Cytomegalovirus excretion in children attending day-care centers

BACKGROUND: Healthy children attending day-care centers (DCC) may excrete cytomegalovirus (CMV) frequently. Mothers of children excreting CMV are at higher risk for acquiring this infection than mothers of children not excreting CMV. Despite the increased attendance to DCC by children there is a lack of information regarding CMV infection in Mexico. METHODS: Prospective determination of CMV excretion in saliva of children attending public and private DCC. Three saliva samples were collected during a 2-month follow-up period from participating children and the presence of CMV was determined by viral culture. Demographic features of children and DCC type were taken into account when comparing children with and without CMV excretion. RESULTS: One hundred fifty-two children participated in the study (84 from public and 68 from private DCC). Overall, 17 (11.2%) children excreted CMV during the study period. Excretion rates varied between DCC from 3.1 to 31.3%. Children from private DCC were as likely to excrete CMV as children from public DCC. There were no demographic or clinical features of children associated with viral excretion. CONCLUSIONS: CMV was excreted on an average of 11.2% children attending DCC. The type of DCC or other demographic features were not associated with the likelihood of CMV excretion. CMV seronegative mothers of children who attend DCC need to be aware of the possibility of CMV acquisition and transmission in DCC.     

肝外胆道闭锁与巨细胞病毒感染相关性研究

为探讨肝外胆道闭锁（EHBA）与巨细胞病毒（CMV）感染的关系，对25例15～90d的EHBA患儿进行了血清CMVIgM抗体和肝组织中CMV前早抗原（IEA）、CMV早期抗原（EA）检测。结果：25例EHBA患儿CMVIgM抗体阳性11例（44％）。25例EHBA肝组织中CMVIEA和CMVEA双阳性9例，单项CMVIEA阳性2例，单项CMVEA阳性互例。肝组织病理检查CMVIEA和CMVEA双阳性或单项阳性与CMV阴性对比病变无显著差异，但肝细胞坏死的程度CMV阳性重于阴性组。肝外胆道呈条索状CMV阳性多见。CMV阳性EHBA患儿肝脾肿大更为显著，SALT峰值高，与肝细胞坏死程度一致。     

Cytomegalovirus myocarditis following liver transplantation.

Cytomegalovirus (CMV) infections are commonly found in patients on immunosuppressive therapy following liver transplantation. However, acute myocarditis is an extremely rare manifestation of CMV infection in this setting. We report the case of a patient who developed acute myocarditis with severe biventricular failure with a cardiac ejection fraction of less than 10%, 6 weeks following orthotopic liver transplantation. Systemic CMV infection was diagnosed on the basis of a clinical viraemia, the presence of CMV antigen in urine, blood, and throat swab, and an associated four-fold rise in serum antibody titres to CMV. A full recovery ensued following treatment with standard anti-cardiac failure therapy and a 10 day course of intravenous ganciclovir.     

Intrauterine diagnosis of cytomegalovirus and rubella infections by amniocentesis.

OBJECTIVE: To establish a correlation between the presence of cytomegalovirus (CMV) or rubella virus in amniotic fluid obtained through amniocentesis and fetal infection. DESIGN: Case series. SETTING: Five hospitals in the Montreal region. Virology testing was done at the Virology Research Centre, Institut Armand-Frappier, Laval, Que. PATIENTS: Thirteen pregnant women infected with CMV, 3 with rubella, their 15 babies and 2 fetuses. Twelve of the women with CMV infection were recruited from a prospective study of CMV infection in pregnancy. Infection in the other women was detected through routine laboratory diagnostic testing. INTERVENTION: Amniotic fluid samples were cultured for CMV and rubella virus. Congenital infection of the neonates was established through isolation of either virus from pharyngeal mucus and urine specimens collected during the first 3 days of life or from fetal tissue if the pregnancy was terminated. MAIN RESULTS: CMV was cultured from the amniotic fluid of three of the CMV-infected women and from the pharyngeal mucus and urine specimens of their infants. Of the three women with rubella the amniotic fluid of one (who had a twin pregnancy) was positive for rubella virus. After the in-utero death of one fetus she underwent a therapeutic abortion of both. Examination of fetal tissue indicated that both fetuses had been infected with rubella virus. Each of the two other women with rubella gave birth to an uninfected, healthy infant. CONCLUSIONS: We found a strong correlation between the isolation of CMV or rubella virus from the amniotic fluid and the presence of congenital infection. This suggests that amniocentesis used to detect the presence of a virus is a useful method for the diagnosis of fetal infection.     

Cytomegalovirus infection is associated with cardiac allograft rejection and atherosclerosis

We studied the effects of cytomegalovirus (CMV) infection on 301 cardiac transplant recipients who were treated during the cyclosporine era of immunosuppression (1980 to the present). These patients received varying combinations of cyclosporine, azathioprine, prednisone, rabbit antithymocyte globulin, and OKT3 as their immunosuppressive therapy. Two hundred ten patients were free of CMV infection (non-CMV group). During the same period CMV infection developed in 91 patients, as manifested by a fourfold IgG serologic titer rise, demonstration of CMV inclusion bodies in tissue, or positive cultures for the virus (CMV group). The rate of graft rejection was significantly higher in the CMV group. Graft atherosclerosis was significantly more severe in the CMV group as judged by angiographic criteria or by pathologic study. Patient survival rates were significantly lower in the CMV group. Death caused by graft atherosclerosis was significantly more common among patients in the CMV group. Finally, the graft loss rate (from either death or retransplantation for atherosclerosis) was significantly greater in the CMV group. These data demonstrate that CMV infection in cardiac transplant recipients is associated with more frequent rejection, graft atherosclerosis, and death.     

Bone marrow granulomas in mononucleosis

Two patients with mononucleosis, one due to cytomegalovirus (CMV), and the other due to Epstein-Barr virus (EBV), presenting with high fever, malaise and hepatitis, had granulomas in the bone marrow but not in the liver. In patients who have unexplained fever, bone marrow granulomas may be a clue to CMV or EBV infection and need not initially raise the fear of prognostically more severe illness.     

Immunomodulatory therapy of cytomegalovirus pneumonia after liver transplantation

Background There has been increasing interest in the research into cytomegalovirus （CMV） pneumonia agter liver transplantation （LT）. This study was undertaken to investigate the immunomodulatory therapy of CMV pneumonia after LT. Methods Six patients with CMV pneumonia after LT from October 2003 to November 2005 were analyzed retrospectively. They were diagnosed according to clinical manifestations, chest X-ray findings and pathogenic changes and given comprehensive therapy including mainly immunomodulation therapy and anti-viral medication. At the early stage of CMV pneumonia, the dose of immunosuppressive agents was decreased or ceased, instead replaced by immunoenhancement therapy. During recovery period from CMV pneumonia, the dose of immunosuppressive agents was given again or enhanced, and immunoenhancement therapy was ceased. The liver function of the patients was monitored closely during the treatment. Results In this series, five patients were survived and one died. The liver function of the six patients remained normal during the treatment, and no episode of acute rejection took place. Conclusions Poor immunity is the pathogenic basis of CMV pneumonia after LT. At early stage of CMV pneumonia, the immunity of the patients should be enhanced, and during the recovery period from CMV pneumonia, immunosuppresants shoud be given again but immunoenhancement therapy ceased. Individualized immunomodulatory therapy is essential to the treatment of CMV pneumonia after LT.     

巨细胞病毒在慢性乙型肝炎患者肝组织中的表达

目的探讨巨细胞病毒(CMV)在慢性乙型肝炎(CHB)患者肝组织中表达意义。方法采用免疫组化以抗-CMV单克隆抗体对76例CHB患者肝组织进行检测,然后用抗-HBcAg多克隆抗体和抗-CMV单克隆抗体双标记技术在CHB患者同一张肝组织切片上显示两种病毒分布特点。结果轻度和重度慢性肝炎患者CMV检出率无显著差异(P=0.444),而重度CHB患者中CMV表达阳性细胞明显多于轻度患者(P=0.012)。双标记染色显示CMVAg和HBcAg多数表达于肝小叶内同一区域肝细胞甚至同一肝细胞内,也可见于肝小叶中不同部位。结论CHB患者更易重叠CMV感染,并且其感染程度与肝组织的活动性病变密切相关。     

Venereal causes of cytomegalovirus mononucleosis.

Cytomegalovirus (CMV) mononucleosis developed in two men after sexual contact with a woman who had had a similar but medically unverified illness several months before. The CMV was cultured from the woman's urine and cervix. Evidence of recent infection with CMV was also found in a new sexual contact of one of the men. However, roommates of the infected patients remained well, and serologic evidence of CMV infection failed to develop. This small outbreak suggests that CMV may be acquired as a venereal infection that sometimes progresses to the mononucleosis syndrome.     

Late-onset CMV disease following CMV prophylaxis

Background  Cytomegalovirus (CMV) is the most common opportunistic infection after solid-organ transplantation, increasing morbidity and mortality. Three months of oral valganciclovir have been shown to provide effective prophylaxis. Late-onset CMV disease, occurring after the discontinuation of prophylaxis, is now increasingly recognised. Aims  To investigate the incidence and the time of detection of CMV infections in liver transplant recipients who received CMV prophylaxis. Methods  Retrospective review of 64 high- and moderate-risk patients with 1 year of follow-up. Results  The incidence of CMV infection was 12.5%, with 4.7% disease. All cases of symptomatic CMV disease were of late-onset. Conclusions  The incidence of CMV infections in this study was low compared with literature reports; however, the late-onset disease is an emerging problem. Detection of late-onset disease may be delayed because of less frequent clinic follow-up visits. Increased regular laboratory monitoring may allow earlier detection at the asymptomatic infection stage. This research was undertaken as part of an MSc in Hospital Pharmacy, awarded by Trinity College Dublin.     

Clinical application of real time-polymerase chain reaction in determining cytomegalovirus viral DNA load in renal transplant recipients

Background Cytomegalovirus (CMV) remains a significant clinical problem among immunosuppressed renal transplant patients.Quantitative PCR assays have become the most common methods in the determination of CMV infections in transplant patients.This study was to determine the relationship between CMV infection and the acute rejection of the transplanted kidney.Methods Plasma samples from 77 renal transplant patients that were pre-transplant negative for CMV infection were tested using real-time quantitative PCR and CMV gene-specific primers.The detected viral loads were retrospectively compared with the acute rejection rate and the chronic or mild rejection rates of the renal transplant.Results CMV-DNA was detected in 29 of 77 recipients,yielding a positive rate of detection of 37.7％ for this procedure.Twelve of the 21 recipients (57.1％) who suffered acute rejection had positive CMV-DNA.Among the 56 recipients suffered from chronic or mild rejection,17 (30.4％) had positive CMV-DNA plasma.Moreover,of the 29 recipients who had detectable CMV-DNA after transplant,12 (41.4％) suffered from acute rejection; of the 48 recipients with undetectable CMV-DNA,only nine (18.8％) developed acute rejection.Post-transplant patients with acute rejection had a higher rate (57.1％ vs.30.4％,P=0.03) of post-transplant CMV infection than those with chronic or mild rejection.Conclusion CMV infection is a risk factor of acute renal transplant rejection and CMV infection should be prevented and treated in renal transplant recipients.Chin Med J 2012; 125(19):3575-3577     

肝移植患者术后巨细胞病毒感染的危险因素分析

目的 通过分析肝移植患者住院期间的不同特征以寻找巨细胞病毒(cytomegalovirus, CMV)感染的危险因素。方法 对2016年12月至2019年2月在首都医科大学附属北京朝阳医院肝胆胰脾外科行肝移植手术并具有CMV实验室检查结果的134例患者的临床资料进行回顾性分析,其中男性113例,女性21例,平均年龄(52±10)岁。根据术后3个月内是否有CMV感染分为感染组(n=24)和对照组(n=110)。应用独立样本t检验、Mann-Whitney U秩和检验对定量资料进行单因素分析,应用卡方检验对定性资料进行单因素分析,应用Logistic回归分析进行多因素分析,探讨肝移植患者术后CMV感染的危险因素。结果 单因素分析结果显示,年龄(P=0.005)、终末期肝病模型(model for end-stage liver disease, MELD)评分(P=0.001)、Child-Pugh评分(P=0.048)、总胆红素(P=0.002)、国际标准化比值(international normalized ratio, INR)(P=0.002)、血氨(P=0.040)、腹水(P=0.042);术中术式(P=0.023)、失血量(P=0.006)、输血量(P=0.004);术后入住重症监护室(intensive care unit, ICU)时间(P=0.016)等因素是肝移植术后CMV感染的危险因素。多因素分析结果提示,MELD评分(P=0.007,95% CI:1.027~1.187)可能为肝移植术后CMV感染的独立危险因素。钙调磷酸酶抑制剂(calcineurin inhibitor, CNI)、霉酚酸酯(mycophenolate mofetil, MMF)、糖皮质激素等免疫抑制剂以及多克隆抗体的使用与肝移植患者术后早期CMV感染不相关。结论 MELD评分高可能是肝移植术后患者CMV感染的独立危险因素。免疫抑制剂不是肝移植患者术后早期CMV感染的危险因素。     

The use of oral ganciclovir in the treatment of cytomegalovirus retinitis in patients with AIDS.

OBJECTIVE: To recommend the appropriate use of oral ganciclovir as an alternative to intravenous (i.v.) maintenance therapy for cytomegalovirus (CMV) retinitis in patients with AIDS. OPTIONS: i.v. infusion of ganciclovir and foscarnet have been the only approved choices for maintenance therapy until the introduction of oral ganciclovir. OUTCOMES: Ease of administering maintenance therapy and improved quality of life for patients with AIDS. VALUES: The medical advisory group comprised physicians treating patients with AIDS therapy. Ease of administration of maintenance therapy and quality of patients' lives were considered important. BENEFITS, HARMS AND COSTS: Oral ganciclovir is a safe and convenient alternative to i.v. maintenance therapy for patients with CMV retinitis. However, its low bio-availability precludes its use for induction therapy and necessitates careful monitoring for compliance. Compared with i.v. administration of ganciclovir, oral maintenance therapy is cost effective. EVIDENCE: Evidence for the guidelines was gathered from data presented at a symposium on CMV retinitis and oral ganciclovir, clinical trials of oral ganciclovir and input from a visiting expert. It was presented at a meeting of the advisory board whose members are involved in the care of patients with AIDS and the management of CMV retinitis. The guidelines were approved by each member of the advisory board. RECOMMENDATIONS: Diagnosis, treatment and follow-up of CMV retinitis should always be in consultation with an ophthalmologist who is experienced in treating this disease. The patient should be fully informed about the limitations of the oral form of ganciclovir; he or she should be involved in decision making and carefully monitored. Oral ganciclovir should not be used for induction therapy or for maintenance therapy in high-risk patients. VALIDATION: Similar guidelines have been produced in England where the drug has been available since January 1995. SPONSOR: The deliberations of the advisory board and the preparation of this report were funded through an educational grant from Hoffmann-La Roche (Canada).     

更昔洛韦治疗小儿巨细胞病毒肺炎疗效观察

目的: 探讨小儿巨细胞病毒(CMV)肺炎临床特点及更昔洛韦的治疗效果。方法: 回顾性分析46例小儿CMV肺炎的临床特点,并观察30例小儿CMV肺炎更昔洛韦治疗前后临床症状、体征、肝脾大小、丙氨酸氨基转移酶(ALT)、胸片变化以及药物不良反应。结果: 小儿CMV肺炎以小婴儿发病多见,多以咳嗽为首发表现就诊(82.61%),且病程较长,有的表现为痉挛样咳。多为间质性肺炎(80.43%)。常合并有肺外表现。应用更昔洛韦5~7.5mg/kg,每12h静滴1次,治疗14天,临床症状、体征消失或明显好转,肝脾回缩,血清ALT降低,胸片吸收好转,总有效率达93.33%,未见更昔洛韦的明显副作用。结论: 对咳嗽时间较长的患儿,尤其有合并症的小婴儿应警惕CMV肺炎。更昔洛韦5~7.5mg/kg,每12h静滴1次治疗,安全、有效、副作用小。     

用PCR检测乙型肝炎患者血清巨细胞病毒活动性感染

应用聚合酶链反应（ＰＣＲ）技术检测１２５例乙型肝炎患者血清中巨细胞病毒脱氧核糖核酸（ＣＭＶ－ＤＮＡ）诊断ＣＭＶ活动性感染、同时与酶联免疫吸附法（ＥＬＩＳＡ）检测血清中ＣＭＶ－ＩｇＭ的结果相比较。结果显示：ＣＶＭ－ＤＮＡ阳性率为３２．８０％，同于ＣＭＶ－ＩｇＭ阳性率１５．０２％，各型肝炎中，急性肝炎、慢性肝炎、肝硬化血清ＣＭＶ－ＤＮＡ阳性率分别为１９．０５％，３５．２９％。血清ＣＭＶ－ＤＮＡ阴性的乙     

更昔洛韦加金双歧治疗巨细胞病毒感染引起婴儿淤胆型肝炎综合征临床观察

目的 观察更昔洛韦加金双歧治疗巨细胞病毒(CMV)感染引起婴儿淤胆型肝炎综合征临床疗效及不良反应.方法 将2000年1月～2007年5月期间通过检测血清CMV-IgM抗体、CMV-DNA及肝功能确诊CMV感染引起的淤胆型肝炎综合征患儿83例,随机分为更昔洛韦加金双歧治疗组、更昔洛韦治疗组、综合治疗组,均常规给予保肝退黄和维生素K1治疗,疗程2周.结果 更昔洛韦加金双歧治疗组在降低血清总胆红素(TB)、结合胆红素(DB)、谷丙转氨酶(ALT)、谷氨酰转肽酶(r-GT)和胆汁酸(TBA)及肝脏回缩方面与更昔洛韦治疗组比较有显著差异(P＜0.05),两组与综合治疗组比较也有显著差异(P＜0.05).结论 更昔洛韦加金双歧是目前治疗CMV感染引起婴儿淤胆型肝炎综合征的理想药物,未发现明显不良反应.     

Cytomegalovirus retinitis in the era of highly active antiretroviral therapy

A number of striking changes have occurred recently in the presentation and course of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS) who are receiving highly active antiretroviral therapy (HAART). Before the use of HAART, CMV retinitis was the most common intraocular infection in patients with AIDS, occurring in up to 40% of patients, typically when CD4+ cell counts have decreased to less than 0.10 x 10(9)/L. By studying CMV retinitis, clinicians can investigate whether the rejuvenated immune system that results from HAART can effectively control opportunistic infections in patients with AIDS. In some patients, retinitis has not progressed when specific anti-CMV therapy was discontinued, but a number of patients have developed substantial intraocular inflammation, which has resulted in decreased visual acuity. Anterior uveitis, cataract, vitritis, cystoid macular edema, epiretinal membrane, and disc edema may occur in patients with CMV retinitis who have experienced HAART-associated elevation in CD4+ cell counts. Since immune recovery uveitis does not occur in eyes without CMV retinitis, the ocular inflammation appears to be related to the CMV infection. Anti-CMV maintenance therapy likely can be safely discontinued in some patients with CMV retinitis if CD4+ cell counts are stable or increasing and have been higher than 0.10 x 10(9)/L for at least 3 months. Immune recovery in patients receiving HAART has been effective in controlling opportunistic infections, but it may also result in intraocular inflammation, which can have adverse effects on the eye.     

巨细胞病毒感染与炎症性肠病相关性研究

目的:从CMV基因水平观察巨细胞病毒(cytomegalovirus,CMV)感染与炎症性肠病(inflammatory bowel disease,IBD)的相关性。方法:我们从2007～2010年.对76例溃疡性结肠炎(ulcerative colitis,UC)52例,克罗恩病(Crohn’s disease,CD)24例的成人患者进行研究,研究CMV感染者肠道病理标本及其血液的分子水平、肠道组织标本免疫组化,以40例非炎症性肠病者作为对照组。结果:免疫组化着色显示CMV抗原阳性9例(7例是UC、8例是严重IBD病例),对照组CMV抗原均阴性。PCR-CMV基因在全部IBD肠组织标本、血液中均阳性有23(30.3%)例,16(30.8%)例为UC,7(25.9%)例为CD。此外,5(6.6%)例IBD中(2例UC,3例CD)在肠道组织检测到CMV基因,而在血液中未检测到。在对照组,5(12.5%)例血液中检测到CMV基因,仅1例(2.5%)在肠道组织检测到CMV基因。结论:UC与对照组相比,更易检测到CMV(在血液和肠道组织样本)(P=0.034和P<0.0001),而CD患者与对照组相比,更易在肠道组织标本检测CMV基因(P=0.002),在血液或肠道检测到CMV基因与IBD持续时间明显相关(P=0.004和0.03),但与年龄、性别、疾病的严重程度、结肠镜下的活动性、全结肠炎、需要特殊治疗和外科手术无关。在本研究中,检测到肠道CMV基因或抗原常与IBD有关。     

Cytomegalovirus encephalitis in immunologically normal adults. Successful treatment with vidarabine.

Acute cytomegalovirus (CMV) encephalitis developed in two immunologically normal adults. The diagnosis was confirmed by isolation of CMV from the CSF and urine in one case and from temporal lobe biopsy tissue, CSF, and urine in the second case. Both patients were treated with vidarabine and showed dramatic clinical improvement. Virus excretion, which had been chronic in one case, cleared after therapy. To our knowledge, these are the first persons with CMV encephalitis evidenced by isolation of the virus from the CNS. The response to vidarabine was impressive and warrants further evaluation.     

Cytomegalovirus infection associated with ulcerative colitis in immunocompetent individuals.

Gastrointestinal infection with cytomegalovirus (CMV) is usually found in immunocompromised patients and rarely affects immunocompetent subjects. We describe two immunocompetent patients who had primary CMV infection, and in both the disease was associated with ulcerative colitis. Both patients recovered from the CMV infection spontaneously.