[Nutritional status and dietary intake in patients with chonic obstructive pulmonary disease]. / Apports nutritionnels et état nutritionnel au cours de la broncho-pneumopathie chronique obstructive.

INTRODUCTION: Undernutrition is a predictor of mortality in chronic obstructive pulmonary disease (COPD). The objectives of our study were to assess nutritional intake in COPD and to study its relationship with disease severity. METHODS: A cross-sectional study that included 66 patients followed for COPD. Patients included had a body composition study and a respiratory and nutritional assessment. RESULTS: The mean age of the population was 66±9 years. The lean body mass index (LMI) was reduced in 26.1% of patients. It was significantly associated with the GOLD group (P=0.04) and significantly correlated with the forced expiratory volume in the first second (FEV1) (P=0.02) and the distance covered during the six-minute walk test (TM6) (P=0.01). A significant difference was found between the caloric intakes and the different GOLD groups (P=0.04). Mean intakes of calories (P=0.002; r=0.07), protein (P=0.01; r=0.16), carbohydrates (P=0.02; r=0.2) and iron (P=0.01; r=0.13) were significantly correlated with the TM6 results. Caloric intake was significantly correlated with LMI (P=0.01; r=0.16), body mass index (P=0.04; r=0.12), FEV1 (P=0.04; r=-0.12) and GOLD stage (0.002). Similarly, protein intake was significantly correlated with LMI (P=0.001; r=0.11), body mass index (P=0.02; r=0.16), FEV1(%) (P=0.001; r=-0.16) and GOLD stage (P=0.002). CONCLUSION: Undernutrition in COPD is caused by decreased food intake and increased resting energy expenditure. Adequate intakes of glucose, protein, fibers, vitamins and zinc are associated with improved ventilatory function.

[Testosterone and chronic obstructive pulmonary disease]. / Testostéronémie et bronchopneumopathie chronique obstructive.

INTRODUCTION: Testosterone level has been shown to be associated with respiratory function and loss of lean body mass in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the relationship between testosterone level and functional respiratory parameters during COPD. METHODS: We conducted a cross-sectional study that included 95 male patients with stable COPD. Functional tests (body plethysmography, six-minute walk test (6MWT), arterial blood gas) were performed in all patients and serum levels of testosterone, prolactin, FSH, LH and C-reactive protein were determined. Lean body mass was measured using bioelectric impedance. RESULTS: The average age was 63.78±8.90years. COPD was classified as stage 3 in 38% of cases and stage 4 in 11% of cases, group C in 10% of cases and group D in 18% of cases. The average testosterone was 20.87±8.60nmol/L. A significant positive correlation was found between FEV1 (P=0.005), FVC (P=0.005), FEV1/FVC ratio (P=0.001), lean mass index (P=0.021), and testosterone. However, testosterone was not correlated with 6MWT or blood gas parameters. Similarly, it was not correlated with FSH, LH, prolactin and C-reactive protein. CONCLUSION: This study found that serum testosterone level was associated with lung function and lean mass during COPD. Further investigations are required to better evaluate the relationship between COPD and serum testosterone levels and the effect of androgen substitution in lung function.

[Assessment of insomnia among Tunisian patients with lung cancer]. / Évaluation de l'insomnie chez les patients tunisiens atteints de cancers bronchopulmonaires primitifs.

INTRODUCTION: Sleep disorders are relatively common in oncology. However, they have not been well studied and are often treated insufficiently. AIM: To assess the prevalence and severity of insomnia in lung cancer patients and evaluate the relationship between insomnia and certain clinical parameters. METHODS: A cross-sectional study was undertaken of patients in Tunis with primary lung cancer. Socio-demographic and clinical data were obtained from the medical records Patients were then asked to answer questionnaires related to insomnia (ISI), depression-anxiety (HAD) and quality of life (QLQ-C30). RESULTS: Fifty patients with lung cancer were included (46 men, 4 women). The average age was 59±9 years. Insomnia was found in 24 patients (48%) and 60% of patients had depression. HAD was significantly higher in the insomniac patients (21.54±8.96 vs. 9.81±5.28, P<0.0001). Similarly, the QLQ-C30 was significantly lower in these patients (41.24±12.55 vs. 56±16.88, P<0.01). ISI was significantly correlated with HAD and QLQ-C30. CONCLUSION: Insomnia is common in patients with lung cancer. It is responsible for impaired quality of life and psychological distress. Diagnosis and management of insomnia in patients with lung cancer is therefore mandatory.

Virulence determinants, biofilm production and antimicrobial susceptibility in Staphylococcus aureus causing device-associated infections in a Tunisian hospital.

Staphylococcus aureus is a clinically relevant pathogen that causes device-related infections (DRI) driven by several virulence factors. This study characterized S. aureus isolates involved in DRI in Tunisian patients. Forty consecutive S. aureus strains causing DRI and 47 randomly selected S. aureus strains causing non-device-related infections (NDRI) were collected. All strains were screened phenotypically for antibiotic susceptibility and biofilm forming ability. They were investigated for accessory gene regulator (agr) types, biofilm encoding genes (icaADBC), adhesins, leukotoxins, toxic shock toxin, enterotoxins and exotoxins encoding genes by polymerase chain reaction. Meticillin-resistant S. aureus (MRSA) strains were further characterized by staphylococcal cassette chromosome mec (SCCmec) typing. MRSA rates among DRI and NDRI isolates were 23% and 49% (P=0.02), respectively. The DRI isolates formed biofilm more frequently (n=32) than the NDRI isolates (n=28) (P=0.04), with predominance of the moderate biofilm producer category (P=0.027). All biofilm-positive isolates except four harboured icaADBC genes. A significant difference was observed between DRI and NDRI isolates for fnbA (53-77%), spa (45-26%), sdrD (80-55%) and sen (33-11%) genes. DRI strains were agrI (48%) and agrII (30%) types, whereas NDRI strains were agrI (36%) and agrIII (43%) types. SCCmec type IV was carried by 50% of MRSA isolates. This study highlights the virulence potential displayed by S. aureus isolated from DRI in comparison with NDRI.

Modelling of seasonal influenza and estimation of the burden in Tunisia.

The burden of influenza was estimated from surveillance data in Tunisia using epidemiological parameters of transmission with WHO classical tools and mathematical modelling. The incidence rates of influenza-associated influenza-like illness (ILI) per 100 000 were 18 735 in 2012/2013 season; 5536 in 2013/14 and 12 602 in 2014/15. The estimated proportions of influenza-associated ILI in the total outpatient load were 3.16%; 0.86% and 1.98% in the 3 seasons respectively. Distribution of influenza viruses among positive patients was: A(H3N2) 15.5%; A(H1N1)pdm2009 39.2%; and B virus 45.3% in 2014/2015 season. From the estimated numbers of symptomatic cases, we estimated that the critical proportions of the population that should be vaccinated were 15%, 4% and 10% respectively. Running the model for the different values of R0, we quantified the number of symptomatic clinical cases, the clinical attack rates, the symptomatic clinical attack rates and the number of deaths. More realistic versions of this model and improved estimates of parameters from surveillance data will strengthen the estimation of the burden of influenza.

Genetic diversity of influenza B virus in 2009-2010 and 2010-2011 in Tunisia.

OBJECTIVE: The authors had for aim to characterize influenza B strains having circulated in Tunisia to identify new mutations and compare them with reference strains. METHODS: The epidemiological surveillance of influenza allowed identifying 19 patients with symptoms related to respiratory infection, who had been infected by influenza B strains isolated in several regions of Tunisia in 2009-2010 and in 2010-2011. Laboratory identification and detection of mutations in the segment encoding hemagglutinin of influenza viruses was performed by real time PCR and sequencing. RESULTS: The two influenza B Tunisian strains of the 2009-2010 season belonged to the Victoria lineage, whereas 2010-2011 season strains belonged to B/Victoria/2/87 and B/Yamagata/16/88 lineages with a dominance of the Yamagata lineage (76%). This study allowed identifying amino acid substitutions: T121A, S150I, N165Y, T181A, G183R, D196N, S229D, M251V and K253R in the B/Yamagata lineage; L58P, N75K, K109N, N165K, S172P and K257R into the B/Victoria lineage. These mutations were specific of Tunisian groups of variants. Most influenza B-Yamagata lineage viruses (69%) were associated with severe cases. CONCLUSION: Molecular analysis of the various influenza B strains circulating in Tunisia is useful to detect new mutations that can modify the phenotype of influenza strains.

Emergence of carbapenem-resistant OXA-48 carbapenemase-producing Enterobacteriaceae in Tunisia.

We screened 21 extended spectrum ß-lactamase-producing Enterobacteriaceae with reduced susceptibility to carbapenems for carbapenemase production. Five strains (four Klebsiella pneumoniae and one Citrobacter freundii) showed carbapenemase production, which was identified as OXA-48. The bla(OXA-48) gene was detected on ~54 kb plasmids belonging to IncA/C in one case. Two isolates harboured IS1999, which is involved in bla(OXA-48) mobilization. Carbapenem resistance in enterobacteria should be regarded as an emerging clinical problem in our hospital and necessitates rigorous surveillance in order to limit its spread.

Macrolide and tetracycline resistance in clinical strains of Streptococcus agalactiae isolated in Tunisia.

Between 2007 and 2009, 226 clinical strains of Streptococcus agalactiae, recovered from female genital specimens and from gastric fluid or ear specimens from infected newborns, were isolated at the Laboratory of Microbiology of Charles Nicolle Hospital of Tunis. They were investigated to determine the prevalence of antibiotic resistance and to characterize the mechanisms of resistance to macrolide and tetracycline. All strains were susceptible to penicillin, ampicillin and quinupristin-dalfopristin. They were resistant to chloramphenicol (3.1%), rifampicin (19.1%), erythromycin (40%) and tetracycline (97.3%); 3.1% were highly resistant to streptomycin and 1.3% to gentamicin. Among the erythromycin-resistant isolates, 78.7% showed a constitutive macrolide-lincosamide-streptogramin B (MLS(B)) phenotype with high-level resistance to macrolides and clindamycin (MIC(50) >256 µg ml(-1)), 10% showed an inducible MLS(B) phenotype with high MICs of macrolides (MIC(50) >256 µg ml(-1)) and low MICs of clindamycin (MIC(50)=8 µg ml(-1)) and 2.2% showed an M phenotype with a low erythromycin-resistance level (MIC range=12-32 µg ml(-1)) and low MICs of clindamycin (MIC range: 0.75-1 µg ml(-1)). All strains were susceptible to quinupristin-dalfopristin and linezolid (MIC(90): 0.75 µg ml(-1) for each). MLS(B) phenotypes were genotypically confirmed by the presence of the erm(B) gene and the M phenotype by the mef(A) gene. Resistance to tetracycline was mainly due to the tet(M) gene (93.1%) encoding a ribosome protection mechanism. This determinant is commonly associated with the conjugative transposon Tn916 (P≤0.0002). tet(O) and tet(T) existed in a minority (2.2% and 0.4%, respectively). The efflux mechanism presented by tet(L) was less frequently present (4.5%). No significant association was found between erm(B) and tet(M) genes.

[Large diversity of routine methods used for monitoring human cytomegalovirus infections in France]. / Diversité des méthodes utilisées par les laboratoires français pour la surveillance des infections à cytomégalovirus humain.

UNLABELLED: Monitoring cytomegalovirus circulating viral load is an important parameter of the follow-up in immunocompromised patients. It can be measured either by DNAemia or by pp65 antigenemia. The French national reference center for cytomegaloviruses organized an investigation of practice in 37 teacher hospital virology laboratories to assess the situation in France in 2010. METHODS: A questionnaire was sent to collect following information: method used in routine for monitoring of circulating viral load of CMV, assay used, sample matrix and extraction method. RESULTS: Thirty-six over thirty-seven laboratories filled the questionnaire. Among these, 67% used the quantitative PCR in routine, 11% antigenemia and 22% antigenemia or quantitative PCR; 87% of the laboratories use whole blood for quantitative PCR, whereas 10% and 3% use plasma and leukocytes respectively. Among the laboratories using DNAemia, 100% used real-time PCR assays, 91% use an automated extraction and 9% a manual extraction. CONCLUSION: Thus in France, measurement of DNAemia by real-time PCR is a tool, which gradually replaces the antigenemia for the monitoring of cytomegalovirus infection among immunocompromised patients. The very great diversity of the methods used justifies the installation of a national quality control on total blood, matrix used by 87% of the laboratories.

[Human immunodeficiency virus type 1 subtypes in Djibouti]. / Sous-types du virus de l'immunodéficience humaine de type 1 a Djibouti.

The authors had for aim to study the distribution of HIV-1 subtypes in a cohort of HIV positive patients in the hospital General Peltier of Djibouti. An epidemiological study was made on 40 HIV-1 positive patients followed up in the Infectious Diseases Department over three months. All patients sample were subtyped by genotyping. Thirty-five patients (15 men and 20 women) were found infected by an HIV-1 strain belonging to the M group. Genotyping revealed that - 66% of samples were infected with subtype C, 20% with CRF02_AG, 8.5% with B, 2.9% with CRF02_AG/C and 2.9% with K/C. In fact, Subtype C prevalence has been described in the Horn of Africa and a similar prevalence was previously reported in Djibouti. However our study describes the subtype B in Djibouti for the first time. It is the predominant subtype in the Western world. The detection of CRF02_AG strains indicates that they are still circulating in Djibouti, the only country in East Africa in which this recombinant virus was found. CRF02_AG recombinant isolates were primarily described in West and Central Africa. The presence of this viral heterogeneity, probably coming from the mixing of populations in Djibouti, which is an essential economic and geographical crossroads, incites us to vigilance in the surveillance of this infection.

[Hepatitis A virus detection in shellfish from Tunisia by reverse transcription-nested PCR--investigation of a correlation between viral and bacterial contamination]. / Détection du virus de l'hépatite A dans les coquillages en Tunisie par reverse transcription-nested PCR - recherche de corrélation entre la contamination virale et bactérienne.

OBJECTIVES: We aimed at evaluating the contamination by hepatitis A virus (HAV) of 54 shellfish samples collected from five Tunisian shellfish harvesting areas and finding a correlation between bacterial and viral contamination. MATERIAL AND METHODS: Fifty-four shellfish samples were analysed in our study. Two methods of viral extraction were evaluated by reverse transcription-nested PCR. The first one was based on elution by glycine solution and the second one used a beef extract solution. Bacteriological determination (Samonella and E. coli) was carried out for all shellfish samples. RESULTS: Glycine extraction showed a higher detection rate of HAV compared to the saline beef extraction method. The hepatitis A virus was detected in 32 % of shellfish samples analysed. None of the samples revealed the presence of Samonella. From 17 samples positive for HAV, we found six samples showing a number of E. coli below the European legislation. CONCLUSION: An important HAV contamination was observed in our study. No correlation between bacterial and viral contamination was found.

Hepatocellular carcinoma in unrelated viral cirrhosis: long-term results after liver transplantation.

INTRODUCTION: Chronic viral hepatitis is considered to be the most significant risk factor for development of hepatocellular carcinoma (HCC). Nevertheless, about 5%-15% of HCC occur in noncirrhotic or virus-unrelated cirrhotic patients. The natural history of HCC in terms of incidence, clinical features, and tumor progression differs according to the underlying cancerogenic factors and differences in hepatocarcinogenetic pathways. Little is know about the relationship between HCC outcomes after liver transplantation (OLT) and the primary liver disease. We retrospectively analyzed the outcomes of patients transplanted due to HCC in settings of either virus-related or virus-unrelated cirrhosis. PATIENTS AND METHODS: From January 2000 to December 2007, 179 patients underwent OLT due to HCC: 157 (87.8%) affected by virus-related (group A) and 22 (12.2%) virus-unrelated cirrhosis (group B). We analyzed patient characteristics including demographics, tumor features, downstaging treatments, and recurrences. RESULTS: At a mean follow-up of 41.2 months, the 3- and 5-year overall long-term survivals between group A versus group B were 81% versus 75% and 85% versus 78.4% respectively (P = NS). The 3- and 5-year disease-free survivals between group A versus group B were 90.8% versus 89.6% and 85.6% versus 85.6%, respectively (P = NS). After OLT, HCC recurrences occurred in 14 group A (14/157, 8.9%) and 4 patients (4/22, 18.1%) group B subjects. DISCUSSION: Our data demonstrated that after OLT, HCC outcomes were not different between patients with virus-related or -unrelated cirrhosis. The direct oncogenetic role played by hepatitis B and C appear to not be associated with a greater risk to develop HCC recurrence.

Successful treatment of influenza A virus by oseltamivir in bone marrow transplant recipients.

INFVA is an important cause of pulmonary infections in patients receiving BMT, and is associated with considerable morbidity and mortality for a readily preventable and treatable infection. Few studies have addressed the impact of the new neuraminidase inhibitors in the prognosis of influenza after BMT. The aim of this study is to assess the impact of oseltamivir on the control of INFVA infection in BMT recipients. INFVA was screened in NPA and/or bronchoalveolar lavage using IF in all BMT recipients having respiratory symptoms. Three URTI and one associated upper and LRTI were diagnosed in three BMT recipients out of six patients admitted to the BMT unit, during eight-wk period (March and April 2008). All patients having INFVA respiratory infection were treated by oral oseltamivir 60 mg/day, begun more than 48 h after symptom onset. Respiratory symptoms disappeared within a mean of 60 h (48-96 h) of treatment. However, viral tests had remained positive for 8-39 days. Outside the initial associated URTI and LRTI, no further viral pneumonia occurred. No patient died of INFVA. Oseltamivir was well tolerated outside vomiting during the first three days of treatment in one patient. Oseltamivir appears to play an important role in the outcome of INFVA infection as well in URTI as in severe LRTI in patients receiving BMT.

Living donor liver transplantation for hepatocellular carcinoma: long-term results compared with deceased donor liver transplantation.

OBJECTIVE: Living donor liver transplantation (LDLT) may represent a valid therapeutic option allowing several advantages for patients affected by hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT). However, some reports in the literature have demonstrated worse long-term and disease-free survivals among patients treated by LDLT than deceased donor liver transplantation (DDLT) for HCC. Herein we have reported our long-term results comparing LDLT with DDLT for HCC. PATIENTS AND METHODS: Among 179 patients who underwent OLT from January 2000 to December 2007, 25 (13.9%) received LDLT with HCC 154 (86.1%) received DDLT. Patients were selected based on the Milan criteria. Transarterial chemoembolization, radiofrequency ablation, percutaneous alcoholization, or liver resection was applied as a downstaging procedure while on the waiting list. Patients with stage II HCC were proposed for LDLT. RESULTS: The overall 3- and 5-year survival rates were 77.3% and 68.7% versus 82.8% and 76.7% for LDLT and DDLT recipients, respectively, with no significant difference by the log-rank test. Moreover, the 3- and 5-year recurrence-free survival rates were 95.5% and 95.5% (LDLT) versus 90.5% and 89.4% (DDLT; P = NS). CONCLUSIONS: LDLT guarantees the same long-term results as DDLT where there are analogous selection criteria for candidates. The Milan criteria remain a valid tool to select candidates for LDLT to achieve optimal long-term results.

Liver adenomatosis: a rare indication for living donor liver transplantation.

Liver adenomatosis (LA) is a rare benign disease of the liver with unclear pathogenesis, which is characterized by multiple hepatic adenomas. The management of LA remains controversial. Herein we have reported a case of LA treated by living donor liver transplantation (LDLT). A 48-year-old woman developed multiple liver adenomas. In view of the sizes and localizations of the lesions, the patient underwent right hepatic resection and segment II nodulectomy. Thirty-four months later, she developed recurrence of multiple hepatic adenomas and 2 nodules were highly suspect for hepatocellular carcinoma. Re-resection was not indicated due to the whole liver being involved with adenomas. The patient underwent LDLT. At 45 months thereafter she is alive and disease-free. In conclusion, LDLT is indicated in cases of nonresectability; it may offer optimal results in view of the absence of portal hypertension and the elimination of waiting list time.

[Effects of prolonged exposure to antiretroviral treatment in Tunisian patients assessed by the HIV-1 resistance genotypic test]. / Effets de l'exposition prolongée au traitement chez des patients tunisiens, évalués par le test génotypique de résistance du VIH-1.

SETTINGS: In Tunisia, therapeutic failure profile is detected in 42.22% of treated patients. These patients are still confronted to ethical and socioeconomic problems but also to therapeutic and technical ones. Indeed, the limited number of available antiretroviral (ARV) molecules and the unavailability of resistance genotypic test in routine use is the reason why the same therapeutic combination of ARV molecules is maintained after therapeutic failure in some cases. OBJECTIVE AND METHOD: The authors studied the evolution, on two consecutive samples, of resistance mutations in patients with prolonged exposure to the same therapeutic combination after therapeutic failure and the resulting effect on management of these patients. RESULTS: We found a greater number of patients presenting with mutant viral stains after a prolonged exposure to the same ARV molecules. Results also showed that the detected mutation frequency increased and even more on the second sample, compared to the first one. Thus, the early diagnostic of resistance mutations using genotypic resistance test would be of great interest by allowing the physician to take necessary measures to reduce resistance rate and find an optimal treatment for the patient. CONCLUSION: The introduction of new ARV molecules in our country was also an important step by improving the therapeutic management of HIV infected patients.

Adult living donor liver transplantation with right lobe graft: the venous outflow management in the Milan-Niguarda experience.

In right lobe living donor liver transplantation (ALDLT), reconstruction of middle hepatic vein (MHV) tributaries is often necessary to avoid severe graft congestion. From March 2001, we performed 36 right lobe ALDLT (segments 5, 6, 7, and 8) without MHV and one pediatric transplant (segments 2 and 3). In the presence of MHV tributaries larger than 5 mm, we intraoperatively evaluated the need for reconstruction. At a mean follow-up of 848 days (range=8-2412), 33/37 transplanted patients are alive with overall patient and graft survivals of 89.2% and 83.8%, respectively. Large MHV tributaries (>5 mm) were present in 10 cases, and inferior right hepatic veins (IRHV) draining segment 6 in 11 cases. In 10 cases, we performed an end-to-side anastomosis between the IRHV and the side of the recipient vena cava. In three cases, the MHV tributaries were end-to-end anastomosed to the stump of the recipient MHV. In all other cases, the vein tributaries were not reconstructed. A computed tomography scan performed from 1 to 3 months after surgery did not show any congested area in the liver parenchyma. In our experience, reconstruction of the MHV tributaries was not always necessary when graft-to-recipient weight ratio is >0.8. Pre- and intraoperative evaluation of the segmental branches of the hepatic vein is crucial to decide about reconstructing these collaterals. Anastomosis of V5 or V8 to the stump of the recipient MHV reduces the number of vascular anastomosis and maintains a physiological angle between these collaterals and the caval vein.

Profile of drug resistance mutations among HIV-1-infected Tunisian subjects failing antiretroviral therapy.

Three years after the introduction of antiretroviral therapy (ART) in Tunisia (North Africa), we aimed to determine the prevalence of drug resistance mutations in Tunisian HIV-1-infected patients failing ART. Plasma samples of 80 patients were tested for genotypic resistance using two distinct line probe assays, LiPA HIV-1 reverse transcriptase RT and LiPA HIV-1 protease assay. Of the 80 patients, 82.5% showed resistance to at least one antiretroviral molecule. In the RT gene, resistance to nucleoside RT inhibitors (NRTIs) and non-nucleoside RT inhibitors (NNRTIs) were recognized in 66.25 and 37.5%, respectively, with M184V, T215Y and K103N being the codons most frequently involved. Resistance to protease inhibitors (PIs) was found in 46.25% of cases. Despite the presence of different mutations, the viral variants were still susceptible to other RTIs and PIs that are currently not available in Tunisia. Thus, alternative therapeutic options exist but are not yet accessible.

[Different human cytomegalovirus glycoprotein B (gB) genotype distribution]. / Distribution de différents génotypes de la glycoprotéine B (gB) du cytomégalovirus humain.

The glycoprotein B (gB) is the major glycoprotein of the envelope of the human cytomegalovirus, it is encoded by UL55 open reading frame, implicated in host cell, entry cell to cell virus transmission and fusion of infected cells and a significant is an important target for immuno-reactions humoral and cellular. A prospective analysis of cytomegalovirus glycoprotein B genotype was conducted on 31 immunodepressed (transplant recipients and AIDS patients). The DNA was extracted directly from the bronchoalveolar liquid (BAL) of these patients. The gB genotypes of CMV was determined by using the polymerase chain reaction, followed by the digestion of two enzymes of restriction HinfI and RsaI. The distribution of the gB genotype of the CMV was: gB1 38,70%; gB2 25,80%; gB3 16,12% and gB4 19,35%. The analysis of the peptide sequence of this region (codons 437-520), indicate the variation was more frequent between codons 448-480.

Analysis of cytomegalovirus (CMV) viremia using the pp65 antigenemia assay, the amplicor CMV test, and a semi-quantitative polymerase chain reaction test after allogeneic marrow transplantation.

A pp65 antigenemia assay for polymorphonuclear leukocytes (PMNLs) (CINAkit Rapid Antigenemia), and a qualitative polymerase chain reaction (PCR) test for plasma 'PCR-P qual' (Amplicor cytomegalovirus [CMV] test) were performed for 126 samples (blood and plasma) obtained from 18 bone marrow transplant patients, over a 9-month surveillance period. Among those samples, 92 were assayed with a semi-quantitative PCR test for PMNLs 'PCR-L quant.' The number of samples with a positive CMV test for antigenemia and PCR-P qual assays was 20.63% and 12.7%, respectively, whereas the PCR-L quant assay was positive in 48 of the 92 samples assayed (52.17%). The rates of concordance of the results of PCR-P qual and antigenemia, PCR-P qual and PCR-L quant, antigenemia and PCR-L quant were 92%, 65.2% and 66.8%, respectively. The analysis of the results for the 92 specimens tested by all 3 methods showed a rate of concordance of 63% among all methods. Good agreement (kappa=0.72) was found only between pp65 Ag and PCR-P qual assays. Clinical disease correlates with an antigenemia high viral load. Three patients had CMV disease despite preemptive therapy, and all of them had graft-versus-host-disease (GVHD). PMNLs-based assays are more efficient in monitoring CMV reactivation, but for high-risk patients with GVHD, more sensitive assays (real-time PCR) must be done.