combined pretransplantation seropositivity of kidney transplant recipients for cytomegalovirus antigens [pp150 and pp28] a predictor for protection against infection?

This study was aimed at detecting antibodies to the antigens which may contribute to protection against cytomegalovirus [CMV] infection after organ transplantation. A total of 203 kidney transplant patients were enrolled in the study. Based on CMV antigenemia assay, 23 patients were antigen-positive and of the remaining 180 antigen-negative patients, 46 were selected as controls matched for age, gender and source of kidney. The 69 kidney recipients [KR] had CMV antibody due to previous infection and were followed up for a period of 6 months after transplantation for the development of active CMV infections by the antigenemia assay. Antibody responses to five CMV-related peptide antigens [pp65, gB, pp150, pp28 and pp38] were investigated by enzyme immunoassay and their presence was correlated with the results of the CMV antigenemia assay. Of the five CMV-related peptide antigens, only gB antigen showed response to the antibody in 10/23 [43.5%] antigen-positive patients and 9/46 antigen-negative patients and the difference was statistically significant [p = 0.048]. On the other hand, there was no significant difference in antibody responses between the antigen-positive and antigen-negative KR to the other four CMV peptide antigens [p > 0.05]. However, among the antigen-positive KR there was only 1 patient who had antibodies to both pp150 and pp28 antigen, while among the antigen-negative KR, 22 of 46 [47.8%] had the antibodies [p < 0.001]. The findings suggest that the combined presence of antibodies against the pp150 and pp28 antigens may indicate a lower risk of CMV reactivation after kidney transplantation

Renal artery stenosis in patients with peripheral vascular disease in Kuwait

The aim of this study was to identify the incidence of atherosclerotic renal artery stenosis [RAS] in patients with peripheral vascular disease [PVD] and its relation to any known risk factors. This prospective study was conducted on 212 patients who were subjected to peripheral angiography for symptoms of PVD over a 3-year period from 1995 to 1998 at the Mubarak AI-Kabeer Hospital, Kuwait. Angiograph-ic evidence of atherosclerotic disease and its severity was recorded in renal, abdominal aorta, iliac, femoral, popliteal and below-knee arteries. In addition, a detailed search of identifiable risk factors was done using history, clinical examination and laboratory studies. The incidence of significant atherosclerotic RAS [more than 50% diameter stenosis] in patients with PVD was 15/212 [7.07%] with no significant difference in ratio between males and females [p = 0.3] compared to that of PVD alone. Patients with common iliac and femoral artery lesions had a high incidence of RAS [93.3 and 86.7%, respectively] with more than 80% probability in RAS patients with involvement of these vessels. There was significant renal impairment [p < 0.005], as assessed byserum creatinine levels, in patients with RAS compared to those who did not have it. There was a high incidence of smoking in patients with RAS [p = 0.02], and smoking was the only risk factor identified in these subjects. Patients with iliac or femoral atherosclerotic disease have a high probability of associated RAS. Presence of renal impairment in patients with PVD is highly indicative of RAS. Smoking is the only identified risk factor for RAS in association with PVD in our population

Pulmonary nocardia transvalensis infection: a case report and review

Infections due to Nocardia transvalensis are rare; only five cases of isolated primary pulmonary disease due to this species have been previously reported. Our patient is a 53-year-old diabetic who developed primary pulmonary N. transvalensis pneumonia and who was successfully treated with trimethoprim-sulfamethoxazole and amikacin. A summary of the published cases with N. transvalensis infection is included. The report emphasizes the increasing importance of N. transvalensis as an etiologic agent of pulmonary disease in immunosuppressed patients