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Cho SY, Ar MC, Machado CM, Wu D, Singh I, Sandhu A, Demuth D, Slavin M. Epidemiology, treatment patterns, and disease burden of cytomegalovirus in hematopoietic cell transplant recipients in selected countries outside of Europe and North America: A systematic review. Transpl Infect Dis 2023; 25:e14083. [PMID: 37287436 DOI: 10.1111/tid.14083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/12/2023] [Accepted: 05/19/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) disease impacts morbidity and mortality in hematopoietic cell transplant (HCT) recipients. This systematic review summarized data on the epidemiology, management, and burden of CMV post-HCT outside of Europe and North America. METHODS The MEDLINE, Embase, and Cochrane databases were searched for observational studies and treatment guidelines in HCT recipients across 15 selected countries from Asia-Pacific, Latin America, and Middle East (search period: 1 January 2011-17 September 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV-related mortality, treatments, refractory, resistant CMV, and burden. RESULTS Of 2708 references identified, 68 were eligible (67 studies and one guideline; 45/67 studies specific to adult allogeneic HCT recipients). The rates of CMV infection and disease within 1 year of allogeneic HCT were 24.9%-61.2% (23 studies) and 2.9%-15.7% (10 studies), respectively. Recurrence occurred in 19.8%-37.9% of cases (11 studies). Up to 10% of HCT recipients died of CMV-related causes. In all countries, first-line treatment for CMV infection/disease involved intravenous ganciclovir or valganciclovir. Conventional treatments were associated with serious adverse events such as myelosuppression (10.0%) or neutropenia only (30.0%, 39.8%) and nephrotoxicity (11.0%) (three studies), frequently leading to treatment discontinuation (up to 13.6%). Refractory CMV was reported in 2.9%, 13.0%, and 28.9% of treated patients (three studies) with resistant CMV diagnosed in 0%-10% of recipients (five studies). Patient-reported outcomes and economic data were scarce. CONCLUSION The incidence of CMV infection and disease post-HCT is high outside of North America and Europe. CMV resistance and toxicity highlight a major unmet need with current conventional treatments.
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Affiliation(s)
- Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Hematology Hospital, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Muhlis Cem Ar
- Department of Haematology, Istanbul University-Cerrahpasa, Cerrahpassa Medical Faculty, Istanbul, Turkey
| | - Clarisse M Machado
- Virology Laboratory, Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo (LIM52-FMUSP), São Paulo, Brazil
| | - Depei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Inderjeet Singh
- Takeda Biopharmaceuticals India Pvt. Ltd., Gurugram, Haryana, India
| | - Anudeep Sandhu
- Takeda Pharmaceuticals International AG-Singapore Branch, Singapore
| | - Dirk Demuth
- Takeda Pharmaceuticals International AG-Singapore Branch, Singapore
| | - Monica Slavin
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Victoria, Australia
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de Almeida Testa LH, Simione AJ, Dos Santos ACF, Colturato I, Barbieri F, de Souza MP, Colturato VR, Machado CM. Compliance with yellow fever and measles vaccines in the revaccination program post-hematopoietic cell transplantation. Transpl Infect Dis 2023; 25:e14098. [PMID: 37428874 DOI: 10.1111/tid.14098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/22/2023] [Accepted: 06/21/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Measles, mumps, rubella, and even poliomyelitis outbreaks have recently perplexed infectious disease clinicians and epidemiologists globally due to the decline in vaccination coverage rates in children and adults. Measles and yellow fever (YF) have represented an increasing burden on the Brazilian public health system in recent decades. Both diseases are preventable by live-attenuated viral vaccines (LAVV), which have restricted use in hematopoietic cell transplant (HCT) recipients. METHODS Autologous and allogeneic HCT recipients returning for regular appointments at the outpatient clinic were invited to participate in the study. Patients transplanted for at least 2 years and with a printed copy of the vaccination record were included. RESULTS We assessed the vaccination records of 273 HCT recipients after the second year of HCT (193 allogeneic and 80 autologous) and observed lower compliance with the YF vaccine (58 patients, 21.2%) than with the measles vaccine (138 patients, 50.5%, p ≤ .0001). This is the largest published series of YF vaccination in HCT recipients so far. No severe adverse events occurred. Although expected, chronic graft-versus-host disease (GVHD) did not affect the compliance with measles (p = .08) or YF vaccination (p = .7). Indeed, more allogeneic recipients received measles vaccine in comparison with autologous patients (p < .0001), suggesting that chronic GVHD was not the main reason for not being vaccinated. Children and allogeneic HCT were more likely to receive measles vaccine. Time elapsed from HCT >5 years favored both measles and YF vaccination. CONCLUSION A better understanding of the reasons for low compliance with LAVV is necessary to overcome this problem.
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Affiliation(s)
| | | | | | | | | | | | | | - Clarisse M Machado
- HCT Program-Amaral Carvalho Foundation, Jau, Brazil
- Virology Laboratory, Institute of Tropical Medicine, University of São Paulo School of Medicine, Sao Paulo, Brazil
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3
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Muhsen IN, Galeano S, Niederwieser D, Koh MBC, Ljungman P, Machado CM, Kharfan-Dabaja MA, de la Camara R, Kodera Y, Szer J, Rasheed W, Cesaro S, Hashmi SK, Seber A, Atsuta Y, Saleh MFM, Srivastava A, Styczynski J, Alrajhi A, Almaghrabi R, Abid MB, Chemaly RF, Gergis U, Brissot E, El Fakih R, Riches M, Mikulska M, Worel N, Weisdorf D, Greinix H, Cordonnier C, Aljurf M. Endemic or regionally limited bacterial and viral infections in haematopoietic stem-cell transplantation recipients: a Worldwide Network for Blood and Marrow Transplantation (WBMT) Review. The Lancet Haematology 2023; 10:e284-e294. [PMID: 36990623 DOI: 10.1016/s2352-3026(23)00032-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/04/2022] [Accepted: 01/18/2023] [Indexed: 03/29/2023]
Abstract
Literature discussing endemic and regionally limited infections in recipients of haematopoietic stem-cell transplantation (HSCT) outside western Europe and North America is scarce. This Worldwide Network for Blood and Marrow Transplantation (WBMT) article is part one of two papers aiming to provide guidance to transplantation centres around the globe regarding infection prevention and treatment, and considerations for transplantation based on current evidence and expert opinion. These recommendations were initially formulated by a core writing team from the WBMT and subsequently underwent multiple revisions by infectious disease experts and HSCT experts. In this paper, we summarise the data and provide recommendations on several endemic and regionally limited viral and bacterial infections, many of which are listed by WHO as neglected tropical diseases, including Dengue, Zika, yellow fever, chikungunya, rabies, brucellosis, melioidosis, and leptospirosis.
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4
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Muhsen IN, Galeano S, Niederwieser D, Koh MBC, Ljungman P, Machado CM, Kharfan-Dabaja MA, de la Camara R, Kodera Y, Szer J, Rasheed W, Cesaro S, Hashmi SK, Seber A, Atsuta Y, Saleh MFM, Srivastava A, Styczynski J, Alrajhi A, Almaghrabi R, Abid MB, Chemaly RF, Gergis U, Brissot E, El Fakih R, Riches M, Mikulska M, Worel N, Weisdorf D, Greinix H, Cordonnier C, Aljurf M. Endemic or regionally limited parasitic and fungal infections in haematopoietic stem-cell transplantation recipients: a Worldwide Network for Blood and Marrow Transplantation (WBMT) Review. The Lancet Haematology 2023; 10:e295-e305. [PMID: 36990624 DOI: 10.1016/s2352-3026(23)00031-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/17/2022] [Accepted: 01/18/2023] [Indexed: 03/29/2023]
Abstract
There is a scarcity of data on endemic and regionally limited fungal and parasitic infections in recipients of haematopoietic stem-cell transplantation (HSCT) outside western Europe and North America. This Worldwide Network for Blood and Marrow Transplantation (WBMT) Review is one of two papers aiming to provide guidance to transplantation centres worldwide regarding prevention, diagnosis, and treatment based on the currently available evidence and expert opinion. These recommendations were created and reviewed by physicians with expertise in HSCT or infectious disease, representing several infectious disease and HSCT groups and societies. In this paper, we review the literature on several endemic and regionally limited parasitic and fungal infections, some of which are listed as neglected tropical diseases by WHO, including visceral leishmaniasis, Chagas disease, strongyloidiasis, malaria, schistosomiasis, histoplasmosis, blastomycosis, and coccidioidomycosis.
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Affiliation(s)
- Ibrahim N Muhsen
- Section of Hematology and Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Dietger Niederwieser
- Division of Hematology and Medical Oncology, University of Leipzig, Leipzig, Germany; Lithuanian University of Health Sciences Kauno Klinikos, Lithuania; Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mickey B C Koh
- Infection and Immunity Clinical Academic Group, University of London and Department of Haematology, St George's Hospital and Medical School, London, UK; Cell Therapy Facility, Blood Services Group, Health Sciences Authority, Singapore
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Karolinska Comprehensive Cancer Center, Stockholm, Sweden; Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Clarisse M Machado
- Virology Laboratory Institute of Tropical Medicine-University of São Paulo Medical School, São Paulo, Brazil; HCT Program - Hospital Amaral Carvalho, Jahu, Brazil
| | | | | | - Yoshihisa Kodera
- Center for Hematopoietic Stem Cell Transplantation, Aichi Medical University Hospital, Nagakute, Japan
| | - Jeff Szer
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Walid Rasheed
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates; College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Adriana Seber
- Hospital Samaritano Higienópolis and Graacc - Unifesp, São Paulo, Brazil
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan; Department of Registry Science for Transplant and Cellular Therapy, Nagakute, Japan
| | - Mostafa F Mohammed Saleh
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Alok Srivastava
- Department of Hematology, Christian Medical College, Vellore, India; Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Abdulrahman Alrajhi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Reem Almaghrabi
- Organ Transplantation Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Muhammad Bilal Abid
- Division of Divisions of Hematology/Oncology & Infectious Diseases, BMT & Cellular Therapy Program, Milwaukee, WI, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Usama Gergis
- Sidney Kimmel Cancer Center, Philadelphia, PA, USA
| | - Eolia Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Riad El Fakih
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Marcie Riches
- Division of Hematology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Malgorzata Mikulska
- Division of Infectious Diseases, DISSAL, University of Genova, Italy and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Nina Worel
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, University of Minnesota, MN, USA
| | | | - Catherine Cordonnier
- Haematology Department, Henri Mondor Hospital and University Paris-Est-Créteil, Créteil, France
| | - Mahmoud Aljurf
- Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Sabaini PMDS, Machado CM. Use of live viral vaccines after HCT: Still a lot to learn. Transpl Infect Dis 2023; 25:e14044. [PMID: 36864672 DOI: 10.1111/tid.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/05/2023] [Accepted: 02/12/2023] [Indexed: 03/04/2023]
Abstract
Revaccination program after HCT is necessary due to the loss of lifelong immunity acquired by previous vaccination or infections. The program is complex and even in a favourable scenario, it takes more than 2 years to be completed. As the complexity of HCT increases (alternative donors, diversity of monoclonal antibodies), studies evaluating the response to vaccination in this population are welcome, especially those that evaluate live attenuated vaccines given their scarcity. Furthermore, measles, mumps, rubella and even yellow fever, and poliomyelitis outbreaks have perplexed infectious diseases clinicians and epidemiologists globally, most of them due to the decline in vaccination coverage rates in children and adults, because of the growth of antivaccine movements around the world. The study of Lin et al. adds important information about measles, mumps and rubella vaccination after HCT.
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Affiliation(s)
| | - Clarisse M Machado
- Institute of Tropical Medicine - Virology Laboratory (LIM52 - HCFMUSP), University of São Paulo School of Medicine, Sao Paulo, São Paulo, Brazil
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6
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Abud KCO, Machado CM, Vilas Boas LS, Maeda NY, Carvalho ES, Souza MFS, Gaiolla PV, Castro CRP, Pereira J, Rabinovitch M, Lopes AA. Respiratory viruses and postoperative hemodynamics in patients with unrestrictive congenital cardiac communications: a prospective cohort study. Eur J Med Res 2023; 28:38. [PMID: 36670454 PMCID: PMC9852807 DOI: 10.1186/s40001-023-01003-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pulmonary vascular abnormalities pose a risk for severe life-threatening hemodynamic disturbances following surgical repair of congenital cardiac communications (CCCs). In the distal lung, small airways and vessels share a common microenvironment, where biological crosstalks take place. Because respiratory cells infected by viruses express a number of molecules with potential impact on airway and vascular remodeling, we decided to test the hypothesis that CCC patients carrying viral genomes in the airways might be at a higher risk for pulmonary (and systemic) hemodynamic disturbances postoperatively. METHODS Sixty patients were prospectively enrolled (age 11 [7-16] months, median with interquartile range). Preoperative pulmonary/systemic mean arterial pressure ratio (PAP/SAP) was 0.78 (0.63-0.88). The presence or absence of genetic material for respiratory viruses in nasopharyngeal and tracheal aspirates was investigated preoperatively in the absence of respiratory symptoms using real-time polymerase chain reaction (kit for detection of 19 pathogens). Post-cardiopulmonary bypass (CPB) inflammatory reaction was analyzed by measuring serum levels of 36 inflammatory proteins (immunoblotting) 4 h after its termination. Postoperative hemodynamics was assessed using continuous recording of PAP and SAP with calculation of PAP/SAP ratio. RESULTS Viral genomes were detected in nasopharynx and the trachea in 64% and 38% of patients, respectively. Rhinovirus was the most prevalent agent. The presence of viral genomes in the trachea was associated with an upward shift of postoperative PAP curve (p = 0.011) with a PAP/SAP of 0.44 (0.36-0.50) in patients who were positive versus 0.34 (0.30-0.45) in those who were negative (p = 0.008). The presence or absence of viral genomes in nasopharynx did not help predict postoperative hemodynamics. Postoperative PAP/SAP was positively correlated with post-CPB levels of interleukin-1 receptor antagonist (p = 0.026), macrophage migration inhibitory factor (p = 0.019) and monocyte chemoattractant protein-1 (p = 0.031), particularly in patients with virus-positive tracheal aspirates. CONCLUSIONS Patients with CCCs carrying respiratory viral genomes in lower airways are at a higher risk for postoperative pulmonary hypertension, thus deserving special attention and care. Preoperative exposure to respiratory viruses and post-CPB inflammatory reaction seem to play a combined role in determining the postoperative behavior of the pulmonary circulation.
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Affiliation(s)
- Kelly C. O. Abud
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Clarisse M. Machado
- grid.11899.380000 0004 1937 0722Virology Laboratory, Institute of Tropical Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Lucy S. Vilas Boas
- grid.11899.380000 0004 1937 0722Virology Laboratory, Institute of Tropical Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Eloisa S. Carvalho
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Maria Francilene S. Souza
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Paula V. Gaiolla
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Claudia R. P. Castro
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Juliana Pereira
- grid.11899.380000 0004 1937 0722Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo, São Paulo, Brazil
| | - Marlene Rabinovitch
- grid.168010.e0000000419368956Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA USA
| | - Antonio Augusto Lopes
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
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7
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de Oliveira Rodrigues M, de Almeida Testa LH, Dos Santos ACF, Zanetti LP, da Silva Ruiz L, de Souza MP, Colturato VR, Machado CM. Latent and active tuberculosis infection in allogeneic hematopoietic stem cell transplant recipients: a prospective cohort study. Bone Marrow Transplant 2021; 56:2241-2247. [PMID: 33966056 DOI: 10.1038/s41409-021-01329-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 02/05/2023]
Abstract
Tuberculosis (TB) is a major infectious complication in hematopoietic stem cell transplant (HSCT) recipients in countries with high TB prevalence. Identifying and treating latent tuberculosis infection (LTBI) helps to prevent TB reactivation after transplantation. Few studies have compared the tuberculin skin test (TST) with interferon Gamma release assays (IGRA) to diagnose LTBI in HSCT candidates. We compared TST and QuantiFeron TB gold in tube (QTF-GIT) and prospectively evaluated the incidence of active tuberculosis in 126 HSCT candidates and 58 HSCT recipients with chronic GVHD followed at the outpatient clinic. TB was diagnosed by culture in Mycobacteria media and by commercial real-time PCR kit. Considering the positivity of any test, the prevalence of LTBI was 8.7% in HSCT candidates (11 out of 126) and 12.5% in HSCT recipients with chronic GVHD (6 out of 48). QTF-GIT indeterminate results were detected in 2.4% of the HSCT candidates. Fair to good agreement (K > 0.50) between tests was observed in both cohorts. Cumulative incidence of TB was 3% in the GVHD cohort. TB was diagnosed in 2 chronic GVHD recipients, both cases confirmed by positive culture and PCR. None of the 11 patients with LTBI diagnosed pre-HSCT who received INH prophylaxis developed TB.
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Affiliation(s)
| | | | | | | | - Luciana da Silva Ruiz
- Centro de Laboratórios Regionais, Instituto Adolfo Lutz - Bauru II, São Bauru, Brazil
| | | | | | - Clarisse M Machado
- HSCT Program - Amaral Carvalho Foundation, Jaú, Brazil. .,Institute of Tropical Medicine, University of São Paulo School of Medicine (LIM 52 HC-FMUSP), São Paulo, Brazil.
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Kerbauy MN, Ribeiro AAF, Arcuri LJ, Kerbauy LN, da Silva CC, Camargo LFA, Machado CM, Hamerschlak N. Clinical impact of multiple DNA virus infections in nondepleted haploidentical and unrelated allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2021; 23:e13626. [PMID: 33900012 DOI: 10.1111/tid.13626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/26/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022]
Abstract
Few studies have compared the clinical impact of multiple DNA-virus infections in haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with posttransplant cyclophosphamide (PTCy) and unrelated donor allogeneic hematopoietic stem cell transplantation (UD-HSCT) with thymoglobulin, so we retrospectively analyzed viral infections in the first 6 mo posttransplant in these scenarios. Fifty-nine patients underwent to haplo-HSCT, and 68 to UD-HSCT. The most frequent infection was cytomegalovirus (CMV) (76.3% in haplo-HSCT and 69.1% in UD-HSCT) (P = .878) and in the group of patients with CMV reactivation, maximal CMV viral load over 2500 UI/ml correlated with worse overall survival-hazard ratio (HR) 1.93 (95% confidence interval [CI] 1.04-3.59) P = .03. The cumulative incidence of multiple DNA virus within 180 d of posttransplant was 78.7% for one virus and 28.4% for two or more viruses with no difference regarding the type of transplant. Viral infections, age, and acute graft versus host disease (GVHD) grades II-IV were risk factors for worse overall survival in multivariate analyses: one virus HR 2.53 (95% CI 1.03-6.17) P = .04, two or more viruses HR 3.51 (95% CI 1.37-9) P < .01, age HR 1.03 (95% CI 1.02-1.05) P < .01 and acute GVHD II-IV HR 1.97 (95% CI 1.13-3.43) P = .01. Also, age over 50 y HR 4.25 (95% CI 2.01-8.97) P < .001, second CMV reactivation or having both CMV and BK polyomavirus (BKV) HR 2.65 (95% CI 1.26-5.56) P = .01 and acute GVHD grades II-IV HR 2.23 (95% CI 1.12-4.43) P = .022 were risk factors for nonrelapse mortality in the multivariate analyses. In conclusion, multiple DNA-virus infections are frequent in both haplo-HSCT and UD-HSCT and a risk factor for worse overall survival.
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Affiliation(s)
- Mariana N Kerbauy
- Department of Hematology and Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andreza A F Ribeiro
- Department of Hematology and Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Leonardo J Arcuri
- Department of Hematology and Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Lucila N Kerbauy
- Department of Hematology and Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Cinthya C da Silva
- Department of Hematology and Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Luis Fernando A Camargo
- Instituto Israelita de Ensino e Pesquisa (IIEP), Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Infectious Diseases, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Clarisse M Machado
- Instituto Israelita de Ensino e Pesquisa (IIEP), Hospital Israelita Albert Einstein, São Paulo, Brazil.,Virology Laboratory, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Nelson Hamerschlak
- Department of Hematology and Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil
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9
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Adati EM, da Silva PM, Sumita LM, Rodrigues MDO, Zanetti LP, Dos Santos ACF, de Souza MP, Colturato VR, Machado CM. Poor response to hepatitis A vaccination in hematopoietic stem cell transplant recipients. Transpl Infect Dis 2020; 22:e13258. [PMID: 32034983 DOI: 10.1111/tid.13258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/17/2019] [Accepted: 01/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hepatitis A virus (HAV) infection is highly prevalent in developing countries. In countries experiencing a shift from intermediate/high endemicity to low endemicity, the World Health Organization recommends the incorporation of HAV vaccine into the national vaccination calendar for children aged ≥1 year. Since HAV antibodies wane over time, most HSCT revaccination guidelines advise vaccination as optional, following the country recommendation. However, no study has evaluated the serological response to HAV vaccine in allogeneic HSCT recipients. METHODS We conducted a prospective study in 46 HSCT recipients who received two doses of inactivated HAV vaccine. Blood samples were taken before vaccination to determine HAV prevalence rates, and before and 4-6 weeks after the second dose. Specific anti-HAV antibodies were detected by a competitive commercial enzyme immune assay. RESULTS Patients received the first dose of vaccine at a median of 332.5 (120-4134) days after HSCT. Median absolute lymphocyte count at vaccination was 1947 (696-12 500)/mm3 . The seroprevalence rate was 93.5% at inclusion. Although safe and well tolerated, the serological response to HAV vaccine in susceptible patients was poor (33%), and no boost effect was observed in seropositive patients. CONCLUSIONS In areas with intermediate/high seroprevalence of HAV, serology should be recommended prior to referral to vaccination. The mechanisms of antibody interference and how to overcome T-cell function deficiency need to be better understood in transplant populations receiving HAV vaccine. Alternative schedules of HAV vaccination should be evaluated in prospective trials.
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Affiliation(s)
| | | | - Laura Massami Sumita
- Virology Laboratory (LIM 52-HCFMUSP), Institute of Tropical Medicine-University of São Paulo Medical School, São Paulo, SP, Brazil
| | | | | | | | | | | | - Clarisse M Machado
- HSCT Program, Amaral Carvalho Foundation, Jahu, Brazil.,Virology Laboratory (LIM 52-HCFMUSP), Institute of Tropical Medicine-University of São Paulo Medical School, São Paulo, SP, Brazil
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10
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Machado CM, de Souza ACMF, Romano CM, Dos Santos Freire W, Costa ÂA, Figueiredo WM, Pannuti CS, Luna EJA. Influenza A and B in a cohort of outpatient children and adolescent with influenza like-illness during two consecutive influenza seasons. Braz J Infect Dis 2020; 24:73-80. [PMID: 31951818 PMCID: PMC7110568 DOI: 10.1016/j.bjid.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/10/2019] [Accepted: 12/15/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Influenza is an important cause of morbimortality worldwide. Although people at the extremes of age have a greater risk of complications, influenza has been more frequently investigated in the elderly than in children, and inpatients than outpatients. Yearly vaccination with trivalent or quadrivalent vaccines is the main strategy to control influenza. OBJECTIVES Determine the clinical and molecular characteristics of influenza A and B infections in children and adolescents with influenza-like illness (ILI). METHODS A cohort of outpatient children and adolescents with ILI was followed for 20 months. Influenza was diagnosed with commercial multiplex PCR platforms. RESULTS 179 patients had 277 episodes of ILI, being 79 episodes of influenza A and 20 episodes of influenza B. Influenza A and B cases were mild and had similar presentation. Phylogenetic tree of influenza B viruses showed that 91.6% belonged to the B/Yamagata lineage, which is not included in trivalent vaccines. CONCLUSIONS Influenza A and B are often detected in children and adolescents with ILI episodes, with similar and mild presentation in outpatients. The mismatch between the circulating influenza viruses and the trivalent vaccine offered in Brazil may have contributed to the high frequency of influenza A and B in this population.
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Affiliation(s)
- Clarisse M Machado
- Universidade de São Paulo, Instituto de Medicina Tropical, Laboratório de Virologia, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas HCFMUSP (LIM52), São Paulo, SP, Brazil.
| | | | - Camila Malta Romano
- Universidade de São Paulo, Instituto de Medicina Tropical, Laboratório de Virologia, São Paulo, SP, Brazil; Universidade de São Paulo, Faculdade de Medicina, Hospital das Clinicas HCFMUSP (LIM52), São Paulo, SP, Brazil
| | - Wilton Dos Santos Freire
- Universidade de São Paulo, Instituto de Medicina Tropical, Laboratório de Virologia, São Paulo, SP, Brazil
| | - Ângela Aparecida Costa
- Faculdade de Saúde Pública da USP, Serviço Especial de Saúde de Araraquara- SESA, São Paulo, SP, Brazil
| | - Walter Manso Figueiredo
- Faculdade de Saúde Pública da USP, Serviço Especial de Saúde de Araraquara- SESA, São Paulo, SP, Brazil
| | - Cláudio S Pannuti
- Universidade de São Paulo, Instituto de Medicina Tropical, Laboratório de Virologia, São Paulo, SP, Brazil
| | - Expedito J A Luna
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Medicina Preventiva, São Paulo, SP, Brazil
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11
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Benalcázar Jalkh EB, Machado CM, Gianinni M, Beltramini I, Piza MMT, Coelho PG, Hirata R, Bonfante EA. Effect of Thermocycling on Biaxial Flexural Strength of CAD/CAM, Bulk Fill, and Conventional Resin Composite Materials. Oper Dent 2019; 44:E254-E262. [DOI: 10.2341/18-146-l] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
New resin-based restorative materials have been developed, such as computer-aided design/computer-aided manufacturing (CAD/CAM) and bulk-fill composites, as an alternative to traditional layering techniques. This study evaluated the biaxial flexural strength (BFS) before and after thermocycling of five different resin composites: one hybrid resin/ceramic CAD/CAM indirect material, Lava Ultimate CAD-CAM Restorative (LU, 3M Oral Care); a conventional composite, Filtek Z350 XT (Z350, 3M Oral Care); two bulk-fill composites, Tetric N-Ceram Bulk Fill (TBF, Ivoclar Vivadent) and Filtek Bulk Fill (FBF, 3M Oral Care); and one bulk-fill flow resin composite, Filtek Bulk Fill Flow (FBFF, 3M Oral Care). Three hundred disc-shaped specimens (6.5 mm in diameter and 0.5 mm thick) were fabricated and divided into five groups (n=30 for each composite and condition). The BFS test was performed in a universal testing machine at a crosshead speed of 0.5 mm/min immediately (i, 24 hours) and after thermocycling (a, 500 thermal cycles of 5°C to 55°C with a 30-second dwell time). The Weibull modulus (m) and characteristic stress (η) were calculated, and a contour plot was used (m vs η) to detect differences between groups (95% two-sided confidence intervals). Significantly higher characteristic stress was observed for LUi (286.6 MPa) and Z350i (248.8 MPa) compared to the bulk-fill groups (FBFi=187.9 MPa, FBFFi=175.9 MPa, TBFi=149.9 MPa), with no differences between LUi and Z350i. Thermocycling significantly decreased the characteristic stress of all groups with the highest values observed for LUa (186.7 MPa) and Z350a (188.9 MPa) and the lowest for FBFFa (90.3 MPa). Intermediate values were observed for FBFa (151.6 MPa) and TBFa (122.8 MPa). The Weibull modulus decreased only for FBFa compared to FBFi. Composition and thermocycling significantly influenced the biaxial flexural strength of resin composite materials.
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Affiliation(s)
- EB Benalcázar Jalkh
- Ernesto Byron Benalcázar Jalkh, DDS, MS, PhD student, Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - CM Machado
- Camila Moreira Machado, DDS, MS, PhD student, Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | - I Beltramini
- Isabela Beltramini, DDS, Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - MMT Piza
- Mariana Miranda de Toledo Piza, DDS, Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - PG Coelho
- Paulo G Coelho, DDS, MS, BS, MSMtE, PhD, Department of Biomaterials and Biomimetics, New York University College of Dentistry, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, Mechanical and Aerospace Engineering, NYU Tandon School of Engineering, New York, NY, USA
| | - R Hirata
- Ronaldo Hirata, DDS, MS, PhD, Department of Biomaterials and Biomimetics, New York University, New York, NY, USA
| | - EA Bonfante
- Estevam A Bonfante, DDS, MS, PhD, Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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12
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da Rocha LKA, Freschi de Barros S, Bandeira F, Bollini A, Testa LHDA, Simione AJ, Souza MDOE, Zanetti LP, de Oliveira LCS, Dos Santos ACF, de Souza MP, Colturado VAR, Kalil J, Machado CM, Guilherme L. Thymopoiesis in Pre- and Post-Hematopoietic Stem Cell Transplantation. Front Immunol 2018; 9:1889. [PMID: 30245685 PMCID: PMC6137257 DOI: 10.3389/fimmu.2018.01889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/31/2018] [Indexed: 12/20/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is an important therapeutic option for some hematological diseases. However, patients who undergo HSCT acquire a state of immunodeficiency that causes significant mortality. Reconstitution of thymic function is needed to support the immune system. One way to measure thymic function is through T-cell receptor excision circle (TREC) quantification. TRECs are generated by T-cell receptor gene rearrangements during T-cell maturation in the thymus and represent a reliable marker for thymic output. In this study, we aimed to assess aging and malignant hematological diseases as two important factors that may influence thymic output before HSCT. We observed that patients before HSCT presented signal joint TREC (sjTREC) numbers lower than 606.55 copies/μg DNA (low values) compared with healthy individuals, with an odds ratio (OR) of 12.88 [95% confidence interval (CI): 5.26–31.53; p < 0.001]. Our results showed that a group of older individuals (≥50 years old), comprising both healthy individuals and patients, had an OR of 10.07 (95% CI: 2.80–36.20) for low sjTREC values compared with younger individuals (≤24 years old; p < 0.001). Multiple logistic regression analysis confirmed that both older age (≥50 years old) and malignant hematological diseases and their treatments were important and independent risk factors related to thymic function impairment (p < 0.001). The median sjTREC value for patients of all ages was significantly lower than the sjTREC median for the subgroup of older healthy individuals (≥50 years old; p < 0.001). These data suggested that patients before HSCT and healthy individuals exhibited age-dependent thymic impairment, and that prior treatment for hematological diseases may exacerbate aging-related deterioration of natural thymic function. Furthermore, we analyzed these patients 9 months post-HSCT and compared patients who underwent autologous HSCT with those who underwent allogeneic HSCT. Both groups of patients achieved sjTREC copy numbers similar to those of healthy individuals. We did not find a close relationship between impaired thymic function prior to HSCT and worse thymic recovery after HSCT.
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Affiliation(s)
- Luis Klaus A da Rocha
- Laboratory of Immunology, Heart Institute (InCor), Clinical Hospital, University of São Paulo, São Paulo, Brazil
| | - Samar Freschi de Barros
- Laboratory of Immunology, Heart Institute (InCor), Clinical Hospital, University of São Paulo, São Paulo, Brazil
| | - Francine Bandeira
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | - Alexia Bollini
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | | | - Anderson João Simione
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | - Marina de O E Souza
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | - Lilian P Zanetti
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | | | | | - Mair Pedro de Souza
- Hematopoietic Stem Cell Transplantation Sector, Amaral Carvalho Hospital, Jaú, Brazil
| | | | - Jorge Kalil
- Laboratory of Immunology, Heart Institute (InCor), Clinical Hospital, University of São Paulo, São Paulo, Brazil
| | - Clarisse M Machado
- Laboratory of Virology, Tropical Medicine Institute (IMT), University of São Paulo, São Paulo, Brazil
| | - Luiza Guilherme
- Laboratory of Immunology, Heart Institute (InCor), Clinical Hospital, University of São Paulo, São Paulo, Brazil
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13
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Pereira BBS, Batista AM, Souza ACMF, Romano CM, Machado CM. A37 Genome sequencing, genetic characterization, and vaccine-match analysis of influenza B virus detected in hematopoietic stem cell transplant recipients (HSCT), an overview from 2010 to 2017. Virus Evol 2018. [PMCID: PMC5905454 DOI: 10.1093/ve/vey010.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- B B S Pereira
- Virology Laboratory, São Paulo Institute of Tropical Medicine, University of Sao Paulo, SP, Brazil
| | - A M Batista
- Virology Laboratory, São Paulo Institute of Tropical Medicine, University of Sao Paulo, SP, Brazil
| | - A C M F Souza
- Virology Laboratory, São Paulo Institute of Tropical Medicine, University of Sao Paulo, SP, Brazil
| | - C M Romano
- Virology Laboratory, São Paulo Institute of Tropical Medicine, University of Sao Paulo, SP, Brazil
| | - C M Machado
- Virology Laboratory, São Paulo Institute of Tropical Medicine, University of Sao Paulo, SP, Brazil
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14
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Machado CM, Lopes ACO, Jalkh EBB, Da Silva CPE, Piza MMT, Bonjardim LR, Bonfante EA. Análise da Retenção de Coroas CAD/CAM Cimentadas em Pilares do Tipo Ti-Base por Meio do Teste de Tração Pull-Out. J Health Scie 2018. [DOI: 10.17921/2447-8938.2017v19n5p112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Este estudo avaliou a resistência ao pull-out de coroas implantossuportadas confeccionadas em CAD/CAM e cimentadas em pilares de implante do tipo ti-base. Quarenta e cinco coroas foram fresadas para uso no pilar de implante ti-base (SIN Implante) e divididas (n15) de acordo com o material: Zircônia, Co-Cr ou Titânio. A cimentação foi realizada com cimento provisório Temp Bond NE (Kerr) ou cimento resinoso RelyX U200 (3M – Oral Care), sob carga de 50N por 10 minutos. As coroas foram submetidas ao teste de tração em máquina de teste universal a 1,0 mm/min. Os testes foram feitos de acordo com a condição de cimentação: sem cimento (SC), cimentação provisória (CP, TempBond NE), sem cimento após a cimentação provisória (SCSP) e cimentação definitiva (CD, RelyX U200). Os resultados obtidos foram analisados por análise de variância e teste Tukey (p<0,05). Os valores médios de resistência (N) e desvio padrão foram: ZirSC (104,90/51,23) ZirCP (154,26/43,53) ZirSCCP (66,38/40,81) ZirCD (300,01/82,65) CoCrSC (72,38/43,07) CoCrCP (40,43/17,46) CoCrCD (900,35/133,63) TiSC (61,13/30,01) TiCP (158,85/22,18) TiSCCP (60,92/26,11) TiCD (566,66/75,82). Os materiais Co-Cr e titânio apresentaram maiores níveis de retenção ao pilar ti-base, na cimentação definitiva. O cimento RelyX U200 apresentou comportamento superior quando comparado ao cimento Temp Bond NE, independente do material da coroa.Palavras-chave: Implante Dentário. Cimentação. Coroa.
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15
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de Souza Pereira BB, Darrigo Junior LG, de Mello Costa TC, Felix AC, Simoes BP, Stracieri AB, da Silva PM, Mauad M, Machado CM. Prolonged viremia in dengue virus infection in hematopoietic stem cell transplant recipients and patients with hematological malignancies. Transpl Infect Dis 2017; 19. [DOI: 10.1111/tid.12721] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 01/28/2023]
Affiliation(s)
| | | | | | - Alvina Clara Felix
- Virology Laboratory; Institute of Tropical Medicine; University of São Paulo; São Paulo Brazil
| | - Belinda P. Simoes
- Faculty of Medicine of Ribeirão Preto; University of São Paulo; São Paulo Brazil
| | | | | | - Marcos Mauad
- HSCT Program; Amaral Carvalho Foundation; São Paulo Brazil
| | - Clarisse M. Machado
- Virology Laboratory; Institute of Tropical Medicine; University of São Paulo; São Paulo Brazil
- HSCT Program; Amaral Carvalho Foundation; São Paulo Brazil
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16
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Sotelo JR, Sotelo AB, Sotelo FJB, Doi AM, Pinho JRR, Oliveira RDC, Bezerra AMPS, Deutsch AD, Villas-Boas LS, Felix AC, Romano CM, Machado CM, Mendes-Correa MCJ, Santana RAF, Menezes FG, Mangueira CLP. Persistence of Zika Virus in Breast Milk after Infection in Late Stage of Pregnancy. Emerg Infect Dis 2017; 23:856-857. [PMID: 28192072 PMCID: PMC5403055 DOI: 10.3201/eid2305.161538] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We detected Zika virus in breast milk of a woman in Brazil infected with the virus during the 36th week of pregnancy. Virus was detected 33 days after onset of signs and symptoms and 9 days after delivery. No abnormalities were found during fetal assessment or after birth of the infant.
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17
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Pinheiro CG, Machado CM, Amaral LP, Silva DT, Almeida CAA, Longhi SJ, Mallmann CA, Heinzmann BM. Seasonal variability of the essential oil of Hesperozygis ringens (Benth.) Epling. BRAZ J BIOL 2016; 76:176-84. [PMID: 26871746 DOI: 10.1590/1519-6984.16314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/21/2014] [Indexed: 11/21/2022] Open
Abstract
This study was developed to evaluate the effect of seasonality on the yield and chemical composition of the essential oil (EO) of Hesperozygis ringens (Benth.) Epling, a native species from the Brazilian Pampa. Leaves were collected from four specimens of a single population in each of the four seasons for a year and were extracted in triplicate by hydro-distillation for 2 hours. The yield of EO (% w/w) was calculated on fresh weight basis (FWB), and the 16 oil samples were analyzed by gas chromatography coupled to mass spectrometry (GC-MS) and gas chromatography with flame ionization detector (GC-FID). Hierarchical Cluster Analysis (HCA) and Principal Component Analysis (PCA) were used as statistical tools to evaluate differences in chemical composition. The highest yields were obtained in autumn, spring and summer (2.32-4.38%), while the lowest yields were detected in winter, ranging from 1.15 to 1.91%. Oxygenated monoterpenoids were the predominant class of chemical constituents in the EO obtained in all seasons, showing the highest contents in autumn and summer, and pulegone was identified as a major compound, whose contents varied between 54.13 and 81.17%. The EO samples were divided into three chemical groups by HCA and PCA and were assigned to the same group, except for the three samples gathered in winter. The results showed a seasonal influence on the yield and chemical composition of the EO.
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Affiliation(s)
- C G Pinheiro
- Centro de Ciências Rurais, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - C M Machado
- Centro de Ciências Rurais, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - L P Amaral
- Centro de Ciências Rurais, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - D T Silva
- Centro de Ciências Rurais, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - C A A Almeida
- Centro de Ciências Rurais, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - S J Longhi
- Centro de Ciências Rurais, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - C A Mallmann
- Centro de Ciências Rurais, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - B M Heinzmann
- Centro de Ciências Rurais, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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Gattás VL, Cardoso MRA, Mondini G, Machado CM, Luna EJA. Effectiveness of influenza vaccination of schoolchildren in the city of São Paulo, Brazil, 2009. Influenza Other Respir Viruses 2015; 9:323-330. [PMID: 26018131 PMCID: PMC4605414 DOI: 10.1111/irv.12328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Children play an important role in maintaining the transmission of influenza. Evidence suggests that vaccination of school-age children can reduce transmission to unvaccinated household contacts. We evaluated the direct and indirect effectiveness of the 2009 inactivated seasonal influenza vaccine in vaccinated schoolchildren and their unvaccinated household contacts. METHODS This was a double-blind cluster randomized trial involving 10 schools and 1742 schoolchildren as well as 5406 household contacts. The schools were randomly assigned to receive the influenza vaccine or the control vaccine. After vaccination, the schoolchildren and household contacts were followed for 6 months to identify cases of acute respiratory infection (ARI). Reverse-transcriptase polymerase chain reaction was performed for the diagnosis of influenza. RESULTS A total of 632 ARI cases were detected. Of those, 103 tested positive for influenza virus (influenza virus A[H1N1]pdm09 virus in 55 and seasonal influenza viruses in 48). The effectiveness of the vaccine in protecting against seasonal influenza virus infection was 65·0% for the household contacts (95% CI, 19·6-84·3) and 65·0% for the schoolchildren (95% CI, 20·9-84·5). CONCLUSION Vaccination of schoolchildren significantly protected them and their household contacts against seasonal influenza.
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Affiliation(s)
| | | | | | - Clarisse M Machado
- Institute of Tropical Medicine, University of São PauloSão Paulo, Brazil
| | - Expedito J A Luna
- Institute of Tropical Medicine, University of São PauloSão Paulo, Brazil
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Schimming BC, Pinheiro PFF, de Matteis R, Machado CM, Domeniconi RF. Immunolocalization of Aquaporins 1 and 9 in the Ram Efferent Ducts and Epididymis. Reprod Domest Anim 2015; 50:617-24. [DOI: 10.1111/rda.12537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/19/2015] [Indexed: 01/14/2023]
Affiliation(s)
- BC Schimming
- Department of Anatomy; Biosciences Institute of Botucatu; UNESP - Universidade Estadual Paulista; Botucatu São Paulo Brazil
| | - PFF Pinheiro
- Department of Anatomy; Biosciences Institute of Botucatu; UNESP - Universidade Estadual Paulista; Botucatu São Paulo Brazil
| | - R de Matteis
- Faculty of Veterinary Medicine and Animal Science; UNESP - Universidade Estadual Paulista; Botucatu São Paulo Brazil
| | - CM Machado
- Department of Anatomy; Biosciences Institute of Botucatu; UNESP - Universidade Estadual Paulista; Botucatu São Paulo Brazil
| | - RF Domeniconi
- Department of Anatomy; Biosciences Institute of Botucatu; UNESP - Universidade Estadual Paulista; Botucatu São Paulo Brazil
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20
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Ambati A, Boas LSV, Ljungman P, Testa L, de Oliveira JF, Aoun M, Colturato V, Maeurer M, Machado CM. Evaluation of pretransplant influenza vaccination in hematopoietic SCT: a randomized prospective study. Bone Marrow Transplant 2015; 50:858-64. [PMID: 25798680 DOI: 10.1038/bmt.2015.47] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/12/2015] [Accepted: 01/15/2015] [Indexed: 11/09/2022]
Abstract
Pretransplant influenza vaccination of the donor or allogeneic hematopoietic SCT (HSCT) candidate was evaluated in a randomized study. One hundred and twenty-two HSCT recipients and their donors were assigned to three randomization groups: no pretransplant vaccination (n=38), donor pretransplant vaccination (n=44) or recipient pretransplant vaccination (n=40). Specific IgG was assessed by both hemagglutinin inhibition (HI) and, in 57 patients, by an indirect influenza-specific ELISA at specified times after HSCT. Vaccinated donors had seroprotective HI titers for Ags H1 and H3 (P<0.001) compared with the other groups at the time of donation. The titers against H1 (P=0.028) and H3 (P<0.001) were highest in the pretransplant recipient vaccination group until day 180 after transplantation. A significant difference was found in the specific Ig levels against pandemic H1N1 at 6 months after SCT (P=0.02). The mean IgG levels against pandemic H1N1 and generic H1N1 and H3N2 were highest in the pretransplant recipient vaccination group. We conclude that pretransplant recipient vaccination improved the influenza-specific seroprotection rates.
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Affiliation(s)
- A Ambati
- 1] Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden [2] Centre for Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden
| | - L S V Boas
- Virology Laboratory (LIM 52-HCFMUSP), Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - P Ljungman
- 1] Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden [2] Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - L Testa
- Hematopoietic Stem Cell Transplant Program, Amaral Carvalho Foundation, Jahu, Brazil
| | - J F de Oliveira
- Clinics Hospital - School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - M Aoun
- Division of Therapeutic Immunology (TIM), Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - V Colturato
- Hematopoietic Stem Cell Transplant Program, Amaral Carvalho Foundation, Jahu, Brazil
| | - M Maeurer
- 1] Centre for Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden [2] Division of Therapeutic Immunology (TIM), Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C M Machado
- 1] Virology Laboratory (LIM 52-HCFMUSP), Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil [2] Hematopoietic Stem Cell Transplant Program, Amaral Carvalho Foundation, Jahu, Brazil
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21
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Machado CM. Chagas disease in transplantation: time to enter an era of better diagnosis and better outcomes. Am J Transplant 2013; 13:3065-6. [PMID: 24266965 DOI: 10.1111/ajt.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 08/20/2013] [Accepted: 08/22/2013] [Indexed: 01/25/2023]
Affiliation(s)
- C M Machado
- Virology Laboratory-Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil; Transplant Infectious Diseases, HSCT Program, Amaral Carvalho Foundation, Jahu, Brazil
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Couto CR, Pannuti CS, Paz JP, Fink MCD, Machado AA, de Marchi M, Machado CM. Fighting misconceptions to improve compliance with influenza vaccination among health care workers: an educational project. PLoS One 2012; 7:e30670. [PMID: 22328920 PMCID: PMC3273463 DOI: 10.1371/journal.pone.0030670] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 12/23/2011] [Indexed: 11/18/2022] Open
Abstract
The compliance with influenza vaccination is poor among health care workers (HCWs) due to misconceptions about safety and effectiveness of influenza vaccine. We proposed an educational prospective study to demonstrate to HCWs that influenza vaccine is safe and that other respiratory viruses (RV) are the cause of respiratory symptoms in the months following influenza vaccination. 398 HCWs were surveyed for adverse events (AE) occurring within 48 h of vaccination. AE were reported by 30% of the HCWs. No severe AE was observed. A subset of 337 HCWs was followed up during four months, twice a week, for the detection of respiratory symptoms. RV was diagnosed by direct immunofluorescent assay (DFA) and real time PCR in symptomatic HCWs. Influenza A was detected in five episodes of respiratory symptoms (5.3%) and other RV in 26 (27.9%) episodes. The incidence density of influenza and other RV was 4.3 and 10.8 episodes per 100 HCW-month, respectively. The educational nature of the present study may persuade HCWs to develop a more positive attitude to influenza vaccination.
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Affiliation(s)
- Carla R. Couto
- Virology Laboratory (LIM 52 - HCFMUSP), Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Cláudio S. Pannuti
- Virology Laboratory (LIM 52 - HCFMUSP), Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - José P. Paz
- Virology Laboratory (LIM 52 - HCFMUSP), Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Maria C. D. Fink
- Virology Laboratory (LIM 52 - HCFMUSP), Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Alessandra A. Machado
- Virology Laboratory (LIM 52 - HCFMUSP), Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Michela de Marchi
- Virology Laboratory (LIM 52 - HCFMUSP), Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Clarisse M. Machado
- Virology Laboratory (LIM 52 - HCFMUSP), Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
- * E-mail:
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Ljungman P, Cordonnier C, Einsele H, Englund J, Machado CM, Storek J, Small T. Vaccination of hematopoietic cell transplant recipients. Bone Marrow Transplant 2009; 44:521-6. [DOI: 10.1038/bmt.2009.263] [Citation(s) in RCA: 232] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Salles MJC, Sens YAS, Boas LSV, Machado CM. Influenza virus vaccination in kidney transplant recipients: serum antibody response to different immunosuppressive drugs. Clin Transplant 2009; 24:E17-23. [PMID: 19758368 DOI: 10.1111/j.1399-0012.2009.01095.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION This study prospectively accessed the immune response to the inactivated influenza vaccine in renal transplant recipients receiving either azathioprine or mycophenolate mofetil (MMF). Side effects were investigated. METHODS Sixty-nine patients received one dose of inactivated trivalent influenza vaccine. Antihemagglutinin (HI) antibody response against each strain was measured before and one to six months after vaccination. RESULTS Geometric mean HI antibody titers for H1N1 and H3N2 strains increased from 2.57 and 2.44 to 13.45 (p = 0.001) and 7.20 (p < 0.001), respectively. Pre- and post-vaccination protection rates for H1N1 and H3N2 increased from 8.7% to 49.3% (p < 0.001); and 36.3% (p < 0.001) and seroconversion rates were 36% and 25.3%, respectively. There was no response to influenza B. The use of MMF reduced the H1N1 and H3N2 protection rates and the seroconversion rate for the H1N1 strain when compared with the use of azathioprine, and subjects transplanted less than 87 months also had inferior antibody response. Adverse events were mild and there were no change on renal function post-vaccination. CONCLUSION Renal transplant patients vaccinated against influenza responded with antibody production for influenza A virus strains, but not for influenza B. Use of MMF and shorter time from transplantation decreased the immune response to the vaccine.
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Affiliation(s)
- Mauro J C Salles
- Clinical of Infectious Diseases, Department of Internal Medicine, Santa Casa of Sao Paulo School of Medicine, Sao Paulo, Brazil.
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Machado AF, Sallum MAM, Vilas Boas LS, Tateno AF, Machado CM. Molecular characterization of strains of respiratory syncytial virus identified in a hematopoietic stem cell transplant outpatient unit over 2 years: community or nosocomial infection? Biol Blood Marrow Transplant 2009; 14:1348-55. [PMID: 19041056 DOI: 10.1016/j.bbmt.2008.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 09/14/2008] [Indexed: 11/17/2022]
Abstract
Respiratory syncytial virus (RSV) is recognized as the leading cause of nosocomial respiratory infection among hematopoietic stem cell transplant (HSCT) recipients, causing considerable morbidity and mortality. RSV is easily transmitted by contact with contaminated surfaces, and in HSCT units, more than 50% of RSV infections have been characterized as of nosocomial origin. From April 2001 to October 2002, RSV was identified by direct immunofluorescent assay in 42 symptomatic HSCT recipients. Seven RSV strains from 2001 and 12 RSV strains from 2002 were sequenced. RNA extraction, cDNA synthesis, and seminested polymerase chain reaction (PCR) with primers complementary to RSV genes G and F were performed. PCR products were analyzed by nucleotide sequencing of the C-terminal region of gene G for typing (in group A or B). Of the 7 strains analyzed in 2001, only 2 belonged to group B; the other 5 belonged to group A. Of these 7 strains, 3 were identical and were from recipients receiving outpatient care. In 2002, of the 12 strains analyzed, 3 belonged to group A and the other 9 belonged to group B. Of these 9 strains, 7 were genetically identical and were also from recipients receiving outpatient care. Therefore, multiple strains of RSV cocirculated in the hematopoietic stem cell transplant units (ward and outpatient units) between 2001 and 2002. Nosocomial transmission was more likely to occur at the HSCT outpatient unit than in the HSCT ward. Infection control practices should also be implemented in the outpatient setting.
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Affiliation(s)
- Adriana F Machado
- Virology Laboratory (LIM52-HCFMUSP), Institute of Tropical Medicine and Faculty of Medical Sciences, University of São Paulo, São Paulo, Brazil
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Machado CM. Infecção pelo vírus sincicial respiratório e o diagnóstico das infecções virais pós-transplante de células-tronco hematopoéticas no Brasil. Rev Bras Hematol Hemoter 2009. [DOI: 10.1590/s1516-84842009000600002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Takayanagi IJ, Cardoso MRA, Costa SF, Araya MES, Machado CM. Attitudes of health care workers to influenza vaccination: why are they not vaccinated? Am J Infect Control 2007; 35:56-61. [PMID: 17276792 DOI: 10.1016/j.ajic.2006.06.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 05/30/2006] [Accepted: 06/01/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Compliance rates with influenza vaccination among health care workers (HCW) are historically low. Although a safe and effective vaccine is available, the reasons for such poor compliance are not well understood. METHODS After a campaign encouraging HWC to vaccinate against influenza, we conducted an epidemiologic survey to evaluate the reasons for compliance and accompanied the impact of these measures (campaign and questionnaire) during the subsequent 2 years. RESULTS Compliance rate was 34.4%. Multivariate analysis showed that "older age" (P = .008), "believing that most departmental colleagues had been vaccinated" (P < .0001), and "having cared for patients suffering from severe influenza" (P = .031) were significantly associated with compliance with influenza vaccination. The main reason given for being vaccinated was "individual protection" and, to a lesser extent, "protection for the patient." In subsequent years, compliance rates among those participating in the survey fell to 20.2% in 2004, when the only measure taken was the questionnaire, and to 12.75% in 2005, when no educational intervention was scheduled. CONCLUSION We conclude that a better understanding of HCW's negative attitude regarding influenza vaccination is needed as are more appealing and convincing continuous education programs, to ensure motivation for influenza vaccination over a longer period.
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Affiliation(s)
- Irvin Jo Takayanagi
- Virology Laboratory, Institute of Tropical Medicine of University of São Paulo, São Paulo, Brazil
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Abstract
Hematopoietic stem cell transplant recipients lose immune memory of exposure to infectious agents and vaccines accumulated through a lifetime, and therefore need to be revaccinated. Reimmunization protocols vary greatly among hematopoietic stem cell transplant centers. Diphtheria and tetanus toxoids, pertussis vaccine, Haemophilus influenza type B conjugate, 23-valent pneumococcal polysaccharide, inactivated influenza and polio vaccine and live attenuated measles-mumps-rubella vaccine are the currently recommended vaccines to be included in a vaccination program after hematopoietic stem cell transplant. Other variables, such as stem cell source, new adjuvants, T-cell depleted transplants, nonmyeloablative conditioning and donor immunization have recently been introduced and a constant update of current recommendations are needed. Studies recently published, the use of other vaccines and the perspectives for different vaccination protocols are discussed in this review.
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Affiliation(s)
- Clarisse M Machado
- Virology Laboratory, São Paulo Institute of Tropical Medicine, University of São Paulo, SP, Brazil.
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Godoi ER, de Souza VAUF, Cakmak S, Machado AF, Vilas Boas LS, Machado CM. Loss of hepatitis A virus antibodies after bone marrow transplantation. Bone Marrow Transplant 2006; 38:37-40. [PMID: 16715111 DOI: 10.1038/sj.bmt.1705391] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Reimmunization guidelines have recommended the inactivated HAV vaccine for hematopoietic stem cell transplant (HSCT) recipients living in or traveling to areas where hepatitis A is endemic. As a shift from high to medium hepatitis A endemicity has been observed in several countries in Latin America, we conducted a retrospective study to evaluate the prevalence of hepatitis A pre-bone marrow transplant (BMT) and the loss of specific antibodies in consecutive stored serum samples from 77 BMT recipients followed up from 82 to 1530 days. The prevalence of HAV antibodies was 92.2% before BMT. As vaccine was not available in Brazil when the samples were taken, it was assumed that this prevalence reflects natural infection. Survival analysis showed that the probability of becoming seronegative was 4.5% (+/-2.6%), 7.9% (+/-3.4%), 10.1% (+/-4.0%), 23.4% (+/-9.6%) at 1, 2, 3 and 4 years after transplant, respectively. The loss of HAV antibodies was significantly associated with longer follow-up (P=0.0015), younger age (P=0.049) and acute graft-versus-host disease (P=0.035). As most reimmunization protocols start around day +365, in developing countries with similar HAV endemicity, BMT recipients should have serological screening before HAV vaccination and the inactivated vaccine should be advised to those seronegative.
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Affiliation(s)
- E R Godoi
- Virology Laboratory, São Paulo Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
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Machado CM, Cardoso MRA, da Rocha IF, Boas LSV, Dulley FL, Pannuti CS. The benefit of influenza vaccination after bone marrow transplantation. Bone Marrow Transplant 2005; 36:897-900. [PMID: 16170332 DOI: 10.1038/sj.bmt.1705159] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Influenza vaccine is recommended yearly for recipients after the sixth month of BMT. Although a higher risk of complications of influenza is expected to occur in BMT patients, no study has addressed the clinical efficacy of influenza vaccination in this setting. Focusing on the clinical benefits of influenza vaccination, we evaluated the risk factors for influenza infection in a cohort of 177 BMT recipients followed up for 1 year. Influenza was diagnosed in 39 patients. Multivariate analyses showed that seasonal exposure and more aggressive conditioning regimens were independently associated with increased risk for influenza. Influenza vaccination and steroid use showed a protective role. Of the 43 patients who had received BMT longer than 6 months, 19 were vaccinated (compliance rate = 44.2%) and vaccine efficacy was 80%. We conclude that influenza vaccination plays an important role in protecting BMT recipients against influenza and all efforts should be made to ensure good compliance with vaccination.
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Affiliation(s)
- C M Machado
- Virology Laboratory (LIM 52-HCFMUSP) of Instituto de Medicina Tropical de São Paulo, São Paulo, Brazil.
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Machado CM, de Souza VAUF, Sumita LM, da Rocha IF, Dulley FL, Pannuti CS. Early measles vaccination in bone marrow transplant recipients. Bone Marrow Transplant 2005; 35:787-91. [PMID: 15750610 DOI: 10.1038/sj.bmt.1704878] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Measles vaccination has been recommended after the second year following bone marrow transplant (BMT) in patients not receiving immunosuppressive drugs. During a measles outbreak, we vaccinated all patients after the first year of transplant, and conducted a prospective trial to evaluate safety, effectiveness and sustained immunity after early vaccination. Patients received attenuated virus vaccine between 9 and 18 months after BMT. A total of 51 patients were evaluated and 27 of them (52.9%) were receiving immunosuppressive drugs. Only mild adverse reactions were noted. Nine patients (17.6%) were susceptible (IgG< or =100 mIU/ml) at vaccination, and all seroconverted. In those immune at vaccination, a four-fold increase in measles IgG titers was found in one of 34 patients (2.9%) with specific IgG> or =200 mIU/ml compared to 14 of 17 (82.3%) with IgG<200 mIU/ml (P< 0.0001). Sustained immunity after 24 months was more likely to occur in patients with specific IgG levels< or =200 or > or =500 mIU/mL (83.4 and 100%, respectively) in comparison to patients with 200<IgG<499 mIU/ml at vaccination (50% P=0.017). We conclude that even though early measles vaccination is safe, few patients are susceptible on day +365 and this strategy should be reserved for epidemic situations posing significant threat for the patients.
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Affiliation(s)
- C M Machado
- Virology Laboratory (LIM 52-HCFMUSP)--Institute of Tropical Medicine, University of São Paulo Medical School, São Paulo, Brazil.
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Pereira CN, Del Nero G, Lacaz CS, Machado CM. The contribution of galactomannan detection in the diagnosis of invasive aspergillosis in bone marrow transplant recipients. Mycopathologia 2005; 159:487-93. [PMID: 15983733 DOI: 10.1007/s11046-005-4996-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Accepted: 04/01/2005] [Indexed: 11/24/2022]
Abstract
Until recently, accurate microbiological diagnosis of invasive aspergillosis (IA) was seldom established in HSCT recipients. Blood samples are rarely positive for Aspergillus species, the reliability of the cultures depends of the specimen (if taken from a normally sterile site or not) and biopsy samples require invasive procedures, rarely recommended in patients with severe thrombocytopenia. Implementing the international consensus defining the microbiological criteria for the diagnosis of Aspergillus infection, we retrospectively evaluated the role of serum galactomannan (GM) detection by EIA to diagnose IA among HSCT patients with proven invasive fungal infection (IFI) and the impact of serum storage in GM concentrations. The EIA assay allowed categorizing as "probable" 5 of the 10 cases of "possible" aspergillosis (50%). Considering a lower cut-off level for the reaction (1.0), 80% of the cases could be categorized as "probable" aspergillosis. Positive or undetermined results were detected one to 4 months before the diagnosis of IA in eight of the 11 patients (72.7%) with proven IFI. Retesting the stored samples after a second storage for four years, we could observe lower reactivity in 20% of the samples. The detection of galactomannan by the EIA test represents a major advance in the diagnosis of IA in HSCT recipients at high risk of IA. A better understanding of the kinetics of the GM in different clinical situations is necessary to maximize the benefit of the test in Aspergillus surveillance.
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Affiliation(s)
- C N Pereira
- Mycology Laboratory, University of São Paulo Institute of Tropical Medicine, São Paulo, Brazil
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Machado CM, Boas LSV, Mendes AVA, da Rocha IF, Sturaro D, Dulley FL, Pannuti CS. Use of Oseltamivir to control influenza complications after bone marrow transplantation. Bone Marrow Transplant 2004; 34:111-4. [PMID: 15094755 DOI: 10.1038/sj.bmt.1704534] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2003] [Accepted: 03/09/2004] [Indexed: 11/08/2022]
Abstract
Influenza infection can be severe in bone marrow transplant (BMT) recipients. Although yearly epidemics occur worldwide, and a higher risk of complication is expected in these patients, few studies have addressed the impact of the new neuraminidase inhibitors in the prognosis of influenza after BMT. Influenza A or B infections were found in 39 of the 66 patients (59%) showing a positive nasal wash by DFA. Influenza A was diagnosed in 18 patients and influenza B in 23 patients; two patients were infected by influenza A and B with 84- and 90-day intervals between episodes, respectively. Of the 41 episodes (61%) of influenza A or B, 25 infections occurred during the spring and summer months. Oseltamivir was introduced within 48 h of symptoms appearing. Only two patients (5.1%) developed influenza pneumonia, and no patient died of influenza. A total of 22 patients (56.4%) acquired influenza before day +180 when preventive vaccination strategies are precluded owing to poor immunogenicity of the vaccine during this period. Oseltamivir proved to be safe and appears to have played an important role in the outcome of influenza infection in this population. The therapeutic and/or prophylactic benefits of Oseltamivir in BMT recipients remain to be demonstrated in randomized, prospective trials.
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Affiliation(s)
- C M Machado
- Virology Laboratory (LIM 52-HCFMUSP) of the Instituto de Medicina Tropical de São Paulo, São Paulo, Brazil.
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Abstract
Autologous and allogeneic bone marrow transplantation (BMT) recipients lose immune memory of exposure to infectious agents and vaccines accumulated through a lifetime and therefore need to be revaccinated. Diphtheria toxoid, tetanus toxoid, pertussis vaccine (children <7 years old), Haemophilus influenzae type b conjugate, 23-valent pneumococcal polysaccharide, inactivated influenza vaccine, inactivated polio vaccine and live-attenuated measles-mumps-rubella vaccine are the currently recommended vaccines to be included in a vaccination program after BMT. For most of them, the best time to vaccinate, the number of vaccine doses and/or the duration of immunity after vaccination have not been established. Vaccination protocols vary greatly among BMT centers, suggesting that the lack of sufficient data has not permitted the formulation of reliable recommendations. The use of other vaccines and the perspectives for different vaccination protocols are analyzed in this review.
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Affiliation(s)
- C M Machado
- Laboratório de Virologia, LIM-52, Instituto de Medicina Tropical de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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Machado CM, Boas LSV, Mendes AVA, Santos MFM, da Rocha IF, Sturaro D, Dulley FL, Pannuti CS. Low mortality rates related to respiratory virus infections after bone marrow transplantation. Bone Marrow Transplant 2003; 31:695-700. [PMID: 12692610 PMCID: PMC7091922 DOI: 10.1038/sj.bmt.1703900] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Respiratory viruses (RVs) frequently cause severe respiratory disease in bone marrrow transplant (BMT) recipients. To evaluate the frequency of RV, nasal washes were collected year-round from BMT recipients with symptoms of upper respiratory tract infection (URI). Direct immunofluorescence assay was performed for respiratory syncytial virus (RSV), influenza (Flu) A and B, adenovirus and parainfluenza (Paraflu) virus. Patients with RSV pneumonia or with upper RSV infection, but considered at high risk for developing RSV pneumonia received aerosolized ribavirin. Oseltamivir was given to patients with influenza. A total of 179 patients had 392 episodes of URI. In all, 68 (38%) tested positive: RSV was detected in 18 patients (26.4%), Flu B in 17 (25%), Flu A in 11 (16.2%) and Paraflu in 7 (10.3%). A total of 14 patients (20.6%) had multiple RV infections or coinfection. RSV pneumonia developed in 55.5% of the patients with RSV-URI. One of the 15 patients (6.6%) with RSV pneumonia died. Influenza pneumonia was diagnosed in three patients (7.3%). RSV and influenza infections peaked in fall-winter and winter-spring months, respectively. We observed decreased rates of influenza and parainfluenza pneumonia and low mortality because of RSV pneumonia. The role of antiviral interventions such as aerosolized ribavirin and new neuraminidase inhibitors remains to be defined in randomized trials.
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Affiliation(s)
- C M Machado
- Virology Laboratory (LIM 52-HCFMUSP) of Instituto de Medicina Tropical de São Paulo, Brazil
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Mendes AVA, Benard G, Pereira CB, Kallas EG, Duarte AJS, Pannuti CS, Dulley FL, Machado CM. Different kinetics in anti-cytomegalovirus immunity reconstitution evaluated by lymphocyte proliferation and IFN-gamma production in allogeneic and autologous bone marrow transplantation. Acta Haematol 2002; 107:187-94. [PMID: 12053145 DOI: 10.1159/000058313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Allogeneic bone marrow transplantation (ALLOBMT) is associated with an increased risk of cytomegalovirus (CMV) morbidity compared to autologous BMT (AUTOBMT). To investigate this, we evaluated AUTOBMT and ALLOBMT patients regarding anti-CMV immune reconstitution at 1 and 4 months after BMT and on the day after first CMV antigenemia detection. Intermittent ganciclovir preemptive therapy was prompted by antigenemia of >or=2 cells. One month after transplant, AUTOBMT recipients already displayed larger CD8+ T cell numbers than ALLOBMT recipients, but comparably small CD4+ T cell numbers. Most AUTOBMT patients had positive CMV antigen (CMV-Ag)-induced lymphoproliferation (86%) and IFN-gamma secretion (86%), whereas this was infrequently seen in ALLOBMT patients (20 and 10%, respectively). This early AUTOBMT immune reconstitution was associated with a lower frequency of CMV reactivation up to +4 months in AUTOBMT (21%) than ALLOBMT patients (91%). At +4 months, most ALLOBMT recipients had also recovered CMV-Ag immune responses. At first antigenemia detection, all 3 AUTOBMT recipients already displayed anti-CMV immune functions and 2 cleared the infection without therapy, whereas of the 10 ALLOBMT recipients only 1 had positive lymphoproliferation. In the latter group, none had IFN-gamma secretion or cleared the infection without therapy. Thus, differences in anti-CMV immune reconstitution may help to explain the contrasting rates of CMV morbidity between ALLOBMT and AUTOBMT patients.
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Affiliation(s)
- A V A Mendes
- Virology Laboratory, Instituto de Medicina Tropical de São Paulo, São Paulo, Brazil
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Machado CM. Reimmunization after bone marrow transplantation: Current recommendations and perspectives. Rev Bras Hematol Hemoter 2002. [DOI: 10.1590/s1516-84842002000300008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
In 1997, a measles outbreak was identified in São Paulo. Between February and December, 20 185 cases were confirmed. From April to July 1997, a seroepidemiologic survey was conducted to identify the recipients of bone marrow (BM) transplants who were susceptible to measles and the occurrence of measles in this population. A total of 156 patients were screened by enzyme immunoassay (EIA). Patients with IgG titers more than 100 mIU/mL were considered immune. Measles reimmunization records were also reviewed. Thirty-two vaccinated patients underwent serologic evaluation. Six of 22 patients (27.3%) within 3 years after vaccination lost measles immunity, in contrast to 7 of 10 patients (70%) vaccinated longer than 3 years previously (P =.049). Among the 122 nonvaccinated patients, 41 (33.6%) were susceptible to measles: 4 of 47 patients (8.5%) within the first year after BM transplantation (BMT), and 37 of the 75 patients (49.3%) after the first year after BMT (P <.001). Eight recipients acquired measles, confirmed by serology (EIA). High-avidity IgG antibodies were observed in the acute phase of measles, suggesting a secondary immune response. Measles interstitial pneumonia was observed in one patient. Seven patients had mild symptoms. Exanthema was present in all patients. All but one patient had fever and nonproductive cough. Koplik spots could be observed in 5 patients. Measles can be mild in BM transplant recipients. Exanthema is frequently present but not often typical. Immunity to measles decreases after day +365 after BMT. Additional studies are needed to evaluate the safety of measles vaccine after the first year of BMT, mostly during outbreaks.
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Affiliation(s)
- Clarisse M Machado
- Virology Laboratory, Instituto de Medicina Tropical de São Paulo, University of São Paulo Medical School, SP, Brazil.
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Machado CM, Menezes RX, Macedo MC, Mendes AV, Boas LS, Castelli JB, Dulley FL, Pannuti CS. Extended antigenemia surveillance and late cytomegalovirus infection after allogeneic BMT. Bone Marrow Transplant 2001; 28:1053-9. [PMID: 11781616 DOI: 10.1038/sj.bmt.1703282] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2000] [Accepted: 09/30/2001] [Indexed: 11/09/2022]
Abstract
Late CMV disease remains a major concern in allogeneic BMT recipients. Few surveillance data are available on the occurrence of CMV infection and recurrences after day +100. We evaluated the occurrence of antigenemia (AG) recurrences until day +365 in 76 patients who received pre-emptive ganciclovir (GCV) therapy prompted by AG > or = 2 positive cells. Sixty-two episodes of AG recurrences were detected in 33 of the 52 patients who had positive AG. Survival analysis showed a 45.4% probability of AG recurrence on day +100, 64.8% on day +180 and 71.2% on day +365. The median time for AG recurrences was 113 (35 to 343) days. Thirty-five of the 62 episodes (56.4%) occurred after day +100. More than 70% of the patients responded to a 2-week course of GCV and no CMV disease was observed shortly after discontinuation of GCV. The Cox proportional model showed a significant effect of AG recurrences on patient's follow-up only when the patient developed chronic GVHD (P = 0.012). Extended surveillance favored early introduction of GCV and late CMV pneumonia occurred in only one of the 76 patients (1.3%). AG recurrences are frequent after day +100 and extended surveillance until day +365 is recommended for patients who develop chronic GvHD.
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Affiliation(s)
- C M Machado
- Virology Laboratory (LIM 52-HCFMUSP) of Instituto de Medicina Tropical de São Paulo, São Paulo, Brazil
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Heins-Vaccari EM, Machado CM, Saboya RS, Silva RL, Dulley FL, Lacaz CS, Freitas Leite RS, Hernandez Arriagada GL. Phialemonium curvatum infection after bone marrow transplantation. Rev Inst Med Trop Sao Paulo 2001; 43:163-6. [PMID: 11452326 DOI: 10.1590/s0036-46652001000300009] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report a case of cutaneous infection caused by Phialemonium curvatum GAMS et COOKE, 1983, after bone marrow transplantation. The genus Phialemonium was created by GAMS & MCGINNIS in 1983 including three new species: Ph. obovatum, Ph. curvatum and Ph. dimorphosporum, and represents an intermediate genus between Acremonium and Phialophora. Nowadays, the genus Phialemonium is considered to be a pheoid fungus which may cause the eventual lesions observed in pheo- and hyalohyphomycosis. Species of this genus have been described as opportunistic agents in humans and animals, mainly as a result of immunosuppression. In the present case, the patient had multiple myeloma and received an allogenic bone marrow transplant from his HLA-compatible brother. Two months after transplantation, he developed purplish and painful nodular lesions on the right ankle. Some of these lesions drained spontaneously and apparently hyaline mycelial filaments were observed, whose culture was initially identified as Acremonium sp. Subsequent studies showed that the fungus was Phialemonium curvatum. The infection was treated with amphotericin B, followed by ketoconazole. The patient was submitted to surgical debridement followed by two skin grafts to repair the bloody area. The duration of the treatment was 4 months and secondary prophylaxis with ketoconazole alone was maintained for one additional month. No recurrence was observed after discontinuation of treatment. The authors comment on the pathogenicity of the genus Phialemonium.
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Affiliation(s)
- E M Heins-Vaccari
- Laboratório de Micologia, Instituto de Medicina Tropical de São Paulo. Brasil
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Machado CM, Macedo MC, Medeiros RS, Massumoto C, Silva AC, Castelli JB, Silva RL, Ostronoff M, Dulley FL. Primary Pneumocystis carinii prophylaxis with aerosolized pentamidine after bone marrow transplantation. Acta Haematol 2000; 99:54-6. [PMID: 9490570 DOI: 10.1159/000040719] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patients undergoing immunosuppressive therapy have a 21% risk of developing <i>Pneumocystis carinii</i> pneumonia (PCP) if no prophylaxis is used [1]. During the first 6 months after bone marrow transplantation (BMT), the recipients have an estimated 9% risk of developing PCP [2]. Standard prophylaxis with sulfamethoxazole and trimethoprim (SMX/TMP) daily or intermittent doses has been used effectively in transplant and other immunosuppressed patients [2–4]. However, poor compliance and undesirable myelotoxicity are expected with this schedule, especially if other myelotoxic drugs such as ganciclovir have to be administered. Aerosolized pentamidine (AP) has been considered an attractive alternative in AIDS patients who do not tolerate SMX/TMP because only 4% of the patients discontinue AP prophylaxis due to side effects [5].
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Affiliation(s)
- C M Machado
- BMT Program, Pró Sangue Hemocentro Foundation and Discipline of Hematology, São Paulo, Brazil
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Machado CM, Dulley FL, Boas LS, Castelli JB, Macedo MC, Silva RL, Pallota R, Saboya RS, Pannuti CS. CMV pneumonia in allogeneic BMT recipients undergoing early treatment of pre-emptive ganciclovir therapy. Bone Marrow Transplant 2000; 26:413-7. [PMID: 10982288 DOI: 10.1038/sj.bmt.1702526] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The incidence, treatment and outcome of CMV interstitial pneumonia (CMV-IP) were reviewed in 139 consecutive allogeneic BMT patients undergoing extended CMV antigenemia surveillance and two different ganciclovir (GCV) strategies to control CMV infection. Nineteen cases of CMV-IP were reviewed, 16 of 63 patients (25.4%) who received early GCV treatment (ET) and three of 76 patients (3.9%) who received preemptive (PE) GCV therapy. In the ET group, the median time for occurrence of CMV-IP was 55 (range 36 to 311) days. Two patients had three episodes of CMV-IP recurrences after day +100. CMV-IP-related death occurred in two patients (15.4%). In the PE group, 41 patients received pre-emptive GCV therapy prompted by the appearance of positive antigenemia > or =2 cells. The median time for the occurrence of CMV-IP was 92 (range 48 to 197) days. Response to therapy was observed when GCV was introduced within 6 days of antigenemia positivity. The use of IVIg in association with GCV did not play a major role in response to therapy. The median time for occurrence of CMV-IP was delayed during PE strategy and the cost-effectiveness of CMV surveillance after day +100 should be investigated in this population.
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MESH Headings
- Adolescent
- Adult
- Antigens, Viral/metabolism
- Antiviral Agents/administration & dosage
- Antiviral Agents/standards
- Bone Marrow Transplantation/adverse effects
- Child
- Child, Preschool
- Cytomegalovirus Infections/drug therapy
- Cytomegalovirus Infections/epidemiology
- Cytomegalovirus Infections/immunology
- Drug Therapy, Combination
- Ganciclovir/administration & dosage
- Ganciclovir/standards
- Humans
- Immunoglobulins, Intravenous/administration & dosage
- Immunoglobulins, Intravenous/standards
- Incidence
- Lung Diseases, Interstitial/drug therapy
- Lung Diseases, Interstitial/epidemiology
- Lung Diseases, Interstitial/virology
- Middle Aged
- Pneumonia, Viral/drug therapy
- Pneumonia, Viral/epidemiology
- Premedication
- Retrospective Studies
- Survival Rate
- Transplantation, Homologous/adverse effects
- Treatment Outcome
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Affiliation(s)
- C M Machado
- BMT Program, Fundação Pró Sangue Hemocentro de São Paulo, Discipline of Hematology, Brazil
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Machado CM, Martins MA, Heins-Vaccari EM, Lacaz CDS, Macedo MC, Castelli JB, Medeiros RS, Silva RL, Dulley FL. Scedosporium apiospermum sinusitis after bone marrow transplantation: report of a case. Rev Inst Med Trop Sao Paulo 1998; 40:321-3. [PMID: 10030078 DOI: 10.1590/s0036-46651998000500010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A forty-year-old man underwent an allogeneic BMT from his HLA identical sister. GvHD prophylaxis was done with cyclosporine (CyA), methotrexate and prednisone (PDN). On day +90 extensive GvHD was noted and higher doses of immunosuppressive drugs alternating CyA with PDN were initiated. Patient's follow-up was complicated by intermittent episodes of leukopenia and monthly episodes of sinusitis or pneumonia. One year after BMT, the patient developed hoarseness and nasal voice. No etiologic agent could be identified on a biopsy sample of the vocal chord. Upon tapering the doses of immunosuppressive drugs, the patient had worsening of chronic GvHD and was reintroduced on high doses of cyclosporine alternating with prednisone on day +550. Three months later, GvHD remained out of control and the patient was started on azathioprine. On day +700, hoarseness and nasal voice recurred. Another biopsy of the left vocal chord failed to demonstrate infection. Episodes of sinusitis became more frequent and azathioprine was withheld 3 months after it was started. One month later, the patient had bloody nasal discharge and surgical drainage of maxillary sinuses was performed. Histopathology showed hyphae and cultures grew Scedosporium apiospermum. Itraconazole 800 mg/day was initiated. The patient developed progressive respiratory failure and died 15 days later.
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Affiliation(s)
- C M Machado
- Mycology Laboratory, Instituto de Medicina Tropical de São Paulo, Brasil
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Machado CM, Macedo MC, Castelli JB, Ostronoff M, Silva AC, Zambon E, Massumoto C, Chamone DF, Dulley FL. Clinical features and successful recovery from disseminated nocardiosis after BMT. Bone Marrow Transplant 1997; 19:81-2. [PMID: 9012936 DOI: 10.1038/sj.bmt.1700616] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nocardiosis has rarely been described after BMT. When the doses of immunosuppressive therapy were tapered, a 46-year-old BMT recipient developed chronic graft-versus-host disease (GVHD) and immunosuppresive drugs were increased. Sixteen days later the patient developed nocardiosis diagnosed by lung biopsy. Trimethoprim/sulfamethoxazole (TMP/SMZ) was initiated but the doses were reduced because of rising creatinine levels. Skin and cerebral dissemination of nocardiosis was observed and TMP/SMZ doses were increased. After 4 months, the brain lesion was unaltered despite resolution of pulmonary lesions. Clinical improvement was observed after drainage of the brain abscess.
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Affiliation(s)
- C M Machado
- BMT Program, Fundação Pró Sangue Hemocentro de São Paulo, Brazil
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Macedo MC, Dulley FL, Ostronoff M, Machado CM, Zambon E, Matsumoto C, Dorlhiac-Llaccer P, Chamone DF. Effectiveness of amphotericin B in lipid emulsion for treating fungal septicemia in granulocytopenic patients. Clin Infect Dis 1994; 19:366-7. [PMID: 7986930 DOI: 10.1093/clinids/19.2.366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Machado CM, Boas LS, Canto CL, Andrade Júnior HF, Castelli J, Bohringer P, Ostronoff M, Dulley F, Pannuti CS. Disseminated toxoplasmosis after BMT--report of a case. Bone Marrow Transplant 1992; 10:475-8. [PMID: 1464016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Machado CM, Fink MC, Boas LS, Sumita LM, Weinberg A, Shiguematsu K, Souza IC, Casanova LD, Pannuti CS. [Perinatal infection due to cytomegaloviruses in a public hospital of the municipality of São Paulo: a prospective study]. Rev Inst Med Trop Sao Paulo 1991; 33:159-66. [PMID: 1668902 DOI: 10.1590/s0036-46651991000200012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In order to demonstrate the occurrence of CMV perinatal infection in a middle socioeconomic class population, the authors conducted a 8-month prospective study in 37 children, not infected congenitally, born in a public hospital of São Paulo city, Prevalence of CMV-IgG antibodies in mothers, detected by immunoenzymatic assay (ELISA), was 92.7%. Survival analysis showed that the risk of acquiring CMV perinatal infection diagnosed by virus isolation in human fibroblasts was 30.9%. When the diagnostic method was detection of IgM class antibodies by indirect immunofluorescence the risk was 8.1% (p < 0.05). Milk samples inoculated in human fibroblasts failed to demonstrate the presence of virus. The infected children did not present any signal of disease in a 4-month follow-up.
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Affiliation(s)
- C M Machado
- Departamento de Doenças Infecciosas e Parasitárias, Escola Paulista de Medicina São Paulo, Brasil
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