1Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
2Nephrology Division, Federal University of São Paulo, São Paulo, Brazil.
Am J Trop Med Hyg. 2021 Jun 28;105(3):564-572. doi: 10.4269/ajtmh.19-0926.
Reports on tropical infections among kidney transplant (KT) recipients have increased in recent years, mainly because of the growing number of KT programs located in tropical and subtropical areas, and greater mobility or migration between different areas of the world. Endemic in emerging and developing regions, like most countries in Latin America, tropical infections are an important cause of morbidity and mortality in this population. Tropical infections in KT recipients may exhibit different pathways for acquisition compared with those in nonrecipients, such as transmission through a graft and reactivation of a latent infection triggered by immunosuppression. Clinical presentation may differ compared with that in immunocompetent patients, and there are also particularities in diagnostic aspects, treatment, and prognosis. KT patients must be screened for latent infections and immunized properly. Last, drug-drug interactions between immunosuppressive agents and drugs used to treat tropical infections are an additional challenge in KT patients. In this review, we summarize the management of tropical infections in KT patients.
近年来,有关肾移植(KT)受者热带感染的报告有所增加,主要是因为位于热带和亚热带地区的 KT 项目越来越多,以及世界不同地区之间的流动性或迁移增加。热带感染在新兴和发展中地区流行,如拉丁美洲的大多数国家,是该人群发病率和死亡率的重要原因。与非受者相比,KT 受者的热带感染可能通过不同途径获得,例如通过移植物传播和免疫抑制引发潜伏感染的再激活。临床表现可能与免疫功能正常的患者不同,在诊断方面、治疗和预后方面也存在特殊性。必须对 KT 患者进行潜伏感染筛查并进行适当免疫接种。最后,免疫抑制剂与用于治疗热带感染的药物之间的药物相互作用是 KT 患者面临的另一个挑战。在这篇综述中,我们总结了 KT 患者热带感染的处理方法。