Tropical Diseases in Kidney Transplantation

Brazil has the second largest organ transplant program in the world and infections are the main cause of death in kidney transplant recipients living in Latin America. This chapter discusses the main clinical aspects of tropical infections in kidney transplantation. Kidney transplant recipients can acquire tropical diseases directly from the community, through the de novo form, as well as from any other exposed individual. Immunosuppression used for preventing rejection causes a significant increase in the risk of infections, such as tuberculosis and leishmaniasis, in which cellular immunity plays an important role. Reactivation or recrudescence of latent diseases is more frequent in the first months after transplantation. Tuberculosis, disseminated strongyloidiasis, Chagas disease, malaria, and leishmaniasis are examples of this form of acquisition, which predominate in individuals living in endemic areas. The diagnosis of certain infections in this population is sometimes more difficult than that in immunocompetent patients. As examples, eosinophilia is often absent in cases of Strongyloides stercoralis hyperinfection; granulomas may be absent in tuberculosis and schistosomiasis; malaria fever may be present without the typical cyclic pattern; organomegaly may be absent in patients with visceral leishmaniasis; and cytopenias, notably anemia and thrombocytopenia, are more common in the course of infectious diseases in kidney transplant recipients than in immunocompetent ones. Renal graft function is commonly affected during the treatment of certain infections. In general, tropical diseases show higher morbidity and mortality in immunosuppressed patients.