感染症と医学ジャーナル

Background: Survival time after heart transplantation continues to rise due to the use of immunosuppression therapy and other advances in care. However, this increase in patient survival and exposure to potent immunosuppression drugs comes at the expense of long-term complications such as infection and malignancy. In addition to immunosuppression exposure, viral infection has been indicated to play a role in carcinogenesis. While the presence of CMV genome or antigens has been found in malignant tumors, conflicting evidence exists regarding the independent nature of this association. Limited data are available regarding the association of Cytomegalovirus (CMV) in skin cancer development post transplant. Study to detect CMV genome specifically in Non-Melanoma Skin Cancers (NMSC’s) yet to be complete in the heart transplant population.

Methods: This is a single center, retrospective, observational study of adult heart transplant recipients managed by the University of Rochester Advanced Heart Failure program. 10 BCC and 10 SCC lesions of heart transplant recipients housed at the URMC were tested for CMV-PCR, DNA.

Results: CMV was not detected from any of the specimens.

Conclusion: We did not identify a connection between CMV DNA and non-melanoma skin cancers.

Introduction: Determining treatment outcomes is a key component of the fight against tuberculosis. This has become even more important with the emergence of multidrug resistant TB. The objective of this study was to determine the outcomes of patients treated for tuberculosis within the National Program for the Fight AgainstTuberculosis (NTP) in Senegal.

Methods: We conducted a retrospective cohort study involving all patients treated for tuberculosis in the Department of Infectious Diseases at the Fann University Hospital in Senegal from January 1, 2011 to December 31, 2014. Data were entered and analysed using the software Epi-Info 3.7.1. The Chi-square test was used to compare treatment outcomes in 2011 versus 2014.

Results: Data were collected for 1030 cases of tuberculosis. Pulmonary (49%), lymphatic (15.9%) and neuromeningeal tuberculosis (11.7%) were the main sites of involvement. The mean weight gain was 5.3 ± 4 kg. TB  treatment outcomes were distributed as follows: 504 (49%) treatment success, 278 (27%) deaths, 103 (10%) lost to follow-up, 143 (13.9%) transferred out and 1 (0.1%) failed. The therapeutic success rate fluctuated from 45.4% to 59.5% between 2011 and 2014 (p=0.07). The proportion of patients lost to follow-up decreased significantly from 15.3% to 3.5% (p<0.001). However, mortality increased from 22% to 31% (p=0.001).

Conclusion: Tuberculosis treatment success rate within this hospital population remains low. Early detection of tuberculosis and HIV is the key point to improve outcome treatment.