251. [PMID: 34474909 DOI: 10.1016/j.transproceed.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Infectious complications in kidney transplant recipients (KTRs) are well studied in temperate countries but remain barely known in tropical ones. The main objective of this study was to describe infection-related hospitalizations in patients living in the Amazon, where it has never been described. METHODS All KTRs residing in French Guiana between 2007 and 2018 were included retrospectively. Infection-related hospitalizations were collected in the main medical centers of the territory. RESULTS Eighty-two patients were included, and 42 were infected during the study period (51%). Eighty-seven infections were identified. The main sites of infection were urinary, in 29% of cases (25/87), and pulmonary, in 22% of cases (19/87). When documented (48/87), bacterial infections were predominant (35/48), followed by viral (8/48), fungal (4/48), and parasitic infections (1/48). Endemic so-called tropical infections accounted for 6% of infections (5/87). Histoplasma capsulatum was the most commonly isolated fungus (2/4). CONCLUSIONS This study suggests that the spectrum of infections in KTRs in French Guiana differs little from that of temperate countries. Nevertheless, some tropical infections are described. More studies on fungal infections in KTRs should be undertaken to clarify the weight of histoplasmosis in these patients.
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Affiliation(s)
- Laurene Cachera
- Infectious and Tropical Medicine Department, Hospital Center of Cayenne, Cayenne, French Guiana, France; Faculté de Médecine, Université de Paris, Paris, France.
| | - Antoine Adenis
- Clinical Investigation Center in Clinical Epidemiology French Guiana « Inserm CIC 1424 », Hospital Center of Cayenne, Cayenne, French Guiana, France; EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Medicine University of the West Indies and French Guiana, Cayenne, French Guiana, France
| | - Jean-Marc Dueymes
- Nephrology Department, Hospital Center of Cayenne, Cayenne, French Guiana, France
| | - Devi Rochemont
- Clinical Investigation Center in Clinical Epidemiology French Guiana « Inserm CIC 1424 », Hospital Center of Cayenne, Cayenne, French Guiana, France
| | - Basma Guarmit
- Coordination Régionale de lutte contre le Virus de l'Immunodéficience Humaine, « COREVIH », Hospital Center of Cayenne, French Guiana, France
| | - Raoul Roura
- Association pour le Traitement de l'Insuffisance Rénale Guyane « A.T.I.R.G », Cayenne, French Guiana, France
| | - Mohamed Meddeb
- Nephrology Department, Hospital Center of Cayenne, Cayenne, French Guiana, France
| | - Mathieu Nacher
- Clinical Investigation Center in Clinical Epidemiology French Guiana « Inserm CIC 1424 », Hospital Center of Cayenne, Cayenne, French Guiana, France; EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Medicine University of the West Indies and French Guiana, Cayenne, French Guiana, France
| | - Felix Djossou
- Infectious and Tropical Medicine Department, Hospital Center of Cayenne, Cayenne, French Guiana, France; EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Medicine University of the West Indies and French Guiana, Cayenne, French Guiana, France
| | - Loic Epelboin
- Infectious and Tropical Medicine Department, Hospital Center of Cayenne, Cayenne, French Guiana, France; EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Medicine University of the West Indies and French Guiana, Cayenne, French Guiana, France
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Meshram HS, Kute V, Patel H, Banerjee S, Chauhan S, Desai S. Successful management of dengue in renal transplant recipients: A retrospective cohort from a single center. Clin Transplant 2021; 35:e14332. [PMID: 33914386 DOI: 10.1111/ctr.14332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The literature on dengue infection in renal transplant recipients has shown wide diversity in clinical presentation and outcome. The objective of this study was to report the clinical profile, short-term and long-term outcomes of dengue among renal transplant recipients. METHODS A total of 59 post-transplant dengue suspected cases were admitted from July 2019 to April 2020 of which 31 had confirmed dengue infection. The clinical and laboratory profile of the confirmed dengue cases (n = 31) were compared with non-dengue cases (n = 28). RESULTS Among the clinical and laboratory features retro-orbital pain, conjunctival redness, thrombocytopenia on admission, and absence of arthralgia were significantly associated with dengue compared to non-dengue cases. No mortality was observed in the dengue cases. Allograft dysfunction, acute rejection and graft losses were identified in 64.5% (n = 20), 6.4% (n = 2) and 6.4% (n = 2) dengue cases respectively. No rejection or graft losses were observed in 1-year follow-up. CONCLUSIONS We report a differential clinical profile for dengue in transplant settings which will aid in the diagnosis. We also report successful management of dengue infection in renal transplant recipients with the majority having allograft dysfunction. A long-term follow-up of the cohort was uneventful.
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Affiliation(s)
| | - Vivek Kute
- Department of Nephrology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Himanshu Patel
- Department of Nephrology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Subho Banerjee
- Department of Nephrology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Sanshriti Chauhan
- Department of Nephrology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Sudeep Desai
- Department of Nephrology and Transplantation, IKDRC-ITS, Ahmedabad, India
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Mrzljak A, Novak R, Pandak N, Tabain I, Franusic L, Barbic L, Bogdanic M, Savic V, Mikulic D, Pavicic-Saric J, Stevanovic V, Vilibic-Cavlek T. Emerging and neglected zoonoses in transplant population. World J Transplant 2020; 10:47-63. [PMID: 32257849 PMCID: PMC7109593 DOI: 10.5500/wjt.v10.i3.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/15/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023] Open
Abstract
Zoonoses represent a problem of rising importance in the transplant population. A close relationship and changes between human, animal and environmental health (“One Health” concept) significantly influence the transmission and distribution of zoonotic diseases. The aim of this manuscript is to perform a narrative review of the published literature on emerging and neglected zoonoses in the transplant population. Many reports on donor-derived or naturally acquired (re-)emerging arboviral infections such as dengue, chikungunya, West Nile, tick-borne encephalitis and Zika virus infection have demonstrated atypical or more complicated clinical course in immunocompromised hosts. Hepatitis E virus has emerged as a serious problem after solid organ transplantation (SOT), leading to diverse extrahepatic manifestations and chronic hepatitis with unfavorable outcomes. Some neglected pathogens such as lymphocytic choriomeningitis virus can cause severe infection with multi-organ failure and high mortality. In addition, ehrlichiosis may be more severe with higher case-fatality rates in SOT recipients. Some unusual or severe presentations of borreliosis, anaplasmosis and rickettsioses were also reported among transplant patients. Moreover, toxoplasmosis as infectious complication is a well-recognized zoonosis in this population. Although rabies transmission through SOT transplantation has rarely been reported, it has become a notable problem in some countries. Since the spreading trends of zoonoses are likely to continue, the awareness, recognition and treatment of zoonotic infections among transplant professionals should be imperative.
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Affiliation(s)
- Anna Mrzljak
- Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Rafaela Novak
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Nenad Pandak
- Depatment of Medicine, The Royal Hospital Muscat, Muscat 111, Oman
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | | | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, Zagreb 10000, Croatia
| | - Danko Mikulic
- Department of Abdominal and Transplant Surgery, Merkur University Hospital, Zagreb 10000, Croatia
| | - Jadranka Pavicic-Saric
- Department of Anesthesiology and Intensive Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health; School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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