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1.
Eur J Clin Microbiol Infect Dis ; 43(3): 623-626, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38231308

ABSTRACT

Endotipsitis is an underdiagnosed entity mainly because it requires a high initial level of suspicion. It should be considered in the differential diagnosis of persistent bacteremia in the cirrhotic patient with TIPS. Most cases are treated conservatively with a long-term antibiotherapy, due to the impossibility of surgical removal of the TIPS, except in a liver transplant or autopsy. The patient we present had endotipsitis that manifested as persistent bacteremia with thrombosis of the TIPS. Initially, conservative management with intravenous antibiotherapy was performed; however, due to mechanical complications caused by migration of the original endoprosthesis, it was decided to perform surgery.


Subject(s)
Bacteremia , Liver Transplantation , Portasystemic Shunt, Transjugular Intrahepatic , Humans , Portasystemic Shunt, Transjugular Intrahepatic/adverse effects , Persistent Infection , Liver Transplantation/adverse effects , Heart Atria
2.
J Infect ; 84(4): 573-578, 2022 04.
Article in English | MEDLINE | ID: mdl-35101535

ABSTRACT

OBJECTIVE: Sensitive and less laborious assays are needed to detect asymptomatic Leishmania among solid organ transplant (SOT) recipients. Using SLA-stimulated plasma from SOT recipients living where an outbreak of Leishmania infantum occurred, we examined potential biomarkers to identify asymptomatic Leishmania infections. METHODS: Concentrations of cytokines/chemokines in plasma from whole blood stimulated with specific Leishmania antigen (SLA) were compared against infection status as determined by a currently used cell proliferation assay. RESULTS: Twenty-six percent (13/50) of the SOT recipients had a cell proliferation assay (CPA) indicating asymptomatic infection, and showed higher processed plasma C-X-C motif chemokine ligand 10 (CXCL10 or IP-10) concentrations than did non-infected subjects (median 2272.0 pg/ml [IQR 1570-2772] vs. 18.2 pg/ml [IQR 1-150.1]; p<0.0001). CXCL10 showed a sensitivity of 93% and a specificity of 95% compared to CPA. In addition, we demonstrated that the number of asymptomatic infections detected using CXCL10, decreased with distance from a park at the center of the mentioned outbreak. CONCLUSION: CXCL10 in plasma from SLA-stimulated blood could be a robust biomarker of asymptomatic L. infantum infection in solid organ transplant recipients.


Subject(s)
Leishmania infantum , Leishmaniasis, Visceral , Organ Transplantation , Asymptomatic Infections , Biomarkers , Chemokine CXCL10 , Humans , Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/epidemiology , Ligands , Transplant Recipients
3.
Transpl Infect Dis ; 23(2): e13479, 2021 Apr.
Article in English | MEDLINE | ID: mdl-32996216

ABSTRACT

BACKGROUND: The impact of late-onset cytomegalovirus (CMV) infection (LOCI) on cardiac allograft vasculopathy (CAV) has yet to be established. METHODS: A retrospective study was performed for patients who had undergone heart transplantation (HT) between January 1995 and October 2017 to analyze epidemiology of LOCI (any positive level of CMV pp65 antigenemia or DNAemia after 100 days, without previous CMV replication) and its association with CAV. Our main hypothesis was that LOCI causes less direct and indirect effects compared to early onset infection (EOCI). RESULTS: Late-onset cytomegalovirus infection developed in 57 of 410 patients (13.9%) in a median time of 4.7 months post-transplant. CAV at 10 years was diagnosed in 31.6% of patients with LOCI, 34.6% with EOCI, and in 19.3% of CMV-uninfected patients. In the multivariate analysis, EOCI was an independent variable for developing CAV (HR 1.8, 95% CI 1.13-2.82, P = .01). Patients with LOCI showed a trend toward a higher risk of CAV, but the difference was not statistically significant (HR 1.7, 95% CI 0.95-3.08, P = .07). In the complementary log-log model, LOCI and EOCI had a similar CAV-free survival, and a higher probability of developing CAV than CMV-uninfected patients (P = .02). CONCLUSIONS: Cytomegalovirus infection after HT may result in the same long-term events regardless of its onset, with a higher risk of developing CAV at 10 years than patients without CMV.


Subject(s)
Cytomegalovirus Infections , Heart Transplantation , Allografts , Humans , Postoperative Complications , Retrospective Studies
4.
Expert Opin Pharmacother ; 21(8): 969-981, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32200657

ABSTRACT

INTRODUCTION: Non-tuberculous Mycobacteria (NTM) are a group of organisms whose importance in medicine seems to be increasing in recent times. The increasing number of patients susceptible to these diseases make it necessary to expand our knowledge of therapeutic options and to explore future possibilities for the development of a therapeutic arsenal. AREAS COVERED: In this review, the authors provide a brief introduction about the present importance of NTM and describe the present recommendations of the available guidelines for their treatment. They include a description of the future options for the management of these patients, especially focusing on new antibiotics. The authors also look at possibilities for future therapeutic options, such as antibiofilm strategies. EXPERT OPINION: No actual changes have been made to the current recommendations for the management of most NTM infections (except perhaps the availability of nebulized amikacin). However, it is also true that we have increased the number of available antibiotic treatment options with good in vitro activity against NTM. The use of these drugs in selected cases could increase the therapeutic possibilities. However, some problems are still present, such as the knowledge of the actual meaning of a NTM isolate, and will probably be a key part of future research.


Subject(s)
Amikacin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Mycobacterium Infections, Nontuberculous/drug therapy , Nontuberculous Mycobacteria/drug effects , Amikacin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Humans , Microbial Sensitivity Tests , Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium Infections, Nontuberculous/microbiology , Nontuberculous Mycobacteria/isolation & purification , Nontuberculous Mycobacteria/pathogenicity , Practice Guidelines as Topic
5.
Rev. esp. quimioter ; 32(5): 451-457, oct. 2019. tab, graf
Article in English | IBECS | ID: ibc-188712

ABSTRACT

INTRODUCTION: Non-pigmented rapidly growing mycobacteria (NPRGM) are a group of organisms of increasing interest due to the growing number of potential patients and the difficulties for a proper treatment in many of them. However, the evolution of these diseases in a long period of time and its evolutionary changes has been described only in a scanty number of reports. MATERIAL AND METHODS: We performed a retrospective study between January 1st 2004 and December 31st 2017 in order to evaluate the clinical significance and types of diseases caused by NPRGM. Patients with isolates of NPRGM during this period were selected for the study, and clinical charts were reviewed using a predefined protocol. RESULTS: During this period we identified 59 patients (76 clinical samples) with isolates of NPRGM, with 12 cases of clinical disease and one patient with doubtful significance (including 6 respiratory tract infections, 2 catheter infections, 1 skin and soft tissue infection, 1 disseminated infection, 1 conjunctivitis, 1 prosthetic joint infection and 1 mastitis). Fifty percent of M. chelonae isolates, 37.5% of M. abscessus isolates and 23.33% of M. fortuitum isolates were clinically significant. None of the isolates of other species were significant. CONCLUSIONS: Most isolates in respiratory samples were contaminants/colonizations. M. abscessus was the main etiological agent in respiratory syndromes, whereas M. chelonae and M. fortuitum were more frequently associated with other infections, especially clinical devices and skin and soft tissue infections


INTRODUCCIÓN: Las micobacterias no pigmentadas de crecimiento rápido (MNPCR) son un grupo de organismos de interés creciente debido al número cada vez mayor de pacientes potenciales y a las dificultades en el tratamiento. Sin embargo, el número de estudios que analizan la evolución de estos casos a lo largo de un periodo de tiempo largo es escaso. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo entre el 1 de enero de 2004 y el 31 de diciembre de 2017 para evaluar el significado clínico y los tipos de enfermedades causados por MNPCR. Se seleccionaron para ello aquellos pacientes con aislamientos de MNPCR, y se revisaron las historias clínicas mediante un protocolo predefinido. RESULTADOS: Se identificaron 59 pacientes (76 muestras) con aislamientos de MNPCR, de los cuales 12 presentaron enfermedad y uno tuvo un significado dudoso (incluyendo 6 infecciones respiratorias, 2 infecciones asociadas a catéter, 1 infección de piel y partes blandas, 1 infección diseminada, 1 conjuntivitis, 1 infección de prótesis osteoarticular y 1 mastitis). El 50 % de los aislamientos de Mycobacterium chelonae, el 37,5 % de Mycobacterium abscessus y el 23,33 % de Mycobacterium fortuitum fueron clínicamente significativos. Ninguno de los aislamientos de otras especies fue significativo. CONCLUSIONES: La mayoría de los aislamientos de muestras respiratorias resultaron ser contaminantes/colonizaciones. M. abscessus fue el principal agente etiológico en las infecciones respiratorias, mientras que M. chelonae y M. fortuitum fueron asociados con mayor frecuencia a otras infecciones, especialmente infecciones de piel y partes blandas e infecciones asociadas a dispositivos biomédicos


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Mycobacterium Infections, Nontuberculous/microbiology , Nontuberculous Mycobacteria/isolation & purification , Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium abscessus/isolation & purification , Mycobacterium chelonae/isolation & purification , Mycobacterium fortuitum/isolation & purification , Retrospective Studies , Time Factors
6.
Emerg Infect Dis ; 23(7): 1155-1159, 2017 07.
Article in English | MEDLINE | ID: mdl-28628447

ABSTRACT

During a visceral leishmaniasis outbreak in an area of Madrid, Spain, the incidence of disease among solid organ transplant recipients was 10.3% (7/68). Being a black person from sub-Saharan Africa, undergoing transplantation during the outbreak, and residing <1,000 m from the epidemic focus were risk factors for posttransplant visceral leishmaniasis.


Subject(s)
Environment , Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/etiology , Organ Transplantation , Transplant Recipients , Adult , Aged , Disease Outbreaks , Female , Geography , Humans , Immunosuppressive Agents/adverse effects , Incidence , Kaplan-Meier Estimate , Leishmaniasis, Visceral/mortality , Leishmaniasis, Visceral/transmission , Male , Middle Aged , Organ Transplantation/adverse effects , Population Groups , Risk Factors , Spain/epidemiology , Spatial Analysis
7.
Transpl Infect Dis ; 19(1)2017 Feb.
Article in English | MEDLINE | ID: mdl-27768239

ABSTRACT

The incidence of visceral leishmaniasis (VL) after solid organ transplantation (SOT) is increasing. The optimal therapy for post-transplant VL remains unclear, as relapses after liposomal amphotericin B (L-AmB) are common. Miltefosine has been shown to be effective for treating VL in immunocompetent patients, although data in the specific population of SOT recipients are lacking. In the setting of an outbreak of leishmaniasis occurring in Southwest Madrid, we reviewed our experience in 6 SOT recipients with persistent or relapsing VL who received a 28-day course of miltefosine (2.5 mg/kg/day) as salvage therapy. All patients had been treated previously with L-AmB as first-line therapy. The incident episode of VL occurred at a median of 14 months after transplantation. Two patients experienced persistent infection and the remaining 4 had a relapse after a median interval of 168 days since the completion of the course of L-AmB. All the patients had an apparent initial clinical improvement with miltefosine. However, VL relapsed in 3 of them (after a median interval of 46 days), which required retreatment with L-AmB-based regimens. Miltefosine therapy was followed by a prolonged secondary prophylaxis with L-AmB in the only 2 cases with sustained clinical response and ongoing immunosuppression. No adverse effects associated with miltefosine were observed. Albeit limited, our experience suggests that miltefosine monotherapy likely has a limited utility to obtain a long-lasting clinical response in complicated (persistent or relapsing) forms of post-transplant VL, although its role in association with L-AmB-based secondary prophylaxis may merit further investigation.


Subject(s)
Antiprotozoal Agents/therapeutic use , Kidney Transplantation/adverse effects , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/epidemiology , Lung Transplantation/adverse effects , Phosphorylcholine/analogs & derivatives , Secondary Prevention/methods , Adult , Aged , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antiprotozoal Agents/administration & dosage , Antiprotozoal Agents/adverse effects , Humans , Immunocompromised Host , Incidence , Leishmania infantum/isolation & purification , Leishmaniasis, Visceral/microbiology , Male , Middle Aged , Phosphorylcholine/administration & dosage , Phosphorylcholine/adverse effects , Phosphorylcholine/therapeutic use , Retrospective Studies , Salvage Therapy/methods , Spain/epidemiology , Treatment Outcome
8.
PLoS Negl Trop Dis ; 9(10): e0004179, 2015.
Article in English | MEDLINE | ID: mdl-26496365

ABSTRACT

Spain has one of the world's largest pools of organ donors and is a global leader in terms of the number of transplants it performs. The current outbreak of leishmaniasis in Fuenlabrada (in the southwest of the region of Madrid, Spain) has involved 600 clinical cases since late 2009 (prevalence 0.2%). It may therefore be wise to monitor the town's transplanted population for Leishmania infantum; its members are immunosuppressed and at greater risk of infection and relapse following treatment. The present work examines the use of cytokine release assays to determine the prevalence of Leishmania infection in this population, and to confirm recovery following treatment for visceral leishmaniasis (VL). The humoral and cellular immune responses to L. infantum were characterized in 63 solid organ transplant (SOT) recipients from Fuenlabrada, 57 of whom reported no previous episode of VL (NVL subjects), and six of whom had been cured of VL (CVL subjects). Seventeen subjects (12 NVL and 5 CVL) showed a patent lymphoproliferative response to soluble Leishmania antigen (SLA). Stimulation of peripheral blood mononuclear cell cultures and of whole blood with SLA led to the production of different combinations of cytokines that might serve to confirm Leishmania infection or recovery from VL and help prevent cured patients from relapsing into this serious condition.


Subject(s)
Clinical Laboratory Techniques/methods , Cytokines/metabolism , Drug Monitoring/methods , Leishmania infantum/immunology , Leishmaniasis/diagnosis , Leukocytes, Mononuclear/immunology , Transplants , Antibodies, Protozoan/blood , Cell Proliferation , Humans , Immunocompromised Host , Leishmaniasis/epidemiology , Spain/epidemiology , Transplant Recipients
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