Nasim A, Anis S, Baqi S, Akhtar S F, Baig-Ansari N
Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Transpl Infect Dis. 2013 Oct;15(5):516-25. doi: 10.1111/tid.12114. Epub 2013 Jul 25.
In Pakistan, dengue viral infection has become hyper-endemic. Renal transplantation is also expanding. We aimed to study dengue in renal transplant recipients (RTR).
We conducted a study of RTR reported to be anti-dengue immunoglobulin-M antibody positive from January 2009 to December 2010 at our institution in Karachi and follow their clinical course and outcome.
Median age was 28 years; 75 (73.7%) were males. Clinical presentation included fever in 82 (80.4%), gastrointestinal symptoms in 35 (34.3%), hemorrhagic complications in 9 (8.8%), and thrombocytopenia in 97 (95%), which was of >15 days duration in 24%. Fever was seen less frequently in patients on high-dose (>7.5 mg) steroids as compared with low-dose (≤7.5 mg) steroids. Forty-four patients (43%) had primary and 58 (56.8%) had secondary dengue infection. Dengue fever (DF) occurred in 90 (88%), and dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) occurred in 12 (11.7%). DHF/DSS was seen in 3 (6.8%) of those with primary and in 9 (15.5%) of those with secondary infection (P < 0.22). In secondary infection, patients on cyclosporine-containing regimen had less severe disease, with DHF/DSS in 22% as opposed to DF in 59% (P < 0.04). Of 102 RTR, 68 (66.7%) had graft dysfunction, 5 of whom died. Of the remaining 63, in 54 patients (85.7%) creatinine returned to baseline by an average of 12.6 days. Of 102 patients, 95 (93%) recovered and 7 (6.9%) died, 6 of whom had bacteremia with sepsis and 1 had respiratory failure. None died due to dengue infection alone.
In conclusion, in RTR without life-threatening co-morbidities, the clinical course of dengue infection is mild, with good recovery and preserved renal function.
在巴基斯坦，登革病毒感染已成为高度地方性流行疾病。肾移植也在不断增加。我们旨在研究肾移植受者（RTR）中的登革热情况。
我们对2009年1月至2010年12月期间在卡拉奇我们机构报告抗登革热免疫球蛋白M抗体呈阳性的肾移植受者进行了一项研究，并跟踪他们的临床病程和结局。
中位年龄为28岁；75名（73.7%）为男性。临床表现包括发热82例（80.4%）、胃肠道症状35例（34.3%）、出血并发症9例（8.8%）和血小板减少97例（95%），其中24%的患者血小板减少持续超过15天。与低剂量（≤7.5mg）类固醇治疗的患者相比，高剂量（>7.5mg）类固醇治疗的患者发热较少见。44例患者（43%）为原发性登革热感染，58例（56.8%）为继发性登革热感染。登革热（DF）发生90例（88%），登革出血热/登革休克综合征（DHF/DSS）发生12例（11.7%）。原发性感染患者中3例（6.8%）出现DHF/DSS，继发性感染患者中9例（15.5%）出现DHF/DSS（P<0.22）。在继发性感染中，接受含环孢素方案治疗的患者病情较轻，22%出现DHF/DSS，而59%为DF（P<0.04）。102例肾移植受者中，68例（66.7%）出现移植功能障碍，其中5例死亡。其余63例中，54例患者（85.7%）的肌酐平均在12.6天恢复至基线水平。102例患者中，95例（93%）康复，7例（6.9%）死亡，其中6例因菌血症伴败血症死亡，1例因呼吸衰竭死亡。无一例仅因登革热感染死亡。
总之，在没有危及生命的合并症的肾移植受者中，登革热感染的临床病程较轻，恢复良好且肾功能得以保留。
