Clinical manifestations and evolution of infection by influenza A (H1N1) in kidney transplant recipients

INTRODUCTION: The emergence of the pan>demic outbreak of influenza A (H1N1) in April, 2009, represented a logistic challenge for public health. Although most infected patients presented clinical and evolutionary manifestations which were very similar to seasonal influenza, a significant number of individuals developed pneumonia and severe acute respiratory failure. The impact of influenza A (H1N1) in immunocompromised patients is not well established yet. METHODS: This study aimed to analyze the clinical presentations and evolution of influenza A (H1N1) in 19 kidney transplant recipients. Influenza A (H1N1) infection was confirmed by RT-PCR in all patients. Treatment included antiviral therapy with oseltamivir phosphate and antibiotics. RESULTS: The studied population was compounded mostly of white people (63%), males (79%), at a mean age of 38.6 ± 17 years and patients with at least one comorbidity (53%). Influenza A (H1N1) infection was identified 41.6 ± 49.6 months after transplantation. Common symptoms included cough (100%), fever (84%), dyspnea (79%), and myalgia (42%). Acute allograft dysfunction was observed in 42% of the patients. Five patients (26%) were admitted to the Intensive Care Unit, two (10%) required invasive ventilation support, and two (10%) required vasoactive drugs. Mortality rate was 10%. CONCLUSIONS: Acute renal allograft dysfunction was a common finding. Clinical, laboratory, and evolutionary characteristics were comparable to those in the general population.INTRODUÇÃO: A emergência do surto pandêmico de influenza A, subtipo H1N1, em abril de 2009, representou um grande desafio para a logística de saúde pública. Embora a maioria dos pacientes infectados apresente manifestações clínicas e evolutivas muito semelhantes às observadas na influenza sazonal, um número significativo de indivíduos evolui com pneumonia e insuficiência respiratória aguda severa. O impacto da infecção pelo vírus influenza A, subtipo H1N1, em pacientes imunossuprimidos não é determinado. MÉTODOS: Neste estudo, foram analisadas a apresentação clínica e a evolução da influenza A, subtipo H1N1, em 19 receptores de transplante renal. Os pacientes receberam confirmação diagnóstica pela técnica de RT-PCR. O manejo clínico incluiu terapêutica antiviral com fosfato de oseltamivir e antibióticos. RESULTADOS: A população estudada foi predominantemente de indivíduos do sexo masculino (79%), brancos (63%), com idade média de 38,6 ± 17 anos e portadores de pelo menos uma comorbidade (53%). A infecção por influenza A, subtipo H1N1, foi diagnosticada em média 41,6 ± 49,6 meses após o transplante. Os sintomas mais comuns foram: tosse (100%), febre (84%), dispneia (79%) e mialgia (42%). Disfunção aguda do enxerto foi observada em 42% dos pacientes. Cinco pacientes (26%) foram admitidos em Unidade de Terapia Intensiva, dois (10%) necessitaram de suporte com ventilação invasiva e dois (10%) receberam drogas vasoativas. A mortalidade foi de 10%. CONCLUSÕES: A disfunção aguda do enxerto renal foi um achado frequente, e as características clínicas, laboratoriais e evolutivas foram comparáveis às da população geral.Universidade Federal de São Paulo (UNIFESP) Departamento de MedicinaUNIFESP, Depto. de MedicinaSciEL

Análise De Fatores De Risco, Aspectos Clínicos E Epidemiológicos Em Infecção Tardia Por Citomegalovírus Após Transplante Renal Em Pacientes Não Expostos À Profilaxia Antiviral

Objective: to compare clinical outcomes and evaluate risk factors for late CMV infection. Methods: In a cohort of kidney transplant recipients not employing CMV specific prophylaxis, patients with CMV infections occurring after the six month of transplantation were compared to patients with CMV infections diagnosed within the first six months (early infections). Results: A total of 556 patients were included in the final analysis. Forty three patients with late CMV infections were compared to 513 patients with early CMV infection. Late CMV infections occurred after a median of 473 days after transplantation and had a more severe course, with a statistically significant higher rate of invasive disease and graft loss. Thirty-day mortality was twice as high for patients with late CMV infections, but did not reach statistical significance. By multivariate analysis, employment of anti-lymphocyte therapy early after transplantation and tacrolimus as initial immunosuppressive therapy significantly reduced the occurrence of late CMV infections. Conclusions: Late CMV infections in the absence of specific prophylaxis after kidney transplantation have a more severe outcome when compared to early infections and occur in patients less immunosuppressed early after transplantation.Objetivo: comparar os resultados clínicos e avaliar fatores de risco para infecção tardia por Citomegalovírus (CMV) na ausência de profilaxia para CMV. Métodos: Em uma coorte de receptores de transplante renal que não receberam profilaxia específica de CMV, os pacientes com infecção por CMV que ocorreram seis meses após o transplante e foram comparados aos pacientes com infecções por CMV diagnosticadas precocemente, nos primeiros seis meses. Resultados: Um total de 556 pacientes foi incluído na análise final. Quarenta e três pacientes com infecção tardia por CMV foram comparados a 513 pacientes com infecção precoce por CMV. As infecções tardias por CMV ocorreram após uma mediana de 473 dias após o transplante e apresentaram um curso mais grave, com uma taxa de doença invasiva e perda de enxerto estatisticamente significativa. A mortalidade de trinta dias foi duas vezes maior para pacientes com infecção tardia por CMV, mas não atingiu significância estatística. Por análise multivariada, o emprego de terapia anti-linfócitos precocemente após transplante e tacrolimus como terapia imunossupressora inicial reduziu de forma significativa a ocorrência de infecções tardias por CMV. Conclusões: As infecções tardias por CMV na ausência de profilaxia específica após o transplante renal têm um desfecho mais grave quando comparadas às infecções precoces e ocorrem em pacientes menos imunossuprimidos precocemente após o transplante.Dados abertos - Sucupira - Teses e dissertações (2017

Morbimortality of Pandemic Influenza A H1N1 Infection in Kidney Transplant Recipients Requiring Hospitalization: A Comparative Analysis With Nonimmunocompromised Patients

Background. Clinical and epidemiological data of pandemic influenza A H1N1 infection in solid-organ transplant recipients have been described, but scarce data compare these outcomes with nonimmunocompromised patients.Methods. We retrospectively reviewed and compared the clinical presentation, morbidity, and mortality of all kidney transplant (KT) and nonimmunocompromised (non-KT) patients admitted for at least 12 hr with a diagnosis of pandemic influenza A H1N1 infection in a single hospital complex during the 2009 pandemic.Results. There were 22 patients in the KT group (29.3%) and 53 in the non-KT group (70.7%). the prevalence of diabetes was higher in KT group (27.3% vs. 5.7%) while chronic pulmonary disease was more frequent in non-KT group (34% vs. 9.1%). Clinical and radiological presentations and duration of disease were similar between the two groups. the incidence of acute renal failure was higher among KT patients (40.9% vs. 17%). No differences in the rate of intensive care unit admission (22.7% vs. 22.6%) or hospital mortality (9.1% vs. 7.5%) were observed. for the overall population, poor outcome, defined as intensive care unit admission or death, was associated with in-hospital acquisition (relative risk [RR] = 42.6 [95% confidence interval {95% CI} 2.2-831.9], P = 0.003), symptom onset more than 48 hr (RR = 12.17 [95% CI 1.3-117.2], P = 0.007), and acute renal failure (RR = 11.8 [95% CI 2.9-48.8], P = 0.001). Among KT recipients, in-hospital acquisition was the only covariate associate with poor outcome (RR = 30.0 [95% CI 2.1421.1], P = 0.004).Conclusions. No significant differences in morbidity and mortality were observed comparing KT and non-KT patients infected with pandemic H1N1 influenza A virus.Universidade Federal de São Paulo, Div Nephrol, BR-04044020 São Paulo, BrazilHosp Rim & Hipertensao, BR-04044020 São Paulo, BrazilUniversidade Federal de São Paulo, Div Infect Dis, BR-04044020 São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, BR-04044020 São Paulo, BrazilUniversidade Federal de São Paulo, Div Infect Dis, BR-04044020 São Paulo, BrazilWeb of Scienc