Dengue Virus Infection in Kidney Transplant Recipients Poses Higher Risk for Graft Dysfunction, Severe Dengue and Death | Virus World | Scoop.it
From journals.plos.org - November 2, 2019 1:00 PM

Dengue infection (DI) is the most important arboviral infection in the world. The majority of immunocompetent patients will have asymptomatic or mild infections, but the degree of dengue severity in kidney transplant recipients (KTx) is unknown. In recent decades, the growing number of organ transplant recipients in developing countries, living in or traveling to an endemic area of dengue, is at risk of developing this infection. Additionally, in kidney transplant recipients (KTx), DI may be associated with other viral infections, such as cytomegalovirus (CMV), increasing the risk for the recipients after renal transplantation (Tx). Because CMV remains one of the most important viruses affecting KTx, it is not clear whether the CMV coinfection may modify the outcome of DI as it usually does in other viral coinfections

 

In this study, we report the clinical profile and outcomes of 39 dengue cases in KTx. From a total of 1,186 KTx outpatients in follow-up we reviewed clinical and laboratory records of 60 (5%) patients admitted with suspected DI initially screened by NS-1, IgM, and when possible, multiplex nested PCR. The prevalence of DI in KTx was 3% (39/1,118), with symptoms leading to hospital admission being fever, myalgia, malaise, and headache.

 

Laboratory tests showed leucopenia, thrombocytopenia, and liver enzyme elevation. DI was confirmed by positivity of NS-1 (33%), IgM (69%), and/or RT-PCR (59%). Twenty-three patients (59%) had dengue with warning signs, and 15% had severe dengue, 2 of them with a fatal course. Acute graft dysfunction occurred in 59% (mean nadir serum creatinine: 2.9 ± 2.6mg/dL), 4 of them requiring dialysis. CMV coinfection diagnosed in 19% of the cases and patients was associated with worse clinical presentation.

 

Our results suggest that KTx with DI presented initial physical and laboratorial profile similar to the general population. However, DI in KTx seems to have a higher risk for graft dysfunction, severe dengue, and death. Because CMV coinfection aggravates the DI clinical presentation and recovery, it must be evaluated in all cases.

 

Published in PLOS One (October 30, 2019):

https://doi.org/10.1371/journal.pone.0219117