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The cytochrome P450 enzymes are capable of catalyzing these metabolic transformation reactions. Toxic manifestations are mainly due to production of oxygen free radicals leading to lipid peroxidation and deoxyribonucleic acid (DNA) damage, as well as produce oxidative stress. This poisoning could affect various body systems, such as the liver, skin, lungs, kidney, central and peripheral nervous system. The treatment in these cases are mainly supportive.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Hicaro Hellano Gonçalves Lima Paiva, Geraldo Bezerra Silva Júnior, Karla do Nascimento Magalhaes, Bianca Lopes Cunha, Sandra Mara Brasileiro Mota, Elizabeth de Francesco Daher, Polianna Lemos Moura Moreira Albuquerque" "autores" => array:7 [ 0 => array:2 [ "nombre" => "José Hicaro Hellano Gonçalves Lima" "apellidos" => "Paiva" ] 1 => array:2 [ "nombre" => "Geraldo Bezerra Silva" "apellidos" => "Júnior" ] 2 => array:2 [ "nombre" => "Karla do Nascimento" "apellidos" => "Magalhaes" ] 3 => array:2 [ "nombre" => "Bianca Lopes" "apellidos" => "Cunha" ] 4 => array:2 [ "nombre" => "Sandra Mara Brasileiro" "apellidos" => "Mota" ] 5 => array:2 [ "nombre" => "Elizabeth de Francesco" "apellidos" => "Daher" ] 6 => array:2 [ "nombre" => "Polianna Lemos Moura Moreira" "apellidos" => "Albuquerque" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251422000670?idApp=UINPBA000064" "url" => "/20132514/0000004200000003/v2_202210261748/S2013251422000670/v2_202210261748/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "SARS-CoV-2 and <span class="elsevierStyleItalic">Aspergillus</span> pneumonia in kidney transplantation: More frequent than we think?" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "359" "paginaFinal" => "360" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Leónidas Luis Cruzado Vega, Alba Santos García" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Leónidas Luis" "apellidos" => "Cruzado Vega" "email" => array:1 [ 0 => "leocruzadov@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Alba" "apellidos" => "Santos García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Nefrología, Hospital General Universitario de Elche, Elche, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neumonía por SARS-COV-2 y <span class="elsevierStyleItalic">Aspergillus</span> en trasplante renal: ¿más frecuente de lo que pensamos?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Invasive pulmonary aspergillosis can complicate some viral infections, such as the flu, and we are starting to perceive it as a poor prognostic factor in patients co-infected with SARS-CoV-2 pneumonia.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 67-year-old man with chronic kidney disease secondary to focal segmental glomerulonephritis, that was on haemodialysis. In June 2020, he received a kidney transplant, with induction with basiliximab and treatment with tacrolimus, mycophenolate and steroids. Also received combined prophylaxis with cotrimoxazole and valganciclovir.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thirty (30) days after transplantation, the patient was diagnosed with SARS-CoV-2. The dose of immunosuppressants was reduced, and azithromycin and hydroxychloroquine were started. On day +14, he was admitted to the hospital due to fever and respiratory failure. Chest X-ray revealed bilateral infiltrates and laboratory tests showed creatinine 1.5 mg/dl, CRP 72 mg/l, Hb 10.6 g/dl, lymphocytes 340/µl, D-dimer 1.021 ng/ml and interleukin-6 31.9 pg/l. On admission, mycophenolate was discontinued and treatment was started with dexamethasone + remdesivir + ceftriaxone + prophylactic heparin. Based on criteria of severity it was decided to administer tocilizumab on the third day after admission and tacrolimus was suspended on the fifth day due to poor clinical course and supratherapeutic levels.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On day +7, he was admitted to the ICU due to reduced level of consciousness and respiratory failure requiring mechanical ventilation. Antibiotics were added, meropenem, amikacin, linezolid and voriconazole, maintaining prophylactic valganciclovir and Soltrim (trimethoprim/sulfamethoxazole). In addition to persistent positive PCR for SARS-CoV-2, <span class="elsevierStyleItalic">Aspergillus fumigatus</span> was found in the routine bronchial aspirate and serum galactomannan was 4,5. Given the persistence of high levels of tacrolimus, voriconazole was replaced by intravenous isavuconazole. After 13 days of hospitalisation, the patient's clinical course deteriorated with massive cerebral haemorrhage and he died that same day.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In November 2020, the COVID-19 Registry of the Spanish Society of Nephrology (SEN) reported 2,474 patients on renal replacement therapy, 37% of which were kidney transplants.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This population is considered to be at higher risk due to their state of immunosuppression and frequent contact with health centres.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Severely ill COVID-19 patients have higher concentrations of proinflammatory cytokines (IL-1, IL-2, IL-6 and tumour necrosis factor alpha) and anti-inflammatory cytokines (IL-4 and IL-10), with lower expression of interferon gamma, and they have lower numbers of CD4 and CD8 cells.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Therefore, the risk of suffering from fungal co-infections is greater.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In fact, an incidence of invasive aspergillosis of up to 0.65% has been described within the first year in kidney transplant recipients, with a mortality rate of up to 39% in the first 12 weeks.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Despite the high number of COVID-19 cases reported, its association with invasive aspergillosis has not been well established. The EORTC/MSG European group concludes that the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA) is a challenge, since the radiological characteristics of the invasive fungal lesion overlap with the pre-existing alterations as a result of viral SARS- CoV-2 pneumonia.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> In addition in COVID-19 patients, the high risk of aerosol generation limits the collection of respiratory samples (bronchial aspirate or bronchoalveolar lavage), so the diagnosis is often based on serum galactomannan antigen, and an index >0.7 is considered positive.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">There are many species of <span class="elsevierStyleItalic">Aspergillus</span> spp., but <span class="elsevierStyleItalic">Aspergillus fumigatus complex</span> is the most common aetiological agent. The treatment of choice is voriconazole. In our case, it was changed to isavuconazole because oral administration was not possible, because of its reduced influence on CYP3A4 activity (the patient had levels above the therapeutic concentrations despite having suspended tacrolimus) and because of its greater propensity to cross the blood-brain barrier.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> However, <span class="elsevierStyleItalic">Aspergillus fumigatus</span> azole resistance is increasingly common. Some authors advise against the use of monotherapy in favour of combination treatment with echinocandins or liposomal amphotericin B if there is suspicion of resistance or poor clinical course, and performing molecular identification.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Unfortunately, antifungal susceptibility for <span class="elsevierStyleItalic">Aspergillus</span> spp. is not available in all laboratories or it may take a long time, so the rate of azole resistance in Spain may be underestimated.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, SARS-CoV-2 and invasive mycoses co-infection in immunosuppressed patients is probably greater than that described in the literature. For this reason, and given the diagnostic limitations, the detection of fungal markers should point to the early establishment of treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Please cite this article as: Cruzado Vega LL, Santos García A. Neumonía por SARS-COV-2 y <span class="elsevierStyleItalic">Aspergillus</span> en trasplante renal: ¿más frecuente de lo que pensamos? Nefrologia. 2022;42:359–360.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "REGISTRO S.E.N. COVID-19. INFORME 16 (18 marzo – 3 octubre). 2020. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 10 | 8 | 18 |
2024 October | 69 | 33 | 102 |
2024 September | 70 | 54 | 124 |
2024 August | 81 | 81 | 162 |
2024 July | 56 | 39 | 95 |
2024 June | 73 | 52 | 125 |
2024 May | 114 | 33 | 147 |
2024 April | 79 | 34 | 113 |
2024 March | 74 | 29 | 103 |
2024 February | 79 | 42 | 121 |
2024 January | 63 | 26 | 89 |
2023 December | 43 | 35 | 78 |
2023 November | 55 | 53 | 108 |
2023 October | 61 | 35 | 96 |
2023 September | 68 | 35 | 103 |
2023 August | 64 | 23 | 87 |
2023 July | 51 | 45 | 96 |
2023 June | 61 | 27 | 88 |
2023 May | 82 | 60 | 142 |
2023 April | 35 | 28 | 63 |
2023 March | 45 | 14 | 59 |
2023 February | 36 | 28 | 64 |
2023 January | 38 | 32 | 70 |
2022 December | 59 | 45 | 104 |
2022 November | 60 | 47 | 107 |
2022 October | 75 | 67 | 142 |
2022 September | 30 | 39 | 69 |