Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Links
The aim of the study was to evaluate the virological parameters associated with
the severity of cytomegalovirus (CMV) disease in renal and simultaneous renal
and pancreatic transplantation. The association of the viral profile and the severity
of the viral disease was analysed taking into account different confounding
variables susceptible to linkage with the severity of the CMV infection and the
viral parameters. All the patients transplanted between 1 January 1989 and 31
December 1990, a total of 242, were prospectively followed by viral cultures in
blood and urine and by serological methods using the detection of CMV-specific
IgM and the complement fixation (CF) test. The samples were taken
systematically each week for the first month and then at day 90, 180 and every 6
months and also in cases of clinical manifestations related to viral disease. CMV
infection was diagnosed virologically by the presence of viraemia, viruria, IgM,
or a significant rise in CMV antibody titre in CF. CMV disease was classified as
asymptomatic, mild (fever and/or leukopenia), moderate (fever, leukopenia and
liver abnormalities), severe (CMV pneumopathy and/or gastrointestinal disease)
or fatal. The incidence of CMV infection was 65% (157/242): 32% asymptomatic,
36% mild, 30% moderate and 2% severe. The presence of IgM was associated
with the severity of CMV disease: 51.4% of moderate and severe CMV infections
in the group with IgM versus only 16% in the group without IgM (P < 0.0001).
The risk of having severe or moderate CMV disease was 3.28 times higher in
patients with positive IgM. However the serological changes in CF were not
significantly associated with the severity of the viral disease since 34.6% of the
patients with CF changes had a severe form versus 20.8% in the group without CF
modification. Viruria was significantly associated with moderate or severe
infection: 43.6% of the patients with viruria had severe infection versus only
12.5% in the patients without viruria (P < 0.0002). The risk of having moderate or
severe CMV disease was 3.48 times higher in the patients with viruria. Viraemia
was also associated with more severe CMV infection: 48.6% of moderate or
severe CMV infection in the group of patients with viraemia versus 19% in the
group without viraemia (P < 0.0001). The risk of having severe or moderate CMV
infection was 2.58 times higher in the patients with viraemia. Viraemia was not
more associated with severe CMV infection than viruria. Using the maximum
likelihood ratio method and the logistic regression model, CMV-specific IgM,
viruria and viraemia were each shown to be associated with the severity of CMV
disease and the addition of one parameter to the other(s), whatever the type
(except the CF changes) and whatever the order of this addition, did not remove
the link between the severity and IgM, viruria and viremia. The incidence of
severe and moderate CMV disease increased with the number of positive viral
parameters (PVP) from 2% of moderate and severe infections in the group with
one PVP, to 28% in the group with two PVP, to 39% in the group with three PVP
and 68% in the group with four PVP (trend, 35.95; P < 0.0001). Taking the
absolute risk of the group of patients without IgM, viruria or viraemia as the basal
level, the observed relative risk of severe CMV infection varied from 6.45 in the
group with positive IgM without viruria or viraemia, to 10.74 in the group with
positive IgM and viruria without viraemia and to 22.5 in the group with the three
positive parameters IgM, viruria and viraemia. The different potential
confounding factors (recipient and donor serology, renal or renal and pancreatic
transplantation, DR compatibility, rejection before CMV infection) did not modify
the link between the viral profile and the severity of CMV disease. This study
suggests that the severity of CMV disease might be linked to the overspread of the
virus as well as to the consequences of a CMV-specific humoral immune
response.
PMID: 14621724 [PubMed - indexed for MEDLINE
Introduction
At the time of admission, her serum alanine aminotransferase level was 60 U/L
(normal, 0–45 U/L), aspartate aminotransferase was 44 U/L (normal, 0–45 U/L),
and alkaline phosphatase was 125 U/L (normal, 0–45 U/L). Her complete blood
counts, electrolytes and coagulation profile were within normal range.
The patient tested negative for serologic markers for HIV, hepatitis A, B, and C
viruses. Additionally, her T-lymphocytes count came back as CD4 of 588 and
CD8 of 1649. Thyroid tests were normal.
Correspondence to:
Correspondence to:
Dr P J Hamlin
Department of Medicine, St James’s University Hospital, Beckett Street, Leeds, West Yorkshire LS9
7TF, UK; pj.hamlin@ukgateway.net
Review
Correspondence
Hans-Oliver Rennekampff
rennekampff@bgu-tuebingen.de
Sepsis is responsible for significant morbidity and mortality in patients suffering from
severe burn injuries. Burn patients are known to be immunocompromised, and it is
generally accepted that the immunosuppressed patient may experience human
cytomegalovirus (HCMV) infection and disease. Review of the very limited available
literature identifies a seroconversion rate of between 18 and 22 % for burn patients who
were seronegative for HCMV prior to suffering their burn injury. Furthermore,
approximately 50 % of HCMV antibody-positive patients may reactivate. Blood products
and allografted skin have clinically been identified as possible sources of HCMV
transmission in burn patients. Experience in the treatment of infection or disease in burn
patients is very scarce and limited to immunoglobulin therapy. Animal experiments have
demonstrated that murine cytomegalovirus (MCMV)-seropositive skin grafts are able to
infect immunodeficient mice as well as burned mice. Murine studies have also
demonstrated that infection with MCMV enhances susceptibility to secondary bacterial
infection and increases mortality in these animals. Burned mice challenged with MCMV
have a significantly higher level of bacterial translocation to mesenteric lymph nodes than
either control thermally injured mice without MCMV inoculation or non-burned mice
injected with MCMV alone. In summary, it remains controversial whether HCMV
infection per se alters outcome for the majority of burn patients. Subgroups of severely
burned, seronegative patients may benefit from blood products and skin from
seronegative donors. Antiviral strategies are not yet evaluated for the burn patient. Further
investigations utilizing modern diagnostic techniques seem necessary Case Report
Cytomegalovirus retinitis and low-grade non-Hodgkin's
lymphoma: Case report and review of the literature
L.A. Derzko-Dzulynsky 1, A.R. Berger 1 2, N.L. Berinstein 3 *
1
Department of Ophthalmology, Sunnybrook Health Science Centre, Toronto, Ontario,
Canada
2
Sunnybrook Health Science Centre, Toronto, Ontario, Canada
3
Departments of Medicine and Immunology, University of Toronto, Toronto-Sunnybrook
Regional Cancer Center, Toronto, Ontario, Canada
email: N.L. Berinstein (neil.berinstein@utoronto.ca)
*
Correspondence to N.L. Berinstein, Toronto-Sunnybrook Cancer Centre, 2075
Bayview Avenue, Toronto, Ontario, CANADA, M4N 3M5
ABSTRACT
Patients with non-Hodgkin's lymphoma may develop retinal or choroidal lesions during
the course of their disease. New immunosuppressive therapies currently used in
reticuloendothelial malignancies have increased the incidence of opportunistic infections
in this patient population. The differentiation of lymphomatous infiltration from
opportunistic infection as a cause of chorioretinal infiltrates is critical, as the treatments
are fundamentally different. We report a case of a patient with non-Hodgkin's lymphoma
who developed a chorioretinal infiltrate that was initially thought to represent progressive
disease. The patient received radiation treatment appropriate for intraocular lymphoma.
The lesion progressed further and after reevaluation a diagnosis of cytomegalovirus
retinitis was made and therapy initiated. Review of the literature for intraocular lymphoma
and cytomegalovirus retinitis is provided and diagnostic strategies are described. We
recommend analysis of intraocular fluid when there is difficulty in clinically
differentiating intraocular lymphoma from opportunistic infection. Am. J. Hematol.
57:228-232, 1998. © 1998 Wiley-Liss, Inc.
Recei
CASE REPORTS
Year : 2005 | Volume : 10 | Issue : 3 | Page : 176-178
Giant pseudocyst of the spleen: A case report and review of the literature
Kalinova K
Department of Pediatric Surgery, University Hospital, Stara Zagora, Bulgaria
Correspondence Address:
Kalinova K
18-À-19 Àrmeiska str., 6003 Stara Zagora
Bulgaria
Abstract
Splenic cysts are rare lesions. Primary cysts have a cellular lining that can be caused by
congenital events or parasitic infection (Echinococcus). Secondary cysts have no cellular
lining and may be of hemorrhagic, serous, inflammatory, or degenerative origin. We
report a case of pseudocyst treated successfully by splenectomy, and we review the
literature.
Correspondence to: Dr. O. S. Breathnach The Dana Farber Cancer Center Thoracic Oncology Program 44
Binney Street Boston, MA 02115 USA
Abstract:
We report a case of transverse myelitis as a complication of acute cytomegalovirus (CMV) infection in
immunocompetent patients; and review the literature on the entity [Switzerland]. Primary CMV infection
was documented by CMV antigenaemia and high serum titres of CMV IgM and IgG antibodies.
Cerebrospinal fluid (CSF) pleocytosis indicated central nervous system inflammation; CSF polymerase chain
reaction (PCR) for CMV, however, was negative. The results of magnetic resonance imaging of the myelon
were normal. Although CMV-associated transverse myelitis has been well described in HIV-positive
individuals, but is very rare in immunocompetent individuals. It remains unclear whether the neuronal
damage is immune mediated or due to a cytotoxic effect of viral infection. The outcome is mainly favourable.
The electronic version of this article is the complete one and can be found
online at: http://www.biomedcentral.com/1471-2458/5/70
Abstract
Background
Each year in the United States, an estimated 40,000 children are born
with congenital cytomegalovirus (CMV) infection, causing an estimated
400 deaths and leaving approximately 8000 children with permanent
disabilities such as hearing or vision loss, or mental retardation. More
children are affected by serious CMV-related disabilities than by
several better-known childhood maladies, including Down syndrome,
fetal alcohol syndrome, and spina bifida.