Cytomegalovirus Infection after Renal Transplantation: Occurrence, Clinical Features, and the Cutoff for Antigenemia in a University Hospital in Brazil.

BACKGROUND: Cytomegalovirus (CMV) is the main infectious agent causative of morbidity and mortality in transplant recipients. This study aimed to describe the occurrence and clinical features of CMV infection, and the optimum antigenemia assay cutoff associated with symptomatic infection. MATERIALS AND METHODS: This was a cohort study that investigated 87 patients undergoing renal transplantation. The patients were monitored with the CMV antigenemia assay performed weekly for the first 3 months post-transplantation and subsequently, when CMV infection was suspected clinically. RESULTS: CMV infection was observed in 63.2% (55/87) of the recipients during the follow-up. Of the 65 episodes observed, 75% (49/65) occurred until 100 days after transplantation (D+100) and 25% (16/65) after D+100 with a median of 60 days. CMV infection was associated with age of the transplant recipients (P = 0.001) and use of deceased donor organ (P = 0.009). There were asymptomatic (34%) and symptomatic (66%) episodes of CMV infection, in which diarrhea was the most common symptom (22.6%), followed by elevated creatinine levels (14.5%), fever (12.9%) and leukopenia (10.5%). The optimum cutoff point associated with symptomatic infection was 5 positive cells/200,000 leukocytes (area under the curve = 0.87, positive predictive value = 88% and negative predictive value= 71%). CONCLUSIONS: The high occurrence and the risk factors for CMV infection such as the age of recipients, the number of positive cells in the antigenemia assay, and use of a deceased donor organ should be considered for appropriate monitoring and management of kidney recipients during the post-transplant period.

Late cytomegalovirus infection after hematopoietic stem cell transplantation: case reports.

Cytomegalovirus is related to high rates of morbidity and mortality after hematopoietic stem cell transplantation. This report highlights the importance of adequate monitoring and management of this infection. We report on two cases of patients with late subclinical cytomegalovirus infection. These patients were monitored for antigenemia by indirect immunofluorescence assay. Active cytomegalovirus infection is most common in the first three months after transplantation however the cases reported herein show the importance of monitoring for active infection after Day +100 post-transplantation. Early detection of active infection enables quick preemptive therapy. In conclusion, we emphasize that patients with risk factors for developing severe or late cytomegalovirus disease should be monitored for more than 100 post-transplant days as late active infection is a reality.

Seroprevalence and serum profile of cytomegalovirus infection among patients with hematologic disorders in Bahia State, Brazil.

Human cytomegalovirus (CMV) is a ubiquitous herpesvirus with from 30% to 100% of the general population exhibiting prior exposure by serology. This cross-sectional study evaluated the serological profile of anti-CMV antibodies and two acute-phase reaction proteins in Haematologic Disorder Patients (HDPs) from Bahia State, Brazil. Immuno-chemiluminescence assays were performed to detect anti-CMV IgM and IgG antibodies. Serological levels of High Sensitivity C-Reactive Protein (CRPH) and Alpha-1-Acid Glycoprotein (AAG) were measured using immunonephelometry. A total of 470 HDPs were enrolled, 238 (50.6%) males and 232 (49.4%) females. The overall seroprevalence of CMV was 89.4%, directly proportional to age and to the amount of blood units transfused. There was no difference between seroprevalence rates according to gender (P = 0.12). Four HDPs (0.9%) were seropositives for anti-CMV IgM, only one could be characterized as recent acute infection. The most CMV seropositive HDPs had anti-CMV IgG in low titers. There was a tendency for females to have higher anti-CMV IgG titers than men (P < 0.05). CRPH levels were different among HDPs CMV negative and positive groups (P < 0.001). There was no difference in the AAG levels between groups (P = 0.15). The high CMV seroprevalence found underscores the importance of using strategies to provide "CMV safe" blood to HDPs who are at high risk of developing severe CMV infection. CRPH can be used as a biomarker associated with CMV seropositivity; however, more efforts are needed to better characterize the clinical profile of active CMV infection in this group of patients.