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Dive into the research topics where Luiz S. Azevedo is active.

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Featured researches published by Luiz S. Azevedo.


Clinics | 2015

Cytomegalovirus infection in transplant recipients

Luiz S. Azevedo; Ligia C. Pierrotti; Edson Abdala; Silvia Figueiredo Costa; Tânia Mara Varejão Strabelli; Silvia Vidal Campos; Jéssica Fernandes Ramos; Acram Zahredine Abdul Latif; Nadia Litvinov; Natalya Zaidan Maluf; Helio Hehl Caiaffa Filho; Claudio S. Pannuti; Marta Heloisa Lopes; Vera Aparecida dos Santos; Camila da Cruz Gouveia Linardi; Maria Aparecida Shikanai Yasuda; Heloisa Helena de Sousa Marques

Cytomegalovirus infection is a frequent complication after transplantation. This infection occurs due to transmission from the transplanted organ, due to reactivation of latent infection, or after a primary infection in seronegative patients and can be defined as follows: latent infection, active infection, viral syndrome or invasive disease. This condition occurs mainly between 30 and 90 days after transplantation. In hematopoietic stem cell transplantation in particular, infection usually occurs within the first 30 days after transplantation and in the presence of graft-versus-host disease. The major risk factors are when the recipient is cytomegalovirus seronegative and the donor is seropositive as well as when lymphocyte-depleting antibodies are used. There are two methods for the diagnosis of cytomegalovirus infection: the pp65 antigenemia assay and polymerase chain reaction. Serology has no value for the diagnosis of active disease, whereas histology of the affected tissue and bronchoalveolar lavage analysis are useful in the diagnosis of invasive disease. Cytomegalovirus disease can be prevented by prophylaxis (the administration of antiviral drugs to all or to a subgroup of patients who are at higher risk of viral replication) or by preemptive therapy (the early diagnosis of viral replication before development of the disease and prescription of antiviral treatment to prevent the appearance of clinical disease). The drug used is intravenous or oral ganciclovir; oral valganciclovir; or, less frequently, valacyclovir. Prophylaxis should continue for 90 to 180 days. Treatment is always indicated in cytomegalovirus disease, and the gold-standard drug is intravenous ganciclovir. Treatment should be given for 2 to 3 weeks and should be continued for an additional 7 days after the first negative result for viremia.


PLOS ONE | 2011

Immunogenicity and reactogenicity of 2009 influenza A (H1N1) inactivated monovalent non-adjuvanted vaccine in elderly and immunocompromised patients.

João Luiz Miraglia; Edson Abdala; Paulo M. Hoff; André Machado Luiz; Danise Senna Oliveira; Carla G. S. Saad; Ieda Maria Magalhães Laurindo; Ana T. R. Viso; Angela Tayra; Ligia C. Pierrotti; Luiz S. Azevedo; Lucia Maria Arruda Campos; Nadia E. Aikawa; Maria do Carmo Sampaio Tavares Timenetsky; Expedito José de Albuquerque Luna; Maria Regina Alves Cardoso; José da S. Guedes; Isaias Raw; Jorge Kalil; Alexander Roberto Precioso

Background Immunosuppressed individuals present serious morbidity and mortality from influenza, therefore it is important to understand the safety and immunogenicity of influenza vaccination among them. Methods This multicenter cohort study evaluated the immunogenicity and reactogenicity of an inactivated, monovalent, non-adjuvanted pandemic (H1N1) 2009 vaccine among the elderly, HIV-infected, rheumatoid arthritis (RA), cancer, kidney transplant, and juvenile idiopathic arthritis (JIA) patients. Participants were included during routine clinical visits, and vaccinated according to conventional influenza vaccination schedules. Antibody response was measured by the hemagglutination-inhibition assay, before and 21 days after vaccination. Results 319 patients with cancer, 260 with RA, 256 HIV-infected, 149 elderly individuals, 85 kidney transplant recipients, and 83 with JIA were included. The proportions of seroprotection, seroconversion, and the geometric mean titer ratios postvaccination were, respectively: 37.6%, 31.8%, and 3.2 among kidney transplant recipients, 61.5%, 53.1%, and 7.5 among RA patients, 63.1%, 55.7%, and 5.7 among the elderly, 59.0%, 54.7%, and 5.9 among HIV-infected patients, 52.4%, 49.2%, and 5.3 among cancer patients, 85.5%, 78.3%, and 16.5 among JIA patients. The vaccine was well tolerated, with no reported severe adverse events. Conclusions The vaccine was safe among all groups, with an acceptable immunogenicity among the elderly and JIA patients, however new vaccination strategies should be explored to improve the immune response of immunocompromised adult patients. (ClinicalTrials.gov, NCT01218685)


Clinical Transplantation | 2005

Acitretin and skin cancer in kidney transplanted patients. Clinical and histological evaluation and immunohistochemical analysis of lymphocytes, natural killer cells and Langerhans' cells in sun exposed and sun protected skin.

Renata V Carneiro; Mirian Nacagami Sotto; Luiz S. Azevedo; Luiz Estevam Ianhez; Evandro A. Rivitti

Abstract:  Background:  Renal transplanted recipients have an increased incidence of actinic keratosis and skin cancer.


Revista Do Instituto De Medicina Tropical De Sao Paulo | 2005

Mycophenolate mofetil may protect against Pneumocystis carinii pneumonia in renal transplanted patients

Luiz S. Azevedo; Maria Cristina Ribeiro de Castro; Flávio Jota de Paula; Luiz Estevam Ianhez; Elias David-Neto

Pneumocystis carinii pneumonia (PCP) is usually prevented in transplanted patients by prophylactic trimethoprim-sulfamethoxazol (TMS). Mycophenolate mofetil (MMF) has been shown to have a strong protective effect against PCP in rats. This effect is also suggested in humans by the absence of PCP in patients receiving MMF. After January 1998 MMF has been used with no TMS prophylaxis in renal transplanted patients. In azathioprine (AZA) treated patients TMS prophylaxis was maintained. The incidence of PCP was analyzed in both groups. Data were collected in order to have a minimum 6-month follow-up. Two hundred and seventy-two patients were eligible for analysis. No PCP occurred either in patients under MMF without TMS prophylaxis nor in patients under AZA. MMF may have an effective protective role against PCP as no patient under MMF, despite not receiving TMS coverage, developed PCP. A larger, controlled, trial is warranted to consolidate this information.


Clinical Transplantation | 2013

Clinical features and outcomes of tuberculosis in kidney transplant recipients in Brazil: a report of the last decade

Igor Denizarde Bacelar Marques; Luiz S. Azevedo; Ligia C. Pierrotti; Renato A. Caires; Víctor A. H. Sato; Lílian Pires de Freitas do Carmo; Gustavo F. Ferreira; Cristiano Gamba; Flávio Jota de Paula; William Carlos Nahas; Elias David-Neto

Among kidney transplant recipients (KTRs), tuberculosis is one of the most common opportunistic infections and is associated with high morbidity and mortality. The aim of this study was to describe the incidence, clinical features, and prognosis of tuberculosis in KTRs.


Transplant Infectious Disease | 2013

Seroconversion of 2009 pandemic influenza A (H1N1) vaccination in kidney transplant patients and the influence of different risk factors

Luiz S. Azevedo; J. Gerhard; J.L. Miraglia; Alexander Roberto Precioso; M.dC.S. Tavares Timenetsky; Fabiana Agena; C. Gamba; M.A. Shikanai Yasuda; Elias David-Neto; Ligia C. Pierrotti

Influenza may present a high morbidity and mortality in solid organ transplanted patients (SOTP). Annual influenza virus vaccine is recommended for SOTP. However, low levels of seroconversion in SOTP have been reported. The aim of this study was to evaluate the immunogenicity of 2009 pandemic influenza A (H1N1) – A(H1N1)pdm09 – vaccine in kidney transplant patients and to analyze which features might affect seroconversion.


Revista Do Instituto De Medicina Tropical De Sao Paulo | 1987

Tuberculosis in renal transplant patients

Flávio Jota de Paula; Luiz S. Azevedo; Luiz Balthazar Saldanha; Luiz Estevam Ianhez; Emil Sabbaga

Tuberculose (TB) foi diagnosticada em 25 de 466 pacientes submetidos a transplante renal. A TB surgiu entre 1 mes e 9 anos pos-transplante. O pulmao foi acometido em 76% dos casos, isoladamente (56%), ou associado a outras localizacoes (20%). Os outros orgaos envolvidos foram: pele, articulacoes, testiculos, trato urinario, sistema nervoso central e linfonodos. O diagnostico foi confirmado por biopsia em 64% dos casos, pela identificacao do bacilo em 24% e apenas a necropsia em 12%. Tres formas histologicas foram identificadas: exudativa (nos casos de aparecimento precoce e de maior gravidade) granulomatosa (naqueles benignos e de aparecimento tardio) e mista (naqueles intermediarios). As doses de azatioprina foram constantes ao longo do periodo pos-transplante, tanto no grupo tuberculoso como no controle, bem como nos pacientes tuberculosos que faleceram e que se curaram. O numero de crises de rejeicao tratadas foi maior no grupo TB do que no grupo controle. As doses de prednisona e o numero de crises de rejeicao foram maiores nos pacientes tuberculosos que faleceram do que naqueles que sobreviveram. Quinze pacientes se curaram e 10 faleceram, oito de causas relacionadas a TB, Seis destes obitos ocorreram nos 6 primeiros meses pos-transplante. Em um paciente a TB foi transmitida pelo enxerto.


Transplant International | 1995

The role of experimental aluminum intoxication in allogeneic immunoresponse

Carmen Tzanno-Martins; Luiz S. Azevedo; Mauri Tanji; Marcia Cianga Tanji; Emil Sabbaga; Marcello Marcondes; Alberto José da Silva Duarte

To evaluate the immunological properties of aluminum (Al) in experimental Al intoxication in rats, we performed heart transplantation and in vitro experiments. Lewis (Lew) rats were intoxicated with intraperitoneal injections of AlCl3. Heart transplants were performed using Brown-Norway (BN) rats as donors. Isotransplants and normal Lew were used as controls. No differences in survival were observed. Unidirectional mixed lymphocyte cultures (MLC) and Concanavalin A (Con A)-stimulated cultures were prepared using spleen cells from normal and Al-intoxicated Lew rats. No differences were found in unidirectional MLC. Intoxicated cells showed a less intense response to Con A than did normal cells. In conclusion, we could not detect an immunosuppressive role of Al intoxication in experimental cardiac transplantation or in MLC. However, the depressed Con A blastogenic response of Al-intoxicated cells may reflect an immunological role yet to be defined.


Revista Do Instituto De Medicina Tropical De Sao Paulo | 1987

Tuberculosis in patients with chronic renal failure

Flávio Jota de Paula; Luiz S. Azevedo; Luiz Estevam Ianhez; João Egidio Romão Junior; Pedro Renato Chocair; Emil Sabbaga

Nine cases of tuberculosis (TB) were diagnosed among 800 uremic patients, followed-up during 11 years, a prevalence of 1125%, 2.5 times higher than that in the general population. Six patients (66.7%) had lymph node involvement (4 cervical and 2 mediastinal). Three patients (33.3%) had pulmonary involvement (2 pleuro-pulmonary and 1 bilateral apical pulmonary). Eight patients were undergoing dialysis and 1 was pre-dialytic. The duration of dialysis ranged from 1 to 60 months. Three patients had previously received immunosuppressive drugs for unsuccessful renal transplantation. Daily fever was present in all but one patient; he was asymptomatic and TB was suspected after routine chest radiography. Biopsy was the diagnostic procedure in 7 patients (77.8%), four by direct cervical lymph node biopsy, 2 by mediastinal, performed by mediastinoscopy and 1 by pleural biopsy. In 2 other patients TB was confirmed by the presence of tubercle bacilli; in sputum (1 patient) and in a bronchial flushing specimen (the other patient). Triple therapy was used in all patients (isoniazid and ethambutol in all), plus rifampicin in 8 and streptomycin in 1. One patient had jaundice and another had optical neuritis. Five patients were cured. The other four died during treatment of causes unrelated to TB or its treatment.


International Journal of Infectious Diseases | 2017

Chikungunya in kidney transplant recipients: A series of cases

Ligia C. Pierrotti; Max Igor Banks Ferreira Lopes; Ana Patrícia do Nascimento; Helio H. Caiaffa-Filho; Francine Brambate Carvalhinho Lemos; José Otto Reusing; Odeli Nicole Encinas Sejas; Elias David-Neto; Luiz S. Azevedo

Chikungunya (CHIK) is a mosquito-borne virus (CHIKV) infection that recently appeared in the Americas and thousands of confirmed cases have been reported in Brazil since the first autochthonous cases were reported in September 2014. We reported four cases of CHIK in kidney transplant recipients. The diagnosis was confirmed by positive CHIKV real-time polymerase chain reaction in two cases and positive CHIKV-IgM serology in two patients. The time between transplantation and CHIKV infection ranged from 2 to 11 years. All of them had arthralgia, and 3 of them had fever. Other symptoms were mild conjunctivitis, rash, and retro-orbital pain. Kidney function remained stable in all cases. In three patients prednisone doses were temporally increased and the symptoms disappeared concurrently with the increase of the dose. As for the fourth patient, the prednisone dose remained unchanged and yet she improved. Other immunosuppressive drugs were not changed for the four cases. As far as we know, there are only two previously reported cases of CHIK among solid organ transplant recipients besides the four cases reported here. Despite the small number of cases, we can speculate that the use of immunosuppression might have played a role in the paucity of symptoms and the gradual complete recovery with no complication.

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Emil Sabbaga

University of São Paulo

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L. E Ianhez

University of São Paulo

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Edson Abdala

University of São Paulo

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