Reactivation versus Primary CMV Infection after Splenectomy in Immunocompetent Patients

Assy, Nimer; Gefen, Hana; Schlesinger, Sorina; Karim, W.

doi:10.1007/s10620-006-9712-1

Cited by 9 publications

(11 citation statements)

References 18 publications

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“…Asplenic persons are not generally thought to be at increased risk for complicated viral infections, since innate and cell-mediated immunity are intact. However, production of antibody involves interaction between the humoral and cell-mediated immune systems which could be altered in asplenic persons, and cases of serious viral infection in asplenic persons have been reported[16]. The association between influenza infection and secondary bacterial pneumonia is established; this may be the mechanism by which influenza vaccine protects asplenic persons.…”

Section: Discussionmentioning

confidence: 99%

Pneumococcal and influenza immunization in asplenic persons: a retrospective population-based cohort study 1990-2002

et al. 2010

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BackgroundSplenectomy is associated with increased risk for bacteremia, due to impaired clearance of bloodborne agents and to altered phagocytosis and humoral immunity. We conducted a retrospective cohort study of patients at risk for splenectomy for a 13-year period to determine immunization coverage, and outcomes of those with and without splenectomy, and with or without receipt of influenza or pneumococcal vaccine.MethodsData were extracted from the provincial Medical Services Insurance database for insured services rendered by a physician for 1990-2002, and from the Vital Statistics Death database. The eligible cohort was selected based on diagnostic codes for hematologic conditions for which splenectomy might be considered, such as immune thrombocytopenia. Each patient was followed longitudinally from the date of first diagnosis until 31Dec2002, or death, or relocation out-of province. In addition, persons with splenectomy and no hematologic condition were identified and followed for 6 months post-surgery. Infectious illness rates per 100 person-years of observation and death rates were calculated with and without splenectomy. Death rates were determined using splenectomy status as a time-dependent covariate. The relationship between splenectomy and death according to immunization status was examined using Cox proportional hazard ratios.ResultsOf 38,812 persons in the cohort 427 subjects with a hematologic diagnosis had splenectomy and another 452 subjects without a hematologic diagnosis had this surgery. 72% were > 18 years of age. Pneumococcal immunization was recorded in 16.5% of asplenic patients overall, and was not associated with reduced risk of death in these persons (adjusted Hazard Ratio [HR] = 1.07, 95% CI 0.70 - 1.65). Influenza immunization was recorded in 53.1% of asplenic patients overall, and was associated with reduced risk of death (adjusted HR = 0.46, 0.33-0.62). No pneumococcal or influenza immunization was recorded in patients with a hematologic diagnosis without splenectomy. Infectious illness visits were higher among all patients who had a splenectomy than among those without a splenectomy (151 visits/100 person-years of observation in the post-splenectomy period vs. 120 visits/100 person-years; p < 0.0001).ConclusionsIn asplenic patients, influenza immunization is associated with a 54% reduced risk of death compared to unimmunized asplenic persons; no reduction in risk was demonstrated with (polysaccharide) pneumococcal vaccine. Vaccine coverage in the entire cohort was less than routinely recommended. Improved delivery of infection prevention programs to this population is warranted. Conjugate pneumococcal vaccines should be urgently studied in this immunocompromised population.

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Section: Discussionmentioning

confidence: 99%

Pneumococcal and influenza immunization in asplenic persons: a retrospective population-based cohort study 1990-2002

et al. 2010

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“…The syndrome likely results from poor control of early viremia because of the lack of both splenic function and the typical brisk IgM response. Although it is difficult to determine acute versus reactivated CMV in these cases one study using anti-CMV IgG maturation indices supports acute infection in this syndrome (170). These cases of widely disseminated post-splenectomy CMV can sometimes be fatal (153).…”

Section: Virusesmentioning

confidence: 99%

Resistant Pathogens, Fungi, and Viruses

Guidry

Mansfield

Sawyer

et al. 2014

Surgical Clinics of North America

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The first reports of antibiotic pathogens occurred a few short years after the introduction of these powerful new agents, heralding a new kind of war between medicine and pathogens. Although originally described in Staphylococcus aureus, resistance among bacteria has now become a grim race to determine which classes of bacteria will become more resistant, pitting the Gram positive staphylococci, enterococci, and streptococci against the increasingly resistant Gram negative pathogens, e. g., carbapenemase-resistant enterobacteriaceae. In addition, the availability of antibacterial agents has allowed the development of whole new kinds of diseases caused by non-bacterial pathogens, related largely to fungi that are inherently resistant to antibacterials. All of these organisms are becoming more prevalent and, ultimately, more clinically relevant for surgeons. It is ironic that despite their ubiquity in our communities, there is seldom a second thought given to viral infections in patients with surgical illness. The extent of most surgeon’s interest in viral infections ends with hepatitis and HIV, no doubt related to transmissibility as well as the implications that these viruses might have in a patient’s hepatic or immune functions. There are chapters and even textbooks written about these viruses so these will not be considered here. Instead, we will present the growing body of knowledge of the herpes family viruses and their occurrence and consequences in patients with concomitant surgical disease or critical illness. We have also chosen to focus this chapter on previously immune competent patients, as the impact of herpes family viruses in immunosuppressed patients such as transplant or AIDS patients has received thorough treatment elsewhere.

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“…Once established, the infection persists, and its containment becomes a priority for the immune system, which is unable to eliminate it completely. Immunocompetent individuals do occasionally experience severe symptoms on viral reactivation, for example, following splenectomy [23], but viral reactivation may also occur repeatedly without clinical symptoms, as discovered serendipitously [24]. Similarly, although primary infection of adults is not usually accompanied by notable symptoms, infectious-mononucleosis with hepatitis can be due to CMV [25,26], and quite severe disease even in immunocompetent hosts may not be as rare as previously believed [27].…”

Section: Prevalence and Impact Of CMV Infectionmentioning

confidence: 99%

Cytomegalovirus and human immunosenescence

Pawelec

Derhovanessian

Larbi

et al. 2008

Reviews in Medical Virology

301

211

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'Immunosenescence' is an imprecise term used to describe deleterious age-associated changes to immune parameters observed in all mammals studied so far. Primarily anecdotal evidence implies that failing immunity is responsible for the increased incidence and severity of infectious disease in old people. However, there is a serious dearth of accurate hard data concerning the actual cause of death in the elderly and the contribution thereto of the multitude of age-associated alterations measured in the immune system. Cross-sectional studies comparing those currently young with those currently old reveal a large number of differences in the distribution of immune cell types in the blood, and to some extent the functional integrity of those cells. Many of these parameters differ markedly between individuals infected with CMV and uninfected people, regardless of infection with other persistent herpesviruses. The adaptive arm of immunity appears to be more seriously affected than the innate arm, particularly the T lymphocytes. However, cross-sectional studies suffer the disadvantage that like is not being compared with like, because the conditions applied during the entire life course of the currently elderly were different from those applied now to the young. These differences in environment, nutrition, pathology and possibly genetics, rather than merely age, may be expected to influence the parameters studied. Moreover, pathogen exposure of the currently elderly was also different from contemporary exposure, probably including CMV. Some of the problems associated with cross-sectional studies can be overcome by performing longitudinal studies, as pointed out in an earlier analysis of the Baltimore Longitudinal Ageing study looking at lymphocyte numbers. However, longitudinal studies are challenging in humans. Nonetheless, the pioneering Swedish OCTO/NONA studies of the very elderly which for the first time included a range of immune parameters, have identified a set of immune parameters predicting mortality at 2, 4 and 6 year follow-up; CMV infection makes a material contribution to this so-called 'immune risk profile (IRP)'. Whether the IRP is informative in younger individuals and the mechanism of the CMV effect is discussed in this review.

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Reactivation versus Primary CMV Infection after Splenectomy in Immunocompetent Patients

Cited by 9 publications

References 18 publications

Pneumococcal and influenza immunization in asplenic persons: a retrospective population-based cohort study 1990-2002

Pneumococcal and influenza immunization in asplenic persons: a retrospective population-based cohort study 1990-2002

Resistant Pathogens, Fungi, and Viruses

Cytomegalovirus and human immunosenescence

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