Cytomegalovirus disease latent and active infection rates during the first trimester after kidney transplantation

Schroeder, Roberto Moreira; Michelon, Tatiana; Fagundes, Iara dos Santos; Bortolotto, A.; Lammerhirt, E; Oliveira, Jarbas Rodrigues de; Santos, A Ribeiro dos; Bittar, A.E; Keitel, Elizete; Garcia, V D; Neumann, Jorge; Saitovitch, David

doi:10.1016/j.transproceed.2004.03.085

Cited by 20 publications

(28 citation statements)

References 17 publications

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“…About one-quarter of renal transplant recipients developed CMV disease [3]. Generally, the highest incidence of CMV disease occurs during the first 3 months post-transplant [4], and is most severe in CMV naïve (CMV seronegative) recipients who receive an organ from a CMV seropositive donor (D?/R-) [5][6][7][8]. Other risk factors for CMV disease include graft rejection and increased levels of immunosuppressive therapy, including anti-lymphocyte therapy, high dose corticosteroids, and Mycophenolate mofetil (MMF) [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus Disease in Renal Transplant Recipients: A Single-Center Experience

et al. 2012

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Cytomegalovirus (CMV) is the most common viral infection following kidney transplant, has been recognized as a major factor for graft loss and increased incidence of acute rejection. Different studies have reported a variable incidence of CMV disease with the use of Mycophenolate mofetil (MMF). We retrospectively analyzed our renal transplant recipients to review the results of CMV disease and to compare CMV disease in patient on Azathioprine and MMF for this purpose we retrospectively reviewed 521 live related kidney transplant recipients at our institute. 74 (14.2 %) live related allograft recipients developed CMV disease after a median interval of 7.18 ± 4.35 months from transplantation. The mean age was 36.15 ± 10.7 years. 63 of the patients were male. Malaise, fever and diarrhea were among most common symptoms. 20 (27.02 %) of the 74 recipients developed transaminitis, 13 (17.2 %) developed CMV gastritis, 5 (9.13 %) recipients developed pneumonia, and 3 (4.05 %) patient developed colitis. 59 (80 %) patients had leucopenia and 41 (56.5 %) developed thrombocytopenia. Mean serum creatinine level was 1.5 ± 0.4 (0.9-2.4) mg/dl before the disease, 1.9 ± 0.6 (1.3-3.6) mg/dl at the time of the diagnosis, and 1.7 ± 0.06 (0.8-4.2) mg/dl at the end of the treatment. CMV disease developed in 9 (36 %) of recipients who received basiliximab as induction therapy and 13 (30.24 %) of recipients who received ATG (p [ 0.05). The incidence of CMV disease was similar in cyclosporine based regimen (13.2 %) and Tacrolimus based regimen 27 (16.16 %) (p = 0.137) and was also similar in Azathioprine 41 (9.5 %) and MMF group 33 (14.3 %) (p = 0.163). There was no significant difference in severity of CMV disease in both groups, except a higher incidence of leucopenia in Azathioprine group (86 vs. 74 %, p \ 0.05) as compared to MMF group. 51 (68.91 %) patient developed graft dysfunction during CMV disease. In conclusion we report a low incidence (14.2 %) and milder form of cytomegalovirus disease at our center. Use of universal cytomegalovirus prophylaxis was associated with a low incidence and milder form of the disease. Incidence of CMV disease was similar between Azathioprine and MMF groups.

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Section: Introductionmentioning

confidence: 99%

Cytomegalovirus Disease in Renal Transplant Recipients: A Single-Center Experience

et al. 2012

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“…The majority of them are highly prevalent in the general population and shows an immunomodulatory effect. [1][2][3][4][5] The deleterious role of the cytomegalovirus (CMV) after transplantation is well recognized, and its active replication is systematically checked. Initially, this active infection was associated with high mortality and morbidity.…”

Section: Introductionmentioning

confidence: 99%

“…Initially, this active infection was associated with high mortality and morbidity. [1][2][3][4][5][6][7][8][9][10] These were the reasons that brought about the current practice of early diagnosis and treatment in risk populations. Nowadays, the morbidity and cost related to the specific antiviral treatment are still major concerns.…”

Section: Introductionmentioning

confidence: 99%

Early HHV-6 replication is associated with morbidity non-related to CMV infection after kidney transplantation

Schroeder¹,

Michelon²,

Garbin³

et al. 2012

Braz J Infect Dis

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Herpesvirus 6, human DNA virus infections Clinical diagnosisPolymerase chain reaction A B S T R A C T Human herpesvirus type 6-(HHV-6) has been associated with morbidity after liver transplantation.Objective: The aim of this study was to determine the HHV-6 seroprevalence among donorrecipient pairs, analyze the incidence of early active infection, its clinical manifestation, interaction with CMV, and the related morbidity in the first year after kidney transplantation.Methods: 46 donor-recipient pairs had IgG evaluated by ELISA before transplantation: HHV-6-(Pambio -USA) and CMV-(Roche -USA). A frozen whole blood sample collected weekly (from the 1 st to the 6 th week) was retrospectively tested for HHV-6 viral load (VL) determination by real time quantitative PCR (qPCR, Nanogen -Italy). Patients were preemptively surveyed for CMV by pp65 antigenemia (Ag, APAAP, immunohistochemistry, Biotest -Germany) from the 4 th to the 12 th week after transplantation. Active infection was defined as qPCR-HHV6+ (viral-load/mL-VL) and Ag+ (+cells/100.000 granulocytes), for HHV-6 and CMV, respectively. DCMV was defined as simultaneous positive antigenemia and suggestive signs/symptoms. Concerning +qPCR-HHV6, associated factors, clinical manifestation, interaction with CMV and morbidity were searched. Conclusion: Latent HHV-6 infection is more common among recipients than donors before transplantation. Early active infection by this pathogen after transplantation does not increase DCMV incidence or severity during the first 3 months of follow-up. However, early HHV-6 replication is associated with other infections and hospitalizations in the first year.

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“…These inclusions can be found in tissue fragments of renal tubules, biliary ducts, lungs and liver parenchyma, intestines, and salivary glands, and less often in the brain tissue in urinary sediment, gastric lavage, and other materials. 28 Basically, three laboratory techniques can be used for the detection of CMV infection: a) virus isolation in cultured human fibroblasts, b) detection of viral DNA by polymerase chain reaction (PCR), and c) serological tests (anti-CMV IgM and IgG anti-CMV). PCR allows identification of genes transcribed by the virus during replication in their host cells, thereby allowing identification of active infection.…”

Section: Discussionmentioning

confidence: 99%

Oral Ulcers Induced by Cytomegalovirus Infection: Report on Two Cases

Ribas¹,

Lima²

2017

J Dent Indones

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Human cytomegalovirus (CMV) is a virus that can compromise the lungs and the liver and cause infection in the gastrointestinal tract. In addition, this virus can cause infectious mononucleosis syndrome, infection in the CNS, and retinitis. Moreover, it has been associated with the development of oral hairy leukoplakia and ulcers. Objective: To report two cases of patients with HIV with oral manifestations associated with CMV infection. Case Report: In the first case, the patient sought medical attention, with complaints of weakness, fever, cough, and weight loss. In the second case, the patient complained of weakness and blurred vision for about a week. Both patients were infected with HIV and made irregular use of antiretroviral therapy. Several ulcers were observed in the mouth that caused much discomfort. The diagnosis of CMV infection was defined by the following tests: enzyme immunoassay fluorescence-CMV IgG and PCR for CMV in real time. Ganciclovir has been used in the treatment of patients, and oral ulcerations received symptomatic treatment. Conclusion: The dentist must be aware that CMV may also be responsible for the development of ulcers in the oral cavity, especially in immunocompromised patients.

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Cytomegalovirus disease latent and active infection rates during the first trimester after kidney transplantation

Cited by 20 publications

References 17 publications

Cytomegalovirus Disease in Renal Transplant Recipients: A Single-Center Experience

Cytomegalovirus Disease in Renal Transplant Recipients: A Single-Center Experience

Early HHV-6 replication is associated with morbidity non-related to CMV infection after kidney transplantation

Oral Ulcers Induced by Cytomegalovirus Infection: Report on Two Cases

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