Cytomegalovirus infection post-pancreas-kidney transplantation--results of antiviral prophylaxis in high-risk patients.

BACKGROUND: Cytomegalovirus (CMV) is a major pathogen affecting solid organ transplant (SOT) recipients. Prophylactic strategies have decreased the rate of CMV infection/disease among SOT. However, data on the effect of current prophylactic strategies for simultaneous pancreas-kidney (SPK) or pancreas after kidney (PAK) transplant remain limited. We report our experience of CMV prophylaxis in SPK/PAK recipients. METHODS: A total of 130 post-SPK/PAK patients were analyzed retrospectively for the rate of CMV and the risk factors associated with the acquisition of CMV. All patients received antiviral prophylaxis. The follow-up period was one yr post-transplant or until death. RESULTS: The rate of CMV post-SPK/PAK transplant was 24%, 44%, and 8.2% among the whole cohort, the D+/R- and the R+ groups, respectively. Median time of prophylaxis was 49 (0-254) d. In the whole cohort, risk factors for CMV infection/diseases were D+/R- CMV status (odds ratio [OR] = 16.075), preceding non-CMV (infection caused by bacteria or fungi and other viruses) infection (OR = 6.362) and the duration of prophylaxis (OR = 0.984). Among the CMV D+/R- group, non-CMV infection was the only risk factor for CMV disease (OR = 10.7). CONCLUSIONS: Forty-four per cent (25/57) of the D+/R- recipients developed CMV infection/disease despite CMV prophylaxis. Current CMV prophylaxis failed to prevent CMV infection/disease in this group of patients.

Human brucellosis in Northern Saudi Arabia.

OBJECTIVES: Analysis of the clinical features, laboratory findings, treatment given and complications seen in brucellosis patients at the Northern Area Armed Forces Hospital, Hafr Al-Batin, Kingdom of Saudi Arabia. METHODS: We retrieved and reviewed the record charts of all patients from January 1995 to December 2001 with a clinical diagnosis of brucellosis whose brucella agglutination titre was 1:160 or greater from the Medical Records Department of Northern Area Armed Forces Hospital, Hafr Al-Batin. We extracted from the files the information on age, gender, occupation, history of raw milk or milk products ingestion, presenting symptoms and physical signs. We also noted the results of routine laboratory tests, treatment given, outcome of treatment and complications. RESULTS: One hundred and fifty-nine patients (males 101, females 58 with a ratio of 1.7:1) had a diagnostic label of brucellosis and a brucella titre of > or -1:160. Thirty-three (20.8%) were < or -12, 96 (60.3%) were 13-40 years old. Twenty-six (16.4%) were 14-60 years while 4 patients (2.5%) were > or -60 years. Fever (> or -=37.7 degrees C) featured in 126 (79.2%) patients; joint pain in 112 (70.4%); while 77 (48.4%) had bone pain. We recorded the abdominal pain in 18 patients (11.3%) vomiting in 9 (5.7%) and anorexia in 6 (3.8%); splenomegaly in 6 (3.8)%, hepatomegaly and lymphadenopathy in 2 (1.3%) patients. Brucella tube agglutination titres ranged from 1:160 to 1:5120. Thirty-eight (35.8%) patients had anemia (Hb <12 gms/dl); 12 patients (9.8%) had lymphocytosis (lymphocyte count >1 k/L). Ten patients (6.2%) had bacteremia. We used Rifampicin and doxycycline in 87 cases (54.7%), doxycycline and streptomycin in 33 (20.8%), and rifampicin and streptomycin in 20 (12.6%) for 6 weeks or longer (we used combinations including septrin in the remaining patients). We recorded relapse in 18 patients (11.3%). Pneumonia, epididymo-orchitis in 2 cases (1.3%) each, abortion, threatened abortion in one case each, complicated the disease in these patients. CONCLUSION: Brucellosis is endemic in Northern Saudi Arabia as in other parts of the Kingdom. The clinical and laboratory features and response to therapy are also similar.