1
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Fan R, Geritz SAH. Modelling and optimising healthcare interventions in a model with explicit within- and between-host dynamics. J Theor Biol 2022; 554:111276. [PMID: 36126777 DOI: 10.1016/j.jtbi.2022.111276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/17/2022] [Accepted: 09/06/2022] [Indexed: 01/14/2023]
Abstract
Given an endemic infectious disease and a budget, how do we optimally allocate interventions to control the disease? This paper shows that the optimal strategy varies depending on the budget, the type of intervention, the trajectory of pathogen load, and the objective. Using a model with explicit within- and between-host dynamics, we model isolation, supportive treatment, and specific treatment. Isolation and supportive treatment affect the transmission coefficient and the disease-induced mortality rate, respectively, in the between-host dynamics. Specific treatment affects the clearance rate of pathogens in the within-host dynamics. We study the optimisation of the three interventions for various budget levels via evaluating isolation and supportive treatment at the population level and specific treatment at both the population and individual levels. At the population level, we consider the risk of transmission, the burden of illness, and the survival probability, and to that end, we choose the population-level infection rate, the population density of infected individuals, and the total disease-induced mortality rate as objective functions. At the individual level, we consider the length of infection and the pathogen load, and to that end, we choose the maximum infection-age and the maximum pathogen load as objective functions. The objective is to minimise these functions through varying two variables that refer to when the intervention starts and when it stops for an infected individual and also indicate what kind of individuals can get the intervention from the population perspective. We find that the optimal strategy of isolation is to isolate individuals with a higher pathogen load, given a lower budget. The optimal strategy of supportive treatment can be the same as isolation or simply no treatment. The optimal strategy of specific treatment is complicated, and it can be to treat individuals with pathogen loads above a particular level until they recover or until the pathogens can decrease when treatment stops, or it can be another scenario.
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Affiliation(s)
- Ruili Fan
- Department of Mathematics and Statistics, University of Helsinki, FIN-00014, Finland.
| | - Stefan A H Geritz
- Department of Mathematics and Statistics, University of Helsinki, FIN-00014, Finland.
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2
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Yang QH, Ma XP, Dai DL, Bai DM, Zou Y, Liu SX, Song JM. Gastrointestinal cytomegalovirus disease secondary to measles in an immunocompetent infant: A case report. World J Gastroenterol 2021; 27:1655-1663. [PMID: 33958850 PMCID: PMC8058656 DOI: 10.3748/wjg.v27.i15.1655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/19/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal cytomegalovirus (CMV) disease occurs commonly in immunocompromised/immunodeficient patients with advanced human immunodeficiency virus infection, neoplasm, solid organ transplantation, hematopoietic stem cell transplantation, or treatment with immunosuppressants, but is rarely reported in association with measles infection.
CASE SUMMARY We describe a case of extensive gastrointestinal CMV disease secondary to measles infection in a 9-mo-old boy who presented with persistent fever and bloody diarrhea. His condition was improved after ganciclovir treatment. Serological analysis of CMV showed negative immunoglobulin (Ig) M and positive IgG. Blood CMV-DNA was 9.26 × 103 copies/mL. The diagnosis of gastrointestinal CMV disease was confirmed by histopathological findings of intranuclear and intracytoplasmic inclusions and Owl’s eye inclusion. This case highlights the differential diagnosis and histopathological characteristics of gastrointestinal CMV infection and laboratory tests.
CONCLUSION Extensive gastrointestinal CMV lesions can be induced by the immune suppression secondary to measles infection. Rational, fast, and effective laboratory examinations are essential for suspected patients.
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Affiliation(s)
- Qing-Hua Yang
- Endoscopy Center and Gastroenterology Department, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
| | - Xiao-Peng Ma
- Endoscopy Center and Gastroenterology Department, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
| | - Dong-Ling Dai
- Endoscopy Center and Gastroenterology Department, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
| | - Da-Ming Bai
- Endoscopy Center and Gastroenterology Department, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
| | - Yu Zou
- Endoscopy Center and Gastroenterology Department, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
| | - Si-Xi Liu
- Endoscopy Center and Gastroenterology Department, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
| | - Jian-Ming Song
- Department of Pathology, Shenzhen Children's Hospital, Shenzhen 518036, Guangdong Province, China
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3
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Chiereghin A, Belotti T, Borgatti EC, Fraccascia N, Piccirilli G, Fois M, Borghi M, Turello G, Gabrielli L, Masetti R, Prete A, Fanti S, Lazzarotto T. Off-Label Use of Letermovir as Preemptive Anti-Cytomegalovirus Therapy in a Pediatric Allogeneic Peripheral Blood Stem Cell Transplant. Infect Drug Resist 2021; 14:1185-1190. [PMID: 33790588 PMCID: PMC8001039 DOI: 10.2147/idr.s296927] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
Despite the effectiveness of the currently available antiviral drugs in treating cytomegalovirus (CMV) infection, high rates of adverse effects are associated with their use. Moreover, a problem of increasing importance is the emergence of drug-resistant CMV infection. Here, we describe the first case of off-label use of letermovir (LMV) as preemptive antiviral therapy, in a pediatric allogeneic peripheral blood stem cell transplant recipient with ganciclovir-resistant CMV infection who was intolerant to foscarnet and unable to achieve viral clearance after seven doses of cidofovir. After the administration of LMV, a gradual reduction in viral load was observed and within 6 weeks of LMV treatment, after more than 6 months of positive CMV-DNAemia, the patient cleared the infection. No adverse effects associated with LMV were observed during treatment. In this pediatric study case, the off-label use of LMV for the treatment of CMV infection has been well tolerated and proved to be effective in leading to the suppression of viral replication.
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Affiliation(s)
- Angela Chiereghin
- Section of Microbiology, Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Bologna, Italy.,Department of Public Health, Local Health Authority of Bologna, Bologna, Italy
| | - Tamara Belotti
- Pediatric Oncology and Haematology Unit "Lalla Seragnoli", Department of Pediatrics, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Eva Caterina Borgatti
- Microbiology Unit, Department of Specialized, Experimental, and Diagnostic Medicine, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Nicola Fraccascia
- Nuclear Medicine Unit, Department of Specialized, Experimental, and Diagnostic Medicine, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Giulia Piccirilli
- Microbiology Unit, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Maura Fois
- Pediatric Oncology and Haematology Unit "Lalla Seragnoli", Department of Pediatrics, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Michele Borghi
- Microbiology Unit, Department of Specialized, Experimental, and Diagnostic Medicine, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Gabriele Turello
- Microbiology Unit, Department of Specialized, Experimental, and Diagnostic Medicine, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Liliana Gabrielli
- Microbiology Unit, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Riccardo Masetti
- Pediatric Oncology and Haematology Unit "Lalla Seragnoli", Department of Pediatrics, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Arcangelo Prete
- Pediatric Oncology and Haematology Unit "Lalla Seragnoli", Department of Pediatrics, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, Department of Specialized, Experimental, and Diagnostic Medicine, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Microbiology Unit, Department of Specialized, Experimental, and Diagnostic Medicine, IRCCS St. Orsola Polyclinic, University of Bologna, Bologna, Italy
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4
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Bueno F, Albert E, Giménez E, Piñana JL, Pérez A, Gómez MD, Hernández‐Boluda JC, Gonzalez‐Barberá EM, Montoro J, Guerreiro M, Balaguer‐Roselló A, Hernani R, Sanz J, Solano C, Navarro D. Cytomegalovirus DNA load monitoring in stool specimens for anticipating the occurrence of intestinal acute graft‐versus‐host disease following allogeneic hematopoietic stem cell transplantation: Is it of any value? Transpl Infect Dis 2020; 22:e13440. [DOI: 10.1111/tid.13440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/15/2020] [Accepted: 08/02/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Felipe Bueno
- Microbiology Service Hospital Clínico UniversitarioInstitute for Research INCLIVA Valencia Spain
| | - Eliseo Albert
- Microbiology Service Hospital Clínico UniversitarioInstitute for Research INCLIVA Valencia Spain
| | - Estela Giménez
- Microbiology Service Hospital Clínico UniversitarioInstitute for Research INCLIVA Valencia Spain
| | - José Luis Piñana
- Hematology Department Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Ariadna Pérez
- Hematology Service Hospital Clínico UniversitarioInstitute for Research INCLIVA Valencia Spain
| | - María Dolores Gómez
- Microbiology Service Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Juan Carlos Hernández‐Boluda
- Hematology Service Hospital Clínico UniversitarioInstitute for Research INCLIVA Valencia Spain
- Department of Medicine School of Medicine University of Valencia Valencia Spain
| | | | - Juan Montoro
- Hematology Department Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Manuel Guerreiro
- Hematology Department Hospital Universitari i Politècnic La Fe Valencia Spain
| | | | - Rafael Hernani
- Hematology Service Hospital Clínico UniversitarioInstitute for Research INCLIVA Valencia Spain
| | - Jaime Sanz
- Hematology Department Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Carlos Solano
- Hematology Service Hospital Clínico UniversitarioInstitute for Research INCLIVA Valencia Spain
- Department of Medicine School of Medicine University of Valencia Valencia Spain
| | - David Navarro
- Microbiology Service Hospital Clínico UniversitarioInstitute for Research INCLIVA Valencia Spain
- Department of Microbiology School of Medicine University of Valencia Valencia Spain
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5
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Carapito R, Aouadi I, Pichot A, Spinnhirny P, Morlon A, Kotova I, Macquin C, Rolli V, Cesbron A, Gagne K, Oudshoorn M, van der Holt B, Labalette M, Spierings E, Picard C, Loiseau P, Tamouza R, Toubert A, Parissiadis A, Dubois V, Paillard C, Maumy-Bertrand M, Bertrand F, von dem Borne PA, Kuball JHE, Michallet M, Lioure B, Peffault de Latour R, Blaise D, Cornelissen JJ, Yakoub-Agha I, Claas F, Moreau P, Charron D, Mohty M, Morishima Y, Socié G, Bahram S. Compatibility at amino acid position 98 of MICB reduces the incidence of graft-versus-host disease in conjunction with the CMV status. Bone Marrow Transplant 2020; 55:1367-1378. [PMID: 32286503 DOI: 10.1038/s41409-020-0886-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 11/10/2022]
Abstract
Graft-versus-host disease (GVHD) and cytomegalovirus (CMV)-related complications are leading causes of mortality after unrelated-donor hematopoietic cell transplantation (UD-HCT). The non-conventional MHC class I gene MICB, alike MICA, encodes a stress-induced polymorphic NKG2D ligand. However, unlike MICA, MICB interacts with the CMV-encoded UL16, which sequestrates MICB intracellularly, leading to immune evasion. Here, we retrospectively analyzed the impact of mismatches in MICB amino acid position 98 (MICB98), a key polymorphic residue involved in UL16 binding, in 943 UD-HCT pairs who were allele-matched at HLA-A, -B, -C, -DRB1, -DQB1 and MICA loci. HLA-DP typing was further available. MICB98 mismatches were significantly associated with an increased incidence of acute (grade II-IV: HR, 1.20; 95% CI, 1.15 to 1.24; P < 0.001; grade III-IV: HR, 2.28; 95% CI, 1.56 to 3.34; P < 0.001) and chronic GVHD (HR, 1.21; 95% CI, 1.10 to 1.33; P < 0.001). MICB98 matching significantly reduced the effect of CMV status on overall mortality from a hazard ratio of 1.77 to 1.16. MICB98 mismatches showed a GVHD-independent association with a higher incidence of CMV infection/reactivation (HR, 1.84; 95% CI, 1.34 to 2.51; P < 0.001). Hence selecting a MICB98-matched donor significantly reduces the GVHD incidence and lowers the impact of CMV status on overall survival.
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Affiliation(s)
- Raphael Carapito
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France. .,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France. .,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France. .,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan. .,Laboratoire d'Immunologie, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, Strasbourg, France.
| | - Ismail Aouadi
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan
| | - Angélique Pichot
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan
| | - Perrine Spinnhirny
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan
| | - Aurore Morlon
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,BIOMICA SAS, Strasbourg, France
| | - Irina Kotova
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,BIOMICA SAS, Strasbourg, France
| | - Cécile Macquin
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan
| | - Véronique Rolli
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France.,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan
| | - Anne Cesbron
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Etablissement Français du Sang (EFS) Centre-Pays de la Loire, Laboratoire HLA, Nantes, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Société Francophone d'Histocompatibilité et d'Immunogénétique (SFHI), Paris, France
| | - Katia Gagne
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Etablissement Français du Sang (EFS) Centre-Pays de la Loire, Laboratoire HLA, Nantes, France.,INSERM 1232, CRCINA, Université Nantes-Angers, Nantes, France
| | - Machteld Oudshoorn
- Europdonor operated by Matchis Foundation, Leiden, The Netherlands.,Department of Immunohematology and Blood transfusion, LUMC, Leiden, The Netherlands
| | - Bronno van der Holt
- HOVON Data Center, Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Myriam Labalette
- Laboratoire d'Immunologie, CHRU de Lille, Lille, France.,LIRIC INSERM U995, Université Lille 2, Lille, France
| | - Eric Spierings
- Laboratory for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christophe Picard
- CNRS, EFS-PACA, ADES UMR 7268, Aix-Marseille Université, Marseille, France
| | - Pascale Loiseau
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Laboratoire Jean Dausset, INSERM UMR_S 1160, Hôpital Saint-Louis, Paris, France
| | - Ryad Tamouza
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Laboratoire Jean Dausset, INSERM UMR_S 1160, Hôpital Saint-Louis, Paris, France
| | - Antoine Toubert
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Laboratoire Jean Dausset, INSERM UMR_S 1160, Hôpital Saint-Louis, Paris, France
| | - Anne Parissiadis
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Etablissement Français du Sang (EFS) Grand-Est, Laboratoire HLA, Strasbourg, France
| | - Valérie Dubois
- Etablissement Français du Sang (EFS) Rhône-Alpes, Laboratoire HLA, Lyon, France
| | - Catherine Paillard
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Service d'Hématologie et d'Oncologie pédiatrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Myriam Maumy-Bertrand
- Institut de Recherche Mathématique Avancée, CNRS UMR 7501, LabEx Institut de Recherche en Mathématiques, ses Interactions et Applications, Université de Strasbourg, Strasbourg, France
| | - Frédéric Bertrand
- Institut de Recherche Mathématique Avancée, CNRS UMR 7501, LabEx Institut de Recherche en Mathématiques, ses Interactions et Applications, Université de Strasbourg, Strasbourg, France
| | | | - Jürgen H E Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mauricette Michallet
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Centre Hospitalier Lyon Sud, Hématologie 1G, Hospices Civils de Lyon, Pierre Bénite, Lyon, France
| | - Bruno Lioure
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Service d'Hématologie Adulte, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Régis Peffault de Latour
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Service d'Hématologie - Greffe, Hôpital Saint-Louis, APHP, Paris, France
| | - Didier Blaise
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Institut Paoli Calmettes, Marseille, France
| | - Jan J Cornelissen
- Department of Hematology and ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ibrahim Yakoub-Agha
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,LIRIC INSERM U995, Université Lille 2, Lille, France
| | - Frans Claas
- Department of Immunohematology and Blood transfusion, LUMC, Leiden, The Netherlands
| | - Philippe Moreau
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Service d'Hématologie Clinique, CHU Hôtel Dieu, Nantes, France
| | - Dominique Charron
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Laboratoire Jean Dausset, INSERM UMR_S 1160, Hôpital Saint-Louis, Paris, France
| | - Mohamad Mohty
- Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Département d'Hématologie, Hôpital Saint Antoine, Paris, France.,Université Pierre & Marie Curie, Paris, France.,Centre de Recherche Saint-Antoine, INSERM UMR_S 938, Paris, France
| | - Yasuo Morishima
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Gérard Socié
- Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.,Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC), Hôpital Edouard Herriot, CHU, Lyon, France.,Service d'Hématologie Adulte, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Seiamak Bahram
- Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, Plateforme GENOMAX, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France. .,Labex TRANSPLANTEX, Faculté de Médecine, Université de Strasbourg, Strasbourg, France. .,INSERM Franco-Japanese Nextgen HLA Laboratory, Strasbourg, France. .,INSERM Franco-Japanese Nextgen HLA Laboratory, Nagano, Japan. .,Laboratoire d'Immunologie, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, Strasbourg, France.
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6
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Bigliano P, Calcagno A, Lucchini A, Audagnotto S, Montrucchio C, Marinaro L, Alcantarini C, Ghisetti V, Di Perri G, Bonora S. The outcome of HIV-positive late presenters according to detectable CMV DNA and anti-CMV treatment. Antivir Ther 2019; 23:451-456. [PMID: 29372886 DOI: 10.3851/imp3221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND HIV late presenters are at high risk of cytomegalovirus (CMV) reactivation and end-organ disease. CMV viraemia has been associated with poor survival but the effect of anti-CMV treatment has not been studied in this setting. METHODS HIV-positive patients were included in a retrospective study if presenting with <350 CD4+ T-cells/μl and starting an antiretroviral treatment within 3 months of the diagnosis. Primary end point was 5-year survival according to the presence of CMV viraemia, CMV end-organ disease and anti-CMV treatment. RESULTS 302 patients were included. 157 patients (52%) presented CMV viraemia (CMV-V) and 44 (14.6%) CMV end-organ disease (CMV-EOD). 5-year mortality was higher in CMV-EOD and CMV-V patients than in CMV-negative patients (11.4 versus 9.6 versus 0%; P=0.002). In patients with CMV-V, 5-year mortality was numerically higher in untreated patients (12.9% versus 6.9%; P=0.257) without reaching statistical significance. At univariate analysis the diagnosis of serious opportunistic infections (cryptococcosis, progressive multifocal leukoencephalopathy, lymphoma; P=0.001) and the absence of a negative CMV DNA in the follow-up (P<0.001) were associated with poor outcome. At multivariate analysis HCV coinfection (P=0.016; aOR 6.98, 95% CI 1.50, 32.59), the absence of a negative CMV DNA in the follow-up (P<0.001; aOR 19.40, 95% CI 3.70, 101.64) and marginally the absence of anti-CMV treatment (P=0.052; aOR 4.944, 95% CI 0.99, 24.73) were independent predictors of poor outcome. CONCLUSIONS CMV reactivation in HIV-positive patients with poor immunity is associated with worse prognosis: the pre-emptive use of anti-CMV therapy was associated with a better outcome in patients with CMV-V.
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Affiliation(s)
- Paolo Bigliano
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Anna Lucchini
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Sabrina Audagnotto
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Montrucchio
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Letizia Marinaro
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Alcantarini
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Valeria Ghisetti
- Laboratory of Microbiology and Molecular Biology, Ospedale Amedeo di Savoia, ASL TO2, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
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7
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Pande A, Dubberke ER. Cytomegalovirus Infections of the Stem Cell Transplant Recipient and Hematologic Malignancy Patient. Infect Dis Clin North Am 2019; 33:485-500. [DOI: 10.1016/j.idc.2019.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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8
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Pump WC, Schulz R, Huyton T, Kunze-Schumacher H, Martens J, Hò GGT, Blasczyk R, Bade-Doeding C. Releasing the concept of HLA-allele specific peptide anchors in viral infections: A non-canonical naturally presented human cytomegalovirus-derived HLA-A*24:02 restricted peptide drives exquisite immunogenicity. HLA 2019; 94:25-38. [PMID: 30912293 PMCID: PMC6593758 DOI: 10.1111/tan.13537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/18/2019] [Accepted: 03/23/2019] [Indexed: 11/30/2022]
Abstract
T‐cell receptors possess the unique ability to survey and respond to their permanently modified ligands, self HLA‐I molecules bound to non‐self peptides of various origin. This highly specific immune function is impaired following hematopoietic stem cell transplantation (HSCT) for a timespan of several months needed for the maturation of T‐cells. Especially, the progression of HCMV disease in immunocompromised patients induces life‐threatening situations. Therefore, the need for a new immune system that delivers vital and potent CD8+ T‐cells carrying TCRs that recognize even one human cytomegalovirus (HCMV) peptide/HLA molecule and clear the viral infection long term becomes obvious. The transcription and translation of HCMV proteins in the lytic cycle is a precisely regulated cascade of processes, therefore, it is a highly sensitive challenge to adjust the exact time point of HCMV‐peptide recruitment over self‐peptides. We utilized soluble HLA technology in HCMV‐infected fibroblasts and sequenced naturally sHLA‐A*24:02 presented HCMV‐derived peptides. One peptide of 14 AAs length derived from the IE2 antigen induced the strongest T‐cell responses; this peptide can be detected with a low ranking score in general peptide prediction databanks. These results highlight the need for elaborate and HLA‐allele specific peptide selection.
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Affiliation(s)
- Wiebke C Pump
- Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - Rebecca Schulz
- Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - Trevor Huyton
- Department of Cellular Logistics, Max Planck Institute for Biophysical Chemistry, Göttingen, Germany
| | | | - Jörg Martens
- Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - Gia-Gia T Hò
- Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - Rainer Blasczyk
- Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany
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9
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Abels WC, Manandhar T, Kunze-Schumacher H, Blasczyk R, Bade-Döding C. The polymorphism at residue 156 determines the HLA-B*35 restricted peptide repertoire during HCMV infection. Immunogenetics 2018; 70:639-646. [PMID: 30128813 PMCID: PMC6182399 DOI: 10.1007/s00251-018-1077-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/16/2018] [Indexed: 12/27/2022]
Abstract
Peptide selection in infected cells is not fully understood yet, but several indications point to the fact that there are differences to uninfected cells, especially in productive HCMV infection, since HCMV evolved various strategies to disable the hosts immune system, including presentation of peptide-HLA complexes to immune effector cells. Therefore, peptide predictions for specific HLA alleles are limited in these cases and the naturally presented peptide repertoire of HCMV-infected cells is of major interest to optimize adoptive T cell therapies. The allotypes HLA-B*35:01 and B*35:08 differ at a single amino acid at position 156 and have been described to differ in their peptide features and in their association with the peptide loading complex. Virus specific T cells recognizing the allelic pHLA-B*35 complexes could be detected, indicating a significant role of this HLA subtypes in viral immunity. However, naturally selected and presented viral peptides have not been described so far. In this study, we analyzed the peptide binding repertoire for HLA-B*35:01 and HLA-B*35:08 in HCMV-infected cells. The isolated peptides from both allelic subtypes were of extraordinary length, however differed in their features, origin, and sequence. For these HCMV-originated peptides, no overlap in the peptide repertoire could be observed between the two allelic subtypes. These findings reveal the discrepancies between predicted and naturally presented immunogenic epitopes and support the need of comprehensive peptide recruitment data for personalized and effective cellular therapies.
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Affiliation(s)
- Wiebke C Abels
- Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | - Trishna Manandhar
- Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany
| | | | - Rainer Blasczyk
- Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany
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10
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Lee HY, Rhee CK, Choi JY, Lee HY, Lee JW, Lee DG. Diagnosis of cytomegalovirus pneumonia by quantitative polymerase chain reaction using bronchial washing fluid from patients with hematologic malignancies. Oncotarget 2018; 8:39736-39745. [PMID: 28061469 PMCID: PMC5503648 DOI: 10.18632/oncotarget.14504] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/27/2016] [Indexed: 12/04/2022] Open
Abstract
Background The incidence of cytomegalovirus (CMV) pneumonia is increasing in patients diagnosed with hematologic malignancies. The utility of CMV-DNA viral load measurement has not been standardized, and viral cut-off values have not been established. This study was designed to investigate the utility of CMV quantitative real-time PCR (qRT-PCR) using bronchial washing fluid. Methods We retrospectively reviewed the microbiologic and pathologic results of bronchial washing fluid and biopsy specimens in addition to the patients' clinical characteristics. Results A total of 565 CMV qRT-PCR assays were performed using bronchial washing fluid from patients with hematologic malignancies. Among them, 101 were positive for CMV by qRT-PCR; of these, 24 were diagnosed with CMV pneumonia and 70 with CMV infection, and 7 were excluded due to a diagnosis of invasive pulmonary aspergillosis rather than viral pneumonia. The median CMV load determined by qPCR was 1.8 × 105 copies/mL (3.6 103-1.5 × 108) in CMV pneumonia patients and 3.0 × 103 copies/mL (5.0 × 102-1.1 × 105) in those diagnosed with CMV infection (P < 0.01). Using the ROC curve, the optimal inflection points were 18,900 copies/mL (137,970 IU/mL) in post-bone marrow transplantation (BMT) patients, 316,415 copies/mL (2,309,825 IU/mL) in no-BMT patients and 28,774 copies/mL (210,054 IU/mL) in all patients. Conclusions The CMV titers in bronchial washing fluid determined by qRT-PCR differed significantly between patients diagnosed with CMV pneumonia and those with CMV infection. The viral cut-off values in bronchial washing fluid were suggested for the diagnosis of CMV pneumonia, which were different depending on the BMT status.
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Affiliation(s)
- Hwa Young Lee
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chin Kook Rhee
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Young Choi
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hea Yon Lee
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Wook Lee
- Department of Internal Medicine, Division of Hematology, The Catholic University of Korea, Seoul, Korea.,The Catholic Blood and Marrow Transplantation Center, The Catholic University of Korea, Seoul, Korea
| | - Dong Gun Lee
- The Catholic Blood and Marrow Transplantation Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Division of Infectious Diseases, The Catholic University of Korea, Seoul, Korea.,Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Korea
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11
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Lilleri D, Gerna G. Strategies to control human cytomegalovirus infection in adult hematopoietic stem cell transplant recipients. Immunotherapy 2017; 8:1135-49. [PMID: 27485084 DOI: 10.2217/imt-2015-0028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Human cytomegalovirus (HCMV) represents the major viral complication after hematopoietic stem cell transplantation. HCMV infection may be controlled by the reconstituting immune system and remain subclinical or can lead to severe systemic and/or organ disease (mainly pneumonia and gastroenteritis) when immune reconstitution is delayed or impaired. In order to prevent the occurrence of HCMV disease, a prompt diagnosis of HCMV infection is mandatory. The adoption of pre-emptive therapy strategies guided by virological monitoring dramatically reduced the occurrence of HCMV disease. However, late-onset end-organ disease may occur in some patients with apparent immune reconstitution. In the near future, introduction of immunological monitoring and immunotherapies could markedly improve management of HCMV infection.
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Affiliation(s)
- Daniele Lilleri
- Laboratori Sperimentali di Ricerca-Area Trapiantologica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.,Università della Svizzera Italiana, Institute for Research in Biomedicine, 6500 Bellinzona, Switzerland
| | - Giuseppe Gerna
- Laboratori Sperimentali di Ricerca-Area Trapiantologica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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12
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Cowley NJ, Owen A, Shiels SC, Millar J, Woolley R, Ives N, Osman H, Moss P, Bion JF. Safety and Efficacy of Antiviral Therapy for Prevention of Cytomegalovirus Reactivation in Immunocompetent Critically Ill Patients: A Randomized Clinical Trial. JAMA Intern Med 2017; 177:774-783. [PMID: 28437539 PMCID: PMC5818821 DOI: 10.1001/jamainternmed.2017.0895] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Latent cytomegalovirus (CMV) infection is present in more than half the adult population, and a viral reactivation (ie, when the virus becomes measurable in body fluids such as blood) can occur in up to one-third of these individuals during episodes of critical illness. OBJECTIVE To determine whether antiviral therapy is safe and effective for preventing CMV reactivation in a general population of critically ill patients. DESIGN, SETTING, AND PARTICIPANTS A single-center, open-label, randomized, controlled clinical trial recruited 124 CMV-seropositive patients undergoing mechanical ventilation for at least 24 hours in the intensive care unit between January 1, 2012, and January 31, 2014. The mean baseline Acute Physiology and Chronic Health Evaluation II score of all patients was 17.6. INTERVENTIONS Patients were randomized to receive anti-CMV prophylaxis with valacyclovir hydrochloride (n = 34) or low-dose valganciclovir hydrochloride (n = 46) for up to 28 days to suppress viral reactivation, or to a control group with no intervention (n = 44). MAIN OUTCOMES AND MEASURES Time to first CMV reactivation in blood within the 28-day follow-up period following initiation of the study drug. RESULTS Among the 124 patients in the study (46 women and 78 men; mean [SD] age, 56.9 [16.9] years), viral reactivation in the blood occurred in 12 patients in the control group, compared with 1 patient in the valganciclovir group and 2 patients in the valacyclovir group (combined treatment groups vs control: hazard ratio, 0.14; 95% CI 0.04-0.50). Although this trial was not powered to assess clinical end points, the valacyclovir arm was halted prematurely because of higher mortality; 14 of 34 patients (41.2%) had died by 28 days, compared with 5 of 37 (13.5%) patients in the control arm at the point of the decision to halt this arm. Other safety end points showed similar outcomes between groups. CONCLUSIONS AND RELEVANCE Antiviral prophylaxis with valacyclovir or low-dose valganciclovir suppresses CMV reactivation in patients with critical illness. However, given the higher mortality, a large-scale trial would be needed to determine the clinical efficacy and safety of CMV suppression. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01503918.
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Affiliation(s)
- Nicholas J Cowley
- Institute of Clinical Sciences, University of Birmingham, Birmingham, England2Department of Anaesthesia and Intensive Care, Worcester Royal Hospital, Worcestershire Acute National Health Service Trust, Worcester, England
| | - Andrew Owen
- Institute of Clinical Sciences, University of Birmingham, Birmingham, England3University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, England
| | - Sarah C Shiels
- University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, England
| | - Joanne Millar
- University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, England
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, England
| | - Natalie Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, England
| | - Husam Osman
- University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, England
| | - Paul Moss
- University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, England5Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, England
| | - Julian F Bion
- Institute of Clinical Sciences, University of Birmingham, Birmingham, England3University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, England
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13
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Ishii K, Onishi Y, Miyamura N, Fukuhara N, Ishizawa K, Nakanishi M, Ohnaka S, Miyasaka T, Kanno E, Kawakami K, Harigae H, Kaku M. Development and evaluation of a quantitative assay detecting cytomegalovirus transcripts for preemptive therapy in allogeneic hematopoietic stem cell transplant recipients. J Med Virol 2017; 89:1265-1273. [DOI: 10.1002/jmv.24775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/28/2016] [Accepted: 01/06/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Keiko Ishii
- Department of Medical Microbiology, Mycology and Immunology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yasushi Onishi
- Department of Hematology and Rheumatology; Tohoku University Hospital; Sendai Japan
| | - Namiko Miyamura
- Department of Medical Microbiology, Mycology and Immunology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology; Tohoku University Hospital; Sendai Japan
| | - Kenichi Ishizawa
- Department of Hematology and Rheumatology; Tohoku University Hospital; Sendai Japan
| | | | | | - Tomomitsu Miyasaka
- Department of Medical Microbiology, Mycology and Immunology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Emi Kanno
- Department of Science of Nursing Practice; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Kazuyoshi Kawakami
- Department of Medical Microbiology, Mycology and Immunology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology; Tohoku University Hospital; Sendai Japan
| | - Mitsuo Kaku
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
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14
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CMV viral load in bronchoalveolar lavage for diagnosis of pneumonia in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2017; 52:895-897. [PMID: 28218754 PMCID: PMC7091633 DOI: 10.1038/bmt.2017.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/20/2016] [Accepted: 01/04/2017] [Indexed: 11/09/2022]
Abstract
The objective of this report is to analyze the value of CMV viral load (VL) in bronchoalveolar lavage (BAL) in recipients of allogeneic hematopoietic stem cell transplantation (AHSCT) and to analyze the concordance between CMV quantification in plasma and BAL samples. Fifty-six patients were included; in 16 (28.6%) patients with symptoms of lung disease a BAL sample was collected, 7 (43.7%) patients had a VL >150 copies/mL (six had probable CMV pneumonia). Patients with CMV pneumonia were female (100%), of median age 53.5 years, and the median time from transplantion to onset of symptoms was 67.5 days. Pneumonia was early in three cases (incidence 5.4%). Median BAL VL was 53 250 copies/mL and plasma VL was 538 copies/mL (in one patient, the plasma VL was negative). Three (50.0%) patients had an improvement in the first week of treatment, and plasma VL became negative; the other 3 (50.0%) patients died with a CMV pneumonia refractory to treatment. Therefore, any value of CMV VL in BAL, especially if it is greater than plasma, with compatible signs or symptoms, should be considered suggestive of CMV pneumonia in recipients of AHSCT and they should receive specific treatment.
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15
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Kwon H, Lee HH, Paik CR, Lim YJ, Park JA. Toxic megacolon and interstitial pneumonia caused by cytomegalovirus infection in a pediatric patient with acute lymphoblastic leukemia receiving chemotherapy. Blood Res 2016; 51:281-285. [PMID: 28090493 PMCID: PMC5234237 DOI: 10.5045/br.2016.51.4.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/28/2016] [Accepted: 03/16/2016] [Indexed: 01/31/2023] Open
Affiliation(s)
- Hyunseop Kwon
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hyun Hee Lee
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Chung Ryul Paik
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Yun-Jeong Lim
- Department of Radiology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jeong A. Park
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea
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16
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Cytomegalovirus infection in patients with haematological diseases and after autologous stem cell transplantation as consolidation: a single-centre study. Ann Hematol 2016; 96:125-131. [PMID: 27730340 DOI: 10.1007/s00277-016-2831-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
Because of the widespread use of immunosuppressive drugs, CMV infection is one of the most important causes of morbidity and mortality in patients with haematological malignancies worldwide. The aim of the study was to retrospectively analyse the epidemiology of CMV infection in haematological patients. Between 2008 and 2014, 1238 quantitative CMV DNA detections from plasma specimens were performed. These specimens were collected from 271 patients with haematological malignancy. Patients were grouped on the basis of underlying diseases (lymphoid and myeloid malignancies and other haematological diseases). In the lymphoid and myeloid groups, we distinguished ASCT and non-ASCT groups. During the studied period, the majority of examined patients (82.6 %) were treated with lymphoproliferative disease. A total of 126 (46.5 %) patients underwent ASCT, while 145 (53.5 %) did not have stem cell transplantation. A total of 118 (9.5 %) of 1238 plasma specimens proved to be positive for CMV DNA; these specimens were collected from 66 (24.4 %) patients. Twenty-four (16.6 %) of 145 non-ASCT patients had CMV PCR positive specimens. Among non-ASCT patients with positive CMV PCR results, 10 patients were asymptomatic, 14 had symptomatic reactivation, while 2 had CMV disease. In the ASCT group, 42 (33.3 %) patients had CMV PCR positive samples. CMV reactivation was asymptomatic in 34 (81 %) cases, and 8 (19 %) patients had symptomatic reactivation. In the non-ASCT group, the rate of CMV infection is low. In the ASCT group, the prevalence of CMV infection was higher than in the non-ASCT group, but the majority of CMV infection was asymptomatic and only small number of patients had symptomatic reactivation. Thus, our results also showed that the use of routine CMV DNA monitoring is not necessary in patients with haematological malignancies not receiving fludarabine-containing regimen or alemtuzumab, in spite of this to decrease the mortality we have to consider the use of molecular tests in case of suspected infectious conditions.
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17
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Greco R, Crucitti L, Noviello M, Racca S, Mannina D, Forcina A, Lorentino F, Valtolina V, Rolla S, Dvir R, Morelli M, Giglio F, Barbanti MC, Lupo Stanghellini MT, Oltolini C, Vago L, Scarpellini P, Assanelli A, Carrabba MG, Marktel S, Bernardi M, Corti C, Clementi M, Peccatori J, Bonini C, Ciceri F. Human Herpesvirus 6 Infection Following Haploidentical Transplantation: Immune Recovery and Outcome. Biol Blood Marrow Transplant 2016; 22:2250-2255. [PMID: 27697585 DOI: 10.1016/j.bbmt.2016.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/21/2016] [Indexed: 12/19/2022]
Abstract
Human herpesvirus 6 (HHV-6) is increasingly recognized as a potentially life-threatening pathogen in allogeneic hematopoietic stem cell transplantation (alloSCT). We retrospectively evaluated 54 adult patients who developed positivity to HHV-6 after alloSCT. The median time from alloSCT to HHV-6 reactivation was 34 days. HHV-6 was present in plasma samples from 31 patients, in bone marrow (BM) of 9 patients, in bronchoalveolar lavage fluid and liver or gut biopsy specimens from 33 patients, and in cerebrospinal fluid of 7 patients. Twenty-nine patients developed acute graft-versus-host disease (GVHD), mainly grade III-IV, and 15 had concomitant cytomegalovirus reactivation. The median absolute CD3+ lymphocyte count was 207 cells/µL. We reported the following clinical manifestations: fever in 43 patients, skin rash in 22, hepatitis in 19, diarrhea in 24, encephalitis in 10, BM suppression in 18, and delayed engraftment in 11. Antiviral pharmacologic treatment was administered to 37 patients; nonetheless, the mortality rate was relatively high in this population (overall survival [OS] at 1 year, 38% ± 7%). A better OS was significantly associated with a CD3+ cell count ≥200/µL at the time of HHV-6 reactivation (P = .0002). OS was also positively affected by the absence of acute GVHD grade III-IV (P = .03) and by complete disease remission (P = .03), but was not significantly influenced by steroid administration, time after alloSCT, type of antiviral prophylaxis, plasma viral load, or organ involvement. Although HHV-6 detection typically occurred early after alloSCT, better T cell immune reconstitution seems to have the potential to improve clinical outcomes. Our findings provide new insight into the interplay between HHV-6 and the transplanted immune system.
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Affiliation(s)
- Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Maddalena Noviello
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Racca
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Mannina
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Forcina
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Lorentino
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Veronica Valtolina
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Rolla
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roee Dvir
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mara Morelli
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Giglio
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Chiara Barbanti
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Chiara Oltolini
- Infectious Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Vago
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunogenetics, Leukemia, Genomics, and Immunobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Infectious Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Assanelli
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo G Carrabba
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sarah Marktel
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Bernardi
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Consuelo Corti
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Clementi
- Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jacopo Peccatori
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Bonini
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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18
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Hasannia T, Moosavi Movahed SM, Vakili R, Rafatpanah H, Hekmat R, Valizadeh N, Rezaee SA. Active CMV and EBV infections in renal transplant recipients with unexplained fever and elevated serum creatinine. Ren Fail 2016; 38:1418-1424. [PMID: 27484706 DOI: 10.1080/0886022x.2016.1214147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Proper identification of active cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are helpful for monitoring antiviral treatment in transplant recipients. Qualitative and quantitative CMV, EBV DNA PCR techniques in the context of serological tests are performed for early detection and differentiation of active and latent CMV and EBV infections in renal transplantation. Basically, 129 renal transplanted recipients monitored carefully and hospitalized for unexplained elevated creatinine levels or high fever and 21 of their donors were studied. CMV DNA was detected in 63.5% of the febrile episodes following transplantation and in 46.42% of readmitted patients using qualitative PCR method. In the first group, 15% of the patients and in the second group 42.85% of the patients had copy numbers more than cutoff point (900 copies/mL). Cutoff point had 100% sensitivity and 82.5% specificity for active and symptomatic CMV infection. Only 15.5% of the subjects were positive for EBV infection by qualitative PCR method. Among them 5% had >2000 copies/mL and were symptomatic. One subject with a history of three times hospitalization had higher EBV viral load and developed post-transplant lymphoproliferative disorder. CMV load was significantly correlated with elevated creatinine levels (OR = 3.1, p = 0.006), abnormal heart sounds (OR = 4.7; p = 0.02) and hypertension (OR = 3.6; p = 0.03). Only qRT-PCR could differentiate between latent and active infections and might be clinically useful for monitoring symptomatic CMV and EBV infections and initiation of the antiviral therapy. Elevated creatinine levels, hypertension, and abnormal heart sounds could be considered as main manifestations of HCMV infection in kidney recipients.
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Affiliation(s)
- Tahereh Hasannia
- a Internal Medicine Department , Arash Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | | | - Rosita Vakili
- b The Center of Pathological and Medical Diagnostic Services, Iranian Academic Center for Education, Culture & Research (ACECR) , Mashhad , Iran
| | - Houshang Rafatpanah
- c Immunology Research Center, Inflammation and Inflammatory Diseases Division, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Reza Hekmat
- d Internal Medicine Department , Medical School, Mashhad University of Medical Science , Mashhad , Iran
| | - Narges Valizadeh
- c Immunology Research Center, Inflammation and Inflammatory Diseases Division, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Seyed Abdolrahim Rezaee
- c Immunology Research Center, Inflammation and Inflammatory Diseases Division, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
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19
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Azevedo* LS, Pierrotti LC, Abdala E, Costa SF, Strabelli TMV, Campos SV, Ramos JF, Latif AZA, Litvinov N, Maluf NZ, Filho HHC, Pannuti CS, Lopes MH, dos Santos VA, da Cruz Gouveia Linardi C, Yasuda MAS, de Sousa Marques HH. Cytomegalovirus infection in transplant recipients. Clinics (Sao Paulo) 2015; 70:515-23. [PMID: 26222822 PMCID: PMC4496754 DOI: 10.6061/clinics/2015(07)09] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Luiz Sergio Azevedo*
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Lígia Camera Pierrotti
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Edson Abdala
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Silvia Figueiredo Costa
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Tânia Mara Varejão Strabelli
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Silvia Vidal Campos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Jéssica Fernandes Ramos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Acram Zahredine Abdul Latif
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Nadia Litvinov
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Natalya Zaidan Maluf
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Helio Hehl Caiaffa Filho
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Claudio Sergio Pannuti
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Marta Heloisa Lopes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Vera Aparecida dos Santos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Camila da Cruz Gouveia Linardi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Maria Aparecida Shikanai Yasuda
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Heloisa Helena de Sousa Marques
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
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20
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Bernard S, Germi R, Lupo J, Laverrière MH, Masse V, Morand P, Gavazzi G. Symptomatic cytomegalovirus gastrointestinal infection with positive quantitative real-time PCR findings in apparently immunocompetent patients: a case series. Clin Microbiol Infect 2015; 21:1121.e1-7. [PMID: 26004014 DOI: 10.1016/j.cmi.2015.05.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/26/2015] [Accepted: 05/11/2015] [Indexed: 11/18/2022]
Abstract
Cytomegalovirus (CMV) gastrointestinal disease rarely occurs in immunocompetent patients, and is mainly diagnosed on the basis of histopathological findings. Real-time PCR for CMV DNA quantification is considered to be a useful diagnostic tool, but its place in the diagnostic strategy is not clearly defined. The goal of the study was to describe the clinical and paraclinical features of apparently immunocompetent patients with CMV gastrointestinal disease diagnosed according to quantitative PCR results. In this retrospective study conducted in a 1500-bed tertiary-care centre, we reviewed the case records of apparently immunocompetent patients with positive findings of CMV DNA in gastrointestinal biopsies with compatible symptoms and endoscopic findings. A total of 13 patients were included between January 2007 and December 2010. The median age was 81 years, and 54% of patients had underlying immune-modulating conditions. Diarrhoea, haematochezia and dysphagia were the main reported symptoms, and ulcers were the main endoscopic findings. The mean value of CMV DNA load in gastrointestinal biopsies was 3845 copies/μg total DNA (range, 15-15 500 copies/μg total DNA). The highest values were found in two patients who were diagnosed with adenocarcinoma in the subsequent course of CMV infection. Clinical features were similar to those in previous series in which diagnosis was based on histopathological analysis. Elderly people are more commonly affected, and a link with immune senescence is possible. Quantification of CMV DNA seems to be a useful tool for diagnosis when combined with clinical and endoscopic findings, but further studies are necessary to interpret quantitative values.
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Affiliation(s)
- S Bernard
- Department of Infectious Diseases, Grenoble University Hospital, Grenoble, France.
| | - R Germi
- Department of Virology, University Hospital, Grenoble, France; Unit of Virus Cell Interactions, UMI 3265, UJF-EMBL-CNRS Grenoble, France
| | - J Lupo
- Department of Virology, University Hospital, Grenoble, France; Unit of Virus Cell Interactions, UMI 3265, UJF-EMBL-CNRS Grenoble, France
| | - M-H Laverrière
- Department of Pathology, Grenoble University Hospital, Grenoble, France
| | - V Masse
- Microbiology and Infectious Diseases, Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
| | - P Morand
- Department of Virology, University Hospital, Grenoble, France; Unit of Virus Cell Interactions, UMI 3265, UJF-EMBL-CNRS Grenoble, France
| | - G Gavazzi
- University Clinic of Geriatric Medicine, Grenoble University Hospital, Grenoble, France
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21
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Romero PP, Blanco P, Giménez E, Solano C, Navarro D. An update on the management and prevention of cytomegalovirus infection following allogeneic hematopoietic stem cell transplantation. Future Virol 2015. [DOI: 10.2217/fvl.14.102] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
ABSTRACT A significant progress has been made in deciphering critical aspects of the biology and immunology of CMV infection in the allogeneic stem cell transplantation setting. Genetic traits predisposing to active CMV infection and CMV end-organ disease have begun to be delineated. Reliable molecular assays for CMV DNA load quantitation in body fluids have been developed. Elucidation of immune mechanisms affording control of CMV infection will help to improve the management of active CMV infection. Finally, the advent of new CMV-specific antivirals and promising vaccine prototypes as well as the development of fine procedures for large-scale ex vivo generation of functional CMV-specific T cells for adoptive T cell transfer therapies will certainly minimize the negative impact of CMV on survival in these patients.
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Affiliation(s)
- Pilar Pérez Romero
- Infectious Diseases, Microbiology & Preventive Medicine Unit, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Pilar Blanco
- Infectious Diseases, Microbiology & Preventive Medicine Unit, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Estela Giménez
- Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - Carlos Solano
- Hematology & Medical Oncology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
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22
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Affiliation(s)
- Aubrey J. Cunnington
- Section of Paediatrics, Medical School Building, St Mary's Campus, Imperial College, Norfolk Place, London, United Kingdom
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23
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Gable J, Acker TM, Craik CS. Current and potential treatments for ubiquitous but neglected herpesvirus infections. Chem Rev 2014; 114:11382-412. [PMID: 25275644 PMCID: PMC4254030 DOI: 10.1021/cr500255e] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Jonathan
E. Gable
- Department
of Pharmaceutical Chemistry, University
of California, San Francisco, 600 16th Street, San Francisco, California 94158-2280, United States
- Graduate
Group in Biophysics, University of California,
San Francisco, 600 16th
Street, San Francisco, California 94158-2280, United States
| | - Timothy M. Acker
- Department
of Pharmaceutical Chemistry, University
of California, San Francisco, 600 16th Street, San Francisco, California 94158-2280, United States
| | - Charles S. Craik
- Department
of Pharmaceutical Chemistry, University
of California, San Francisco, 600 16th Street, San Francisco, California 94158-2280, United States
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24
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Ganzenmueller T, Kluba J, Becker JU, Bachmann O, Heim A. Detection of cytomegalovirus (CMV) by real-time PCR in fecal samples for the non-invasive diagnosis of CMV intestinal disease. J Clin Virol 2014; 61:517-22. [PMID: 25453330 DOI: 10.1016/j.jcv.2014.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/09/2014] [Accepted: 10/14/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection of the gastrointestinal tract can cause CMV intestinal disease (CMV-ID), a severe complication in immunocompromised patients. Current gold standard for diagnosing CMV-ID requires the analysis of colon biopsies. Testing of fecal samples by CMV PCR might be a non-invasive diagnostic alternative, but data on this method is scarce. OBJECTIVES To evaluate the use of quantitative CMV real-time PCR in fecal samples for diagnosing CMV-ID. STUDY DESIGN Fecal samples and lower intestinal tract biopsies from 66 patients were analyzed by quantitative CMV PCR. To evaluate the diagnostic significance of CMV detection by PCR in fecal samples, patients were classified according to the etiology of their intestinal disease (based on results of endoscopy, histopathology and quantitative CMV DNA detection in biopsies) into three groups: "CMV-ID", "non-CMV-ID", and "equivocal". RESULTS 10/66 fecal samples were tested positive by quantitative CMV PCR, but CMV DNA loads were low (range <1000-11,000copies/ml). CMV detection by PCR in fecal samples was positive in 8/12 patients of the CMV-ID group, resulting in a sensitivity of 67% for diagnosing CMV-ID. With two exceptions, fecal CMV PCR was negative in the non-CMV-ID group (45/47) indicating a good specificity (96%). Moreover, CMV DNA detection in feces was associated with high CMV DNA levels in intestinal biopsies. CONCLUSIONS Negative CMV PCR results from fecal samples cannot exclude CMV-ID and thus have to be confirmed by analyzing intestinal biopsies. However, positive fecal PCR results are diagnostically useful and might help to circumvent invasive diagnostic procedures as endoscopy.
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Affiliation(s)
- Tina Ganzenmueller
- Institute of Virology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - Jeanette Kluba
- Institute of Virology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Jan Ulrich Becker
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Oliver Bachmann
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Germany
| | - Albert Heim
- Institute of Virology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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25
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Sousa H, Boutolleau D, Ribeiro J, Teixeira AL, Pinho Vaz C, Campilho F, Branca R, Campos A, Baldaque I, Medeiros R. Cytomegalovirus infection in patients who underwent allogeneic hematopoietic stem cell transplantation in Portugal: a five-year retrospective review. Biol Blood Marrow Transplant 2014; 20:1958-67. [PMID: 25139217 DOI: 10.1016/j.bbmt.2014.08.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/12/2014] [Indexed: 02/03/2023]
Abstract
Cytomegalovirus (CMV) infection is 1 of the leading causes of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (aHSCT), mainly within the first 100 days after transplantation. We aimed to characterize CMV infection in a cohort of 305 patients with different malignancies undergoing aHSCT at the Portuguese Institute of Oncology of Porto between January 2008 and December 2012. In total, 184 patients (60.3%) developed CMV infection, mainly viral reactivations rather than primary infections (96.2% versus 3.8%, respectively). The majority of patients (166 of 184) developed CMV infection ≤100 days after transplantation, with median time to infection of 29 days (range, 0 to 1285) and median duration of infection of 10 days (range, 2 to 372). Multivariate analysis revealed that CMV infection was increased in donor (D)-/recipient (R)+ and D+/R+ (odds ratio [OR], 10.5; 95% confidence interval [CI], 4.35 to 25.4; P < .001) and in patients with mismatched or unrelated donors (OR, 2.54; 95% CI, 1.34 to 4.80; P = .004). Cox regression model showed that the risk of death was significantly increased in patients >38 years old (OR, 1.89; 95% CI, 1.14 to 3.12; P = .0137), who underwent transplantation with peripheral blood (OR, 3.02; 95% CI, 1.33 to 6.86; P = .008), with mismatched or unrelated donor (OR, 2.16; 95% CI, 1.48 to 3.13; P < .001), and who developed CMV infection (OR, 1.76; 95% CI, 1.07 to 2.90; P = .025). Moreover, patients who developed CMV infection had a significantly reduced median post-transplantation survival (16 versus 36 months; P = .002).
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Affiliation(s)
- Hugo Sousa
- Virology Service, Portuguese Institute of Oncology of Porto, Porto, Portugal; Molecular Oncology Group, Portuguese Institute of Oncology of Porto, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - David Boutolleau
- Sorbonne Universités, UPMC Université Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France; INSERM, U1135, CIMI-Paris, Paris, France; AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Service de Virologie, Paris, France
| | - Joana Ribeiro
- Virology Service, Portuguese Institute of Oncology of Porto, Porto, Portugal; Molecular Oncology Group, Portuguese Institute of Oncology of Porto, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana L Teixeira
- Virology Service, Portuguese Institute of Oncology of Porto, Porto, Portugal; Molecular Oncology Group, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Carlos Pinho Vaz
- Bone Marrow Transplantation Unit, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Fernando Campilho
- Bone Marrow Transplantation Unit, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Rosa Branca
- Bone Marrow Transplantation Unit, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - António Campos
- Bone Marrow Transplantation Unit, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Inês Baldaque
- Virology Service, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Rui Medeiros
- Virology Service, Portuguese Institute of Oncology of Porto, Porto, Portugal; Molecular Oncology Group, Portuguese Institute of Oncology of Porto, Porto, Portugal; Research Department, Portuguese League Against Cancer (LPCC-NRNorte), Porto, Portugal
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26
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Cytomegalovirus viral load kinetics in patients with HIV/AIDS admitted to a medical intensive care unit: a case for pre-emptive therapy. PLoS One 2014; 9:e93702. [PMID: 24699683 PMCID: PMC3974798 DOI: 10.1371/journal.pone.0093702] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/06/2014] [Indexed: 12/27/2022] Open
Abstract
Background Cytomegalovirus (CMV) infection is associated with severe diseases in immunosuppressed patients; however, there is a lack of data for pre-emptive therapy in patients with HIV/AIDS. Method This was a retrospective study, which enrolled patients diagnosed with HIV/AIDS (CD4<200 cells/μl), who had detectable CMV viral load (VL) during their stay in an adult medical intensive care unit between 2009–2012. Results After screening 82 patients’ records, 41 patients met the enrolment criteria. Their median age was 37 (interquartile range [IQR]: 31–46), and median CD4 count was 29 cells/μl (IQR: 5–55). Sixteen patients (39%) had serial measurements of CMV VL before treatment with ganciclovir. Patients whose baseline CMV VL values were between 1,000–3,000 copies/ml had significantly higher values (median of 14,650 copies/ml) on follow-up testing done 4–12 days later. Those with undetectable VLs at baseline testing had detectable VLs (median of 1,590 copies/ml) mostly within 20 days of follow-up testing. Patients who had VLs >1,000 copies/ml at baseline testing had significantly higher mortality compared to those who had <1,000 copies/ml {hazard ratio of 3.46, p = 0.003 [95% confidence interval (CI): 1.55–7.71]}. Analysis of the highest CMV VL per patient showed that patients who had VLs of >5,100 copies/ml and did not receive ganciclovir had 100% mortality compared to 58% mortality in those who received ganciclovir at VLs of >5,100 copies/ml, 50% mortality in those who were not treated and had low VLs of <5,100 copies/ml, and 44% mortality in those who had ganciclovir treatment at VLs of <5,100 copies/ml (p = 0.084, 0.046, 0.037, respectively). Conclusion This study showed a significantly increased mortality in patients with HIV/AIDS who had high CMV VLs, and suggests that a threshold value of 1,000 copies/ml may be appropriate for pre-emptive treatment in this group.
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27
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Ariza-Heredia EJ, Nesher L, Chemaly RF. Cytomegalovirus diseases after hematopoietic stem cell transplantation: a mini-review. Cancer Lett 2014; 342:1-8. [PMID: 24041869 DOI: 10.1016/j.canlet.2013.09.004] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 09/08/2013] [Indexed: 02/03/2023]
Abstract
Cytomegalovirus (CMV) infection remains a significant complication after hematopoietic stem cell transplantation (HSCT) and may have a deleterious impact on the overall outcome after transplantation. In addition to the direct effects of CMV infection, tissue-invasive CMV diseases may be associated with increased risk of graft versus host disease, myelosuppression, and invasive bacterial and fungal infections. Because of these direct and indirect adverse effects, prevention of CMV infection, mostly through pre-emptive therapy, is one of the essential strategies that may improve outcomes of HSCT recipients. Management of CMV infection relies mainly on intravenous (IV) antiviral therapy with ganciclovir and foscarnet, with or without IV polyclonal immunoglobulins. Although viral resistance remains rare, better tolerated antiviral agents with less serious side effects are needed, and a few will be evaluated in phase III clinical trials in the near future.
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Affiliation(s)
- Ella J Ariza-Heredia
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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28
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Kralickova P, Mala E, Vokurkova D, Krcmova I, Pliskova L, Stepanova V, Bartos V, Koblizek V, Tacheci I, Bures J, Brozik J, Litzman J. Cytomegalovirus disease in patients with common variable immunodeficiency: three case reports. Int Arch Allergy Immunol 2013; 163:69-74. [PMID: 24247002 DOI: 10.1159/000355957] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 09/23/2013] [Indexed: 01/15/2023] Open
Abstract
Common variable immunodeficiency (CVID) is the most frequent clinically relevant primary immunodeficiency and shows enormous heterogeneity in clinical presentation. Despite clinical immunodeficiency, opportunistic infections are not a typical manifestation of CVID. A retrospective study of 32 patients followed up for 335 patient-years was performed to determine the frequency of cytomegalovirus (CMV) disease. Symptomatic CMV infection was documented in 3 CVID patients. Patients No. 1 and 2 suffered from CMV pneumonia, with complications due to atypical mycobacteriosis in patient No. 1. Patient No. 3 suffered from CMV enteritis. A history of cancer and chronic hepatitis C infection (patient No. 1), immunosuppressive therapy for interstitial lung disease (patient No. 2) and serious enteropathy complicated with malnutrition (patient No. 3) may have contributed to the complications despite only mild abnormalities in T-cell subpopulations. The direct detection of CMV in bronchoalveolar lavage, stool or tissue samples was the most beneficial diagnostic laboratory method, whereas the detection of CMV DNA in blood did not produce positive results. Adequate treatment of CMV disease led to significant clinical improvement in all 3 patients. The frequency of CMV disease appears to be higher than previously described. In our experience, the probability of opportunistic infections in CVID patients increases with secondary comorbidities and their management.
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Affiliation(s)
- Pavlina Kralickova
- Institute of Clinical Immunology and Allergy, University Hospital Hradec Kralove, Faculty of Medicine, Charles University in Prague, Hradec Kralove, Czech Republic
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29
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Travi G, Pergam SA. Cytomegalovirus pneumonia in hematopoietic stem cell recipients. J Intensive Care Med 2013; 29:200-12. [PMID: 23753231 DOI: 10.1177/0885066613476454] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/23/2012] [Indexed: 01/29/2023]
Abstract
Cytomegalovirus (CMV) is a frequently encountered infection following hematopoietic cell transplantation, and tissue invasive pneumonia is a dreaded complication of the virus in this population. In this review of CMV pneumonia, we address epidemiology, pathogenesis, diagnostics, current therapy, and strategies to prevent the development of CMV. We also review emerging treatment and prevention options for this challenging disease.
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Affiliation(s)
- Giovanna Travi
- Department of Infectious Diseases, AO Ospedale Niguarda Cà Granda, Milan, Italy
| | - Steven A Pergam
- Vaccine and Infectious Diseases and Clinical Research Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, USA Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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Martín-Gandul C, Pérez-Romero P, Sánchez M, Bernal G, Suárez G, Sobrino M, Merino L, Cisneros JM, Cordero E. Determination, validation and standardization of a CMV DNA cut-off value in plasma for preemptive treatment of CMV infection in solid organ transplant recipients at lower risk for CMV infection. J Clin Virol 2012; 56:13-8. [PMID: 23131346 DOI: 10.1016/j.jcv.2012.09.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/04/2012] [Accepted: 09/06/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Valganciclovir preemptive therapy guided by the viral load is the current strategy recommended for preventing CMV disease in CMV-seropositive Solid Organ Transplant Recipients (SOTR) at lower risk for developing CMV infection. However, universal viral load cut-off has not been established for initiating therapy. OBJECTIVES Our goal was to define and validate a standardized cut-off determined in plasma by real-time PCR assay for initiating preemptive therapy in this population. STUDY DESIGN A prospective cohort study of consecutive cases of CMV-seropositive SOTR was carried out. The cut-off value was determined in a derivation cohort and was validated in the validation cohort. Viral loads were determined using the Quant CMV LightCycler 2.0 real-time PCR System (Roche Applied Science) and results were standardized using the WHO International Standard for human CMV. RESULTS A viral load of 3983 IU/ml (2600 copies/ml) was established as the optimal cut-off for initiating preemptive therapy in a cohort of 141 patients with 982 tests and validated in a cohort of 252 recipients with a total of 2022 test. This cut-off had a 99.6% NPV indicating that the great majority of patients at lower risk will not develop CMV disease without specific antiviral therapy. The high sensitivity and specificity (89.9% and 88.9%, respectively) and the relatively small numbers of patients with CMV disease confirm that real-time PCR was optimal. CONCLUSIONS We have established a cut-off viral load for starting preemptive therapy for CMV-seropositive SOT recipients. Our results emphasized the importance of a mandatory follow-up protocol for CMV-seropositive patients receiving preemptive treatment.
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Affiliation(s)
- C Martín-Gandul
- Unit of Infectious Disease, Microbiology and Preventive Medicine, Instituto de Biomedicina de Sevilla, University Hospital Virgen del Rocío/CSIC/University of Sevilla, Spain.
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31
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Merindol N, Salem Fourati I, Brito RM, Grenier AJ, Charrier E, Cordeiro P, Caty M, Mezziani S, Malette B, Duval M, Alfieri C, Ovetchkine P, Le Deist F, Soudeyns H. Reconstitution of protective immune responses against cytomegalovirus and varicella zoster virus does not require disease development in pediatric recipients of umbilical cord blood transplantation. THE JOURNAL OF IMMUNOLOGY 2012; 189:5016-28. [PMID: 23034171 DOI: 10.4049/jimmunol.1201759] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CMV and varicella zoster virus (VZV) are significant causes of morbidity and mortality following umbilical cord blood transplantation (UCBT). However, the kinetics of reconstitution and protective potential of antiviral cell-mediated immune responses following UCBT remain poorly characterized. In this study, the reconstitution of CMV- and VZV-specific T cell responses was assessed using IFN-γ ELISPOT in 28 children who underwent UCBT to treat hematological or inherited disorders. Barely detectable in the first 3 mo posttransplantation, CMV- and VZV-specific T cell responses were observed in 30.4% and 40.3% of study subjects after 36 mo of follow-up. Four of five CMV-seropositive subjects developed detectable levels of circulating CMV DNA (DNAemia), and 5 of 17 VZV-seropositive patients experienced herpes zoster during the posttransplant period. Four CMV-seronegative subjects developed IFN-γ responses against CMV, and four subjects developed a VZV-specific IFN-γ response without clinical signs of infection. No CMV- or VZV-related events were observed in study subjects following the development of CMV- or VZV-specific responses > 150 spot-forming units/10(6) PBMCs, consistent with T cell-mediated protection. Finally, famciclovir prophylaxis did not strictly prevent the reconstitution of the VZV-specific T cell repertoire, because the frequency of T cells producing IFN-γ in response to VZV Ags reached levels consistent with protection in two nonzoster subjects. Monitoring of CMV- and VZV-specific cell-mediated immunity could inform immunocompetence and guide the initiation and cessation of antiherpetic prophylaxis in UCBT recipients.
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Affiliation(s)
- Natacha Merindol
- Unité d'Immunopathologie Virale, Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec H3T 1C5, Canada
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32
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Breuer S, Rauch M, Matthes-Martin S, Lion T. Molecular diagnosis and management of viral infections in hematopoietic stem cell transplant recipients. Mol Diagn Ther 2012; 16:63-77. [PMID: 22497528 DOI: 10.1007/bf03256431] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Viral infections after allogeneic hematopoietic stem cell transplantation (HSCT) are important complications associated with high morbidity and mortality. In this setting, reactivations of persisting latent viral pathogens from donor and/or recipient cells play a central role whereas the sterile environment of transplant units renders new infections less likely. The viruses currently regarded as most relevant in the HSCT setting include particularly the herpes virus family--specifically cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus 6 (HHV-6)--as well as human adenoviruses (AdVs) and the polyoma virus BK (BKV). Timely detection and monitoring of virus copy numbers are prerequisites for successful preemptive treatment approaches. Pre- and post-transplant surveillance by sensitive and quantitative molecular methods has therefore become an essential part of the diagnostic routine. In this review, we discuss diagnostic aspects and the clinical management of the most important viral infections in HSCT recipients, with a focus on pediatric patients.
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Affiliation(s)
- Sabine Breuer
- Department of Pediatric Stem Cell Transplantation, St. Anna Childrens Hospital, Medical University of Vienna, Vienna, Austria
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Verheyen J, Kaiser R, Bozic M, Timmen-Wego M, Maier BK, Kessler HH. Extraction of viral nucleic acids: Comparison of five automated nucleic acid extraction platforms. J Clin Virol 2012; 54:255-9. [DOI: 10.1016/j.jcv.2012.03.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 03/13/2012] [Accepted: 03/14/2012] [Indexed: 02/02/2023]
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Razonable RR. Strategies for managing cytomegalovirus in transplant recipients. Expert Opin Pharmacother 2010; 11:1983-97. [PMID: 20642369 DOI: 10.1517/14656566.2010.492395] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE OF THE FIELD Cytomegalovirus (CMV) is the most important pathogen that affects transplant recipients, by directly causing clinical disease and by indirectly reducing patient and allograft survival. AREAS COVERED IN THIS REVIEW This review provides a brief overview of the direct and indirect effects of CMV disease and the traditional and newly described factors that increase the risk of disease after transplantation. Newly acquired data in the diagnostics, prevention and treatment of CMV infection are discussed, with emphasis on guidelines for management as recently endorsed by the American Society of Transplantation and the Transplantation Society. WHAT THE READER WILL GAIN The reader will gain up-to-date insights into the contemporary management of CMV after solid organ transplantation. Practical aspects of its diagnosis, prevention and treatment are discussed. Emerging concerns of late-onset CMV disease and antiviral resistance are also highlighted to emphasize the need to optimize CMV-prevention strategies. TAKE HOME MESSAGE Prevention of CMV disease is an important goal in the management of solid organ transplant recipients. The efficacy of CMV prevention should be measured not only by the significant reduction in CMV incidence but, as importantly, by the improvement in long-term allograft and patient survival.
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Affiliation(s)
- Raymund R Razonable
- William J von Liebig Transplant Center, College of Medicine, Mayo Clinic, Division of Infectious Diseases, Department of Internal Medicine, Rochester, MN 55905, USA.
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35
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Ticha O, Stouracova M, Kuman M, Studenik P, Freiberger T, Litzman J. Monitoring of CD38high expression in peripheral blood CD8+ lymphocytes in patients after kidney transplantation as a marker of cytomegalovirus infection. Transpl Immunol 2010; 24:50-6. [DOI: 10.1016/j.trim.2010.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/30/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
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36
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Differences in cytomegalovirus plasma viral loads measured in allogeneic hematopoietic stem cell transplant recipients using two commercial real-time PCR assays. J Clin Virol 2010; 48:142-6. [DOI: 10.1016/j.jcv.2010.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/12/2010] [Accepted: 03/17/2010] [Indexed: 12/26/2022]
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37
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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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38
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Fleming T, Dunne J, Crowley B. Ex vivo monitoring of human cytomegalovirus-specific CD8(+) T-Cell responses using the QuantiFERON-CMV assay in allogeneic hematopoietic stem cell transplant recipients attending an Irish hospital. J Med Virol 2010; 82:433-40. [PMID: 20087937 DOI: 10.1002/jmv.21727] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Reconstitution of human cytomegalovirus (HCMV) T-cell immunity is crucial in hematopoietic stem cell transplant (HSCT) recipients. The QuantiFERON-CMV assay for cellular HCMV-specific immunity was evaluated in allogeneic HSCT recipients (n = 43) and patients with hematological malignancies (n = 29) attending a tertiary-care Irish hospital. An intracellular cytokine (ICC) assay correlated with the QuantiFERON-CMV assay. Although there was agreement between HCMV seropositivity and QuantiFERON-CMV assay, six HCMV seropositive immunosuppressed patients with hematological malignancy had negative QuantiFERON-CMV results. The 43 HSCT recipients were classified as high risk (D(-)/R(+)) (n = 18), intermediate risk (D(+)/R(+) and D(+)/R(-)) (n = 17), and low risk (D(-)/R(-)) (n = 8). During episodes of HCMV DNAemia no evidence of HCMV-specific immunity was found using the QuantiFERON-CMV assay. Furthermore, the recovery of HCMV-specific CD8(+) T-cell responses in high-risk seropositive recipients of matched unrelated donors was severely delayed, a mean of 200 (SD = 117) days compared to 58 (SD = 23) days for sibling donors (P < or = 0.028). In addition, three patients with late HCMV infection (infection >100 days post-transplant) had delayed reconstitution of HCMV-specific CD8(+) T cells. Interestingly, two recipients (R(+)/D(-)) developed rapid immune reconstitution by days 15 and 36 post-HSCT, suggesting HCMV-specific T-cell lymphopoiesis of recipient origin. Levels of CD8(+) T-cell immunity in HCMV seropositive HSCT recipients were lowest following HSCT. A high number (33%) of indeterminate results was observed immediately after transplantation. Patients with indeterminate QuantiFERON-CMV results had low levels of HCMV-specific CD8(+) T cells. J. Med. Virol. 82:433-440, 2010. (c) 2010 Wiley-Liss, Inc.
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Affiliation(s)
- T Fleming
- Department of Clinical Microbiology, University of Dublin, Dublin, Ireland
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Multicenter external quality assessment of molecular methods for detection of human herpesvirus 6. J Clin Microbiol 2010; 48:2536-40. [PMID: 20147642 DOI: 10.1128/jcm.01145-09] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to evaluate the performance of laboratories for the detection and quantification of human herpesvirus 6 (HHV-6) by an external quality assessment (EQA) evaluation. The HHV-6 EQA panel consisted of eight samples containing various concentrations of HHV-6 type A (strain GS) or type B (strain Z29), two samples containing other herpesviruses (i.e., human cytomegalovirus [HCMV] and Epstein-Barr virus [EBV]), and two HHV-6-negative samples. Panel samples were prepared in human plasma, heat inactivated, and lyophilized. Panel distribution, data management, and analysis were coordinated by Quality Control for Molecular Diagnostics (QCMD), Glasgow, United Kingdom. Fifty-one laboratories participated and submitted 57 data sets. Eleven (19.3%) data sets were generated using conventional in-house assays, 11 (19.3%) data sets using commercial real-time PCR assays, and 35 (61.4%) data sets using in-house real-time PCR assays. The presence of HHV-6 DNA at viral loads exceeding 6,000 copies/ml was detected by all participants, and over 80% of the participants still reported correct qualitative results for the sample containing just over 200 copies/ml. The false-positivity rate was 1.8% for both the negative samples and the samples containing HCMV or EBV DNA. The majority (23/33; 69.7%) of quantitative data sets were generated using in-house real-time PCR assays. The standard deviations of the geometric means of the samples ranged from 0.5 to 0.7 log(10). The results of this first international EQA demonstrate encouraging analytical sensitivity for the detection of HHV-6-DNA in human plasma, although we observed extensive interlaboratory variation of quantitative HHV-6 DNA results. Standardization needs to be improved to allow further elucidation of the clinical significance of HHV-6 loads.
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40
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Solano C, Navarro D. Clinical virology of cytomegalovirus infection following hematopoietic transplantation. Future Virol 2010. [DOI: 10.2217/fvl.09.64] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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41
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Comparison between pp65 antigenemia assay and quantitative real-time polymerase chain reaction for detection of active cytomegalovirus infection in routine diagnostics. Diagn Microbiol Infect Dis 2009; 65:192-5. [DOI: 10.1016/j.diagmicrobio.2009.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 05/15/2009] [Accepted: 05/28/2009] [Indexed: 12/31/2022]
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42
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Ganzenmueller T, Henke-Gendo C, Schlué J, Wedemeyer J, Huebner S, Heim A. Quantification of cytomegalovirus DNA levels in intestinal biopsies as a diagnostic tool for CMV intestinal disease. J Clin Virol 2009; 46:254-8. [PMID: 19748823 DOI: 10.1016/j.jcv.2009.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 08/13/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND CMV intestinal disease (CMV-ID) is a serious complication in immunocompromised patients and mainly diagnosed by clinical, endoscopic and histopathologic findings, whereas qualitative CMV-PCR in tissue samples is not recommended for diagnosis due to its low positive predictive value (PPV). OBJECTIVES To study the interpretation and diagnostic use of CMV-quantification by PCR in intestinal tissue biopsies to recognize CMV-ID. To develop cut-off intestinal CMV-loads attributing illness to CMV. STUDY DESIGN CMV-genome copies in 163 biopsies from the lower intestinal tract of immunocompromised patients were determined by quantitative real-time PCR, normalized to the cell number, and retrospectively compared to histopathological analysis, clinical findings and occurrence of CMV-antigenemia. Two cut-off intestinal CMV-loads, cut-off(histo) and cut-off(clin), were defined using histopathological or clinical criteria as gold standard, respectively. RESULTS CMV was detected in 32.5% of biopsies with a more than six log range of CMV-concentrations (1 x 10(-4)-1.4 x 10(2)copies/cell). Notably, biopsies with histopathologically or clinically confirmed CMV-ID had a significantly higher CMV-load (p<0.001). Cut-off(histo) and cut-off(clin) were defined at the intestinal CMV-load of 0.14 and 0.01 copies/cell, respectively, and improved the PPV. However, cut-off(histo) showed a decreased sensitivity for clinically defined CMV-ID cases. Interestingly, many patients with CMV-ID showed no concomitant CMV-antigenemia, suggesting a localized intestinal CMV-replication. CONCLUSIONS Quantification of CMV in intestinal biopsies is a useful diagnostic tool allowing the definition of cut-off values that can predict CMV-ID more accurate than qualitative PCR results. Further prospective studies have to clarify wether these cut-offs can improve diagnostics and treatment of CMV-ID in day-to-day clinical practice.
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Affiliation(s)
- Tina Ganzenmueller
- Institute of Virology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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43
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Michaux C, Morlat P, Bonnet F. [Cytomegalovirus and other herpes virus infections in systemic diseases]. Presse Med 2009; 39:34-41. [PMID: 19446998 DOI: 10.1016/j.lpm.2009.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 03/31/2009] [Accepted: 04/06/2009] [Indexed: 10/20/2022] Open
Abstract
Reactivation of Herpesviridae is well known among transplant patients, but has not been sufficiently studied in patients who receive immunosuppressive treatment for systemic inflammatory diseases. CMV infection seems relatively rare; it is easily diagnosed by real-time PCR, a fast and reliable diagnostic tool. CMV disease is most often manifested in the form of lung disease, hepatitis, or colitis. The highest risks are associated with steroid or cyclophosphamide boluses and methotrexate. Prophylactic treatment cannot be recommended in clinical practice. The utility of monitoring viremia and of preemptive therapy must be evaluated. Herpes zoster is the most frequent viral infection in systemic diseases. Most immunosuppressive treatments, except methotrexate, promote its occurrence. Visceral involvement is quite rare, and outcome almost always favorable. Prophylactic treatment cannot be recommended.
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Affiliation(s)
- Christian Michaux
- Service de médecine interne et maladies infectieuses, Hôpital Saint-André, CHU de Bordeaux, F-33075 Bordeaux, France
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44
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Life-threatening human herpes virus-6 infection in early childhood: presenting symptom of a primary immunodeficiency? Pediatr Crit Care Med 2009; 10:e16-8. [PMID: 19265361 DOI: 10.1097/pcc.0b013e31819bb956] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report two previously healthy children with a life-threatening course of human herpes virus type 6 (HHV-6) infection and prolonged pediatric intensive care treatment. DESIGN Case reports. SETTING A 16 bed pediatric intensive care unit at a tertiary care children's hospital. PATIENTS Two children with life-threatening HHV-6 disease. INTERVENTIONS Both children were mechanically ventilated because of respiratory failure. A detailed viral and immunologic workup was performed and treatment with antiviral medication started. MEASUREMENTS Polymerase chain reaction assays of plasma, cerebrospinal fluid, bronchoalveolar lavage, and lung biopsies yielded HHV-6 in both patients. Immunophenotyping and lymphocyte stimulation tests with both mitogens and antigens indicated an immunodeficiency in both patients. CONCLUSION HHV-6 infection should be considered in infants and young children with respiratory failure or meningo-encephalitis without clear causative agent or failure to respond to empirical treatment. A thorough immunologic workup and early start with antiviral therapy in any patient with a life-threatening course of HHV-6 infection is mandatory, because a severe HHV-6 infection can be the first indication of a primary immunodeficiency.
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45
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Choi SM, Lee DG, Park SH, Kim SH, Kim YJ, Min CK, Kim HJ, Lee S, Choi JH, Yoo JH, Kim DW, Lee JW, Min WS, Shin WS, Kim CC. Characteristics of Cytomegalovirus Diseases among Hematopoietic Stem Cell Transplant Recipients : A 10-year Experience at an University Hospital in Korea. Infect Chemother 2009. [DOI: 10.3947/ic.2009.41.1.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Su-Mi Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Hee Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si-Hyun Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo-Jin Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Ki Min
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee-Je Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Hyun Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Hong Yoo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Wook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Wook Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo-Sung Min
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wan-Shik Shin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chun-Choo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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de Pagter P, Schuurman R, Meijer E, van Baarle D, Sanders E, Boelens J. Human herpesvirus type 6 reactivation after haematopoietic stem cell transplantation. J Clin Virol 2008; 43:361-6. [DOI: 10.1016/j.jcv.2008.08.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
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47
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Lamoth F, Jayet PY, Aubert JD, Rotman S, Mottet C, Sahli R, Lautenschlager I, Pascual M, Meylan P. Case report: human herpesvirus 6 reactivation associated with colitis in a lung transplant recipient. J Med Virol 2008; 80:1804-7. [PMID: 18712834 DOI: 10.1002/jmv.21268] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Whereas human herpesvirus 6 (HHV-6) reactivation is frequent in solid organ transplant recipients, symptomatic disease is rare. A case of colitis associated with HHV-6B reactivation was observed in a lung transplant recipient. This case report suggests that symptomatic HHV-6 infection may occur in the absence of detectable viremia.
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Affiliation(s)
- F Lamoth
- Department of Internal Medicine, Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Cytomegalovirus DNA Measurement in Blood and Plasma Using Roche LightCycler CMV Quantification Reagents. ACTA ACUST UNITED AC 2008; 17:166-73. [DOI: 10.1097/pdm.0b013e3181599242] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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49
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Quantification of DNA in plasma by an automated real-time PCR assay (cytomegalovirus PCR kit) for surveillance of active cytomegalovirus infection and guidance of preemptive therapy for allogeneic hematopoietic stem cell transplant recipients. J Clin Microbiol 2008; 46:3311-8. [PMID: 18753357 DOI: 10.1128/jcm.00797-08] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The performance of a plasma real-time PCR (cytomegalovirus [CMV] PCR kit; Abbott Diagnostics) was compared with that of the antigenemia assay for the surveillance of active CMV infection in 42 allogeneic hematopoietic stem cell transplantation (Allo-SCT) recipients. A total of 1,156 samples were analyzed by the two assays. Concordance between the two assays was 82.2%. Plasma DNA levels correlated with the number of pp65-positive cells, particularly prior to the initiation of preemptive therapy. Fifty-seven episodes of active CMV infection were detected in 37 patients: 18 were defined solely by the PCR assay and four were defined on the basis of the antigenemia assay. Either a cutoff of 288 CMV DNA copies/ml or a 2.42-log(10) increase of DNAemia levels between two consecutive PCR positive samples was an optimal value to discriminate between patients requiring preemptive therapy and those not requiring therapy on the basis of the antigenemia results. The real-time PCR assay allowed an earlier diagnosis of active CMV infection and was a more reliable marker of successful clearance of CMV from the blood. Analysis of the kinetics of DNAemia levels at a median of 7 days posttreatment allowed the prediction of the response to CMV therapy. Two patients developed CMV colitis. The PCR assay tested positive both before the onset of symptoms and during the disease period. The plasma real-time PCR from Abbott is more suitable than the antigenemia assay for monitoring active CMV infection in Allo-SCT recipients and may be used for guiding preemptive therapy in this clinical setting.
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de Pagter PJA, Schuurman R, Visscher H, de Vos M, Bierings M, van Loon AM, Uiterwaal CSPM, van Baarle D, Sanders EAM, Boelens J. Human herpes virus 6 plasma DNA positivity after hematopoietic stem cell transplantation in children: an important risk factor for clinical outcome. Biol Blood Marrow Transplant 2008; 14:831-9. [PMID: 18541204 DOI: 10.1016/j.bbmt.2008.04.016] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 04/30/2008] [Indexed: 11/25/2022]
Abstract
Human herpes virus 6 (HHV6) is known to reactivate after hematopoietic stem cell transplantation (HSCT), and has been suggested to be associated with severe clinical manifestations in adults. The clinical significance in children remains unclear. We investigated the incidence of HHV6 reactivation in relation to HSCT-associated morbidity and mortality in children. Between January 2004 and May 2006, 58 pediatric patients, median age 7.6 years (range: 0.1-18.1 years), received their first allogeneic HSCT. After HSCT, HHV6, Epstein Barr Virus (EBV), cytomegalovirus (CMV), and adenovirus (AdV)-plasma loads were weekly measured by quantitative PCR. Clinical features, engraftment, graft-versus-host disease (GVHD), and HSCT-associated mortality and morbidity were monitored. HHV6 reactivations were classified in group I (no reactivation), group II (loads <1000 cp/mL) and group III (loads >1000 cp/mL). CMV, EBV, Herpes Simpex Virus, Varicella Zoster Virus, and AdV-reactivations were treated according to local guidelines. HHV6 was treated only when there was clinical suspicion of disease. Thirty-six HLA-identical and 22 HLA nonidentical grafts were transplanted of which 43 were bone marrow or peripheral blood stem cells grafts and 15 were cord blood (CB) grafts. Median follow-up of the patients was 15.5 (1-35) months. HHV6 reactivation occurred in 39 of 58 (67%) patients with 31 of 39 (80%) occurring within the first 30 days post-HSCT. In 26 of 58 (45%) patients (group III), HHV 6 reactivation was significantly associated with higher nonrelapse mortality (P = .02), using multivariate Cox proportional hazard models and grade 2-4 acute GVHD (P = .03) and chronic GVHD (P = .05) in a multivariate logistic regression analysis. HHV6 reactivation is very common after HSCT in children and is associated with serious transplantation-related morbidity and mortality. Although the exact role of HHV6 reactivation after HSCT has to be elucidated, early detection and initiation of therapy might be of benefit.
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Affiliation(s)
- P J Anne de Pagter
- Department of Immunology/Haematology and BMT, University Medical Center Utrecht, Utrecht, The Netherlands.
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