Catarata congênita nas infecções intrauterinas mais comuns (STORCH): revisão de literatura / Congenital cataract in the most common intrauterine infections (STORCH): a review of the literature

RESUMO Objetivo: O objetivo deste estudo foi revisar os aspectos clínicos e patológicos da catarata congênita secundária às infecções por sífilis, toxoplasmose, rubéola, citomegalovírus e herpes simples. Métodos: Trata-se de uma revisão de literatura, na qual foram incluídos artigos de periódicos indexados às bases de dados PubMed®, Cochrane, Lilacs, Embase e SciELO de 2010 a 2023. Resultados: Foram encontrados 45 artigos, e, após seleção, restaram 9 artigos. Além disso, foram adicionados artigos para enriquecer a discussão. A infecção por sífilis está relacionada a alterações corneanas. O citomegalovírus e a toxoplasmose estão relacionados com a coriorretinite e/ou microftalmia. A rubéola é responsável por causar catarata, glaucoma, microftalmia e retinite em sal e pimenta. Conclusão: Foram abordadas as principais etiologias infecciosas e seu quadro clínico na CC. O melhor tratamento para CC é cirúrgico associado a acompanhamento clínico, mas a prevenção é a maneira mais eficaz de combater a CC de etiologia infecciosa. O diagnóstico precoce e o tratamento efetivo previnem alterações e sequelas visuais irreversíveis. Nesse contexto, mostram-se importantes as ações de políticas públicas para o melhor desfecho clínico e melhor qualidade de vida.

ABSTRACT Objective: To review the clinical and pathological aspects of CC secondary to infections by syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes simplex. Methods: This is a literature review. Articles from journals indexed to PubMed, COCHRANE, LILACS, EMBASE and SCIELO from 2010 to 2023 were included. Results: A total of 45 articles were found, which, after selection, remained in 9 articles. Some articles were included to enrich the discussion in this topic. The infection caused by syphilis is related to corneal changes. Cytomegalovirus and Toxoplasmosis due to chorioretinitis and/or microphthalmia. Rubella is responsible for causing cataracts, glaucoma, microphthalmia, and salt and pepper retinitis. Conclusion: The main infectious etiologies and their clinical status in CC were addressed. The best treatment for CC is surgery associated with clinical follow-up, but prevention is the most effective way to combat CC of infectious etiology. Early diagnosis and effective treatment prevent irreversible visual changes and sequelae. In this context, public policy actions are important for the best clinical outcome and better quality of life.

Evaluación neurológica durante el primer año en niños muy bajo peso al nacer con infección por citomegalovirus / Neurological evaluation during the first year in very low birth weight children with cytomegalovirus infection

Introducción: La infección congénita por citomegalovirus es causa de pérdida auditiva y alteraciones cognitivas. La infección perinatal por este virus es más frecuente en neonatos< 1500 g y produce menos secuelas neurológicas. Objetivo: Describir la evaluación neurológica en el primer año de vida en niños muy bajo peso al nacer con infección por citomegalovirus. Métodos: Estudio descriptivo y longitudinal en el que se incuyeron 14 neonatos< 1500 g, con diagnóstico de infección congénita o perinatal por citomegalovirus; a los cuales se les realizó evaluación del neurodesarrollo, ultrasonido craneal, potenciales evocados auditivos de tallo cerebral y potenciales visuales a las 40 semanas, a los seis meses y al año de edad gestacional corregida. En la primera evaluación se realizó además, electroencefalograma. Resultados: El 43 por ciento tuvo infección congénita y 57 por ciento infección perinatal. A las 40 semanas se evaluaron completamente 79 % de los casos, a los seis meses 64 por ciento y al año 36 por ciento. No se observaron anormalidades en el ultrasonido craneal, ni en el electroencefalograma. Al año de edad corregida, se detectaron alteraciones ligeras del neurodesarrolo en 33,3 por ciento del total de casos (2/6) y con igual porcentaje en los niños con infección congénita (1/3) y perinatal (1/3). En ningún paciente evaluado se detectó sordera neurosensorial, ni daño del nervio visual. Conclusiones: Las alteraciones del neurodesarrollo encontradas al año de edad corregida pueden estar relacionadas con la prematuridad o la infección por citomegalovirus. El seguimiento a mediano y largo plazo es necesario para detectar otras secuelas neurológicas de debut tardío(AU)

Introduction: Congenital cytomegalovirus infection is a cause of hearing loss and cognitive impairments. Perinatal infection by this virus is more frequent in neonates< 1500 g and produces fewer neurological sequelae. Objective: To describe neurological evaluation in the first year of life in very low birth weight children with cytomegalovirus infection. Methods: A descriptive and longitudinal study involving 14 neonates< 1500 g, with a diagnosis of congenital or perinatal cytomegalovirus infection; to which neurodevelopmental evaluation, cranial ultrasound, auditory brain stem evoked potentials and visual potentials were performed at 40 weeks, six months and one year of corrected gestational age. In the first evaluation, electroencephalogram was also performed. Results: 43 percent had congenital infection and 57 percent perinatal infection. At 40 weeks, 79 percent of cases were fully evaluated, at six months 64 percent and at one year 36 percent. No abnormalities were observed on the cranial ultrasound or electroencephalogram. At one year of corrected age, slight alterations in neurodevelopment were detected in 33.3 percent of all cases (2/6) and with the same percentage in children with congenital (1/3) and perinatal (1/3) infection. In no patient evaluated, sensorineural deafness or visual nerve damage was detected. Conclusions: The neurodevelopmental alterations found at one year of corrected age may be related to prematurity or cytomegalovirus infection. Medium- and long-term follow-up is necessary to detect other late-onset neurological sequelae(AU)

Prognóstico da COVID-19 em pacientes com coinfecção viral: revisão de literatura / COVID-19 prognosis in patients with viral coinfection: literature review

Casos de infecção pelo coronavírus surgiram em 2019 e fatores de risco podem conduzir complicações, entre elas, a coinfecção viral podendo comprometer a resposta imunológica e interferir no prognóstico. Objetivos: Analisar estudos sobre coinfecção viral na COVID-19, avaliando prevalência e correlação com seu prognóstico. Métodos: Foram realizadas buscas em bases de dados utilizando os descritores: SARS-COV 2, coinfecção, vírus, coronavírus, e COVID-19. Resultados: Foram selecionados 12 artigos com os seguintes vírus: influenza, HIV e herpes. Apesar da coinfecção com influenza ser pouco prevalente, seu reconhecimento permitiu compreender diferentes manifestações clínicas e tratamento adequado. Já a coinfecção com HIV revelou que pacientes com AIDS não tratada tiveram pior prognóstico. Por fim, a coinfecção com herpes resultou em reativação, com os seguintes tipos associados: HSV-1, HSV-3, EBV, CMV e HHV-6. Conclusão: Não há evidências científicas suficientes para afirmar que a coinfecção com SARS-COV 2 com outros vírus traz pior prognóstico para COVID-19, sendo necessários mais estudos sobre tais interações

Cases of coronavirus infection emerged in 2019 and risk factors can lead to complications, including viral coinfection, which can compromise the immune response and interfere with prognosis. Objectives: To analyze studies on viral coinfection in COVID-19, evaluating prevalence and correlation with its prognosis. Methods: Database searches were performed using the descriptors: SARS-COV 2, coinfection, virus, coronavirus, and COVID-19. Results: Twelve articles with the following viruses were selected: influenza, HIV and herpes. Although coinfection with influenza is not very prevalent, its recognition made it possible to understand different clinical manifestations and appropriate treatment. Coinfection with HIV revealed that patients with untreated AIDS had a worse prognosis. Finally, coinfection with herpes resulted in reactivation, with the following types associated: HSV-1, HSV-3, EBV, CMV, and HHV-6. Conclusion: There is not enough scientific evidence to state that co-infection with SARS-COV 2 with other viruses brings a worse prognosis for COVID-19, and further studies on such interactions are needed

Endotelitis por citomegalovirus y su diagnóstico mediante la microscopia confocal / Cytomegalovirus endotheliitis and its diagnosis by confocal microscopy

Objetivo: Describir las características del endotelio corneal por microscopia confocal en pacientes con lesiones basofílicas de inclusión como patognomónicas de endotelitis por citomegalovirus. Métodos: Se realizó un estudio observacional de casos clínicos en pacientes con diagnóstico de endotelitis por citomegalovirus, atendidos en la Consulta de Córnea del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", entre febrero del año 2010 y junio del 2018. La muestra incluyó 39 pacientes con diagnóstico clínico de endotelitis, a quienes se les realizó microscopia confocal con el equipo Confoscan 4 (Nidek Technologies). Resultados: De los 39 pacientes, 29 fueron del sexo masculino y 10 del femenino. Todos tenían entre 41 y 60 años de edad. En el 97,4 por ciento de los casos existió el antecedente de una conjuntivitis viral y un solo paciente fue positivo de HIV (2,6 por ciento). La mejor agudeza visual corregida de 0,3 o menos se mostró en el 100 por ciento de ellos antes del tratamiento, y después de este los 39 tenían entre 0,8 y 1,0. En el 100 por ciento de los casos se observaron cuerpos de inclusión basofílicos en el endotelio corneal, que fueron apreciables mediante la microscopia confocal. Conclusiones: Existe una relación entre la presencia de cuerpos de inclusión basofílicos en el endotelio corneal y las pruebas virológicas a citomegalovirus positivas, lo que puede permitir hacer PCR a casos que ya tienen confirmación mediante microscopia confocal de las características patognomónicas del endotelio corneal(AU)

Objective: Describe the characteristics of the corneal endothelium by confocal microscopy in patients with inclusion basophilic lesions as pathognomonic signs of cytomegalovirus endotheliitis. Methods: An observational study was conducted of clinical cases of patients diagnosed with cytomegalovirus endotheliitis attending the Cornea Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2010 to June 2018. The study sample was 39 patients with a clinical diagnosis of endotheliitis who underwent confocal microscopy with a Confoscan 4 device (Nidek Technologies). Results: Of the 39 patients examined, 29 were male and 10 were female. All were aged 41-60 years. 97.4 percent had a history of viral conjunctivitis and only one was HIV positive (2.6 percent). Best corrected visual acuity was 0.3 or less in 100 percent before treatment, and 0.8 to 1.0 after treatment. Inclusion basophilic bodies visible by confocal microscopy were observed in the corneal endothelium of all patients. Conclusions: A relationship exists between the presence of inclusion basophilic bodies in the corneal endothelium and virological tests positive for cytomegalovirus, making it possible to perform PCR testing in cases with confocal microscopy confirmation of the pathognomonic characteristics of the corneal endothelium(AU)

Molecular detection of Porcine cytomegalovirus (PCMV) in wild boars from Northeastern Patagonia, Argentina / Detección molecular de citomegalovirus porcino (PCMV) en jabalíes del noreste de la Patagonia argentina

ABSTRACT Porcine cytomegalovirus(PCMV) is a recognized pathogen of domestic swine that is widely distributed around the world. PCMV is the etiological agent of inclusion body rhinitis and has also been associated with other diseases that cause substantial losses in swine production. Wild boar populations can act as reservoirs of numerous infectious agents that affect pig livestock, including PCMV. The aim of this work was to assess the circulation of this virus in free-living wild boars that inhabit Northeastern Patagonia (Buenos Aires and Río Negro Provinces), Argentina. Nested-PCR assays were conducted to evaluate the presence of PCMV in samples of tonsil tissue collected from 62 wild boar individuals. It was found that the overall rate of infection was about 56%, with significant higher values (almost 90%) in the age group corresponding to piglets (animals less than 6 months old). In addition, a seasonal variation was observed in the PCMV detection rate, with an increase during the transition from summer to autumn. In conclusion, this study confirmed that wild boars are major carriers and dispersal agents of PCMV in Northeastern Patagonia, which raises the necessity to evaluate the extent to which this virus affects local livestock production.

RESUMEN El citomegalovirus porcino (CMVP) es un reconocido patógeno de los cerdos domésticos y cuenta con una amplia distribución mundial. Es el agente etiológico de la rinitis por cuerpos de inclusión y también se lo ha asociado con otras enfermedades que causan pérdidas sustanciales en la producción porcina. Las poblaciones de jabalíes pueden actuar como reservorios de numerosos agentes infecciosos que afectan al ganado porcino, incluido el CMVP. El objetivo de este trabajo fue evaluar la circulación de este virus en jabalíes de vida libre que habitan en la región noreste de la Patagonia argentina, en las provincias de Buenos Aires y Río Negro. Se realizaron ensayos de PCR anidada para evaluar la presencia de CMVP en muestras de tejido de amígdalas tomadas de 62 jabalíes. Se encontró que la tasa general de infección fue de aproximadamente el 56%, con valores significativamente más altos (casi el 90%) en el grupo de edad correspondiente a los lechones (animales con menos de 6meses). Además, se observó una variación estacional en la tasa de detección de CMVP, con un incremento durante la transición de verano a otoño. En conclusión, este estudio confirmó que los jabalíes son importantes portadores y agentes de dispersión del CMVP en el noreste patagónico, lo cual plantea la necesidad de evaluar en qué medida este virus afecta la producción ganadera local.

Atipicidades de un síndrome adénico de causa toxoplásmica / Outlier adenic toxoplasmic syndrome

Introducción: Las adenopatías, linfadenopatías o linfoadenomegalias constituyen causas frecuentes de consulta pediátrica. Estas entidades nosológicas pueden variar desde infecciones benignas transitorias hasta procesos malignos como linfoma, metástasis de tumores y otros. Objetivo: Describir un caso clínico con un síndrome adénico que por las características semiológicas sugería un proceso oncoproliferativo y los resultados de los estudios complementarios confirmaron un proceso infeccioso causado por Toxoplasma gondii. Presentación de caso: Adolescente femenina de 11 años de edad, eutrófica, con antecedentes personales de salud. Ingresó en el Hospital Pediátrico Universitario "William Soler " por presentar aumento de volumen en la región cérvico-lateral derecha. Al examen físico se palpó una adenopatía de aproximadamente 2 x 3 cm de diámetro, dura, inmóvil, no dolorosa, sin signos de inflamación, no adherida a planos profundos; evolutivamente, apareció otra adenopatía en posición cervical derecha baja, de iguales características. Se indicó hemograma, velocidad de sedimentación globular, proteína C reactiva, transaminasas, glicemia, proteínas totales, albúmina, triglicéridos, colesterol, marcadores tumorales, ecografía, rayos X de tórax, serología para detectar anticuerpos anti citomegalovirus, virus de inmunodeficiencia humana y Toxoplasma gondii. Se realizó, además, biopsia para estudio por anatomía patológica y biología molecular. Se concluyó el caso como un síndrome adénico de etiología toxoplásmica. Conclusiones: En pacientes adolescentes con adenopatías cervicales, independientemente de tamaño, tiempo de evolución y consistencia, se debe realizar diagnóstico diferencial por infección por Toxoplasma gondii, teniendo en cuenta que las adenopatías causadas por este parásito pueden tener algunas características similares a las ocasionadas por procesos oncoproliferativos que pueden presentarse a esta edad(AU)

Introduction: Adenopathies, lymphadenopathies or lymphadenomegalies are common causes of pediatric consultation. These nosological entities can range from transient benign infections to malignant processes such as lymphoma, tumor metastases, and others. Objective: Describe a clinical case with an adenic syndrome that from the semiological characteristics suggested an onco-proliferative process and the results of the complementary studies confirmed an infectious process caused by Toxoplasma gondii. Case presentation: 11-year-old female adolescent, eutrophic, with a personal health history. She was admitted at "William Soler" University Pediatric Hospital after presenting volume increase in the right lateral cervical region. An adenopathy of approximately 2 x 3 cm in diameter, hard, motionless, non-painful, with no signs of inflammation, not attached to deep planes was found at the physical examination; in the evolution, another adenopathy appeared in a lower right cervical position, with equal characteristics. Blood counts, globular sedimentation rate, C-reactive protein, transaminases, glycemia, total proteins, albumin, triglycerides, cholesterol, tumor markers, ultrasound, chest x-rays, serology for anti-cytomegalovirus antibodies, human immunodeficiency virus and Toxoplasma gondii tests were indicated. Biopsy was also performed for study by pathological anatomy and molecular biology. The case was concluded as an adenic toxoplasmic syndrome. Conclusions: In adolescent patients with cervical adenopathies, regardless of size, evolution time and consistency, differential diagnosis for Toxoplasma gondii infection should be made, taking into account that adenopathies caused by this parasite may have some characteristics similar to those caused by onco-proliferative processes that may occur at this age(AU)

Cargas virales en pacientes trasplantados y genotipificación de Citomegalovirus / Viral loads in transplant patients and Cytomegalovirus genotyping

Resumen Objetivo: Determinar el curso de infecciones virales por un periodo de un año, mediante la medición de la carga viral de Adenovirus, virus BK, virus Epstein-Barr, Citomegalovirus y Herpesvirus humano 6, en 30 pacientes del Hospital San Juan de Dios, sometidos a trasplante de riñón o células progenitoras hematopoyéticas. Métodos: Se determinaron las cargas virales en diez muestras de sangre por paciente: una muestra pretransplante, ocho muestras obtenidas cada dos semanas postrasplante y una última muestra a los seis meses posteriores al trasplante. La cuantificación de los virus se realizó por reacción en cadena de la polimerasa en tiempo real y, solo en el caso del Adenovirus, por reacción en cadena de la polimerasa de punto final. También se determinaron los genotipos de Citomegalovirus en los pacientes positivos para este virus, utilizando una reacción en cadena de la polimerasa dirigida al gen de la glicoproteína B y secuenciación de los fragmentos amplificados. Las secuencias obtenidas fueron comparadas y alineadas con una secuencia de referencia, utilizando el programa Clustal Omega. Resultados: Al 77 % de los pacientes se les detectó al menos uno de los cinco virus analizados y el virus con mayor prevalencia fue el Citomegalovirus, con un 57% de positividad del total de la población. El genotipo de Citomegalovirus que más se detectó fue el genotipo 3. Se monitoreó el comportamiento de las cargas virales para cada virus analizado y la proporción de su incidencia entre pacientes masculinos y femeninos. Conclusiones: La cuantificación y caracterización de virus en pacientes de trasplante, permite un mejor manejo clínico del paciente con infecciones oportunistas y también un manejo más adecuado de las terapias farmacológicas.

Summary Aim: The objective of this study was to determine the course of viral infections during a period of one year, by measuring viral loads for Adenovirus, BK virus, Epstein-Barr virus, Cytomegalovirus and Human herpesvirus 6, in 30 patients from the San Juan de Dios National Hospital, undergoing kidney or hematopoietic progenitor cell transplants. Methods: Viral loads were determined in ten blood samples from each patient: a pre- transplant sample, eight samples obtained at two-week intervals post-transplant and one last sample at six months post-transplant. Viral quantification was performed by real-time polymerase chain reaction and, only for Adenovirus, by end-point polymerase chain reaction. Also, Cytomegalovirus genotypes were determined in patients that tested positive for this virus, by polymerase chain reaction directed towards the glycoprotein B gene and sequencing of the amplified fragments. These sequences were compared and aligned with a reference sequence, using the Clustal Omega Program. Results: The results of the study indicated that 77% of the patients had at least one of the five viruses detected and the virus with the highest prevalence was Cytomegalovirus, exhibiting 57% positivity in the total population studied. The most frequent Cytomegalovirus genotype detected was genotype 3. The viral load behavior was monitored for each virus analyzed as well as the incidence proportion between male and female patients. Conclusions. Viral quantification and characterization in transplant patients allows for better clinical management of patients with opportunistic infections and also a better management of pharmacological therapies.

Atresia biliar por citomegalovirus: un reporte de caso / Cytomegalovirus-associated biliary atresia: Case report

Resumen La atresia biliar asociada con inmunoglobulina M (IgM) positiva para citomegalovirus (CMV) es una entidad infrecuente que se caracteriza por la obliteración inflamatoria progresiva de los conductos intra- o extrahepáticos producida por una reacción autoinmune perinatal contra el CMV. El diagnóstico se realiza con IgM positiva para CMV y biopsia hepática con evidencia de atresia de las vías biliares. El conocimiento y la identificación temprana de esta patología conduce a un manejo quirúrgico temprano, mejorando considerablemente el pronóstico de estos pacientes. Se presenta un caso clínico de una paciente de 82 días de edad con un cuadro de acolia, coluria e ictericia de inicio tardío, asociado con hiperbilirrubinemia a expensas de la directa, elevación de perfil hepático e IgM positiva para CMV. La colangiorresonancia intraoperatoria confirmó el cuadro de atresia de las vías biliares. Se realizó una derivación biliodigestiva tipo Kasai y la toma de biopsia hepática que confirmó el cuadro clínico.

Abstract Biliary atresia associated with positive cytomegalovirus IgM results is a rare condition characterized by progressive inflammatory obliteration of the intra- or extrahepatic ducts. It is caused by a perinatal autoimmune reaction against cytomegalovirus (CMV). Diagnosis is made based on positive IgM for CMV and liver biopsy with evidence of bile duct atresia. Knowledge and timely identification of this disease leads to early surgical management, considerably improving the prognosis of these patients. This is the clinical case of an 82-day-old female patient with late-onset acholia, choluria, and jaundice, associated with conjugated hyperbilirubinemia, elevated liver function tests and positive CMV IgM results. Intraoperative cholangioresonance confirmed bile duct atresia. The Kasai procedure was performed, and a liver biopsy was taken, confirming the diagnosis.

Infección por citomegalovirus en púrpura de Henoch-Schönlein del anciano como complicación y factor perpetuador de la enfermedad. Reporte de caso / Cytomegalovirus infection and Henoch-Schönlein purpura in the elderly as a complication and factor that perpetuates the disease. Case report

RESUMEN La púrpura de Henoch-Schönlein en el adulto es un reto diagnóstico. Su baja incidencia y su sintomatología poco específica configuran un cuadro clínico que puede pasar desapercibido en diversas ocasiones o solaparse bajo el peso de diferentes sospechas diagnósticas. La púrpura de Henoch-Schönlein no es un cuadro de espectro único. Se considera un grupo de enfermedades de manifestación heterogénea con un eje patogénico común dado por el hallazgo de inflamación de la pared en vasos de pequeño calibre mediada por complejos inmunes. Este es el caso de un paciente de 70 arios quien cursa con un cuadro compatible con púrpura de Henoch-Schönlein, de inicio tardío, caracterizada por su difícil manejo y constantes recaídas. a pesar del uso cuidadoso de las pautas terapéuticas establecidas por los consensos actuales. En este paciente se documentó, de forma concomitante, una infección por citomegalovirus que al recibir tratamiento permitió el control adecuado de síntomas. Adicionalmente, este paciente presentaba una linfocitopenia que parecía ser secundaria a la infección viral.

ABSTRACT Henoch-Schönlein purpura in the adult is a diagnostic challenge. Its low incidence and its unspecific symptomatology in this age group, establish a clinical chart that can be ignored on several occasions. Henoch-Schönlein purpura is considered a group of diseases of heterogeneous manifestation with a common pathogenic axis: the finding of inflammation of the wall of the small calibre vessels, mediated by immune complexes. The case is presented of a 70-year-old patient with a difficult to treat Henoch-Schönlein purpura, with constant relapses despite the use of the therapeutic guidelines established in the current guidelines. In this patient, a concomitant cytomegalovirus infection was documented that, after receiving treatment, allowed adequate control of symptoms. Additionally, this patient also had a lymphocytopenia that was secondary to cytomegalovirus.

El citomegalovirus en los receptores de trasplante hematopoyético / Cytomegalovirus in hematopoietic stem cell transplant recipients

Introducción: La infección por citomegalovirus es muy frecuente en pacientes sometidos a trasplante de progenitores hematopoyéticos, debido a tratamientos mieloablativos de acondicionamiento, disparidad genética y al tratamiento inmunosupresor, y ocurre fundamentalmente después de la toma del implante. Objetivos: Actualizar el diagnóstico, manejo y seguimiento de la infección por citomegalovirus en pacientes trasplantados. Métodos: Se realizó revisión bibliográfica en los idiomas español e inglés, utilizando los motores de búsqueda de Pubmed, Google Académico y Scielo sobre el diagnóstico y manejo del citomegalovirus en pacientes receptores de trasplante hematopoyético. Análisis y síntesis de la información: Se recolectó y organizó la información obtenida siguiendo cronológicamente el surgimiento de técnicas para diagnóstico y la aparición de nuevos medicamentos en los últimos años. Se seleccionaron artículos recientes de expertos en el tema en revistas prestigiosas, donde se evidencia la importancia del diagnóstico adelantado y el inicio del tratamiento. Conclusiones: En la actualidad se cuenta con nuevas formas de diagnóstico y medicamentos novedosos para el citomegalovirus, pero la mortalidad puede llegar a ser alta, si el paciente no es tratado antes de que aparezcan los síntomas de la enfermedad e incluso a pesar del tratamiento. En ocasiones, no es posible erradicar el virus, lo que lleva a complicaciones importantes y a la muerte. La enfermedad citomegálica continúa siendo una complicación frecuente en estos pacientes a pesar de las medidas para evitar su reactivación(AU)

Introduction: Cytomegalovirus infection is very common in patients undergoing hematopoietic progenitor transplantation, due to myeloablative conditioning treatments, genetic disparity, and immunosuppressive treatment, and occurs mainly after the engrafment. Objective: A review and update of the diagnosis and management of cytomegalovirus is made in hematopoietic transplant recipients. Method: A bibliographic review was carried out in Spanish and English, using the search engines of Pubmed, Scholar Google and Scielo about the diagnosis and management of cytomegalovirus in hematopoietic transplant recipients. Development: The information obtained was collected and organized chronologically about the emergence of techniques for diagnosis and the appearance of new drugs in recent years. Recent articles by experts in prestigious journals were reviewed and the importance of early diagnosis and initiation of treatment is evidenced. Conclusions: There are currently new forms of diagnosis and novel medications, but mortality can be high, if the patient is not treated before the symptoms of the disease appear and even despite treatment, sometimes it is not possible to eradicate the virus, leading to major complications and death. Cytomegalic disease continues to be a frequent complication in these patients despite measures to prevent virus reactivation(AU)

Infarto esplénico asociado a infección por citomegalovirus, primer reporte de caso en Colombia / Splenic infarction associated with cytomegalovirus infection, first Colombian Case report

Resumen Introducción: El infarto esplénico ocurre cuando la arteria esplénica o alguna de sus ramas quedan ocluidas, ya sea por émbolos distantes o por trombosis in situ. Dentro de la literatura mundial hay muy pocos casos documentados de infarto esplénico asociado a infección por Citomegalovirus, por lo que este podría considerarse el primero en Colombia. Presentación del Caso: Se trata de una paciente femenina de 53 años quien fue atendida en una institución de tercer nivel de la Ciudad de Bogotá, Colombia, por cuadro de dolor abdominal, a quien se le realizó una tomografía abdominal contrastada que demostró en el bazo una lesión hipodensa en cuña correspondiente con infarto esplénico por lo cual se realizaron estudios complementarios evidenciando como único dato positivo la positividad de la IgM para Citomegalovirus, descartándose eventos de h ipercoagulabilidad. Discusión: El infarto esplénico es una condición infrecuente que normalmente se presenta con síntomas variables e inespecíficos, dentro de las enfermedades infecciosas que corresponden con aproximadamente el 30% de los diagnósticos de Infarto esplénico, la infección por Citomegalovirus únicamente ha sido reportada en muy pocos casos. Se presenta el caso de una mujer joven con infarto esplénico como diagnóstico final de dolor abdominal en quien se descartaron causas de hipercoagulabilidad y se confirma la infección aguda por Citomegalovirus, lo cual se ha descrito muy poco en la literatura y puede considerarse el primer caso reportado en Colombia.

Abstract Introduction: Splenic infarction occurs when the splenic artery or any of its branches are occluded, either by distant emboli or by thrombosis in situ. Within the world literature, there are very few documented cases of splenic infarction associated with Cytomegalovirus infection, so this could be considered the first in Colombia. Case Presentation: This is a 53-year-old female patient who was treated at a third-level institution in the City of Bogotá, Colombia, for symptoms of abdominal pain, who underwent a contrasted abdominal tomography that she demonstrated in the spleen. a hypodense wedge lesion corresponding to splenic infarction, for which reason complementary studies were carried out, showing the positivity of IgM for Cytomegalovirus as the only positive data, ruling out events of hypercoagulability. Discussion: Splenic infarction is an infrequent condition that normally presents with variable and nonspecific symptoms. Among infectious diseases that correspond to approximately 30% of the diagnoses of splenic infarction, Cytomegalovirus infection has only been reported in very few cases. The case of a young woman with splenic infarction is presented as the final diagnosis of abdominal pain in whom causes of hypercoagulability were ruled out and acute infection by Cytomegalovirus was confirmed, which has been described very little in the literature and can be considered the first reported case In colombia.

Optimización del diagnóstico de hepatitis por citomegalovirus en receptores de trasplante hepático: diez años de experiencia / Cytomegalovirus hepatitis diagnosis optimization in liver transplant recipients: 10 years of experience

Resumen Introducción: Para los pacientes receptores de trasplante hepático (TH) la hepatitis por citomegalovirus (CMV) constituye una entidad de difícil diagnóstico. Nuestro objetivo fue determinar la real incidencia de hepatitis por CMV aplicando técnicas diagnósticas más específicas. Material y Métodos: Estudio retrospectivo/ prospectivo, en un centro de trasplante hepático. Período de estudio: años 2009 al 2019. Se incluyeron los TH que presentaron elementos sugestivos y/o específicos de CMV en la histopatología de la punción biopsia hepática (PBH), a los que se les realizó inmunohistoquimica (IHQ) en la PBH. Población control n = 17. Resultados: 41 casos cumplieron los criterios de inclusión. La IHQ fue positiva en n = 6 (14,6%). En la población control, la IHQ fue negativa en el 100% de los casos. Esto traduce un valor predictor negativo de 100% para la histopatología en el diagnóstico de hepatitis por CMV, con un valor predictor positivo de 14,6%. En 85% de los pacientes con IHQ negativa, hubo diagnósticos alternativos. La terapia antiviral en la fase retrospectiva se indicó en 48% y en la prospectiva en 21%. Conclusiones: Combinar la histopatología con la IHQ optimiza el diagnóstico de hepatitis por CMV; lo que permite la racionalización del uso de antivirales de alto costo y la búsqueda de etiologías diferenciales.

Abstract Background: Cytomegalovirus (CMV) hepatitis constitutes a challenging diagnostic entity in liver transplant (LT) recipients. Aim: To determine the real incidence of CMV hepatitis using more specific diagnostic tools as those currently used before. Methods: Retrospective/prospective study conducted in a hepatic transplant unit from 2009 to 2019. LT recipients with CMV specific or suggestive elements in histopathology of hepatic biopsies were included. Immunohistochemistry (IHQ) was performed in tissue samples of the studied cohort as well as in a control one. Results: 41 patients met the inclusion criteria. IHQ was diagnostic in 6 (14.6%), and was negative in 100% of the control population. The negative predictive value of the histopathology for CMV hepatitis diagnosis was 100% and the positive predictive value was 14.6%. 85% of patients in whom the IHQ was negative had alternative diagnosis Antiviral therapy in the retrospective analysis was indicated in 48% of patients and in 21% of the prospectively analyzed cohort. Conclusions: Histopathology and IHQ combination improves the diagnostic accuracy of CMV hepatitis which translates into a rational us of expensive antiviral therapy and to search for differential diagnosis

Infección por citomegalovirus y Helicobacter pylori, en un niño con enfermedad de Ménétrier / Citomegalovirus and Helicobacter pylori infection in a child with Ménétrier´s disease

Resumen La enfermedad de Ménétrier es una entidad clínica rara, de etiología no clara, caracterizada por hiperplasia foveolar gástrica asociada con pérdida secundaria de proteínas. En niños se presenta con edema, que puede ser generalizado, sin compromiso renal ni hepático y difiere de la forma adulta por la persistencia del edema y la remisión espontánea. En la mayoría de casos publicados, se relaciona con infecciones, usualmente por cytomegalovirus y Helicobacter pylori. Aquí se presenta el caso de un niño de 9 años, que consulta por un mes de evolución de edema y dolor abdominal. Al examen físico se documenta anasarca, y estudios de laboratorio revelaron hipoalbuminemia sin proteinuria.

Abstract Ménétrier disease is a rare disorder characterized by gastric foveolar hyperplasia associated with secondary protein loss. In children, this condition presents as an edematous syndrome without renal or hepatic impairment and differs from the adult form by the constant presence of edema and spontaneous remission. It has been related to infections in most published cases, especially to cytomegalovirus and Helicobacter pylori. Here we analyze the case of a 9 year old boy, complaining of one month of edema and abdominal pain. Physical exam revealed a patient with anasarca and laboratory results documented hypoalbumenemia without proteinuria.

Colitis por cytomegalovirus en trasplante renal: Presentación de 2 casos / Cytomegalovirus colitis in kidney transplant recipients: presentation of two cases

Resumen La infección por citomegalovirus (CMV) es un riesgo latente en pacientes inmunocomprometidos por trasplante renal, asociándose con aumento del riesgo de rechazo del injerto y muerte. La infección por CMV puede manifestarse como infección activa o enfermedad por CMV (dividida en síndrome por CMV y enfermedad tisular invasiva por CMV). Presentamos dos casos de enfermedad tisular invasiva por CMV, la cual se presentó entre los primeros siete meses posteriores al trasplante. Ambos casos eran D+/R-; recibieron agentes depletores de linfocitos y micofenolato y profilaxis para CMV de acuerdo con las guías de práctica clínica. Los criterios para enfermedad por CMV incluyeron replicación viral detectable en sangre, hallazgos endoscópicos clásicos y confirmación histopatológica. Hacemos énfasis en la necesidad de identificar los factores de riesgo para la infección por CMV en pacientes con trasplante renal, especialmente el seroestatus donador/receptor y los medicamentos inmunosupresores. Aun cuando las guías de práctica clínica sugieren de uno a tres meses de profilaxis para CMV en casos de alto riesgo, debería considerarse la profilaxis extendida y el ajuste de los medicamentos inmunosupresores.

Abstract Cytomegalovirus infection is a latent risk among immunocompromised kidney transplant recipients and is associated with increased risk of allograft failure and death. CMV infection can manifest as active infection or as CMV disease (divided in CMV syndrome and CMV tissue-invasive disease). We present two cases of tissue invasive CMV disease, presenting within 7 months after kidney transplantation. Both cases were D+/R-, received lymphocyte-depleting agents and mycophenolate, and both received CMV prophylaxis according to General Practice Guidelines. CMV disease criteria included detectable viral replication in blood, classical endoscopic findings and histopathological confirmation. We emphasize the need of categorical identification of CMV infection risk factors among kidney transplantation recipients, specially CMV donor/recipient serostatus and immunosuppressive medication. Although clinical practice guidelines suggest 1 to 3 months CMV prophylaxis in high-risk cases, extended prophylaxis and immunosuppressive medication adjustment should be considered.

Cytomegalovirus infection in AIDS patients. An illustrative case series / Infección por citomegalovirus en pacientes con SIDA. Una serie ilustrativa

ABSTRACT Background: Cytomegalovirus (CMV) is an opportunistic infection (OI) in immunosuppressed patients. However, there are no clear cut-off values available for quantitative plasmatic CMV measures (viral load [VL]) to discriminate those with CMV illness from those infected suffering a transient viral reactivation. Aim: To estimate a CMV VL cut-off point that discriminates infected patients and those with CMV related diseases, and to clinically characterize AIDS patients with this OI. Patients and Methods: Retrospective analysis of AIDS patients admitted by any reason between years 2017 and 2019 and who had a positive plasma CMV VL at any titer. Cases were categorized with illness or infected using accepted criteria and the cut-off value was obtained by receiver operating characteristic curve (ROC) analysis. Results: Twelve patients were identified as having a CMV-associated illness and seven with CMV infection. A CMV VL of 3,800 copies/mL had a sensitivity of 91.6% and 100% specificity to discriminate both states. Of the 12 patients with CMV illness, all were in AIDS stage and only five were receiving HIV therapy. Predominant clinical presentations were gastrointestinal (50%), followed by liver involvement (25%) and CMV disease (25%). All patients were treated with ganciclovir or valganciclovir. Ten patients had a favorable response (83.3%), one patient only had a laboratory improvement (8.3%) and one died during treatment (8.3%). Drug toxicity was recorded in nine patients but in only three cases, a dose adjustment was necessary. Conclusions: The predominant clinical manifestation in our series was gastrointestinal. A CMV VL cutoff level of CMV VL of 3,800 copies / mL is useful to discriminate infected patients from those with CMV related disease.

Antecedentes: Citomegalovirus (CMV) es una infección oportunista (IO) en pacientes inmunosuprimidos. Sin embargo, se requieren puntos de corte de carga viral (CV) para discriminar a aquellos con enfermedad por CMV de aquellos infectados que sufren una reactivación viral transitoria. Objetivos: Estimar un punto de corte de la CV de CMV que discrimine a los enfermos de los infectados y, además, caracterizar clínicamente a los pacientes con sida que presentan esta IO. Pacientes y Métodos: Análisis retrospectivo de pacientes con sida hospitalizados por cualquier motivo entre los años 2017 y 2019, y que presentaron un CV de CMV plasmática positiva a cualquier título. Los casos se clasificaron como enfermos utilizando criterios aceptados y el valor de corte se obtuvo mediante análisis de una curva ROC. Resultados: Durante el período de estudio, 12 pacientes fueron identificados con enfermedad asociada al CMV y siete con infección. Una CV de 3.800 copias/ml logró una sensibilidad de 91,6% y una especificidad de 100% para discriminar ambos estados. De los 12 pacientes enfermos, todos estaban en etapa de sida y solo 5 recibían terapia contra el VIH. La presentación clínica predominante fue gastrointestinal (50%) seguida del compromiso hepático (25%) y de la enfermedad por CMV (25%). Todos los pacientes fueron tratados con ganciclovir o valganciclovir. Diez pacientes tuvieron una respuesta favorable (83,3%), uno solo tuvo mejoría de laboratorio (8,3%) y otro paciente falleció durante el tratamiento (8,3%). Nueve pacientes evolucionaron con toxicidad farmacológica, pero en solo 3 casos fue necesario ajustar las dosis. Conclusiones: La forma predominante de presentación de la enfermedad fue gastrointestinal. Un punto de corte de 3.800 copias/ml discrimina pacientes infectados de aquellos con la enfermedad.

Evaluation of Toxoplasma, Rubella, and Cytomegalovirus serological results in women of childbearing age

SUMMARY OBJECTIVE This study aimed to determine the rates of IgG and IgM antibodies against cytomegalovirus, rubella, and Toxoplasma gondii (all of which may cause congenital infections) in women of childbearing age who were admitted to Bolu Abant İzzet Baysal University Training and Research Hospital. METHODS Between January 2015 and December 2017, Toxoplasma gondii, rubella, and cytomegalovirus IgM and IgG antibody levels were studied using the ELISA method (Architect i2000SR, Abbott, Germany) in patients aged 15 to 45 who attended the obstetrics and gynecology outpatient clinics. Toxoplasma gondii and cytomegalovirus IgG avidity levels were analyzed retrospectively. RESULTS A total of 13.470 tests were conducted in the laboratory. Seropositivity percentages of IgM antibodies were found to be 1.3%, 0.5%, and 1.6% for Toxoplasma (n = 3607), rubella (n = 3931), and cytomegalovirus (n = 3795), respectively. The seropositivity percentages of IgG antibodies were 22%, 94.2%, and 98.2% for Toxoplasma (n = 702), rubella (n = 693), and cytomegalovirus (n = 679), respectively. Primary infection (acute, recently acquired) was found in 7 (35%) patients with low Toxoplasma IgG avidity. One (3%) patient with low cytomegalovirus IgG avidity had a primary infection. CONCLUSION Toxoplasma gondii seronegativity was found to be high in the region. Therefore, screening women of childbearing age may be important for the prevention of congenital infections caused by Toxoplasma gondii.

RESUMO OBJETIVO O objetivo deste estudo foi determinar as taxas de anticorpos IgG e IgM contra citomegalovírus, rubéola e Toxoplasma gondii (todos os quais podem causar infecções congênitas) em mulheres em idade fértil que foram admitidas no Hospital de Pesquisa e Treinamento da Universidade Bolu Abant İzzet Baysal. MÉTODOS Entre janeiro de 2015 e dezembro de 2017, os níveis de anticorpos IgG e IgM para Toxoplasma gondii, rubéola e citomegalovírus foram estudados usando o método Elisa (Architect i2000SR, Abbott, Alemanha) em pacientes de 15 a 45 anos que compareceram a ambulatórios de obstetrícia e ginecologia. Os níveis de avidez de IgG para Toxoplasma gondii e citomegalovírus foram analisados retrospectivamente. RESULTADOS Um total de 13.470 testes foram realizados em laboratório. As porcentagens de soropositividade dos anticorpos IgM foram de 1,3%, 0,5% e 1,6% para Toxoplasma (n=3.607), rubéola (n=3.931) e citomegalovírus (n=3.795), respectivamente. As porcentagens de soropositividade dos anticorpos IgG foram 22%, 94,2% e 98,2% para Toxoplasma (n=702), rubéola (n=693) e citomegalovírus (n=679), respectivamente. Infecção primária (aguda, adquirida recentemente) foi encontrada em sete (35%) pacientes com baixa avidez para Toxoplasma IgG. Um (3%) paciente com baixa avidez para citomegalovírus IgG teve uma infecção primária. CONCLUSÃO A soronegatividade do Toxoplasma gondii foi alta na região. Portanto, testar mulheres em idade fértil pode ser importante para a prevenção de infecções congênitas causadas pelo Toxoplasma gondii.

Cost minimization analysis of an in-house molecular test for cytomegalovirus in relation to a commercial molecular system

ABSTRACT Introduction: Cytomegalovirus may cause severe disease in immunocompromised patients. Nowadays, quantitative polymerase chain reaction is the gold-standard for both diagnosis and monitoring of cytomegalovirus infection. Most of these assays use cytomegalovirus automated molecular kits which are expensive and therefore not an option for small laboratories, particularly in the developing world. Objective: This study aimed to optimize and validate an in-house cytomegalovirus quantitative polymerase chain reaction test calibrated using the World Health Organization Standards, and to perform a cost-minimization analysis, in comparison to a commercial cytomegalovirus quantitative polymerase chain reaction test. Study design: The methodology consisted of determining: optimization, analytical sensitivity, analytical specificity, precision, curve variability analysis, and inter-laboratorial reproducibility. Patients (n = 30) with known results for cytomegalovirus tested with m2000 RealTime System (Abbott Laboratories, BR) were tested with the in-house assay, as well as patients infected with other human herpes virus, in addition to BK virus. A cost-minimization analysis was performed, from a perspective of the laboratory, assuming diagnostic equivalence of the methodologies applied in the study. Results: The in-house assay had a limit of detection and quantification of 60.3 IU/mL, with no cross-reactivity with the other viral agents tested. Moreover, the test was precise and had a R 2 of 0.954 when compared with the m2000 equipment. The cost analysis showed that the assay was economically advantageous costing a median value of 37.8% and 82.2% in comparison to the molecular test in use at the hospital and the m2000 equipment, respectively. Conclusions: These results demonstrated that in-house quantitative polymerase chain reaction testing is an attractive alternative in comparison to automated molecular platforms, being considerably less expensive and as efficacious as the commercial methods.

Pneumonia por toxoplasmose em paciente imunocompetente / Toxoplasma pneumonia in an immunocompetent patient: case repor

Com grande distribuição mundial e incidência significativa, a toxoplamose é uma doença comum em mamíferos e pássaros, causada pelo protozoário Toxoplasma gondii. No homem, o parasitismo na fase proliferativa intracelular pode se apresentar sem sintomas, ou causar clínica transitória caracterizada por febre, fadiga e linfadenopatia. Por se tratar de patologia com sintomas inespecíficos e comuns a muitas outras, é fundamental a correta pesquisa de diagnósticos diferenciais, como citomegalovírus e Epstein-Barr. Relatamos o caso de um jovem e hígido, que desenvolveu pneumonia e, após confirmação sorológica para toxoplasmose e o tratamento adequado, apresentou melhora clínica.

With great worldwide distribution and significant incidence, toxoplamosis is a common disease in mammals and birds, caused by the protozoan Toxoplasma gondii. In humans, the parasitism in its intracellular proliferative phase may present no symptoms, or cause a transient condition characterized by fever, fatigue, and lymphadenopathy. Because it is a pathology with nonspecific symptoms that are common to many other conditions, it is fundamental to find the correct research of differential diagnoses, such as for Cytomegalovirus and Epstein Barr. We report a case of a young and healthy man who developed pneumonia and, after serological confirmation for toxoplasmosis and the appropriate treatment, presented clinical improvement