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Sassine J, Siegrist EA, Wilson Dib R, Henao-Cordero J, Agudelo Higuita NI. Infection prevention in the immunocompromised traveler due to conditions other than transplantation: a review. Ther Adv Infect Dis 2025; 12:20499361251313827. [PMID: 39866828 PMCID: PMC11758519 DOI: 10.1177/20499361251313827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 12/20/2024] [Indexed: 01/28/2025] Open
Abstract
This narrative review explores the risks related to infection in immunocompromised travelers due to conditions other than transplantation, and evaluates the evidence behind current prophylactic strategies, including immunizations, antimicrobials, and non-pharmacological interventions, to prevent various infection and how the current evidence applies to this special patient population, from the perspective of a US-based traveler.
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Affiliation(s)
- Joseph Sassine
- Infectious Diseases Section, Department of Medicine, The University of Oklahoma Health Sciences Center, 800 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA
| | - Emily A. Siegrist
- Department of Pharmacy, The University of Oklahoma Health, Oklahoma City, OK, USA
| | - Rita Wilson Dib
- Infectious Diseases Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - José Henao-Cordero
- Infectious Diseases Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Nelson Iván Agudelo Higuita
- Infectious Diseases Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
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Wilson Dib R, Henao-Cordero J, Sassine J, Siegrist EA, Agudelo Higuita NI. Prevention of travel-related infections in solid organ and hematopoietic cell transplant recipients. Ther Adv Infect Dis 2025; 12:20499361251338571. [PMID: 40370372 PMCID: PMC12075967 DOI: 10.1177/20499361251338571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Accepted: 04/14/2025] [Indexed: 05/16/2025] Open
Abstract
The growing population of transplant survivors receiving a solid organ transplantation (SOT) or a hematopoietic cell transplantation (HCT) and the emergence of cellular therapies are contributing to an increase in high-risk travelers to different regions of the world. Timely pretravel evaluations are essential for risk stratification and a segway to planning proper immunization, personalized antimicrobial prophylaxis, and preventative counseling based on individual medical conditions, immune status, and potential drug-drug interactions. In addition, clinicians can provide emergency and specialized medical center contacts as available. We herein review the available strategies for the prevention and management of travel-related infections in adult recipients of HCT and SOT.
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Affiliation(s)
- Rita Wilson Dib
- Infectious Diseases Section, Department of Medicine, The University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd., Oklahoma City, OK 73104, USA
| | - José Henao-Cordero
- Infectious Diseases Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Joseph Sassine
- Infectious Diseases Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Nelson Iván Agudelo Higuita
- Infectious Diseases Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
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Im S, Altuame F, Gonzalez‐Bocco IH, Martins de Oliveira Filho C, Shipper AG, Malinis M, Foppiano Palacios C. A Scoping Review of Arthropod-Borne Flavivirus Infections in Solid Organ Transplant Recipients. Transpl Infect Dis 2024; 26:e14400. [PMID: 39494749 PMCID: PMC11666879 DOI: 10.1111/tid.14400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/26/2024] [Accepted: 10/09/2024] [Indexed: 11/05/2024]
Abstract
Arthropod-borne flaviviruses (ABFs), transmitted by mosquitoes or ticks, are increasing due to climate change and globalization. This scoping review examines the epidemiology, clinical characteristics, diagnostics, treatment, and outcomes of ABF infection in solid organ transplant recipients (SOTRs). A database search up to January 25, 2024, focused on ABFs such as West Nile virus (WNV), dengue virus (DENV), Japanese encephalitis virus (JEV), Powassan virus (POWV), yellow fever virus (YFV), and Zika virus (ZIKV), limited to SOTRs. We identified 173 WNV cases from 84 studies, with 28 donor-derived infections (DDIs). Common clinical features included fever (78.5%), altered mental status (65.1%), and weakness or paralysis (45.6%). Treatment involved reducing immunosuppression (IS) in 93 cases, with intravenous immunoglobulin (IVIG), interferon alfa-2b, and ribavirin used in 75 cases. Seven cases involved graft loss or rejection post-infection. WNV infection had a 23.7% mortality rate, with severe neurological complications in 43.9% For DENV infection, 386 cases from 47 studies were identified, including 14 DDI cases. Symptoms included fever (85%), myalgias (56.4%), and headache or retro-orbital pain (34.6%). Severe dengue occurred in 50 cases (13.0%). IVIG was administered in six cases. Reduction in IS was reported in 116 patients. DENV mortality rate was 4.9%. Additionally, 26 cases of less common ABFs such as JEV, POWV, YFV, and ZIKV were described. In summary, ABF infections among SOTRs are associated with higher morbidity and mortality compared to the general population, emphasizing the need for improved preventive strategies, timely diagnosis, and optimized management protocols.
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Affiliation(s)
- Seohyeon Im
- Department of Internal MedicineMass General Brigham‐Salem HospitalSalemMassachusettsUSA
| | - Fadie Altuame
- Department of NeurologyBrigham and Women's HospitalBostonMassachusettsUSA
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Isabel H. Gonzalez‐Bocco
- Division of Infectious DiseasesBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | | | - Maricar Malinis
- Department of MedicineDivision of Infectious DiseasesVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Carlo Foppiano Palacios
- Department of MedicineDivision of Infectious DiseasesCooper Medical School of Rowan UniversityCamdenNew JerseyUSA
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Sohail A, Zhong S, Nguyen PY, McGuinness SL, Leder K. Dengue fever in immunocompromised patients: A systematic review and meta-analysis. Int J Infect Dis 2024; 149:107272. [PMID: 39490806 DOI: 10.1016/j.ijid.2024.107272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 09/04/2024] [Accepted: 10/15/2024] [Indexed: 11/05/2024] Open
Abstract
OBJECTIVES Given the complex role of immunity in dengue severity, we aimed to review the clinical course of dengue infection in immunocompromised patients. METHODS We conducted a systematic review of studies reporting outcomes among immunocompromised patients with laboratory-confirmed dengue infection. Meta-analysis using the Mantel-Haenszel method (fixed effects) was performed for studies with control groups. We registered the study with PROSPERO (No. CRD42021258930). RESULTS We included 115 studies. Among these, 30 studies compared immunocompromised (cases) and nonimmunocompromised (control) patients, focusing mainly on children (n = 22 studies) with malnutrition (n=18). Immunocompromised patients had a higher likelihood of dengue complications (OR 1.87; 95% CI: 1.04-3.35]) but a lower likelihood of severe dengue (OR 0.83; 95% CI: 0.69-1.00]. No significant difference in mortality was observed. In the 85 studies focused solely on immunocompromised patients, severe dengue and mortality rates were 9% and 4%, respectively, mostly among adult solid organ transplant recipients and those with inflammatory diseases. Immunosuppressive treatment alterations and temporary graft dysfunction were reported. CONCLUSION Immunocompromised patients have an increased risk of dengue-related complications. However, definitive conclusions about the comparative severity of dengue across different immunocompromised patient groups are limited by a lack of robust data, highlighting the need for well-designed future studies.
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Affiliation(s)
- Asma Sohail
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Infectious Diseases Department, Grampians Health Service, Ballarat, Victoria, Australia.
| | - Shannon Zhong
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia
| | - Phi-Yen Nguyen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sarah L McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Infectious Diseases Department, Alfred Health, Melbourne, Victoria, Australia
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, Melbourne Health, Parkville, Victoria, Australia
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Cachera L, Oehler E, Abdelmoumen K, Tardieu L, Thomas I, Lagrange M, Manaquin R, Quirin N, Sidibe M, Gbaguidi T, Davodoun T, Claudeon J, Vacher H, Roger PM, Markowicz S, Cabié A, Scemla A, Manchon R, Paccoud O, Pilmis B, Lanternier F, Lortholary O, Epelboin L. Prevention and management of infectious and tropical diseases in kidney transplant recipients residing in European outermost and overseas territories. Transpl Infect Dis 2024; 26:e14386. [PMID: 39400485 DOI: 10.1111/tid.14386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 09/11/2024] [Accepted: 09/18/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND The European Union encompasses 30 outermost and overseas countries and territories (OCTs). Despite a recent increasing activity of renal transplantation in these territories, many patients still undergo transplantation in continental Europe, with follow-up care coordinated between health professionals from both their transplant center and their home region. Each territory has its unique infectious epidemiology which must be known to ensure appropriate care for kidney transplant recipients (KTRs). AIMS This paper proposes a pragmatic approach to optimize pre-transplant check-up and to provide an overview of the specific epidemiological features of each region. It offers practical algorithms to help practitioners in managing infected KTR living in these territories. This work advocates for increased collaborative research among European OCTs.
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Affiliation(s)
- Laurène Cachera
- Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Erwan Oehler
- Service de Médecine Interne, CHU de Polynésie Française, Papeete, French Polynesia
| | - Karim Abdelmoumen
- Service de Maladies Infectieuses et Tropicales, CH de Mayotte, Mamoudzou, Mayotte, France
| | - Laurène Tardieu
- Service de Néphrologie-Transplantation Rénale, CHU de Montpellier, Montpellier, France
| | - Ian Thomas
- Internal Medicine/Nephrology Department, Mount St John's Medical Center, Saint John's, Antigua and Barbuda
| | - Marie Lagrange
- Service de Maladies Infectieuses et Tropicales, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Rodolphe Manaquin
- Services de Maladies Infectieuses et Tropicales, CHU de La Réunion (site Sud), La Réunion, France
| | - Nicolas Quirin
- Service de Néphrologie-Hémodialyse, Centre Hospitalier Territorial Gastron-Bourret, Nouméa, Nouvelle-Calédonie, France
| | - Mohamed Sidibe
- Service de Néphrologie-Hémodialyse, Centre Hospitalier Territorial Gastron-Bourret, Nouméa, Nouvelle-Calédonie, France
| | - Tanguy Gbaguidi
- Service de Néphrologie-Hémodialyse, Centre Hospitalier de Cayenne, Guyane Française, France
| | - Timoté Davodoun
- Service de Néphrologie-Hémodialyse, Centre Hospitalier de Cayenne, Guyane Française, France
| | - Joelle Claudeon
- Service de Néphrologie, CHU de Guadeloupe, Pointe-à-Pître, Guadeloupe, France
| | - Henri Vacher
- Service de Néphrologie, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Pierre-Marie Roger
- Service de Maladies Infectieuses et Tropicales, CHU de Guadeloupe, Pointe-à-Pître, Guadeloupe, France
| | - Samuel Markowicz
- Service de Maladies Infectieuses et Tropicales, CHU de Guadeloupe, Pointe-à-Pître, Guadeloupe, France
| | - André Cabié
- Service de Maladies Infectieuses et Tropicales, CHU de Martinique, Fort-de-France, Martinique, France
- PCCEI, Univ Montpellier, INSERM, EFS, Montpellier, France
- CIC Antilles Guyane, INSERM CIC1424, Fort-de-France, France
| | - Anne Scemla
- Service de Néphrologie-Transplantation, CHU Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Université-Paris Cité, Paris, France
| | - Romain Manchon
- Service de Maladies Infectieuses et Tropicales, CHU Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Université-Paris Cité, Paris, France
| | - Olivier Paccoud
- Service de Maladies Infectieuses et Tropicales, CHU Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Université-Paris Cité, Paris, France
| | - Benoît Pilmis
- Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, CHU Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Université-Paris Cité, Paris, France
- CNR Mycoses Invasives, Groupe de Recherche Mycologie Translationnelle, Institut Pasteur, Université Paris Cité, Paris, France
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, CHU Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Université-Paris Cité, Paris, France
- CNR Mycoses Invasives, Groupe de Recherche Mycologie Translationnelle, Institut Pasteur, Université Paris Cité, Paris, France
| | - Loïc Epelboin
- Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Guyane Française, France
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Gajurel K, Dhakal R, Deresinski S. Arbovirus in Solid Organ Transplants: A Narrative Review of the Literature. Viruses 2024; 16:1778. [PMID: 39599892 PMCID: PMC11599096 DOI: 10.3390/v16111778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 11/10/2024] [Accepted: 11/13/2024] [Indexed: 11/29/2024] Open
Abstract
The incidence of arbovirus infections has increased in recent decades. Other than dengue, chikungunya, and West Nile viruses, the data on arbovirus in solid organ transplant (SOT) are limited to case reports, and infections in renal transplant recipients account for most of the reported cases. Dengue and West Nile infections seem to be more severe with higher mortality in SOT patients than in the general population. Acute kidney injury is more frequent in patients with dengue and chikungunya although persistent arthralgia with the latter is less frequent. There is no clear relationship between arboviral infection and acute cellular rejection. Pre-transplant screening of donors should be implemented during increased arboviral activity but, despite donor screening and negative donor nucleic acid amplification test (NAT), donor derived infection can occur. NAT may be transiently positive. IgM tests lack specificity, and neutralizing antibody assays are more specific but not readily available. Other tests, such as immunohistochemistry, antigen tests, PCR, metagenomic assays, and viral culture, can also be performed. There are a few vaccines available against some arboviruses, but live vaccines should be avoided. Treatment is largely supportive. More data on arboviral infection in SOT are needed to understand its epidemiology and clinical course.
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Affiliation(s)
- Kiran Gajurel
- Division of Infectious Diseases, Carolinas Medical Center, Atrium Health, Charlotte, NC 28204, USA
| | | | - Stan Deresinski
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA 94305, USA;
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Shahani W, Fayyaz F, Abdul Samad S, Nizamuddin M, Abid M, Jamal A, Ghayas Z, Rafiq A, Hayee A, Safdar D, Farzana T, Zaidi U. Dengue virus infection in hematopoietic stem cell transplant recipients: A case series and comparative literature review from dengue endemic region. SAGE Open Med Case Rep 2024; 12:2050313X241269637. [PMID: 39246732 PMCID: PMC11378234 DOI: 10.1177/2050313x241269637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/24/2024] [Indexed: 09/10/2024] Open
Abstract
This case series describes the wide spectrum of clinical presentation, laboratory findings, and morbidity/mortality associated with dengue fever in hematopoietic stem cell transplant recipients, treated in a dengue endemic region. The risk of acquiring viral infections increases manifold after transplant due to the severely immunocompromised state amid conditioning toxicity and immunosuppressive therapy. The classical warning signs of dengue viremia are often masked in posttransplant patients, leading to a missed diagnosis of dengue and grave consequences observed in some of the patients. Accurate and timely diagnosis of dengue fever especially in dengue prevalent areas can prevent the unwarranted complications and reduce the morbidity and mortality associated with dengue in allogeneic/autologous transplant recipients.
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Affiliation(s)
- Waseem Shahani
- Department of Clinical hematology and Bone Marrow Transplantation, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Faiqa Fayyaz
- Department of Clinical Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Shafaq Abdul Samad
- Department of Clinical hematology and Bone Marrow Transplantation, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Muhammad Nizamuddin
- Department of Research and Development, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Madiha Abid
- Department of Research and Development, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Aisha Jamal
- Department of Clinical hematology and Bone Marrow Transplantation, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Zainab Ghayas
- Department of Pediatric hematology and Bone Marrow Transplantation, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Ayesha Rafiq
- Department of Clinical Pharmacy and Bone Marrow Transplantation, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Abdul Hayee
- Department of Clinical hematology and Bone Marrow Transplantation, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Dilnasheen Safdar
- Department of Clinical hematology and Bone Marrow Transplantation, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Tasleem Farzana
- Department of Clinical hematology and Bone Marrow Transplantation, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Uzma Zaidi
- Department of Clinical hematology and Bone Marrow Transplantation, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
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Tan SSX, Ho QY, Thangaraju S, Tan TT, Kee T, Chung SJ. Dengue virus infection among renal transplant recipients in Singapore: a 15-year, single-centre retrospective review. Singapore Med J 2024; 65:235-241. [PMID: 34749495 PMCID: PMC11132622 DOI: 10.11622/smedj.2021167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Dengue is a mosquito-borne viral infection endemic in Singapore. Its impact on renal transplantation is limited to small case series. We aimed to characterise the clinical presentation and outcomes of dengue infection among renal transplant recipients in Singapore. METHODS We conducted a 15-year retrospective review of dengue in renal transplant patients treated at Singapore General Hospital between January 2005 and October 2019. The diagnosis of dengue was made if there were a compatible clinical syndrome and a positive dengue diagnostic assay (dengue non-structural 1 antigen, immunoglobulin M or reverse transcriptase-polymerase chain reaction). RESULTS Of the 31 patients diagnosed with dengue, 18 (58.1%) were deceased donor recipients. The median age was 52 (interquartile range [IQR] 40-61) years; 16 (51.6%) were females. The median time to diagnosis was 99 (IQR 18-169) months from transplant. The most common clinical symptoms were fever (87.1%), myalgia (41.9%), gastrointestinal symptoms (38.7%) and headache (25.8%). Nineteen (61.3%) patients had dengue without warning signs, nine (29.0%) had dengue with warning signs, three (9.7%) had severe dengue and 30 (96.8%) were hospitalised. Seventeen (54.8%) patients had graft dysfunction, 16 (94.1%) of whom had recovery of graft function. One (3.2%) patient required dialysis and subsequently died. There were two cases of donor-derived infections (DDIs) with favourable outcomes. CONCLUSION Our experience with dengue in renal transplant recipients is concordant with published data. Although graft dysfunction is common, it is often transient with favourable outcomes. Outpatient management may be considered for mild infections. Although dengue DDIs are uncommon, more stringent donor screening may be considered in endemic regions.
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Affiliation(s)
| | - Quan Yao Ho
- Department of Renal Medicine, Singapore General Hospital, SingHealth Duke-NUS Transplant Centre, Singapore
| | - Sobhana Thangaraju
- Department of Renal Medicine, Singapore General Hospital, SingHealth Duke-NUS Transplant Centre, Singapore
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Terence Kee
- Department of Renal Medicine, Singapore General Hospital, SingHealth Duke-NUS Transplant Centre, Singapore
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Sajid M, Tur Razia I, Kanwal A, Ahsan M, Tahir RA, Sajid M, Khan MS, Mukhtar N, Parveen G, Sehgal SA. Computational Advancement towards the Identification of Natural Inhibitors for Dengue Virus: A Brief Review. Comb Chem High Throughput Screen 2024; 27:2464-2484. [PMID: 37859315 DOI: 10.2174/0113862073244468230921050703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/19/2023] [Accepted: 08/03/2023] [Indexed: 10/21/2023]
Abstract
Viral infectious illnesses represent a severe hazard to human health due to their widespread incidence worldwide. Among these ailments, the dengue virus (DENV) infection stands out. World Health Organization (WHO) estimates that DENV infection affects ~400 million people each year, with potentially fatal symptoms showing up in 1% of the cases. In several instances, academic and pharmaceutical researchers have conducted several pilot and clinical studies on a variety of topics, including viral epidemiology, structure and function analyses, infection source and route, therapeutic targets, vaccinations, and therapeutic drugs. Amongst Takeda, TAK-003, Sanofi, Dengvaxia®, and Butantan/NIH/Merck, Dengvaxia® (CYD-TDV) is the only licensed vaccination yet; however, the potential inhibitors are under development. The biology and evolution of DENVs are briefly discussed in this review, which also compiles the most recent studies on prospective antiviral targets and antiviral candidates. In conclusion, the triumphs and failures have influenced the development of anti-DENV medications, and the findings in this review article will stimulate more investigation.
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Affiliation(s)
- Muhammad Sajid
- Department of Biotechnology, University of Okara, Okara, Punjab, Pakistan
| | - Iashia Tur Razia
- Department of Biotechnology, University of Okara, Okara, Punjab, Pakistan
| | - Ayesha Kanwal
- Department of Biotechnology, University of Okara, Okara, Punjab, Pakistan
| | - Muhammad Ahsan
- Institute of Environmental and Agricultural Sciences, University of Okara, Okara, Punjab, Pakistan
| | - Rana Adnan Tahir
- Department of Biosciences, COMSATS University Islamabad, Sahiwal Campus, Sahiwal, Punjab, Pakistan
| | - Muhammad Sajid
- Department of Biotechnology, University of Okara, Okara, Punjab, Pakistan
| | | | - Naila Mukhtar
- Department of Botany, University of Okara, Okara, Punjab, Pakistan
| | - Gulnaz Parveen
- Department of Botany, Women University Swabi, Swabi, KPK, Pakistan
| | - Sheikh Arslan Sehgal
- Department of Bioinformatics, Institute of Biochemistry, Biotechnology, and Bioinformatics, The Islamia University of Bahawalpur, Punjab, Pakistan
- Department of Bioinformatics, University of Okara, Okara, Punjab, Pakistan
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10
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Meshram HS, Kute V, Patel H, Banerjee S, Chauhan S, Desai S. Successful management of dengue in renal transplant recipients: A retrospective cohort from a single center. Clin Transplant 2021; 35:e14332. [PMID: 33914386 DOI: 10.1111/ctr.14332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The literature on dengue infection in renal transplant recipients has shown wide diversity in clinical presentation and outcome. The objective of this study was to report the clinical profile, short-term and long-term outcomes of dengue among renal transplant recipients. METHODS A total of 59 post-transplant dengue suspected cases were admitted from July 2019 to April 2020 of which 31 had confirmed dengue infection. The clinical and laboratory profile of the confirmed dengue cases (n = 31) were compared with non-dengue cases (n = 28). RESULTS Among the clinical and laboratory features retro-orbital pain, conjunctival redness, thrombocytopenia on admission, and absence of arthralgia were significantly associated with dengue compared to non-dengue cases. No mortality was observed in the dengue cases. Allograft dysfunction, acute rejection and graft losses were identified in 64.5% (n = 20), 6.4% (n = 2) and 6.4% (n = 2) dengue cases respectively. No rejection or graft losses were observed in 1-year follow-up. CONCLUSIONS We report a differential clinical profile for dengue in transplant settings which will aid in the diagnosis. We also report successful management of dengue infection in renal transplant recipients with the majority having allograft dysfunction. A long-term follow-up of the cohort was uneventful.
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Affiliation(s)
| | - Vivek Kute
- Department of Nephrology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Himanshu Patel
- Department of Nephrology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Subho Banerjee
- Department of Nephrology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Sanshriti Chauhan
- Department of Nephrology and Transplantation, IKDRC-ITS, Ahmedabad, India
| | - Sudeep Desai
- Department of Nephrology and Transplantation, IKDRC-ITS, Ahmedabad, India
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11
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Lecadieu A, Teysseyre L, Larsen K, Vidal C, Caron M, Traversier N, Aujoulat T, Allyn J, Allou N. Case Report: Transmission of Dengue Virus from a Deceased Donor to a Kidney Transplant Recipient Previously Infected by Dengue Virus. Am J Trop Med Hyg 2021; 104:2199-2201. [PMID: 33939641 DOI: 10.4269/ajtmh.21-0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/05/2021] [Indexed: 12/21/2022] Open
Abstract
Since 2018, a dengue epidemic has been ongoing in the French overseas department of Reunion Island, in the Indian Ocean, with more than 25,000 serologically confirmed cases. Currently, three dengue serotypes have been identified in Réunion Island (DENV-1, DENV-2, and DENV-3) progressing in the form of epidemic outbreaks. This arbovirus is mainly transmitted by mosquitoes of the genus Aedes and may be responsible for serious clinical forms. To date, very few cases of kidney transplant-related dengue virus infection have been described. Here we report the first case of severe dengue virus infection related to kidney transplantation from a patient previously infected with dengue. Testing for dengue fever with PCR search in donor's urine may help complete the pretransplant assessment in areas where this disease occurs.
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Affiliation(s)
- Arnaud Lecadieu
- 1Centre Hospitalier Universitaire Félix Guyon, réanimation Polyvalente, Allée des Topazes, 97400, Saint Denis, France
| | - Laura Teysseyre
- 1Centre Hospitalier Universitaire Félix Guyon, réanimation Polyvalente, Allée des Topazes, 97400, Saint Denis, France
| | - Kevin Larsen
- 1Centre Hospitalier Universitaire Félix Guyon, réanimation Polyvalente, Allée des Topazes, 97400, Saint Denis, France
| | - Charles Vidal
- 1Centre Hospitalier Universitaire Félix Guyon, réanimation Polyvalente, Allée des Topazes, 97400, Saint Denis, France
| | - Margot Caron
- 1Centre Hospitalier Universitaire Félix Guyon, réanimation Polyvalente, Allée des Topazes, 97400, Saint Denis, France
| | - Nicolas Traversier
- 2Centre Hospitalier Universitaire Félix Guyon, Service de Microbiologie, Allée des Topazes, 97400, Saint Denis, France
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- 3Centre Hospitalier Universitaire Félix Guyon, Service de Néphrologie, Allée des Topazes, 97400, Saint Denis, France
| | - Thomas Aujoulat
- 4Centre Hospitalier Universitaire Félix Guyon, Service de Réanimation de chirurgie cardio-thoracique, Allée des Topazes, 97400, Saint Denis, France
| | - Jérôme Allyn
- 1Centre Hospitalier Universitaire Félix Guyon, réanimation Polyvalente, Allée des Topazes, 97400, Saint Denis, France
| | - Nicolas Allou
- 1Centre Hospitalier Universitaire Félix Guyon, réanimation Polyvalente, Allée des Topazes, 97400, Saint Denis, France
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12
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Mrzljak A, Novak R, Pandak N, Tabain I, Franusic L, Barbic L, Bogdanic M, Savic V, Mikulic D, Pavicic-Saric J, Stevanovic V, Vilibic-Cavlek T. Emerging and neglected zoonoses in transplant population. World J Transplant 2020; 10:47-63. [PMID: 32257849 PMCID: PMC7109593 DOI: 10.5500/wjt.v10.i3.47] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/15/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023] Open
Abstract
Zoonoses represent a problem of rising importance in the transplant population. A close relationship and changes between human, animal and environmental health ("One Health" concept) significantly influence the transmission and distribution of zoonotic diseases. The aim of this manuscript is to perform a narrative review of the published literature on emerging and neglected zoonoses in the transplant population. Many reports on donor-derived or naturally acquired (re-)emerging arboviral infections such as dengue, chikungunya, West Nile, tick-borne encephalitis and Zika virus infection have demonstrated atypical or more complicated clinical course in immunocompromised hosts. Hepatitis E virus has emerged as a serious problem after solid organ transplantation (SOT), leading to diverse extrahepatic manifestations and chronic hepatitis with unfavorable outcomes. Some neglected pathogens such as lymphocytic choriomeningitis virus can cause severe infection with multi-organ failure and high mortality. In addition, ehrlichiosis may be more severe with higher case-fatality rates in SOT recipients. Some unusual or severe presentations of borreliosis, anaplasmosis and rickettsioses were also reported among transplant patients. Moreover, toxoplasmosis as infectious complication is a well-recognized zoonosis in this population. Although rabies transmission through SOT transplantation has rarely been reported, it has become a notable problem in some countries. Since the spreading trends of zoonoses are likely to continue, the awareness, recognition and treatment of zoonotic infections among transplant professionals should be imperative.
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Affiliation(s)
- Anna Mrzljak
- Department of Medicine, Merkur University Hospital, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Rafaela Novak
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Nenad Pandak
- Depatment of Medicine, The Royal Hospital Muscat, Muscat 111, Oman
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | | | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, Zagreb 10000, Croatia
| | - Danko Mikulic
- Department of Abdominal and Transplant Surgery, Merkur University Hospital, Zagreb 10000, Croatia
| | - Jadranka Pavicic-Saric
- Department of Anesthesiology and Intensive Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health; School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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13
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Rosso F, Sanz AM, Parra-Lara LG, Moncada PA, Vélez JD, Caicedo LA. Dengue Virus Infection in Solid Organ Transplant Recipients: A Case Series and Literature Review. Am J Trop Med Hyg 2020; 101:1226-1231. [PMID: 31628736 DOI: 10.4269/ajtmh.19-0414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Dengue fever is the most prevalent arbovirus infection among humans, and tropical regions are hyperendemic for this infection. The number of solid organ transplant recipients is continuously increasing, and there are few data regarding the clinical course and outcomes of dengue infection among this population. We report on a retrospective case series of solid organ transplant recipients with dengue virus infection from 2001 to 2018 at Fundación Valle del Lili in Cali, Colombia. A total of 20 patients were included. The median age was 50.5 years (interquartile range [IQR] = 31-63.5 years) and 65% were female. Regarding the clinical course, 75% of patients had at least one warning sign, 45% were managed in the intensive care unit, and 30% had severe dengue. The median of time from transplant and dengue infection was 27.6 months (IQR = 3.82-59.12 months), and three patients had the disease in the first month after the transplant. All patients were discharged, and none of them had graft rejection. Dengue is an endemic disease in our region and represents a threat among solid organ transplantation recipients. All patients had a full recovery after the infection, suggesting that timely and effective management of patients and the access to high-complexity services could prevent fatal cases.
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Affiliation(s)
- Fernando Rosso
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia.,Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia.,Fundación Valle del Lili, Departamento de Medicina Interna, Servicio de Enfermedades Infecciosas, Cali, Colombia
| | - Ana María Sanz
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | | | - Pablo Andrés Moncada
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia.,Fundación Valle del Lili, Departamento de Medicina Interna, Servicio de Enfermedades Infecciosas, Cali, Colombia
| | - Juan Diego Vélez
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia.,Fundación Valle del Lili, Departamento de Medicina Interna, Servicio de Enfermedades Infecciosas, Cali, Colombia
| | - Luis Armando Caicedo
- Fundación Valle Del Lili, Unidad de Trasplantes, Cali, Colombia.,Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia
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14
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Fernandes-Charpiot IMM, Estofolete CF, Caldas HC, de Souza GR, da Silva RDCMA, Baptista MASF, Nogueira ML, Abbud-Filho M. Clinical and laboratorial profiles of dengue virus infection in kidney transplant recipients: Report of a single center. PLoS One 2019; 14:e0219117. [PMID: 31665142 PMCID: PMC6821097 DOI: 10.1371/journal.pone.0219117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 10/04/2019] [Indexed: 02/08/2023] Open
Abstract
Dengue infection (DI) is the most important arboviral infection in the world. The majority of immunocompetent patients will have asymptomatic or mild infections, but the degree of dengue severity in kidney transplant recipients (KTx) is unknown. In this study, we report the clinical profile and outcomes of 39 dengue cases in KTx. From a total of 1,186 KTx outpatients in follow-up we reviewed clinical and laboratory records of 60 (5%) patients admitted with suspected DI initially screened by NS-1, IgM, and when possible, multiplex nested PCR. The prevalence of DI in KTx was 3% (39/1,118), with symptoms leading to hospital admission being fever, myalgia, malaise, and headache. Laboratory tests showed leucopenia, thrombocytopenia, and liver enzyme elevation. DI was confirmed by positivity of NS-1 (33%), IgM (69%), and/or RT-PCR (59%). Twenty-three patients (59%) had dengue with warning signs, and 15% had severe dengue, 2 of them with a fatal course. Acute graft dysfunction occurred in 59% (mean nadir serum creatinine: 2.9 ± 2.6mg/dL), 4 of them requiring dialysis. CMV coinfection diagnosed in 19% of the cases and patients was associated with worse clinical presentation. Our results suggest that KTx with DI presented initial physical and laboratorial profile similar to the general population. However, DI in KTx seems to have a higher risk for graft dysfunction, severe dengue, and death. Because CMV coinfection aggravates the DI clinical presentation and recovery, it must be evaluated in all cases.
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Affiliation(s)
| | - Cassia Fernanda Estofolete
- Laboratory of Research in Virology, Faculty of Medicine of São José do Rio Preto, FAMERP, São José do Rio Preto, Brazil
| | - Heloisa Cristina Caldas
- Kidney Transplant Unit, Faculty of Medicine of São José do Rio Preto, FAMERP—Hospital de Base São José do Rio Preto, São José do Rio Preto, Brazil
| | - Gabriela Rodrigues de Souza
- Kidney Transplant Unit, Faculty of Medicine of São José do Rio Preto, FAMERP—Hospital de Base São José do Rio Preto, São José do Rio Preto, Brazil
| | | | - Maria Alice Sperto Ferreira Baptista
- Kidney Transplant Unit, Faculty of Medicine of São José do Rio Preto, FAMERP—Hospital de Base São José do Rio Preto, São José do Rio Preto, Brazil
| | - Mauricio Lacerda Nogueira
- Laboratory of Research in Virology, Faculty of Medicine of São José do Rio Preto, FAMERP, São José do Rio Preto, Brazil
| | - Mario Abbud-Filho
- Kidney Transplant Unit, Faculty of Medicine of São José do Rio Preto, FAMERP—Hospital de Base São José do Rio Preto, São José do Rio Preto, Brazil
- Instituto de Urology e Nefrologia, São José do Rio Preto, Brazil
- * E-mail:
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15
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Hsu AY, Ho TC, Lai ML, Tan SS, Chen TY, Lee M, Chien YW, Chen YP, Perng GC. Identification and characterization of permissive cells to dengue virus infection in human hematopoietic stem and progenitor cells. Transfusion 2019; 59:2938-2951. [PMID: 31251408 DOI: 10.1111/trf.15416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Dengue virus (DENV) is a significant threat to public health in tropical and subtropical regions, where the frequency of human migration is increasing. Transmission of DENV from donors to recipients after hematopoietic stem cell transplantation has been steadily described. However, the underlying mechanisms remain unclear. STUDY DESIGN AND METHODS Freshly isolated bone marrow (BM) was subjected to DENV infection, followed by multicolor fluorescence-activated cell sorting (FACS) analysis. Virus in supernatants was collected and analyzed by plaque assay. RESULTS DENV-1 to DENV-4 could effectively infect freshly obtained BM and produced infectious virus. DENV infection did not change the quantitative population of hematopoietic stem and progenitor cells (HSPCs), megakaryocytic progenitor cells (MkPs) and megakaryocytes. Additionally, DENV antigen, nonstructural protein 1, was enriched in HSPCs and MkPs of DENV infected marrow cells. CD34+, CD133+, or CD61+ cells sorted out from BM were not only the major contributing targets facilitating the DENV infection directly but also facilitated the spread of DENV into other cells when cocultured. CONCLUSION Results suggest that DENV can efficiently infect HSPCs, which might jeopardize the recipients if DENV-infected cells were subsequently used. We therefore raise the need for DENV screening for both the donors and recipients of hematopoietic stem cell transplantation, especially for donors exposed to endemic areas, to mitigate DENV infection in immunocompromised recipients.
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Affiliation(s)
- Alan Y Hsu
- Department of Microbiology and Immunology, National Cheng Kung University, Tainan, Taiwan.,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Biological Sciences, Purdue University, West Lafayette, Indiana
| | - Tzu-Chuan Ho
- Department of Microbiology and Immunology, National Cheng Kung University, Tainan, Taiwan.,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mei-Ling Lai
- Department of Microbiology and Immunology, National Cheng Kung University, Tainan, Taiwan
| | - Sia Seng Tan
- Department of Microbiology and Immunology, National Cheng Kung University, Tainan, Taiwan
| | - Tsai-Yun Chen
- Division of Hematology and Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meed Lee
- Department of Microbiology and Immunology, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Wen Chien
- Departement of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Ping Chen
- Division of Hematology and Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Guey Chuen Perng
- Department of Microbiology and Immunology, National Cheng Kung University, Tainan, Taiwan.,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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16
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Moura-Neto JA, Braga Silva CA, Moura AF, Rocco Suassuna JH. Emergent Arboviruses and Renal Transplantation: A Global Challenge. Kidney Int Rep 2019; 4:647-655. [PMID: 31080919 PMCID: PMC6506706 DOI: 10.1016/j.ekir.2019.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 12/23/2022] Open
Abstract
In recent years, Zika, Chikungunya, Dengue, West Nile Fever, and Yellow Fever epidemics have generated some concerns. Besides difficulties related to vector control, there are challenges related to behavior of pathologies not yet fully understood. The transplanted population requires additional care due to immunosuppressive drugs. Furthermore, the potential risk of transmission during donation is another source of uncertainty and generates debate among nephrologists in transplant centers. Do the clinical outcomes and prognoses of these infections tend to be more aggressive in this population? Is there a risk of viral transmission via kidney donation? In this review article, we address these issues and discuss the relationship between arbovirus and renal transplantation.
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Affiliation(s)
| | | | | | - José Hermógenes Rocco Suassuna
- Clinical and Academic Unit of Nephrology, Hospital Universitário Pedro Ernesto, Rio de Janeiro State University, Rio de Janeiro, Brazil
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17
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Buchan CA, Kotton CN. Travel medicine, transplant tourism, and the solid organ transplant recipient-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13529. [PMID: 30859623 DOI: 10.1111/ctr.13529] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review recommendations for prevention and management of travel-related infection in solid organ transplant (SOT) recipients as well as risks associated with transplant tourism. Counseling regarding travel post-transplant should be included during the pre-transplant evaluation, and all SOT recipients should be seen by a travel medicine specialist prior to traveling to destinations with higher rates of infection. Patients should be advised on vaccine-preventable illnesses as well as any need for prophylaxis (ie, malaria) based on their individual travel itineraries. Information with regards to specific recommendations for vaccines and prophylactic medications, along with drug-drug interactions, is summarized. Counseling should be provided for modifiable risks and exposures (ie, food and water safety, and insect bite prevention) as well as non-infectious travel topics. These guidelines also briefly address risks associated with transplant tourism and specific infections to consider if patients seek care for transplants done in foreign countries.
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Affiliation(s)
- C Arianne Buchan
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Camille Nelson Kotton
- Transplant Infectious Disease and Compromised Host Program, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Travelers' Advice and Immunization Center, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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18
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Weerakkody RM, Palangasinghe DR, Wijewickrama ES. Dengue fever in a kidney transplant recipient with complicated clinical course: a case report. J Med Case Rep 2018; 12:260. [PMID: 30170627 PMCID: PMC6119327 DOI: 10.1186/s13256-018-1790-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dengue fever is the commonest mosquito-borne illness in the tropics and subtropics. Renal transplantation is one of the ever expanding modes of treatment of end-stage renal disease. Hepatitis B is a common infection in South and East Asia, but rare in Sri Lanka. Here we describe a recipient of a renal transplant with a stable graft, on antiviral treatment for hepatitis B infection, developing dengue superinfection and entering a complex clinical course. To the best of our knowledge this is the first report of such a case. CASE PRESENTATION A 59-year-old Sri Lankan woman developed acute renal failure and needed dialysis support; she had upper gastrointestinal bleeding that needed transfusions, pancytopenia, and a prolonged phase of thrombocytopenia. She eventually recovered from illness, and her renal functions returned to baseline levels. The differences in presentation, signs, symptoms, and mortality of renal transplant recipients infected with dengue fever from the general population are discussed, with possible reasons for altered presentation. CONCLUSIONS Dengue superinfection in transplant recipients with hepatitis B infection can lead to management difficulties. The recovery can be slow as seen from this case, with prolonged thrombocytopenia.
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19
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Subbiah A, Mahajan S, Yadav RK, Agarwal SK. Intravenous immunoglobulin therapy for dengue capillary leak syndrome in a renal allograft recipient. BMJ Case Rep 2018; 2018:bcr-2018-225225. [PMID: 29925559 DOI: 10.1136/bcr-2018-225225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
A 45-year-old man presented 4 months after ABOi renal transplantation with febrile illness and bicytopenia necessitating cessation of mycophenolate mofetil. Dengue non-structural protein 1 antigen (NS1 Ag) test was positive. Lowest total leucocyte count was 3.1×109/L and platelet count was 14×109/L. As fever subsided, patient became tachypneic with abdominal distention and hypotension. Ultrasonographic evaluation revealed ascites, gall bladder wall oedema and bilateral pleural effusion consistent with dengue capillary leak syndrome. He developed massive ascites with abrupt weight gain of 4 kg within 24 hours and worsening renal dysfunction. Patient was deteriorating rapidly in spite of adequate supportive care and we gave a trial of intravenous immunoglobulin (0.5 g/kg/day) for 5 days. Patient improved from day 2, and by day 3, he became haemodynamically stable and recovered completely. Patient was stable at discharge and is on regular follow-up.
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Affiliation(s)
- Arunkumar Subbiah
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sandeep Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Raj Kanwar Yadav
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sanjay Kumar Agarwal
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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20
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Darrigo LG, de Sant'Anna Carvalho AM, Machado CM. Chikungunya, Dengue, and Zika in Immunocompromised Hosts. Curr Infect Dis Rep 2018; 20:5. [PMID: 29551005 PMCID: PMC5857271 DOI: 10.1007/s11908-018-0612-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Describe the characteristics of chikungunya, dengue, and Zika in transplant recipients and immunocompromised hosts. RECENT FINDINGS Stem cell/bone marrow grafts, organs, and blood transfusions can transmit CHIKV/DENV/ZIKV infections, which are clinically similar, resembling influenza-like illness. Laboratory confirmation is necessary. In the acute phase, RT-PCR is preferred. DENV and ZIKV serology may cross-react. Delayed engraftment and extended viruria is observed in ZIKV+/HSCT recipients, while longer viremia is observed in DENV+/HSCT patients. Arbovirus persistence in organ tissues is generally unknown. Vaccine development is in early stages for CHIKV/ZIKV. No data is available to recommend the licensed DENV vaccine in transplant recipients. In endemic areas, the assessment of epidemiological risk is mandatory. Donor deferral for 120 days in suspected or confirmed ZIKV+ has been recommended, while CHIKV+ donors should wait 30 days. No deferral is recommended for DENV+ donors. CHIKV/DENV/ZIKV tests should be included in the differential of febrile neutropenia and other transplant syndromes. Reassessment of DENV serology is urgently needed. Prospective studies are necessary to determine the impact of CHIKV/DENV/ZIKV in this special population.
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Affiliation(s)
- Luiz Guilherme Darrigo
- Bone Marrow Transplant Unit - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alexandre Machado de Sant'Anna Carvalho
- Virology Laboratory - Institute of Tropical Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 470 - 2nd floor, São Paulo, SP, 05403-000, Brazil
| | - Clarisse Martins Machado
- Virology Laboratory - Institute of Tropical Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 470 - 2nd floor, São Paulo, SP, 05403-000, Brazil.
- HSCT Program, Amaral Carvalho Foundation, Jahu, São Paulo, Brazil.
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21
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Sullivan KE, Bassiri H, Bousfiha AA, Costa-Carvalho BT, Freeman AF, Hagin D, Lau YL, Lionakis MS, Moreira I, Pinto JA, de Moraes-Pinto MI, Rawat A, Reda SM, Reyes SOL, Seppänen M, Tang MLK. Emerging Infections and Pertinent Infections Related to Travel for Patients with Primary Immunodeficiencies. J Clin Immunol 2017; 37:650-692. [PMID: 28786026 PMCID: PMC5693703 DOI: 10.1007/s10875-017-0426-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/21/2017] [Indexed: 12/18/2022]
Abstract
In today's global economy and affordable vacation travel, it is increasingly important that visitors to another country and their physician be familiar with emerging infections, infections unique to a specific geographic region, and risks related to the process of travel. This is never more important than for patients with primary immunodeficiency disorders (PIDD). A recent review addressing common causes of fever in travelers provides important information for the general population Thwaites and Day (N Engl J Med 376:548-560, 2017). This review covers critical infectious and management concerns specifically related to travel for patients with PIDD. This review will discuss the context of the changing landscape of infections, highlight specific infections of concern, and profile distinct infection phenotypes in patients who are immune compromised. The organization of this review will address the environment driving emerging infections and several concerns unique to patients with PIDD. The first section addresses general considerations, the second section profiles specific infections organized according to mechanism of transmission, and the third section focuses on unique phenotypes and unique susceptibilities in patients with PIDDs. This review does not address most parasitic diseases. Reference tables provide easily accessible information on a broader range of infections than is described in the text.
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Affiliation(s)
- Kathleen E Sullivan
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, 3615 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Hamid Bassiri
- Division of Infectious Diseases and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3501 Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Ahmed A Bousfiha
- Clinical Immunology Unit, Infectious Department, Hopital d'Enfant Abderrahim Harouchi, CHU Ibn Rochd, Laboratoire d'Immunologie Clinique, d'Inflammation et d'Allergie LICIA, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Morocco
| | - Beatriz T Costa-Carvalho
- Department of Pediatrics, Federal University of São Paulo, Rua dos Otonis, 725, São Paulo, SP, 04025-002, Brazil
| | - Alexandra F Freeman
- NIAID, NIH, Building 10 Room 12C103, 9000 Rockville, Pike, Bethesda, MD, 20892, USA
| | - David Hagin
- Division of Allergy and Immunology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, University of Tel Aviv, 6 Weizmann St, 64239, Tel Aviv, Israel
| | - Yu L Lau
- Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Rm 106, 1/F New Clinical Building, Pok Fu Lam, Hong Kong.,Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Michail S Lionakis
- Fungal Pathogenesis Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy & Infectious Diseases (NIAID), National Institutes of Health (NIH), 9000 Rockville Pike, Building 10, Room 11C102, Bethesda, MD, 20892, USA
| | - Ileana Moreira
- Immunology Unit, Hospital de Niños Ricardo Gutiérrez, Gallo 1330, 1425, Buenos Aires, Argentina
| | - Jorge A Pinto
- Division of Immunology, Department of Pediatrics, Federal University of Minas Gerais, Av. Alfredo Balena 190, room # 161, Belo Horizonte, MG, 30130-100, Brazil
| | - M Isabel de Moraes-Pinto
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Federal University of São Paulo, Rua Pedro de Toledo, 781/9°andar, São Paulo, SP, 04039-032, Brazil
| | - Amit Rawat
- Pediatric Allergy and Immunology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shereen M Reda
- Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Saul Oswaldo Lugo Reyes
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Av Iman 1, Torre de Investigacion, Piso 9, Coyoacan, 04530, Mexico City, Mexico
| | - Mikko Seppänen
- Harvinaissairauksien yksikkö (HAKE), Rare Disease Center, Helsinki University Hospital (HUH), Helsinki, Finland
| | - Mimi L K Tang
- Murdoch Children's Research Institute, The Royal Children's Hospital, University of Melbourne, Melbourne, Australia
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Fernandes PFCBC, Siqueira RA, Girão ES, Siqueira RA, Mota MU, Marques LCBF, Andrade SCA, Barroso WM, Silva SL, Rodrigues dos Santos BG, de Oliveira CMC. Dengue in renal transplant recipients: Clinical course and impact on renal function. World J Transplant 2017; 7:57-63. [PMID: 28280696 PMCID: PMC5324029 DOI: 10.5500/wjt.v7.i1.57] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/21/2016] [Accepted: 01/14/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To present clinical characteristics from renal transplant recipients with dengue fever and its impact on graft function.
METHODS We retrospectively evaluated 11 renal transplant recipients (RTR) with dengue infection confirmed by laboratory test, between January 2007 and July 2012, transplanted in the Renal Transplant Center of Walter Cantídio University Hospital from Federal University of Ceará.
RESULTS Positive dengue serology (IgM) was found in all patients. The mean time between transplant and dengue infection was 43 mo. Fever was presented in all patients. Nine patients presented with classical dengue and two (18%) with dengue hemorrhagic fever. All cases had satisfactory evolution with complete recovery of the symptoms. The time for symptom resolution varied from 2 to 20 d, with an average of 9 d. An increase of creatinine after the infection was observed in three (27.2%) patients with no clinically impact on the kidney graft function.
CONCLUSION RTR with dengue infection seems to have a clinical presentation and evolution similar to those seen in the general population, with no long-term damage to patient and to the graft.
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Dengue fever in renal transplant patients: a systematic review of literature. BMC Nephrol 2017; 18:15. [PMID: 28086881 PMCID: PMC5237298 DOI: 10.1186/s12882-016-0428-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 12/20/2016] [Indexed: 01/30/2023] Open
Abstract
Background Dengue fever in renal transplanted patients has not been studied well, and we review all the literature about episodes dengue fever in renal transplant patients. Methods The aim was to describe clinico-pathological characteristics, immunosuppressive protocols, need renal outcome and mortality. PubMed, LILACS, Google Scholar and Research Gate were searched for “Dengue” and “Renal/Kidney Transplantation” with no date limits. Hits were analyzed by two researchers separately. Results Fever, myalgia, arthralgia and headache was significantly lower than normal population, while pleural effusions and ascites were observed more. Incidence of severe dengue is significantly higher among transplant patients in this review, as well as they had a significantly higher mortality (8.9% vs 3.7%, p = 0.031). Age, period after transplantation and immunosuppressive profile had no effect on disease severity, mortality or graft out come. Presence of new bleeding complications and ascites was associated with more severe disease (p < 0.001 and p = 0.005), death (p = 0.033) or graft loss (p = 0.035). Use of tacrolimus was associated with new bleeding complications (p = 0.027), and with ascites (p = 0.021), but not with thrombocytopenia. 25% of patients with primary disease fail to mount an IgG response by 15 weeks of the illness. 58.9% had graft dysfunction during illness. Postoperative transplanted patients were at risk of severe disease and unfavorable outcome. Conclusions The physical and laboratory findings in dengue fever in renal transplanted patients differ from the general population. Some degree of graft dysfunction is common during the illness, but only a minority develops graft failure.
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Costa SD, da Silva GB, Jacinto CN, Martiniano LVM, Amaral YS, Paes FJVN, De Mattos Brito Oliveira Sales ML, de Matos Esmeraldo R, De Francesco Daher E. Dengue Fever Among Renal Transplant Recipients: A Series of 10 Cases in a Tropical Country. Am J Trop Med Hyg 2015; 93:394-6. [PMID: 26033028 DOI: 10.4269/ajtmh.15-0038] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/11/2015] [Indexed: 12/13/2022] Open
Abstract
This is a case series of 10 consecutive renal allograft recipients, followed at a tertiary hospital in northeast Brazil, with a confirmed diagnosis of dengue. Five of the patients needed hospitalization. Half of them were males and age ranged from 19 to 60 years with a median of 38.2 years. They had been transplanted for a mean of 5 days to 166 months. Four patients developed dengue hemorrhagic fever (DHF). All patients had myalgia and headache. All of them, except one, had fever. Positive dengue serology (IgM) was found in all patients. No patient died. Dengue is an important infectious disease that can affect renal transplant recipients, mainly in endemic areas. Its presentation seems to be similar to that seen in immunocompetent patients.
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Affiliation(s)
- Silvana Daher Costa
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Renal Transplantation, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Post-Graduation Program in Collective Health, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Geraldo Bezerra da Silva
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Renal Transplantation, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Post-Graduation Program in Collective Health, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Camilla Neves Jacinto
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Renal Transplantation, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Post-Graduation Program in Collective Health, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Lorena Vasconcelos Mesquita Martiniano
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Renal Transplantation, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Post-Graduation Program in Collective Health, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Yago Sucupira Amaral
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Renal Transplantation, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Post-Graduation Program in Collective Health, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Fernando Jose Villar Nogueira Paes
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Renal Transplantation, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Post-Graduation Program in Collective Health, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Maria Luiza De Mattos Brito Oliveira Sales
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Renal Transplantation, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Post-Graduation Program in Collective Health, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Ronaldo de Matos Esmeraldo
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Renal Transplantation, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Post-Graduation Program in Collective Health, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Elizabeth De Francesco Daher
- Post-Graduation Program in Medical Sciences, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Division of Renal Transplantation, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil; Post-Graduation Program in Collective Health, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
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Weerakkody RM, Palangasinghe DR, Dalpatadu KPC, Rankothkumbura JP, Cassim MRN, Karunanayake P. Dengue fever in a liver-transplanted patient: a case report. J Med Case Rep 2014; 8:378. [PMID: 25412699 PMCID: PMC4244141 DOI: 10.1186/1752-1947-8-378] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 09/23/2014] [Indexed: 01/02/2023] Open
Abstract
Introduction Dengue fever is one of the commonest mosquito-borne diseases in the tropics, and Sri Lanka is no exception. Despite its commonness, dengue fever has rarely been described among patients who have undergone transplantation. We report the case of a patient with dengue fever after liver transplantation, which, to the best of our knowledge, is the first such reported case outside Brazil. Case presentation Our patient was a 46-year-old Sri Lakan man who presented to our institution two years after undergoing an ABO-compatible cadaveric liver transplant. At presentation, he had typical symptoms of dengue fever. He was taking prednisolone 5mg daily and tacrolimus 3mg twice daily as immunosuppression. Initial investigations showed thrombocytopenia and neutropenia that reached a nadir by day 7 of his illness. He had elevated liver enzymes as well. The diagnosis was confirmed on the basis of NS1 antigen detection by enzyme-linked immunosorbent assay. His blood cultures and polymerase chain reaction tests for cytomegalovirus were negative. He made an uneventful recovery and was discharged by day 9 of his illness. However, normalization of liver function took nearly two weeks. In three previously reported Brazilian cases of dengue after liver transplantation, the patients presented with dengue shock syndrome, in contrast to the relatively milder presentation of our patient. Because of the lack of case reports in the literature, it is difficult to ascertain the risk factors for severe dengue infection in transplants, but dengue fever reported in renal transplants sheds some light on them. High-dose steroids increase the risk of thrombocytopenia, whereas tacrolimus has been reported to prolong the duration of symptoms. Otherwise, dengue fever is a relatively mild illness in patients who have undergone renal transplantation, and renal allograft survival has been reported to be 86% following dengue fever. Conclusion Dengue is a rarely reported infection in patients who have undergone transplantation. A high degree of suspicion is required for diagnosis. Dengue NS1 antigen detection is a useful addition to the already existing methods of diagnosis. Steroids and tacrolimus have effects on the morbidity of the disease. Graft outcomes following the infection has been excellent in all reported cases.
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Affiliation(s)
- Ranga Migara Weerakkody
- University Medical Unit, National Hospital of Sri Lanka, Regent Street, Colombo 9 CO00900, Sri Lanka.
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