ABSTRACT
INTRODUCCIÓN: Las infecciones por Aspergillus spp son la principal infección micótica por hongos en pacientes con trasplante hepático, con una mortalidad reportada de hasta un 90% de los casos. En los pacientes trasplantados de hígado se espera que hasta un 50% desarrollen un episodio infeccioso en sus primeros meses postrasplante, de los cuales un 10% se asocian con agentes oportunistas. OBJETIVO: Describir el diagnóstico y manejo de un episodio de Aspergilosis Pulmonar Invasora (API) en una paciente con un trasplante hepático CASO CLÍNICO: Paciente de 11 meses de vida, con trasplante hepático secundario a atresia de vías biliares. En el periodo post-trasplante inmediato evolucionó con una neumonía grave asociada a ventilación mecánica. El lavado broncoalveolar presentó niveles altos de galactomanano y cultivo positivo para Aspergillus fumigatus, diagnosticándose una API. Este episodio se trató con un esquema de antifúngico con un resultado clínico favorable. CONCLUSIÓN: La API es una infección oportunista en pacientes con trasplante hepático, que debe ser sospechada en este grupo de pacientes, ya que el diagnóstico y tratamiento oportuno impacta directamente en la resolución de la infección por Aspergillus fumigatus.
INTRODUCTION: Mycotic infections due to Aspergillus spp, are the main mycotic associated infections in liver transplant patients, with mortality rates up to 90% of the cases. Almost 50% of patients will de velop an infection during the first months after transplantation, of which 10% are associated with op portunistic agents. OBJECTIVE: To describe the diagnosis and management of an Invasive Pulmonary Aspergillosis (IPA) episode in a liver transplant patient. CASE-REPORT: 11-months-old patient with liver transplant due to a biliary atresia who developed severe pneumonia associated with mechanical ventilation. The bronchoalveolar lavage showed high levels of galactomannan and positive culture for Aspergillus fumigatus leading to an IPA diagnosis. This episode was treated with antifungal with a favorable outcome. CONCLUSION: The IPA is an opportunistic infection in liver transplant patients, with high mortality rates, that must be suspected in this group of patients since an early diagnosis and treatment reduce mortality.
Subject(s)
Humans , Female , Infant , Postoperative Complications/diagnosis , Liver Transplantation , Invasive Pulmonary Aspergillosis/diagnosis , Postoperative Complications/drug therapy , Invasive Pulmonary Aspergillosis/etiology , Invasive Pulmonary Aspergillosis/drug therapy , Antifungal Agents/therapeutic useABSTRACT
ABSTRACT Dengue fever is a vector-transmitted viral infection. Non-vectorial forms of transmission can occur through organ transplantation. We reviewed medical records of donors and recipients with suspected dengue in the first post-transplant week. We used serologic and molecular analysis to confirm the infection. Herein, we describe four cases of dengue virus transmission through solid organ transplantation. The recipients had positive serology and RT-PCR. Infection in donors was detected through serology. All cases presented with fever within the first week after transplantation. There were no fatal cases. After these cases, we implemented dengue screening with NS1 antigen detection in donors during dengue outbreaks, and no new cases were detected. In the literature review, additional cases had been published through August 2017. Transmission of Dengue virus can occur through organ donation. In endemic regions, it is important to suspect and screen for dengue in febrile and thrombocytopenic recipients in the postoperative period.
Subject(s)
Humans , Male , Adult , Middle Aged , Tissue Donors , Dengue/transmission , Dengue Virus/isolation & purification , Transplant Recipients , Heart Transplantation/adverse effects , Liver Transplantation/adverse effects , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
INTRODUCCIÓN: El trasplante renal es el tratamiento de elección para los pacientes con insuficiencia renal terminal. Los pacientes mayores de sesenta años representan la población de mayor crecimiento con esta patología. Sin embargo, no se realizan los trasplantes de manera oportuna y la mayoría permanecen en diálisis con una menor sobrevida y calidad de vida. En este estudio se exponen los desenlaces de los trasplantes renales anciano-para-anciano realizados en una clínica de alta complejidad en Cali, Colombia. MATERIAL Y MÉTODOS: Estudio de cohorte, descriptivo de 31 trasplantes renales con donantes y receptores mayor de 60 años, realizados en la Fundación Valle del Lili en Cali, Colombia, desde enero del 2002 a marzo de 2016. RESULTADOS: De los 31 pacientes trasplantados renales, el 16% presentaron enfermedad cardiovascular post-trasplante, el 6,4% enfermedad cerebrovascular y el 22,6% malignidad. Se presentaron 12 (38,7%) infecciones oportunistas. Cinco pacientes (16%) presentaron disfunción crónica del injerto y tres (9,6%) pérdida del injerto. Nueve pacientes (29%) fallecieron con injerto funcionante. CONCLUSIÓN: La supervivencia de los pacientes trasplantados anciano para anciano en la Fundación Valle del Lili, es equiparable con los resultados en la literatura mundial. Las principales complicaciones asociadas a este tipo de trasplantes son malignidad, infecciones y patologías cardiovasculares. Debido a la alta complejidad y complicaciones de este tipo de trasplantes, los pacientes deben ser cuidadosamente seleccionados
INTRODUCTION: Kidney transplant is the first-line therapy for end-stage renal disease. Patients over 60 constitute a population which is increasingly affected by this disease. However, they do not receive timely transplantation and most of them stay on dialysis treatment with a reduction of their survival time and life quality. In this study we show the results of the kidney transplants between elderly patients performed at a private tertiary care hospital in Cali, Colombia. METHODS: This descriptive, cohort study includes 31 kidney transplants with donors and recipients over 60, which were carried out at Fundación Valle del Lili in Cali, Colombia, from January 2002 to March 2016. RESULTS: The average ages were 66 for recipients and 65 for donors. In most cases (90%) deceased donors were involved. The main cause of renal disease was diabetic nephropathy. CONCLUSION: The survival rate for the patients who underwent this procedure at the center mentioned above is similar to the results shown in the literature all over the world. The most common complications associated with this kind of operation are malignancy, infections and cardiovascular pathologies. Candidates for this transplantation should be carefully chosen given its complexity and related complications
Subject(s)
Humans , Aged , Survival , Kidney Transplantation , Graft SurvivalABSTRACT
El trasplante renal es el tratamiento de elección para los pacientes con enfermedad renal terminal. El trasplante con donante vivo, es la mejor opción para los receptores al implicar menor morbi-mortalidad y disminución del tiempo en lista activa. A pesar que el riesgo de ser donante vivo ha sido determinado y es bajo, se debe realizar una evaluación médica a los posibles donantes para identificar factores de riesgo para desarrollar insuficiencia renal crónica. En este reporte se describe un paciente quien fue donante y 21 años después desarrolló insuficiencia renal crónica (IRC) avanzada secundaria a hipertensión arterial no tratada por lo que fue trasplantado
Kidney transplant is the first-line therapy for end-stage renal disease. Living-donor transplant is the best choice for recipients as it reduces morbidity and mortality and the time spent on the active waitlist. Although it is known that the risk of being a living donor is low, a medical evaluation must be performed in order to identify risk factors for the development of chronic kidney disease. We report a case of a patient who was a donor and 21 years later presented advanced chronic kidney disease (CKD) following untreated high blood pressure. For this reason, the patient underwent a transplant