1
|
Chung CS, Tsai CC, Chen KC, Lin CK, Lee TH, Tsai HW, Chen Y. Surveillance of Rejection After Intestinal Transplantation Using an Image Enhanced Endoscopy "VENCH" Scoring System. Transplant Proc 2020; 53:364-370. [PMID: 33309060 DOI: 10.1016/j.transproceed.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Graft rejection after intestinal transplantation remains challenging. We aimed to use endoscopy for rejection prediction. MATERIALS AND METHODS Patients ≥7 years old who underwent intestinal transplantation between November 2016 and September 2019 were prospectively enrolled. Magnifying endoscopy under narrow-band imaging was performed through ileostomy. Endoscopic findings were reported as five components (each graded from 0-2): "V" (villi appearance), "E" (erythema), "N" (capillary network), "C" (crypt widening), and "H" (heterogeneity). The correlation between histological severity and endoscopic score was analyzed. RESULTS Ninety-nine endoscopic biopsies from three female and one male patient were analyzed. The mean ± SD age was of 41.25±13.77 (range 29-58) years. Three short bowel syndrome patients after multiple intestinal resections and one with chronic intestinal pseudo-obstruction were indicated for intestinal transplantation. Sensitivity, specificity, and accuracy of V, E, N, C, and H scores for predicting rejection were 97.4%, 45.9%, 65.7%; 94.7%, 70.5%, 79.8%; 97.4%, 52.5%, 69.7%; 94.7%, 54.1%, 69.7%; and 97.4%, 62.3%, 75.8%, respectively. Pearson's correlation coefficients between total and individual V, E, N, C, H scores and histological rejection were 0.79, 0.64, 0.70, 0.71, 0.73, and 0.66, respectively (P < .001). To predict mild and moderate/severe rejection, total scores more than 4 and 6 had the sensitivity/specificity of 87.50%/57.38% and 96.67%/85.25%, respectively (area under the ROC 0.791 and 0.987). CONCLUSION Endoscopic VENCH scoring is promising for predicting rejection after IT. More studies are warranted to validate such results. (ClinicalTrials.gov number, NCT03616548.).
Collapse
Affiliation(s)
- Chen-Shuan Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taoyuan City, Taiwan; College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chien-Chen Tsai
- Department of Anatomical Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Chih Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taoyuan City, Taiwan
| | - Cheng-Kuan Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzong-Hsi Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taoyuan City, Taiwan
| | - Huang-Wen Tsai
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yun Chen
- Taiwan Association for the Study of Small Intestinal Diseases (TASSID), Taoyuan City, Taiwan; Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Chemical Engineering and Materials Science, Yuan Ze University, Taoyuan City, Taiwan.
| |
Collapse
|
2
|
|
3
|
Demir Z, Frange P, Lacaille F. Vaccinations, response, and controls before and after intestinal transplantation in children. Pediatr Transplant 2016; 20:449-55. [PMID: 26847771 DOI: 10.1111/petr.12669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2015] [Indexed: 11/25/2022]
Abstract
Vaccination is an effective strategy to decrease infections in transplant recipients. Children after intestinal transplantation carry a high risk of infection due to increased immunosuppression. In a series of 22 children after intestinal transplantation, we studied the vaccination schedules and the antibodies against vaccine-preventable diseases before transplantation, and at one and five yr after transplantation. We reviewed whether the vaccination schedules were complete, and we analysed the factors that may influence serological immunity and the incidence of disease in patients with deficient immunity. All patients completed the recommended vaccination schedules for DTaP-IPV and HBV. After transplantation, the negative antibodies against vaccine-preventable diseases were mostly related to an antirejection therapy: for DTaP-IPV: four of four patients with no antibody had been treated for rejection, for HBV: two of five, HAV: three of four, MMR: three of seven, and VZV: three of four. A post-transplantation varicella infection was followed by acute rejection, with probability for a relationship between both events. We observed 50% of varicella cases in unvaccinated children, highlighting the importance of pretransplant vaccination. Waning immunogenicity mediated by antibodies against vaccine-preventable disease after transplantation indicated a need for boosters. The recommendations should be regularly enforced, as the reliance on routine immunizations schedules is not adequate in immunocompromised patients.
Collapse
Affiliation(s)
- Z Demir
- Pediatric Hepato-Gastro-Enterology-Nutrition Unit, Necker-Enfants Malades Hospital, Paris, France
| | - P Frange
- Microbiology Department, Necker-Enfants Malades Hospital, Paris, France.,Pediatric Immunology and Hematology Unit, Necker Hospital, Paris, France.,EA 7327, Paris Descartes University, Sorbonne Paris Cite, Paris, France
| | - F Lacaille
- Pediatric Hepato-Gastro-Enterology-Nutrition Unit, Necker-Enfants Malades Hospital, Paris, France
| |
Collapse
|
4
|
Echenique IA, Penugonda S, Stosor V, Ison MG, Angarone MP. Diagnostic yields in solid organ transplant recipients admitted with diarrhea. Clin Infect Dis 2014; 60:729-37. [PMID: 25371488 DOI: 10.1093/cid/ciu880] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although diarrhea is a frequent complaint among solid organ transplant recipients, the contribution of infectious etiologies remains incompletely defined. We sought to define the etiologies of diarrhea and the yields of testing at our institution. METHODS We performed a retrospective analysis over an 18-month period of hospitalized solid organ transplant recipients. We stratified diarrhea by community onset vs hospital onset of diarrhea. RESULTS We identified 422 admissions (representing 314 unique patients) with community-onset diarrhea, and 112 admissions (representing 102 unique patients) with hospital-onset diarrhea. The majority of community- and hospital-onset diarrheal episodes had no identified etiology (60.9% and 75.9%, respectively; P = .03), yet were also self-limited (91% and 91%, respectively; P = .894). Thereafter, the most frequently encountered infectious etiologies were Clostridium difficile infection (13.3% and 11.8%, respectively), norovirus enteritis (8.2% and 3%), cytomegalovirus disease or colitis (6.3% and 2.7%), and bacterial enterocolitis (0.9% and 0%) (P = .03). In aggregate, these entities represented 93.7% and 90.5% of the identified infectious etiologies, respectively. Protozoan causes were rarely seen. Coinfection, or the simultaneous detection of ≥2 pathogens, occurred in 8 (1.9%) and 2 (1.8%) community- and hospital-onset diarrheal admissions, respectively (P = .99). CONCLUSIONS In solid organ transplant recipients who presented at our institution with diarrhea, approximately one-third had infectious etiologies identified, consisting predominantly of C. difficile, norovirus, cytomegalovirus, and bacterial enterocolitis. Other infectious etiologies were rare.
Collapse
Affiliation(s)
| | | | - Valentina Stosor
- Division of Infectious Diseases Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael G Ison
- Division of Infectious Diseases Division of Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | |
Collapse
|
5
|
Ajumobi A, Daniels J, Sostre C, Trevino H. Giardiasis in a hematopoietic stem cell transplant patient. Transpl Infect Dis 2014; 16:984-7. [DOI: 10.1111/tid.12272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/10/2014] [Accepted: 07/03/2014] [Indexed: 11/26/2022]
Affiliation(s)
- A.B. Ajumobi
- Department of Internal Medicine; Division of Gastroenterology; University of Texas Health Science Center; San Antonio Texas USA
| | - J.A. Daniels
- Department of Pathology; University of Texas Health Science Center; San Antonio Texas USA
| | - C.F. Sostre
- Department of Internal Medicine; Division of Gastroenterology; Audie L Murphy Memorial VA Hospital; San Antonio Texas USA
| | - H.H. Trevino
- Department of Internal Medicine; Division of Gastroenterology; Audie L Murphy Memorial VA Hospital; San Antonio Texas USA
| |
Collapse
|
6
|
Moreno Camacho A, Ruiz Camps I. [Nosocomial infection in patients receiving a solid organ transplant or haematopoietic stem cell transplant]. Enferm Infecc Microbiol Clin 2014; 32:386-95. [PMID: 24950613 PMCID: PMC7103322 DOI: 10.1016/j.eimc.2014.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 12/25/2022]
Abstract
Bacterial infections are the most common infections in solid organ transplant recipients. These infections occur mainly in the first month after transplantation and are hospital-acquired. Nosocomial infections cause significant morbidity and are the most common cause of mortality in this early period of transplantation. These infections are caused by multi-drug resistant (MDR) microorganisms, mainly Gram-negative enterobacteria, non-fermentative Gram-negative bacilli, enterococci, and staphylococci. The patients at risk of developing nosocomial bacterial infections are those previously colonized with MDR bacteria while on the transplant waiting list. Intravascular catheters, the urinary tract, the lungs, and surgical wounds are the most frequent sources of infection. Preventive measures are the same as those applied in non-immunocompromised, hospitalized patients except in patients at high risk for developing fungal infection. These patients need antifungal therapy during their hospitalization, and for preventing some bacterial infections in the early transplant period, patients need vaccinations on the waiting list according to the current recommendations. Although morbidity and mortality related to infectious diseases have decreased during the last few years in haematopoietic stem cell transplant recipients, they are still one of the most important complications in this population. Furthermore, as occurs in the general population, the incidence of nosocomial infections has increased during the different phases of transplantation. It is difficult to establish general preventive measures in these patients, as there are many risk factors conditioning these infections. Firstly, they undergo multiple antibiotic treatments and interventions; secondly, there is a wide variability in the degree of neutropenia and immunosuppression among patients, and finally they combine hospital and home stay during the transplant process. However, some simple measures could be implemented to improve the current situation.
Collapse
Affiliation(s)
- Asunción Moreno Camacho
- Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, España.
| | - Isabel Ruiz Camps
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| |
Collapse
|
7
|
Cervera C, Linares L, Bou G, Moreno A. Multidrug-resistant bacterial infection in solid organ transplant recipients. Enferm Infecc Microbiol Clin 2012; 30 Suppl 2:40-8. [PMID: 22542034 DOI: 10.1016/s0213-005x(12)70081-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The most frequent complication from infection after solid organ transplantation is bacterial infection. This complication is more frequent in organ transplantation involving the abdominal cavity, such as liver or pancreas transplantation, and less frequent in heart transplant recipients. The sources, clinical characteristics, antibiotic resistance and clinical outcomes vary according to the time of onset after transplantation. Most bacterial infections during the first month post-transplantation are hospital acquired, and there is usually a high incidence of multidrug-resistant bacterial infections. The higher incidence of complications from bacterial infection in the first month post-transplantation may be associated with high morbidity. Of special interest due to their frequency are infections by S. aureus, enterococci, Gram-negative enteric and non-fermentative bacilli. Opportunistic bacterial infections may occur at any time on the posttransplant timeline, but are more frequent between months two and six, the period in which immunosuppression is higher. The most frequent bacterial species causing opportunistic infections in organ transplant recipients are Listeria monocytogenes and Nocardia spp. After month six, posttransplantation solid organ transplant patients usually develop conventional community-acquired bacterial infections, especially urinary tract infections by E. coli and S. pneumoniae pneumonia. In this article we review the clinical characteristics, epidemiology, diagnosis and prognosis of bacterial infections in solid organ transplant patients.
Collapse
Affiliation(s)
- Carlos Cervera
- Department of Infectious Diseases, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | | | | | | |
Collapse
|
8
|
How can pathologists help to diagnose late complications in small bowel and multivisceral transplantation? Curr Opin Organ Transplant 2012; 17:273-9. [DOI: 10.1097/mot.0b013e3283534eb0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
9
|
|
10
|
Abstract
This article reviews the current status of pediatric intestinal transplantation, focusing on referral and listing criteria, surgical techniques, patient management, monitoring, complications after transplant, and short- and long-term patient outcome. Intestine transplantation has become the standard of care for children who develop life-threatening complications associated with intestinal failure. The results of intestinal failure treatment have significantly improved in the last decade following the establishment of gut rehabilitation programs and advances in transplant immunosuppressive protocols, surgical techniques, and posttransplant monitoring. The 1-year patient survival is now 80% and more than 80% of the children who survive the transplant are weaned off parenteral nutrition. Early referral for pretransplant assessment and careful follow-up after transplant with prompt recognition and treatment of transplant-related complications are key factors contributing to superior patient outcomes and survival. The best results are being obtained at high-volume centers with survival rates of up to 75% at 5 years.
Collapse
Affiliation(s)
- Yaron Avitzur
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
| | | |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW To provide a general understanding of Clostridium difficile infection with a focus on recent publications that evaluate the disease in solid organ transplant recipients. RECENT FINDINGS The incidence of C. difficile infection is increasing worldwide. Epidemics due to a hypervirulent C. difficile strain are associated with an escalating severity of disease. New evidence further supports basing initial treatment choice on disease severity. SUMMARY C. difficile is a significant pathogen in solid organ transplant recipients. Multiple risk factors are found in this population that may result in more severe disease. A high index of suspicion is necessary for the early diagnosis and treatment of C. difficile infection in transplant recipients. Metronidazole and vancomycin show equivalent efficacy in the treatment for mild-to-moderate disease, but vancomycin has demonstrated superiority in the treatment of severe disease. Surgical intervention is also an important consideration in the treatment of solid organ transplant recipients with severe colitis. Rigorous infection control practices are essential for preventing the spread of C. difficile within the hospital environment.
Collapse
|
12
|
Sudan DL. Treatment of intestinal failure: intestinal transplantation. ACTA ACUST UNITED AC 2007; 4:503-10. [PMID: 17768395 DOI: 10.1038/ncpgasthep0901] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Accepted: 07/02/2007] [Indexed: 01/18/2023]
Abstract
Over the past 15 years, intestinal transplantation for the treatment of intestinal failure has changed from a desperate last-ditch effort into a standard therapy for which a good outcome is expected. Patient survival after intestinal transplantation has improved in the past 3-5 years and now approaches that of other solid organ allograft recipients, including liver and kidney, and is similar to survival on permanent therapy with parenteral nutrition. Complications are more common and often more severe during the initial hospitalization period after intestinal transplantation than they are after transplantation of other solid organs. After intestinal transplantation the initial hospitalization period is, therefore, usually 3-8 weeks long. Nearly all patients discharged after intestinal transplantation have good allograft function and have been weaned from total parenteral nutrition. The cost of the initial hospitalization period is one to two times the cost of permanent total parenteral nutrition for 1 year, which means that, in most cases, intestinal transplantation is cost-saving within 2 years of transplantation. In addition, quality of life after intestinal transplantation, as determined by standardized quality of life measures, is good or normal.
Collapse
Affiliation(s)
- Debra L Sudan
- University of Nebraska Medical Center, Omaha, NE, USA.
| |
Collapse
|
13
|
Rayani A, Bode U, Habas E, Fleischhack G, Engelhart S, Exner M, Schildgen O, Bierbaum G, Maria Eis-Hübinger A, Simon A. Rotavirus infections in paediatric oncology patients: a matched-pairs analysis. Scand J Gastroenterol 2007; 42:81-7. [PMID: 17190767 DOI: 10.1080/00365520600842179] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To conduct a systematic investigation of the clinical relevance of rotavirus infection in the setting of paediatric cancer patients receiving intensive chemotherapy. MATERIAL AND METHODS Twenty-eight paediatric cancer patients with positive rotavirus antigen tests were eligible for a retrospective case-control study (January 1995-December 2004). Rota-positive patients were compared with 28 rota-negative patients matched for age, underlying disease and chemotherapy. The National Cancer Institute Common Toxicity Criteria were used to determine clinical severity. RESULTS Median duration of rota-related symptoms (diarrhoea, fever and vomiting) was 7 days (range 4-34 days; 75th percentile 9 days). Median duration of viral shedding was 17 days (4-73 days; 75th percentile 39.5 days). The rota infection was nosocomially acquired in 19 patients (68%). The proportions of patients with diarrhoea > or =NCI II, fever >39 degrees C, clinically relevant dehydration, metabolic acidosis, mucositis and neutropenia were significantly higher in rota-positive patients. Rota-positive patients tended to have a prolonged period of hospitalization (median 8 versus 4 days; p=0.008). A higher proportion of rota-positive patients had to receive parenteral nutrition and tube feeding (p<0.001). CONCLUSIONS Rotavirus is a clinically relevant but preventable pathogen in paediatric cancer patients, since many cases seem to be nosocomial in origin. Rapid microbiological testing and contact precautions should be strictly applied to any symptomatic patient and to their immediate contacts. Prolonged viral shedding in immunocompromised paediatric patients necessitates repeated testing in order to determine the duration of isolation.
Collapse
Affiliation(s)
- Amnna Rayani
- Department of Paediatric Haematology and Oncology, Children's Hospital Medical Centre, Bonn, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Tashiro Y, Goto M, Takemoto Y, Sato E, Shirahama H, Utsunomiya A, Eizuru Y, Yonezawa S. Epstein-Barr virus-associated enteritis with multiple ulcers after stem cell transplantation: first histologically confirmed case. Pathol Int 2006; 56:530-7. [PMID: 16930333 DOI: 10.1111/j.1440-1827.2006.02001.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The present case involves unique enteritis forming multiple ulcers associated with Epstein-Barr virus (EBV). A 57-year-old man had undergone a reduced intensity allogeneic stem cell transplantation for a relapse of multiple myeloma following sequential autologous peripheral blood stem cell transplantation. The ileum, resected for massive melena, showed multiple irregular ulcers with occasional cobblestone-like appearance. There was inflammation including numerous plasma cells in the ulcer bases and surrounding areas, where many EBV-infected plasma cells were detected by double staining with EBV-encoded small RNA-1 (EBER-1) in situ hybridization and CD79a, while EBV-infected epithelial cells were not noted. The number of EBER-1-positive cells in the ileum (mucosa, 1451 cells/mm(2); submucosa, 465 cells/mm(2)) was much larger than in control samples (malignant lymphoma or leukemia after allogeneic stem cell transplantation, n = 4, range 0-113 cells/mm(2); malignant lymphoma after chemotherapy, n = 14, range 0-0.89 cells/mm(2); colon cancer, n = 12, range 0-3.5 cells/mm(2)). In the mucosa near the ulcers, EBER-1-positive cells often surrounded and involved the glandular epithelium, forming lymphoepithelial-like lesions. The histological findings differ from post-transplant lymphoproliferative disorders or intestinal thrombotic microangiopathy, and this is the first case of EBV-associated enteritis with ulcers characterized by numerous plasma cells and lymphoepithelial-like lesions after stem cell transplantation.
Collapse
Affiliation(s)
- Yukie Tashiro
- Department of Pathology, Imakiire General Hospital, Japan
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Ozolek JA, Cieply K, Walpusk J, Ranganathan S. Adenovirus infection within stromal cells in a pediatric small bowel allograft. Pediatr Dev Pathol 2006; 9:321-7. [PMID: 16944984 DOI: 10.2350/06-01-0026.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 01/21/2006] [Indexed: 11/20/2022]
Abstract
Adenovirus infection is not uncommon in pediatric small bowel transplant recipients. Histopathologic findings include characteristic epithelial changes of intranuclear inclusions and smudging of nuclei. We present a case of adenovirus within stromal cells of the lamina propria in a biopsy from a small bowel allograft. Immunohistochemistry and double-labeled immunofluorescence were performed using antibodies against adenovirus, CD31, vimentin, cytokeratin, and CD163 on the allograft intestinal biopsy. Electron microscopy was done to confirm the presence of viral particles and to attempt to confirm the origin of the infected cells. The index biopsy showed scant cells within the lamina propria double-labeled with vimentin and adenovirus. Several cells showed predominantly cytoplasmic staining for adenoviral antigen. Intranuclear adenoviral particles were found in several cells of the lamina propria by electron microscopy. A subsequent biopsy showed typical adenoviral intranuclear inclusions within surface enterocytes. Adenovirus may infect stromal cells within the lamina propria. Although the typical location of adenoviral inclusions in small bowel is the surface epithelial cell nuclei, some cases may show inclusions within stromal cells. This observation may be important in the pathobiology of adenoviral infection, especially in the setting of pediatric transplantation. This finding should alert pathologists examining small bowel transplant biopsies, particularly those biopsies with extensive ulceration, to include careful surveillance of the lamina propria.
Collapse
MESH Headings
- Adenovirus Infections, Human/etiology
- Adenovirus Infections, Human/metabolism
- Adenovirus Infections, Human/pathology
- Adenoviruses, Human/immunology
- Adenoviruses, Human/isolation & purification
- Antibodies, Viral/metabolism
- Biomarkers/metabolism
- Biopsy
- Child, Preschool
- Humans
- Intestine, Small/metabolism
- Intestine, Small/pathology
- Intestine, Small/transplantation
- Intestine, Small/virology
- Intranuclear Inclusion Bodies/pathology
- Male
- Postoperative Complications
- Stromal Cells/virology
- Transplantation, Homologous/pathology
- Vimentin/metabolism
Collapse
Affiliation(s)
- John A Ozolek
- Department of Pathology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | | | | | | |
Collapse
|
16
|
Abstract
Diarrhea is common after liver transplantation (LT). The true incidence of diarrhea in liver transplant recipients is unknown but possibly ranges from 10% to 43% based on a few published studies in other solid organ and bone marrow transplantation. Infectious etiologies, including cytomegalovirus (CMV), Clostridium difficile, and occasional atypical intestinal infections, are the most common causes. Diarrhea is also a frequent side effect of immunosuppressive medications. To variable extents, mycophenolate mofetil (MMF), cyclosporine A (CSA), tacrolimus, and sirolimus are all known to be associated with diarrhea. Rarely, graft-versus-host disease (GVHD), lymphoproliferative disorder, de novo inflammatory bowel disease (IBD), or colon cancer may present as diarrhea. Flare-up of preexisting IBD is also not uncommon after LT. However, the cause of acute diarrhea remains unidentified in 1 of 3 patients. This review summarizes the literature and provides recommendations on the management of acute diarrhea after LT. Although our focus is on LT, the etiology and management recommendations apply to most transplant recipients.
Collapse
Affiliation(s)
- Philip M Ginsburg
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, MD 21204, USA
| | | |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Descriptions of outbreaks of viral gastroenteritis have become a prominent feature in scientific journals and other media such as the electronic reporting service 'promed'. A review of outbreak reports was done to further our understanding of the burden of disease, common and rare modes of transmission, complications, and possibilities for control and prevention. RECENT FINDINGS Viral gastroenteritis outbreaks occur worldwide. In 2004, besides outbreak reports and surveys, there was considerable attention paid to food and waterborne outbreaks and the difficulties in proving these modes of transmission. Costs of viral gastroenteritis outbreaks are high. Complications and unusual manifestations of viral gastroenteritis, such as convulsions, transplant rejection, and chronic infection, may have been underreported. SUMMARY Viral gastroenteritis is a very common illness in health care settings that can cause significant disruption. Clinicians working in these settings should be familiar with the epidemiology and the possible modes of transmission of enteric viruses to be able to translate them into strategies for prevention or intervention. Research is needed to support these strategies.
Collapse
Affiliation(s)
- Marion Koopmans
- Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
| |
Collapse
|
18
|
Sudan D. Small bowel transplantation: current status and new developments in allograft monitoring. Curr Opin Organ Transplant 2005. [DOI: 10.1097/01.mot.0000163040.48954.8c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Abstract
PURPOSE OF REVIEW Since Kapakian first identified a virus in the stool of a patient with diarrhoea in 1972, many viruses have been described that cause diarrhoea directly or indirectly. It is now appreciated that viruses are the most common cause of diarrhoeal illness worldwide. Although bacteria and other pathogens cause significant numbers of gastroenteritis, it is the viruses that are dealt with in this review. The viruses responsible will be discussed individually. RECENT FINDINGS Rotavirus remains the leading cause of diarrhoeal disease overall, with the newly designated calicivirus family causing the most outbreaks in the industrialized nations. As diagnostic techniques improve, however, the importance of astrovirus and other previously under-reported pathogens is becoming more apparent and the number of viruses associated with gastroenteritis continues to increase. The emergence of severe acute respiratory syndrome coronavirus, arguably the most important emerging infection of recent years and a cause of significant gastrointestinal disease, is also discussed. SUMMARY No effective treatments have been developed for viral gastroenteritis. Current efforts are targeted at the development of suitable vaccines and the implementation of infection control measures.
Collapse
Affiliation(s)
- Benjamin Clark
- Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | | |
Collapse
|
20
|
Pozio E, Rivasi F, Cacciò SM. Infection with Cryptosporidium hominis and reinfection with Cryptosporidium parvum in a transplanted ileum. APMIS 2004; 112:309-13. [PMID: 15233648 DOI: 10.1111/j.1600-0463.2004.apm11204-0513.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A transplanted ileum was found to be infected with Cryptosporidium hominis 6 days after transplantation. Although the infection resolved, the ileum was later found to be infected with Cryptosporidium parvum. The presence of the parasite was not always correlated with diarrhea. No other gastrointestinal symptom was ever detected. Treatment with azithromycin and paromomycin apparently failed.
Collapse
Affiliation(s)
- Edoardo Pozio
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | | | | |
Collapse
|