LIGIA CAMERA PIERROTTI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/47 - Laboratório de Hepatologia por Vírus, Hospital das Clínicas, Faculdade de Medicina
LIM/47 - Laboratório de Hepatologia por Vírus, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
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- Seroconversion of 2009 pandemic influenza A (H1N1) vaccination in kidney transplant patients and the influence of different risk factors(2013) AZEVEDO, L. S.; GERHARD, J.; MIRAGLIA, J. L.; PRECIOSO, A. R.; TIMENETSKY, M. dC S. Tavares; AGENA, F.; GAMBA, C.; YASUDA, M. A. Shikanai; DAVID-NETO, E.; PIERROTTI, L.BackgroundInfluenza may present a high morbidity and mortality in solid organ transplanted patients (SOTP). Annual influenza virus vaccine is recommended for SOTP. However, low levels of seroconversion in SOTP have been reported. The aim of this study was to evaluate the immunogenicity of 2009 pandemic influenza A (H1N1) - A(H1N1)pdm09 - vaccine in kidney transplant patients and to analyze which features might affect seroconversion. MethodsThis study was conducted from March to August 2010 at the Renal Transplantation Unit of University of SAo Paulo, Brazil. A total of 85 renal transplant patients attending the outpatient unit received one 15-g intramuscular dose of A(H1N1)pdm09 influenza vaccine (reassortant vaccine virus A/California/7/2009 [NYMC X-179A]). Blood samples were collected immediately before and 21days after the vaccine was given. Antibody response was measured by the standard hemagglutination-inhibition (HI) assay. The primary immunogenicity endpoint for this study was seroconversion in previously seronegative patients (HI titers <1:40), and the secondary endpoint was the identification of features that could affect seroconversion in this population. ResultsFive (5.9%) patients presented HI titers prevaccination 1:40 and were excluded from further analysis. Seroconversion in previously negative patients occurred in 27 (34%) of 80 patients. Prevaccination HI titers geometrical mean was 5.8 and postvaccination 19.6 (ratio 3.4). Significant seroconversion rate factors were female gender, non-Caucasian ethnicity, and post-transplant time before vaccination. No impact was seen on seroconversion for age, donor type, tacrolimus and cyclosporine blood levels, renal function, or blood lymphocyte counts. Mycophenolate (MPA) showed a lower rate of seroconversion when compared with azathioprine. Tacrolimus and cyclosporine had similar seroconversion rates. Sirolimus use was associated with the highest rate of seroconversion, although these patient numbers were low. Immunosuppresssion containing MPA was considerably less effective in seroconversion than drug combinations with no MPA. Patients receiving sirolimus had more chance of seroconversion. HI titers geometric means pre/post vaccine were as follows: MPA (n=56): 5.8/12.8; tacrolimus (n=50): 5.9/16.2; cyclosporine (n=18): 5.4/24.2; azathioprine (n=19): 6.2/51.6; and sirolimus (n=6): 8/80. By univariate analysis, being female and non-White were variables associated with 3.3 times more chance of seroconversion than being male and White. In the multivariate analysis, the variables remaining in the model showed similar hazard ratios. ConclusionsIn this study, the monovalent A(H1N1)pdm09 influenza vaccine demonstrated low rates of seroconversion, particularly in patients on MPA, but with potentially higher response rates in patients on sirolimus.
conferenceObject Defining pp65 Enemia and qPCR Cut-Offs for Pre-Emptive Therapy of CMV Disease in Low-Risk, Seropositive Renal Transplanted Recipients(2013) DAVID-NETO, E.; LEMOS, A.; BOAS, L. Vilas; LATIF, A.; AGENA, F.; PAULA, F. Jota de; PIERROTI, L.; LEMOS, F.; NAHAS, W.; CAIAFFA FILHO, H.; PANUTTI, C.CMV disease mostly invasive gastro-intestinal with low viremia occurs in approximately 16% of CMV seropositive renal transplant recipients not receiving Thymoglobuline (ATG). Pre-emptive therapy (PETh) to avoid disease in this group should cover the majority of patients at risk (high Negative Predictive Value – NPV). To define cut-offs for whole blood real-time quantitative PCR (qPCR) and antigenemia (pp65) assays and use PETh for CMV disease we collected blood samples weekly from day 7 to 120 after TX in pts CMV IgG+/ IgG+ donors who did not receive ATG. Results remained blinded. A suspicion of CMV disease required new qPCR/pp65 or biopsy. The highest value of pp65 and qPCR in pts without CMV disease one week before disease were used in ROC curves. As for Nov 2012, 92 pts had completed the collections or developed disease. They were males (54%), caucasians (69%), mean age 45±14y, 61% deceased donors, all under TAC/MPA/ Prednisone. Overall 12 pts (13%) had CMV disease (11 invasive gastro-intestinal/ 1 syndrome), at 64±21 days (31-98), and 80 did not. Of these 80 pts, 45 (56%) presented at least one episode of asymptomatic viremia and cleared it spontaneously (8 (18%) had PCR+/pp65+; 26 (56%) Pp65+/qPCR- and 11 (24%) qPCR+/Pp65-). Among pts with viremia or disease there was a trend for a higher pp65+ cells for disease than for viremia (152±352vs31±131/10 6 cells, p=0.073,) detected earlier for disease than viremia (64±21vs80±25 days, p=0.049). ROC curves (area 0.902±0.036, p=0.0001) revealed that pp65 of 4 cells had 83% sensitivity and 83% specificity to predict CMV disease. Using this cut-off, the NPV was 97%. The CMV copies detected by qPCR was higher for disease than for viremia (46657±50671 vs 5438±16681 copies, p=0.001) but time for detection was similar for both (74±25 vs 59±18 days, p=NS). ROC curve (area 0.903±0.056,p=0.0001) revealed that qPCR=844 copies had 83% sensitivity and 86% specificity to predict disease with the same NPV of 97%. These data indicate that both methods are adequate to detect CMV disease prior to its development in this low-risk population. Blood samples collection should start at day 30 and then weekly until day 120. When these cut-offs are reached, starting pre-emptive therapy would lead untreated only 3% of patients who would develop CMV disease.- Infection Related to Implantable Central Venous Access Devices in Cancer Patients: Epidemiology and Risk Factors(2013) FREIRE, Maristela P.; PIERROTTI, Ligia C.; ZERATI, Antonio E.; ARAUJO, Pedro H. X. N.; MOTTA-LEAL-FILHO, J. M.; DUARTE, Laiane P. G.; IBRAHIM, Karim Y.; SOUZA, Antonia A. L.; DIZ, Maria P. E.; PEREIRA, Juliana; HOFF, Paulo M.; ABDALA, EdsonOBJECTIVE. To describe the epidemiology of infections related to the use of implantable central venous access devices (CVADs) in cancer patients and to evaluate measures aimed at reducing the rates of such infections. DESIGN. Prospective cohort study. SETTING. Referral hospital for cancer in Sao Paulo, Brazil. PATIENTS. We prospectively evaluated all implantable CVADs employed between January 2009 and December 2011. Inpatients and outpatients were followed until catheter removal, transfer to another facility, or death. METHODS. Outcome measures were bloodstream infection and pocket infection. We also evaluated the effects that the creation of a multidisciplinary team for CVAD care, avoiding in-hospital implantation of CVADs, and limiting CVAD insertion in neutropenic patients have on the rates of such infections. RESULTS. During the study period, 966 CVADs (mostly venous ports) were implanted in 933 patients, for a combined total of 243,792 catheter-days. We identified 184 episodes of infection: 154 (84%) were bloodstream infections, 21 (11%) were pocket infections, and 9 (5%) were surgical site infections. During the study period, the rate of CVAD-related infection dropped from 2.2 to 0.24 per 1,000 catheter-days (P < .001). Multivariate analysis revealed that relevant risk factors for such infection include surgical reintervention, implantation in a neutropenic patient, in-hospital implantation, use of a cuffed catheter, and nonchemotherapy indication for catheter use. CONCLUSIONS. Establishing a multidisciplinary team specifically focused on CVAD care, together with systematic reporting of infections, appears to reduce the rates of infection related to the use of these devices.
- Clinical features and outcomes of tuberculosis in kidney transplant recipients in Brazil: a report of the last decade(2013) MARQUES, Igor D. B.; AZEVEDO, Luiz S.; PIERROTTI, Ligia C.; CAIRES, Renato A.; SATO, Victor A. H.; CARMO, Lilian P. F.; FERREIRA, Gustavo F.; GAMBA, Cristiano; PAULA, Flavio J. de; NAHAS, William C.; DAVID-NETO, EliasBackground Among kidney transplant recipients (KTRs), tuberculosis is one of the most common opportunistic infections and is associated with high morbidity and mortality. The aim of this study was to describe the incidence, clinical features, and prognosis of tuberculosis in KTRs. Methods Retrospective single-center observational study involving all cases of tuberculosis in KTRs between 2000 and 2010. Results Of the 1549 KTRs evaluated, 43 (2.8%) developed tuberculosis, translating to an annual incidence of 803 cases/100000 patients, considerably higher than that reported for the general population of Brazil. The median time to tuberculosis (TB) onset after transplantation was 196d (range, 193626d). Of the KTRs with tuberculosis, 67% became infected within the first year post-transplant, 74% had pulmonary tuberculosis, and 7% had a previous history of active tuberculosis. No tuberculosis prophylaxis was employed before or after transplantation. The most common symptoms were fever (in 79%), cough (in 35%), and dyspnea (in 16%). The median time from the onset of symptoms to the start of treatment was 28d. The median duration of antituberculosis therapy was 196d. In 15 patients (35%), the immunosuppressive therapy was reduced, and the incidence of acute rejection was higher in patients with tuberculosis than in those without (44% vs. 28%). Mortality during tuberculosis treatment was 12% (5 cases), and all five deaths were attributed to tuberculosis. Ten-yr death-censored graft survival and patient survival were similar between patients with tuberculosis and those without. Conclusion Among KTRs, symptoms of tuberculosis are often attenuated, which leads to delayed diagnosis, and tuberculosis-related mortality remains high.
conferenceObject Risk factors for severe complications during febrile neutropenic episodes in patients with solid tumors(2013) MARTINS, R.; CECOTTI, H. C.; PIERROTTI, L. C.; ABDALA, E.; HOFF, P. M.; CASTRO, G.- Health care-associated infections in hematology-oncology patients with neutropenia: A method of surveillance(2013) IBRAHIM, Karim Yaqub; PIERROTTI, Ligia Camera; FREIRE, Maristela Pinheiro; GUTIERREZ, Patricia Pinheiro; DUARTE, Laiane do Prado Gil; BELLESSO, Marcelo; PEREIRA, Juliana; CHAMONE, Dalton de Alencar Fischer; ABDALA, EdsonWe present a prospective method of surveillance of health care-associated infection in hematology-oncology inpatients with neutropenia. Incidence rates were calculated on the basis of the number of hospitalized patients, the duration of hospital stay (in days), the number of days of neutropenia, and (in cases of central line-associated blood stream infection) the number of central line-days. We detected 11.4 and 66.4 episodes of febrile neutropenia per 1,000 hospital-days and per 1,000 days of neutropenia, respectively. The incidence of central line-associated blood stream infection was 2.6 per 1,000 central line-days. Gram-negative bacteria were the most prevalent pathogens. Efforts should be made to monitor infection rates on hematology-oncology wards.