y Both authors have contributed equally to this work. Donor-derived Strongyloides stercoralis infections in transplant recipients are a rare but recognized complication. In this case series, we report donor-derived allograft transmission of Strongyloides in three solid organ transplant recipients. Following detection of infection in heart and kidney-pancreas recipients at two different transplant centers, a third recipient from the same donor was identified and diagnosed.S. stercoralis larvae were detected in duodenal aspirates, bronchial washings, cerebrospinal fluid, urine and stool specimens. Treatment with ivermectin and albendazole was successful in two of the three patients identified. The Centers for Disease Control and Prevention was contacted and performed an epidemiologic investigation. Donor serology was strongly positive for S. stercoralis antibodies on retrospective testing while all pretransplant recipient serum was negative. There should be a high index of suspicion for parasitic infection in transplant recipients and donors from endemic regions of the world. This case series underscores the need for expanded transplant screening protocols for Strongyloides. Positive serologic or stool tests should prompt early treatment or prophylaxis in donors and recipients as well as timely notification of organ procurement organizations and transplant centers.
Introduction/Objective. Revascularization in multivessel coronary artery
disease (MVD) in patients with ST elevation myocardial infarction (STEMI) is
a matter of debate. We sought to compare outcomes between revascularization
strategies based on angiographic lesion severity or inducible ischemia.
Methods. In prospective study, first ever STEMI patients with MVD, defined as
> 70% stenosis in non-culprit vessel, treated with culprit only primary PCI
were randomized to: A. Complete revascularization of all non-culprit
significant lesions during initial hospitalization; B. Complete
revascularization after 30 days, or C. Revascularization based on
non-invasive testing for inducible ischemia. The study explored occurrence of
major adverse cardio-cerebral events (MACCE) (cardiac death, repeated MI,
cerebrovascular event). Results. The study enrolled 120 patients with door to
balloon time within appropriate limits (A 51 ? 26 vs. B 47 ? 33 vs. C 44 ? 29
min, p = 0.604) The patients in group A underwent complete revascularization
at 6 [4-7] days after primary PCI, while in the group B it was 35 [32-39]
days. In group C, 16/43 (37.2%) patients underwent PCI at 82 [66-147] days
after infarction (p < 0.001). The patients were followed for 2.7 ? 0.8 years.
The events occurred less frequently in patients that underwent planned
complete revascularization compared to those who underwent ischemia testing
(7.8 vs. 20.9%, p = 0.040). Kaplan-Meier analysis favored complete delayed
revascularization (MACCE A 8.8 vs. B 6.9 vs. C 20.9%, log rank p = 0.041).
Conclusions. Planned, angiography guided, complete revascularization after
initial event may be favorable strategy compared to single stress test for
multivessel coronary artery disease in STEMI.
Thrombus aspiration is associated with a greater incidence of severe diastolic dysfunction in unselected STEMI patients treated with primary PCI, but it doesn't influence the incidence of major adverse cardiovascular events.
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