Abstract
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.
Highlights
Dengue virus (DENV), an arbovirus transmitted by the Aedes mosquito, is the causative agent of Dengue infection (DI) and is the major cause of morbidity and mortality in many endemic Asian and South American countries [1,2,3]
This work is part of an arbovirus surveillance program approved by the Ethics Committee in Research of the Faculty of Medicine of São Josedo Rio Preto–FAMERP with waiver of informed consent as this was a retrospective study and the data were analyzed anonymously
Demographic characteristics, along with the most common initial clinical symptoms and laboratorial findings of patients are shown in Tables 1 and 2
Summary
Dengue virus (DENV), an arbovirus transmitted by the Aedes mosquito, is the causative agent of Dengue infection (DI) and is the major cause of morbidity and mortality in many endemic Asian and South American countries [1,2,3]. Dengue virus infection in kidney transplant recipients that are usually associated with the introduction of a new serotype [4,5,6]. Our region is a DENV surveillance and control area due to the endemic circulation of different serotypes [8,9,10,11] and, during the period from 2015 to 2016, our city faced a dengue epidemic, with 21,839 confirmed and 16,291 dengue-probable cases [12,13]
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