OPPORTUNISTIC INFECTIONS IN CHILDREN FOLLOWING RENAL-TRANSPLANTATION

被引：22

作者：

HARMON, WE

机构：

[1] Division of Nephrology, Children's Hospital, Boston, 02115, Massachusetts

[2] Department of Pediatrics, Harvard Medical School, Boston, 02115, Massachusetts

[3] Harvard Center for the Study of Kidney Diseases, Boston, 02115, Massachusetts

来源：

PEDIATRIC NEPHROLOGY | 1991年 / 5卷 / 01期

关键词：

RENAL TRANSPLANTATION; OPPORTUNISTIC INFECTIONS; VARICELLA; PNEUMOCYSTIS-CARINII PNEUMONIA; CYTOMEGALOVIRUS DISEASE;

D O I：

10.1007/BF00852868

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Opportunistic infections following renal transplantation in children are a major cause of severe morbidity and mortality. These infections account for the majority of early post renal-transplant deaths in children. General risk factors which affect the incidence and severity of these infections include: transmission of the infectious agent by the donor organ; history of immunity in the recipient prior to transplantation; type and amount of immunosuppression including treatment for rejection episodes; availability of specific treatment for the infection. Children are at particular risk because of the lack of exposure to certain pathogens prior to transplantation. There have been recent advances in the prevention and treatment of important infections which occur in children following transplantation, including varicella, Pneumocystis carinii pneumonia (PCP) and cytomegalovirus (CMV) disease. Varicella is treatable with acyclovir, often without decreasing immunosuppression and placing the graft at risk. Prophylaxis against PCP may be achieved by provision of alternate-day trimethoprim sulpha, but clear guidelines for determining who should be treated are lacking. Treatment of this disease with high-dose trimethoprim sulfa or pentamidine is usually successful. CMV disease is frequently severe, especially when the donor is seropositive and the recipient seronegative. In these situations, prophylactic CMV immunoglobulin reduces the morbidity and the mortality of the disease and prophylactic oral acyclovir may decrease its incidence. Treatment of severe CMV disease with gancyclovir is promising.

引用

页码：118 / 125

页数：8

共 77 条

[41] Girard P.M., Brun-Pascaud M., Farinotti R., Tamisier L., Kernbaum S., Pentamidine aerosol in prophylaxis and treatment of murine Pneumocystis carinii pneumonia, Antimicrob Agents Chemother, 31, pp. 978-981, (1987)
[42] Young F.E., Nightingale S.L., Cooper E.C., Trapnell C.B., Aerosolized pentamidine. Approved for HIV-infected individuals at high risk for Pneumocystis carinii pneumonia, Arch Intern Med, 149, pp. 2412-2413, (1989)
[43] Jarowenko M., Pifer L., Kerman R., Kahan B.D., Serologic methods for the early diagnosis of Pneumocystis carinii infection in renal allograft recipients, Transplantation, 41, pp. 436-442, (1986)
[44] Girard P.M., Landman R., Gaudebout C., Lepretre A., Lottin P., Michon C., DeTruchis P., Matheron S., Camus F., Farinotti R., Marche C., Coulaud J.P., Salmot A.G., Prevention of Pneumocystis carinii pneumonia relapse by pentamidine aerosol in zidovudine-treated AIDS patients, Lancet, 1, pp. 1348-1353, (1989)
[45] Tuazon C.U., Delaney M.D., Simon G.L., Witorsch P., Varma V.M., Utility of gallium<sup>67</sup> scintigraphy and bronchial washings in the diagnosis and treatment of Pneumocystis carinii pneumonia in patients with the acquired immune deficiency syndrome, Am Rev Respir Dis, 132, pp. 1087-1092, (1985)
[46] Zaman M.K., Wooten O.J., Suprahmanya B., Ankobiah W., Finch P.J., Kamholz S.L., Rapid noninvasive diagnosis of Pneumocystis carinii from induced liquefied sputum, Ann Intern Med, 109, pp. 7-10, (1988)
[47] Masur H., Gill V.J., Ognibene F.P., Shelhamer J., Godwin C., Kovacs J.A., Diagnosis of Pneumocystis pneumonia by induced sputum technique in patients without the acquired immunodeficiency syndrome, Ann Intern Med, 109, pp. 755-756, (1988)
[48] Siegel S.E., Wolff L.J., Baehner R.L., Hammond D., Treatment of Pneumocystis carinii pneumonitis. A comparative trial of sulfamethoxazole-trimethoprim v pentamidine in pediatric patients with cancer report from the Children's Cancer Study Group, Am J Dis Child, 138, pp. 1051-1054, (1984)
[49] Sattler F.R., Cowan R., Nielsen D.M., Ruskin J., Trimethoprimsulfamethoxazole compared with pentamidine for treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A prospective, noncrossover study, Ann Intern Med, 109, pp. 280-287, (1988)
[50] Whyarton J.M., Coleman D.L., Wofsy C.B., Luce J.M., Blumenfeld W., Hadley W.K., Ingram-Drake L., Volberding P.A., Hopewell P.C., Trimethoprim-sulfamethoxazole or pentamidine for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A prospective randomized trial, Annals of Internal Medicine, 105, pp. 37-44, (1986)

← 1 2 3 4 5 6 7 8 →