ABSTRACT
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Abstract Introduction: The numbers of SARS-CoV-2 infection in the pediatric population are low so far. There is limited information about the behavior of SARS-CoV-2 in a pediatric patient with chronic kidney disease. Objective: To formulate informed recommendations to the prevention, diagnosis, and management of SARS-CoV-2 infection in pediatric patients with kidney disease or acute kidney injury associated with COVID-19 in Colombia. Methodology: A rapid systematic review was performed in Embase and Pubmed databases and scientific societies, to answer questions prioritized by clinical experts in pediatric nephrology. The quality of the evidence was evaluated with validated tools according to the type of study. The preliminary recommendations were consulted by an expert group. The agreement was defined when approval was obtained from at least 70% of the experts consulted. Results: A response was obtained from ' 9 experts in pediatric nephrology in Colombia, who declared the conflict of interest before the consultation. The range of agreement for the recommendations ranged from 78.9% to '00%. The recommendations did not require a second consultation. Conclusion: The evidence-based recommendations for the management of a patient with kidney disease and COVID-19 in the Colombian context are presented.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Pediatrics , COVID-19 , Patients , Societies, Scientific , Colombia , Renal Insufficiency, Chronic , Acute Kidney Injury , NephrologyABSTRACT
Resumen Las feohifomicosis cerebrales son infecciones graves causadas por mohos dematiáceos, entre los cuales Cladophialophora bantiana es una de las especies más comúnmente aislada. Esta tiene tropismo por el sistema nervioso central y frecuentemente produce abscesos cerebrales en pacientes inmunocompetentes; además, en los inmunocomprometidos también puede ocasionar infección diseminada. Pese a la disponibilidad de medicamentos antifúngicos de amplio espectro, a menudo se requiere también la intervención quirúrgica; de todas maneras, la mortalidad es elevada. El diagnóstico debe hacerse interviniendo para tomar la muestra y hacer el cultivo y las pruebas de sensibilidad. Se presenta aquí el caso de un paciente con trasplante renal que presentó un absceso cerebral por C. bantiana, el cual se extrajo mediante resección quirúrgica. El paciente recibió tratamiento con voriconazol, con adecuada respuesta, mejoría y sin secuelas neurológicas.
Abstract Cerebral feohifomycosis are severe infections caused by dematiaceous fungi. Cladophialophora bantiana is one of the most commonly isolated species; it has central nervous system tropism and it often manifests as a brain abscess in immunocompetent patients. In immunocompromised patients, it can lead to brain abscesses and disseminated infections. Despite the availability of broad-spectrum antifungal drugs, it is a must to perform surgical management, in addition to drug therapy. However, mortality is high. The diagnostic approach must be invasive to establish a timely diagnosis and direct treatment based on culture and susceptibility tests. We report a case of brain abscess caused by C. bantiana in an immunosuppressed patient who was treated with surgical resection and voriconazole with an adequate response to therapy and without neurological sequels.
Subject(s)
Humans , Male , Middle Aged , Postoperative Complications/microbiology , Brain Abscess/microbiology , Kidney Transplantation , Saccharomycetales/isolation & purification , Cerebral Phaeohyphomycosis/microbiology , Postoperative Complications/surgery , Postoperative Complications/etiology , Postoperative Complications/drug therapy , Recurrence , Hyperoxaluria, Primary/complications , Hyperoxaluria, Primary/diagnosis , Hyperoxaluria, Primary/genetics , Brain Abscess/surgery , Brain Abscess/etiology , Brain Abscess/drug therapy , Amphotericin B/therapeutic use , Renal Dialysis , Immunocompromised Host , Combined Modality Therapy , Craniotomy , Nephrolithiasis/etiology , Cerebral Phaeohyphomycosis/surgery , Cerebral Phaeohyphomycosis/etiology , Cerebral Phaeohyphomycosis/drug therapy , Graft Rejection/drug therapy , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Antifungal Agents/therapeutic useABSTRACT
El trasplante renal pediátrico es el tratamiento de elección en los niños con enfermedad renal crónica terminal. Muchos agentes se utilizan en dos regímenes de terapia inmunosupresora, primero en una fase de inducción y posteriormente para el mantenimiento. Existen dos estrategias para disminuir el riesgo de rechazo del injerto renal: la primera consiste en suministrar altas dosis de los inmunosupresores convencionales, y la segunda, en la utilización en la fase de inducción de anticuerpos monoclonales o policlonales contra antígenos de los linfocitos T. Los dos anticuerpos policlonales más usados son las globulinas antitimocito de caballo (ATGAM) y de conejo (rATG). Los anticuerpos monoclonales más usados son aquellos contra el receptor de IL-2 (basiliximab y daclizumab) y el dirigido contra el antígeno CD52 (alemtuzumab). La terapia de mantenimiento consiste en un esquema que combina el uso de tres drogas inmunosupresoras convencionales: glucocorticoides, inhibidores de la calcineurina, inhibidores de mTOR y antiproliferativos. Entre las principales complicaciones del trasplante renal pediátrico están: rechazo agudo del injerto, infecciones virales (por poliomavirus-BK y citomegalovirus) y aparición del trastorno linfoproliferativo postrasplante (PTLD, por la sigla en inglés de Post-transplant lymphoproliferative disorder).
Pediatric renal transplantation is the treatment of choice in children with chronic kidney disease. Many agents are available for immunosuppressive therapy, which are used in two different regimes: first for the induction phase, and then for maintenance. There are two strategies for reducing the risk of renal graft rejection: the first is the use of high doses of conventional immunosuppressive agents, and the second is the use in the induction phase of monoclonal or polyclonal antibodies against antigens of T cells. The two most frequently used polyclonal antibodies are horse and rabbit anti-thymocyte globulins, ATGAM and rATG, respectively. The most frequently used monoclonal antibodies are those against IL-2 receptor (basiliximab and daclizumab) and the one against antigen CD52 (alemtuzumab). Maintenance therapy is a scheme that combines the use of three conventional immunosuppressive drugs: glucocorticoids, calcineurin inhibitors, mTOR inhibitors and antiproliferatives. The following are among the major complications of renal transplantation: acute graft rejection, viral infection (cytomegalovirus and BK polyomavirus) and appearance of PTLD (posttransplant lymphoproliferative disorder).
O transplante renal pediátrico é o tratamento de eleição nas crianças com doenças renais crónica terminal. Muitos agentes utilizam em dois regimes de terapia imunossupressora, primeiro em uma fase de indução e posteriormente para a manutenção. Existem duas estratégias para diminuir o risco de rejeição do inserto renal: a primeira consiste em subministrar altas dose dos imunossupressores convencionais, e a segunda, na utilização na fase de indução de anticorpos monoclonais ou policlonais contra antígenos dos linfócitos T. os dois anticorpos policlonais mais usados são as globulinas antitimócito de cavalo (ATGAM) e de coelho (rATG). Os anticorpos monoclonais mais usados são: aqueles contra o receptor de IL-2 (basiliximab e daclizumab) e o dirigido contra o antígeno CD52 (alemtuzumab). A terapia de manutenção consiste num esquema que combina o uso de três drogas imunossupressoras convencionais: glicocorticoides, inibidores da calcineurina, inibidores de mTOR e antiproliferativos. Entre as principais complicações do transplante renal pediátrico estão: rejeição aguda do inserto, infecções virais (por poliomavirus-BK e citomegalovírus) e aparição do transtorno linfoproliferativa pós-transplante (PTLD, pela sigla em inglês de Post-transplant lymphoproliferative disorder).