Risk factors for hepatotoxicity in solid organ transplants recipients being treated for tuberculosis.

BACKGROUND: Tuberculosis (TB) is associated with high morbidity and mortality in solid organ transplant (SOT) recipients. Also, SOT patients have a 20- to 74-fold increase in the chance of developing TB compared to the general population. Here we evaluated the incidence of hepatotoxicity in SOT recipients on treatment for TB and determined risk factors for liver toxicity in these patients. PATIENTS AND METHODS: Retrospective cohort conducted in a reference hospital for SOT in Southern Brazil. All SOT recipients who underwent TB treatment during the years 2000-2012 were considered for the study. RESULTS: A total of 69 patients were included in the study and 23 had liver toxicity (incidence 33.3%). Independent risk factors for hepatotoxicity were rifampin use at doses of ≥600 mg daily (P = .016; OR 2.47; 95% CI, 1.18-5.15) and lung transplantation (P = .017; OR 2.05; 95% CI, 1.14-3.70). Kidney transplantation appeared as a protective factor (P = .036; OR 0.50; 95% CI, 0.26-0.96). Mortality was higher in the patients who had hepatotoxicity (43.5%), compared with those who did not (19.6%). CONCLUSION: In this study, the use of rifampin at doses of 600 mg daily or higher was found to be an independent risk factor for liver toxicity in SOT recipients. The importance of additional risk factors for hepatotoxicity, such as lung transplantation as well as the protective role of kidney transplantation, should be better investigated in SOT recipients being treated for TB.

Prevalence rates and antifungal susceptibility profiles of the Candida parapsilosis species complex: results from a nationwide surveillance of candidaemia in Brazil.

The genetically heterogeneous taxon Candida parapsilosis was recently reclassified into three species: Candida parapsilosis, Candida orthopsilosis and Candida metapsilosis. The prevalences of these species among 141 bloodstream isolates tested in Brazil were 88% for C. parapsilosis, 9% for C. orthopsilosis, and 3% for C. metapsilosis. Except for three C. orthopsilosis isolates that were considered resistant to 5-flucytosine, all isolates representing the different species of this complex were susceptible to polyenes, triazoles and caspofungin.

[Morphological study of the small intestine in rats with experimental zinc deficiency]. / Estudo morfológico do intestino delgado de ratos com carência experimental de zinco.

Rats were maintained 4 weeks on a zinc deficient diet from the time of weaning. A control group received the same basic diet supplemented with zinc. Zinc deficiency, was indicated by poor weight gain, diarrhea, exudative vesicular dermatitis around ears, eyes, nose and extremities, and lowering of blood zinc levels. The morphometric study of the small intestine showed: 1) decreased thickness of the intestinal wall and of the mucosa; 2) significant decrease of the mean villies length and of the mean crypt depth; 3) no alterations in the height of the enterocytes from the middle one third of the villis and in the number of Paneth cells; 4) a decreased mitotic index; 5) a diminished number of epithelial cells living the ville, and 6) a decreased population of intraepithelial lymphocytes, both in the proximal jejunum and distal ileum. These findings are compatible with an impairment of cell replication in the small intestine in experimental zinc deficiency in rats, and allow us to speculate that the diarrhea usually seen in states of zinc malnutrition, at least in part, could be dependent on these changes.