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Rammohan R, Hajib Naraharirao M, Veerappan S, Vijayaraghavan P, Rajaraman R, Manayath GJ, Dsouza P, Radhakrishnan S, Venkatapathy N, Lakshmipathi D, Madhuravasal Krishnan J, Raghavan A. Cluster of Post-Operative Endophthalmitis Caused by Acanthamoeba T10 Genotype - A First Report. Cornea 2021; 40:232-241. [PMID: 33201060 DOI: 10.1097/ico.0000000000002603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To report a cluster of postoperative Acanthamoeba endophthalmitis after routine cataract surgeries. METHODS A brief summary of sentinel events leading to the referral of 4 patients of postoperative endophthalmitis to our hospital is followed by clinical descriptions and the various diagnostic approaches and interventions used. Genotyping and phylogenetic analysis are also discussed. RESULTS Four cases of postoperative cluster endophthalmitis, presumed to be bacterial and treated as such, were referred to our hospital. The presence of an atypical ring infiltrate in the first case facilitated the diagnosis of Acanthamoeba endophthalmitis. All patients had vitritis, corneal involvement, and scleral inflammation. Multiple diagnostic methods, such as corneal scrapings, confocal microscopy, aqueous and vitreous taps, scleral abscess drainage, histopathological studies, polymerase chain reaction, and genotyping and phylogenetic analyses of isolated Acanthamoeba, were used to confirm the diagnosis of endophthalmitis and to establish the extent of ocular involvement. Various medical and therapeutic interventions used to control the infections were also documented. The isolated Acanthamoeba were confirmed as belonging to the T10 genotype, an environmentally and clinically rare variety. CONCLUSIONS This is the first report of a cluster of postoperative T10 genotype Acanthamoeba endophthalmitis, occurring after routine cataract surgery in immunocompetent individuals. Contrary to current perceptions, a rapidly evolving infection can occur with Acanthamoeba.
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Affiliation(s)
- Ram Rammohan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | | | - Saravanan Veerappan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Prabhu Vijayaraghavan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Revathi Rajaraman
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - George J Manayath
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Palmeera Dsouza
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Shanthi Radhakrishnan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Narendran Venkatapathy
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Dhanurekha Lakshmipathi
- Sankara Nethralaya Referral Laboratory (Medical Research Foundation), Chennai, Tamil Nadu, India; and
| | | | - Anita Raghavan
- Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Clavijo Sánchez F, Vázquez Sánchez T, Cabello Díaz M, Sola Moyano VE, Jironada Gallego C, Hernández Marrero D. Visceral Leishmaniasis in Renal Transplant Recipients: Report of 2 Cases. Transplant Proc 2018; 50:581-582. [PMID: 29579858 DOI: 10.1016/j.transproceed.2017.12.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/02/2017] [Accepted: 12/04/2017] [Indexed: 11/17/2022]
Abstract
Visceral leishmaniasis is a disease caused by the protozoan Leishmania and is transmitted by Lutzomyia longipalpis (sand fly). It is an endemic parasitic infection in numerous areas around the Mediterranean basin. Though immunocompetent patients may not develop the disease, in transplant recipients the use of corticoids and intensified immunosuppressants to prevent graft rejection may accelerate the disease, causing severe damage to the liver, spleen, and hematopoietic system. We report 2 cases of visceral leishmaniasis with an atypical presentation in transplant recipients. The first patient, who had a kidney transplant, was treated successfully with liposomal amphotericin B, and the second patient, a combined kidney-pancreas transplant recipient, suffered a relapse 3 years after treatment. Visceral leishmaniasis should be considered in the differential diagnosis of pancytopenia or unexplained fever occurring after organ transplantation in patients living in endemic areas or returning from endemic countries.
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Affiliation(s)
- F Clavijo Sánchez
- Nephrology Department, Torrecárdenas Hospital Complex, Almería, Spain.
| | - T Vázquez Sánchez
- Nephrology Department, Regional University Hospital of Málaga, Málaga, Spain
| | - M Cabello Díaz
- Nephrology Department, Regional University Hospital of Málaga, Málaga, Spain
| | - V E Sola Moyano
- Nephrology Department, Regional University Hospital of Málaga, Málaga, Spain
| | - C Jironada Gallego
- Nephrology Department, Regional University Hospital of Málaga, Málaga, Spain
| | - D Hernández Marrero
- Nephrology Department, Regional University Hospital of Málaga, Málaga, Spain
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3
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Wołyniec W, Sulima M, Renke M, Dębska-Ślizień A. Parasitic Infections Associated with Unfavourable Outcomes in Transplant Recipients. Medicina (Kaunas) 2018; 54:E27. [PMID: 30344258 PMCID: PMC6037257 DOI: 10.3390/medicina54020027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/21/2018] [Accepted: 04/27/2018] [Indexed: 01/10/2023]
Abstract
Introduction. The immunosuppression used after transplantation (Tx) is associated with an increased risk of opportunistic infections. In Europe, parasitic infections after Tx are much less common than viral, bacterial and fungal ones. However, diseases caused by parasites are very common in tropical countries. In the last years the number of travellers with immunosuppression visiting tropical countries has increased. Methods. We performed a literature review to evaluate a risk of parasitic infections after Tx in Europe. Results. There is a real risk of parasitic infection in patients after Tx travelling to tropical countries. Malaria, leishmaniasis, strongyloidiasis and schistosomiasis are the most dangerous and relatively common. Although the incidence of these tropical infections after Tx has not increased, the course of disease could be fatal. There are also some cosmopolitan parasitic infections dangerous for patients after Tx. The greatest threat in Europe is toxoplasmosis, especially in heart and bone marrow recipients. The most severe manifestations of toxoplasmosis are myocarditis, encephalitis and disseminated disease. Diarrhoea is one of the most common symptoms of parasitic infection. In Europe the most prevalent pathogens causing diarrhoea are Giardia duodenalis and Cryptosporidium. Conclusions. Solid organ and bone marrow transplantations, blood transfusions and immunosuppressive treatment are associated with a small but real risk of parasitic infections in European citizens. In patients with severe parasitic infection, i.e., those with lung or brain involvement or a disseminated disease, the progression is very rapid and the prognosis is bad. Establishing a diagnosis before the patient's death is challenging.
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Affiliation(s)
- Wojciech Wołyniec
- Department of Occupational, Metabolic and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80⁻210 Gdansk, Poland.
| | - Małgorzata Sulima
- Department of Tropical and Parasitic Diseases, Institute of Maritime and Tropical Medicine, 81⁻519 Gdynia, Poland.
| | - Marcin Renke
- Department of Occupational, Metabolic and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80⁻210 Gdansk, Poland.
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Gdansk, 80⁻210 Gdansk, Poland.
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4
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Rego Silva J, Macau RA, Mateus A, Cruz P, Aleixo MJ, Brito M, Alcobia A, Oliveira C, Ramos A. Successful Treatment of Strongyloides stercoralis Hyperinfection in a Kidney Transplant Recipient: Case Report. Transplant Proc 2018; 50:861-866. [PMID: 29661454 DOI: 10.1016/j.transproceed.2018.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Strongyloides stercoralis (SS) can cause hyperinfection and disseminated infection in immunosuppressed individuals, with risk of mortality. We report the case of a cadaveric kidney transplant recipient who developed gastrointestinal symptoms and eosinophilia, approximately 3 months after transplantation. Stool examination and esophagogastroduodenoscopy with biopsies were positive for SS larvae. The patient was started on oral ivermectin and immunosuppression was reduced, but still the clinical picture got worse with metabolic ileus and respiratory symptoms, with the need for administration of subcutaneous ivermectin and combined therapy with albendazol. The patient survived and graft function was preserved. The patient was unlikely to be the source of infection. We also present a review of cases of SS infection in kidney transplant recipients.
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Affiliation(s)
- J Rego Silva
- Nephrology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - R A Macau
- Nephrology Department, Hospital Garcia de Orta, Almada, Portugal
| | - A Mateus
- Nephrology Department, Hospital Garcia de Orta, Almada, Portugal
| | - P Cruz
- Nephrology Department, Hospital Garcia de Orta, Almada, Portugal
| | - M J Aleixo
- Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
| | - M Brito
- Pharmacy, Hospital Garcia de Orta, Almada, Portugal
| | - A Alcobia
- Pharmacy, Hospital Garcia de Orta, Almada, Portugal
| | - C Oliveira
- Nephrology Department, Hospital Garcia de Orta, Almada, Portugal
| | - A Ramos
- Nephrology Department, Hospital Garcia de Orta, Almada, Portugal
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5
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Galván-Ramírez MDLL, Sánchez-Orozco LV, Gutiérrez-Maldonado AF, Rodriguez Pérez LR. Does Toxoplasma gondii infection impact liver transplantation outcomes? A systematic review. J Med Microbiol 2018; 67:499-506. [PMID: 29458555 DOI: 10.1099/jmm.0.000694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Approximately one-third of the world's population has Toxoplasma gondii infection, and one of the main routes of transmission is organ transplantation. The aim of this study was to evaluate the impact of Toxoplasma infection on liver transplantation patients. METHODOLOGY We searched PubMed, Lilacs, Medline, Science direct, Scielo, Ebsco, Springer, Wiley, Ovid and Google Scholar for reports published up to June 2017, and a systematic review was performed. RESULTS Twenty cases were analysed before and after liver transplantation. Primary and reactivated infections were investigated. Before transplantation, positive IgG antibodies were the predominant serological markers in donors and recipients: 40 % (D+/R-), 20 % (D+/R+) and 20 % (D-/R+). IgM was present in only 5 % of the donors (D+/R-). In four cases, the serological markers were not specified or were negative (D?/R? or D?/R-). After transplantation, IgM anti-Toxoplasma antibodies were found in 30 % of the recipients, and in 67 % of the seronegative recipients the presence of Toxoplasma DNA or tachyzoites was reported, suggesting a primary infection. Clinical symptoms were meningitis, massive cerebral oedema, encephalitis and seizures. Treatment was administered in 70 % of the patients, and 40 % died after presenting symptoms associated with Toxoplasma infection. CONCLUSIONS Although we review Toxoplasma infection and liver transplantation cases, problems associated with the parasite may be greater than identified. Hence, follow-up studies on Toxoplasma infection in liver transplantation patients are recommended.
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Affiliation(s)
- Maria de la Luz Galván-Ramírez
- Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Laura V Sánchez-Orozco
- Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Adrián Fernando Gutiérrez-Maldonado
- Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Laura Roció Rodriguez Pérez
- Department of Physiology, Neurophysiology Laboratory, Health Sciences University Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
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6
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Zaucha-Prażmo A, Samardakiewicz M, Dubelt J, Kowalczyk JR. Cerebral toxoplasmosis after haematopoietic stem cell transplantation. Ann Agric Environ Med 2017; 24:237-239. [PMID: 28664700 DOI: 10.5604/12321966.1232086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Toxoplasmosis is an opportunistic infection caused by the parasite Toxoplasma gondii. The infection is severe and difficult to diagnose in patients receiving allogeneic haematopoietic stem cell transplantation (HSCT). It frequently involves the central nervous system. The case is presented of cerebral toxoplasmosis in a 17-year-old youth with Fanconi anaemia treated with haematopoietic stem cell transplantation (HSCT).
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Affiliation(s)
- Agnieszka Zaucha-Prażmo
- Department of Paediatric Haematology, Oncology and Transplantology, Medical University, Lublin, Poland
| | - Marzena Samardakiewicz
- Department of Paediatric Haematology, Oncology and Transplantology, Medical University, Lublin, Poland
| | - Joanna Dubelt
- Department of Paediatric Neurology, Medical University, Lublin, Poland
| | - Jerzy R Kowalczyk
- Department of Paediatric Haematology, Oncology and Transplantology, Medical University, Lublin, Poland
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Abstract
BACKGROUND Ophthalmomyiasis is a rare entity seen mainly in immunocompromised host with neglected wounds under poor hygienic conditions. CASE We report a case of extreme ophthalmomyiasis with extensive facial and scalp involvement in an old rural inhabitant following evisceration. CONCLUSION Proper wound care and personal hygiene are of paramount importance for good wound healing.
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8
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Ekçı B, Gürol Y, Aydin I, Yalniz F, Ozcan M, Zengın K. [The protoskolicidal effect of 1% polyvinylpyrrolidone-iodine (PVP-1) and 2% taurolidine on abdominal hydatidosis]. Turkiye Parazitol Derg 2010; 34:152-155. [PMID: 20954114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of this study is to determine the efficacy of 1% polyvinylprolidone-iodine (Betadine, PVP-I) and 2% Taurolidine as scolicidal agents for the prevention of abdominal hydatidosis defined as the rupture of the echinococcal cyst spontaneously or traumatically. The study was carried out in fifty mice randomly assigned into 5 treatment groups as following: group with no expose to any scolicidal agent, groups with 1% PVP-I for 2 and 5 minutes; groups with 2 % Taurolidine for 2 minutes, and 5 minutes. PVP-I has found to be effective according to results of staining with the eosin dye in vitro and abdominal hydatidosis in vivo, while Taurolidine was ineffective as a scolicidal agent.
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Affiliation(s)
- Baki Ekçı
- Yeditepe University Hospital, Department of General Surgery, Istanbul, Turkey, Turkey
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10
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Vilela EG, Clemente WT, Mira RRL, Torres HOG, Veloso LF, Fonseca LP, de Carvalho E Fonseca LR, Franca MDC, Lima AS. Strongyloides stercoralis hyperinfection syndrome after liver transplantation: case report and literature review. Transpl Infect Dis 2009; 11:132-6. [PMID: 18983416 DOI: 10.1111/j.1399-3062.2008.00350.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Strongyloides stercoralis is an intestinal nematode that causes human infections and whose life cycle has special features, including autoinfection. Strongyloides infection may be asymptomatic for years, owing to a low parasite load. During immunosuppressive therapy, however, if cellular immunity is depressed, autoinfection can occur at a higher rate, resulting in hyperinfection syndrome. In this specific circumstance, it can become a fatal illness. We describe a case of hyperinfection syndrome in a liver transplant recipient and also review the literature.
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Affiliation(s)
- E G Vilela
- Transplant Unit, Alfa Institute of Gastroenterology, Clinic Hospital, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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11
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Foca E, Zulli R, Buelli F, De Vecchi M, Regazzoli A, Castelli F. P. falciparum malaria recrudescence in a cancer patient. Infez Med 2009; 17:33-34. [PMID: 19359823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Persons living for long periods of time in malaria hyper-endemic areas may suffer from hyper-reactive malarial splenomegaly (HMS), a frequent cause of splenomegaly in such areas. Splenomegaly and sub-microscopic P. falciparum parasitaemia are hallmarks of HMS. Spleen has been suggested to play a protective antimalarial role and splenectomy may trigger symptomatic malaria attacks. Other causes of immune suppression may possibly reactivate latent malaria parasites. We report the case of an Italian 60-year-old male, who had spent 33 years in sub-Saharan Africa, who experienced a P. falciparum malaria attack 12 months after his return to Italy, concomitantly with a diagnosis of lung carcinoma possibly impairing his immune system.
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Affiliation(s)
- E Foca
- Institute for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
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12
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Abstract
Surgery of hydatid cysts is often complicated with intrabiliary rupture (IBR), which if not recognized may lead to biliary fistula with rather high rates of morbidity and mortality. We report our experience with the application of radiofrequency (RF) ablation for the treatment of an operated hepatic echinococcal cyst which was complicated with biliocystic communication and cysteocutaneous fistula with bile leakage. RF ablation was performed under CT guidance into the remaining cyst through the cutaneous fistula. Since ablation of the cyst and the fistula the patient has been asymptomatic.
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Affiliation(s)
- L Thanos
- Department of Radiology, Korgialeneio-Benakeio Red Cross Hospital of Athens, Athens, Greece.
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13
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Atambay M, Bayraktar MR, Kayabas U, Yilmaz S, Bayindir Y. A rare diarrheic parasite in a liver transplant patient: Isospora belli. Transplant Proc 2007; 39:1693-5. [PMID: 17580223 DOI: 10.1016/j.transproceed.2007.02.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
Abstract
We describe the first case of isosporiasis in a liver transplant patient. Watery diarrhea due to Isospora belli was observed in a woman who had undergone liver transplantation 8 months prior. She was successfully treated with trimethoprim-sulfamethoxazole. This parasite should be taken into consideration as an opportunistic infection in transplant patients who need increased hygienic awareness.
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Affiliation(s)
- M Atambay
- Medical Faculty, Inonu University, Elazig Yolu 8 Km., Malatya 44280, Turkey
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14
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Said T, Nampoory MRN, Nair MP, Halim MA, Shetty SA, Kumar AV, Mokadas E, Elsayed A, Johny KV, Samhan M, Al-Mousawi M. Hyperinfection Strongyloidiasis: An Anticipated Outbreak in Kidney Transplant Recipients in Kuwait. Transplant Proc 2007; 39:1014-5. [PMID: 17524878 DOI: 10.1016/j.transproceed.2007.03.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hyperinfection strongyloidiasis is a potentially fatal syndrome associated with conditions of depressed host cellular immunity. A high degree of suspicion is required to detect cases early and thereby avoid a fatal outcome. PATIENTS AND METHODS Three consecutive cadaveric kidney transplant recipients died within 2 months from hyperinfections with strongyloides. All members of the transplant team were involved in a campaign to localize the source of infection, identify and treat affected patients, and provide adequate prophylaxis to other transplant recipients. We reviewed cadaveric donor files and screened 61 hospital personnel, 27 hospital inpatients, and the 87 hospital outpatients transplanted in a year's time before that event for a possible source. The screening test included analysis of fresh stool samples on 3 consecutive days for strongyloides larvae. The anti-helminthic drug albendazol was administered to all patients during screening. They were followed for possible development of the disease during the infectivity period. RESULTS The first 2 recipients received their kidneys from 1 cadaveric donor, while the third received it from a different donor. Both donors came from areas endemic for strongyloidiasis. The 3 recipients were on tacrolimus-based immunosuppression. The twin recipient of the second kidney was on cyclosporine and did not manifest a disease. All stool samples taken for screening were negative for the infective larvae. None of the other recipients developed the disease. CONCLUSIONS Cadaveric donors were the possible source for this outbreak. Cyclosporine probably has a protective effect against strongyloides. In our setting, screening of cadaveric donors for strongyloides is mandatory before accepting them for donation, and oral prophylaxis is required for all recipients.
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Affiliation(s)
- T Said
- Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Kuwait.
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15
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Galván Ramírez ML, Castillo-de-León Y, Espinoza-Oliva M, Bojorques-Ramos MC, Rodríguez-Pérez LR, Bernal Redondo R, Cañedo-Solares I, Espinoza López L, Correa D. Acute infection of Toxoplasma gondii and cytomegalovirus reactivation in a pediatric patient receiving liver transplant. Transpl Infect Dis 2007; 8:233-6. [PMID: 17116139 DOI: 10.1111/j.1399-3062.2006.00140.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 7-year-old Mexican boy with end-stage cirrhosis underwent liver transplantation and was maintained with cyclosporine and prednisolone. No specific data about Toxoplasma gondii or cytomegalovirus (CMV) infections in the cadaver donor were available. The recipient was seronegative for Toxoplasma, but CMV-IgG positive before transplantation. Ganciclovir was administered for prophylaxis during 3 months, but 5 months later he presented with icterus and increased transaminases. Acute transplant rejection was ruled out by biopsy. A seroconversion for T. gondii IgM and IgG and a small increase in CMV-IgM antibodies were observed, although the CMV-polymerase chain reaction (PCR) was negative. Ganciclovir was re-started, and the patient improved, but 6 months later he relapsed, and chorioretinitis lesions compatible both with T. gondii and CMV infections appeared. Pyrimethamine, sulfadiazine, folinic acid, and ganciclovir were administered. The boy showed favorable clinical improvement and remained stable for 12 months. Then, new retinal CMV lesions appeared in both eyes and the PCR for CMV became positive; therefore, the patient received a new regimen of ganciclovir, and clinically improved. From these data we concluded that the child presented a reactivation of CMV and a primary infection with T. gondii after transplantation.
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Affiliation(s)
- M L Galván Ramírez
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, Mexico.
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16
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Menichetti F, Bindi ML, Tascini C, Urbani L, Biancofiore G, Doria R, Esposito M, Mozzo R, Catalano G, Filipponi F. Fever, mental impairment, acute anemia, and renal failure in patient undergoing orthotopic liver transplantation: posttransplantation malaria. Liver Transpl 2006; 12:674-6. [PMID: 16555320 DOI: 10.1002/lt.20730] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A case of post-transplant malaria is described. The patient presented fever and severe anemia after orthotopic liver transplantation. Diagnosis was made only after the review of donor characteristics. Although a high parasitemia was found at the moment of diagnosis, the treatment with quinine and doxycycline was successful. Donor epidemiology should always be considered for a prompt diagnosis of rare tropical diseases in the graft recipients.
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Affiliation(s)
- Francesco Menichetti
- Department of Infectious Diseases, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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17
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Abstract
Toxoplasmosis is an infrequent, often difficult to diagnose and potentially lethal disease in kidney transplant recipients. Among reported cases, a few were associated with hemophagocytic syndrome (HPS), a rare condition characterized by widespread proliferation of macrophages phagocytizing blood elements, accompanied by fever and pancytopenia. We report here the case of a patient who received a Toxoplasma gondii positive kidney allograft and developed invasive toxoplasmosis 10 days after surgery, with high fever, skin rash, arthralgias, and renal failure, followed by pneumonia, anemia, thrombocytopenia, liver dysfunction, and encephalitis. Mislead by the absence of Toxoplasma on blood smears, alveolar fluid, renal graft biopsy, and negative brain computed tomography, confusion with serum sickness, and simultaneous herpetic infection, we failed to make the right diagnosis and the patient died with septic shock 11 days later. An HPS was revealed by a late bone marrow analysis. This may well be the fourth case ever reported of toxoplasmosis-associated HPS in renal transplant recipients.
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Affiliation(s)
- Liviu Segall
- Service de Néphrologie, Hôpital Cavale Blanche, CHU Brest, Brest, France
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18
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Tubbs RS, Salter EG, Wellons JC, Blount JP, Oakes WJ. Superficial landmarks for the spinal accessory nerve within the posterior cervical triangle. J Neurosurg Spine 2005; 3:375-8. [PMID: 16302632 DOI: 10.3171/spi.2005.3.5.0375] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The spinal accessory nerve (SAN) within the posterior cervical triangle (PCT) is the most commonly iatrogenically injured nerve in the body. Nevertheless, there is a paucity of published information regarding superficial landmarks for the SAN in this region. Additional identifiable landmarks of this nerve may assist the surgeon in identifying it for repair, use of it in peripheral nerve neurotization, or avoiding it as in proximal brachial plexus repair. The present study was undertaken to provide reliable superficial landmarks for the identification of the SAN within the PCT. METHODS The PCT was dissected in 30 cadaveric sides. Measurements were made between the SAN and surrounding landmarks. The mean distances between the entry site of the SAN into the trapezius and a midpoint of the clavicle, mastoid process, acromion process, and lateral aspect of the sternocleidomastoid (SCM) muscle were 6, 7, 5.5, and 3.5 cm, respectively. The mean distances between the angle of the mandible and the mastoid process and the exit point of the SAN from the posterior border of the SCM muscle were 6 and 5 cm, respectively. The mean width and length of the SAN were 3 and 3.5 cm, respectively. CONCLUSIONS It is the authors' hope that these data will aid those who may need to locate or avoid the SAN while undertaking surgery in the PCT and thus decrease morbidity that may follow manipulation of this region.
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Affiliation(s)
- R Shane Tubbs
- Department of Cell Biology, University of Alabama at Birmingham, USA.
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19
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Cho DS, Kim SJ, Seo EK, Chung IH, Oh CS. Quantitative anatomical and morphological classification of the iliac vessels anterior to the lumbosacral vertebrae. J Neurosurg Spine 2005; 3:371-4. [PMID: 16302631 DOI: 10.3171/spi.2005.3.5.0371] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Anterior surgical approaches to the lumbosacral disc spaces are being undertaken with increasing frequency. This increase and the use of minimally invasive techniques themselves have the potential to raise the incidence of major vessel injuries. The purpose of this study was to determine the variability of the vascular anatomy anterior to the lumbosacral spine and to draw conclusions regarding surgical accessibility of the L5-S1 disc space. METHODS Thirty-five cadavers (age range at the time of death 31-87 years) were obtained to evaluate the anatomical features of iliac vessels with respect to the anterior approach to the lumbosacral spine. Direct measurement and morphological classification regarding the relations of these great vessels to the four arbitrary reference points of the lumbosacral disc space were performed. The mean width and height of the L5-S1 disc were 56.4 mm (range 41.6-65.4 mm) and 18.8 mm (range 10-24 mm), repectively. According to the authors' morphological classification, nine specimens (26%) were found to be Type A (standard), 12 (34%) Type B (narrow), two (6%) Type C (ajar), and 12 (34%) Type D (obstacle). CONCLUSIONS The authors have noted quite a variation in the venous vascular anatomy anterior to the lumbosacral disc. During surgical planning for the anterior approach to the lumbosacral spine when using any technique, it is vital to assess carefully radiographic and neuroimaging studies to minimize potentially disastrous vascular complications.
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Affiliation(s)
- Do-Sang Cho
- Department of Neurosurgery, Ewha Women's University Mokdong Hospital, Seoul, Korea
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20
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Gorgulu A, Albayrak BS, Gorgulu E, Tural O. Postoperative cerebral abscess formation caused by Toxocara canis in a meningioma cavity. J Neurooncol 2005; 77:325-6. [PMID: 16314947 DOI: 10.1007/s11060-005-9040-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 09/02/2005] [Indexed: 11/26/2022]
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22
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Abstract
Cryptosporidium infestations are common in immunocompromised AIDS patients. However, the literature in renal transplant recipients is scarce. We conducted a study to know the prevalence, disease manifestations, and management of cryptosporidial infestations in live related renal transplant recipients. Cryptosporidial infestations were observed in 20% of patients, including 16.6% who had symptomatic diarrhea. We conclude that the prevalence is high in the transplant population, but only a few patients are symptomatic. Clinicians should routinely request special stains to demonstrate cryptosporidium in stool specimens.
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Affiliation(s)
- N Udgiri
- Department of Transplant Surgery, Chandigart India
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Abstract
We report the case of a simultaneous kidney and pancreas transplant recipient who presented with vague neurologic symptoms 21 months following the surgery. Computed tomography, magnetic resonance imaging, and fundoscopy findings were normal. Serology titers for antitoxoplasmic antibodies were increased. This was an atypical presentation of toxoplasmosis in a simultaneous kidney and pancreas transplant patient.
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Affiliation(s)
- Q J Nasser
- Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland
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Bestetti RB, Cury PM, Theodoropoulos TAD, Villafanha D. Trypanosoma cruzi myocardial infection reactivation presenting as complete atrioventricular block in a Chagas' heart transplant recipient. Cardiovasc Pathol 2004; 13:323-6. [PMID: 15556779 DOI: 10.1016/j.carpath.2004.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2004] [Revised: 07/21/2004] [Accepted: 08/09/2004] [Indexed: 11/17/2022] Open
Abstract
A 56-year-old man underwent orthotopic heart transplantation because of end-stage Chagas' cardiomyopathy. One hundred and ten days following heart transplantation, an electrocardiogram tracing showed complete atrioventricular block, which was treated with temporary transvenous pacemaker insertion. An underlying endomyocardial biopsy was graded 3A. The patient was treated with pulse steroid therapy. One week later, the patient died of multiorgan failure secondary to septicemia. A careful review of the endomyocardial biopsy showed nests of parasites in the myocardial tissue accompanied by mononuclear cell infiltrate similar to that found in acute graft rejection. Thus, complete atrioventricular block may be another clinical manifestation of Trypanosoma cruzi infection reactivation in Chagas' heart transplant recipients.
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Affiliation(s)
- Reinaldo B Bestetti
- Department of Cardiology, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto City, Brazil.
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25
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26
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Determann MM, Kollenbaum VE, Henne-Bruns D. [Utility of the questionnaire for quality of life EORTC-QLQ-C30 in psycho-oncological outcome research]. Zentralbl Chir 2004; 129:14-7. [PMID: 15011106 DOI: 10.1055/s-2004-44873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim of this paper is to examine the utility and validity of the questionnaire for quality of life EORTC-QLQ-C30 (European Organization for Research and Treatment of Cancer). Data were collected within the scope of a study for evaluation of individual psycho-oncological support for inpatients with colorectal cancer undergoing surgery. The study was sponsored by the German Cancer Aid. The design was a prospective randomized controlled trial. After informed consent, patients were randomized in one of two groups: patients in the experimental group received individualized psychotherapeutic support during the hospital stay; those in the control group received a daily program of classical music. All patients were assessed one day before surgical treatment, ten days and three months after surgery. Instruments were questionnaires for quality of life and state anxiety. 106 patients met the inclusion criteria. Results show insufficient discriminative power (high significant bivariate correlations between most EORTC scales, Kendalls tau-b) and insufficient construct validity (high and significant bivariate correlations between most EORTC scales and state anxiety, Kendalls tau-b) of the EORTC scales. The scores of "cognitive functioning" and some symptom scales show an insufficient scatter. The illustration of situational influences and therefore an insufficient illustration of effects of specific interventions are connected with a high sensitivity of the scales and a tendency to extreme sores. The psycho-oncological intervention shows a significant stress reducing effect on the specific EORTC-scale "Emotional Functioning" and on State Anxiety (STAI). The testing of utility and validity of the EORTC-Questionnaire shows that they are insufficient and therefore the benefit for evaluation of specific intervention procedures is restricted.
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Affiliation(s)
- M M Determann
- Abteilung für Viszeral- und Transplantationschirurgie, Universitätsklinikum Ulm.
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Minz M, Udgiri NK, Heer MK, Kashyap R, Malla N. CRYPTOSPORIDIASIS IN LIVE RELATED RENAL TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE. Transplantation 2004; 77:1916-7. [PMID: 15223922 DOI: 10.1097/01.tp.0000132341.99938.c1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gaeta GB. [Clinical signs of visceral leishmaniasis in adults: is the manner of presentation changing?]. Parassitologia 2004; 46:225-6. [PMID: 15305722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Although the typical clinical signs and symptoms of visceral leishmaniasis (VL) are always the same, in the recent years the disease has emerged in new settings, for example in HIV infected individuals, in organ transplant recipients, in patients with chronic liver disease, in pregnancy. At the same time, VL has emerged as a model for exploring the host-parasite interplay for intracellular infections. The common feature of VL is that it is fatal without treatment. Liposomal Amphotericin B is the first line treatment in developed countries. Unfortunately, the high cost makes this treatment unaffordable for developing countries.
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Affiliation(s)
- G B Gaeta
- Centro di Riferimento Regionale per la Leishmaniosi Viscerale, Dipartimento di Malattie Infettive, Seconda Università di Napoli
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Hommann M, Schotte U, Voigt R, Glutig H, Grube T, Küpper B, Kornberg A, Richter K, Scheele J. Cerebral toxoplasmosis after combined liver-pancreas-kidney and liver-pancreas transplantation. Transplant Proc 2003; 34:2294-5. [PMID: 12270404 DOI: 10.1016/s0041-1345(02)03241-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M Hommann
- Department of General and Visceral Surgery, Friedrich-Schiller-University Jena, Jena, Germany
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Baden LR, Katz JT, Franck L, Tsang S, Hall M, Rubin RH, Jarcho J. Successful toxoplasmosis prophylaxis after orthotopic cardiac transplantation with trimethoprim-sulfamethoxazole. Transplantation 2003; 75:339-43. [PMID: 12589155 DOI: 10.1097/01.tp.0000044864.99398.f1] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The efficacy of trimethoprim-sulfamethoxazole (TMP/SMX) in the prevention of toxoplasmosis after orthotopic cardiac transplantation has been the subject of some controversy, with many transplant groups preferring to use the combination of pyrimethamine and sulfadiazine. Although effective, this latter regimen does not offer equal protection against other pathogens, such as or. To assess the value of TMP/SMX, we reviewed the experience in our heart transplant patients, all of whom received TMP/SMX (160/800 mg) three times weekly for approximately 8 months after transplantation. METHODS We report on 417 orthotopic cardiac transplants during a 17-year period. We have 100% one-year patient follow-up after transplantation. Data was collected on pretransplantation donor and recipient anti- serology, immunosuppression, allograft rejection, survival, yearly posttransplantation anti- serology, development of acute toxoplasmosis, and the occurrence of other infections. RESULTS In this cohort, acute toxoplasmosis developed after transplantation in one case (0.2%). Among the highest risk patients (D+R-) who were treated for at least one episode of rejection, the risk of acute toxoplasmosis was 5% (1 of 22 patients). No change in survival was found between the different anti- IgG serogroups (D-R-, D-R+, D+R-, or D+R+). Anti- IgG seroconversion occurred in eight -seronegative recipients after transplantation; all patients, except the case already noted, were asymptomatic and required no specific anti- therapy. No cases of, or infections were identified. Five proven and two suspected cases of pneumonia were found (only 2 of these 7 patients were receiving TMP/SMX at the time of pneumonia diagnosis). CONCLUSIONS These data demonstrate that TMP/SMX prophylaxis (160/800 mg) three times per week is effective prophylaxis after orthotopic cardiac transplantation and has prophylactic benefits against other posttransplantation opportunistic pathogens.
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Affiliation(s)
- L R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA 02215, USA.
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32
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Affiliation(s)
- Elena Núñez
- Servicio de Medicina Interna. Hospital El Escorial. San Lorenzo de El Escorial. Madrid. Spain.
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Zardi EM, Iori A, Picardi A, Costantino S, Petrarca V. Myiasis of a perineal fistula. Parassitologia 2002; 44:201-2. [PMID: 12701384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
We report a case of myiasis of a rectocutaneous fistula in a subject suffering from bone metastases after surgical resection of a neoplastic bladder. The fistula was infested by maggots identified as third-instar larvae of flies belonging to the family Sarcophagidae, genus Sarcophaga. The infestation was neither intestinal nor pseudointestinal; it was probably caused by a fly ovipositing on the fistula of the patient while having wound care at home, even though the possibility that the infestation might have occurred during hospitalization cannot be ruled out.
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Affiliation(s)
- E M Zardi
- Interdisciplinary Center for Biomedical Research (CIR), Laboratory of Internal Medicine and Hepatology, University Campus Bio-Medico, Via Emilio Longoni 83, 00155 Roma, Italy.
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Herwaldt BL, Neitzel DF, Gorlin JB, Jensen KA, Perry EH, Peglow WR, Slemenda SB, Won KY, Nace EK, Pieniazek NJ, Wilson M. Transmission of Babesia microti in Minnesota through four blood donations from the same donor over a 6-month period. Transfusion 2002; 42:1154-8. [PMID: 12430672 DOI: 10.1046/j.1537-2995.2002.00189.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Babesiosis is a tick-borne zoonosis caused by intraerythrocytic protozoa. More than 40 US cases of Babesia microti infection acquired by blood transfusion have been reported. This report describes the identification of a transfusion-associated case of babesiosis and the subsequent identification of the infected blood donor and three other infected recipients of cellular blood components from three other donations by this donor. STUDY DESIGN AND METHODS Serum specimens from the donors of blood that had been made into cellular components received by the index recipient and from other recipients of such components from the implicated donor were tested by the indirect fluorescent antibody (IFA) assay for antibodies to B. microti. Whole blood from IFA-positive persons was tested by PCR for B. microti DNA. RESULTS IFA testing of serum from 31 of 36 donors implicated a 45-year-old man (titer, 1 in 256), whose donation had been used for RBCs. He likely became infected when bitten by ticks while camping in Minnesota in June 1999 and had donated blood four times thereafter. As demonstrated by PCR, he remained parasitemic for at least 10 months. Of the five other surviving recipients of cellular blood components from the implicated donor, three recipients (one for each of the three other donations) had become infected through either RBC or platelet transfusions. CONCLUSIONS Babesiosis should be included in the differential diagnosis of posttransfusion febrile illness, and effective means for preventing transmission by blood transfusion are needed.
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Affiliation(s)
- Barbara L Herwaldt
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.
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Botterel F, Ichai P, Feray C, Bouree P, Saliba F, Tur Raspa R, Samuel D, Romand S. Disseminated toxoplasmosis, resulting from infection of allograft, after orthotopic liver transplantation: usefulness of quantitative PCR. J Clin Microbiol 2002; 40:1648-50. [PMID: 11980935 PMCID: PMC130685 DOI: 10.1128/jcm.40.5.1648-1650.2002] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Disseminated toxoplasmosis is a life-threatening disease in liver transplant recipients that can result from an organ-transmitted infection. We report here a case of fatal disseminated toxoplasmosis after orthotopic liver transplantation from a seropositive donor (immunoglobulin G [IgG](+) and IgM(-)) in a patient who was nonimmune for toxoplasmosis prior to transplantation. Quantitative PCR analyses of various clinical specimens, including serum samples, appeared retrospectively to be a valuable diagnostic tool that might guide therapeutic attitudes.
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Affiliation(s)
- Francoise Botterel
- Service de Microbiologie, Departement de Parasitologie-Mycologie, Hopital de Bicetre, Faculté de Médecine Paris-Sud, 78 rue du Général Leclerc, 94275 Kremlin-Bicetre Cedex, France.
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36
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Delis SG, Tector J, Kato T, Mittal N, Weppler D, Levi D, Ruiz P, Nishida S, Nery JR, Tzakis AG. Diagnosis and treatment of cryptosporidium infection in intestinal transplant recipients. Transplant Proc 2002; 34:951-2. [PMID: 12034256 DOI: 10.1016/s0041-1345(02)02712-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- S G Delis
- Division of Transplantation, Jackson Memorial Hospital, Miami, Florida 33136, USA
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Abstract
BACKGROUND The pattern of host defense against plasmodium is comparable to the immune response to bacterial infection. Posttraumatic immunosuppression may therefore cause relapses of malaria secondary to trauma and trauma surgery in asymptomatic carriers of the parasites in endemic areas. To our knowledge this has not been validated in epidemiologic studies. METHODS Postinjury malaria was registered retrospectively in 342 land mine and war victims from malaria-endemic areas in Cambodia. The incidence rate was analyzed in terms of age, gender, preinjury endemicity, evacuation times, anatomic injury severity, systolic blood pressure at admission, blood transfusion, and duration of the first surgical intervention as independent variables. RESULTS The rate of postinjury malaria in the study patients was 33.3% (95% CI, 28.3-38.3%). Injury Severity Score (ISS) and surgical operation time were risk factors (area under the curve in receiver operating characteristic plots were 0.73 and 0.79, respectively). The impact of the other risk factors was nonsignificant. CONCLUSION Despite difficulties in diagnosing postoperative malaria in endemic areas, the study demonstrates that the rate of postinjury malaria is high. The results legitimate controlled trials of immediate postinjury chemoprophylaxis to severely injured in endemic areas. The authors recommend staged surgical operations with brief primary interventions in victims with severe injuries.
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Affiliation(s)
- Hans Husum
- Tromsoe Mine Victim Resource Center, Institute of Clinical Medicine, Tromsoe University Hospital, Tromsoe, Norway.
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Schmidtke C, Hüppe M, Berndt S, Nötzold A, Sievers HH. [Quality of life after aortic valve replacement. Self-management or conventional anticoagulation therapy after mechanical valve replacement plus pulmonary autograft]. Z Kardiol 2001; 90:860-6. [PMID: 11771453 DOI: 10.1007/s003920170084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The improvement of quality of life gains increasing importance for the judgement of operative techniques. Besides the commonly used mechanical substitutes or bioprostheses for aortic valve replacement, the interest in the Ross procedure is growing. The aim of the study was to compare the quality of life after the Ross procedure with that after mechanical aortic valve replacement with two different anticoagulation regimes (self-management or conventional therapy). METHODS AND RESULTS Clinical, echocardiographic and quality of life investigations (SF-36) were performed in patients with mechanical aortic valve replacement and self-management of anticoagulation (group A, n = 20) or conventional anticoagulation therapy (group B, n = 20) and in patients after the Ross procedure (group C, n = 20). The mean ages were 59.5 +/- 9.2 (group A), 61.2 +/- 8.1 (group B) and 59.3 +/- 9 years (group C). Significantly lower values of quality of life (SF-36) were observed in group B compared with group A (5 of 9 subtests) and with group C (6 of 9 subtests) and also in the physical and mental health sum scales. CONCLUSION In this study the quality of life in patients after the Ross procedure and similarly after mechanical valve replacement and self-management of anticoagulation is superior to the quality of life after mechanical valve replacement and conventional anticoagulation.
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Affiliation(s)
- C Schmidtke
- Klinik für Herzchirurgie Universitätsklinikum Lübeck Ratzeburger Allee 160 23538 Lübeck, Germany.
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Gómez Campderá F, Berenguer J, Anaya F, Rodriguez M, Valderrábano F. Visceral leishmaniasis in a renal transplant recipient. Short review and therapy alternative. Am J Nephrol 2000; 18:171. [PMID: 9569963 DOI: 10.1159/000013329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Central nervous system (CNS) infections, accounting for 4-29% of CNS lesions in transplant recipients, are a significant post-transplant complication. Focal CNS infectious lesions or brain abscesses have been documented in 0.36-1% of the transplant recipients. Mycelial fungi, particularly Aspergillus, are by far the most frequent etiologies of post-transplant brain abscesses. Bacteria, with the exception of Nocardia, are rarely associated with brain abscesses in transplant recipients. Time of onset and concurrent extraneural lesions have implications relevant towards invasive diagnostic procedures in transplant recipients with brain abscesses. Meningoencephalitis in transplant recipients is predominantly due to viruses, e.g., herpesviruses, and less frequently due to Listeria monocytogenes, Toxoplasma gondii, and Cryptococcus. Despite a wide, and at times perplexing array of opportunistic pathogens that can cause CNS infections, the temporal association of the infection with the time elapsed since transplantation, risk factors, clinical manifestations, and neuroimaging characteristics of the lesion can allow a reasoned and rational approach towards the recognition, diagnosis, and appropriate management of CNS infections in transplant recipients.
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Affiliation(s)
- N Singh
- VA Medical Center and University of Pittsburgh, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania 15240, USA. nis5+@pitt.edu
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Honoré S, Couvelard A, Garin YJ, Bedel C, Hénin D, Dardé ML, Derouin F. [Genotyping of Toxoplasma gondii strains from immunocompromised patients]. Pathol Biol (Paris) 2000; 48:541-7. [PMID: 10965531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The genotypes of Toxoplasma gondii strains isolated from HIV and non-HIV immunocompromised patients with cerebral and extracerebral toxoplasmosis were determined and compared to those of strains isolated from non-immunocompromised patients in order to identify the possible relationships between parasite genotype and morbidity of toxoplasmosis. One hundred and ten strains of T. gondii were obtained, either by cell culture (n = 73), brain biopsy (n = 17) or mouse inoculation (n = 20). Ninety strains isolated from immunocompromised patients (74 HIV+ and 16 non-HIV patients) were compared to 20 strains isolated from immunocompetent patients (17 cases of congenital toxoplasmosis, and three cases of primary acquired infection). Genotyping was performed by PCR/RFLP on locus SAG2, and T. gondii strains were classified as Type I, II or III. Ninety out of 110 strains were successfully genotyped, including 20 strains that had been maintained in mice, 69/73 strains maintained in cell cultures, but only 1/17 strains from formalin-fixed paraffin-embedded brain biopsies. 76.7% of the strains in the study population were of type II, 15.6% were type I and 7.7% were type III. The distribution of strain genotypes in immunocompromised and non-immunocompromised patients was comparable: 14.1% and 21% for type I, 76.1% and 79% for type II and 9.8% and 0% for type III, respectively; no correlation could be established between genotype and clinical presentation, i.e., cerebral or extracerebral toxoplasmosis. These results suggest that the type of infecting parasitic strain does not predominantly influence the pathogenesis of toxoplasmosis in immunocompromised patients and fully supports the need for specific prophylaxis in patients infected by T. gondii, regardless of the strain genotype.
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MESH Headings
- AIDS-Related Opportunistic Infections/epidemiology
- AIDS-Related Opportunistic Infections/parasitology
- Animals
- Antigens, Protozoan/genetics
- Antigens, Surface/genetics
- Biopsy
- Bone Marrow Transplantation
- DNA, Protozoan/genetics
- DNA, Protozoan/isolation & purification
- France/epidemiology
- Genotype
- Hematologic Neoplasms/complications
- Hematologic Neoplasms/immunology
- Humans
- Immunocompromised Host
- Mice
- Polymerase Chain Reaction
- Polymorphism, Restriction Fragment Length
- Postoperative Complications/parasitology
- Protozoan Proteins
- Toxoplasma/classification
- Toxoplasma/genetics
- Toxoplasma/isolation & purification
- Toxoplasmosis/complications
- Toxoplasmosis/epidemiology
- Toxoplasmosis/parasitology
- Toxoplasmosis, Cerebral/complications
- Toxoplasmosis, Cerebral/epidemiology
- Toxoplasmosis, Cerebral/parasitology
- Toxoplasmosis, Cerebral/pathology
- Toxoplasmosis, Congenital/parasitology
- Transplantation
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Affiliation(s)
- S Honoré
- Laboratoire de parasitologie-mycologie, hôpital St-Louis, Paris, France
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Abstract
A 7-year-old female with a type I choledochal cyst underwent an exploratory laparotomy. A Roux-en-Y choledochojejunostomy was done following cyst excision. The patient was re-explored 8 days later for an anastomotic bile leak and high fever. A round-worm was found obstructing the jejunal lumen at the porta hepatis, resulting in a biliary leak. Various aspects of biliary ascariasis are discussed along with the case report.
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Affiliation(s)
- L S Kasat
- C/O Dr. Viraj Tambwekar, 14/A, "Sneha Sadan", 2nd floor, Mangal Wadi, Girgaum, Bombay, India
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43
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Colomina J, Esparza L, Buesa J, Marí J. [Corneal ulcer caused by Nocardia asteroides after penetrating keratoplasty]. Med Clin (Barc) 1997; 108:424-5. [PMID: 9213641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report the case of a 43-years-old patient, to whom a corneal transplantation was made because he presented a Salzmann nodular degeneration in his left eye. The patient was observed every week and his development during the following months was good. Nine weeks later he was attended at the emergency room of the hospital, with an intensive secretion and partial loss of vision in the operated eye. It was detected a peripheral ulcer of a diffused borders with a loss of epithelium and anterior stroma in the superior temporal part of the cornea. Five days later, the microbiological cultures confirmed the presence of Nocardia asteroides. In spite of the initial good evolution of the ulcer treated topically with a 20% sulfacetamide and trimetoprim-sulfadiacine p.o., the graft ended unsuccessfully.
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Affiliation(s)
- J Colomina
- Servicio de Microbiología, Facultad de Medicina, Hospital Clínico Universitario, Valencia
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44
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Machado A, Lozano A, Astete M, Watanabe J, Miyagui J, Velásquez H, Villena M. [Endoscopic retrograde cholangiopancreatography and sphincterotomy in parasitic diseases]. Rev Gastroenterol Peru 1996; 16:258-63. [PMID: 12165792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
We report six patients with billary duct obstruction due to parasites (Fasciola hepatica, ascariasis and hydatid cyst) that were diagnosed and managed with the endoscopic approach. This is the first national paper which highlights the importance of endoscopic retrograde cholangiopancreatography in the management of this parasitosis. Despite choledocholithiasis as the most common cause of extrahepatic jaundice, biliary tree parasitosis must be considered in the differential diagnosis.
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MESH Headings
- Adolescent
- Ascariasis/complications
- Ascariasis/diagnosis
- Ascariasis/surgery
- Cholangiopancreatography, Endoscopic Retrograde
- Cholecystectomy
- Cholestasis, Extrahepatic/diagnosis
- Cholestasis, Extrahepatic/etiology
- Cholestasis, Extrahepatic/surgery
- Cholestasis, Intrahepatic/diagnosis
- Cholestasis, Intrahepatic/etiology
- Cholestasis, Intrahepatic/surgery
- Common Bile Duct/parasitology
- Common Bile Duct Diseases/diagnosis
- Common Bile Duct Diseases/parasitology
- Common Bile Duct Diseases/surgery
- Diagnosis, Differential
- Echinococcosis, Hepatic/complications
- Echinococcosis, Hepatic/diagnosis
- Echinococcosis, Hepatic/surgery
- Fascioliasis/complications
- Fascioliasis/diagnosis
- Fascioliasis/surgery
- Female
- Gallstones/diagnosis
- Humans
- Male
- Middle Aged
- Pancreatectomy
- Postoperative Complications/parasitology
- Sphincterotomy, Endoscopic
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45
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Rostaing L, Baron E, Fillola O, Roques C, Durand D, Massip P, Lloveras JJ, Suc JM. Toxoplasmosis in two renal transplant recipients: diagnosis by bone marrow aspiration. Transplant Proc 1995; 27:1733-4. [PMID: 7725476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- L Rostaing
- Service de Néphrologie, CHU Rangueil, Toulouse, France
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46
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Bogatov AI, Volova LT, Grinenko NM. [Osteo-gingivoplasty in the combined treatment of periodontitis and in the prevention of odontogenic maxillary sinusitis at a polyclinic]. Stomatologiia (Mosk) 1994; 73:38-40. [PMID: 9612047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The authors suggest a method for surgical treatment of periodontitis using allogenic demineralized bone tissue of adults and fetuses. This method was effectively used at dentistry clinics of the Samara Province starting from 1984. A total of 177 patients with generalized and local periodontitis of medium and grave severity aged 19 to 55 were operated on. The process stabilized, the teeth were fortified. The method is effective not only therapy of periodontitis, but for prevention of its complications as well, of odontogenic maxillary sinusitis among other conditions.
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47
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Abstract
Human babesiosis in Europe came to medical attention in 1957 and until now 19 cases have been reported, most of them due to Babesia divergens. The onset of the disease is characterized by hemoglobinuria, high fever and renal failure ensue rapidly. The patients were generally asplenic and resident in a rural area. Intraerythrocytic pleomorphic parasites (1-3 microns) observed in stained thin blood smears are essential for Genus diagnosis. Parasitemia varied from 5 to 80% of red blood cells. Massive blood exchange transfusion (2-3 blood volumes) followed by intravenous clindamycin (3-4 times daily) and oral quinine (600 mg base, 3 times daily) were successfully used in the treatment of three recent cases. Splenectomised individuals should be aware for prevention.
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Affiliation(s)
- P Brasseur
- Laboratoire de Parasitologie, Centre Hospitalier Universitaire, Rouen, France
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48
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Shokeir AA, Bakr MA, el-Diasty TA, Sobh MA, Moustafa FE, el-Agroudi AE, Ghoneim MA. Urological complications following live donor kidney transplantation: effect of urinary schistosomiasis. Br J Urol 1992; 70:247-51. [PMID: 1422682 DOI: 10.1111/j.1464-410x.1992.tb15725.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Urological complications were studied in 310 live donor kidney transplants. All recipients and donors were investigated for urinary schistosomiasis by examining tissue obtained intra-operatively from the donor's ureter or the patient's bladder. Schistosomiasis was histologically documented in 76 cases (patient's bladder (46), donor's ureter (9), both (21)). The incidence of urological complications was 11/76 (15%) in the schistosomal group and 14/234 (6%) in the non-schistosomal group; this was statistically significant. Among the schistosomal patients, the site of infestation had no statistically significant effect on the incidence of urological complications. No deaths or graft losses were directly attributable either to these complications or to their surgical correction.
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Affiliation(s)
- A A Shokeir
- Urology and Nephrology Centre, Mansoura University, Egypt
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49
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Affiliation(s)
- J H Texter
- Division of Urology, Southern Illinois University School of Medicine, Springfield 62794-9230
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50
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Schenone H, Schenone S, Arriagada J. [Oral elimination of strobila segments of Taenia saginata]. Bol Chil Parasitol 1992; 47:33-5. [PMID: 1306992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Within a 14-24 hours lapse after gynecological operative surgery, a 27-year-old woman eliminated with vomit two large taperworm pieces, measuring 3 and 2 meters respectively. At the laboratory they were identified as Taenia saginata strobila with immature, mature and gravid proglottids. The patient informed that she liked to eat raw beef. Treatment consisted in a single dose of praziquantel: 15 mg/kg body weight. Parasitological controls (two series of three fecal samples each), performed three months later, resulted negative for Taenia eggs.
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Affiliation(s)
- H Schenone
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad de Chile, Santiago
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