Article information
Resumen
Las enfermedades gastrointestinales son frecuentes en los pacientes inmunodeprimidos. La flora endógena constituye la principal fuente de infección en el hombre, pero es especialmente relevante cuando los mecanismos de barrera de la mucosa digestiva se ven afectados por diversos factores. La translocación bacteriana, los traumatismos, los procesos isquémicos o las intervenciones quirúrgicas son eventos que pueden afectar a la población general. Además de éstos, la infiltración tumoral, la mucositis posquimio o radioterapia, la hipoproteinemia, la neutropenia o el déficit de la función linfocitaria constituyen, entre otros, factores agravantes para el desarrollo de infección intraabdominal en determinados pacientes. Las formas clínicas de estas infecciones son muy variadas, dependiendo del tipo de paciente en el que concurran y el escenario en el que se desarrollen, incluido el ambiente hospitalario. En este capítulo se revisan las características diferenciales de las complicaciones infecciosas intraabdominales en los pacientes con diferentes tipos de inmunosupresión.
Palabras clave:
Infección abdominal
Inmunosupresión
Peritonitis
Abstract
Diseases of the gastrointestinal system frequently complicate immunosuppressed patients. Endogenous flora is the principal source of infection in humans, especially in patients with dysfunction of the digestive epithelial barrier due to various factors. Bacterial translocation, traumatisms, ischemia and surgery are frequent events in the general population. In addition, important risk factors for abdominal infections in specific patients include tumoral infiltration, mucositis complicating chemotherapy and/or radiotherapy, hypoproteinemia, neutropenia and lymphocyte deficiency. Clinical pictures vary according to patients’ baseline condition and the environmental setting, including nosocomial infections. The differential clinical characteristics of abdominal infections observed in distinct types of immunosuppressed patients are reviewed.
Keywords:
Abdominal infection
Immunosuppression
Peritonitis
Full text is only aviable in PDF
Bibliografía
[1.]
P. Muñoz, M. Giannella, L. Alcalá, E. Sarmiento, J. Fernández Yañez, J. Palomo, et al.
Clostridium difficile-associated diarrhea in heart transplant recipients: is hypogammaglobulinemia the answer?.
J Heart Lung Transplant, 26 (2007), pp. 907-914
[2.]
R. San Juan, J.M. Aguado, C. Lumbreras, C. Díaz-Pedroche, F. López-Medrano, M. Lizasoain, et al.
Incidence, clinical characteristics and risk factors of late infection in solid organ transplant recipients: data from the RESITRA study group.
Am J Transplant, 7 (2007), pp. 964-971
[3.]
Y. Iinuma, K. Senda, N. Fujihara, T. Saito, S. Takakura, T. Kudo, et al.
Surgical site infections in living-donor liver transplant recipients: a prospective study.
Transplantation, 78 (2004), pp. 704-709
[4.]
J.A. Fishman, R.H. Rubin.
Infection in organ-transplant recipients.
N Engl J Med, 338 (1998), pp. 1741-1751
[5.]
D.J. Winston, C. Emmanoulides, R.W. Busuttil.
Infections in liver transplant recipients.
Clin Infect Dis, 21 (1995), pp. 1077-1089
[6.]
A. Asensio, A. Ramos, V. Cuervas-Mons, E. Cordero, V. Sánchez-Turrión, M. Blanes, et al.
Effect of antibiotic prophylaxis on the risk of surgical site infection in orthotopic liver transplant.
Liver Transpl, 14 (2008), pp. 799-805
[7.]
P.E. Marik.
Fungal infections in solid organ transplantation.
Expert Opin Pharmacother, 7 (2006), pp. 297
[8.]
J.S. Sartin, M.P. Wilhelm, M.R. Keating, K. Batts, R.A. Krom.
A case of Aspergillus fumigatus peritonitis complicating liver transplantation.
Eur J Clin Microbiol Infect Dis, 13 (1994), pp. 25-28
[9.]
M.M. Roden, T.E. Zaoutis, W.L. Buchanan, T.A. Knudsen, T.A. Sarkisova, R.L. Schaufele, et al.
Epidemiology and outcome of zygomycosis: a review of 929 reported cases.
Clin Infect Dis, 41 (2005), pp. 634-653
[10.]
C. Lumbreras, J.R. Otero, J.M. Aguado, M. Lizasoain, R. Gómez, I. García, et al.
Prospective study of cytomegalovirus infection in liver transplant recipients.
Med Clin (Barc), 99 (1992), pp. 401-405
[11.]
J.A. Alexander, R.E. Cuellar, R.J. Fadden, J.J. Genovese, J.S. Gavaler, D.H. Van Thiel.
Cytomegalovirus infection of the upper gastrointestinal tract before and after liver transplantation.
Transplantation, 46 (1988), pp. 378-382
[12.]
A.D. Pinna, J. Rakela, A.J. Demetris, J.J. Fung.
Five cases of fulminant hepatitis due to herpes simplex virus in adults.
Dig Dis Sci, 47 (2002), pp. 750-754
[13.]
S. Kusne, O. Pappo, R. Manez, G. Pazin, B. Carpenter, J.J. Fung, et al.
Varicella-zoster virus hepatitis and a suggested management plan for prevention of VZV infection in adult liver transplant recipients.
Transplantation, 60 (1995), pp. 619-621
[14.]
C. Duvoux, G.P. Pageaux, C. Vanlemmens, F. Roudot-Thoraval, A.L. Vincens-Rolland, C. Hezode, et al.
Risk factors for lymphoproliferative disorders after liver transplantation in adults: an analysis of 480 patients.
Transplantation, 74 (2002), pp. 1103-1109
[15.]
J.J. Fung, A. Jain, E.J. Kwak, S. Kusne, I. Dvorchik, B. Eghtesad.
De novo malignancies after liver transplantation: a major cause of late death.
Liver Transpl, 7 (2001), pp. S109-S118
[16.]
C. Lumbreras, I. Fernández, J. Velosa, S. Munn, S. Sterioff, C.V. Paya.
Infectious complications following pancreatic transplantation: Incidence, microbiological and clinical characteristics, and outcome.
Clin Infect Dis, 20 (1995), pp. 514-520
[17.]
M.S. Kapchik, A. Castelo Filho, J.O. Pestana, A.P. Silva Filho, S.B. Wey, et al.
Risk factors for nosocomial urinary tract and postoperative wound infections in renal transplant patients: A matched-pair case-control study.
J Urol, 147 (1992), pp. 994-998
[18.]
A.G. Tzakis, T. Kato, D.M. Levi, W. Defaria, G. Selvaggi, D. Weppler, et al.
100 multivisceral transplants at a single center.
Ann Surg, 242 (2005), pp. 480-493
[19.]
C. Loinaz, T. Kato, S. Nishida, D. Weppler, D. Levi, L. Dowdy, et al.
Bacterial infections after intestine and multivisceral transplantation. The experience of the University of Miami.
Hepato-Gastroenterology, 53 (2006), pp. 234-242
[20.]
P. Ruiz, T. Kato, A. Tzakis.
Current status of transplantation of the small intestine.
Transplantation, 83 (2007), pp. 1-6
[21.]
F. Di Benedetto, A. Lauro, M. Masetti, N. Cautero, C. Quintini, Dazzi, et al.
Outcomes after adult isolated small bowel transplantation: experience from a single European centre.
Dig Liv Dis, 37 (2005), pp. 240-246
[22.]
L. Backman, C. Brattstrom, F.P. Reinholt, J. Andersson, G. Tydén.
Developement of intrapancreatic abscess- a consequence of CMV pancreatitis?.
Transplant Int, 4 (1991), pp. 116-121
[23.]
F. Sauvat, L. Dupic, D. Caldari, F. Lesage, J.P. Cezard, F. Lacaille, et al.
Factors influencing outcome after intestinal transplantation in children.
Transplant Proc, 38 (2006), pp. 1689-1691
[24.]
A. Langnas, S. Chinnakotla, D. Sudan, S. Horslen, T. McCashland, D. Schafer, et al.
Intestinal transplantation at the University of Nebraska Medical Center: 1990 to 2001.
Tansplant Proc, 34 (2002), pp. 958-960
[25.]
J. Fortún, P. Martín-Dávila, J. Pascual, C. Cervera, F. Cofan, J. Gavaldà, et al.
Immunosuppressive therapy and infection after kidney transplantation.
Transpl Infect, (2010),
[26.]
W.C. Lee, M.J. Wu, C.H. Cheng, C.H. Chen, M.C. Wen, H.C. Chen, et al.
Acute pancreatitis following antilymphocyte globulin therapy in a renal transplant recipient.
Clin Nephrol, 65 (2006), pp. 144-146
[27.]
M.S. Delbridge, M.S. Karim, B.M. Shrestha, W. McKane.
Colitis in a renal transplant patient with human herpesvirus-6 infection.
Transpl Infect Dis, 8 (2006), pp. 226-228
[28.]
B.D. Maes, I. Dalle, K. Geboes, M. Oellerich, V.W. Armstrong, P. Evenepoel.
Erosive enterocolitis in mycophenolate mofetil-treated renal-transplant recipients with persistent afebrile diarrhea.
Transplantation, 75 (2003), pp. 665-672
[29.]
M. Batlle, F. Vall-Llovera, J. Bechini, I. Camps, P. Marcos, S. Vives, et al.
Neutropenic enterocolitis in adult patients with acute leukemia or stem cell transplant recipients: study of 7 cases.
Med Clin (Barc), 129 (2007), pp. 660-663
[30.]
B. Alioglu, Z. Avci, F. Ozcay, S. Arda, N. Ozbek.
Neutropenic enterocolitis in children with acute leukemia or aplastic anemia.
Int J Hematol, 86 (2007), pp. 364-368
[31.]
J.A. Katz, M.L. Wagner, M.V. Gresik, D.H. Mahoney Jr., D.J. Fernbac.
Typhlitis. An 18-year experience and postmortem review.
Cancer, 65 (1990), pp. 1041-1047
[32.]
M. Gorschlüter, U. Mey, J. Strehl, C. Ziske, M. Schepke, I.G. Schmidt-Wolf, et al.
Neutropenic enterocolitis in adults: systematic analysis of evidence quality.
Eur J Haematol, 75 (2005), pp. 1-13
[33.]
I.D. Kirkpatrick, H.M. Greenberg.
Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT.
Radiology, 226 (2003), pp. 668-674
[34.]
J. Sayfan, O. Shoavi, N. Benyamin.
Acute abdomen caused by neutropenic enterocolitis: surgeon dilema.
Eur J Surg, 165 (1999), pp. 502-504
[35.]
M.G. Van Kraaij, A.W. Dekker, L.F. Verdonck, A.M. Van Loon, J. Vinjé, M.P. Koopmans, et al.
Infectious gastro-enteritis: an uncommon cause of diarrhoea in adult allogeneic and autologous stem cell transplant recipients.
Bone Marrow Transplant, 26 (2000), pp. 299-303
[36.]
A. Rampling, R.E. Warren, P.C. Bevan, C.E. Hoggarth, D. Swirsky, F.G. Hayhoe.
Clostridium difficile in haematological malignancy.
J Clin Pathol, 38 (1985), pp. 445-451
[37.]
D.P. Kontoyiannis, M.A. Luna, B.I. Samuels, G.P. Bodey.
Hepatosplenic candidiasis. A manifestation of chronic disseminated candidiasis.
Infect Dis Clin North Am, 14 (2000), pp. 721-739
[38.]
P. Priftakis, G. Bogdanovic, P. Kokhaei, H. Mellstedt, T. Dalianis.
BK virus (BKV) quantification in urine samples of bone marrow transplanted patients is helpful for diagnosis of hemorrhagic cystitis, although wide individual variations exist.
J Clin Virol, 26 (2003), pp. 71-77
[39.]
H.J. Deeg.
New strategies for prevention and treatment of graft-versus-host disease and for induction of graft-versus-leukemia effects.
Int J Hematol, 77 (2003), pp. 15-21
[40.]
M.R. Litzow, P.D. Repoussis, G. Schroeder, D. Schembri-Wismayer, K.P. Batts, P.M. Anderson, et al.
Veno-occlusive disease of the liver after blood and marrow transplantation: analysis of pre- and post-transplant risk factors associated with severity and results of therapy with tissue plasminogen activator.
Leuk Lymphoma, 43 (2002), pp. 2099-2107
[41.]
B. De Singly, M. Simon, J. Bennani, S. Wittnebel, A.M. Zagadanski, V. Pacault, et al.
Prolonged acute pancreatitis after bone marrow transplantation.
Gastroenterol Clin Biol, 32 (2008), pp. 413-416
[42.]
D.S. David, B.R. Tegtmeier, M.R. O’Donnell, I.B. Paz, T.M. McCarty.
Visceral varicellazoster after bone marrow transplantation: report of a case series and review of the literature.
Am J Gastroenterol, 93 (1998), pp. 810-813
[43.]
K.E. Mönkemüller, S.A. Call, A.J. Lazenby, C.M. Wilcox.
Declining prevalence of opportunistic gastrointestinal disease in the era of combination antiretroviral therapy.
Am J Gastroenterol, 95 (2000), pp. 457-462
[44.]
C.G. Varsky, M.C. Correa, N. Sarmiento, M. Bonfanti, G. Peluffo, A. Dutack, et al.
Prevalence and etiology of gastroduodenal ulcer in HIV-positive patients: a comparative study of 497 symptomatic subjects evaluated by endoscopy.
Am J Gastroenterol, 93 (1998), pp. 935-940
[45.]
E.A. Lew, D.T. Dieterich.
Severe hemorrhage caused by gastrointestinal Kaposi's syndrome in patients with the acquired immunodeficiency syndrome: treatment with endoscopic injection sclerotherapy.
Am J Gastroenterol, 87 (1992), pp. 1471-1474
[46.]
M.S. Cappell, N. Botros.
Predominantly gastrointestinal symptoms and signs in 11 consecutive AIDS patients with gastrointestinal lymphoma: a multicenter, multiyear study including 763 HIV-seropositive patients.
Am J Gastroenterol, 89 (1994), pp. 545-549
[47.]
M. Bonacini.
Hepatobiliary complications in patients with human immunodeficiency virus infection.
Am J Med, 92 (1992), pp. 404-411
[48.]
N.B. Vakil, S.M. Schwartz, B.P. Buggy, C.F. Brummitt, M. Kherellah, D.M. Letzer, et al.
Biliary cryptosporidiosis in HIV-infected people after the waterborne outbreak of cryptosporidiosis in Milwaukee.
N Engl J Med, 334 (1996), pp. 19-23
[49.]
Sulkowski MS, Chaisson RE. Gastrointestinal and hepatobiliary manifestations of human immunodeficiency virus infection. En: Mandell GL, Bennett JE, Dolin R, editors. 6th ed. Philadelphia: Elsevier-Churchill Livingstone; 2005. p. 1575-83.
[50.]
I. Gan, G. May, J. Raboud, J. Tilley, R. Enns.
Pancreatitis in HIV infection: predictors of severity.
Am J Gastroenterol, 98 (2003), pp. 1278-1283
[51.]
J. Farman, J. Brunetti, J.W. Baer, H. Freiman, G.M. Comer, F.J. Scholz, et al.
AIDS-related cholangiopancreatographic changes.
Abdom Imaging, 19 (1994), pp. 417-422
[52.]
B. Jaber, R. Gleckman.
Tuberculous pancreatic abscess as an initial AIDS-defining disorder in a patient infected with the human immunodeficiency virus: case report and review.
Clin Infect Dis, 20 (1995), pp. 890-894
[53.]
R.D. Moore, J.C. Keruly, R.E. Chaisson.
Incidence of pancreatitis in HIV-infected patients receiving nucleoside reverse transcriptase inhibitor drugs.
AIDS, 15 (2001), pp. 617-620
[54.]
S.H. Mehta, R.D. Moore, D.L. Thomas, R.E. Chaisson, M.S. Sulkowski.
The effect of HAART and HCV infection on the development of hyperglycemia among HIV-infected persons.
J Acquir Immune Defic Syndr, 33 (2003), pp. 577-584
[55.]
F.J. Angulo, D.L. Swerdlow.
Bacterial enteric infections in persons infected with human immunodeficiency virus.
Clin Infect Dis, 21 (1995), pp. S84-S93
[56.]
J.B. Glaser, L. Morton-Kute, S.R. Berger, J. Weber, F.P. Siegal, C. López, et al.
Recurrent Salmonella typhimurium bacteremia associated with the acquired immunodeficiency syndrome.
Ann Intern Med, 102 (1985), pp. 189-193
[57.]
R.K. Lin, C.A. Behling, J.J. Garvie.
Cytomegalovirus ischemic colitis: a near-fatal presentation of HIV infection.
AIDS Patient Care STDS, 18 (2004), pp. 497-500
[58.]
U. Von Both, R. Laffer, C. Grube, W. Bossart, A. Gaspert, H.F. Günthard.
Acute cytomegalovirus colitis presenting during primary HIV infection: an unusual case of an immune reconstitution inflammatory syndrome.
Clin Infect Dis, 46 (2008), pp. e38-e40
[59.]
H. De Vuyst, G.M. Clifford, M.C. Nascimento, M.M. Madeleine, S. Franceschi.
Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis.
Int J Cancer, 124 (2009), pp. 1626-1636
[60.]
J.K. Greenson, P.C. Belitsos, J.H. Yardley, J.G. Bartlett.
AIDS enteropathy: occult enteric infections and duodenal mucosal alterations in chronic diarrhea.
Ann Intern Med, 114 (1991), pp. 366-372
[61.]
C. Alifrangis, P. Thompson, G. Thwaites, D. Churchill.
Primary pneumococcal peritonitis as a presenting feature of HIV infection.
Int J STD AIDS, 17 (2006), pp. 779-780
[62.]
L. Tarantino, A. Giorgio, G. De Stefano, N. Farella, A. Perrotta, F. Esposito.
Disseminated mycobacterial infection in AIDS patients: abdominal US features and value of fine-needle aspiration biopsy of lymph nodes and spleen.
Abdom Imaging, 28 (2003), pp. 602-608
[63.]
J.R. Foruny, J. Blázquez, A. Moreno, R. Bárcena, L. Gil-Grande, C. Quereda, et al.
Safe use of pegylated interferon/ribavirin in hepatitis C virus cirrhotic patients with hypersplenism after partial splenic embolization.
Eur J Gastroenterol Hepatol, 17 (2005), pp. 1157-1164
[64.]
M. Aguas, G. Bastida, P. Nos, B. Beltrán, J.L. Grueso, J. Grueso.
Septic thrombophlebitis of the superior mesenteric vein and multiple liver abscesses in a patient with Crohn's disease at onset.
BMC Gastroenterol, 7 (2007), pp. 22
[65.]
J.T. Diep, L.D. Kerr, S. Sarebahi, M. Tismenetsky.
Opportunistic infections mimicking gastrointestinal vasculitis in systemic lupus erythematosus.
J Clin Rheumatol, 13 (2007), pp. 213-216
[66.]
W.-L. Chang, Y.-H. Yang, H.-T. Lin, B.-L. Chiang.
Gastrointestinal manifestations in Henoch-Schoënlein purpura: a review of 261 patients.
Acta Paediatr, 93 (2004), pp. 1427-1431
[67.]
A. Gajera, S. Kais.
HIV polyarteritis nodosa-like vasculitis presenting as chronic abdominal pain.
Clin Rheumatol, 28 (2009), pp. 869-872
Copyright © 2010. Elsevier España S.L.. Todos los derechos reservados
