Clinical and laboratorial profiles of dengue virus infection in kidney transplant recipients: Report of a single center


Autoři: Ida Maria Maximina Fernandes-Charpiot aff001;  Cassia Fernanda Estofolete aff002;  Heloisa Cristina Caldas aff001;  Gabriela Rodrigues de Souza aff001;  Rita de Cássia Martins Alves da Silva aff001;  Maria Alice Sperto Ferreira Baptista aff001;  Mauricio Lacerda Nogueira aff002;  Mario Abbud-Filho aff001
Působiště autorů: Kidney Transplant Unit, Faculty of Medicine of São José do Rio Preto, FAMERP—Hospital de Base São José do Rio Preto, São José do Rio Preto, Brazil aff001;  Laboratory of Research in Virology, Faculty of Medicine of São José do Rio Preto, FAMERP, São José do Rio Preto, Brazil aff002;  Instituto de Urology e Nefrologia, São José do Rio Preto, Brazil aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0219117

Souhrn

Dengue infection (DI) is the most important arboviral infection in the world. The majority of immunocompetent patients will have asymptomatic or mild infections, but the degree of dengue severity in kidney transplant recipients (KTx) is unknown. In this study, we report the clinical profile and outcomes of 39 dengue cases in KTx. From a total of 1,186 KTx outpatients in follow-up we reviewed clinical and laboratory records of 60 (5%) patients admitted with suspected DI initially screened by NS-1, IgM, and when possible, multiplex nested PCR. The prevalence of DI in KTx was 3% (39/1,118), with symptoms leading to hospital admission being fever, myalgia, malaise, and headache. Laboratory tests showed leucopenia, thrombocytopenia, and liver enzyme elevation. DI was confirmed by positivity of NS-1 (33%), IgM (69%), and/or RT-PCR (59%). Twenty-three patients (59%) had dengue with warning signs, and 15% had severe dengue, 2 of them with a fatal course. Acute graft dysfunction occurred in 59% (mean nadir serum creatinine: 2.9 ± 2.6mg/dL), 4 of them requiring dialysis. CMV coinfection diagnosed in 19% of the cases and patients was associated with worse clinical presentation. Our results suggest that KTx with DI presented initial physical and laboratorial profile similar to the general population. However, DI in KTx seems to have a higher risk for graft dysfunction, severe dengue, and death. Because CMV coinfection aggravates the DI clinical presentation and recovery, it must be evaluated in all cases.

Klíčová slova:

Brazil – Co-infections – Creatinine – Cytomegalovirus infection – Human cytomegalovirus – Reverse transcriptase-polymerase chain reaction – Serology – Arboviral infections


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2019 Číslo 10