Diagnostic Performance of the Cytomegalovirus (CMV) Antigenemia Assay in Patients with CMV Gastrointestinal Disease

Jang, Eun-Young; Park, Seong Yeon; Lee, Eun Jung; Song, Eun Ju; Chong, Yong Pill; Lee, Sang‐Oh; Choi, Sang‐Ho; Woo, Jun Hee; Kim, Yang Soo; Kim, Sung-Han

doi:10.1086/599116

Cited by 72 publications

(55 citation statements)

References 12 publications

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“…After 100 days, monthly CMV antigenemia assays were conducted to monitor for CMV reactivation until 1 year after transplantation. For antigenemia monitoring, 10-ml heparinized blood samples were processed and 2 ϫ 10 5 cells were stained after fixation (Light Diagnostic CMV pp65 Antigenemia; Chemicon International Inc., Temecula, CA) (11). Patients were classified into low and high CMV risk groups.…”

Section: Methodsmentioning

confidence: 99%

Paradoxical Rising Cytomegalovirus Antigenemia during Preemptive Ganciclovir Therapy in Hematopoietic Stem Cell Transplant Recipients: Incidence, Risk Factors, and Clinical Outcomes

et al. 2011

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Preemptive ganciclovir (GCV) therapy is adopted increasingly in hematopoietic stem cell transplant (HCT) recipients, but occasional cases of increasing cytomegalovirus (CMV) antigenemia levels occur during preemptive GCV therapy. This prospective study investigated the incidence, risk factors, and clinical outcomes of paradoxical responses during GCV therapy. Adult patients receiving allogeneic HCTs during a 24-month period were enrolled. Patients were prospectively monitored for CMV antigenemia once a week until 3 months after engraftment. Paradoxical responders were defined as patients exhibiting CMV antigenemia levels elevated from the baseline after the first week of preemptive GCV therapy. Of 252 HCT recipients, 97 (38%) received preemptive GCV therapy due to CMV infection. Of these 97 patients, 23 (24%) were classified as paradoxical responders. Risk factors for paradoxical response were a low white blood cell ( Cytomegalovirus (CMV) diseases, including pneumonitis, gastroenteritis, retinitis, and encephalitis, are among the most important causes of morbidity and mortality in patients who undergo allogeneic hematopoietic stem cell transplantation (HCT) (3,17,18). Recently, the value of noninvasive diagnostic methods such as CMV blood antigenemia assay (1) and CMV DNA assay by PCR (5) in identifying candidates for preemptive therapy after HCT has been demonstrated. While preemptive ganciclovir (GCV) therapy based on the CMV blood antigenemia assay is being adopted increasingly for HCT recipients (2), occasional cases show increasing CMV antigenemia levels during preemptive GCV therapy. However, there are limited data on the clinical characteristics and outcomes of these paradoxical responders to GCV (7-9, 15). We therefore investigated the incidence of and risk factors for paradoxical responses among HCT patients during preemptive GCV therapy and their clinical outcomes.

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Section: Methodsmentioning

confidence: 99%

Paradoxical Rising Cytomegalovirus Antigenemia during Preemptive Ganciclovir Therapy in Hematopoietic Stem Cell Transplant Recipients: Incidence, Risk Factors, and Clinical Outcomes

et al. 2011

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“…In the current era, gastrointestinal CMV disease constitutes the vast majority of tissueinvasi ve cases [3,7,20] , and in a number of cases, especially in CMV R+ patients, this type of CMV disease is "compartmentalized." In a retrospective study, the sensitivity of pp65 antigenemia assay (defined as detection of ≥ 1 positi ve cells/2 ×10 5 leukocytes) for diagnosis of CMV gastrointestinal disease was only 54% [82] . Such a clinical presentation is reminiscent of CMV retinitis, a very rare manifestation of tissue invasi ve CMV disease after transplantation, that is often not accompanied by viremia [83,84] .…”

Section: Treatment Of Compartmentalized CMV Diseasementioning

confidence: 98%

Current concepts on cytomegalovirus infection after liver transplantation

Lee

Razonable

2010

WJH

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Cytomegalovirus (CMV) is the most common viral pathogen that negatively impacts on the outcome of liver transplantation. CMV cause febrile illness often accompanied by bone marrow suppression, and in some cases, invades tissues including the transplanted allograft. In addition, CMV has been significantly asso ciated with an increased predisposition to allograft rejection, accelerated hepatitis C recurrence, and other opportunistic infections, as well as reduced overall pa tient and allograft survival. To negate the adverse effects of CMV on outcome, its prevention, whether through antiviral prophylaxis or preemptive therapy, is regarded as an essential component to the medical management of liver transplant patients. Two recent guidelines have suggested that antiviral prophylaxis or preemptive therapy are similarly effective in preventing CMV disease in modest-risk CMV-seropositive liver trans plant recipients, while antiviral prophylaxis is the preferred strategy over preemptive therapy for the preven tion of CMV disease in high-risk recipients [CMV-seronegative recipients of liver allografts from CMV-seropositive donors (D+/R-)]. However, antiviral prophylaxis has only delayed the onset of CMV disease in many CMV D+/R-liver transplant recipients, and at least in one study, such occurrence of late-onset primary CMV disease was significantly associated with increased mortality after liver transplantation. Therefore, optimized strategies for prevention are needed, and aggressive treatment of CMV infection and disease should be pursued. The standard treatment of CMV disease consists of intravenous ganciclovir or oral valganciclovir, and if feasible, one should also reduce the degree of immunosuppression. In one recent controlled clinical trial, val ganciclovir was found to be as effective and safe as intravenous ganciclovir for the treatment of mild to mo derate CMV disease in solid organ (including liver) tran splant recipients. In this article, the authors review the current state and the future perspectives of prevention and treatment of CMV disease after liver transplantation.

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“…26,27 However, BEAM chemotherapy, gastrointestinal CMV infection, or GVHD might also cause small bowel edema, but exclusive involvement of the small intestine has been observed infrequently in intestinal CMV infection or GVHD, and radiologic studies in patients with gastrointestinal complications after BEAM chemotherapy (eg, colitis and stomatitis) are missing. 28,29 The coexistence of NV infection and intestinal GVHD could represent a diagnostic and therapeutic challenge. We found evidence of simultaneous GVHD in large bowel biopsies in a single patient with NV-GE.…”

Section: Norovirus Enteritis In Immunocompromised Patients 5853mentioning

confidence: 99%

Norovirus gastroenteritis causes severe and lethal complications after chemotherapy and hematopoietic stem cell transplantation

Schwartz

Vergoulidou

Schreier

et al. 2011

Blood

145

121

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Norovirus (NV) infections are a frequent cause of gastroenteritis (GE), but data on this disease in immunocompromised patients are limited. We analyzed an NV outbreak, which affected immunosuppressed patients in the context of chemotherapy or HSCT. On recognition, 7 days after admission of the index patient, preventive measures were implemented. Attack rates were only 3% (11/334) and 10% (11/105) among patients and staff members, respectively.The median duration of symptoms was 7 days in patients compared with only 3 days in staff members (P ‫؍‬ .02). Three patients died of the NV infection. Commonly used clinical diagnostic criteria (Kaplan-criteria) were unsuitable because they applied to 11 patients with proven NV-GE but also to 15 patients without NV-GE. With respect to the therapeutic management, it is important to differentiate intestinal GVHD from NV-GE. Therefore, we analyzed the histopathologic patterns in duodenal biopsies, which were distinctive in both conditions. Stool specimens in patients remained positive for NV-RNA for a median of 30 days, but no transmission was observed beyond an asymptomatic interval of 48 hours. NV-GE is a major threat to patients with chemotherapy or HSCT, and meticulous measures are warranted to prevent transmission of NV to these patients. (Blood. 2011;117(22): 5850-5856)

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Diagnostic Performance of the Cytomegalovirus (CMV) Antigenemia Assay in Patients with CMV Gastrointestinal Disease

Cited by 72 publications

References 12 publications

Paradoxical Rising Cytomegalovirus Antigenemia during Preemptive Ganciclovir Therapy in Hematopoietic Stem Cell Transplant Recipients: Incidence, Risk Factors, and Clinical Outcomes

Paradoxical Rising Cytomegalovirus Antigenemia during Preemptive Ganciclovir Therapy in Hematopoietic Stem Cell Transplant Recipients: Incidence, Risk Factors, and Clinical Outcomes

Current concepts on cytomegalovirus infection after liver transplantation

Norovirus gastroenteritis causes severe and lethal complications after chemotherapy and hematopoietic stem cell transplantation

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