title: Clinical presentation and outcome of dengue viral infection in live-related renal transplant recipients in Karachi, Pakistan.
abstract: BACKGROUND
  In Pakistan, dengue viral infection has become hyper-endemic. Renal transplantation is also expanding. We aimed to study dengue in renal transplant recipients (RTR).
  
  
  METHODS
  We conducted a study of RTR reported to be anti-dengue immunoglobulin-M antibody positive from January 2009 to December 2010 at our institution in Karachi and follow their clinical course and outcome.
  
  
  RESULTS
  Median age was 28 years; 75 (73.7%) were males. Clinical presentation included fever in 82 (80.4%), gastrointestinal symptoms in 35 (34.3%), hemorrhagic complications in 9 (8.8%), and thrombocytopenia in 97 (95%), which was of >15 days duration in 24%. Fever was seen less frequently in patients on high-dose (>7.5 mg) steroids as compared with low-dose (≤7.5 mg) steroids. Forty-four patients (43%) had primary and 58 (56.8%) had secondary dengue infection. Dengue fever (DF) occurred in 90 (88%), and dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) occurred in 12 (11.7%). DHF/DSS was seen in 3 (6.8%) of those with primary and in 9 (15.5%) of those with secondary infection (P < 0.22). In secondary infection, patients on cyclosporine-containing regimen had less severe disease, with DHF/DSS in 22% as opposed to DF in 59% (P < 0.04). Of 102 RTR, 68 (66.7%) had graft dysfunction, 5 of whom died. Of the remaining 63, in 54 patients (85.7%) creatinine returned to baseline by an average of 12.6 days. Of 102 patients, 95 (93%) recovered and 7 (6.9%) died, 6 of whom had bacteremia with sepsis and 1 had respiratory failure. None died due to dengue infection alone.
  
  
  CONCLUSIONS
  In conclusion, in RTR without life-threatening co-morbidities, the clinical course of dengue infection is mild, with good recovery and preserved renal function.
authors.affiliation: Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: A
authors.initials: A
authors.lastname: Nasim
authors.forename: S
authors.initials: S
authors.lastname: Anis
authors.forename: S
authors.initials: S
authors.lastname: Baqi
authors.forename: S F
authors.initials: SF
authors.lastname: Akhtar
authors.forename: N
authors.initials: N
authors.lastname: Baig-Ansari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood*; D002648:Child; D003715:Dengue / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D003716:Dengue Virus / Q000276:immunology* / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents
keywords: Pakistan; dengue viral infection; immunosuppression; renal transplantation