Papers by Marjorie Batista
Tropical Medicine & International Health, 2011
To evaluate the frequency and clinical features of endemic and other opportunistic infections in ... more To evaluate the frequency and clinical features of endemic and other opportunistic infections in liver or kidney transplant recipients in four transplant centres in different geographical areas of Brazil. Retrospective analysis of medical and laboratory records of four transplant centres on endemic and other opportunistic infections in liver or kidney transplant recipients. Analyses were performed with spss statistical software. From 2001 to 2006, 1046 kidney and 708 liver transplants were registered in all centres. The average age was 42 years. Among 82 (4.7%) cases with infections, the most frequent was tuberculosis (2.0%), followed by systemic protozoal infections (0.7%), toxoplasmosis (0.4%) and visceral leishmaniasis (0.3%). Systemic fungal infections occurred in 0.6%, of which 0.4% were cryptococcosis and 0.2% were histoplasmosis. Dengue was the only systemic viral infection and was registered in two cases (0.1%), of which one was classified as the classic form and the other as dengue haemorrhagic fever. Nocardiosis was described in one case (0.05%). The infectious agents most frequently associated with diarrhoea were Blastocystis sp., Schistosoma mansoni and Strongyloides stercoralis. Opportunistic Infections in transplant patients have a wide spectrum and may vary from asymptomatic to severe infections with high mortality. A better understanding of the epidemiology of endemic pathogens and clinical manifestations can contribute to the establishment of an early diagnosis as well as correct treatment aimed at decreasing morbidity and mortality.
Abstract: Invasive aspergillosis is a life-threatening lung or systemic infection caused by the o... more Abstract: Invasive aspergillosis is a life-threatening lung or systemic infection caused by the opportunistic mold Aspergillus fumigatus. The disease affects mainly immunocompromised hosts, and patients with hematological malignances or who have been submitted to stem cell transplantation are at high risk. Despite the current use of Platelia ™ Aspergillus as a diagnostic test, the early diagnosis of invasive aspergillosis remains a major challenge in improving the prognosis of the disease. In this study, we used an immunoproteomic approach to identify proteins that could be putative candidates for the early diagnosis of invasive aspergillosis. Antigenic proteins expressed in the first steps of A. fumigatus germination occurring in a human host were revealed using 2-D Western immunoblots
This is an Open Access article distributed under the terms of the Creative Commons Attribution Li... more This is an Open Access article distributed under the terms of the Creative Commons Attribution License
Journal of global antimicrobial resistance, 2019
OBJECTIVES Based on pulsed-field gel electrophoresis (PFGE) profile, whole-genome sequencing (WGS... more OBJECTIVES Based on pulsed-field gel electrophoresis (PFGE) profile, whole-genome sequencing (WGS) of eight carbapenem-resistant Pseudomonas aeruginosa isolates from a bone marrow transplant unit in São Paulo, Brazil, was performed to investigate the presence of resistance and virulence genes as well as to determine the sequence type (ST) by multilocus sequence typing (MLST). METHODS The initial phenotypic susceptibility pattern of the isolates was determined by VITEK®2. Minimum inhibitory concentrations (MICs) were determined by the broth microdilution method for amikacin, meropenem and colistin. WGS was performed using an Illumina MiSeq system. A Galleria mellonella infection model was used to evaluate the virulence of the strains. RESULTS WGS demonstrated that mutations in genes encoding outer membrane proteins and efflux pumps in an isolate harbouring blaVIM-36 (ST308) differed from those in isolates harbouring blaSPM (ST277). The mexT gene harboured a mutation resulting in a fr...
Revista do Instituto de Medicina Tropical de São Paulo
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License.
IDCases
We report a case of bloodstream infection caused by R. hoagii in a woman with acute myeloid leuke... more We report a case of bloodstream infection caused by R. hoagii in a woman with acute myeloid leukemia, 37-years-old, who received an allogeneic hematopoietic stem cell transplant. She developed cutaneous and gastrointestinal tract graft versus host disease, respectively on day 29 and day 69. On day 157 she developed to acute severe respiratory failure. Rhodococcus sp was identified by MALDI-TOF and 16S rRNA sequencing from blood culture as Rhodococcus hoagii. The patient was a nurse that lived in urban areas, and stated no recent trips to countryside areas neither contacted with animals. Despite of the treatment with antibiotics with action against R. hoagii such as linezolid and meropenem the patient evolved to multiorgan dysfunction and death. Our case-report emphasizes the importance of early diagnosis and the use of 16S rRNA sequencing to confirmed the identification of species of Rhodococcus infection.
The Brazilian Journal of Infectious Diseases
In the present paper we summarize the suggestions of a multidisciplinary group including experts ... more In the present paper we summarize the suggestions of a multidisciplinary group including experts in pediatric oncology and infectious diseases who reviewed the medical literature to elaborate a consensus document (CD) for the diagnosis and clinical management of invasive fungal diseases (IFDs) in children with hematologic cancer and those who underwent hematopoietic stem-cell transplantation. All major multicenter studies designed to characterize the epidemiology of IFDs in children with cancer, as well as all randomized clinical trials addressing empirical and targeted antifungal therapy were reviewed. In the absence of randomized clinical trials, the best evidence available to support the recommendations were selected. Algorithms for early diagnosis and best clinical management of IFDs are also presented. This document summarizes practical recommendations that will certainly help pediatricians to best treat their patients suffering of invasive fungal diseases.
Clinics
Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ tr... more Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ transplantation (SOT) in the past. However, HIV management has improved since highly active antiretroviral therapy (HAART) became available in 1996, and the long-term survival of patients living with HIV has led many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection. Based on the available data in the medical literature and the cumulative experience of transplantation in HIVpositive patients at our hospital, the aim of the present article is to outline the criteria for transplantation in HIVpositive patients as recommended by the Immunocompromised Host Committee of the Hospital das Clínicas of the University of Sã o Paulo.
Open Forum Infectious Diseases
Background The PD-1 inhibitors or check point inhibitors (CPI) are commonly used for the treatmen... more Background The PD-1 inhibitors or check point inhibitors (CPI) are commonly used for the treatment of many solid tumors (ST) and hematological malignancies (HM). By blocking PD-1 in fatigued T cells, an increase in viral clearance may be noted as evidenced in cases of JC virus. Our objective was to assess the outcomes related to cancer patients with microbiologically documented acute respiratory viral infections while on CPI. Methods All patients who were infected with either influenza, respiratory syncytial virus (RSV), parainfluenza virus (PIV), and human metapneumovirus (HMPV) from 9/2016 to 6/2018 with prior or concurrent CPI therapy were included in this study. Demographics and clinical data were collected retrospectively. Comparisons were done between patients with concurrent (group 1) or prior (group 2) CPI therapy. Results A total of 92 cancer patients were identified and of those, 50 patients (54%) were on concurrent CPI therapy at the time of infection. Most patients had S...
Open Forum Infectious Diseases
Background Respiratory viral infections (RVIs) commonly infect immunocompromised patients, and ma... more Background Respiratory viral infections (RVIs) commonly infect immunocompromised patients, and may cause increased morbidity and mortality. However, data on lymphoma and multiple myeloma (MM) patients with RVIs is scarce. The objectives of our study were to identify risk factors for progression to lower respiratory tract infection (LRTI) and fatal outcome in this patient population with RVIs. Methods All lymphoma or MM patients at our center who were diagnosed with either influenza, respiratory syncytial virus (RSV), parainfluenza virus (PIV) or human metapneumovirus (hMPV) from January 2016 and July 2018 were included in our study. All demographics and clinical data were collected from electronic medical records retrospectively. Patients were classified as having an upper respiratory tract infection (URTI) if nasal wash was positive for the respiratory virus with no radiological evidence of lower respiratory tract involvement. Patients were deemed with lower respiratory tract infec...
Current Opinion in Infectious Diseases
PURPOSE OF REVIEW Refractory or resistant cytomegalovirus (CMV) infections are challenging compli... more PURPOSE OF REVIEW Refractory or resistant cytomegalovirus (CMV) infections are challenging complications after hematopoietic cell transplantation (HCT). Most refractory or resistant CMV infections are associated with poor outcomes and increased mortality. Prompt recognition of resistant or refractory CMV infections, understanding the resistance pathways, and the treatment options in HCT recipients are imperative. RECENT FINDINGS New definitions for refractory and resistant CMV infections in HCT recipients have been introduced for future clinical trials. Interestingly, refractory CMV infections are more commonly encountered in HCT recipients when compared with resistant CMV infections. CMV terminase complex mutations in UL56, UL89, and UL51 could be associated with letermovir resistance; specific mutations in UL56 are the most commonly encountered in clinical practice. Finally, brincidofovir, maribavir, letermovir, and CMV-specific cytotoxic T-cell therapy expanded our treatment options for refractory or resistant CMV infections. SUMMARY Many advances have been made to optimize future clinical trials for management of refractory or resistant CMV infections, and to better understand new resistance mechanisms to novel drugs. New drugs or strategies with limited toxicities are needed to improve outcomes of difficult to treat CMV infections in HCT recipients.
Journal of Medical Virology
Cytomegalovirus (CMV) infection remains a major complication after allogeneic hematopoietic cell ... more Cytomegalovirus (CMV) infection remains a major complication after allogeneic hematopoietic cell transplantation (allo‐HCT). We conducted a retrospective study to determine the clinical and economic burden of pre‐emptive therapy (PET) for CMV infection in 100 consecutive hospitalized adult CMV positive serostatus allo‐HCT recipients and compared their hospitalization cost with allo‐HCT recipients hospitalized with graft vs host disease without CMV infection (control group) and across 19 US cancer centers for hospitalized patients with CMV infection between 2012 and 2015 (Vizient database). A total of 192 CMV episodes of PET for CMV infection occurred within 1 year post‐HCT. PET consisted of ganciclovir (41% of episodes), foscarnet (40%), and valganciclovir (38%) with the longest average length of stay in foscarnet‐treated patients (41 days). The average direct cost per patient admitted for PET was $116 976 (range: $7866‐$641 841) compared with $12 496 (range: $2004‐$43 069) in the control group (P < .0001). The total direct cost per encounter was significantly higher in patients treated with foscarnet and had nephrotoxicity ($284 006) compared with those who did not ($112 195). The average cost amongst the 19 US cancer centers, including our institution, was $42 327 with major disparities in cost and clinical outcomes. PET for CMV infection is associated with high economic burden in allo‐HCT recipients.
Biology of Blood and Marrow Transplantation
Journal of Global Antimicrobial Resistance
Based on pulsed field gel electrophoresis profile, whole genome sequencing (WGS) of 8 CarbR P. ae... more Based on pulsed field gel electrophoresis profile, whole genome sequencing (WGS) of 8 CarbR P. aeruginosa strains from a bone marrow transplant unit, in São Paulo, Brazil, was carried out to investigate which resistance and virulence genes are present as well as determine the multilocus sequence types (ST). Initial susceptible pattern was obtained by Vitek 2. Minimal inhibitory concentrations (MICs) were determined by broth microdilution for amikacin, meropenem and colistin. WGS was performed using Illumina MiSeq. The Galleria mellonella infection model was used to evaluate the virulence of the strains. WGS demonstrated that mutations in the genes that encode outer-membrane proteins and efflux pumps in the isolate harboring bla (ST308) differ from those in the isolates harboring bla (ST277). The mexT gene possessed a mutation resulting in a frameshift in all isolates; in addition, the oprD gene of the isolate carrying bla had an insertion that led to a frameshift. The virulence genes did not differ between ST277 and ST308. Moreover, only two isolates harboring bla indicated virulence in the G. mellonella model, killing 100% of larvae after 18-24hours. P. aeruginosa carrying bla gene belonging to ST308 was identified for the first time in our hospital. Although, the virulence genes profiles were similar in isolates carrying bla and the isolate carrying bla, only two isolates harboring bla indicated virulence in the G. mellonella model.
Mediterranean Journal of Hematology and Infectious Diseases
BACKGROUND: Invasive aspergillosis (IA) is a life-threatening infection in immunocompromised pati... more BACKGROUND: Invasive aspergillosis (IA) is a life-threatening infection in immunocompromised patients. In this study, we compared the efficacy of voriconazole containing regimen vs non-voriconazole containing regimen in patients with IA. METHODS: In this retrospective study, we reviewed the medical records of all immunocompromised cancer patients diagnosed with proven or probable IA between February 2012 and March 2018. This trial included 26 patients from the American University of Beirut, Lebanon, 20 patients from Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, Brazil, and 10 patients from St. Luke's International Hospital Tokyo, Japan. RESULTS: A total of 56 patients were analyzed. They were divided into 2 groups voriconazole containing regimen and non-voriconazole containing regimen (90% Amphotericin B based regimen) . Both groups had similar characteristic, age, gender, and immunocompromised status. The majority of patients had underlying leu...
The Brazilian Journal of Infectious Diseases
de hemoculturas e tratamento adequado de receptores baseado nos resultados obtidos é necessário.
The Brazilian Journal of Infectious Diseases
Bone Marrow Transplantation
Open Forum Infectious Diseases
Background Patients with certain types of cancer are at increased risk for progression from laten... more Background Patients with certain types of cancer are at increased risk for progression from latent tuberculosis infection (LTBI) to active tuberculosis (ATB) because of immunosuppression. The purpose of this study was to compare the utility of the two commonly used IGRAs, QuantiFERON-TB Gold® (QFT) and T-spot.TB® (T-spot.TB), for diagnosis of LTBI or ATB in cancer patients. Methods We identified patients who had an initial IGRA during 2013 and 2014 at our institution. Along with demographic information, collected clinical data included type of underlying cancer or other condition, reason for testing, diagnosis of ATB following testing, and absolute lymphocyte count (ALC) at the time of testing. IGRA results (positive, negative, borderline, or indeterminate/invalid) were compared between patients who underwent testing with either QFT or T-spot.TB. Results A total of 356 patients had 411 QFT tests done, while 737 patients had 853 T-spot.TB tests performed. The most common underlying m...
Open Forum Infectious Diseases
Conclusion. DDTB presents early as febrile illness after SOT, and carries a high mortality risk. ... more Conclusion. DDTB presents early as febrile illness after SOT, and carries a high mortality risk. Donors should be screened, with particular attention to risk factors.
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Papers by Marjorie Batista