ABSTRACT
BACKGROUND: To realize if cardiac surgery could interfere with the evolution of HIV infected patients to the acquired immunodeficiency syndrome (AIDS). METHODS: The study group consisted of 30 HIV positive patients (0.21%) among 14,785 who underwent cardiac surgery at the Heart Institute of University of Sao Paulo Medical School (Incor-FMUSP) from November 1988 to December 1994. Patients were followed up until they were discharged from hospital and a new contact was kept at the end of the first semester of 1995. RESULTS: All patients were asymptomatic at the time they were operated. Two patients progressed to death during hospitalization due to non-infectious complications and other three patients could not be traced. After all 25 patients had their progression evaluated. Six patients (24%) died within a period ranging from 1 to 46 months (average=17 months): 2 due to bacterial pneumonia and 04 due to AIDS-related complications. The average follow-up period for the 19 surviving patients was 33.6 months (ranging from 13 to 74 months), and only one of them (5.3%) saw the infection progress to AIDS. In summary, 5/25 (20%) saw HIV infection progress to AIDS within a maximum period of 74 months. CONCLUSIONS: Data available up to now show no conclusive evidence of acceleration of HIV into AIDS associated with cardiac surgery.
Subject(s)
AIDS-Related Opportunistic Infections/mortality , Acquired Immunodeficiency Syndrome/mortality , Cardiac Surgical Procedures/mortality , Cause of Death , HIV Infections/mortality , AIDS-Related Opportunistic Infections/diagnosis , Acquired Immunodeficiency Syndrome/diagnosis , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Follow-Up Studies , HIV Infections/diagnosis , Humans , Infant , Infant, Newborn , Male , Middle Aged , Survival RateABSTRACT
PURPOSE: To analyse prevalence, clinical features and organ involvement in viral infections occuring after heart transplantation. METHODS: One hundred consecutive heart transplantation patients were studied. The follow-up was three to 90 (mean 23.32 +/- 25.97) months. Viral infections were diagnosed using the Center for Disease Control criteria. RESULTS: Viral infections were responsible for 51 infections, 19.6% of all infections in this patient population. Herpesvirus infection was the most common etiology: 32 (59.25%) of all viral infections were caused by reactivation of or reinfection by cytomegalovirus. Of those infections 27 (84.37%) occurred in the first three weeks following surgery. Only 4 (12.50%) of those showed clinical signs of cytomegalovirus disease. Other herpesvirus causing infections were herpes simplex and varicella-zoster virus. CONCLUSION: Infections are common after heart transplantation and viral infections of herpesviridae family are important causes of those infections; usually as reactivation in an immune suppressed patient. The most important viral infections were caused by reactivation of or reinfection by cytomegalovirus.
Subject(s)
Heart Transplantation/adverse effects , Virus Diseases/etiology , Actuarial Analysis , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Follow-Up Studies , Herpesviridae Infections/etiology , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
PURPOSE: To evaluate clinical findings and etiology of bacterial infections diagnosed in 100 consecutive heart transplantations. METHODS: One hundred consecutive heart transplant patients were studied. Follow-up after heart transplantation varied from 3 to 90 (mean 25.38 +/- SD 25.97) months. Etiology of bacterial infection was established using the Centers for Disease Control criteria. RESULTS: Bacterial infection was the most common cause of infection after heart transplantation; diagnosis was difficult. Infection sites were skin, mucous, membranes, soft tissue, surgical scar, pericardial and pleural spaces, soft tissue around heart pacing devices, urinary tract; bacteremias and endocarditis were also found. All bacterial agents recovered were fully identified. CONCLUSION: Bacterial infections are the most common infections in the first month after heart transplantation. They are important and also common after the treatment of the rejection episodes. Rapid diagnosis and adequate treatment are essential to prevent morbidity and death.
Subject(s)
Bacterial Infections/etiology , Heart Transplantation/adverse effects , Adolescent , Adult , Aged , Bacterial Infections/drug therapy , Bacterial Infections/epidemiology , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Period , Prospective StudiesABSTRACT
PURPOSE: To evaluate prevalence, causes, clinical aspects, topography and deaths due to fungal infections diagnosed in a series of patients submitted to heart transplantation. METHODS: 100 consecutive patients submitted to heart transplantation were studied. Follow-up was three to 90 (mean 25.38 +/- 25.97) months. Fungal infections were diagnosed by the Centers for Disease Control criteria. RESULTS: Forty seven fungal infections were found, with three deaths caused mainly by fungal infection. The most common infection in this series was oral infection by Candida albicans, Acremonium sp, Aspergillus sp, Candida tropicalis, Histoplasma capsulatum and Pneumocystis carinii were also responsible for infections in this patient population. CONCLUSION: Fungal infections caused three deaths in this series, and were responsible for increased morbidity. The authors suggest prophylactic and therapeutic recommendations.
