ABSTRACT
AIM: To review the incidence, timing, and outcome of infectious enteritis after intestinal transplantation (IT). METHOD: A retrospective review of all patients undergoing IT at a single institution between 1991 and 2003 was analyze with standard statistical tools. RESULTS: Among 33 IT recipients, 13 (39%) developed 20 culture- or biopsy-proven episodes of infectious enteritis. The recipient demographics were 77% men and median age 2.6 years. Infections were diagnosed at a median of 76 days (32 to 1800) after IT. There were 14 viral (CMV one, rotavirus eight, adenovirus four, EBV one, three bacterial (Clostridium difficile), and three other infections (Giardia lamblia one, cryptosporidium two). Complete resolution was achieved in 17 (94%) infectious after appropriate antimicrobial or conservative therapy. Interestingly, there were six rejection episodes following infectious enteritis. Grafts were lost to rejection after rotaviral enteritis (n = 1) and adenoviral enteritis misdiagnosed as rejection (n = 1). Patient and graft survival were not adversely affected by infections. CONCLUSIONS: Infectious enteritis occurs frequently after IT. Viral agents are the cause in two-thirds of cases. With supportive care and appropriate treatment, resolution is possible in the majority of cases. Differentiating rejection and infection by histopathology can be difficult.
Subject(s)
Bacterial Infections/epidemiology , Enteritis/epidemiology , Intestines/transplantation , Virus Diseases/epidemiology , Adult , Child , Female , Humans , Intestines/microbiology , Male , Postoperative Complications/microbiology , Postoperative Complications/virology , Retrospective Studies , Time Factors , Treatment OutcomeSubject(s)
AIDS-Related Opportunistic Infections , Abscess , Aspergillosis , Aspergillus fumigatus , Epidural Space , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/therapy , Abscess/diagnosis , Abscess/therapy , Aspergillosis/diagnosis , Aspergillosis/therapy , Humans , Male , Middle Aged , Spinal Diseases/diagnosis , Spinal Diseases/therapyABSTRACT
Early diagnosis of alcoholism requires exploration of the impact of alcohol on the patient's life. The disease cannot be readily detected simply by asking questions about the quantity of alcohol consumed. Few physical findings are present until late in the disease, and laboratory tests for alcoholism are neither sensitive nor specific when used alone. Use of screening questionnaires should be part of routine office practice. Elderly alcoholics are difficult to identify and need special consideration. Effective therapy is available if alcoholism is detected early.
