Clinical analysis of 5 cases of paratyphoid fever A after renal transplantation / 中华器官移植杂志

ABSTRACT

Objective To probe into the clinical features, ways of diagnosis and treatment measures of concurrent paratyphoid fever A after renal transplantation. Methods The 5 patients were all town or village people under the county level. After the operation, the immunosuppressive scheme of ciclosporin A (or Tacrolimus) + mycophenolate mofetil (MMF) + prednisone acetate was adopted. One case was caused by catching cold and the rest 4 had no any distinct inducement. Five patients fell ill respectively at the 5th, 7th, 7th, 9th and 14th month after the operation. On the admission, the 5 patients suffered from gastrointestinal symptoms such as vomiting and diarrhea to varying degrees; 3 from toxic symptoms such as fever, intolerance of cold, hypodynamia and headache; 3 from symptoms of the respiratory system such as stuffy nose and congestion of throat; 1 from elevation of blood pressure; 1 from relative slow pulse. In 3 patients with decrease of urine volume, 1 suffered from gross hematuria, swelling of transplanted area of the kidney, pain on pressure and rise of blood pressure. Only 1 patient's paratyphoid fever A antibody in the Widal's test gastroenteritis or untoward reaction of MMF and the curative effect was bad. After definite diagnoses,the combined treatment of the third-generation cephalosporin and FQNS were given to all of them.After treatment for 7-10 days, the symptoms in all patients all disappeared. During the treatment, 1 patient was diagnosed as acute rejection and given the methylprednisolone shock for 3 days. After that, the patient's graft function was improved; 3 patients suffered from relatively great fluctuation of blood concentration of immunosuppressive agent and toxic symptoms such as decrease of the graft function, etc. After adjustment of dosage, their indicators of renal function became normal. Conclusion Early symptoms and accessory examinations of paratyphoid fever A after renal transplantation lack specificities. Diagnosis of paratyphoid fever A after renal transplantation mainly depends on blood culture. Drugs of first choice include FQNS and the third-generation cephalosporin. During the treatment, the doctor should closely monitor blood concentration of the immunosuppressive agent.