scholarly journals Emerging of Fatal Colitis with Multidrug-Resistant Candida glabrata after Small Bowel Transplantation

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Zahra Zareshahrabadi ◽  
Mojtaba Shafiekhani ◽  
Hamed Nikoupour ◽  
Hasti Nouraei ◽  
Hamid Morovati ◽  
...  
Keyword(s):  
Small Bowel ◽  
Candida Glabrata ◽  
Antifungal Susceptibility ◽  
Small Bowel Transplantation ◽  
Intestinal Failure ◽  
Multidrug Resistant ◽  
Antifungal Drugs ◽  
Wall Thickening ◽  
Its2 Region ◽  
Sequencing Analysis

Background. Small bowel transplantation is a potential option for patients with intestinal-failure, and the incidences of infections caused by Candida species that are more resistant to antifungal drugs are increasing in these patients. In this manuscript, we reported a case of fatal colitis after small bowel transplantation induces by multidrug-resistant (MDR) Candida glabrata. Case Presentation. A 52-year-old man has undergone an extensive small bowel resection with the length of the remaining bowel which was less than 40 cm who became a candidate for transplantation. Four months after transplantation, the patient experienced severe bloody diarrhea with abdominal distension. Ileoscopy and colonoscopy did not show neither pathological change and rejection nor cytomegalovirus (CMV) infection posttransplantation. Abdomen computed tomography showed diffuse moderate small bowel wall thickening. After detection of budding yeast in the stool samples, stool culture was positive for Candida, DNA was extracted, and ITS1-5.8s-ITS2 region of the fungal agent was amplified. Sequencing analysis of PCR and antifungal susceptibility testing revealed that this isolate was multidrug-resistant C. glabrata. Besides, there was no evidence for other pathogens known to cause infection in various laboratory tests. Immediate antifungal treatments with caspofungin remained unsuccessful, and on the eighteenth day of admission, the patient expires with septic shock. Conclusion. These findings highlight the challenging management of candidiasis in patients with small bowel transplantation. Infectious diseases due to MDR organisms have emerged as a vital clinical problem in this patient population.

scholarly journals Plasma citrulline levels and acute cellular rejection early after small bowel transplantation in pigs

2009 ◽  
Vol 54 (No. 5) ◽  
pp. 215-222 ◽  
Author(s):  
E. Honsova ◽  
A. Lodererova ◽  
P. Balaz ◽  
M. Oliverius
Keyword(s):  
Small Bowel ◽  
Small Bowel Transplantation ◽  
Intestinal Failure ◽  
Acute Cellular Rejection ◽  
Control Group ◽  
Plasma Citrulline ◽  
Potential Biomarker ◽  
Histologic Evaluation ◽  
Group B ◽  
Cellular Rejection

Small bowel transplantations (SBT) are increasingly performed to treat patients with irreversible intestinal failure or short-bowel syndrome. Histologic evaluation of small bowel allograft biopsies is important for the diagnosis of acute cellular rejection (ACR). A reliable serological marker of ACR after SBT is still unknown. Recently, citrulline was identified as a potential biomarker of reduced enterocyte mass. The aim of our study was to analyze rejection and plasma citrulline levels early after SBT in pigs. 24 pigs were used and divided into four groups. Group A, autologous SBT (<I>n</I> = 3) as a control group; Group B, allogeneic SBT with tacrolimus monotherapy (<I>n</I> = 7); Group C, allogeneic SBT immunosuppressed with tacrolimus and sirolimus (<I>n</I> = 8); and Group D, without immunosuppresion (<I>n</I> = 6). The observation period was 30 days. Mucosal biopsies were obtained on Days 0, 3, 5, 7, 10, 14, 20, 28 and simultaneously plasma citrulline levels were measured. ACR was classified according to standardized grading schema on a scale of indeterminate, mild, moderate, and severe. There were no significant differences in citrulline plasma levels between cases with mild ACR and indeterminate for ACR. A significant decline in plasma citrulline levels occurred in cases of moderate and severe rejection. Plasma citrulline levels constituted a marker of more advanced injury of small bowel epithelium.

Small-Bowel Allograft Biopsies in the Management of Small-Intestinal and Multivisceral Transplant Recipients: Histopathologic Review and Clinical Correlations

2012 ◽  
Vol 136 (7) ◽  
pp. 761-771 ◽  
Author(s):  
Helen Remotti ◽  
Sukanya Subramanian ◽  
Mercedes Martinez ◽  
Tomoaki Kato ◽  
Margret S. Magid
Keyword(s):  
New York ◽  
Small Bowel ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Small Bowel Transplantation ◽  
Intestinal Failure ◽  
Lymphoproliferative Disease ◽  
Close Monitoring ◽  
Columbia University ◽  
Barr Virus

Context.—Intestinal transplant has become a standard treatment option in the management of patients with irreversible intestinal failure. The histologic evaluation of small-bowel allograft biopsy specimens plays a central role in assessing the integrity of the graft. It is essential for the management of acute cellular and chronic rejection; detection of infections, particularly with respect to specific viruses (cytomegalovirus, adenovirus, Epstein-Barr virus); and immunosuppression-related lymphoproliferative disease. Objective.—To provide a comprehensive review of the literature and illustrate key histologic findings in small-bowel biopsy specimen evaluation of patients with small-bowel or multivisceral transplants. Data Sources.—Literature review using PubMed (US National Library of Medicine) and data obtained from national and international transplant registries in addition to case material at Columbia University, Presbyterian Hospital, and Mount Sinai Medical Center, New York, New York. Conclusions.—Key to the success of small-bowel transplantation and multivisceral transplantation are the close monitoring and appropriate clinical management of patients in the posttransplant period, requiring coordinated input from all members of the transplant team with the integration of clinical, laboratory, and histopathologic parameters.

ISOLATED LIVER TRANSPLANT AND SEQUENTIAL SMALL BOWEL TRANSPLANTATION FOR INTESTINAL FAILURE AND RELATED LIVER DISEASE IN CHILDREN

2000 ◽  
Vol 69 (11) ◽  
pp. 2323-2326 ◽  
Author(s):  
Paolo Muiesan ◽  
Anil Dhawan ◽  
Manuele Novelli ◽  
Giorgina Mieli-Vergani ◽  
Mohamed Rela ◽  
...  
Keyword(s):  
Liver Disease ◽  
Small Bowel ◽  
Liver Transplant ◽  
Small Bowel Transplantation ◽  
Intestinal Failure ◽  
Related Liver Disease ◽  
Isolated Liver

Irreversible intestinal failure, nutrition support, and small bowel transplantation

Nutrition ◽  
2001 ◽  
Vol 17 (9) ◽  
pp. 747-750 ◽  
Author(s):  
Paolo Dionigi ◽  
Mario Alessiani ◽  
Alberta Ferrazi
Keyword(s):  
Small Bowel ◽  
Small Bowel Transplantation ◽  
Intestinal Failure ◽  
Nutrition Support

Molecular Identification, And Antifungal Susceptibility Patterns of Candida Species Isolated From Candidemia Patients in Yasuj, Southwestern Iran

2021 ◽  
Author(s):  
Shaghayegh Rostami Yasuj ◽  
Seyed Sajad Khoramrooz ◽  
Marjan Salahi ◽  
Ali Keshtkari ◽  
Jabar Taghavi ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Amphotericin B ◽  
Molecular Identification ◽  
Antifungal Susceptibility ◽  
Hospitalized Patients ◽  
Antifungal Drugs ◽  
Its2 Region ◽  
Susceptibility Tests ◽  
Susceptibility Patterns

Abstract Candidemia is the most common systemic infection in hospitalized patients and causing high mortality. Hence, the diagnosis of this infection in the early-stage with appropriate antifungal therapy has been attributed to the lowest mortality. The aims of this study are molecular identification of Candida species isolated from candidemia patients and evaluated the in vitro antifungal susceptibility patterns of these strains to fluconazole, amphotericin B, and caspofungin. In the present study, 800 hospitalized patients who suspected candidemia were sampled. Candida species were isolated and identified based on morphological and PCR-sequencing of the ITS1-5.8S-ITS2 region. Antifungal susceptibility tests for fluconazole, amphotericin B, and caspofungin was performed according to the Clinical and Laboratory Standards Institute M27-A3. Also, clinical data were recorded from patient's records. Overall, 27 candidemia patients were detected among hospitalized patients. 33.3% of candidemia patients were treated with amphotericin B, however, the mortality rate was 14.8%. The majority of patients (59%) were from the neonatal intensive care unit and premature born was the most underlying condition. C. albicans (n = 18; 66.6%) was the most common species isolated from blood cultures, followed by C.parapsilosis (n = 7; 25.9%), C.pelliculosa ( n = 1;3.7% ) and C.tropicalis (n = 1;3.7%). Only one C. albicans isolate were resistance to fluconazole (MIC = 32 µg/mL). Generally, C. albicans has been the most frequent causative agent of candidemia. Resistance to antifungal drugs among candidemia agents was rare. Also, the identification of Candida isolates at the species level with in-vitro antifungal susceptibility tests can manage and decrease the mortality rate among candidemia patients.

scholarly journals Antifungal Susceptibility of Non-albicans Candida Species in A Tertiary Care Hospital, Bulgaria

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Hristina Yotova Hitkova ◽  
Diana Simeonova Georgieva ◽  
Preslava Mihailova Hristova ◽  
Teodora Vasileva Marinova-Bulgaranova ◽  
Biser Kirilov Borisov ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Antifungal Agents ◽  
Antifungal Susceptibility ◽  
Tertiary Care ◽  
Acquired Resistance ◽  
Multidrug Resistant ◽  
Antifungal Drugs ◽  
Care Hospital ◽  
And Control

Background: Emerging non-albicans Candida (NAC) species are a major threat because of their intrinsic or acquired resistance to routinely applied antifungal agents. Objectives: The purpose of our study was to reveal in vitro activity of nine antifungal agents against NAC isolates. Methods: A total of 67 NAC (27 Candida glabrata, 10 C. tropicalis, 6 C. krusei, 6 C. parapsilosis, 4 C. lusitaniae, 4 C. lipolytica, etc.) were identified and tested. The antifungal susceptibility was estimated on the basis of minimum inhibitory concentrations (MIC). Results: Overall, 13 species were determined, of which C. glabrata was the most common (40.3%), followed by C. tropicalis (14.9%), C. krusei, and C. parapsilosis (8.9 % each). Forty-nine NAC isolates (73.13%) demonstrated decreased susceptibility to one or more antifungals, and 18 of them were resistant to all azoles. Out of 27 C. glabrata, 12 (44.4%) were resistant to fluconazole with MICs: 32 - >128 µg/mL and 15 (55.6%) were intermediate with MICs: 8 - 16 µg/mL Non-albicans Candida revealed a good susceptibility to echinocandins. Amphotericin B resistance was found in 5.97% of the isolates. Of particular interest was the detection of 6 (8.95%) multidrug-resistant NAC, which expressed resistance to azoles and echinocandins and/or amphotericin B. Conclusions: About one-fourth of the studied NAC were resistant to all azoles. These findings as well as the detection of several multidrug-resistant isolates determine the necessity of susceptibility testing of clinically important yeast isolates and control of the antifungal drugs in our hospital.

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