Antivirals and resistance: influenza virus.

Influenza causes annual epidemics of respiratory viral infections are associated with significant morbidity and mortality. Influenza vaccines have been shown to reduce the risk of infection and mitigate against some of the virus' sequellae. Likewise, two classes of antivirals, the adamantanes (amantadine and rimantadine) and the neuraminidase inhibitors (laninamivir, oseltamivir, peramivir, and zanamivir) are currently approved for the prevention and treatment of influenza; several other classes of antivirals and immune modulators are also currently under investigation.

Diagnosis, management and outcomes of adults hospitalized with influenza.

Annual influenza epidemics and periodic pandemics result in excess hospital admissions. Hospitalization typically occurs in those with underlying medical conditions, those at the extremes of age and in pregnant woman; young adults and obese individuals were also at increased risk during the 2009 H1N1 pandemic. Severe influenza pneumonia, exacerbation of underlying lung diseases, cardiovascular and cerebrovascular events and bacterial superinfection are common reasons for hospitalization.

Antiviral therapies for respiratory viral infections in lung transplant patients.

Because the lung is in constant contact with the environment, infections with respiratory viruses are a common and potentially serious complication of lung transplantation. Infection can cause direct effects, typically manifested as respiratory symptoms and changes in pulmonary function, and indirect effects, such as an enhanced risk of developing chronic allograft rejection. Infections with all of the identified respiratory viruses have been associated with infection in lung transplant recipients.

Pharmacokinetic assessment of peramivir in a hospitalized adult undergoing continuous venovenous hemofiltration.

Objective: To report a sieving coefficient for peramivir in a patient receiving continuous venovenous hemofiltration (CVVH).

Case Summary: An 18-year-old male presented with chills, myalgias, and dyspnea and was hospitalized. Nasal secretions were positive for influenza by rapid antigen test at an outside facility and oseltamivir was commenced.

The challenge of informed consent for increased risk living donation and transplantation.

The Organ Procurement and Transplantation Network (OPTN) mandates that organ recipients provide "specific informed consent" before accepting organs that the OPTN defines as "increased risk". However, the OPTN does not provide specific guidelines for what information should be disclosed to potential recipients. Such vagueness opens the door to inadequate informed consent.

Uniform definitions for donor-derived infectious disease transmissions in solid organ transplantation.

High-profile cases of infectious diseases transmitted from organ donors to transplant recipients, such as the transmission of human immunodeficiency virus, have driven policy globally. Many nations have or are developing regulations requiring reporting and investigation of such disease transmissions as part of broader biovigilance programs for all substances of human origin. A group of experts (see Acknowledgments) developed definitions for proven, probable, possible, unlikely, excluded, intervened upon without documented transmission, and positive assay without apparent disease transmission events that should be used, as a starting point, to standardize nomenclature and facilitate global tracking and study of such infectious disease transmissions.

Kidney transplant candidates' understanding of increased risk donor kidneys: a qualitative study.

Background: The Organ Procurement and Transplantation Network (OPTN) requires specific informed consent when "increased risk" (IR) donor organs are utilized. Little is known about kidney transplant candidates' understanding of IR donor kidneys.

Methods: We assessed kidney transplant candidates' perceptions, reasons for accepting or declining a future IR donor kidney offer, and information needs through semi-structured interviews.

Influenza vaccination in the organ transplant recipient: review and summary recommendations.

Influenza virus causes a spectrum of illness in transplant recipients with a high rate of lower respiratory disease. Seasonal influenza vaccination is an important public health measure recommended for transplant recipients and their close contacts. Vaccine has been shown to be safe and generally well tolerated in both adult and pediatric transplant recipients.

Use of the QuantiFERON-TB Gold interferon-gamma release assay for screening transplant candidates: a single-center retrospective study.

Background: Tuberculosis (TB) reactivation is a rare but significant complication of organ transplantation, and screening of all transplant candidates for latent infection is recommended with either an interferon-γ release assay (IGRA) or tuberculin skin test (TST).

Methods: After institutional review board approval, we retrospectively collected data to describe the yield of transplant candidate screening using the QuantiFERON-TB Gold (QFT) and QuantiFERON-TB Gold In-Tube (QFT-IT) assays since the institution of TB screening in 2008 and the epidemiology of all cases of post-transplant TB in our institution since 2004.

Results: A total of 2392 patients were screened with either the QFT or QFT-IT assay through October 2009; 245 (10.

A category-specific response to animals in the right human amygdala.

The amygdala is important in emotion, but it remains unknown whether it is specialized for certain stimulus categories. We analyzed responses recorded from 489 single neurons in the amygdalae of 41 neurosurgical patients and found a categorical selectivity for pictures of animals in the right amygdala. This selectivity appeared to be independent of emotional valence or arousal and may reflect the importance that animals held throughout our evolutionary past.

Selectivity of pyramidal cells and interneurons in the human medial temporal lobe.

Neurons in the medial temporal lobe (MTL) respond selectively to pictures of specific individuals, objects, and places. However, the underlying mechanisms leading to such degree of stimulus selectivity are largely unknown. A necessary step to move forward in this direction involves the identification and characterization of the different neuron types present in MTL circuitry.

Transmission of human immunodeficiency virus and hepatitis C virus from an organ donor to four transplant recipients.

In 2007, a previously uninfected kidney transplant recipient tested positive for human immunodeficiency virus type 1 (HIV) and hepatitis C virus (HCV) infection. Clinical information of the organ donor and the recipients was collected by medical record review. Sera from recipients and donor were tested for serologic and nucleic acid-based markers of HIV and HCV infection, and isolates were compared for genetic relatedness.

Donor-transmitted malignancies in organ transplantation: assessment of clinical risk.

The continuing organ shortage requires evaluation of all potential donors, including those with malignant disease. In the United States, no organized approach to assessment of risk of donor tumor transmission exists, and organs from such donors are often discarded. The ad hoc Disease Transmission Advisory Committee (DTAC) of the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) formed an ad hoc Malignancy Subcommittee to advise on this subject.

An update on donor-derived disease transmission in organ transplantation.

Several recent donor-to-recipient disease transmissions have highlighted the importance of this rare complication of solid organ transplantation. The epidemiology of donor-derived disease transmissions in the United States has been described through reports to the Organ Procurement and Transplant Network (OPTN); these reports are reviewed and categorized by the ad hoc Disease Transmission Advisory Committee (DTAC); additional data comes through the published literature. From these reports, it is possible to estimate that donor-derived disease transmission complicates less than 1% of all transplant procedures but when a transmission occurs, significant morbidity and mortality can result.

Organ donor screening practices for Trypanosoma cruzi infection among US Organ Procurement Organizations.

Donor-derived Trypanosoma cruzi infection in solid organ transplant recipients is associated with significant morbidity and mortality. Little is known about T. cruzi screening practices among U.

Screening and treatment of chagas disease in organ transplant recipients in the United States: recommendations from the chagas in transplant working group.

Donor-derived transmission of Trypanosoma cruzi, the etiologic agent of Chagas disease, has emerged as an issue in the United States over the past 10 years. Acute T. cruzi infection causes substantial morbidity and mortality in the posttransplant setting if not recognized and treated early.

Clinical experience in adults and children treated with intravenous peramivir for 2009 influenza A (H1N1) under an Emergency IND program in the United States.

Background: Peramivir, an investigational intravenous neuraminidase inhibitor in Phase 3 trials for hospitalized patients, was made available during the 2009 H1N1 influenza pandemic under the Emergency Investigational New Drug (eIND) regulations. We describe the clinical characteristics and outcomes of all patients for whom peramivir was requested under the eIND.

Methods: After obtaining eIND approval from the Food and Drug Administration and local institutional review board approval, clinicians caring for hospitalized patients with influenza administered intravenous peramivir and collected information on demographic characteristics, clinical characteristics, and outcomes.

Epidemiology, prevention, and management of influenza in patients with hematologic malignancy.

Influenza results in annual epidemics of respiratory viral illness during the winter; when a novel virus enters the human population, a pandemic may result with a larger proportion of the population sickened. Unlike the mild and typically self-limited disease seen in immunocompetent patients, immunocompromised patients frequently have a more severe course. These individuals shed virus for a prolonged period of time, have a high rate of viral pneumonia, more frequently develop bacterial and fungal super-infections, and may develop late-onset airflow obstruction.

Occupational asthma in the aluminum smelters of Australia and New Zealand: 1991-2006.

Objective: To examine the incidence of occupational asthma in the seven aluminum smelters of Australia and New Zealand from 1991 to 2006.

Methods: Incidence and exposure data were collected by survey from the smelters prospectively during the study period.

Results: The incidence of occupational asthma across all smelters combined was highest in 1992 at 9.

Alemtuzumab induction in non-hepatitis C positive liver transplant recipients.

Limited data exist for the use of alemtuzumab (AL) induction in liver transplantation (LT) recipients. We compared the outcomes of hepatitis C virus-negative LT recipients who received AL induction followed by tacrolimus and mycophenolate mofetil without steroids to cohort who received no AL induction, tacrolimus, and a steroid taper. Fifty-five AL-induced recipients were compared to 85 non-AL-induced recipients with similar characteristics.

Influenza 2010-2011: lessons from the 2009 pandemic.

Much was learned about the diagnosis, management, and pathogenesis of influenza from the 2009 pandemic of influenza A (H1N1). This knowledge can be applied to the management of people affected by seasonal infection and to future pandemics.

Influenza, including the novel H1N1, in organ transplant patients.

Purpose Of Review: This article will review the epidemiology, diagnosis, prevention and management of influenza in solid organ transplant recipients.

Recent Findings: A number of recent studies have documented that influenza vaccination is both well tolerated and generally effective in producing an immunologic response in most solid organ transplant (SOT) recipients. Antiviral use is associated with improved clinical outcomes, but prolonged shedding may require a longer course of therapy than what is currently approved by the FDA.

Expanded infectious diseases screening program for Hispanic transplant candidates.

Most guidelines for pre-transplant screening recommend enhanced screening among patients with potential exposure to such pathogens as Strongyloides stercoralis and Trypanosoma cruzi, the cause of Chagas disease. The incidence of these diseases in the Hispanic immigrant population has not been extensively studied. Transplant candidates who were evaluated by our program's Hispanic Transplant Program were referred for expanded infectious disease screening including Mycobacterium tuberculosis, S.