Tan Sophie Seine Xuan, Ho Quan Yao, Thangaraju Sobhana, Tan Thuan Tong, Kee Terence, Chung Shimin Jasmine
Department of Infectious Diseases, Singapore General Hospital, Singapore.
Department of Renal Medicine, Singapore General Hospital, SingHealth Duke-NUS Transplant Centre, Singapore.
Singapore Med J. 2024 Apr 1;65(4):235-241. doi: 10.11622/smedj.2021167. Epub 2021 Nov 8.
Dengue is a mosquito-borne viral infection endemic in Singapore. Its impact on renal transplantation is limited to small case series. We aimed to characterise the clinical presentation and outcomes of dengue infection among renal transplant recipients in Singapore.
We conducted a 15-year retrospective review of dengue in renal transplant patients treated at Singapore General Hospital between January 2005 and October 2019. The diagnosis of dengue was made if there were a compatible clinical syndrome and a positive dengue diagnostic assay (dengue non-structural 1 antigen, immunoglobulin M or reverse transcriptase-polymerase chain reaction).
Of the 31 patients diagnosed with dengue, 18 (58.1%) were deceased donor recipients. The median age was 52 (interquartile range [IQR] 40-61) years; 16 (51.6%) were females. The median time to diagnosis was 99 (IQR 18-169) months from transplant. The most common clinical symptoms were fever (87.1%), myalgia (41.9%), gastrointestinal symptoms (38.7%) and headache (25.8%). Nineteen (61.3%) patients had dengue without warning signs, nine (29.0%) had dengue with warning signs, three (9.7%) had severe dengue and 30 (96.8%) were hospitalised. Seventeen (54.8%) patients had graft dysfunction, 16 (94.1%) of whom had recovery of graft function. One (3.2%) patient required dialysis and subsequently died. There were two cases of donor-derived infections (DDIs) with favourable outcomes.
Our experience with dengue in renal transplant recipients is concordant with published data. Although graft dysfunction is common, it is often transient with favourable outcomes. Outpatient management may be considered for mild infections. Although dengue DDIs are uncommon, more stringent donor screening may be considered in endemic regions.
登革热是一种由蚊子传播的病毒感染，在新加坡为地方病。其对肾移植的影响仅限于小病例系列研究。我们旨在描述新加坡肾移植受者中登革热感染的临床表现和结局。
我们对2005年1月至2019年10月在新加坡总医院接受治疗的肾移植患者的登革热进行了为期15年的回顾性研究。如果存在符合的临床综合征且登革热诊断检测（登革热非结构1抗原、免疫球蛋白M或逆转录聚合酶链反应）呈阳性，则诊断为登革热。
在31例诊断为登革热的患者中，18例（58.1%）为已故供体受者。中位年龄为52岁（四分位间距[IQR]40 - 61岁）；16例（51.6%）为女性。从移植到诊断的中位时间为99个月（IQR 18 - 169个月）。最常见的临床症状为发热（87.1%）、肌痛（41.9%）、胃肠道症状（38.7%）和头痛（25.8%）。19例（61.3%）患者患无警示体征的登革热，9例（29.0%）患伴有警示体征的登革热，3例（9.7%）患重症登革热，30例（96.8%）住院治疗。17例（54.8%）患者出现移植肾功能障碍，其中16例（94.1%）移植肾功能恢复。1例（3.2%）患者需要透析，随后死亡。有2例供体源性感染（DDIs），结局良好。
我们在肾移植受者中治疗登革热的经验与已发表的数据一致。虽然移植肾功能障碍很常见，但通常是短暂的，结局良好。对于轻度感染可考虑门诊治疗。虽然登革热DDIs不常见，但在流行地区可考虑更严格的供体筛查。
