Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

TB incidence is increased among SOT recipients. The risk factors identified were age and receipt of a lung transplant. TB-attributable mortality (9.5%) is still high.

Am J Transplant. 2020;00:1-4. | 1 amjtransplant.com | BACKG ROU N DCoronavirus Disease 2019 (COVID-19) is a novel viral disease with over 93 000 confirmed cases worldwide,1 in which knowledge regarding disease epidemiology and clinical presentation has been evolving in the past 4 months since the initial identification. In the general population, the reported case fatality rate is about 1%-6%.2 Solid organ transplant (SOT) recipients are under chronic immunosuppression, and respiratory infections may present atypically, often with two or more infectious processes presenting simultaneously.3 There have been currently only a couple of reports of COVID-19 among SOT recipients. Hence, in such a high risk population, a strong clinical suspicion is crucial. Herein we present the case of a COVID-19 infection in a kidney transplant recipient. | C A S E REP ORTA 50-year-old man with end-stage renal disease due to IgA nephropathy, recipient of a 3rd deceased-donor kidney transplant in 2016 with serum creatinine (Cr) of 1.3 mg/dL and estimated glomerular filtration rate (eGFR) of 60 mL/min, was admitted on February 28 to the emergency room (ER) with a 24-hour history of fever (38.2°C/100.8°F) and vomiting. He reported no other symptoms, nor had a history of travels abroad nor exposure to patients infected or suspected of contagious COVID-19. Previous medical history included an elective splenectomy performed in 2003 due to immune thrombocytopenia, and an Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disease (PTLD) in 2005, treated with rituximab and withdrawal of immunosuppression, achieving complete response of the PTLD, but leading to rejection and failure of the 2nd kidney graft. Following PTLD remission and a negative EBV viral load, he received a 3rd kidney transplant with induction immunosuppression (IS) with thymoglobulin, tacrolimus, everolimus and steroids, and maintenance IS with tacrolimus, everolimus and prednisone 5 mg QD. He was also under treatment with losartan 50 mg bid due to arterial hypertension.At first evaluation in the ER the patient presented signs of mild dehydration. Physical examination was otherwise unremarkable, including breath sounds on chest auscultation. On blood workup acute phase reactants were normal, such as a C-reactive protein (CRP) of <0.50 mg/dL (normal range <1.0 mg/dL) and white blood cells (WBC) count of 8.58 × 10 9 /L, but a mild kidney function impairment (Cr

M tuberculosis causes serious and potentially life-threatening disease in solid-organ transplant recipients. Treatment with at least three drugs during 9 months or more, avoiding the use of rifampin, appears to be appropriate.

Risk factors in patients with early-onset cases and patients with late-onset cases of posttransplantation invasive aspergillosis are not the same, a fact that could have implications for the preventive approaches used for this infection.

According to preliminary data, seroconversion after mRNA SARS‐CoV‐2 vaccination might be unsatisfactory in Kidney Transplant Recipients (KTRs). However, it is unknown if seronegative patients develop at least a cellular response that could offer a certain grade of protection against SARS‐CoV‐2. To answer this question, we prospectively studied 148 recipients of either kidney (133) or kidney‐pancreas (15) grafts with assessment of IgM/IgG spike (S) antibodies and ELISpot against the nucleocapside (N) and the S protein at baseline and 2 weeks after receiving the second dose of the mRNA‐1273 (Moderna) vaccine. At baseline, 31 patients (20.9%) had either IgM/IgG or ELISpot positivity and were considered to be SARS‐CoV‐2‐pre‐immunized, while 117 (79.1%) patients had no signs of either cellular or humoral response and were considered SARS‐CoV‐2‐naïve. After vaccination, naïve patients who developed either humoral or cellular response were finally 65.0%, of which 29.9% developed either IgG or IgM and 35.0% S‐ELISpot positivity. Factors associated with vaccine unresponsiveness were diabetes and treatment with antithymocytes globulins during the last year. Side effects were consistent with that of the pivotal trial and no DSAs developed after vaccination. In conclusion, mRNA‐1273 SARS‐CoV‐2 vaccine elicits either cellular or humoral response in almost two thirds of KTRs.

In this large, prospective, multinational cohort, more than one half of all cases of non-HACEK gram-negative bacillus endocarditis were associated with health care contact. Non-HACEK gram-negative bacillus endocarditis is not primarily a disease of injection drug users.

From the first descriptions of HIV/AIDS, the lung has been the site most frequently affected by the disease. Most patients develop a pulmonary complication during the history of HIV infection, mainly of infectious aetiology.Important changes in the epidemiology of HIV-related pulmonary infections have occurred. Overall, prescription of Pneumocystis jirovecii prophylaxis and the introduction of highly active antiretroviral therapy (HAART) are the main causes.Currently, the most frequent diagnosis in developed countries is bacterial pneumonia, especially pneumococcal pneumonia, the second most frequent cause is Pneumocystis pneumonia and the third is tuberculosis. However, in Africa, tuberculosis could be the most common pulmonary complication of HIV.Pulmonary infections remain one of the most important causes of morbidity and mortality in these patients, and the first cause of hospital admission in the HAART era. Achieving an aetiological diagnosis of pulmonary infection in these patients is important due to its prognostic consequences.