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Yang R, Zhang R, Zhang Y, Huang Y, Liang H, Gui G, Gong S, Wang H, Xu M, Fan J. Risk Factors Analysis for Human Cytomegalovirus Viremia in Donor+/Recipient+ Hematopoietic Stem Cell Transplantation. Lab Med 2020; 51:74-79. [PMID: 31150544 DOI: 10.1093/labmed/lmz030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To assess the rate of, and risk factors for, human cytomegalovirus viremia (HCMV) in donor+/recipient+ (HCMV serostatus matched) hematopoietic stem-cell transplantation (HSCT) recipients. METHODS HCMV DNA from 144 donor+/recipient+ HSCT recipients was examined by quantitative polymerase chain reaction (qPCR). RESULTS The cumulative incidence of HCMV viremia was 69.4% (100/144) during the 48 weeks after HSCT. In a multivariate analysis, acute graft-versus-host disease (aGVHD) was discovered to be a risk factor for the occurrence of HCMV viremia (P = .006). The cumulative incidence of HCMV viremia and increasing DNA loads were significantly associated with aGVHD occurrence (P = .001 for each). The occurrence of late-term HCMV viremia was associated with aGVHD (P = .001) and a higher DNA load during the first 12 weeks after HSCT (P = .04). CONCLUSIONS aGVHD is a risk factor for HCMV viremia. Recipients with aGVHD who have a high HCMV DNA load should be strictly monitored to prevent HCMV activation.
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Affiliation(s)
- Rong Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China
| | - Runan Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yanyue Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yaping Huang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hanying Liang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China
| | - Genyong Gui
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shengnan Gong
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China
| | - Huiqi Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China
| | - Min Xu
- Department of Information Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Fan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, Zhejiang University, Hangzhou, China
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2
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Farid AH, Rupasinghe PP. A fast and accurate method of detecting Aleutian mink disease virus in blood and tissues of chronically infected mink. Can J Microbiol 2017; 63:341-349. [PMID: 28177788 DOI: 10.1139/cjm-2016-0567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study was to assess the sensitivity of the Omni Klentaq-LA DNA polymerase for detecting Aleutian mink disease virus (AMDV) in mink blood and tissues by PCR without DNA extraction. The presence of AMDV DNA was directly tested by Klentaq in the plasma, serum, whole blood, and spleen homogenates of 188 mink 4 and 16 months after inoculation with the virus. Samples from bone marrow, small intestine, liver, lungs, kidneys, and lymph nodes of 20 of the same mink were also tested by Klentaq. DNA was extracted from paired samples of plasma and the aforesaid tissues by a commercial nucleic acid extraction kit (Dynabeads Silane) and tested by PCR. Compared with the extracted DNA, Klentaq detected a significantly greater number of samples in the whole blood, serum, plasma, spleen, and small intestine. It was concluded that Klentaq is a preferred system for directly detecting AMDV DNA in mink blood and tissues. The lower success rate of extracted DNA compared with Klentaq could be the result of DNA losses during the extraction process. This is an important factor in chronically infected mink, which have a low AMDV copy number in the bloodstream. Direct AMDV detection also reduces the cost of PCR amplification and lowers the risk of sample contamination.
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Affiliation(s)
- A H Farid
- Department of Animal Science and Aquaculture, Dalhousie University Faculty of Agriculture, Truro, NS B2N 5E3, Canada.,Department of Animal Science and Aquaculture, Dalhousie University Faculty of Agriculture, Truro, NS B2N 5E3, Canada
| | - P P Rupasinghe
- Department of Animal Science and Aquaculture, Dalhousie University Faculty of Agriculture, Truro, NS B2N 5E3, Canada.,Department of Animal Science and Aquaculture, Dalhousie University Faculty of Agriculture, Truro, NS B2N 5E3, Canada
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3
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Abbate I, Piralla A, Calvario A, Callegaro A, Giraldi C, Lunghi G, Gennari W, Sodano G, Ravanini P, Conaldi PG, Vatteroni M, Gaeta A, Paba P, Cavallo R, Baldanti F, Lazzarotto T. Nation-wide measure of variability in HCMV, EBV and BKV DNA quantification among centers involved in monitoring transplanted patients. J Clin Virol 2016; 82:76-83. [DOI: 10.1016/j.jcv.2016.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/28/2022]
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4
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Chen XY, Hou PF, Bi J, Ying CM. Detection of human cytomegalovirus DNA in various blood components after liver transplantation. ACTA ACUST UNITED AC 2014; 47:340-4. [PMID: 24714815 PMCID: PMC4075299 DOI: 10.1590/1414-431x20133353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 12/13/2013] [Indexed: 11/30/2022]
Abstract
The quantification of human cytomegalovirus (HCMV DNA) by real-time PCR is currently
a primary option for laboratory diagnosis of HCMV infection. However, the optimal
sample material remains controversial due to the use of different PCR assays. To
explore the best blood component for HCMV DNA surveillance after liver
transplantation, whole blood (WB), serum (SE), and plasma (PL) specimens were
collected simultaneously from targeted patients and examined for HCMV DNA using one
commercially available assay. The HCMV DNA-positive rate with WB (16.67%) was higher
than that with either SE or PL (8.33%, both P<0.01). Quantitative DNA levels in WB
were of greater magnitude than those in SE (WB-SE mean log-transformed difference,
0.99; 95%CI=0.74-1.25; P<0.0001) and PL (WB-PL mean log-transformed difference,
1.37; 95%CI=1.07-1.66; P<0.0001). Dynamic monitoring revealed that HCMV DNA in WB
was positive sooner and had higher values for a longer period of time during therapy.
With earlier positive detection, higher sensitivity, and yield of greater viral
loads, WB compared favorably to SE or PL and hence is recommended as the superior
material for HCMV DNA surveillance after liver transplantation. In addition, infant
recipients require more intensive monitoring and prophylactic care because of their
higher susceptibility to primary HCMV infection.
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Affiliation(s)
- X Y Chen
- Department of Clinical Laboratory, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - P F Hou
- Department of Clinical Laboratory, Rushan Hospital, Shandong, China
| | - J Bi
- Department of Clinical Laboratory, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - C M Ying
- Department of Clinical Laboratory, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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5
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Choquet S, Varnous S, Deback C, Golmard JL, Leblond V. Adapted treatment of Epstein-Barr virus infection to prevent posttransplant lymphoproliferative disorder after heart transplantation. Am J Transplant 2014; 14:857-66. [PMID: 24666832 DOI: 10.1111/ajt.12640] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 12/03/2013] [Accepted: 12/18/2013] [Indexed: 01/25/2023]
Abstract
Up to 35% of posttransplant lymphoproliferative disorder (PTLD) cases occur within 1 year of transplantation, and over 50% are associated with Epstein-Barr virus (EBV). EBV primary infection and reactivation are PTLD predictive factors, but there is no consensus for their treatment. We conducted a prospective single-center study on 299 consecutive heart-transplant patients treated with the same immunosuppressive regimen and monitored by repetitive EBV viral-load measurements and endomyocardial biopsies to detect graft rejection. Immunosuppression was tapered on EBV reactivation with EBV viral loads >10(5) copies/mL or primary infection. In the absence of response at 1 month or a viral load >10(6) copies/mL, patients received one rituximab infusion (375 mg/m(2) ). All patients responded to treatment without increased graft rejection. One primary infection case developed a possible PTLD, which completely responded to diminution of immunosuppression, and one patient, whose EBV load was unevaluable, died of respiratory complications secondary to PTLD. Compared with a historical cohort of 820 patients, PTLD incidence was decreased (p = 0.033) by a per-protocol analysis. This is the largest study on EBV primary infection/reactivation treatment, the first using rituximab following solid organ transplantation to prevent PTLD and the first to demonstrate an acceptable tolerability profile in this setting.
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Affiliation(s)
- S Choquet
- Clinical Hematology Unit, CHU La Pitié Salpêtrière Hospital, APHP, Paris, France
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6
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Validation of the QIAsymphony RGQ system for DNA quantitation of different BK virus genotypes in whole blood samples. J Virol Methods 2014; 196:32-5. [DOI: 10.1016/j.jviromet.2013.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/16/2013] [Accepted: 10/18/2013] [Indexed: 11/29/2022]
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7
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Deback C, Burrel S, Varnous S, Carcelain G, Conan F, Aït-Arkoub Z, Autran B, Gandjbakhch I, Agut H, Boutolleau D. Management of multidrug-resistant cytomegalovirus infection in immunocompromised patients: case report of a heart-transplant recipient and review of the literature. Antivir Ther 2014; 20:249-54. [DOI: 10.3851/imp2818] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
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8
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Pillet S, Roblin X, Cornillon J, Mariat C, Pozzetto B. Quantification of cytomegalovirus viral load. Expert Rev Anti Infect Ther 2013; 12:193-210. [PMID: 24341395 DOI: 10.1586/14787210.2014.870887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cytomegalovirus (CMV), a member of the Herpesviridae family, is worldwide distributed. After the primary infection, CMV induces a latent infection with possible reactivation(s). It is responsible for severe to life-threatening diseases in immunocompromised patients and in foetuses and newborns of infected mothers. For monitoring CMV load, classical techniques based on rapid culture or pp65 antigenemia are progressively replaced by quantitative nuclear acid tests (QNAT), easier to implement and standardize. A large variety of QNAT are available from laboratory-developed assays to fully-automated commercial tests. The indications of CMV quantification include CMV infection during pregnancy and in newborns, and viral surveillance of grafted and non-grafted immunocompromised patients, patients with bowel inflammatory diseases and those hospitalised in intensive care unit. A close cooperation between virologists and clinicians is essential for optimizing the benefit of CMV DNA monitoring.
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Affiliation(s)
- Sylvie Pillet
- Faculty of Medicine of Saint-Etienne, University of Lyon, Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP)-EA3064, 42023 Saint-Etienne, France
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9
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Przybylski M, Dzieciatkowski T, Les K, Mucha MA, Wroblewska M, Mlynarczyk G. Comparison of real-time PCR quantitative analysis of the cytomegalovirus DNA level using LightCycler 2.0 and LightCycler 480 instruments. J Clin Virol 2012; 55:270-3. [PMID: 22921517 DOI: 10.1016/j.jcv.2012.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/25/2012] [Accepted: 08/03/2012] [Indexed: 11/19/2022]
Abstract
UNLABELLED Cytomegalovirus infection is a frequent complication after transplantation. It is commonly believed that the level of CMV viraemia, usually measured with real-time PCR, is directly correlated with the risk of developing a serious cytomegaloviral disease. OBJECTIVES The aim was the comparison of results obtained with a commercial test for the quantitative diagnostics of CMV infections, using LightCycler 2.0 and LightCycler 480 real-time PCR systems. STUDY DESIGNS Study comprised 97 samples of nucleic acids isolated from serum, in which the CMV DNA was detected during routine tests. Measurement in both analysers was performed simultaneously for paired serum samples. Comparison and of the results obtained with two types of thermocyclers included regression analysis, Spearman correlation, Friedman test and Bland-Altman analysis (p<0.05). RESULTS CMV DNA was detected in all samples with use of both thermocyclers. Correlation coefficient of results obtained with both analysers was 0.94. According to Friedman and Bland-Altman tests' results, there were significant differences in measurements between instruments (p<0.001 and p=0.017, respectively). Difference of median values was 0.137 log(10)CMV viral load/ml, and difference of mean values was 0.215 log(10)CMV viral load/ml. Clear threshold of fluorescence crossing point of 1.4-1.8 cycles in advantage of LightCycler 480 was an apparent difference between both analysers. CONCLUSIONS There was good overall correlation between both analysers, as detected shift in both median and mean values was close to intra-assay variability declared by its producer. Observed differences were probably due to different fluorescence excitation and detection systems used in both instruments.
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Affiliation(s)
- Maciej Przybylski
- Department of Medical Microbiology, Medical University of Warsaw, Poland
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10
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Burrel S, Fovet C, Brunet C, Ovaguimian L, Hamm N, Conan F, Kalkias L, Agut H, Boutolleau D. Routine use of duplex real-time PCR assays including a commercial internal control for molecular diagnosis of opportunistic DNA virus infections. J Virol Methods 2012; 185:136-41. [PMID: 22766177 DOI: 10.1016/j.jviromet.2012.05.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 04/26/2012] [Accepted: 05/02/2012] [Indexed: 11/29/2022]
Abstract
The aim of this work was to improve the validity of laboratory-developed real-time PCR protocols implemented in the laboratory for molecular diagnosis of opportunistic DNA virus infections using the Simplexa™ extraction and amplification control (SEAC) which allows the monitoring of the whole extraction and amplification process. Herpes simplex virus (HSV), varicella-zoster virus (VZV), human cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK virus (BKV), and adenovirus (AdV) genomes were investigated in 152 different clinical specimens. The use of the SEAC did not influence the results of the different virus-specific PCRs. The SEAC results showed high reproducibility with a mean Cp value of 31.08±1.44, and were not influenced by the virus-specific PCR performed or the type of clinical specimen tested. The SEAC in the DNA extracts showed high stability during storage at both +4°C and -20°C. These data allowed establishing a new procedure for the validation of viral PCR results. In conclusion, the SEAC provides a reliable option for improving the diagnosis of opportunistic viral infections by laboratory-developed real-time PCR assays in quality assurance programs.
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Affiliation(s)
- Sonia Burrel
- UPMC Univ Paris 06, ER1 DETIV, F-75013 Paris, France
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11
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Emergence of cytomegalovirus resistance to foscarnet in a patient receiving foscarnet salvage therapy for multidrug-resistant HIV infection. J Clin Virol 2012; 54:194-6. [DOI: 10.1016/j.jcv.2012.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 02/07/2012] [Accepted: 02/13/2012] [Indexed: 11/19/2022]
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12
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Chawla J, Ghobadi A, Mosley J, Verkruyse L, Trinkaus K, Abboud C, Cashen A, Stockerl-Goldstein K, Uy G, Westervelt P, DiPersio J, Vij R. Oral valganciclovir versus ganciclovir as delayed pre-emptive therapy for patients after allogeneic hematopoietic stem cell transplant: a pilot trial (04-0274) and review of the literature. Transpl Infect Dis 2011; 14:259-67. [DOI: 10.1111/j.1399-3062.2011.00689.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 07/01/2011] [Accepted: 08/28/2011] [Indexed: 11/29/2022]
Affiliation(s)
- J.S. Chawla
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - A. Ghobadi
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - J. Mosley
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - L. Verkruyse
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - K. Trinkaus
- Biostatistics; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - C.N. Abboud
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - A.F. Cashen
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | | | - G.L. Uy
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - P. Westervelt
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - J.F. DiPersio
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
| | - R. Vij
- Division of Oncology; Washington University School of Medicine; Saint Louis; Missouri; USA
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Atkinson C, Emery VC. Cytomegalovirus quantification: where to next in optimising patient management? J Clin Virol 2011; 51:223-8. [PMID: 21620764 DOI: 10.1016/j.jcv.2011.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 04/11/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Over the years quantification of cytomegalovirus (HCMV) load in blood has become a mainstay of clinical management helping direct deployment of antiviral therapy, assess response to therapy and highlight cases of drug resistance. AIMS The review focuses on a brief historical perspective of HCMV quantification and the ways in which viral load is being used to improve patient management. METHODS A review of the published literature and also personal experience at the Royal Free Hospital. RESULTS Quantification of HCMV is essential for efficient patient management. The ability to use real time quantitative PCR to drive pre-emptive therapy has improved patient management after transplantation although the threshold viral loads for deployment differ between laboratories. The field would benefit from access to a universal standard for quantification. CONCLUSIONS We see that HCMV quantification will continue to be central to delivering individualised patient management and facilitating multicentre trials of new antiviral agents and vaccines in a variety of clinical settings.
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Affiliation(s)
- Claire Atkinson
- Centre for Virology, Department of Infection, UCL London, United Kingdom
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Halfon P, Berger P, Khiri H, Martineau A, Pénaranda G, Merlin M, Faucher C. Algorithm based on CMV kinetics DNA viral load for preemptive therapy initiation after hematopoietic cell transplantation. J Med Virol 2011; 83:490-5. [DOI: 10.1002/jmv.21996] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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15
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Abstract
In routine molecular diagnostics, detection of herpesviruses has made a major impact. Infection with herpesviruses is indicated by demonstrating the presence of the virus in selected specimens. Rapid and reliable detection of herpesvirus DNA helps to decrease the lethality as well as the sequelae of herpesvirus infection in patients at risk. This chapter discusses specimen types and both laboratory-developed and commercially available assays useful for molecular detection of herpesviruses. To meet the need for reliable laboratory results, it is advisable to employ maximum automated and standardized kits based on reagents and standards of reproducible high quality. In the routine diagnostic laboratory, introduction of IVD/CE and/or FDA-labeled tests is preferred.
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Affiliation(s)
- Harald H Kessler
- Molecular Diagnostics Laboratory, IHMEM, Medical University of Graz, Graz, Austria
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16
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Rapid quantitation of cytomegalovirus DNA in whole blood by a new molecular assay based on automated sample preparation and real-time PCR. Med Microbiol Immunol 2010; 199:311-6. [DOI: 10.1007/s00430-010-0164-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Indexed: 12/17/2022]
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Peres RMB, Costa CRC, Andrade PD, Bonon SHA, Albuquerque DM, de Oliveira C, Vigorito AC, Aranha FJP, de Souza CA, Costa SCB. Surveillance of active human cytomegalovirus infection in hematopoietic stem cell transplantation (HLA sibling identical donor): search for optimal cutoff value by real-time PCR. BMC Infect Dis 2010; 10:147. [PMID: 20515464 PMCID: PMC2890007 DOI: 10.1186/1471-2334-10-147] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 06/01/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human cytomegalovirus (CMV) infection still causes significant morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Therefore, it is extremely important to diagnosis and monitor active CMV infection in HSCT patients, defining the CMV DNA levels of virus replication that warrant intervention with antiviral agents in order to accurately prevent CMV disease and further related complications. METHODS During the first 150 days after allogeneic HSTC, thirty patients were monitored weekly for active CMV infection by pp65 antigenemia, nested-PCR and real-time PCR assays. Receiver operating characteristic (ROC) plot analysis was performed to determine a threshold value of the CMV DNA load by real-time PCR. RESULTS Using ROC curves, the optimal cutoff value by real-time PCR was 418.4 copies/104 PBL (sensitivity, 71.4%; specificity, 89.7%). Twenty seven (90%) of the 30 analyzed patients had active CMV infection and two (6.7%) developed CMV disease. Eleven (40.7%) of these 27 patients had acute GVHD, 18 (66.7%) had opportunistic infection, 5 (18.5%) had chronic rejection and 11 (40.7%) died - one died of CMV disease associated with GVHD and bacterial infection. CONCLUSIONS The low incidence of CMV disease in HSCT recipients in our study attests to the efficacy of CMV surveillance based on clinical routine assay. The quantification of CMV DNA load using real-time PCR appears to be applicable to the clinical practice and an optimal cutoff value for guiding timely preemptive therapy should be clinically validated in future studies.
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Affiliation(s)
- Renata M B Peres
- Department of Clinical Medicine, Faculty of Medical Sciences, University of Campinas, P.O. Box 6111, Zipe Code 13083-970, Campinas, SP, Brazil
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18
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Fengqin F, Kezi M, Li Z, Zhijun Y, Jiong H, Yide L, Xianghui W, Yuhua J. The Complex Relationship of CMV IgM, pp65 Antigenemia, Plasma, and Cellular HCMV Q-PCR as Observed in an Immunocompetent Population and in HSCT Patients. Lab Med 2010. [DOI: 10.1309/lmu62g9yadogjeqf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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19
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Boutolleau D, Deback C, Géli J, Aït-Arkoub Z, Angleraud F, Gautheret-Dejean A, Agut H. Évaluation de la plate-forme de PCR en temps réel LightCycler® 480 pour la mesure des charges virales CMV, EBV, HHV-6 et BKV dans le sang total. ACTA ACUST UNITED AC 2010; 58:166-9. [DOI: 10.1016/j.patbio.2009.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 06/26/2009] [Indexed: 11/16/2022]
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20
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[Evaluation of cytomegalovirus quantification in blood by the R-gene real-time PCR test]. ACTA ACUST UNITED AC 2009; 58:162-5. [PMID: 19854587 DOI: 10.1016/j.patbio.2009.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/21/2009] [Indexed: 12/16/2022]
Abstract
AIM OF THE STUDY Diagnosing the presence of cytomegalovirus (CMV) in the blood of immunodepressed patients is often done by quantitative polymerase chain reaction (Q-PCR) even though the reference method remains the antigenemia pp65 (Ag-pp65) test. OBJECTIVES To define the predictive value of the Q-PCR in the diagnosis of CMV disease and assess treatment efficacy using the CMV R-gene test. To compare the Q-PCR results and feasibility with those of the Ag-pp65 test. PATIENTS AND METHODS The Q-PCR was performed in 34 whole blood samples (frozen at -80 degrees C until use) from five patients diagnosed with CMV disease, defined as the presence of clinical signs and Ag-pp65 in the nuclei of more than two cells. After extraction, viral DNA was quantified in each sample using the Q-PCR CMV R-gene kit according to the manufacturer's instructions. Immediately after blood was drawn, the Ag-pp65 test had been performed in 32 samples using CINAkit (Argene). RESULTS The 16 samples positive by the Ag-pp65 test were also positive by PCR; six samples negative by the Ag-pp65 test were positive by PCR; and the remaining 10 samples were negative by both techniques. During treatment, the two markers' kinetics were similar. CONCLUSION The CMV R-gene test has a predictive value as good as that of the Ag-pp65 test but is fast and easier to use. A prospective study with a greater number of patients is needed to define the prediction threshold for CMV disease.
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Comparative evaluation of a commercially available automated system for extraction of viral DNA from whole blood: application to monitoring of epstein-barr virus and cytomegalovirus load. J Clin Microbiol 2009; 47:3753-5. [PMID: 19710270 DOI: 10.1128/jcm.01497-09] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The NucliSENS easyMAG automated system was compared to the column-based Qiagen method for Epstein-Barr virus (EBV) or cytomegalovirus (CMV) DNA extraction from whole blood before viral load determination using the corresponding R-gene amplification kits. Both extraction techniques exhibited a total agreement of 81.3% for EBV and 87.2% for CMV.
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Use of the Roche LightCycler® 480 system in a routine laboratory setting for molecular diagnosis of opportunistic viral infections: Evaluation on whole blood specimens and proficiency panels. J Virol Methods 2009; 159:291-4. [DOI: 10.1016/j.jviromet.2009.03.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 03/24/2009] [Accepted: 03/31/2009] [Indexed: 11/24/2022]
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Zhang X, Fan J, Yang MF, Chen XM, Gao HN, Zhao H, Ma WH, Li LJ. Monitoring of human cytomegalovirus infection in bone marrow and liver transplant recipients by antigenaemia assay and enzyme-linked immunosorbent assay. J Int Med Res 2009; 37:31-6. [PMID: 19215671 DOI: 10.1177/147323000903700104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Human cytomegalovirus (HCMV) infection is a common complication in transplant recipients. Sensitive, specific and timely diagnostic tests for the detection of HCMV infection remain essential for successful therapy. The results of three tests to detect HCMV in bone marrow and liver transplant recipients were compared: a pp65 antigenaemia assay, an immediate-early (IE) antigenaemia assay and an anti-HCMV immunoglobulin M (IgM) antibody enzyme-linked immunosorbent assay (ELISA). Of 1344 samples, 911 (67.8%) and 917 (68.2%) samples were positive for pp65 and IE, respectively. The coincidence level was 85.1%. There was no statistical difference after transplantation to the first positive detection of HCMV (mean first checkout time) between the pp65 and IE antigenaemia assays. Moreover, the levels of HCMV detected by the pp65 and IE antigenaemia assays were significantly correlated. The HCMV-positivity rate as detected by the anti-HCMV IgM ELISA was 11.1%, which was significantly different from the IE and pp65 antigenaemia assays. We suggest that the IE antigenaemia assay could replace the pp65 antigenaemia assay for monitoring active HCMV infection and early detection of HCMV infection.
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Affiliation(s)
- X Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Resistance pattern of cytomegalovirus (CMV) after oral valganciclovir therapy in transplant recipients at high-risk for CMV infection. Antiviral Res 2008; 81:174-9. [PMID: 19063923 DOI: 10.1016/j.antiviral.2008.11.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 10/24/2008] [Accepted: 11/12/2008] [Indexed: 10/21/2022]
Abstract
In transplant recipients, cytomegalovirus (CMV) resistance to antivirals causes an increasing problem. Here we report the clinical, therapeutic, and virological characteristics of 11 cases of CMV resistance among transplant recipients at high-risk for CMV infection and receiving valganciclovir as a prophylactic, preemptive or maintenance therapy. Active CMV infection was monitored by viral DNA quantification in whole blood, and CMV resistance was assessed by UL97 and UL54 viral gene sequencing. For 10 patients, ganciclovir resistance detected after valganciclovir therapy was associated with one mutation within UL97 phosphotransferase located at codons 460 and 592-603, which constitutes a similar pattern of resistance to what has been reported previously in AIDS patients treated with valganciclovir. For the last patient, two mutations in UL97 and UL54 genes were identified. The start of valganciclovir maintenance treatment after an intravenous curative treatment while CMV DNA is still detectable in peripheral blood might represent a risk factor for the emergence of CMV resistance. The possible emergence of CMV resistance in transplant recipients at high-risk for CMV infection who receive valganciclovir therapy should be taken into account. Among those patients, CMV infection has to be closely monitored in order to detect promptly the emergence of drug-resistance.
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Koidl C, Bozic M, Marth E, Kessler HH. Detection of CMV DNA: Is EDTA whole blood superior to EDTA plasma? J Virol Methods 2008; 154:210-2. [DOI: 10.1016/j.jviromet.2008.08.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 08/18/2008] [Accepted: 08/20/2008] [Indexed: 10/21/2022]
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Expansion of human cytomegalovirus (HCMV) immediate-early 1-specific CD8+ T cells and control of HCMV replication after allogeneic stem cell transplantation. J Virol 2008; 82:10143-52. [PMID: 18684826 DOI: 10.1128/jvi.00688-08] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recovery of human cytomegalovirus (HCMV)-specific T immunity is critical for protection against HCMV disease in the early phase after allogeneic stem cell transplantation (SCT). Using an enzyme-linked immunospot assay with overlapping 15-mer peptides spanning pp65 and immediate-early 1 HCMV proteins, we investigated which HCMV-specific CD8(+) gamma interferon-positive (IFN-gamma(+)) T-cell responses against pp65 and IE-1 were associated with control of HCMV replication in 48 recipients of unmanipulated HLA-matched allografts at 3 months (M3) and 6 months (M6) after SCT and in 23 donors. At M3 after SCT, the magnitude of the pp65-specific IFN-gamma-producing CD8(+) T-cell response was greater in recipients than in donors, regardless of HCMV status. In contrast, expansion of IE-1-specific CD8(+) T cells at M3 was associated with protection against HCMV, and no patient with this expansion had HCMV replication at M3. At M6, the number of HCMV-specific CD8(+) T cells against both pp65 and IE-1 had expanded in all recipients, regardless of their previous levels of HCMV replication. The recipients' HCMV-specific CD8(+) T cells already detectable in related donors were predominantly targeting pp65. In contrast, in 40% of the cases, the HCMV-specific CD8(+) T cells in recipients involved new CD8(+) T-cell specificities undetectable in their related donors and preferentially targeting IE-1. Taken together, these results showed that the delay in reconstituting IE-1-specific CD8(+) T cells is correlated with the lack of protection against HCMV in the first 3 months after SCT. They also show that IE-1 is a major antigenic determinant of the early restoration of protective immunity to HCMV after SCT.
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BenMarzouk-Hidalgo OJ, Cordero E, Martín-Peña A, García-Prado E, Gentil MA, Gomez-Bravo MA, Barrera-Pulido L, Cisneros JM, Perez-Romero P. Prevention of cytomegalovirus disease using preemptive treatment after solid organ transplant in patients at high risk for cytomegalovirus infection. Antivir Ther 2008. [DOI: 10.1177/135965350901400509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The use of pre-emptive or prophylactic treatment to control cytomegalovirus (CMV) replication after solid organ transplant (SOT) remains controversial. The aim of this study was to evaluate whether administration of pre-emptive treatment to control viral replication guided by a highly sensitive diagnostic tool is an effective approach for preventing CMV disease, even in high-risk transplant recipients. Methods Plasma samples from eight SOT patients were tested using antigenaemia and real-time PCR (RT-PCR) assays. Pre-emptive treatment was administered guided by RT-PCR when viral load values were >1,000 copies/ml. Results All patients developed episodes of CMV infection, but none of them developed CMV disease or indirect effects. No patient in this study died or experienced graft rejection. Treatment was needed in 10 replication episodes. At the end of treatment, four had undetectable levels and the other six were cleared 3 weeks later. In 42.6% of tested samples RT-PCR was more sensitive for detecting viral infection. Conclusions Pre-emptive monitoring of SOT patients at high risk for CMV infection protected patients from developing CMV disease during the first 6 months after transplant. The use of this sensitive method for guiding pre-emptive treatment diminished viral load early enough that it did not have consequences for patient health.
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Affiliation(s)
- Omar Jesus BenMarzouk-Hidalgo
- Service of Infectious Diseases, Hospitales Universitarios Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Elisa Cordero
- Service of Infectious Diseases, Hospitales Universitarios Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Almudena Martín-Peña
- Service of Infectious Diseases, Hospitales Universitarios Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Elena García-Prado
- Service of Infectious Diseases, Hospitales Universitarios Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Miguel Angel Gentil
- Service of Nephrology, Hospitales Universitarios Virgen del Rocío, Seville, Spain
| | - Miguel Angel Gomez-Bravo
- Hepatho-bilio-pancreatic Surgery and Hepatic Transplant Unit, Hospitales Universitarios Virgen del Rocío, Seville, Spain
| | - Lydia Barrera-Pulido
- Hepatho-bilio-pancreatic Surgery and Hepatic Transplant Unit, Hospitales Universitarios Virgen del Rocío, Seville, Spain
| | - Jose Miguel Cisneros
- Service of Infectious Diseases, Hospitales Universitarios Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Pilar Perez-Romero
- Service of Infectious Diseases, Hospitales Universitarios Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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