Is cytomegalovirus a cause of ureteral stricture in renal transplant recipients?

Cytomegalovirus (CMV) is regarded as a predominant infectious agent in solid organ transplants. CMV disease has highly protean clinical manifestations. Nevertheless, urinary tract involvement seems to be very rare during CMV infection. We report two cases of renal transplant recipients in whom ureteral stricture developed in the course of CMV disease. Histologic data were available for them and were consistent with CMV infection. We discuss previous case reports and propose physiopathologic mechanisms. Received: 3 October 1996 Received after revision: 13 February 1997 Accepted: 17 February 1997     

指末端毛细血管血检测CMV抗体的研究

本文用ELISA方法对110名住院病儿指末端毛细血管血和静脉血配对血标本中巨细胞病毒(CMV)抗体进行了对照研究。配对血标本检测CMV IgM、IgG抗体的一致性分别为99.09％和96.36％;敏感性分别为87.5％和95.58％;特异性分别为100％和98.48％。反复多次重复检测配对血标本中CMV抗体,结果均呈正相关。本结果表明:指末端毛细血管血可代替静脉血检测儿科病血中CMV抗体.这对儿科CMV感染病儿进行动态血清学监测具有重要意义。     

巨细胞病毒感染捕获ELISA分析方法的建立和应用

目的：建立CMVIgM抗体捕获ELISA法并用聚合酶链反应（PCR）技术对此方法进行了评价。评价：采用巨细胞病毒（CMV）AD－169株感染人胚肺细胞的方法制备CMV抗原，并采用冻化抗制备法及甘愿酸法制备抗原，羊抗人IgM（μ链）McAb包被酶标板，建立CMVIgM抗体捕获ELISSA法。结果：不同浓度抗μ链McAb包被，包被时间、包被液、封闭液等不同条件，以有抗原浓度、抗CMV抗体酶结合物浓度对此法的建立有不同的影响。PCR法与用最佳条件配合后的本方法CMVIgM抗体检出率无显著差异（P＞0．05）。结论：本法测定CMV－IgM抗体的敏感性和特异性较高，简便、适用，易于推广，可广泛应用于临床。     

Correlation between the intensity of cytomegalovirus infection and the amount of perivasculitis in aortic allografts

Abstract  We previously demonstrated that cytomegalovirus (CMV) infection enhanced perivascular inflammation in rat aortic allografts. In this study, we investigated the relationship between the CMV infection load and the magnitude of perivasculitis (chronic rejection) in aortic transplants. Rats received or-thotopic abdominal aortic grafts, different degrees of total body irradiation (TBI) for immunosuppres-sion and CMV inoculation. The spleens of the rats receiving 5 Gy of TBI contained more infectious virus and viral antigens than those of rats receiving 3 Gy of TBI or no TBI. Although the number of inflammatory cells infiltrating the perivascular area was decreased after TBI, CMV infection resulted in increased perivasculitis in rats that received 5 Gy of TBI as compared to non-infected animals. This virus-induced effect was characterized predominantly by an increased T-cell infiltration, including CD4 and CD8 T-cells. It is concluded that an enhanced systemic CMV infection during severe immunosuppressive therapy can accelerate the development of chronic rejection, which seems to be mediated mainly by T-cells.     

Neurological complications in AIDS patients: the 1-year retrospective study in Chiang Mai University, Thailand

The first case of AIDS patient in the northern part of Thailand was reported in 1987 (Vithayasai et al., 1996), marking the outbreak of an epidemic. In our experience, the neurological involvement in AIDS patients seems to have changed in pattern and incidence during the last 8 years. We have conducted a retrospective study to review the incidence of AIDS-defining diseases in the patients admitted to Chiang Mai University Hospital, Thailand during the period September 2001 to August 2002. There were 155 AIDS patients admitted during this specified period, 118 of which were male and 37 female, aged between 16 and 60. The incidence of neurological complications was 50.3 per 100 person-years, in which central nervous system involvement account for 46.5 per 100 person-years and peripheral nervous system involvement account for 3.8 per 100 person-years. The incidence of cryptococcal meningitis appeared to be decreasing since 1994 whereas the incidence of cerebral toxoplasmosis appeared to be increasing. The incidence of cryptococcal meningitis, cerebral toxoplasmosis and cytomegalovirus (CMV) infection was 18.0, 14.8 and 7.0 per 100 person-years, respectively. Other common non-neurological AIDS-defining illnesses in northern Thailand include pulmonary tuberculosis (15.4 per 100 person-years), extra-pulmonary tuberculosis (9.6 per 100 person-years), and disseminated penicilliosis (12.2 per 100 person-years). In this way and summarizing, in northern Thailand, the three most common neurological involvements before the era of highly active anti-retroviral therapy are cryptococcal meningitis, cerebral toxoplasmosis and CMV infection. The incidence of cryptococcal meningitis appeared to be decreasing whereas the incidence of cerebral toxoplasmosis seemed to be increasing.     

巨细胞病毒感染小鼠行为学及脑皮质CaMmRNA表达的改变

目的探讨巨细胞病毒感染致中枢神经系统功能紊乱的神经生物学机制.方法将BALB/C乳鼠同母鼠随机分为实验对照组(18只)和接种病毒组(35只),感染方法为颅内注射,3个月后检测两组鼠的行为学变化及脑皮质CaMmRNA表达的改变.结果接种病毒组小鼠学习记忆能力下降,皮质CaMmRNA表达增加(1.0493±0.32,P＜0.01).结论巨细胞病毒感染所引起的脑皮质CaMmRNA表达增高可能是其神经系统发育异常的神经生物学机制之一.     

Does cyclosporine influence the results of cadaver retransplantation?

The results of cadaveric retransplantation in 55 recipients immunosuppressed with cyclosporine and prednisone were compared to 156 recipients of primary renal allografts. By 3 yr posttransplant, there is no significant difference in patient survival, but the yearly graft survival for primary (79%, 72%, 72%) as compared to retransplant (69%, 58%, 58%) recipients was significantly (p less than 0.05) better. There was no significant difference in rejection episodes or mean +/- SD serum creatinine (mg/dl) at 2 yr between primary (32%, 2.14 +/- 1.1) and retransplant (33%, 2.08 +/- 1.4) patients, respectively. Donor source, third kidneys, human leukocyte antigen AB and Dr matching, percent reactive antibody levels, and cause of first graft loss do not have significant impact on cyclosporine-treated retransplant outcome. However, retransplant patients who have lost a previous graft in less than 3 months continue to be at high risk for subsequent early graft loss. These results suggest that the combination of cyclosporine and prednisone is the preferred regimen for cadaveric retransplantation.     

Chemokines and soluble adhesion molecules in renal transplant recipients with cytomegalovirus infection

Cytomegalovirus (CMV) infection is associated with leucocyte infiltration in various organs, which supports a role for chemokines and adhesion molecules in the pathogenesis of CMV infection. In a prospectively conducted study of renal transplant recipients, 10 patients with CMV disease, five patients with asymptomatic CMV infection and 10 patients who did not have any CMV infection were included. During CMV infection, and in particular during CMV disease, plasma levels of the chemokines IL-8, macrophage inflammatory protein-1alpha (MIP-1alpha) and monocyte chemotactic protein-1 (MCP-1) and the soluble adhesion molecules vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1) and L-selectin increased and were positively correlated with the degree of CMV pp65 antigenaemia. Furthermore, a decrease in plasma levels of these chemokines and adhesion molecules was observed following ganciclovir therapy in the patients with CMV disease. This could suggest a role for these molecules in the pathogenesis of CMV infection.     

生物素─链霉亲和素系统在检测巨细胞病毒抗体中的应用

本文用自制ＣＭＶ抗原和生物素－链霉亲和素系统试剂，通过最适条件的对比，建立了检测人血清中抗巨细胞病毒ＩｇＭ、ＩｇＡ类抗体的ＢＳＡ－ＥＬＩＳＡ，并与普通ＥＬＩＳＡ作比较，结果表明，ＢＳＡ－ＥＬＩＳＡ的非特异性吸附明显低于普通ＥＬＩＳＡ，与普通ＥＬＩＳＡ相比，抗体效价分别提高５和７倍，阳性率分别提高６８％和１５３．５％。在实际工作中曾用ＢＳＡ－ＥＬＩＳＡ检测临床样品１６５份，就所得结果进行分析。表明ＢＳＡ－ＥＬＩＳＡ检测ＣＭＶＩｇＭ和ＩｇＡ可提高特异性和灵敏度，值得推广应用。     

Area under the viraemia curve versus absolute viral load: utility for predicting symptomatic cytomegalovirus infections in kidney transplant patients

A novel approach to predicting symptomatic cytomegalovirus (CMV) infections combines the level and the duration of viraemia in a single parameter. Sixty-four kidney transplant recipients were monitored by quantitative shell vial culture, pp65 antigenaemia, and polymerase chain reaction (PCR) of leucocytes. The area under the curve (AUC) of each parameter was determined from the onset of viraemia to the beginning of antiviral treatment. The AUC values were significantly higher in symptomatic than in asymptomatic patients. For antigenaemia and PCR, optimal AUC thresholds for predicting symptomatic CMV infections were determined. They were superior to standard cutoff levels of absolute viral load in sensitivity, specificity, and positive and negative predictive value. In 8 of the 23 patients who became symptomatic, impending clinical features were indicated earlier by the AUC thresholds than by standard viral load. In conclusion, the concept of the AUC should facilitate identification of patients at risk of symptomatic CMV infection.