Application of real-time PCR for the detection of Mycobacterium tuberculosis enables results to be obtained in about 2 h. A total of 340 nonrespiratory samples were processed using two real-time PCR assay kits: Xpert MTB/RIF and Cobas TaqMan MTB. The sensitivity and specificity of the Xpert assay were 95% and 100%, respectively, compared to 78% and 98% for the Cobas assay.

In this prospective study we analyzed pretransplant interferon-c secretion by cytomegalovirus (CMV)-specific CD8+ T cells to assess its possible utility in determining the risk of CMV replication after solid organ transplantation. A total of 113 lung and kidney transplant patients were enrolled in the study but only 55 were evaluable. All CMV-seronegative recipients were pretransplant "nonreactive" (IFNc <0.2 IU/mL) (11/11), whereas 30/44 (68.2%) CMV-seropositive (R+) recipients were "reactive" (IFNc ≥0.2 IU/mL) and 14/44 (31.8%) were "nonreactive" . In the R(+) "nonreactive" group, 7/14 (50%) developed posttransplant CMV replication, whereas the virus replicated only in 4/30 (13.3%) of the R(+) "reactive" patients (p = 0.021). According to the best multivariate model, pretransplant "nonreactive" recipients receiving an organ from a CMV-seropositive donor had a 10-fold increased risk of CMV replication compared to pretransplant "reactive" recipients (adjusted OR 10.49, 95% CI 1.88-58.46). This model displayed good discrimination ability (AUC 0.80) and calibration (Hosmer-Lemeshow test, p = 0.92). Negative and positive predictive values were 83.7% and 75%, respectively. The accuracy of the model was 82%. Therefore, assessment of interferon-c secretion by cytomegalovirus (CMV)-specific CD8+ T cells prior to transplantation is useful in informing the risk of posttransplant CMV replication in solid organ transplant patients.

High-dose ganciclovir/valganciclovir can be an option in the treatment of resistant CMV replication and could be considered an alternative treatment in nonsevere patients for whom the use of foscarnet should be avoided. The toxicity of this regimen does not appear to limit its use.

In this cross-sectional study of 42 solid organ transplant recipients, the association of human cytomegalovirus (HCMV) replication and age with the phenotype of the HCMV-specific CD8 ؉ T cells was analyzed by using the CMV pp65 HLA-A*0201 pentamer. A correlation between the proportion of CD28 ؊ HCMV-specific CD8 ؉ T cells and age was observed in patients without HCMV replication (r ‫؍‬ 0.50; P ‫؍‬ 0.02) but not in patients with HCMV replication (r ‫؍‬ ؊0.05; P ‫؍‬ 0.83), a finding which differs from that observed for total CD8 ؉ T cells. Within the group of patients younger than 50 years of age, patients with HCVM replication after transplantation had higher percentages of CD28 ؊ HCMV-specific CD8 ؉ T cells (85.6 compared with 58.7% for patients without HCMV replication; P ‫؍‬ 0.004) and CD27؊ HCMV-specific CD8 ؉ T cells (90.7 compared with 68.8% for patients without HCMV replication; P ‫؍‬ 0.03). However, in patients older than age 50 years, a high frequency of these two subpopulations was observed in patients both with and without previous HCMV replication (for CD28 ؊ HCMVspecific CD8 ؉ T cells, 84.4 and 80.9%, respectively [P ‫؍‬ 0.39]; for CD27 ؊ HCMV-specific CD8 ؉ T cells 86.6 and 81.5%, respectively [P ‫؍‬ 0.16]). In conclusion, the present study shows that in the group of recipients younger than age 50 years, HCMV replication after transplantation is associated with a high percentage of CD27 ؊ and CD28 ؊ HCMV-specific CD8 ؉ T cells. These results suggest that the increased percentage of CD27 ؊ or CD28 ؊ HCMVspecific subsets can be considered a biomarker of HCMV replication in solid organ transplant recipients younger than age 50 years but not in older patients. Further studies are necessary to define the significance of these changes in HCMV-associated clinical complications posttransplantation.