BackgroundVisceral leishmaniasis is a disease caused by the protozoan Leishmania sp. and is transmitted by Lutzomyia longipalpis (sand fly). In renal transplant recipients, visceral leishmaniasis causes severe damage to the liver, spleen, and hematopoietic system, as well as poor outcomes for patients with transplanted kidneys. This study describes the largest series of cases of visceral leishmaniasis in renal transplant recipients, providing important information about the diagnostic routines and therapeutic strategies in this patient population.MethodsA retrospective, descriptive study was performed to analyze the distribution and evaluate the extent of the epidemiologic, clinical, diagnostic and therapeutic aspects of 30 renal transplant recipients from endemic regions who presented with visceral leishmaniasis in the post-transplantation period.ResultsIn this study, visceral leishmaniasis was more frequent in men (80%). The mean age of presentation was 40 ± 10.5 years. The majority of patients worked in urban areas (66.7%), cohabitated with domestic animals (90%), and were from low-income households. In 73.3% of cases, diagnosis was made by direct isolation of Leishmania forms. Patients were treated with liposomal amphotericin, resulting in a high degree of disease remission (80%).ConclusionsThis study describes the largest series of visceral leishmaniasis in renal transplant recipients and expands clinical-epidemiological knowledge for transplantation teams to perform adequate disease management for this specific patient population.

Cytomegalovirus infection after transplantation and living with cats increased the risk of VL in renal transplant recipients living in VL endemic areas.

Visceral leishmaniasis (VL) is a well recognized opportunistic infection in immunosuppressed patients, which may cause febrile illness. We describe 4 renal transplant patients with VL in an endemic area in Brazil and their response to therapy. In 3 cases the diagnosis was confirmed by bone marrow aspirate that revealed the presence of Leishmania. In 1 case the bone marrow aspirate was inconclusive and the diagnosis was made through spleen biopsy that showed the presence of the parasite. VL needs to be considered as a cause of febrile illness in transplanted patients living in endemic areas.

Visceral leishmaniasis is an endemic disease caused by various species of Leishmania. We made a retrospective study of 57 consecutive patients with visceral leishmaniasis in Brazil. Patients with visceral leishmaniasis were identified using the registries of the São José Infectious Diseases Hospital. The sample was divided into two groups: patients with serum creatinine (Scr) <1.3mg/dL and Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. We compared these two groups for differences in clinical manifestations and laboratory features. Patients' mean age was 28 ± 18 years old; 74% were male. The main clinical symptoms and signs presented in the initial evaluation were: fever (97%), splenomegaly (96.4%), weight loss (95.5%), pallor (93.6%), cough (89.7%), hepatomegaly (87.2%), asthenia (83.3%), anorexia (82.9%) and vomiting (73.9%). Acute renal failure was found in 15 patients (26.3%) and eight of these patients had ARF before amphotericin B administration. The mean age was higher in the group with Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. Death occurred in three cases; all deaths occurred with Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. There were no significant differences in the frequencies of the clinical symptoms and signs between the two groups. The laboratory data and demographic characteristics were significantly worse in the Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL group. Renal dysfunction is an important feature of this disease; it is associated with important morbidity and can increase mortality.

As abelhas africanizadas surgiram no Brasil, na década de cinqüenta, originadas de um laboratório de apicultura que realizou a hibridização de abelhas africanas, trazidas da África, com as européias já existentes na natureza brasileira, naquela época. Caracterizam-se por serem muito agressivas, atacando suas vítimas de forma maciça, em enxames, inoculando grande quantidade de veneno 2 9 . Nos casos de múltiplas picadas tem sido observada, além dos casos de anafilaxia, a capacidade de causar danos devido ao efeito tóxico direto do veneno, por exemplo insuficiência renal aguda, bem como a morte 1 2 7 9 12 14 .A insuficiência renal aguda (IRA) é caracterizada por uma deterioração na função renal que acontece no decorrer de horas a dias, resultando na falência dos rins em excretar produtos nitrogenados e em manter o equilíbrio hidroeletrolítico e ácido-básico 13 16 .A rabdomiólise é uma síndrome caracterizada por lesão muscular extensa com liberação de inúmeras substâncias intracelulares na circulação, podendo ser causada por trauma ABSTRACTRhabdomyolysis is a syndrome characterized by muscle injury, most frequently due to muscle crushing and trauma. However, it may also be induced by non-traumatic causes, for example by means of stinging by Africanized bees. We describe two cases of rhabdomyolysis that presented dialytic acute renal failure after several bee stings.

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Disseminated strongyloidiasis (DS) is a rare and severe parasitic disease that is difficult to recognize and affects immunocompromised individuals. We report the case of a kidney transplant recipient who presented with DS despite prophylaxis with albendazole. We have discussed the need for better prophylactic strategies and for a higher degree of suspicion in order to diagnose DS.

PRES is a rare syndrome that must be suspected in every patient presenting neurologic symptoms in the course of immunosuppression. It can be induced by CSA and is totally reversible when the drug is rapidly withdrawn.