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Mucocutaneous Manifestations in Kidney Transplant Patients: Risk Factors. Cureus 2023; 15:e36177. [PMID: 37065336 PMCID: PMC10103621 DOI: 10.7759/cureus.36177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction Mucocutaneous complications in kidney transplant patients are due to drug toxicity or immunosuppression. The main objective of our study was to determine the risk factors associated with their occurrence. Methods We conducted a prospective analytical study (January 2020- June 2021) including kidney transplant patients seen at the Nephrology Department. We described the characteristics of the patients who presented mucocutaneous complications and then compared them to those who didn't to deduce the risk factors. Statistical analysis was performed using SPSS 20.0 (p<0.05). Results Of the 86 patients recruited, thirty patients had mucocutaneous complications. The mean age was 42.73, with a male predominance (73%). Ten kidney transplants were performed from a living-related donor. All the patients received corticosteroids, Mycophenolate Mofetil, and the Calcineurin Inhibitor: Tacrolimus (76.7%) or Ciclosporin (23.3%). Induction was performed with Thymoglobulin (n=20) or Basiliximab (n=10). Mucocutaneous complications were dominated by infectious manifestations (53.4%): eight cases of fungal infections; six cases of viral infections: warts (n=3), herpes labialis (n=2), intercostal herpes zoster (n=1), and two cases of bacterial infections: atypical mycobacteria and boils. Inflammatory complications (36.6%) included acne (n=4), urticaria (n=3), rosacea (n=1), simple maculopapular exanthema (n=1), aphthous lesion (n=1), and black hairy tongue (n=1). Actinic keratosis, skin xerosis, and bruises were found in one patient respectively. The evolution with a symptomatic treatment was good in all the patients. After statistical analysis, the factors significantly associated with the occurrence of mucocutaneous complications were advanced age, male gender, anemia, HLA non-identical donor, as well as the use of Tacrolimus or Thymoglobulin. Conclusion Infectious mucocutaneous complications are the most common dermatological manifestations among renal transplant recipients. Their occurrence is related to advanced age, male gender, anemia, HLA non-identical donor, and the use of Tacrolimus or Thymoglobulin.
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Abstract
The diagnosis of a skin and soft tissue infection (SSTI) requires careful attention to a patient's history, physical examination, and diagnostic test results. We review for many bacterial, viral, fungal, and parasitic pathogens that cause SSTIs the clues for reaching a diagnosis, including reported past medical history, hobbies and behaviors, travel, insect bites, exposure to other people and to animals, environmental exposures to water, soil, or sand, as well as the anatomic site of skin lesions, their morphology on examination, and their evolution over time. Laboratory and radiographic tests are discussed that may be used to confirm a specific diagnosis.
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Affiliation(s)
- Richard R Watkins
- Division of Infectious Diseases, Cleveland Clinic Akron General, 224 West Exchange Street, Akron, OH 44302, USA; Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Michael Z David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Blockley Hall 707, Philadelphia, PA 19104, USA; Department of Epidemiology, Biostatistics and Informatics, University of Pennsylvania, Philadelphia, PA, USA.
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3
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Dermatological conditions seen in renal transplant recipients in a Singapore tertiary hospital. Singapore Med J 2019; 59:519-523. [PMID: 30386860 DOI: 10.11622/smedj.2018126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Lifelong immunosuppression after renal transplant exerts effects on the recipients' skin, including skin infections, skin cancers and drug-induced skin disorders. Our study aimed to determine the epidemiology of skin conditions among renal transplant recipients in the largest tertiary hospital in Singapore. METHODS We reviewed the medical records of kidney transplant recipients at Singapore General Hospital, Singapore, between 1 January 2003 and 31 December 2013. Among these patients, the clinical data of patients who sought skin consultations with either dermatologists or plastic surgeons within the hospital was captured. RESULTS A total of 178 patients were included in our study. There were 88 (45.6%) skin infections, 23 (11.9%) drug-induced skin conditions, 9 (4.7%) skin cancers and 73 (37.8%) other skin conditions. Skin infection was the predominant reason for consultation, with viral warts (15%, n = 29) being the most common. Of the nine cases in our cohort with skin cancer, there were three cases of basal cell carcinoma, three cases of Bowen's disease, two cases of extramammary Paget's disease and one case of squamous cell carcinoma. Drug-induced skin conditions, mainly attributable to long-term steroids and cyclosporin use, were represented by acne (9.3%, n = 18) and sebaceous hyperplasia (2.6%, n = 5). CONCLUSION Our study demonstrated the spectrum of skin conditions that can be expected after renal transplantation. We wish to highlight the importance of careful dermatological screening and long-term follow-up for these patients, in order to reduce post-transplant skin complications.
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Affiliation(s)
- Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore
| | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore
| | - Bien Keem Tan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | | | | | - Shiu Ming Pang
- Department of Dermatology, Singapore General Hospital, Singapore
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Cutaneous complications of immunosuppression in 812 transplant recipients: a 40-year single center experience. GIORN ITAL DERMAT V 2018; 155:662-668. [PMID: 30014685 DOI: 10.23736/s0392-0488.18.06091-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND As a consequence of the improvement in survival after solid organ transplantation, to visit transplant recipients with neoplastic and non-neoplastic skin disorders due to immunosuppressive treatment has become common for dermatologists. METHODS Our endpoints were: 1) to investigate the most common skin diseases in a population of transplant recipients; 2) their associations with the type of immunosuppressant or transplant received; and 3) to compare our single center 40-year experience with the literature data. We retrospectively analyzed the clinical details of the adult patients transplanted in the years 1974-2014, visited for consultation at the Unit of Dermatology of our hospital. RESULTS Pathologic conditions were observed in more than 3/4 of 812 adults during the follow-up (mean 12.1 years): nonmelanoma skin cancers or actinic keratoses were seen in 44.0% (N.=357) of patients, non-neoplastic events in 55.2% (N.=448). Heart transplant had the statistically significant highest rate of NMSC and AK (52.6%, P=0.0352). Patients receiving cyclosporine A developed at least one non-melanoma skin cancer or actinic keratosis in 57.7% of cases (P=0.0001), while tacrolimus showed a lower risk (33%, P=0.0001). CONCLUSIONS As transplant recipients are susceptible to skin changes, especially after immunosuppressant treatments, a dermatological follow-up should be scheduled for each patient.
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Affiliation(s)
- Salvatore D Infusino
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Camilla Loi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giulia M Ravaioli
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy -
| | - Bianca M Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Skin disorders in renal transplant recipients: a retrospective study. An Bras Dermatol 2018; 92:638-641. [PMID: 29166499 PMCID: PMC5674695 DOI: 10.1590/abd1806-4841.20176040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 07/07/2016] [Indexed: 11/21/2022] Open
Abstract
Background Immunosuppressive therapy, which is necessary to avoid graft rejection in
renal transplant recipients, presents an increased risk of several
pathologies, namely infectious and neoplastic. Objectives To identify the most frequent skin diseases and their clinical and
demographical risk factors within a population of renal transplant
recipients. Methods A retrospective study of renal transplant recipients referred to dermatology
visit and observed for the first time from January 2008 to December
2014. Results The study included 197 patients, 120 men (60,9%). Mean age was 50,7 years
(±13,4). 12 patients (6,1%) had previous skin cancer. Infections were
the most frequent reason of referral (93/197; 44%). From the total referred,
18,3% (36/197) presented pre-cancerous lesions. Malignancy was diagnosed in
36 patients (18,3%), with 29 non-melanoma skin cancers (14,7%) and 7 Kaposi
sarcomas (3,6%). Ratio of basal cell carcinoma to squamous cell carcinoma
was 1,1:1. Non-melanoma skin cancer was significantly associated with older
age (p = 0,002), male gender (p = 0,028), history of previous skin cancer (p
= 0,002) and higher duration of immunosuppressive therapy (p<0,001). Study limitations Retrospective study, with data from the first visit in dermatology. We didn't
made classification on skin-types. Conclusions The great incidence of cutaneous infections and skin cancer is responsible
for a significant morbidity. It is important to assure the regular
dermatological follow-up of renal transplant recipients, which will promote
the prevention, an early diagnosis and an efficient treatment.
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Affiliation(s)
| | - João Borges-Costa
- Unidade de Investigacao em Dermatologia, Faculdade de Medicina da Universidade de Lisboa (FMUL) - Lisbon, Portugal.,Clinica Dermatologica da Universidade de Lisboa, Centro Hospitalar Lisboa Norte, EPE (CHLN) - Lisbon, Portugal
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Abstract
Organ transplant recipients (OTRs) are a population at high risk for cutaneous adverse events. Their early recognition and appropriate treatment is an important component of the clinical management of OTRs and should be optimally dealt with by dermatologists working in the context of a transplant dermatology clinic. Skin examination should be a standard procedure before performing organ transplantation to assess conditions which may be difficult to manage after the transplant procedure has been performed or which may represent a contraindication to transplantation, e.g., malignant melanoma. It also offers an opportunity to educate patients on skin care after organ transplantation. Skin infections can occur at any time after organ transplantation and include viral, bacterial, and fungal opportunistic infections. The risk of reactivation of latent viruses, such as varicella-zoster virus (VZV) and cytomegalovirus (CMV), is high. Bacterial infections are frequent and may be caused by unusual agents such Actinomyces, Mycobacteria, Legionella, or Nocardia. A large spectrum of fungal infections may occur, ranging from superficial (e.g., dermatophytes) to deeper and more severe ones (Alternaria, Aspergillus, Cryptococcus, Histoplasma). Drug-related idiosyncratic reactions usually occur early after the introduction of the causative drug, e.g., hypersensitivity reaction to azathioprine. On the long-term run, cutaneous effects due to cumulative drug toxicity, e.g., sebaceous hyperplasia from cyclosporine, may appear. Rare immunologically driven inflammatory reactions may occur in OTRs such as GVH or autoimmune disease. Tumors are particularly frequent. Kaposi's sarcoma, associated with persistent human herpes virus 8 (HHV8) infection, and cutaneous anaplastic large-cell lymphoma (ALCL) occur early after transplantation. Other cancers, such as nonmelanoma skin cancer (NMSCs), associated with persistent human papillomavirus (HPV) infections, malignant melanoma, Merkel cell carcinoma, or adnexal tumors, manifest later with an incidence which is much higher than observed in the general population. The incidence increases further after a first NMSC occurs.
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Affiliation(s)
- Luigi Naldi
- Department of Dermatology, AULSS 8 - Ospedale San Bortolo, viale Rodolfi 37, 36100, Vicenza, Italy.
- Study Center Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy.
| | - Anna Venturuzzo
- Study Center Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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Severe dermatophytosis in solid organ transplant recipients: A French retrospective series and literature review. Transpl Infect Dis 2018; 20. [PMID: 29094463 DOI: 10.1111/tid.12799] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/09/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Severe dermatophytosis is described in immunocompromised patients with defective cellular immunity. We report here a large series and a literature review of severe dermatophytosis in solid-organ transplant (SOT) recipients. METHOD The data main source was a national French retrospective study of severe dermatophytosis in SOT recipients between 2010 and 2016. Inclusion criteria were the presence of dermatophytes in skin culture and 1 severity criteria: dermal invasion by dermatophytes (invasive dermatophytosis) or involvement of at least two body sites or >10% of body surface area (extensive dermatophytosis). RESULTS A total of 12 patients were included (8 men, median age of 56 years [range: 33-71]). Of the 12 patients, 10 underwent kidney transplantation. The median time from transplantation to severe dermatophytosis diagnosis was 16 months [range: 2-94]. Clinical signs of superficial dermatophytosis were present in 8/12 patients before the emergence of severe dermatophytosis. Nine patients had invasive forms and three extensive ones, and nodules of the lower extremities were found in eight. Trichophyton rubrum was isolated in 11 cases. First-line treatment was terbinafine (7/12), posaconazole (3/12), or topical treatment alone (2/12). Immunosuppressive therapy was reduced in 3 patients because of associated infections. Complete response was obtained for 3/3 and 5/9 patients with extensive or invasive forms, respectively, after a median treatment's duration of 2.5 [range: 1.5-5] months and 7.5 months [range: 4-12]. Unrelated deaths (n = 2) and graft function impairment (n = 3) occurred. CONCLUSION Severe dermatophytosis is a late complication in SOT recipients presenting with lower limb nodules, which might be prevented by prompt treatment of superficial dermatophytosis.
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Affiliation(s)
- Claire Rouzaud
- Infectious Diseases and Tropical Medicine Department, Necker-Pasteur Infectious Diseases Center, Necker-Enfants malades Hospital, AP-HP, IHU Imagine, Paris Descartes University, Paris, France
| | - Olivier Chosidow
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Paris-Est Créteil University, Créteil, France
| | - Anabelle Brocard
- Department of Dermatology, Nantes University Hospital, Nantes, France
| | - Sylvie Fraitag
- Department of Pathology, Necker-Enfants malades Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Anne Scemla
- Department of Nephrology-Transplantation, Necker-Enfants malades Hospital, AP-HP, Paris Descartes Sorbonne Paris Cité University, RTRS Centaure, Labex Transplantex, Paris, France
| | - Dany Anglicheau
- Paris Descartes University, Department of Nephrology-Transplantation, Necker-Enfants malades Hospital, AP-HP, Paris, France
| | | | - Nicolas Dupin
- Department of Dermatology, Cochin Tarnier Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Marie-Elisabeth Bougnoux
- Department of Mycology, Necker-Enfants malades Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Roderick Hay
- Dermatology Department, King's College Hospital NHS Trust, London, UK
| | - Olivier Lortholary
- Infectious Diseases and Tropical Medicine Department, Necker-Pasteur Infectious Diseases Center, Necker-Enfants malades Hospital, AP-HP, IHU Imagine, Paris Descartes University, Paris, France.,National Reference Center for Invasive Mycoses and Antifungals Molecular Mycology Unit, CNRS URA3012, Institut Pasteur, Paris, France
| | - Fanny Lanternier
- Infectious Diseases and Tropical Medicine Department, Necker-Pasteur Infectious Diseases Center, Necker-Enfants malades Hospital, AP-HP, IHU Imagine, Paris Descartes University, Paris, France.,National Reference Center for Invasive Mycoses and Antifungals Molecular Mycology Unit, CNRS URA3012, Institut Pasteur, Paris, France
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The Human Papillomavirus and Its Role in Plantar Warts: A Comprehensive Review of Diagnosis and Management. Clin Podiatr Med Surg 2016; 33:337-53. [PMID: 27215155 DOI: 10.1016/j.cpm.2016.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Viral warts or verruca pedis (plantar warts) are common skin conditions seen in both children and adults. Human papilloma virus (HPV), a DNA virus, is responsible for plantar verrucae. It needs an epidermal abrasion and a transiently impaired immune system to inoculate a keratinocyte. These entities are a therapeutic conundrum for many practitioners. This article discusses HPV infiltration and its subtypes involved in plantar warts; the evaluation of patients with plantar warts; and subsequent treatment options, such as laser, Candida albicans immunotherapy, topical therapy such as phytotherapy, and surgical excision.
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Affiliation(s)
- Tracey C Vlahovic
- Department of Podiatric Medicine, Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA.
| | - M Tariq Khan
- Marigold Clinic, The Royal London Hospital for Integrated Medicine, University College London Hospital NHS Foundation Trust, 60 Great Ormond Street, London WC1N 3HR, UK; Department of Dermatology, Barts Health Trust, London, UK; EB Department, Great Ormond Street Hospital for Sick Children, London, UK; St George Medical School, University of New South Wales, New South Wales, Australia; Department of Podiatric Medicine, Temple University School of Podiatric Medicine, Philadelphia, PA, USA
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9
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Skin changes following organ transplantation: an interdisciplinary challenge. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:188-94. [PMID: 24698074 DOI: 10.3238/arztebl.2014.0188] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 01/07/2014] [Accepted: 01/07/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The immunosuppressants used in transplantation medicine significantly elevate the incidence of neoplasia, particularly in the skin. The cumulative incidence of non-melanocytic skin cancer (NMSC) in renal transplant recipients was 20.5% in a study carried out in German centers. Data on more than 35 000 renal transplant recipients in the USA document a cumulative NMSC incidence of over 7% after 3 years of immunosuppression. METHOD The authors selectively review publications obtained by a PubMed search to discuss the incidence of, and major risk factors for, skin tumors and infectious diseases of the skin in immunosuppressed patients. RESULTS The main risk factors for skin tumors are age at the time of transplantation, light skin color, previous and present exposure to sunlight, and the type and duration of immunosuppressive treatment. Squamous-cell carcinoma (SCC) is the most common kind of skin tumor in immunosuppressed patients. Human herpesvirus 8 and Merkel-cell polyoma virus also cause neoplasia more often in immunosuppressed patients than in the general population. Surgical excision is the treatment of choice. Actinic keratosis markedly elevates the risk that SCC will arise in the same skin area (odds ratio 18.36, 95% confidence interval 3.03-111). Patients with multiple actinic keratoses can be treated with photodynamic therapy or with acitretin. To lower the skin cancer risk, organ transplant recipients should apply medical screening agents with a sun protection factor of at least 50 to exposed skin areas every day. 55% to 97% of organ transplant recipients have skin infections; these are treated according to their respective types. CONCLUSION Squamous-cell carcinoma of the skin adds to the morbidity and mortality of transplant recipients and is therefore among the major oncological challenges in this patient group. Structured concepts for interdisciplinary care enable risk-adapted treatment.
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Affiliation(s)
- Claas Ulrich
- Outpatient Clinic for the Follow-up Care of Immunosuppressed Patients, Skin Tumor Center, Charité - Universitätsmedizin Berlin, Department of Hematology, Oncology, and Tumor Immunology Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medical Director, Charité - Universitätsmedizin Berlin, Department of Cardiac, Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Department of General, Visceral, and Transplant Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin
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Risk of infectious diseases and cutaneous tumours in solid organ recipients: A meta-analysis of literature. World J Meta-Anal 2015; 3:11-19. [DOI: 10.13105/wjma.v3.i1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/08/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare the risk of cutaneous infections and tumours in kidney transplant recipients with data recently published about this topic.
METHODS: In the present work, we evaluated the incidence of bacterial, fungal and viral cutaneous infectious diseases and the development of skin cancers in a cohort of 436 patients who underwent a renal transplantation. The median age at transplantation of our patients was 50 years and the median duration of the immunosuppression was of 7.2 years. Data obtained from our cohort were compared with those obtained by a systematic review of the literature of the last 20 years about the same topic.
RESULTS: Infectious diseases were the most frequent dermatological disorders that were diagnosed after transplantation, affecting about the 16.5% of patients. Herpes virus reactivation occurs in about the 35% of patients and is more common within 6 mo from transplantation, whereas when the immunosuppression is reduced, skin infections are mainly represented by Human Papilloma Virus infections and localized mycosis, such as pityriasis versicolor and superficial candidiasis. Bacterial infections were relatively rare and occur mainly in the first months after transplantation. The cumulative risk to develop skin cancer enhance significantly over the time, as consequence of long-term immunosuppressive regiments. Endogenous and exogenous risk factors, as well as the schedule of immunosuppression can play a role and justify the different incidence of skin cancer in the various series.
CONCLUSION: Skin infections and cancer, commonly diagnosed in transplanted patients, impact on survival and life-quality, justifying the realization of follow-up programs for the early diagnosis and treatment.
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Evaluation of Varicella Zoster Virus Infection Morbidity and Mortality in Pancreas and Kidney-Pancreas Transplant Recipients. Transplant Proc 2013; 45:701-4. [DOI: 10.1016/j.transproceed.2012.10.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 10/09/2012] [Indexed: 01/09/2023]
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Effect of maintenance immunosuppressive drugs on virus pathobiology: evidence and potential mechanisms. Rev Med Virol 2012; 23:97-125. [PMID: 23165654 DOI: 10.1002/rmv.1733] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 09/07/2012] [Accepted: 09/20/2012] [Indexed: 12/11/2022]
Abstract
Recent evidence suggesting a potential anti-CMV effect of mTORis is of great interest to the transplant community. However, the concept of an immunosuppressant with antiviral properties is not new, with many accounts of the antiviral properties of several agents over the years. Despite these reports, to date, there has been little effort to collate the evidence into a fuller picture. This manuscript was developed to gather the evidence of antiviral activity of the agents that comprise a typical immunosuppressive regimen against viruses that commonly reactivate following transplant (HHV1 and 2, VZV, EBV, CMV and HHV6, 7, and 8, HCV, HBV, BKV, HIV, HPV, and parvovirus). Appropriate immunosuppressive regimens posttransplant that avoid acute rejection while reducing risk of viral reactivation are also reviewed. The existing literature was disparate in nature, although indicating a possible stimulatory effect of tacrolimus on BKV, potentiation of viral reactivation by steroids, and a potential advantage of mammalian target of rapamycin (mTOR) inhibition in several viral infections, including BKV, HPV, and several herpesviruses.
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Squamous cell carcinoma of the lung in lung transplantation - a relation to human papilloma virus? Acta Oncol 2012; 51:812-3. [PMID: 22229746 DOI: 10.3109/0284186x.2011.644043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lymphangiectases Are Common Underlying Warts and in Normal Peritumoral Skin: Histologic Evidence of Decreased Immune Surveillance. Am J Dermatopathol 2011; 33:152-60. [DOI: 10.1097/dad.0b013e3181ef2d65] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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15
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Abstract
Skin infections after transplantation are frequent and of special importance because they may be quite severe. The spectrum of dermatologic infections in transplant recipients includes bacterial, mycotic and viral diseases. Pyoderma, herpes virus 6/7, herpes simplex virus, varicella-zoster virus, cytomegalovirus and candida infections predominate. Rare pathogens must be also considered. Cutaneous infections can be divided into three phases following transplantation. Diagnosis and adequate early therapy together with specific prophylaxis and follow-up of transplant patients should be strived for to avoid life-threatening complications.
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Affiliation(s)
- I H Wolf
- Universitätsklinik für Dermatologie und Venerologie, Abteilung für Allgemeine Dermatologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8036, Graz, Osterreich.
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Evaluation of a novel broad-spectrum PCR-multiplex genotyping assay for identification of cutaneous wart-associated human papillomavirus types. J Clin Microbiol 2010; 48:1706-11. [PMID: 20237103 DOI: 10.1128/jcm.02122-09] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A large number of human papillomavirus (HPV) types, distributed over five papillomavirus genera, are detectable in the skin. HPV types belonging to the alpha, gamma, and mu genera have been detected in cutaneous warts. A state-of-the-art HPV genotyping assay for these cutaneous wart-associated HPV types does not exist although warts constitute a highly prevalent skin condition, especially in children (33%) and organ transplant recipients (45%). Cutaneous warts are again the focus of attention as their clinical relevance rises with the increasing number of chronically immunosuppressed patients. The objective of this study was to develop and evaluate a DNA-based genotyping system for all known cutaneous wart-related HPV types using PCR and Luminex xMAP technology. The broad-spectrum PCR amplified DNA of all known wart-associated HPV types from the genera alpha (HPVs 2, 3, 7, 10, 27, 28, 29, 40, 43, 57, 77, 91, and 94), gamma (HPVs 4, 65, 95, 48, 50, 60, and 88), mu (HPVs 1 and 63), and nu (HPV41). The probes were evaluated using plasmid HPV DNA and a panel of 45 previously characterized cutaneous wart biopsy specimens showing high specificity. HPV was also identified in 96% of 100 swabs from nongenital cutaneous warts. HPV types 1, 2, 27, and 57 were the most prevalent HPV types detected in 89% of the swabs. In conclusion, this Luminex-based genotyping system identifies all known cutaneous wart HPV types including phylogenetically related types, is highly HPV type specific, and is suitable for large-scale epidemiological studies.
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Toll-like receptor 4, 7 and 8 polymorphisms have no association with nonmelanoma skin cancer in renal transplant patients. Br J Dermatol 2009; 161:715-7. [PMID: 19614650 DOI: 10.1111/j.1365-2133.2009.09370.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Can routine posttransplant HPV vaccination prevent commonly occurring epithelial cancers after allogeneic stem cell transplantation? Clin Cancer Res 2009; 15:2219-21. [PMID: 19293253 DOI: 10.1158/1078-0432.ccr-08-3099] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The association between squamous cell carcinoma (SCC) of the oral cavity, female genital tract, and skin with human papilloma virus (HPV) subtypes is well established in the general population and in solid organ transplant recipients, but no consistent link has been reported between HPV infection and SCC after allogeneic stem cell transplantation (allo-SCT). Studies are needed to determine if SCC, the most common secondary malignancy after allo-SCT, which is linked to chronic graft versus host disease and immunosuppressive therapy, is HPV related. Consideration should be given to assessing pretransplant HPV antibodies to identify patients at risk for HPV reactivation. If a strong relationship between HPV and second malignancies after SCT exists, studies to evaluate the immunogenicity and efficacy of quadrivalent HPV vaccine (subtypes 6, 11, 16, and 18) should be considered in both male and female long-term survivors after allo-SCT.
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Affiliation(s)
- Bipin N Savani
- Vanderbilt University and VAMC Transplant Program, Nashville, Tennessee, USA
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Interaction of human papillomaviruses with the host immune system: a well evolved relationship. Virology 2008; 384:410-4. [PMID: 18986661 DOI: 10.1016/j.virol.2008.10.004] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 10/03/2008] [Indexed: 12/22/2022]
Abstract
Human papillomavirus (HPV) infections are generally long lasting, and a host immune response to infection is hard to detect. Nevertheless immunocompromised subjects control HPV infection less well than those with intact immunity. Immune responses are best documented for the papillomavirus groups that cause evident human disease, particularly those responsible for anogenital cancers and genital warts. Humoral immunity to the viral capsid has been shown sufficient for protection against infection, while innate and adaptive cell mediated immunity appears important for eventual elimination of HPV infection. However, molecular and cellular mechanisms responsible for protection from and clearance of HPV infection are not completely established.
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Affiliation(s)
- Ian H Frazer
- The University of Queensland Diamantina Institute for Cancer, Immunology and Metabolic Medicine, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia.
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