Nocardia infection in patients with liver transplants or chronic liver disease: radiologic findings
Nocardiosis is a rare bacterial infection that causes systemic disease in man. It is usually characterized by pulmonary (lung) lesions and abnormalities. Infection most commonly occurs in organ transplant patients, whose immune systems are suppressed. Because liver transplants are increasingly being performed, this condition is now arising in this group of patients. This study examined the characteristics of Nocardia infection as seen on X-rays and computed tomography (CT) in patients who either had undergone liver transplants or who had severe liver disease. CT is an imaging technique that uses a computer to generate images from data obtained from scanning X-rays. Chest X-ray results from eight patients with nocardiosis, six of whom had a liver transplant and two of whom had severe liver disease, and chest CT results from three of the eight patients were evaluated. Chest X-ray results were abnormal for all eight patients, with three showing disease in many areas of the lungs and five showing disease in large but isolated areas of the lungs. A variety of lung abnormalities were seen, but none could be used to specifically diagnose the infection. CT results showed abnormalities in all three patients, but as with X-rays, none of the abnormalities could be used to specifically diagnose nocardiosis. CT results were useful in guiding biopsy procedures to obtain tissue samples from the abnormal areas. Examination of these samples led to a specific diagnosis. CT examinations of the head were performed in four patients, with abnormalities detectable in three of the four. CT and X-rays are useful in determining the extent of infection and in choosing areas where biopsy samples should be obtained, but the images they yield cannot specifically diagnose nocardiosis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Radiology
Cytomegalovirus pneumonitis after cardiac transplantation
People who undergo organ transplants face the possibility that their own immune systems might reject the transplanted organs. To prevent this, such patients are given drugs known as immunosuppressives. One unfortunate consequence of suppressing the immune system of a transplant patient is that the patient is then susceptible to a number of infections. One of the more common infections seen is transplant patients is cytomegalovirus, which healthy people can often carry unknowingly and without symptoms. Heart transplant patients suffer cytomegalovirus infections of the lungs, or CMV pneumonitis, more often and with greater severity than other organ transplant recipients. A total of 171 heart transplant patients were studied to determine the frequency and best means of detecting and treating CMV pneumonitis. Fifty-five of these patients developed some sort of lung infection, and in 27 of these, CMV was positively identified. The most sensitive method of identifying CMV was by bronchoalveolar lavage, in which a tube is passed into the lungs, through which salt water is flushed into the lungs, and then suctioned out and the liquid analyzed. CMV pneumonitis was found to be quite serious in these transplant patients. The overall probability of survival for one year after transplant was approximately 80 percent; for the CMV patients, survival was approximately 40 percent. In this study, ganciclovir, an antiviral drug often used for CMV, was not found to be helpful. The study concludes that prompt diagnosis is needed if treatment is to be of any benefit for heart transplant patients who contract CMV. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Pulmonary infection after cardiac transplantation: clinical and radiologic correlations
Cardiac (heart) transplantation has increased in incidence since the introduction, in 1983, of an immunosuppressive drug, cyclosporine A. This drug has proven highly successful in allowing the foreign tissue (the donated heart) from being destroyed by the body's immune system. Due to its suppression of the immune system, cyclosporine A also makes patients more susceptible to pathogenic organisms. This paper reports on 41 episodes of pulmonary (lung) infection as seen by X-ray in 118 transplant patients who are supported on cyclosporine. The observed rate of pulmonary infections was 30 percent. The most common organism was cytomegalovirus (13 cases), pneumocystis carinii (12 cases) and Aspergillus (5 cases). The distinctive radiologic appearance of these various pathogens is discussed and illustrated. Nine patients died of infection within four months of transplantation. The study appears to indicate the need for frequent chest X-rays in the early months following cardiac transplantation.
Publication Name: Radiology
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