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Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia. 2022;42:611-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Eficacia de los sellados sistemáticos de catéter con taurolidina/heparina versus taurolidina/uroquinasa en pacientes con insuficiencia renal crónica estadio 5D" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "611" "paginaFinal" => "613" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Efficacy of systematic catheter locks solution of taurolidine/heparin versus taurolidine/urokinase in end-stage renal insufficiency stage 5D" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1209 "Ancho" => 1500 "Tamanyo" => 89291 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Curvas de supervivencia (Kaplan-Meier) analizando la permeabilidad primaria (PP) en cada uno de los subgrupos de sellado de catéter tunelizado (T-Hep vs. T-UQ).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Néstor Fontseré, Alex Soriano, Gaspar Mestres, Patricia Bermudez, Federico Zarco, Valentín Lozano, Lida Rodas, Jose Broseta, Marta Arias, Francisco Maduell" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Néstor" "apellidos" => "Fontseré" ] 1 => array:2 [ "nombre" => "Alex" "apellidos" => "Soriano" 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"https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699521000874?idApp=UINPBA000064" "url" => "/02116995/0000004200000005/v1_202209080524/S0211699521000874/v1_202209080524/es/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "COVID-19 reinfection in a kidney transplant recipient, time for rethinking?" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "613" "paginaFinal" => "615" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Borja Quiroga, Andrés Fernández Ramos, Alicia Delgado Arroyo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Borja" "apellidos" => "Quiroga" "email" => array:1 [ 0 => "borjaqg@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Andrés" "apellidos" => "Fernández Ramos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Alicia" "apellidos" => "Delgado Arroyo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Nephrology Department, Hospital Universitario de La Princesa, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Intensive Care Unit, Hospital Universitario de La Princesa, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reinfección por COVID-19 en un paciente portador de trasplante renal, ¿tiempo para reflexionar?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1583 "Ancho" => 3000 "Tamanyo" => 935494 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of the patient highlighting the SARS-CoV-2 tests performed since the first infection. Abbreviation: real-time reverse transcription-polymerase chain reaction (rRT-PCR).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">COVID-19 reinfections in immunocompromised patients are a challenge for scientific community. Here we present the first case of a kidney transplant receipt with a lethal COVID-19 reinfection.</p><p id="par0010" class="elsevierStylePara elsevierViewall">He is a 60-year-old male, with chronic kidney disease (CKD) due to focal and segmental glomeruloesclerosis that received his first kidney transplant 2004. In treatment with prednisone and rapamycin since 2007 when we was diagnosed of a hepatocellular carcinoma.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In August 2020, after a close contact to a COVID-19 family member, he developed mild symptoms (cough and low-grade fever) and SARS-CoV-2 infection was confirmed by a positive nasopharyngeal real-time reverse transcription-polymerase chain reaction (rRT-PCR) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The clinical course was favorable, and he did not need further clinical assistance in that moment. A confirmatory rRT-PCR was performed showing a negative result.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In December 2020 and January 2021, he was admitted in the hospital due to two episodes of urinary tract infection caused by <span class="elsevierStyleItalic">Staphilococcus aureus</span> and <span class="elsevierStyleItalic">Serratia marcenses</span>. In both hospitalizations, rRT-PCR were repeated five times (12th, 30th December and 4th, 9th, 17th January 2021) resulting negative in all of them. A chest X-ray performed on 12th December 2020 showed very low intensity bilateral infiltrates. In addition, on 8th January 2021, a chest-abdomen computed tomography scan demonstrated bilateral infiltrates in both hemithorax, probably as a residual lesion of the SARS-CoV-2 previous infection (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). After diuretic and antibiotic treatment, chest X-ray improved significantly, and the patient was discharge asymptomatic 20th January 2021.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">However, 28th January 2021, the patient was again admitted due to respiratory fever and acute injury of the allograft function. A chest X-ray showed bilateral infiltrates with unilateral pleural effusion. A new rRT-PCR confirmed SARS-CoV-2 infection by the same viral genotype, so immunosuppression was stopped, and dexamethasone was started. A thoracentesis of the pleural effusion demonstrated SARS-CoV-2 in the obtained sample. Antibodies (IgM and IgG) for SARS-CoV2 resulted negative. Although he was theoretically immunosuppressed, lymphocyte populations were normal. Despite established treatment including high flux oxygen, the patient deceased on 5th February 2021.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Several doubts have emerged around reinfections in general population. Technical errors in specimen collection or false negative results in rRT-PCR have been demonstrated in many patients driving to mistakes in COVID-19 reinfections. In addition, virus or non-active fragments of them can persist in sputum for weeks showing false positive results. However, the most part of the published reinfections have shown an asymptomatic course in the second positive rRT-PCR episode.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> This situation interestingly differs from our patient who presented a pauci-symptomatic course of COVID-19 infection with a lethal reinfection 5 months later.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Our patient presented some confirmatory features of a COVID-19 reinfection. First, he had positive rRT-PCR concurring with a family member contact and some mild symptoms. Despite this classical clinical picture, and even using a highly specific rRT-PCR, in some circumstances false positives can occur. Second, we confirmed negative rRT-PCR in several times, but radiological images showed residual bilateral lesions suggestive of COVID-19 past infection. Third, he developed new symptoms and chest X-ray worsen significantly simultaneously. In addition, in the reinfection episode, pleural effusion revealed the presence of SARS-COV-2 in the lungs.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Reasons for reinfection have not been widely studied, in part because immune response to SARS-CoV-2 has not been yet addressed.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Probably, immunosuppressive factors can contribute to limit viral clearance and to impair cellular and humoral immunity in COVID-19 as in other infections.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The clinical course of our patient agrees with this hypothesis. Although lymphocyte populations were normal at admission, in our patient concurred the personal history of the active neoplasia and the immunosuppression due to kidney transplant. Unfortunately, data regarding humoral or cellular immunity was not available after the first episode.</p><p id="par0045" class="elsevierStylePara elsevierViewall">On this regard, reinfections can raise some concerns about the COVID-19 vaccines efficacy in those populations with risk factors for attenuating humoral immunity. In addition, pivotal COVID-19 vaccines randomized clinical trials have systematically excluded CKD patients so there is an important lack of information about their efficacy in that population. A very recent investigation letter has shown that a single dose of SARS-CoV2 mRNA vaccine generates a poor antispike antibody response, situation than can explain a COVID-19 reinfection, especially more than 4 months before the primoinfection.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> On the other hand, we must be cautious with those patients with prior episodes of COVID-19 who develop new symptoms and chest X-ray lesions and, of course, always recommend maintaining infection preventive measures.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, reinfections in kidney transplants are plausible and require paying attention to those patients who developed COVID-19 symptoms even if they have had a previous episode.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1583 "Ancho" => 3000 "Tamanyo" => 935494 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of the patient highlighting the SARS-CoV-2 tests performed since the first infection. Abbreviation: real-time reverse transcription-polymerase chain reaction (rRT-PCR).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 841 "Ancho" => 905 "Tamanyo" => 150120 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Chest and abdomen computed tomography showing bilateral infiltrates in lungs.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COVID-19 reinfection: linked possibilities and future outlook" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. 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JAMA. 2021;325:1784-6, https://doi.org/10.1001/jama.2021.4385" ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02116995/0000004200000005/v1_202209080524/S0211699521000886/v1_202209080524/en/main.assets" "Apartado" => array:4 [ "identificador" => "48186" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/02116995/0000004200000005/v1_202209080524/S0211699521000886/v1_202209080524/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699521000886?idApp=UINPBA000064" ]
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