Spectrum of Pulmonary Infections in Renal Transplant Recipients in the Tropics: A Single Center Study

Kalra, VK; Agarwal, Sanjay Kumar; Khilnani, Gopi C; Kapil, Arti; Dar, Lalit; Singh, Urvashi; Mirdha, Bijay Ranjan; Xess, Immaculata; Gupta, Sanjay; Bhowmik, D; Tiwari, Suresh; Dash, Suvashis

doi:10.1007/s11255-005-4012-9

Cited by 16 publications

(20 citation statements)

References 22 publications

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“…It would be prudent to practice a low threshold for early invasive diagnostic evaluation as a delay in diagnosis can lead to rapid deterioration and poor outcomes in immunocompromised patients. Bacterial infections are the predominant cause of pneumonia in renal transplant recipients [10,12–15] and this was also evident in our study (29.4%). They occurred throughout the post‐transplant course highlighting the susceptibility of immunocompromised patients to community‐acquired infections.…”

Section: Discussionsupporting

confidence: 83%

Pulmonary infections after renal transplantation: a prospective study from a tropical country

Mangalgi

Madan²,

Das

et al. 2021

Transpl Int

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Summary Pulmonary infection is a leading cause of morbidity and mortality in renal transplant recipients. In a prospective study, we characterized their epidemiology in a tropical country with high infectious disease burden. Adult renal transplant recipients presenting with pulmonary infections from 2015 to 2017 were evaluated using a specific diagnostic algorithm. 102 pulmonary infections occurred in 88 patients. 32.3% infections presented in the first year, 31.4% between 1 and 5, and 36.3% beyond 5 years after transplantation. Microbiological diagnosis was established in 69.6%, and 102 microorganisms were identified. Bacterial infection (29.4%) was most common followed by tuberculosis (23.5%), fungal (20.6%), Pneumocystis jiroveci (10.8%), viral (8.8%), and nocardial (6.9%) infections. Tuberculosis(TB) and bacterial infections presented throughout the post‐transplant period, while Pneumocystis (72.7%), cytomegalovirus (87.5%) and nocardia (85.7%) predominantly presented after >12 months. Fungal infections had a bimodal presentation, between 2 and 6 months (33.3%) and after 12 months (66.7%). Four patients had multi‐drug resistant(MDR) TB. In 16.7% cases, plain radiograph was normal and infection was diagnosed by a computed tomography imaging. Mortality due to pulmonary infections was 22.7%. On multivariate Cox regression analysis, use of ATG (HR‐2.39, 95% CI: 1.20–4.78, P = 0.013), fungal infection (HR‐2.14, 95% CI: 1.19–3.84, P = 0.011) and need for mechanical ventilation (9.68, 95% CI: 1.34–69.82, P = 0.024) were significant predictors of mortality in our patients. To conclude, community‐acquired and endemic pulmonary infections predominate with no specific timeline and opportunistic infections usually present late. Nocardiosis and MDR‐TB are emerging challenges.

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Section: Discussionsupporting

confidence: 83%

Pulmonary infections after renal transplantation: a prospective study from a tropical country

Mangalgi

Madan²,

Das

et al. 2021

Transpl Int

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“…Among renal transplant recipients with lung infiltrates, invasive procedures such as bronchoalveolar lavage has a diagnostic yield of 75.8%. 11 In both of our cases, the diagnosis was made through culture of bronchial washings alone and all other clinical specimens like sputum and pleural fluid, blood, bone marrow were negative. The only smear to show nocardial species was the Gram and modified Kinyoun staining of bronchial washings in case no.…”

Section: Discussionmentioning

confidence: 70%

Pulmonary Nocardiosis Owing to Nocardia otitidiscaviarum

Gowrinath¹,

Attur

Bairy

et al. 2008

Journal of Bronchology

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Among the nocardial species, Nocardia otitidiscaviarum (formerly Nocardia caviae) as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals. We report 2 renal transplant recipients presenting with pleural effusion and acute respiratory distress syndrome owing to N. otitidiscaviarum. Culture of bronchial washings led to the diagnosis in both the cases and established importance of early bronchoscopy in diagnosing opportunistic pulmonary infections in immunocompromised individuals. Severe side effects of trimethoprim-sulfamethoxazole (TMP-SMX) in both the cases suggest the need to evolve safe and effective alternate drug regimens to treat nocardiosis. (J Bronchol 2008;15:113-115) CASE REPORTThe incidence of nocardiosis is low (0.2%) in renal transplant recipients and the most frequent pathogen is Nocardia asteroids complex. 1 Nocardia otitidiscaviarum (formerly Nocardia caviae) is an infrequent cause of human disease and has been isolated in less than 5% cases of all the nocardial infections. 2,3 In humans, N. otitidiscaviarum is a rare cause of pulmonary disease, and the site of disease in most of the cases are cutaneous or subcutaneous. 4,5 We report 2 cases of pulmonary nocardiosis caused by N. otitidiscaviarum in renal transplant recipients. Case Report 1A 23-year-old unmarried male student was referred for evaluation of right pleural effusion. He suffered with right-sided pleuritic chest pain and fever of 10 days duration. Cough was occasional and productive of scanty mucoid sputum. He had undergone renal transplantation for IgA nephropathy 2 years earlier with his mother as the donor. Currently, he was receiving azathioprine (75 mg/d) and prednisolone (15 mg/d) as an immunosuppressive therapy. On physical examination, he looked sick with pallor and had pedal edema. Chest examination revealed signs of pleural effusion on right side.Investigations revealed total leukocyte count of 12,400/ mm 3 with a differential of 89% neutrophils. Blood chemistry revealed fasting blood sugar of 84 mg/dL, blood urea nitrogen of 173 mg/dL, and serum creatinine of 4 mg/dL. A chest radiograph revealed right pleural effusion and blunting of left costophrenic angle. Computed tomography of chest confirmed right pleural effusion. At diagnostic thoracentesis, pleural fluid was free flowing and blood tinged. Pleural fluid protein was 3.4 gm/dL and lactose dehydrogenase was 962 units. Pleural fluid adenosine deaminase was 17 IU. All smear and culture reports of sputum and pleural fluid were negative for bacteria, fungi, and acid-fast bacilli. Cultures of blood and bone marrow were sterile. HIV serology was negative. Cytomegalovirus serum antigen was negative. Flexible bronchoscopy showed thick purulent secretions within right main bronchial lumen. During bronchoscopy, after about 25 mL of bronchial washings were collected, patient became dyspneic and hypoxemic and the procedure was aborted. Bronchial samples were cultured on sheep blood agar and Sabouraud dextrose agar aerobically at 371C. Grow...

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“…Jha V et al 13 reported an incidence of 30.7%. Vikram Kalra et al 14 found the incidence of tuberculosis in post-renal transplant patients to be 36.3%. As quoted in the previous study, this is probably because of the use of bronchoscopy in the isolation of the organism in the recent studies.…”

Section: Discussionmentioning

confidence: 99%

Profile of Pulmonary Infections in Renal Transplant Patients

Anandhakrishnan¹,

Murugan²,

Rajendran³

et al. 2018

jebmh

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BACKGROUNDRenal transplantation is a successful therapy for patients with end-stage kidney disease. In a country like India, where tuberculosis is highly prevalent, it poses immense diagnostic challenge. Proper knowledge about the microbiological spectrum would help to start appropriate therapy empirically, awaiting confirmation.The aim of the study is to study the microbiological profile of lower respiratory tract infections in renal transplant recipients.

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Spectrum of Pulmonary Infections in Renal Transplant Recipients in the Tropics: A Single Center Study

Cited by 16 publications

References 22 publications

Pulmonary infections after renal transplantation: a prospective study from a tropical country

Pulmonary infections after renal transplantation: a prospective study from a tropical country

Pulmonary Nocardiosis Owing to Nocardia otitidiscaviarum

Profile of Pulmonary Infections in Renal Transplant Patients

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