Abstract
Introduction: The growing number of transplants (Tx) in developing countries has brought the impact of neglected tropical diseases such as Dengue infection (DI) and the natural course of this disease to the attention of researchers dealing with kidney Tx in tropical areas. Objectives: To report the impact of DI in 11 Tx recipients (KTx) in a single center in Brazil. Methods: From January 2010 to December 2013, all KTx with confirmed diagnosis of DI were studied. Results: Eleven KTx requiring hospitalization were diagnosed as DI in 306 KTx (3.6%). Two cases occurred in 2010 and 9 during the outbreak of 2013. Patients were a mean age of 48 ±17 years, Caucasian (81%), males (63%), and non-diabetics (9%). Immunosuppression protocols consisted of induction therapy in 82% of cases; 72% were using calcineurin inhibitors and all patients were taking steroids. Diagnosis was made 34 ± 26 months after transplantation and the principal clinical features were fever (72%), muscular pain (73%), leucopenia (90%), and thrombocytopenia (81%). Ten (91%) cases were diagnosed as classic dengue fever (DF), and one had dengue hemorrhagic fever/shock syndrome (DHF/DSS). All diagnoses were confirmed by at least one of the following serologic tests: NS1- dengue nonstructural protein 1 antigen (3/4; 27%), dengue-specific immunoglobulin M serology (7/8; 64%), or dengue virus serotype by reverse transcriptase-polymerase chain reaction (7/9; 64%). The viremia time was 6 ± 7 (3-28) days, and co-infection with cytomegalovirus was present in 18% of cases. Dengue type 1 was the main subtype (6 cases). Graft dysfunction occurred in 10 patients, but none lost their grafts after a mean follow-up time of 17±14 months. The only patient with DHF/DSS had fulminant course and died (9%). Conclusions: The most common DI virus affecting our Tx population was type1. It seems that the clinical manifestation disease in KTx is not different from that in the general population. However, KTx seems to carry the risk of life-threatening complications in patients with DHF/DSS.
Published Version
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