Recurrent cytomegalovirus disease, visceral leishmaniosis, and Legionella pneumonia after liver transplantation: a case report

Details

Serval ID
serval:BIB_56E8043034A1
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Recurrent cytomegalovirus disease, visceral leishmaniosis, and Legionella pneumonia after liver transplantation: a case report
Journal
Canadian Journal of Anaesthesia
Author(s)
Halkic  N., Ksontini  R., Scholl  B., Blanc  C., Kovacsovics  T., Meylan  P., Muheim  C., Gillet  M., Mosimann  F.
ISSN
0832-610X (Print)
Publication state
Published
Issued date
2004
Volume
51
Number
1
Pages
84-87
Notes
DA - 20040107
LA - eng
PT - Case Reports
PT - Journal Article
RN - 0 (Anti-Bacterial Agents)
RN - 0 (Antimony Sodium Gluconate)
RN - 0 (Antiviral Agents)
RN - 0 (Schistosomicides)
RN - 4428-95-9 (Foscarnet)
RN - 81103-11-9 (Clarithromycin)
RN - 82410-32-0 (Ganciclovir)
SB - IM
Abstract
PURPOSE: Recurrent cytomegalovirus (CMV) disease is a frequent complication of liver transplantation. Visceral leishmaniosis in a transplant recipient is, on the other hand, extremely rare and only two cases of kala-azar have been described after liver transplantation. Immunosuppressed patients are known to be at risk of Legionella infection and the relationship between infection with this organism and hospital water supplies has been well described. These three diseases carry a high mortality rate. Our report examines the potential relationship between these complications. CLINICAL FEATURES: We describe the case of a liver transplant recipient who presented the three complications successively and survived. After reviewing the literature, we explore hypotheses linking these infections and discuss treatment strategies. CONCLUSIONS: In the patient described, infection with leishmania probably occurred months prior to the clinical presentation, a delay that matches the incubation period of kala-azar. The simultaneous onset of leishmaniosis and of a high CMV viremia may have been a coincidence. However, CMV infection has been shown to be an independent predictor of invasive fungal infection in liver transplant recipients. CMV does indeed have a suppressive effect on the humoral and cellular immune response in vitro as well as in vivo. The clinical manifestations of leishmaniosis may, therefore, have been precipitated in this patient by the additive immunosuppressive effect of antirejection drugs and CMV
Keywords
Anti-Bacterial Agents/therapeutic use/Antimony Sodium Gluconate/Antiviral Agents/Bone and Bones/parasitology/pathology/Clarithromycin/Cross Infection/epidemiology/therapy/Cytomegalovirus Infections/complications/drug therapy/virology/Foscarnet/Ganciclovir/Humans/Legionnaires' Disease/Leishmaniasis,Visceral/Liver Transplantation/Male/Middle Aged/Postoperative Complications/etiology/Schistosomicides/Viral Load
Pubmed
Web of science
Open Access
Yes
Create date
18/02/2008 14:30
Last modification date
20/08/2019 15:11
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