Mycotic Pseudoaneurysm After Kidney Transplantation: Two Case Reports

BACKGROUND

Vascular complications after kidney transplantation may cause allograft loss. Here, we describe 2 patients with extrarenal mycotic pseudoaneurysm after kidney transplantation.

PATIENTS

Patient 1 was a 54-year-old man who developed pseudoaneurysm 60 days after transplantation, and patient 2 was a 48-year-old woman who was diagnosed with a pseudoaneurysm 5 months after transplantation.

RESULTS

Patient 1 had a deceased-donor kidney transplant with end-to-side external iliac arterial anastomosis that was reconstructed 8 days after transplantation owing to rupture and major bleeding. At 60 days after transplantation, he had high serum creatinine level and Doppler ultrasonography showed a pseudoaneurysm of the arterial graft anastomosis and postanastomotic renal artery stenosis. Treatment included surgical excision of the pseudoaneurysm, vascular reconstruction, and fluconazole, with mycologic culture of the resected pseudoaneurysm showing Candida albicans. Patient 2 developed nondisabling intermittent claudication at 5 months after kidney transplantation, with a pseudoaneurysm subsequently observed on Doppler ultrasonography and computerized tomographic angiography. Treatment included renal artery thrombectomy and common iliac bypass to the hilar donor renal artery with inverted ipsilateral long saphenous vein. Operative samples showed C albicans, and she was treated with fluconazole. Both patients had satisfactory outcomes, and both kidney allografts were preserved.

CONCLUSIONS

Extrarenal mycotic pseudoaneurysms after kidney transplantation require a high index of suspicion for early diagnosis, and preservation of the kidney graft may be achieved with the use of surgical treatment and antifungal therapy.

The genetic basis for susceptibility to Rift Valley fever disease in MBT/Pas mice

The large variation in individual response to infection with Rift Valley fever virus (RVFV) suggests that host genetic determinants play a role in determining virus-induced disease outcomes. These genetic factors are still unknown. The systemic inoculation of mice with RVFV reproduces major pathological features of severe human disease, notably the hepatitis and encephalitis. A genome scan performed on 546 (BALB/c × MBT) F2 progeny identified three quantitative trait loci (QTLs), denoted Rvfs-1 to Rvfs-3, that were associated with disease susceptibility in MBT/Pas mice. Non-parametric interval-mapping revealed one significant and two suggestive linkages with survival time on chromosomes 2 (Rvfs-1), 5 (Rvfs-3) and 11 (Rvfs-2) with respective logarithm of odds (LOD) scores of 4.58, 2.95 and 2.99. The two-part model, combining survival time and survival/death, identified one significant linkage to Rvfs-2 and one suggestive linkage to Rvfs-1 with respective LOD scores of 5.12 and 4.55. Under a multiple model, with additive effects and sex as a covariate, the three QTLs explained 8.3% of the phenotypic variance. Sex had the strongest influence on susceptibility. The contribution of Rvfs-1, Rvfs-2 and Rvfs-3 to survival time of RVFV-infected mice was further confirmed in congenic mice.

Ovarian cancer emerging subtypes: role of oxidative stress and fibrosis in tumour development and response to treatment

Epithelial ovarian cancer is a silent disease of usually late diagnosis and poor prognosis. Currently treatment options are limited and mainly consist of surgery followed by taxol- and platinum-based chemotherapy. Patient response to treatment is difficult to predict and there is a serious need for anticipating tumour response and orientating medical choices. In that aim, recent researches have focused on molecular aspects of ovarian tumours that could help patient stratification. We review here published discoveries in that field. We emphasize that signatures, defined by combining miRNA and transcriptomic data, enlighten important aspects of ovarian cancer biology and reliably stratify patients. The miR-200-dependent "Oxidative stress" and "Fibrosis" signatures are promising in patient stratification for defining oriented therapeutic strategies. Indeed, the "Stress" patients survive longer than the "Fibrosis" patients, who exhibit partial debulking and incomplete response to chemotherapy. Interestingly, these two subgroups might benefit from specifically targeted therapeutic approaches, as discussed here.

Florfenicol feed supplemented decrease the clinical effects of Mycoplasma hyopneumoniae experimental infection in swine in México

The therapeutic value of Florfenicol feed supplemented was evaluated in conventional pigs to eliminate consequences of chronic infection of Mycoplasma hyopneumoniae. The experimental animals were pigs with an average of 16 kg, after intratracheally inoculation with M. hyopneumoniae they were divided in two experimental groups: (a) the non-medicated; and (b) the feed supplemented group (20 g Florfenicol/ton of feed) during the ensuing 35 days. The average daily weight gain of the Florfenicol-treated pigs (0.33±0.14 kg/day) was significantly higher than that of the non-treated ones (0.21±0.10 kg/day). In medicated animals was still impaired relative to that of the uninfected ones control group (0.39±0.02 kg/day). The average percentage of pneumonic gross lesions extensions' of the pigs groups was: 13.99% for M. hyopneumoniae infected non-medicated group; 1.79% M. hyopneumoniae infected, Florfenicol-treated group and, 0.56% of the uninfected control group. M. hyopneumoniae; colonization was detected at these levels in 7 and 9 members of the respective infected groups. The extent of the pneumonic lesions and M. hyopneumoniae generally was greater in the non-medicated pigs. Therefore, oral administration of Florfenicol via feed ingestion seemed to be somewhat effective in ameliorating the clinical effects of M. hyopneumoniae infection of swine.

154 EVALUATION OF THE EFFECTIVENESS OF TREATMENT WITH TRYPSIN IN MURINES EMBRYOS EXPERIMENTALLY EXPOSED TO BOVINE HERPES VIRUS TYPE-1 (BoHV-1) BY THE NESTED-PCR TECHNIQUE

The cryopreservation of bovine embryos has allowed an increase in their commercialization causing concern about the transmission of pathogens through the production and transfer of in vitro embryos. The International Society of Embryo Transfer (IETS) suggests the treatment of embryos with trypsin or antibiotics in alternating washes with culture medium in order to remove and/or inactivate infectious agents that may interfere with the final product. The aim of this study was to evaluate the effectiveness of trypsin treatment in the elimination and/or removal of bovine herpes virus type-1 (BoHV-1), Colorado strain, in murine embryos. Viral detection was made by n-PCR and cytopathic effect in Madin Darby bovine kidney (MDBK) cells. Six- to 8-wk-old female mice (Swiss) were superovulated and mated with fertile males of the same strain. After 24 h, the zygotes (n = 262) were divided into 3 groups: control group submitted to sequential wash (CSW), the group exposed to the virus (30 μL; 106.5 virus mL–1) and submitted to sequential wash (ESW), and the group exposed to the virus and submitted to the trypsin treatment (ETT). All the groups of zygotes and the last sequential wash drops were tested by nested-PCR and inoculated in MDBK cells to allow observation of cytopathic effects. All groups except for CSW showed positive results for the nested-PCR for both zygotes and for the last wash drops. A cytopathic effect was observed in all groups except for CSW, demonstrating the viability of the virus after treatment. These results demonstrated that trypsin treatment was not effective in eliminating or removal of BoHV-1. The need for such studies is fundamentally important when considering the potential risk of pathogen transmission by reproductive biotechnologies.

Identification of genotype 3 hepatitis E virus (HEV) in serum and fecal samples from pigs in Thailand and Mexico, where genotype 1 and 2 HEV strains are prevalent in the respective human populations

Hepatitis E virus (HEV), the causative agent of hepatitis E, is an important public health concern in many developing countries. Increasing evidence indicates that hepatitis E is a zoonotic disease. There exist four major genotypes of HEV, and HEV isolates identified in samples from pigs belong to either genotype 3 or 4. Genotype 1 and 2 HEVs are found exclusively in humans. To determine whether genotype 1 and 2 HEVs also exist in pigs, a universal reverse transcription-PCR assay that is capable of detecting all four HEV genotypes was used to test for the presence of HEV RNA in serum and/or fecal samples from pigs in Thailand, where genotype 1 human HEV is prevalent, and from pigs in Mexico, where genotype 2 human HEV was epidemic. In Thailand, swine HEV RNA was detected in sera from 10/26 pigs of 2 to 4 months of age but not in sera from 50 pigs of other ages. In Mexico, swine HEV RNA was detected in 8/125 sera and 28/92 fecal samples from 2- to 4-month-old pigs. Antibodies to swine HEV were also detected in about 81% of the Mexican pigs. A total of 44 swine HEV isolates were sequenced for the open reading frame 2 gene region. Sequence analyses revealed that all swine HEV isolates identified in samples from pigs in Thailand and Mexico belong to genotype 3. Phylogenetic analyses revealed that minor branches associated with geographic origin exist among the swine HEV isolates. The results indicated that genotype 1 or 2 swine HEV does not exist in pigs from countries where the respective human HEV genotype 1 or 2 is prevalent. It is likely that only genotype 3 and 4 HEV strains have zoonotic potential.

Individual genetic identification of biological samples: a case of an aircraft accident

In 2003, an aircraft accident occurred in the Madeira island north coast, in which 10 persons (4 female and 6 male) have died. STRs (autosomic and Y-chromosome) and mtDNA were made in order to identify the recovered human body remains and results compared with relatives.

Bilateral segmental regression of the carotid and vertebral arteries with rete compensation in a Western patient

We report a case of symptomatic symmetrical, bilateral absence of the cavernous internal carotid (ICA) and transdural vertebral artery (VA) segments with formation of a rete mirabile. There have been similar reports in Asian patients; ours is the first in the Western population. A 29- year-old woman presented with recurrent temporary blindness and an episode of minor subarachnoid haemorrhage. Angiography demonstrated absence of the C5 and C6 segments of the ICA and the C1/2 segments of the VA bilaterally, with typical carotid rete mirabile formation to reconstitute the distal flow. Comparative anatomy and embryology show retia in several species and point to their secondary origin. The anomalies of the ICA cannot be called agenesis but rather absence since they are likely to result from perinatal disappearance of the artery rather its failure to develop.

Experimental colonization of piglets and gilts with systemic strains of Haemophilus parasuis and Streptococcus suis to prevent disease

Haemophilus parasuis and Streptococcus suis are both major causes of losses during the nursery period, especially in herds using the segregated early weaning system. In this system, only a few piglets may be colonized with the herd's prevalent systemic strain, which results in infection of naive penmates late in the nursery. In view of these factors, the objectives of this study were: (1) to evaluate the early colonization of piglets with the farm's prevalent systemic strain of H. parasuis and S. suis as an alternative method for disease prevention; and (2) to evaluate 2 different protocols for experimental colonization: direct colonization of piglets and colonization of piglets through nose-to-nose contact with inoculated sows. Haemophilus parasuis and S. suis isolates recovered from diseased nursery pigs were characterized by the rep-PCR technique and the herd's prevalent strains were used for colonization. Piglets in the experimentally colonized groups were inoculated at 5 days of age by the oral route using a spray pump. Sows were colonized at 2 weeks prior to farrowing using a similar protocol. Although both colonization protocols were successful in getting the piglets colonized, direct inoculation of 5-day-old piglets with the herd's systemic strains of H. parasuis and S. suis tended to be more effective in reducing the morbidity and the mortality than the colonization of piglets by nose-to-nose contact with inoculated sows.

Immunodiagnosis of human leptospirosis by dot-ELISA for the detection of IgM, IgG, and IgA antibodies

A dot-ELISA was evaluated using antigen obtained from Leptospira interrogans cultures of the serovars brasiliensis, canicola, cynopteri, hebdomadis, and icterohaemorrhagiae for the detection of human IgM, IgG, and IgA. Single serum samples from 63 patients with the icterohemorrhagic form of leptospirosis in the acute phase, collected 3-14 days (mean = 7 days) after the onset of symptoms were tested. Ten patients were examined during convalescence and followed up for a period of 4-12 months. For a control group, serum samples from 10 apparently healthy individuals with no clinical or epidemiologic history of leptospirosis, and from 38 patients with nonleptospiral illnesses were used. In the acute phase, IgM antibodies were detected in 62 (98%) of 63 patients and IgG and IgA were observed in 70% and 76% of them, respectively. For the admission serum samples, the predictive value negative of the dot-ELISA was 98% for IgM, 72% for IgG, and 76% for IgA detection. All 10 patients followed-up during convalescence showed IgM antibodies up to the sixth month, decreasing to 57% by the 10th month, and persisting in only one of six patients during the 11th and 12th months of follow-up. Immunoglobulin G was detected in six patients up to the fourth month and in two of six individuals up to the end of follow-up. Immunoglobulin A was observed in all patients up to the end of the first month, decreasing progressively up to the sixth month, and was no longer detected in any patients from seventh to the 12th months of follow-up. The dot-ELISA can be used as an important laboratory screening test, especially when detecting IgM antibodies. It proved to be effective in the diagnosis of human leptospirosis, and appears to have advantages in terms of yield, time, and case of execution and low cost.

CD8+,CD38+ lymphocyte percent: a useful immunological marker for monitoring HIV-1-infected patients

We investigated the relationship between three prognostic markers, CD4 lymphocyte count, serum beta2-microglobulin (beta2M) levels, and CD8+,CD38+ lymphocyte percent, and the association with the rate of development of AIDS. The markers were measured regularly throughout follow-up in 224 patients. The risk of developing AIDS during follow-up was investigated using Cox proportional hazards models. Time-updated values of the prognostic markers were used, which modelled the risk of AIDS according to the latest measurement of the marker rather than using a single value of the marker at baseline. During a median follow-up period of 13.6 months (range 0.5-31.9 months), 34 cases of AIDS occurred. In a univariate analysis, all three markers predicted the development of AIDS; a 10% increase in the percentage of CD8+ T cells expressing CD38+ resulted in an 88% increase in the risk of AIDS (95% confidence interval: 53-130%; p < 0.0001). After adjustment for the current CD4 count and beta2M, a 10% increase in the CD8+,CD38+ population was associated with a 37% increase in the risk of AIDS (95% confidence interval: 4-81%; p = 0.02). Thus, the percentage CD8+,CD38+ level predicts the development of AIDS independently of the latest CD4 count and beta2M. This assay is therefore potentially useful in conjunction with blood CD4 counts and serum beta2M levels in patient management and clinical trial design.

Application of anti-leptospira ELISA-IgM for the etiologic elucidation of meningitis

Leptospirosis is one of the causes of meningitis, although its importance is not well known. In the present study we contributed to this knowledge by demonstrating specific IgM class anti-leptospira antibodies by the immunoenzymatic method ELISA in 14.6% of cerebrospinal fluid (CSF) samples from 171 patients with meningitis considered to be of indeterminate etiology. The frequencies of positivity were similar in cases with predominance of polymorphonuclear or lymphomonuclear leucocytes in the CSF. Age distribution showed a predominance of the 5 to 15 year age range (72%), and sex distribution showed a predominance of males (68%). The authors discuss the contribution of this method to the etiologic elucidation of meningitis.

Antigen-specific immunosuppression in paracoccidioidomycosis

To characterize the immune dysfunction associated with paracoccidioidomycosis, we studied the in vitro lymphocyte reactivity to phytohemagglutinin (PHA), pokeweed mitogen (PWM), a Candida albicans antigen (CMA), and a Paracoccidioides brasiliensis antigen (PbAg) in 32 patients with the acute and the chronic form of the disease before or during the initial phase of treatment and after clinical cure. We also studied, as controls, 30 healthy individuals, 15 of them immune to P. brasiliensis. Results showed a strong hyporesponsiveness to the PbAg while responses to mitogens and CMA were comparable with those of controls. Patients with the acute form of the disease (usually more severe) had more marked PbAg hyporesponsiveness than those with the chronic form. After patients' clinical cure, PbAg proliferative responses were similar to controls and greater than those seen before pretreatment. Changes in other parameters were also seen in the treated patients; skin test anergy to paracoccidioidin, high levels of anti-P. brasiliensis antibodies, leukocytosis, and eosinophilia. These changes were usually more intense in patients with the acute form of the disease. The post-treatment CD4+, CD8+, and total lymphocyte counts were similar to those of controls. Correlation between these parameters and the lymphoproliferative responses to the various stimuli was only found with PbAg: PbAg responses correlated inversely with eosinophil and anti P. brasiliensis antibody levels. Overall, our results demonstrate an antigen-specific-cellular immunity defect, which is reversible with treatment and possibly related to a T helper cell-2 pattern of immune response during active disease.

Behaviour of specific IgM, IgG and IgA class antibodies in human leptospirosis during the acute phase of the disease and during convalescence

The behaviour of specific IgM, IgG and IgA class antibodies in human leptospirosis was studied by ELISA. Two groups of patients were followed up, 57 of them in the acute phase and 10 during convalescence, the latter with a mean follow-up of 10.5 months. IgM class antibodies were detected starting on the 2nd day of symptoms and were observed in 100% of patients up to the 5th month, in 66.7% up to the 7th month and in 50% up to the 12th month after the onset of symptoms. IgG class antibodies were first detected on the 7th day of symptoms in 9.1% of patients, with maximum reactivity (87.5%) between the 2nd and 3rd month, and were not detected at all in one patient. IgA class antibodies were detected starting on the 5th day of symptoms in 7.7% of patients, and in all patients on the 15th day, persisting in 100% of cases up to the 9th follow-up month. During the 12th month, they were observed in 83.3% of patients. The results indicate that an anti IgA ELISA could be of great value in seroprevalence studies on human leptospirosis.

Dot-ELISA-IgM in saliva for the diagnosis of human leptospirosis using polyester fabric-resin as support (preliminary report)

In order to improve the diagnosis of human leptospirosis, we standardized the dot-ELISA for the search of specific IgM antibodies in saliva. Saliva and serum samples were collected simultaneously from 20 patients with the icterohemorrhagic form of the disease, from 10 patients with other pathologies and from 5 negative controls. Leptospires of serovars icterohaemorrhagiae, canicola, hebdomadis, brasiliensis and cynopteri grown in EMJH medium and mixed together in equal volumes, were used as antigen at individual protein concentration of 0.2 micrograms/microliters. In the solid phase of the test we used polyester fabric impregnated with N-methylolacrylamide resin. The antigen volume for each test was 1 microliter, the saliva volume was 8 microliters, and the volume of peroxidase-labelled anti-human IgM conjugate was 30 microliters. A visual reading was taken after development in freshly prepared chromogen solution. In contrast to the classic nitrocellulose membrane support, the fabric support is easy to obtain and to handle. Saliva can be collected directly onto the support, a fact that facilitates the method and reduces the expenses and risks related to blood processing.

Immunodiagnosis of human leptospirosis using saliva

When the enzyme-linked immunosorbent assay for the detection of specific immunoglobulin M class antibodies was applied to paired saliva and serum samples from 40 patients with leptospirosis, positivity was 87.5% and 100%, respectively. No positive result was obtained with any saliva or serum sample from 60 individuals used as controls. These results suggest the alternative use of saliva for diagnosis and for epidemiological studies of human leptospirosis.

[An evaluation of the ELISA-IgM test in the early diagnosis of human leptospirosis]

Thirty-seven sera samples from patients with leptospirosis icterohaemorrhagic form were studied with a time interval of 2 to 12 days between the beginning of the symptoms and the collection blood samples. It was isolated leptospira of 5 patients' hemocultures (13.5%) and from 4 of these the etiological agent pertained to the serogroup Icterohaemorrhagiae serovar copenhageni. Thirty-five of them (94.6%), including the four patients whose the etiological agent was isolated, showed reactivity in the enzyme linked immunosorbent (ELISA) IgM test. By this way, it was demonstrated that this test is important for a rapid diagnosis of human leptospirosis, even in the beginning of the disease, when there is still leptospiraemic phase.

[Leptospirosis in patients with anti-HIV antibodies: report of 2 cases]

Two patients with concomitant leptospirosis and the acquired immunodeficiency syndrome (AIDS) are reported. In these cases different clinical aspects that can be attributed to simultaneity of these pathologies was not observed.

[Immunoenzymatic test for the detection of anti-Cysticercus cellulosae antibodies in cerebrospinal fluid of patients with meningitis of unknown etiology]

The enzyme-linked-immunosorbent assay using a new type of support consisting of discs of synthetic fabric-resin (ELISA-d) with antigenic components of Cysticercus cellulosae covalently bound, was employed with the purpose of investigating the presence of specific antibodies to the cysticerci (neurocysticercosis) in the cerebrospinal fluid (CSF) of patients with meningitis without etiological agent determined by the conventional methods. The test was performed in 277 CSF samples (128 children and 149 adults). The mean of optical density values (OD) obtained for 22 CSF normal patients (the diagnostic hyphotesis of meningitis was discarded) was of 0.03. The 44 CSF of patients with meningitis caused by other agents but C. cellulosae, showed OD of 0.05. The cut off determined with these two groups (control group) was 0.13 (OD + 3 SD). The group of 13 CSF of neurocysticercotic meningitis presented OD of 0.41 (0.10 to 0.91). Among the 198 CSF samples of indetermined meningitis, 23 (11.6%) presented OD above the cut off, which suggests the possibility that Cysticercus cellulosae was the etiological agent in this meningitis episode. The ELISA-d test has proved to be efficient for the immunodiagnosis of neurocysticercosis when conducted on CSF samples. The alterations observed in the 23 CSF reactive on ELISA-d were: increased number of lymphomononuclear cells in five, of polymorphonuclear cells in 13 and both cells in five samples.