Dengue Fever Among Renal Transplant Recipients: A Series of 10 Cases in a Tropical Country

Costa, Silvana Daher; Silva, Geraldo Bezerra da; Jacinto, Camilla N.; Martiniano, Lorena Vasconcelos Mesquita; Amaral, Yago Sucupira; Paes, Fernando José Villar Nogueira; Sales, Maria Luiza de Mattos Brito Oliveira; Esmeraldo, Ronaldo de Matos; Daher, Elizabeth De Francesco

doi:10.4269/ajtmh.15-0038

Cited by 30 publications

(25 citation statements)

References 9 publications

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“…This group consisted of 29 patients (Male 48.3%), from six countries, across six studies [3–5, 7, 13, 14]. As explained earlier in the text, two studies were left out in forming the composite group.…”

Section: Resultsmentioning

confidence: 99%

“…The affected countries are places of great tourist attraction, and travelling transplant recipients are at risk too. Dengue is described as a mild disease in renal transplant patients [6], but severe morbidity (graft failure needing dialysis and graft nephrectomy) [7], and mortality [4], had been reported. This paper reviews demographical, clinic-pathological and immunosuppression profiles of the renal transplant patients with confirmed dengue infection.…”

Section: Introductionmentioning

confidence: 99%

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Dengue fever in renal transplant patients: a systematic review of literature

2017

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BackgroundDengue fever in renal transplanted patients has not been studied well, and we review all the literature about episodes dengue fever in renal transplant patients.MethodsThe aim was to describe clinico-pathological characteristics, immunosuppressive protocols, need renal outcome and mortality. PubMed, LILACS, Google Scholar and Research Gate were searched for “Dengue” and “Renal/Kidney Transplantation” with no date limits. Hits were analyzed by two researchers separately.ResultsFever, myalgia, arthralgia and headache was significantly lower than normal population, while pleural effusions and ascites were observed more. Incidence of severe dengue is significantly higher among transplant patients in this review, as well as they had a significantly higher mortality (8.9% vs 3.7%, p = 0.031). Age, period after transplantation and immunosuppressive profile had no effect on disease severity, mortality or graft out come. Presence of new bleeding complications and ascites was associated with more severe disease (p < 0.001 and p = 0.005), death (p = 0.033) or graft loss (p = 0.035). Use of tacrolimus was associated with new bleeding complications (p = 0.027), and with ascites (p = 0.021), but not with thrombocytopenia. 25% of patients with primary disease fail to mount an IgG response by 15 weeks of the illness. 58.9% had graft dysfunction during illness. Postoperative transplanted patients were at risk of severe disease and unfavorable outcome.ConclusionsThe physical and laboratory findings in dengue fever in renal transplanted patients differ from the general population. Some degree of graft dysfunction is common during the illness, but only a minority develops graft failure.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dengue fever in renal transplant patients: a systematic review of literature

2017

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“…The current paradigm is that dengue is passed from human to human by the bite of an infected mosquito. However, reports of nonvector transmission are steadily escalated . Most of these nonvector DENV infections are underreported even in endemic countries.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, DENV is transmitted to humans via the bite of the infectious female mosquitos of the genus Aedes , mainly A. aegypti . Recently, nonvector DENV transmission has been reported in the literature, including intravenous and/or intradermal inoculation, mucocutaneous exposure, blood transfusion, hematopoietic stem cell transplantation (HSCT), solid organ transplantation, needlestick in patient care or laboratory accident, vertical transmission from mother to infant, and breastfeeding . This line of evidence suggests that DENV can be transmitted through direct exposure through blood/body fluid exposure, leading to disease.…”

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confidence: 99%

Identification and characterization of permissive cells to dengue virus infection in human hematopoietic stem and progenitor cells

Hsu

Lai

et al. 2019

Transfusion

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BACKGROUND Dengue virus (DENV) is a significant threat to public health in tropical and subtropical regions, where the frequency of human migration is increasing. Transmission of DENV from donors to recipients after hematopoietic stem cell transplantation has been steadily described. However, the underlying mechanisms remain unclear. STUDY DESIGN AND METHODS Freshly isolated bone marrow (BM) was subjected to DENV infection, followed by multicolor fluorescence‐activated cell sorting (FACS) analysis. Virus in supernatants was collected and analyzed by plaque assay. RESULTS DENV‐1 to DENV‐4 could effectively infect freshly obtained BM and produced infectious virus. DENV infection did not change the quantitative population of hematopoietic stem and progenitor cells (HSPCs), megakaryocytic progenitor cells (MkPs) and megakaryocytes. Additionally, DENV antigen, nonstructural protein 1, was enriched in HSPCs and MkPs of DENV infected marrow cells. CD34+, CD133+, or CD61+ cells sorted out from BM were not only the major contributing targets facilitating the DENV infection directly but also facilitated the spread of DENV into other cells when cocultured. CONCLUSION Results suggest that DENV can efficiently infect HSPCs, which might jeopardize the recipients if DENV‐infected cells were subsequently used. We therefore raise the need for DENV screening for both the donors and recipients of hematopoietic stem cell transplantation, especially for donors exposed to endemic areas, to mitigate DENV infection in immunocompromised recipients.

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“…In the case series from India, three out of eight patients developed DHF and expired 12. Four patients out of 10 dengue cases developed DHF in the series from Brazil but none of them expired 13. The very first series from Singapore with six patients did not have any cases of DHF 14.…”

Section: Discussionmentioning

confidence: 88%

Intravenous immunoglobulin therapy for dengue capillary leak syndrome in a renal allograft recipient

Subbiah

Mahajan²,

Yadav

et al. 2018

BMJ Case Reports

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A 45-year-old man presented 4 months after ABOi renal transplantation with febrile illness and bicytopenia necessitating cessation of mycophenolate mofetil. Dengue non-structural protein 1 antigen (NS1 Ag) test was positive. Lowest total leucocyte count was 3.1×10/L and platelet count was 14×10/L. As fever subsided, patient became tachypneic with abdominal distention and hypotension. Ultrasonographic evaluation revealed ascites, gall bladder wall oedema and bilateral pleural effusion consistent with dengue capillary leak syndrome. He developed massive ascites with abrupt weight gain of 4 kg within 24 hours and worsening renal dysfunction. Patient was deteriorating rapidly in spite of adequate supportive care and we gave a trial of intravenous immunoglobulin (0.5 g/kg/day) for 5 days. Patient improved from day 2, and by day 3, he became haemodynamically stable and recovered completely. Patient was stable at discharge and is on regular follow-up.

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Dengue Fever Among Renal Transplant Recipients: A Series of 10 Cases in a Tropical Country

Cited by 30 publications

References 9 publications

Dengue fever in renal transplant patients: a systematic review of literature

Dengue fever in renal transplant patients: a systematic review of literature

Identification and characterization of permissive cells to dengue virus infection in human hematopoietic stem and progenitor cells

Intravenous immunoglobulin therapy for dengue capillary leak syndrome in a renal allograft recipient

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