Case report of hepatic mucormycosis after liver transplantation: successful treatment with liposomal amphotericin B followed by posaconazole sequential therapy.

Mucormycosis is a rare but emerging fungal infection complicating solid organ transplantation (SOT), with a cumulative incidence of around 2% during the first year after SOT. The associated mortality rate is high, and surgical debridement is frequently required as part of the treatment along with antifungal therapy based mostly on amphotericin B formulations, We describe here an unusual case of hepatic mucormycosis in a liver transplant recipient that was successfully treated with clinical therapy based on liposomal amphotericin B followed by posaconazole, without surgical resection.

Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in solid organ transplantation.

Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae is spreading globally and represents a challenge in infection control and treatment. Solid organ transplant (SOT) recipients are especially at risk for infection by multidrug-resistant bacteria, and little is known about infection with KPC-producing organisms in this setting. The aim of this study was to describe the clinical and microbiologic aspects of KPC-producing K. pneumoniae infections in SOT recipients. A KPC-2-producing K. pneumoniae outbreak was identified in a public teaching tertiary care hospital in São Paulo, Brazil, in June 2009. During the outbreak, cases of KPC-2-producing K. pneumoniae infection in SOT recipients occurred between July 2009 and February 2010; these cases were retrospectively reviewed. Overall, 12 episodes of infection with KPC-producing K. pneumoniae occurred in 2 heart, 4 liver, and 6 kidney transplant recipients with incidence rates of 16.7%, 12.9%, and 26.3% in heart, liver, and kidney transplantation, respectively. Infection occurred at a median time of 20 days after transplantation. Primary infection sites were as follows: 4 urinary tract infections, 4 bloodstream infections, 2 pneumonias, and 2 surgical site infections. All patients except one had received antibiotics in the last 30 days, mostly piperacillin-tazobactam or glycopeptides. All strains exhibited susceptibility to amikacin and gentamicin. Patients were treated with tigecycline plus polymyxin B (3 cases), polymyxin B plus carbapenem (3 cases), polymyxin B alone (3 cases), or tigecycline plus imipenem (1 case). In 2 cases, patients received only carbapenem, and death occurred before the final culture result. The overall 30-day mortality rate was 42%. In this series of KPC-producing K. pneumoniae infection in SOT recipients, the infection occurrence was high during an institutional outbreak and was potentially life threatening.

Infection with Klebsiella pneumonia carbapenemase (KPC)-producing K. pneumonia in solid organ transplantation

Abstract: Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae is spreading globally and represents achallenge in infection control and treatment. Solid organtransplant (SOT) recipients are especially at risk for infection bymultidrug-resistant bacteria, and little is known about infectionwith KPC-producing organisms in this setting. The aim of thisstudy was to describe the clinical and microbiologic aspects ofKPC-producing K. pneumoniae infections in SOT recipients. AKPC-2-producing K. pneumoniae outbreak was identified in apublic teaching tertiary care hospital in Sa˜o Paulo, Brazil, in June2009. During the outbreak, cases of KPC-2-producing K.pneumoniae infection in SOT recipients occurred between July2009 and February 2010; these cases were retrospectivelyreviewed. Overall, 12 episodes of infection with KPC-producingK. pneumoniae occurred in 2 heart, 4 liver, and 6 kidneytransplant recipients with incidence rates of 16.7%, 12.9%, and26.3% in heart, liver, and kidney transplantation, respectively.Infection occurred at a median time of 20 days aftertransplantation. Primary infection sites were as follows: 4 urinarytract infections, 4 bloodstream infections, 2 pneumonias, and 2surgical site infections. All patients except one had receivedantibiotics in the last 30 days, mostly piperacillin-tazobactam orglycopeptides. All strains exhibited susceptibility to amikacin andgentamicin. Patients were treated with tigecycline plus polymyxinB (3 cases), polymyxin B plus carbapenem (3 cases), polymyxin Balone (3 cases), or tigecycline plus imipenem (1 case). In 2 cases,patients received only carbapenem, and death occurred before thefinal culture result. The overall 30-day mortality rate was 42%. Inthis series of KPC-producing K. pneumoniae infection in SOTrecipients, the infection occurrence was high during aninstitutional outbreak and was potentially life threatening.

Aesthetic-functional rehabilitation through single restorations: immediate load.

In this case report of monoedentulia we will deal with the positioning o fan upper jaw implant in zone 2.6. In such surgery the strategy of a flapless (1, 2) operation with minimum invasive approach has allowed u sto combine both the aesthetic and functionality with an immediate provisional rehabilitation, thus saving recuperation time and trouble for the patient (3).Multidisciplinary character of the execution of this clinical case is underlined, where we associate the knowleadge of conservatori of the prosthetic; always maintaining respect for the canons of gnatology which must not be left out of consideration.

Twenty years of liver transplantation in Brazil.

This paper summarizes the 20 years of liver transplantation in Brazil, in the context of the Western world scenario. More than 5000 liver transplantations have been performed in the country since September 1, 1985. The living-donor liver transplantation, one of the landmarks in liver transplantation, was first described by our team in 1989. Brazil is the seventh country in number of liver transplants in the Western world and the first in Latin America. Almost 1000 procedures were performed in 2004, 19% of them involving living donors.

Systemic and hepatic hemodynamics in hepatosplenic Manson's schistosomiasis with and without propranolol.

Systemic and hepatic hemodynamics were prospectively studied in 11 patients with Manson's schistosomiasis and portal hypertension, as well as alterations resulting from the use of propranolol. It was decided that patients whose portal pressure was reduced by 30% with the use of the drug would not undergo surgery and that treatment would consist of the chronic use of propranolol, associated with sclerosis of esophageal varices. This objective was not met by any of the patients whose portal pressure was measured and the study was interrupted. Results show that patients with Manson's schistosomiasis and portal hypertension have hyperdynamic circulation, mild pulmonary hypertension, greatly increased splenic blood flow, and preservation of total hepatic blood flow. Administration of propranolol corrects hyperdynamic circulation, aggravates pulmonary hypertension, does not alter portal pressure and reduces the sectorial portal blood flows, especially of the azygos vein, with maintenance of total hepatic blood flow. These data favor the hypothesis of portal overflow in the physiopathology of portal hypertension of schistosomiasis.