Cobicistat Significantly Increases Tacrolimus Serum Concentrations in a Renal Transplant Recipient with Human Immunodeficiency Virus Infection.

Cobicistat is a pharmacokinetic booster in several fixed-dose combination products for treatment of human immunodeficiency virus (HIV) infection. As a potent inhibitor of cytochrome P450 (CYP) 3A enzymes, significant drug-drug interactions are expected between cobicistat and medications that are metabolized primarily through the CYP3A pathway, including calcineurin inhibitors (e.g.

Infectious complications of stem cell transplantation.

Hematopoietic stem cell transplantation (HSCT) is an accepted treatment for a variety of hematologic malignancies. The profound immunosuppression these patients experience adversely affects their risk of infection. This risk is much higher than in the general population and requires aggressive diagnostic and therapeutic interventions.

Zygomycosis in solid organ transplant recipients: a prospective, matched case-control study to assess risks for disease and outcome.

Background: Clinical characteristics, risks, and outcomes in solid organ transplant (SOT) recipients with zygomycosis in the era of modern immunosuppressive and newer antifungal agent use have not been defined.

Methods: In a matched case-controlled study, SOT recipients with zygomycosis were prospectively studied. The primary outcome measure was success (complete or partial response) at 90 days.

Combination therapeutic approaches for the management of invasive aspergillosis in organ transplant recipients.

Outcomes in organ transplant recipients with invasive aspergillosis remain sufficiently dismal that combination antifungal approaches present an attractive therapeutic option. The efficacy of such approaches has not been incontrovertibly documented. However, limited data suggest that combination antifungal therapy may be considered in subsets of high-risk patients e.

Mycobacterium haemophilum: a rare cause of endophthalmitis.

Nontuberculous mycobacterial (NTM) infections are becoming an increasingly important complication in ophthalmology, particularly among immunocompromised patients. We report a case of NTM in a 66-year-old male immunosuppressed after cardiac transplantation. Chronic granulomatous iridocyclitis progressed to purulent endophthalmitis despite intraocular and systemic antimicrobial therapy.

Successful allogeneic transplantation of patients with suspected prior invasive mold infection.

Prior invasive fungal infection (IFI) has historically limited the use of allogeneic stem cell transplantation for patients with hematologic malignancies. Transplantation of such patients frequently resulted in recurrent infection and high mortality rates. Several new antifungal agents have been introduced over the past 5 years with broader spectra of activity against molds such as Aspergillus and a favorable toxicity profile.

Antifungal management practices and evolution of infection in organ transplant recipients with cryptococcus neoformans infection.

Background: Therapeutic practices for Cryptococcus neoformans infection in transplant recipients vary, particularly with regards to antifungal agent employed, and duration of therapy. The risk of relapse and time to recurrence is not known. We assessed antifungal treatment practices for cryptococcosis in a cohort of prospectively followed organ transplant recipients.

Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED.

The objective was to provide a descriptive analysis of infectious processes in transplant patients admitted from the emergency department (ED). A database of all adult transplant patients at a university medical center was cross-referenced with a computerized record of all ED visits over an 18-month period. ED charts, inpatient records, and microbiology data were retrospectively reviewed.

A standardized protocol for the treatment of severe pneumonia in kidney transplant recipients.

Although the incidence of pneumonia after kidney transplantation is the lowest among all solid organ transplants, it is associated with high mortality rate (40-50%). We evaluated the efficacy of a protocol consisting of bronco-alveolar-lavage (BAL) for early microbiological diagnosis, reduction of the immunosuppressive therapy, and prompt administration of standardized antibiotic regimen in renal transplant recipients with severe pneumonia. Between 6/1989 and 5/1999, 40 kidney transplant recipients developed 46 episodes of severe pneumonia (hypoxia and/or infiltrate on the chest X-ray).

Analysis and characterization of antiviral drug-resistant cytomegalovirus isolates from solid organ transplant recipients.

The development of cytomegalovirus (CMV) disease and subsequent emergence of drug-resistant strains was examined in a large group of solid organ transplant recipients; drug-resistant CMV was detected in a total of 30 transplant recipients (20 lung, 5 kidney, 4 heart, and 1 liver). Drug resistance was confirmed both phenotypically and genotypically. The sequences of drug-resistant CMV strains from the same patient differed from drug-susceptible baseline sequences only at single sites previously confirmed to confer drug resistance.