JC Polyomavirus and Transplantation: Implications for Virus Reactivation after Immunosuppression in Transplant Patients and the Occurrence of PML Disease

The JC polyomavirus (JCPyV/JCV) is a member of the Polyomaviridae family and is ubiquitious in the general population, infecting 50–80% of individuals globally. A primary infection with JCV usally results in an asymptomatic, persistent infection that establishes latency in the renourinary tract. Reactivation from latency via iatrogenic immununosuppression for allograft transplantation may result in organ pathology and a potential life-threatening neuropathological disease in the form of progressive multifocal leukoencephalopathy (PML). Currently, no treatment exists for PML, a rare complication that occurs after transplantation, with an incidence of 1.24 per 1000 persons a year among solid organ transplant patients. PML is also observed in HIV patients who are immununosuppressed and are not receiving antiretroviral therapy, as well as individuals treated with biologics to suppress chronic inflammatory responses due to multiple sclerosis, Crohn’s disease, non-Hodgkin’s lymphoma, rheumatoid arthritis, and other autoimmune-mediated hematological disorders. Here, we describe the proposed mechanisms of JCV reactivation as it relates to iatrogenic immunosuppression for graft survival and the treatment of proinflammatory disease, such as biologics, proposed trafficking of JCV from the renourinary tract, JCV central nervous system dissemination and the pathology of PML in immunosuppressed patients, and potential novel therapeutics for PML disease.

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Dapsone for Pneumocystis jirovecii pneumonia prophylaxis – applying theory to clinical practice with a focus on drug interactions

Drug Metabolism and Personalized Therapy ◽

10.1515/dmpt-2019-0018 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Carmela Emma Corallo ◽

John Coutsouvelis ◽

Susan Morgan ◽

Orla Morrissey ◽

Sharon Avery

Keyword(s):

Organ Transplant ◽

Cost Effective ◽

Chemotherapeutic Agents ◽

Pneumocystis Jirovecii ◽

Haematopoietic Stem Cell ◽

Pneumocystis Jirovecii Pneumonia ◽

Solid Organ ◽

Immunosuppressed Patients ◽

Life Threatening ◽

Substantial Risk

AbstractPneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised individuals. The incidence can be as high as 80% in some groups but can be reduced to less than 1% with appropriate prophylaxis. HIV-infected patients with a low CD4 count are at the highest risk of PJP. Others at substantial risk include haematopoietic stem cell and solid organ transplant recipients, those with cancer (particularly haematologic malignancies), and those receiving glucocorticoids, chemotherapeutic agents, and other immunosuppressive medications. Trimethoprim-sulfamethoxazole is an established first-line line agent for prevention and treatment of PJP. However, in some situations, this medication cannot be used and dapsone is considered a suitable cost-effective second line agent. However, information on potential interactions with drugs commonly used in immunosuppressed patients is lacking or contradictory. In this this article we review the metabolic pathway of dapsone with a focus on interactions and clinical significance particularly in patients with haematological malignancies. An understanding of this process should optimise the use of this agent.

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Survey of Alternative Medicine Use among Organ Transplant Patients

Journal of Transplant Coordination ◽

10.1177/090591999700700307 ◽

1997 ◽

Vol 7 (3) ◽

pp. 123-130 ◽

Cited By ~ 3

Author(s):

Catherine C Crone ◽

Thomas N Wise

Keyword(s):

Drug Interactions ◽

Organ Transplant ◽

Herbal Medicines ◽

Food Supplements ◽

Solid Organ ◽

Health Food ◽

Transplant Patients ◽

Increased Risk ◽

Life Threatening ◽

Pharmacologically Active

Herbal medicine and health food supplements have become increasingly popular. However, many of these pharmacologically active compounds remain poorly understood. Patients with chronic and life-threatening conditions often use alternative therapies while receiving conventional medical care, and this population is at increased risk for complications and adverse drug interactions due to poor health and complex drug regimens. Patients awaiting or who had received solid organ transplants were surveyed about their use of herbal medicines and health food supplements. Twenty percent of respondents acknowledged experience with these products, which they used to prolong the function of a failing organ or to obtain relief from fatigue and insomnia. Transplant staff often were unaware of their patients' use of these treatments, despite patients' claims to the contrary. The potential for unexpected drug interactions, toxicity, and other adverse reactions resulting from the use of herbal medicines or supplements must be recognized and identified by transplant teams.

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Contraception for Solid Organ Transplant Patients: Utilizing Social Media

Case Medical Research ◽

10.31525/ct1-nct03979950 ◽

2019 ◽

Author(s):

Keyword(s):

Social Media ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Patients

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Evaluation of Pulmonary Infections in Solid Organ Transplant Patients: 12 Years of Experience

Transplantation Proceedings ◽

10.1016/j.transproceed.2013.09.024 ◽

2013 ◽

Vol 45 (10) ◽

pp. 3458-3461 ◽

Cited By ~ 20

Author(s):

F.Ö. Eyüboğlu ◽

E. Küpeli ◽

Ş.S. Bozbaş ◽

Z.E. Özen ◽

E.S. Akkurt ◽

...

Keyword(s):

Organ Transplant ◽

Solid Organ Transplant ◽

Solid Organ ◽

Years Of Experience ◽

Pulmonary Infections ◽

Transplant Patients

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Terminal ileum resection as a trigger for Strongyloides stercoralis hyperinfection and ensuing serial sepsis in a 37-year-old patient with complicated Crohnʼs disease: a case report

Zeitschrift für Gastroenterologie ◽

10.1055/a-0578-9799 ◽

2018 ◽

Vol 56 (04) ◽

pp. 380-383 ◽

Cited By ~ 1

Author(s):

Mirjana Topić ◽

Silvija Čuković-Čavka ◽

Marko Brinar ◽

Mirjana Kalauz ◽

Ivica Škrlec ◽

...

Keyword(s):

Terminal Ileum ◽

Skin Penetration ◽

Strongyloides Stercoralis ◽

Developed Countries ◽

Clinical Settings ◽

Solid Organ ◽

Transplant Patients ◽

Skin Contact ◽

Life Threatening ◽

The Tropics

AbstractThe nematode Strongyloides stercoralis, outside the tropics and subtropics present in small endemic foci, can cause an infection after direct skin contact with contaminated soil containing infective filariform larvae and, rarely, after intimate interhuman contact or after transplantation of an infected solid organ. Following skin penetration, migration, and maturation through several stages, a small number of invasive filariform larvae can develop anew in the gut lumen, perpetuating new cycles of penetration, tissue migration, and reproduction, without leaving the host.In a state of immunosuppression, autoinfection can progress to life-threatening hyperinfection and/or infection disseminated through virtually any organ. In developed countries, the most frequently recognized risk for severe hyperinfection is corticosteroid therapy, but this has been also described in malnourished, alcoholic, cancer, and transplant patients. Due to the frequent need for immunosuppressive therapy, patients suffering from inflammatory bowel disease (IBD) are susceptible to develop overwhelming strongyloidiasis. Strongyloidiasis can be easily overlooked in clinical settings, and in many European regions there is poor insight into the epidemiological burden of this disease.We present a case of S. stercoralis hyperinfection that triggered 3 successive episodes of sepsis caused by pathogens of the gut flora in a young patient suffering from stenotic form of Crohn’s disease. S. stercoralis hyperinfection occurred in the corticosteroid-free period, shortly after resection of the terminal ileum, which was probably the trigger for the overwhelming course. The patient was successfully treated with 10-day albendazole therapy.

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