Introduzione.L'infezione da Toxoplasma gondii è una possibile complicanza nei pazienti trapiantati di organo solido toracico in Europa dove la sieroprevalenza è alta.La toxoplasmosi può essere causata dalla presenza di cisti nel cuore trapiantato in un ricevente sieronegativo oppure dalla riattivazione di una pregressa infezioni di pazienti sieropositivi.Scopo dello studio è stato: 1) valutare la frequenza di siero conversione per toxoplasmosi in riceventi sieronegativi di organo solido (cuore e/o polmone) con donatori sieropositivi (R-/ D+) o sieronegativi (R-/D-).2) Verificare l'efficacia della chemioprofilassi in R-/D+ e della profilassi igienico alimentare in tutti i riceventi sieronegativi.3) Valutare le caratteristiche clinico sierologiche della malattia in tutti i pazienti infetti.Metodi.Abbiamo valutato 114 riceventi sieronegativi sottoposti a follow-up clinico e sierologico dopo il trapianto per diversi intervalli di tempo (2 mesi-14 anni) presso il Dipartimento di Malattie Infettive.I pazienti erano così suddivisi R-/D-: 50 pazienti follow-up da 2 a 198 mesi, 38 maschi, 36 cuore, 13 polmone, 1 polmone/fegato.Solo profilassi igienico alimentare.R-/D+: 64 pazienti follow-up da 2 a 151 mesi, 46 maschi, 51 cuore, 13 polmone.Profilassi igienico alimentare e terapia con PYR+SUL per due mesi.Tutti i pazienti sono stati testati per anticorpi IgG IgM con i seguenti tests: ELISA IgG IgM( Diasorin Saluggia Italia), IgG ELFA (Biomerieux Marcy L'Etoile).In tutte le sospette sieroconversioni anche con Toxo IgM ISAGA, Toxo IgG Avidity (Biomerieux Marcy L'Etoile France), IgA Elisa (Diasorin Saluggia Italia), IgG IgM Western-Blot (LDBIO Lyon France).Nei casi sintomatici è stata anche eseguita una nested PCR con gene target AF 487580 (Clonit Milano Italia).Risultati.

Scopo: Rilevare la presenza di infestazione di Strongyloides stercoralis in soggetti ospedalizzati asintomatici a rischio per tale nematodosi, individuare un metodo diagnostico efficace per lo screening dei pazienti residenti in zone a rischio.

Reactivation of hepatitis B virus (HBV) infection is known to occur in chronic HBsAg carriers who are immunosuppressed. From November 1985 through September 2000 a total of 786 recipients (160 female and 626 male, mean age 47.6, range 8-71 years) underwent thoracic organ transplantation (612 heart, 29 heart-lung, 70 double lung and 75 single lung) at our Institution. Twenty-one HbsAg positive, HBV-DNA negative patients underwent thoracic organ transplantation (15 heart and 6 lung). Nine (42.8%) patients died of HBV unrelated causes at a mean of 33.1 (median 17.6, range 0.167-107.3) months after transplantation, two are still alive with HBV-DNA negativity and 10 (47.6%) developed HBV reactivation, documented by HBV-DNA detection on peripheral blood, at a mean of 31.5 (median 20.7, range 0.133-129.5) months after transplantation. Of these 10 patients two died of decompensated liver disease before lamivudine was available at 20.9 and 40.9 months after transplantation, respectively. The other 8 patients underwent a liver biopsy and were treated with lamivudine at the dose of 100 mg/day. Furthermore five patients who tested negative for HBV markers and one who was HBsAb and HBcAb positive prior to transplantation were found HBV-DNA positive at a mean of 37.6 (median 25.1, range 9.5-120.6) months after transplantation and two of them were treated with lamivudine. Five of the 10 lamivudine treated patients cleared HBV-DNA from blood and the mean time to HBV-DNA clearance was 53.2 (range 31-83) days after the start of lamivudine treatment. Serum ALT returned to normal in 5/7 patients with pre-treatment liver function tests abnormalities after a mean of 123.6 (range 31-277) days of lamivudine treatment. No significant side effect was observed during the treatment that was given for a median of 296 days (range 2-908). Thoracic organ transplantation in HBsAg positive and HBV-DNA negative recipients is followed by HBV reactivation in a high percentage of cases. However, the clinical outcome and the availability of lamivudine suggest not to exclude these patients from transplantation.