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Nocardiosis in tropical renal transplant recipients
George T John1, Viswanathan Shankar, Abi M Abraham
1Department of Nephrology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. george@cmcvellore.ac.in
Background:
The epidemiology of nocardiosis in the tropics among renal transplant recipients has not been reported.
Methods:
An evaluation of nocardiosis for 30 yr in one of the large transplant centres in South Asian region.
Results:
Of the 1968 patients who received primary renal allografts at Christian Medical College & Hospital, 27 patients developed nocardiosis over 30 yr. Early nocardiosis (2 yr). Seventeen patients (63%) had two or more associated post-transplant infections, of whom 10 had tuberculosis. Mortality in these patients was associated with chronic liver disease.
Conclusions:
Nocardiosis manifests earlier (<2 yr) in CsA treated patients who have chronic liver disease. Among renal transplant recipients of the tropics nocardiosis is a marker of a high susceptibility to tuberculosis and other infections, the association with tuberculosis is stronger in those developing early nocardiosis (<2 yr). Chronic liver disease is a risk factor for death in patients with nocardiosis especially when associated with tuberculosis. This report constitutes the largest single centre experience among renal transplant recipients.