Significance of Epstein-Barr virus (HHV-4) and CMV (HHV-5) infection among subtype-C human immunodeficiency virus-infected individuals

Purpose: Opportunistic viral infections are one of the major causes of morbidity and mortality in HIV infection and their molecular detection in the whole blood could be a useful diagnostic tool. Objective: The frequency of opportunistic DNA virus infections among HIV-1-infected individuals using multiplex real-time PCR assays was studied. Materials and Methods: The subjects were in two groups; group 1: Having CD4 counts <100 cells/µl (n = 118) and the group 2: counts >350 cells/µl (n = 173). Individuals were classified by WHO clinical staging system. Samples from 70 healthy individuals were tested as controls. In-house qualitative multiplex real-time PCR was standardised and whole blood samples from 291 were tested, followed by quantitative real-time PCR for positives. In a proportion of samples genotypes of Epstein-Barr virus (EBV) and CMV were determined. Results: The two major viral infections observed were EBV and CMV. The univariate analysis of CMV load showed significant association with cryptococcal meningitis, oral hairy leukoplakia (OHL), CMV retinitis, CD4 counts and WHO staging (P < 0.05) while the multivariate analysis showed an association with OHL (P = 0.02) and WHO staging (P = 0.05). Univariate analysis showed an association of EBV load with CD4 counts and WHO staging (P < 0.05) and multivariate analysis had association only with CD4 counts. The CMV load was significantly associated with elevated SGPT and SGOT level (P < 0.05) while the EBV had only with SGOT. Conclusion: This study showed an association of EBV and CMV load with CD4+ T cell counts, WHO staging and elevated liver enzymes. These viral infections can accelerate HIV disease and multiplex real-time PCR can be used for the early detection. Genotype 1 and 2 of EBV and genotype gB1 and gB2 of CMV were the prevalent in the HIV-1 subtype C-infected south Indians.     

161例低出生体重儿输血后巨细胞病毒感染情况调查分析

目的 研究探讨低出生体重儿血液制品输注的安全性.方法 收集161例输血（巨细胞病毒血清检测阴性）的低出生体重儿的尿液,利用荧光定量PCR的方法检测其巨细胞病毒的滴度,同时结合临床症状来评估低出生体重儿输血后巨细胞病毒的感染情况.结果 25例输注悬浮红细胞的患儿输血后,2例中患儿尿液中巨细胞病毒检测阳性;101例少白悬浮红细胞输注的患儿输血后,尿液中巨细胞病毒检测结果均为阴性;35例输注洗涤红细胞的患儿输血后,尿液中巨细胞病毒检测结果均为阴性（0％）.结论 输注巨细胞病毒血清检测阴性的少白悬浮红细胞与洗涤红细胞感染巨细胞病毒的几率与输注悬浮红细胞的感染几率有显著差异（P＜0.05）.     

高血压患者人巨细胞病毒感染率及其血浆中和抗体水平分析

目的 对高血压患者人巨细胞病毒（HCMV）感染率及其血浆中和抗体水平展开研究分析,研究高血压与人巨细胞病毒感染的相关性.方法 随机选取2011年12月-2013年12月期间接收治疗的50例高血压患者血标本作为观察组,同时选取50例健康体检人员的血标本作为对照组.对两组标本人巨细胞病毒特异性中和抗体、人巨细胞病毒特异性IgG和IgM、人巨细胞病毒特异性UL93 DNA进行检测.结果 观察组HCMV UL93 DNA的阳性率为72.0％,HCMV IgG阳性率为70.0％,HCMV IgM阳性率为4.0％;对照组HCMV UL93 DNA阳性率为54.0％,HCMV IgG阳性率为52.0％,HCMV IgM阳性率为2.0％;观察组HCMV UL93 DNA阳性率、HCMV IgG阳性率显著高于对照组,数据差异具有统计学意义（P＜0.05）;两组HCMV IgM阳性率数据对比差异无统计学意义（P＞0.05）.结论 高血压患者人巨细胞病毒感染率显著高于健康对照组,但特异性中和抗体水平较健康对照组显著下降,即高血压患者的人巨细胞病毒感染体液免疫状态不足,高血压与人巨细胞病毒感染显著相关.     

EB病毒和巨细胞病毒双重感染的传染性单核细胞增多症的临床特征

目的 探讨EB病毒（EBV）和巨细胞病毒（CMV）双重感染的传染性单核细胞增多症（IM）的临床特征.方法 回顾性总结21例由EBV和CMV双重感染导致IM的临床特点,并与单独EBV感染导致的IM病例进行比较.结果 ①两组间临床特点比较：双重感染组的发热持续时间显著长于EBV感染组（P＜0.01）,双重感染组的肝肿大发生率和脾肿大发生率均显著高于EBV感染组（分别P＜0.05,P＜0.01）.IM并发症,如血小板减少症、肺炎和贫血的发生率在双重感染组均显著高于EBV感染组（P＜0.01）.②各组间实验室指标比较：异型淋巴细胞百分比和肝功能异常的发生率在双重感染组均显著高于EBV感染组（P＜0.01）.结论 EBV和CMV双重感染IM常临床症状较重,发热持续时间较长,并发症如血小板减少症、肺炎和贫血的发生率较高.     

Adaptive reconfiguration of the human NK‐cell compartment in response to cytomegalovirus: A different perspective of the host‐pathogen interaction

As discussed in this review, human cytomegalovirus (HCMV) infection in healthy individuals is associated with a variable and persistent increase of NK cells expressing the CD94/NKG2C activating receptor. The expansion of NKG2C⁺ NK cells reported in other infectious diseases is systematically associated with HCMV co‐infection. The functionally mature NKG2C^bright NK‐cell subset expanding in HCMV⁺ individuals displays inhibitory Ig‐like receptors (KIR and LILRB1) specific for self HLA class I, and low levels of NKp46 and NKp30 activating receptors. Such reconfiguration of the NK‐cell compartment appears particularly marked in immunocompromised patients and in children with symptomatic congenital infection, thus suggesting that its magnitude may be inversely related with the efficiency of the T‐cell‐mediated response. This effect of HCMV infection is reminiscent of the pattern of response of murine Ly49H⁺ NK cells against murine CMV (MCMV), and it has been hypothesized that a cognate interaction of the CD94/NKG2C receptor with HCMV‐infected cells may drive the expansion of the corresponding NK‐cell subset. Yet, the precise role of NKG2C⁺ cells in the control of HCMV infection, the molecular mechanisms underlying the NK‐cell compartment redistribution, as well as its putative influence in the response to other pathogens and tumors remain open issues.     

Przedtransplantacyjne czynniki ryzyka reaktywacji zakażenia wirusem cytomegalii po przeszczepieniach allogenicznych komórek hematopoetycznych u dzieci i młodych dorosłych

BackgroundCytomegalovirus (CMV) reactivation remains one of the most frequent complications after allogeneic hematopoietic stem cell transplantation (HSCT).MethodsAn analysis of the pre-transplant risk factors of CMV reactivation was performed in 98 patients aged 0.5–22 years (median 10.5) undergoing allogeneic HSCT. CMV reactivation was tested by assessing viral load using PCR method. Following factors were analyzed: type of conditioning, graft source, donor type, use of T-depletion and CMV-serostatus of the donor and recipient. Each factor was assigned from 0 to 2 points. Based on total score for each patient, CMV reactivation risk scale was developed, and two groups with low (LR) and high (HR) risk were determined.ResultsCMV reactivation was seen in 25 patients (24.5%). The significant risk factors for CMV reactivation were: CMV-positive recipient (p<0.001), unrelated donor (p<0.002), use of ATG (p<0.002) and PBSC (p<0,01). In the HR group the incidence of reactivation CMV was significantly higher than in LR group (47.8% vs. 5.4%, p<0.001).ConclusionsCMV seropositivity of the recipient was an independent predictor factor of CMV reactivation. The use of risk point scale of CMV reactivation allows for identification of patients with the higher risk of CMV reactivation.     

孕妇巨细胞病毒感染对胎儿影响的前瞻性研究

用酶联免疫吸附试验（ＥＬＩＳＡ）及聚合酶链反应（ＰＣＲ）方法对沈阳市４５０名孕妇进行巨细胞病毒（ＣＭＶ）筛查，并前瞻性追查到其婴儿１００名ＣＭＶ感染状况。结果孕妇９７．１１％为既往感染，０．８９％为原发感染，１１．１１％为复发感染，仅２％为易感者。４５０例中感染组孕妇有畸形儿３例，流产３例，其胎儿感染率与致畸率明显高于对照组。１００例母婴检查结果：感染组孕妇所生先天性感染儿比对照组多１．４３倍（ＲＲ＝１．４３），感染组有２名低智儿，对照组无。本组早孕原发感染对胎儿危害最大，其宫内传播率为３３．３％。感染组孕妇９例感染儿中２例巨细胞包涵体病，７例无症状。为了早期诊断达到优生目的，对孕妇进行ＣＭＶ筛查是必要的，但筛查过程中发现有活动感染时处理要慎重，最好追查到羊水阳性时考虑终止妊娠。     

人巨细胞病毒在逃避宿主干扰素信号方面的研究进展北大核心CSCD

人巨细胞病毒(HCMV)在人群中感染广泛, 但主要影响免疫力低下的人群。作为固有免疫的重要组分, 干扰素在早期抗病毒免疫中具有关键作用。然而, HCMV庞大的基因组使其能够合成多种蛋白组分, 甚至可利用宿主细胞自身成分共同参与抵抗干扰素信号的抗病毒免疫应答, 最终在宿主体内形成长期潜伏感染。现就HCMV在逃避宿主干扰素信号方面的研究进展作一综述。     

新生儿TORCH感染的血清学检测与临床分析

目的 对新生儿进行TORCH感染的血清学检查及临床表现分析。方法 用ELASA法检测血清中TORCH(弓形体、风疹病毒、巨细胞病毒、单纯疱疹病毒)IgM。结果 2000年1月至2003年1月本院新生儿重症监护室(NICU)共收治新生儿l554例，其中48例为TORCH感染，巨细胞病毒感染率最高占52．1％；风疹病毒感染占33．3％；单纯疱疹病毒感染占14．6％。未发现弓形体抗体阳性的患儿。结论 新生儿TORCH感染可造成多器官损伤，主要为听力异常、高胆红素血症和肝功能异常、神经系统损伤、心肌损伤、血小板减少、先天性心脏病。计划免疫、母亲孕期筛查、新生儿早期筛查、干预治疗非常重要。     

Is Cytomegalovirus Testing of Blood Products Still Needed for Hematopoietic Stem Cell Transplant Recipients in the Era of Universal Leukoreduction?

Hematopoietic stem cell transplantation (HSCT) recipients are a high-risk, immunocompromised group of patients who receive frequent transfusions after transplantation. Transfusion of cytomegalovirus (CMV)-negative blood products has long been the standard of care to prevent transfusion-transmitted CMV in this patient population. Leukoreduction of blood products before transfusion has been shown to significantly reduce the risk of transfusion-transmitted CMV. In the era of universal leukoreduction in Canada, the need for CMV testing of blood products remains unclear. We sought to identify whether there is a difference in transfusion-transmitted CMV viremia in patients receiving only leukoreduced versus CMV-negative and leukoreduced blood products in HSCT recipients. Patients who were CMV negative and received an allogeneic HSCT from a CMV-negative donor between October 1, 1999 and June 30, 2012 were included in the analysis. Transfusion data were collected from The Ottawa Hospital Blood Bank and Canadian Blood Services. CMV viremia was defined as PCR positivity. One hundred sixty-six patients were identified who met the inclusion criteria. Of these, 89 patients received an HSCT before January 2007, during the time when patients received leukoreduced and CMV-negative blood products. Seventy-seven patients received an HSCT after this time, receiving only leukoreduced blood products. The 2 groups did not differ in terms of age, gender, diagnosis, graft type, graft source, conditioning regimen, or ABO compatibility (P > .05). CMV viremia was detected in 3 patients who received CMV-negative leukoreduced blood products (3.37%) and in 1 patient who received only leukoreduced blood products (1.30%, P = .6244). Of the patients who developed CMV viremia, 2 developed suspected CMV disease. Both of these patients were transfused with CMV-negative blood products. Secondary outcomes, including total length of stay in hospital, admission to the intensive care unit, acute and chronic graft versus host disease, and 100-day nonrelapse mortality, did not differ between the groups. In the era of universal leukoreduction of blood products, this study demonstrates that testing for CMV-negative blood products is not needed for HSCT recipients.