Bevacizumab-Associated Thrombotic Microangiopathy Treated with Eculizumab: A Case Report

BACKGROUND Bevacizumab is an approved targeted therapy for metastatic cancer treatment. It can have adverse effects on multiple organs. Despite its low incidence, thrombotic microangiopathy (TMA) is the most severe complication. TMA has been associated with complement dysregulation, and treatment with eculizumab can be effective, despite the paucity of literature on eculizumab therapy for bevacizumab-associated TMA. To date, 10 cases have been reported, with less than half of them including a kidney biopsy. We present a new case of bevacizumab-associated TMA successfully treated with eculizumab, along with kidney biopsy records and an overview of mechanisms underlying TMA development in bevacizumab-treated patients. CASE REPORT A female patient diagnosed with metastatic breast cancer who was treated with bevacizumab in conjunction with chemotherapy was admitted to the hospital for acute kidney injury requiring hemodialysis, microangiopathic hemolytic anemia, and thrombocytopenia. TMA was diagnosed and was later confirmed by a kidney biopsy. Primary causes for TMA, such as ADAMTS13 deficiency and shiga toxin associated hemolytic-uremic syndrome, were ruled out, and the patient's condition was ultimately found to be triggered by exposure to bevacizumab. After discontinuing bevacizumab and receiving 4 weekly doses of eculizumab, kidney function and hematological parameters improved. CONCLUSIONS Bevacizumab-associated TMA can be reversed or attenuated in some patients with the use of eculizumab (inhibiting complement system overactivation), possibly reducing time to recovery, with fewer long-term sequelae. This additional case encourages future clinical trials to evaluate the safety and efficacy of eculizumab in cases of TMA associated with bevacizumab.

Molecular detection of hemoplasma infection among cats from São Luís island, Maranhão, Brazil

Hemoplasmas are bacteria that infect erythrocytes, attaching to the red blood cell. There is a need for more reports of hemoplasma infection prevalence and molecular characterization among cats in Brazil since there are only few published reports. The present work aimed to detect and molecularly characterize the presence of hemotrophic mycoplasmas in domestic cats with outdoor access from São Luís, Maranhão, Brazil. Twenty cats (10%) were positive for Candidatus M. haemominutum, five (2.5%) for M. haemofelis, and four (2.%) for M. turicensis based on 16S rRNA gene PCRs. Five cats (2.5%) were co-positive for Candidatus M. haemominutum and M. haemofelis. PCR diagnosis was confirmed by sequencing; and phylogenetic analysis was based on 16S rRNA and rnpb genes.

Molecular and serological detection of Theileria equi and Babesia caballi in donkeys (Equus asinus) in Brazil

Piroplasmosis in donkeys has been recognized as a serious problem of major economic importance, since the affected animals manifest loss of appetite and decreased working capacity. The present work is aimed at detecting infection or exposure of donkeys in São Paulo, Brazil to Theileria (T.) equi and Babesia (B.) caballi using molecular and serological approaches. EDTA-blood and serum samples were collected from 88 donkeys (Equus asinus). From 88 sampled donkeys, 65 (73.86%; 95% confidence interval, PI=63.41, 82.65) and 82 (93.2%; 95% confidence interval, PI=85.75, 97.46) animals showed IgG antibodies to T. equi (by ELISA) and B. caballi (by IFAT), respectively. Twenty-eight (31.81%; 95% confidence interval, PI=22.3, 42.61) and 18 (20.45%; 95% confidence interval, PI=12.6, 30.39) donkeys were positive to T. equi and B. caballi nested PCR assays, respectively. The results indicated that T. equi and B. caballi are prevalent among donkeys in Brazil.

A serological study of Cryptosporidium transmission in a periurban area of a Brazilian Northeastern city

OBJECTIVES

To study the prevalence of Cryptosporidium infection by measuring the levels of anti-Cryptosporidium IgG antibodies among people inhabiting three neighbourhoods of a periurban area of Salvador, Northeast of Brazil; and to investigate the effects of environmental sanitation measures, hygienic habits and household water supply, storage and handling on the frequency of these antibodies in sera of the studied population.

METHODS

Cryptosporidium inter-household transmission was studied by comparing the frequency of anti-Cryptosporidium IgG antibodies among people inhabiting areas with or without different environmental sanitation measures and intra-household transmission by comparing the presence of these antibodies in families with or without cases of diarrhoea, associated with the presence of Cryptosporidium oocysts in their stools. Children or family members with diarrhoeal episodes were evaluated parasitologically for Cryptosporidium infection by testing stool specimens with the Ritchie-modified formol-ether concentration and the acid-fast staining methods. All groups were serologically evaluated for parasite exposure by an indirect enzyme-linked immunosorbent assay.

RESULTS

A statistically significant difference was detected in the prevalence of Cryptosporidium infection between area 1 which had no environmental sanitation measures and area 3 which had improved environmental sanitation measures (P = 0.044). Most of the hygienic habits investigated did not correlate with the presence of anti-Cryptosporidium antibody in sera of the population studied. However, positive associations were found between both poor household water supply (OD = 0.17; 90% CI = 0.09-0.32; P = 0.0001) and drinking unboiled/unfiltered water (OD = 0.40; 90% CI = 0.24-0.67; P = 0.0002) with high levels of anti-Cryptosporidium antibodies in sera.

CONCLUSIONS

These data suggest that although uncorrected household water supply, storage and handling play an important role on Cryptosporidium transmission in periurban areas of developing country cities, like Salvador, Brazil, inadequate environmental conditions may also contribute to the spread of this parasite.