Etiologic agents of diarrhea in solid organ recipients

Arslan, Hande; Inci, EK; Azap, Özlem Kurt; Karakayalı, H.; Torgay, Adnan; Haberal, Mehmet

doi:10.1111/j.1399-3062.2007.00237.x

Cited by 119 publications

(100 citation statements)

References 22 publications

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“…In practice, negative microbiological diagnosis leads nephrologists to perform invasive complementary tests like colonoscopy and often to modify immunosuppressive treatment considered to be the cause of diarrhea, with a risk of acute or chronic transplant rejection (9)(10)(11). Yet in various studies, it has been reported that, in 38 to 64% of cases, diarrhea was of infectious origin (1,(12)(13)(14). The implicated microorganisms corresponded mainly to enteric bacteria (Campylobacter spp., enterovirulent Escherichia coli, Salmonella spp., Clostridium difficile), parasites (Giardia intestinalis), and viruses (Norovirus and Rotavirus) that are already responsible for gastroenteritis in the general population (1,2,6,(12)(13)(14)(15)(16).…”

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confidence: 99%

“…Yet in various studies, it has been reported that, in 38 to 64% of cases, diarrhea was of infectious origin (1,(12)(13)(14). The implicated microorganisms corresponded mainly to enteric bacteria (Campylobacter spp., enterovirulent Escherichia coli, Salmonella spp., Clostridium difficile), parasites (Giardia intestinalis), and viruses (Norovirus and Rotavirus) that are already responsible for gastroenteritis in the general population (1,2,6,(12)(13)(14)(15)(16). However, some pathogens, like human cytomegalovirus (CMV), microsporidia, and cryptosporidia, were specifically found in immunocompromised patients (1,12,13,(17)(18)(19)(20)34).…”

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confidence: 99%

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Microbiological Diagnosis of Severe Diarrhea in Kidney Transplant Recipients by Use of Multiplex PCR Assays

Coste¹,

Vuiblet

Moustapha

et al. 2013

J Clin Microbiol

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Diarrhea is a frequent complication after kidney transplantation, ascribed to adverse effects of the immunosuppressive therapy in case of negative microbiological examination of the stools. The aim of this study was to improve the microbiological diagnosis by implementing molecular tests. Fifty-four severe diarrhea events that occurred in 49 adult kidney transplant recipients from September 2010 to November 2011 were investigated. One or several enteric pathogens were detected in 13 (23%) stool samples using classical microbiological methods versus 39 (72%) for the seven commercially available multiplex PCR assays used retrospectively (P ‫؍‬ 0.006). Interestingly, molecular diagnosis identified 15 multiple infections compared to none using classical techniques. The primary pathogens detected were enteropathogenic Escherichia coli (EPEC) (n ‫؍‬ 15; 38%), Campylobacter spp. (n ‫؍‬ 15; 38%), and Norovirus (n ‫؍‬ 14; 36%). Specificities for Campylobacter and Norovirus infection diagnosis were 75 and 100%, respectively, by comparison to reference methods. Based on molecular findings, a cyclosporine-mycophenolate mofetil combination was identified as a risk factor for developing Norovirus-induced diarrhea. Norovirus infections were also responsible for higher weight loss than all the other causes of diarrhea. In samples from asymptomatic immunocompromised and immunocompetent patients, EPEC but not Norovirus and Campylobacter infections were detected at a frequency similar to that observed in symptomatic kidney transplant recipients. In conclusion, molecular tools significantly improved the detection of single and multiple enteric infections by comparison to classical techniques and could quickly become the key element in the management of severe acute diarrhea in transplant recipients.

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confidence: 99%

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confidence: 99%

Microbiological Diagnosis of Severe Diarrhea in Kidney Transplant Recipients by Use of Multiplex PCR Assays

Coste¹,

Vuiblet

Moustapha

et al. 2013

J Clin Microbiol

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“…The difference in the prevalence from the previous studies could be due to the differences in the methods of identification (ie, stool examination in previous studies versus only duodenal biopsy in our study). 6,11 Several nonspecific histologic changes have been identified with giardiasis infestation in the normal population, including increases in intraepithelial lymphocytes, changes in villous 149 architecture, presence of lymphoid follicles, and eosinophilic infiltration in the lamina propria. Villous flattening was identified in 33 patients (41.2%) in a study of 80 patients with giardiasis, 12 whereas atrophic villous architecture was observed in 61.2% of patients in another study.…”

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confidence: 99%

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Hanif

Luck²,

Abbas³

et al. 2016

Exp Clin Transplant

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“…8 After solid-organ transplant, patients are in general more susceptible to opportunistic pathogens than immunocompetent individuals are. 9 Another cause of diarrhea is cytomegalovirus infection with gastrointestinal involvement. In cytomegalovirus enterocolitis, with or without fever, possible complications include gastrointestinal bleeding, perforation, and toxic megacolon.…”

Section: Discussionmentioning

confidence: 99%

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Ensaroğlu

Harmancı²,

Öcal³

et al. 2015

Exp Clin Transplant

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Objectives: We aimed to investigate the colonoscopy findings in patients after kidney transplant. Materials and Methods: We retrospectively analyzed kidney transplant patients who had colonoscopy examinations for various indications between 2011 and 2015. Results: Eighty-one patients (25 women and 56 men) with a mean age of 39 years (range, 18-64 y) were identified. Mean follow-up after transplant was 9 years (range, 1-29 y). The most common indications for colonoscopy were diarrhea (41%), anemia (29%), gastrointestinal bleeding (12%), abdominal pain (12%), and unexplained weight loss (6%). Either colitis or ileitis or both were diagnosed in 20 patients (25%), whereas polyps were found in 9 patients (11%). One patient presented with hematochezia, which was diagnosed as cytomegalovirus colitis. The remaining cases of colitis or ileitis were diagnosed as nonspecific inflammation. Indications for colonoscopy were not correlated with age, duration after transplant, or use of immunosuppressive drugs. A subgroup analysis for mycophenolate-induced colitis found that 88% of patients used mycophenolate, but presence of colitis or ileitis had no statistical correlation with its use. In patients with poor gastrointestinal symptoms, the only significant predictor of presence of colitis or ileitis was a high C-reactive protein value (> 5 mg/dL; P = .02). Conclusions:Incidence of colitis and/or ileitis is a relatively common finding in patients after kidney transplant. Opportunistic infections, mycophenolate use, and mild degree of indeterminate colitis or ileitis disease may be the underlying condition. Cytomegalovirus infection should be screened in all recipients because it may cause serious complications or death in chronically immunocompromised patients.

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Etiologic agents of diarrhea in solid organ recipients

Cited by 119 publications

References 22 publications

Microbiological Diagnosis of Severe Diarrhea in Kidney Transplant Recipients by Use of Multiplex PCR Assays

Microbiological Diagnosis of Severe Diarrhea in Kidney Transplant Recipients by Use of Multiplex PCR Assays

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