ABSTRACT
Abstract Introduction: Human cytomegalovirus is a major cause of morbidity in kidney transplant patients. Objectives: We aimed to study viral replication and serological response in the first months post kidney transplant in patients undergoing universal prophylaxis or preemptive therapy and correlate the findings with the clinical course of Human cytomegalovirus infection. Patients and methods: Independent from the clinical strategy adopted for managing Human cytomegalovirus infection, prophylaxis versus preemptive therapy, the pp65 antigenemia assay and serological response were assessed on the day of transplantation, and then weekly during the first three months of post-transplant. Results: From the 32 transplant recipients, 16 were positive for pp65 antigenemia, with a similar incidence rate in each group. There were no positive results in the first three weeks of monitoring; the positivity rate peaked at week eight. There was a trend for a higher and earlier frequency of positivity in the universal prophylaxis group in which the course of the Human cytomegalovirus infection was also more severe. Despite the differences in clinical picture and in the initial immunosuppressant schedule, the serological response was similar in both groups. Conclusion: Routine monitoring during the first three post-transplant months has a positive impact on the early detection of Human cytomegalovirus viral replication allowing for timely treatment in order to reduce morbidity of the disease. The strategy of universal therapy employing intravenous ganciclovir was associated to a worse clinical course of the Human cytomegalovirus infection suggesting that the use of >10 cells/2 × 105 leukocytes as a cut-off in this setting may be inappropriate.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Antiviral Agents/therapeutic use , Phosphoproteins/blood , Monitoring, Immunologic/methods , Viral Matrix Proteins/blood , Kidney Transplantation , Cytomegalovirus Infections/prevention & control , Pre-Exposure Prophylaxis/methods , Postoperative Complications/prevention & control , Postoperative Period , Time Factors , Virus Replication , Biomarkers/blood , Ganciclovir/therapeutic use , Prospective Studies , Cause of Death , Treatment Outcome , Fluorescent Antibody Technique, Indirect , Cytomegalovirus/isolation & purification , Immunosuppressive Agents/adverse effectsABSTRACT
Descreve-se o caso de um enfermo, transplantado renal, que apresentou febre persistente e prolongada, manifestaçöes clínicas respiratórias, perda de visäo do olho esquerdo e múltiplos nódulos pulmonares escavados bilaterais. Excetuando-se uma elevaçäo nos títulos sorológicos para CMV, a despeito de intensas pesquisas, o diagnóstico permaneceu desconhecido. Após piora progressiva, caracterizada por angústia respiratória, hemorragia digestiva e choque séptico, o paciente faleceu. O estudo necroscópico revelou que apenas o CMV foi o agente responsável, confirmando os dados da literatura pertinente ao assunto
Subject(s)
Middle Aged , Humans , Male , Cytomegalovirus Infections/complications , Kidney/transplantation , Pneumonia/etiology , Postoperative Complications , Pneumonia/pathologyABSTRACT
Säo descritos dois casos clínicos de intoxicaçäo aguda pelo monóxido de carbono. A história patológica, o exame físico e os dados laboratoriais nos casos estudados demonstram a açäo nociva multissistêmica do gás. Embora conhecida desde o século passado, aquela intoxicaçäo é raramente estudada entre nós em seu decurso clínico, que tanto termina em êxito letal rápido, como origina casos "benignos" de repercussäo clínica inespecífica, muitas vezes näo-diagnosticados. Evidencia-se no quadro clínico um fenômeno trombótico venoso pouco citado na literatura pesquisada