Background: Hepatitis C virus (HCV) infection is common among patients on haemodialysis (HD) therapy and is an important cause of morbidity and mortality. In patients with chronic kidney disease (CKD), the risks for negative outcomes are significantly higher in HCV-infected patients than in those without HCV infection, including progression to cirrhosis, hepatocellular carcinoma and liver-related mortality. Ombitasvir (OBV), paritaprevir (PTV), ritonavir (r), and dasabuvir (DSV) are all hepatically metabolized and, therefore, require no dose adjustment in patients with any degree of renal impairment. Aims: We studied the safety and efficacy of OBV/PTV/r + DSV in a small group of HCV infected patients on haemodialysis therapy. Methods: Treatment course with ombitasvir/paritaprevir/ritonavir and dasabuvir; (3-DAA regimen of OBV/PTV/r+DSV±RBV) was analysed. Pre-treatment evaluation of HCV infection included HCV RNA, genotype, and liver fibrosis assed by transient fibroelastography (FibroScan). The stage 5 CKD was defined as an eGFR of <15 mL/min/1.73 m2, respectively; those on haemodialysis were considered to have stage 5 CKD or end-stage renal disease (ESRD). Demographic data and concomitant medication were retrieved from patients’ records. The primary endpoint was sustained virologic response at post-treatment week 12 (SVR12). We collected data on on-treatment adverse events (AEs), serious AEs, and laboratory abnormalities. Results: Among 7 treated patients, 6 were male and 1 female, all were infected with genotype 1 (5 GT1b, 2 GT1a). Patient had compensated liver cirrhosis and six patients did not have liver cirrhosis, none were liver transplant recipients. All of seven patients completed 12 weeks of treatment and achieved SVR12. Concomitant medication had to be modified with the treatment initiation in 5 out of 7 patients. One of the patients presented with a significant decrease in haemoglobin level, white blood cell and platelet count during the treatment period. The most frequent adverse events were nausea, diarrhoea. Adverse events were primarily mild, and no patient discontinued treatment due to an AE. Conclusions: Treatment with OBV/PTV/r +DSV ± RBV was well-tolerated and resulted in high rates of SVR12 (100%) for patients with HCV GT1b/1a on haemodialysis.
Introduction: Infectious mononucleosis is one of the most common syndromes in our clinical practice. It is characterized by elevated temperature, pharyngitis and generalized lymphadenopathy. Objectives: To describe a clinical charachteristics of infectious mononucleosis (IM) caused by the Epstein Barr virus (EBV) in splenectomized patients since in the literature we found insufficient data. Subjects and Methods: Retrospective analysis of medical documentation of the patient treated in the Clinic for Infectious Diseases of the University Clinical Center of Republic of Srpska. Results: We have described the case of infectious mononucleosis, caused by Epstein Barr virus in a splenectomized patient. In support of acute EBV viral infection were the presence of lymphadenopathy, pharyngitis, hepatomegaly, as well as the occurrence of a typical generalized maculopapulous rash, and positive ELISA EBV VCA IgM and anti EBV VCA / EA IgG, were reported. According to the aforementioned patient, it fulfilled most criteria for setting the diagnosis of acute EBV infectious mononucleosis. Our patient showed some atypical signs such as absence of fever during hospitalization, marked leukocytosis with lymphocytosis (with a maximum increase in leukocyte count at 37.3 x 10 9 , in the differential blood sample dominated lymphocytes with 29.96 x 10 9 (reference values 1.1-3.35), i.e. 80.3% (Ref. 20.0-46.0). Due to the maintenance of leukocytosis with lymphocytosis, the range of clinical has been extended trials (US abdomen, US neck, CT neck, chest, abdomen and pelvis, sternal puncture, hematologists' consultation). Based on the aforementioned hematologists' consultation, and post-release and recovery monitoring it is concluded that there has been no sign of acute hematologic disease but it has been just EBV-IM. Conclusion: Because of insufficient data on clinical presentation of Epstein Barr viral infections in splenectomized this we believe that this is one of the clinical variants although the possibility of individual variation cannot be excluded. Briefly, we can conclude that the immune system in the splenectomized patient can greatly modify the clinical presentation of Epstein barr viral infection, with the pathogenic mechanism that are still unclear.. However, due to the variety of clinical syndromes and the oncogenic potency of the Epstein-Barr virus, we should be extremely cautious and sometimes expand the diagnostic range beyond conventional examinations.
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