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1.
BMC Infect Dis ; 19(1): 1046, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31822287

RESUMO

BACKGROUND: Congenital cytomegalovirus (cCMV) infection is the most common congenital infection and a leading cause of long-term neurological and sensory sequelae, the most common being sensorineural hearing loss (SNHL). Despite extensive research, clinical or laboratory markers to identify CMV infected children with increased risk for disease have not been identified. This study utilizes viral whole-genome next generation-sequencing (NGS) of specimens from congenitally infected infants to explore viral diversity and specific viral variants that may be associated with symptomatic infection and SNHL. METHODS: CMV DNA from urine specimens of 30 infants (17 asymptomatic, 13 symptomatic) was target enriched and next generation sequenced resulting in 93% coverage of the CMV genome allowing analysis of viral diversity. RESULTS: Variant frequency distribution was compared between children with symptomatic and asymptomatic cCMV and those with (n = 13) and without (n = 17) hearing loss. The CMV genes UL48A, UL88, US19 and US22 were found to have an increase in nucleotide diversity in symptomatic children; while UL57, UL20, UL104, US14, UL115, and UL35 had an increase in diversity in children with hearing loss. An analysis of single variant differences between symptomatic and asymptomatic children found UL55 to have the highest number, while the most variants associated with SNHL were in the RL11 gene family. In asymptomatic infants with SNHL, mutations were observed more frequently in UL33 and UL20. CONCLUSION: CMV genomes from infected newborns can be mapped to 93% of the genome at a depth allowing accurate and reproducible analysis of polymorphisms for variant and gene discovery that may be linked to symptomatic and hearing loss outcomes.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Citomegalovirus/genética , DNA Viral/genética , Perda Auditiva Neurossensorial/diagnóstico , Criança , Citomegalovirus/classificação , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/virologia , DNA Viral/metabolismo , DNA Viral/urina , Feminino , Perda Auditiva Neurossensorial/complicações , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Lactente , Recém-Nascido , Masculino , Mutação , Filogenia , Análise de Componente Principal
2.
Georgian Med News ; (295): 67-70, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31804202

RESUMO

The article presents the results of a comparative analysis of the level of interleukins of children with Shigellosis in different periods of the disease depending on the presents of CMV-infection in patients. To achieve the goal, 63 children aged from three to eight years old with Shigellosis were examined, who were treated at the Regional Children's Infectious Clinical Hospital of Kharkiv, Ukraine. It has been established that the presence of CMV in patients with Shigellosis leads to the development of cytokine imbalance which persists until the period of early convalescence. In the acute period of Shigellosis in children with CMV infection, the level of IL-1ß significantly increases with unreliable fluctuations in the indices of TNF-α and IL-4. In children with Shigellosis without comorbidities, an increase in the level of all cytokines is recorded. In children with monoinfection to the period of convalescence, a significant dynamics of decrease in the levels of all interleukins was observed with their indicators approaching the physiological norm. In case of Shigellosis in children with CMV, the content of IL-1ß and IL-4 was still significantly high. Violation of the normalization of the cytokine profile of patients with Shigellosis on the background of CMV infection may be one of the leading factors in the torpid clinical recovery, the formation of an unfavorable course of the disease. In our opinion, these features of the cytokine response of patients must be considered during the period of rehabilitation and follow-up.


Assuntos
Citocinas , Infecções por Citomegalovirus , Disenteria Bacilar , Criança , Pré-Escolar , Citocinas/metabolismo , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/imunologia , Disenteria Bacilar/complicações , Disenteria Bacilar/imunologia , Humanos , Interleucinas , Ucrânia
3.
Medicine (Baltimore) ; 98(49): e18163, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804330

RESUMO

RATIONALE: Non-traumatic bowel perforation caused by cytomegalovirus (CMV) and Mycobacterium avium complex (MAC) infections has become rare among patients with acquired immunodeficiency syndrome (AIDS) in the era of combination antiretroviral therapy (cART); however, CMV-associated and MAC-related immune reconstitution inflammatory syndrome (IRIS) has subsequently emerged owing to the wide use of integrase inhibitor-based regimens. Here we report a case of spontaneous perforation of the jejunum in a patient with human immunodeficiency virus (HIV) infection with good compliance to cART. PATIENT CONCERNS: A 32-year-old HIV-infected man developed CMV disease and DMAC infection, as unmasking IRIS, 3 days after the initiation of cART. After appropriate treatment for opportunistic infections, intermittent fever with enlarged lymph nodes in the abdomen occurred as paradoxical IRIS. The patient was administered prednisolone with subsequent tapering according to his clinical condition. DIAGNOSES: Unexpected perforation of hollow organ during the titration of steroid dose with clinical presentations of severe abdominal pain was diagnosed by chest radiography. INTERVENTIONS: He underwent surgical repair with peritoneal toileting smoothly. OUTCOMES: He was discharged well with a clean surgical wound on post-operative day 10. LESSONS: Bowel perforation may be a life-threatening manifestation of IRIS in the era of cART. Steroids should be avoided, if possible, to decrease the risk of bowel perforation, especially in IRIS occurred after opportunistic diseases involving the gastrointestinal tract.


Assuntos
Infecções por Citomegalovirus/complicações , Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Perfuração Intestinal/etiologia , Doenças do Jejuno/etiologia , Infecção por Mycobacterium avium-intracellulare/complicações , Infecções Oportunistas Relacionadas com a AIDS , Adulto , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Humanos , Masculino
4.
Postgrad Med ; 131(8): 619-622, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31506001

RESUMO

Cytomegalovirus (CMV) infections are asymptomatic in immunocompetent patients but in immunocompromised patients, CMV infections have varying manifestations depending on their location. Patient who are organ transplant recipients, taking immunosuppressive therapy for a long time are at increased risk of CMV infections. CMV-induced gastric ulcer is very rare but many cases have been reported in the literature. No case describing association between CMV-related gastric ulcer and glomerulonephritis has been reported in the literature so far. In this article, we describe a case of pauci immune crescentic glomerulonephritis in a patient who was on rituximab and long-term steroid therapy and found to have CMV-related gastric ulcer. The association of small vessel vasculitis and CMV-related gastrointestinal infection has not been studied in the literature. Pauci immune crescentic glomerulonephritis is a subtype of rapidly progressive glomerulonephritis manifested by continuous loss of renal functions with features of dysmorphic red blood cells and glomerular proteinuria. Treatment of such condition is a genetically engineered chimeric murine/human monoclonal IgG1 kappa antibody directed against the CD20 antigen known as Rituximab. We also discussed the pathogenesis of CMV- induced gastric ulcer after rituximab therapy. This case emphasizes the importance of opportunistic infections in glomerulonephritis patients and raises the awareness that glomerunephritis patients are at increased risk of opportunistic infections as well. Rituximab was considered to be a safer drug but over the years, the incidence if opportunistic infections in patients on rituximab has been increasing.


Assuntos
Infecções por Citomegalovirus/complicações , Glomerulonefrite/tratamento farmacológico , Hospedeiro Imunocomprometido , Rituximab/uso terapêutico , Úlcera Gástrica/etiologia , Corticosteroides/uso terapêutico , Idoso , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Glomerulonefrite/complicações , Humanos , Masculino , Rituximab/administração & dosagem , Rituximab/efeitos adversos
5.
Arkh Patol ; 81(4): 43-47, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31407717

RESUMO

OBJECTIVE: To study a change in the architectonics of fetal surface veins of the placenta and the structure of the latter in cytomegalovirus infection in pregnant women. MATERIAL AND METHODS: Placentas were studied and divided in 3 groups: 1) 35 placentas from women with physiological pregnancy; 2) 37 placentas from women with an exacerbation of latent cytomegalovirus infection and with chronic compensated placental insufficiency; 3) 30 placentas from those with an exacerbation of latent cytomegalovirus infection and with chronic subcompensated placental insufficiency. After X-ray contrasting the fetal surface veins of the placenta and collecting its sections for morphological analysis, the changes in the blood vessels were compared with the structure of the villous chorion. RESULTS: As compared with Group 2, Group 3 showed reductions in placental weights and placental areas, as well as cotyledon asymmetry and a preponderance of anatomical forms with weak vascular contrasting along with the more frequent emergence of areas of varicosity, contraction, and inflammation of the umbilical vein, as well as the placental fetal surface veins. The investigators more often detected collagenization, fibrinoid degradation, and the increased stromal volume of the stem villi, fibrinoid deposition around the latter, and decreases in the proportion of the intervillous space and syncytiotrophoblast; dilatation of the veins and narrowing of the arteries of the stem villi; pronounced plethora of terminal villi and their avascular forms, intermediate immature villi, chorioamnionitis, deciduitis, pseudonecrosis, calcifications, as well as hemorrhages in the intervillous space. CONCLUSION: In the development of subcompensated placental insufficiency in women who have experienced an exacerbation of latent cytomegalovirus infection in the second trimester of pregnancy, an important role is assigned to anatomical and pathological changes in the umbilical, fetal surface, and villous chorionic veins, which indicate the development of fetoplacental hypertension, the deceleration of blood flow, and the longer contact of the pathogen with the endothelium and syncytiotrophoblast.


Assuntos
Infecções por Citomegalovirus , Placenta , Insuficiência Placentária , Complicações Infecciosas na Gravidez , Córion , Infecções por Citomegalovirus/complicações , Feminino , Humanos , Placenta/irrigação sanguínea , Placenta/patologia , Insuficiência Placentária/virologia , Gravidez , Complicações Infecciosas na Gravidez/patologia , Segundo Trimestre da Gravidez
6.
Virol J ; 16(1): 96, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370833

RESUMO

BACKGROUND: Human cytomegalovirus (HCMV) has been associated with malignant gliomas. The purpose of the present study was to investigate the presence of HCMV in common non-glial tumors of the central nervous system (CNS) and to determine whether it is a glioma-specific phenomenon. METHODS: Using HCMV-specific immunohistochemical staining, HCMV proteins IE1-72 and pp65 were examined in 65 meningiomas (benign, atypical and malignant), 45 pituitary adenomas, 20 cavernous hemangiomas, and 30 metastatic carcinomas specimens. HCMV DNA was also measured in these tumor tissues and the peripheral blood from patients using nested PCR. RESULTS: In meningioma, IE1-72 was detected in 3.1% (2/65) and pp65 was detected in 4.6% (3/65), whereas no IE1-72 and pp65 were detected in atypical and malignant meningioma. A low level of IE1-72 immunoreactivity 6.7% (2/30) was detected in metastatic carcinoma; pp65 was not detected. No HCMV components were detected in pituitary adenoma and cavernous hemangioma. The results of immunohistochemical staining were confirmed by HCMV-specific PCR. HCMV DNA was not detected in the peripheral blood of the non-glial CNS tumors patients. CONCLUSIONS: Our results demonstrate that the presence of HCMV components is not an entirely glioma-specific phenomenon, and that HCMV is present in a low percentage in some non-glioma CNS tumors. Comparing HCMV-positive non-glial CNS tumors with HCMV-positive gliomas may cast light on the mechanism and role of HCMV in CNS tumors.


Assuntos
Neoplasias Encefálicas/virologia , Infecções por Citomegalovirus/complicações , Citomegalovirus/isolamento & purificação , Hemangioma/virologia , Meningioma/virologia , Neoplasias Hipofisárias/virologia , Adulto , Idoso , Neoplasias Encefálicas/secundário , Citomegalovirus/genética , Feminino , Glioma/virologia , Humanos , Proteínas Imediatamente Precoces/genética , Masculino , Pessoa de Meia-Idade , Proteínas da Matriz Viral/genética , Proteínas Virais/genética
7.
Asian Pac J Cancer Prev ; 20(8): 2275-2279, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31450895

RESUMO

Breast cancer is the most common cause of death among women worldwide. Although there are many known risk factors in breast cancer development, infectious diseases have appeared as one of the important key to contribute to carcinogenesis formation. The effects of Human Cytomegalovirus (HCMV) on women with breast cancer has been recently studied and reported. To contribute to this research trend, this study was conducted to evaluate the association between HCMV and the women with breast cancer. Objective: This experiment aimed to evaluate HCMV DNA in women with breast cancer in Ahvaz city, Iran. Materials and Methods: A total of 37 formalin fixed paraffin embedded tissues of the patients with ductal breast carcinoma and 35 paraffin embedded tissues of the patients with fibro adenoma as control group were collected. The deparaffinization of all the samples were carried out and the DNA was extracted. Initially, the PCR test was carried out to detect beta ­globulin DNA as an internal control. For those samples positive for beta ­globulin DNA, Polymerase Chain reaction (PCR) was used to detect HCMV for the tests and control samples. Results: Among 37 ductal breast carcinoma, 20 (54.04%) cases were proved positive for HCMV DNA by PCR. While among the 35 control group (fibroadenoma), 10 (28.57%) cases were positive for HCMV DNA (P >0.028). The prevalences of HCMV DNA among the age groups 30-39, 40-49 and >50 years were 7 (72.22%), 9 (69.23%), 4 (57.14%), respectively (P=0.066). A high frequency of HCMV DNA was detected in tumor grade III, 13/18 (58.33%) compared with tumor grade II, 7/19 (36.84%) (p=0.044). A high frequency of 16/24 (66.66%) of HCMV DNA was found in invasive ductal breast cancer compared with 4/13 (30.76%) HCMV DNA in situ (P<0.028). Conclusion: A high prevalence of 54.05% HCMV was found among the patients with ductal carcinoma. The percentages of the high prevalence of HCMV among age group (40-49) years, tumors grades, and invasive stage were (69.23%), (58.33%), (66.66%), respectively. Further study of HCMV in the latency phase in patients with ductal carcinoma would be necessary to extend our knowledge.


Assuntos
Neoplasias da Mama/genética , Carcinoma Ductal de Mama/genética , Infecções por Citomegalovirus/complicações , Citomegalovirus/genética , DNA Viral/genética , Fibroadenoma/genética , Adulto , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/virologia , Carcinoma Ductal de Mama/epidemiologia , Carcinoma Ductal de Mama/virologia , Estudos de Casos e Controles , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/virologia , Feminino , Fibroadenoma/epidemiologia , Fibroadenoma/virologia , Seguimentos , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Prognóstico , Reação em Cadeia da Polimerase em Tempo Real
8.
Rom J Ophthalmol ; 63(2): 178-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31334398

RESUMO

BACKGROUND: Endogenous endophthalmitis is a serious sight-threatening disease. Common causes include immunocompromised state and intravenous drug use, permitting opportunistic pathogens to reach the eye through the blood stream. We reported a rare case of a presumed simultaneous opportunistic intraocular fungal and cytomegalovirus (CMV) infection. Case presentation: A 67-year-old male patient with a recent history of hospitalization due to pneumonia, presented to our department with bilateral loss of vision. Ocular examination revealed low visual acuity, signs of vitritis with chorioretinal infiltrations and cotton ball colony-like lesions, bilaterally. A bilateral endogenous fungal endophthalmitis was suspected and topical and systemic antifungal treatment was initiated. Nevertheless, vitreous and blood cultures were negative for fungi and other bacteria, while serological examinations revealed primary infection with CMV. Following vitrectomy, polymerase chain reaction (PCR) of vitreous washings confirmed the intraocular infection with CMV. Treatment was modified, including intravenous administration of Gancyclovir. In the following days, the patient's clinical signs and visual acuity improved remarkably. Conclusions: A case of a presumed mixed fungal and CMV intraocular infection was presented. High level of suspicion with prompt diagnosis and aggressive combination treatment led to a favorable result.


Assuntos
Infecções por Citomegalovirus/complicações , Citomegalovirus , Endoftalmite/diagnóstico , Infecções Oculares Fúngicas/complicações , Fungos/isolamento & purificação , Infecções Oportunistas/complicações , Acuidade Visual , Idoso , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/virologia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/microbiologia , Humanos , Masculino , Infecções Oportunistas/diagnóstico
9.
Intern Med ; 58(20): 2949-2955, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31292384

RESUMO

A 49-year-old man with diabetes taking clopidogrel and celecoxib underwent interbody fusion surgery for spinal spondylolysis. Ten days after the surgery, he vomited a large amount of fresh blood. A blood examination revealed hemodynamic failure. Esophagogastroduodenoscopy showed an adherent blood clot and multiple superficial ulcers in the esophagus. Endoscopic hemostasis was successfully achieved. Biopsy specimens from the esophageal ulcer showed positive immunohistochemical staining results for anti-CMV antibodies. The esophageal ulcer improved after the oral administration of ganciclovir. This case emphasizes that CMV esophagitis with bleeding can occur in a diabetic patient with a poor nutritional status due to relative immune dysfunction.


Assuntos
Infecções por Citomegalovirus/complicações , Diabetes Mellitus Tipo 2/complicações , Esofagite/complicações , Hemorragia Pós-Operatória/etiologia , Fusão Vertebral/efeitos adversos , Antivirais/uso terapêutico , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Endoscopia do Sistema Digestório , Esofagite/diagnóstico , Esofagite/tratamento farmacológico , Esofagite/virologia , Ganciclovir/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade
10.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31266824

RESUMO

OBJECTIVE: In this study, we determined the prevalence of hearing loss in 157 children with proven congenital cytomegalovirus (cCMV) infection. We looked at possible risk determinants for developing hearing loss and proposed recommendations for screening and follow-up in the newborn. METHODS: In a prospective 22-year study, 157 children with proven cCMV infection were evaluated for sensorineural hearing loss (SNHL). The development of SNHL was correlated with the type of maternal infection (primary versus nonprimary), the gestational age of maternal primary infection, imaging findings at birth, and the presence of symptomatic or asymptomatic infection in the newborn. RESULTS: Of all children, 12.7% had SNHL, and 5.7% needed hearing amplification because of SNHL. Improvement, progression, and fluctuations of hearing thresholds were seen in 45%, 53.8%, and 5.7% of the children, respectively. Hearing loss was more common in the case of a symptomatic infection at birth (P = .017), after a maternal primary infection in the first trimester of pregnancy (P = .029), and in the presence of abnormalities on a neonatal brain ultrasound and/or MRI (P < .001). CONCLUSION: SNHL is a common sequela in children with cCMV infection. Risk factors for SNHL were primary maternal infections before the 14th week of pregnancy, the presence of a disseminated infection at birth, and imaging abnormalities in the newborn. These children may benefit from a more thorough investigation for SNHL than children who do not present with those risk factors.


Assuntos
Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/diagnóstico por imagem , Perda Auditiva/diagnóstico por imagem , Perda Auditiva/etiologia , Efeitos Tardios da Exposição Pré-Natal/diagnóstico por imagem , Efeitos Tardios da Exposição Pré-Natal/etiologia , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Triagem Neonatal/métodos , Gravidez , Estudos Prospectivos
11.
J Cancer Res Clin Oncol ; 145(8): 2083-2095, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203442

RESUMO

PURPOSE: While enhanced expression of cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LO) and their derived metabolites is associated with breast cancer (BC) risk, the precise link between BC carcinogenesis and enhanced inflammatory activity remains to be clarified. Human Cytomegalovirus (HCMV) may induce expression of COX-2 and 5-LO and is frequently found in breast cancer biopsies. Thus, we investigated whether there is an association between HCMV proteins and expression of COX-2 and 5-LO in human BC tissue and BC cell lines. MATERIALS AND METHODS: Paraffin embedded biopsies obtained from 49 patients with breast cancer and 26 tissue samples from adjacent, benign breast tissues were retrospectively examined for HCMV-immediate early (IE), HCMV-Late (LA), COX-2, and 5-LO proteins by immunohistochemistry. In vitro, uninfected and HCMV-infected BC cell lines were examined for COX-2 and 5-LO transcripts and proteins by PCR and flow cytometry. RESULTS: Extensive expression of COX-2, 5-LO and HCMV-IE proteins were preferentially detected in BC samples. We found a statistically significant concordant correlation between extensive HCMV-IE and COX-2 (P < 0.0001) as well as with HCMV-IE and 5-LO (P = 0.0003) in infiltrating BC. In vitro, HCMV infection induced COX-2 and 5-LO transcripts and COX-2 proteins in MCF-7 cells (P =0.008, P =0.018, respectively). In MDA-MB-231 cells that already had high base line levels of COX-2 expression, HCMV induced both COX-2 and 5-LO proteins but not transcripts. CONCLUSION: Our findings demonstrate a significant correlation between extensive HCMV-IE protein expression and overexpression of COX-2 and 5-LO in human breast cancer.


Assuntos
Araquidonato 5-Lipoxigenase/metabolismo , Neoplasias da Mama/complicações , Neoplasias da Mama/metabolismo , Ciclo-Oxigenase 2/metabolismo , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/metabolismo , Neoplasias da Mama/virologia , Células Cultivadas , Feminino , Células Endoteliais da Veia Umbilical Humana , Humanos , Células MCF-7 , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise Serial de Tecidos
13.
Med Microbiol Immunol ; 208(3-4): 271-280, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31053999

RESUMO

In the year 2000, cytomegalovirus was identified as a risk factor for mortality in a seminal study of octogenarian residents in Sweden. This finding triggered a wave of additional epidemiological investigations, some of which supported this association whilst others observed no such effect. In addition, this increased risk of death in CMV-seropositive people was correlated with observed changes within the T-cell repertoire such that accelerated 'immunosenescence' became a de facto explanation, without strong evidence to this effect. Recent years have seen a re-appraisal of these findings. Interestingly, many studies show that cytomegalovirus acts to improve immune function, most clearly in younger donors. In addition, the excess mortality in older people that is observed in CMV-seropositive cohorts appears to be related primarily to an excess of vascular disease rather than impairment of immune function. CMV is an important member of the natural 'virome' of Homo sapiens and has an important, and generally positive, modulatory influence on human immune function throughout most of life. However, within certain populations, this influence can become negative and age, co-morbidity and environment all act as determinants of this effect. As such, it is important that new interventions are developed that can mitigate the damaging influence of CMV on human health in populations at risk.


Assuntos
Anticorpos Antivirais/sangue , Infecções por Citomegalovirus/imunologia , Citomegalovirus/imunologia , Imunossenescência , Linfócitos T/imunologia , Envelhecimento , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Comorbidade , Infecções por Citomegalovirus/complicações , Humanos
15.
World J Gastroenterol ; 25(15): 1899-1906, 2019 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-31057303

RESUMO

BACKGROUND: Cytomegalovirus (CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia (AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation (LDLT). CASE SUMMARY: The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy (GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE. CONCLUSION: This case report suggests a monitoring method that could be useful for AG-negative CMV gastroenteritis after a solid-organ transplantation.


Assuntos
Doenças do Colo/diagnóstico , Infecções por Citomegalovirus/complicações , Gastroenterite/complicações , Perfuração Intestinal/diagnóstico , Transplante de Fígado/efeitos adversos , Antígenos Virais/sangue , Antígenos Virais/imunologia , Colo/diagnóstico por imagem , Colo/virologia , Doenças do Colo/etiologia , Citomegalovirus/imunologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/virologia , Doença Hepática Terminal/imunologia , Doença Hepática Terminal/patologia , Doença Hepática Terminal/cirurgia , Endoscopia Gastrointestinal , Feminino , Gastroenterite/sangue , Gastroenterite/imunologia , Gastroenterite/virologia , Hepatite Autoimune/imunologia , Hepatite Autoimune/patologia , Hepatite Autoimune/cirurgia , Humanos , Perfuração Intestinal/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
16.
BMC Infect Dis ; 19(1): 394, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068128

RESUMO

BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is a rare, potentially fatal disease with multisystem involvement. Cytomegalovirus (CMV) infection as a cause of refractory TTP, has been reported only in immunocompromised individuals. We report a case of CMV-induced refractory TTP in an immunocompetent individual. CASE PRESENTATION: A 35-year-old, previously healthy Sri Lankan man, presented with fever for 3 days with gum bleeding and progressive drowsiness. His Glasgow coma scale score was 10/15. He did not have papilloedema or neck stiffness. Laboratory evaluation showed a severe thrombocytopenia with microangiopathic haemolytic anaemia. There was marginal renal impairment and normal coagulation profile. Non-contrast CT scan of brain was normal. A diagnosis of thrombotic thrombocytopenic purpura was made. Despite daily plasma exchanges and high-dose steroids, he failed to achieve the expected therapeutic response, thus demonstrating refractory TTP. On exploring for possible causes of refractoriness to treatment, a clinically significant PCR titre of CMV was detected. Treatment of CMV infection lead to complete recovery of TTP. His disease course was further complicated with spontaneous spinal haemorrhage leading to neurological sequelae. DISCUSSION AND CONCLUSIONS: This is the first report of CMV induced refractory TTP in an immunocompetent adult. It is also the first report of clinically significant spontaneous spinal haematoma in TTP. These two rare occurrences should be considered when patients with refractory TTP do not improve as expected.


Assuntos
Infecções por Citomegalovirus/complicações , Púrpura Trombocitopênica Trombótica/virologia , Adulto , Anemia Hemolítica/tratamento farmacológico , Anemia Hemolítica/virologia , Antivirais/uso terapêutico , Infecções por Citomegalovirus/tratamento farmacológico , Febre/virologia , Humanos , Imunocompetência , Masculino , Púrpura Trombocitopênica Trombótica/tratamento farmacológico , Púrpura Trombocitopênica Trombótica/etiologia , Valganciclovir/uso terapêutico
17.
Rheumatol Int ; 39(7): 1229-1240, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31076831

RESUMO

The disease burden, risk factors and clinical sequelae of CMV reactivation in patients with rheumatologic conditions is poorly understood. We have described a cohort with underlying rheumatic disease and CMV, and compared a subgroup with systemic lupus erythematosus (SLE) to controls to identify potential risk factors for CMV reactivation. Adults with rheumatic disease and CMV infection from 2000-2015 were identified. SLE cases were matched 3:1 with controls based on age, sex and year of admission, and compared. Fourteen patients were included (6 SLE, 4 rheumatoid arthritis, 2 sarcoidosis, 1 psoriatic arthritis, 1 microscopic polyangiitis). Seven had viremia alone, the remainder tissue-invasive disease. Thirteen received glucocorticoids prior to CMV reactivation. Fever was the most common symptom, and coinfections were seen in eight including four with bacteremia. Thirteen received antiviral therapy (median 33 days), four died during hospitalization. Six patients with underlying SLE and CMV reactivation were compared to 18 SLE controls. Cases received more glucocorticoids prior to admission (median 36.5 vs. 2.5 mg/day, p = 0.006), had longer hospitalizations (median 47 vs. 7 days, p = 0.006) and more coinfections (67% vs. 17%, p = 0.04). There were no significant differences in symptoms at presentation. CMV reactivation occurs in patients with rheumatologic disease, can result in severe clinical sequelae, and is difficult to distinguish from a flare of the underlying disease. Patients with CMV received higher doses of glucocorticoids and developed more co-infections. CMV should be considered during the evaluation of a febrile illness in this complex patient population.


Assuntos
Infecções por Citomegalovirus/virologia , Citomegalovirus/fisiologia , Doenças Reumáticas/complicações , Ativação Viral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Infecções por Citomegalovirus/complicações , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/virologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças Reumáticas/virologia , Fatores de Risco
18.
Med Microbiol Immunol ; 208(3-4): 469-473, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076879

RESUMO

Cytomegalovirus (CMV) infection has a profound impact on the host's immune system. Immunological imprinting by CMV is not restricted to immunity against CMV itself, but can affect immunity against other viral or non-viral infectious agents and also immunopathological responses. One category is heterologous immunity based on molecular mimicry, where antigen recognition receptors specific for a CMV antigen with broad avidity distribution also bind with some avidity to unrelated antigens and exert effector functions against target structures other than those linked to CMV. Another category is induction of cytokines by CMV infection that inhibit or drive immune responses to bystander antigens unrelated to CMV, and a third category is the activation of antigen-presenting cells by CMV from which unrelated antigens profit as "stowaways". A striking example of the "stowaway" category, actually one that is of medical importance, has been published recently and will be discussed here for the more general reader. Specifically, in a murine model, CMV airway infection and inhaled environmental antigen of poor intrinsic allergenic potential were found to sensitize for allergic airway disease (AAD) only when combined. As to the mechanism, viral activation of CD11b+ conventional dendritic cells (CD11b+ cDC) that localize to airway mucosa facilitates uptake and processing of inhaled antigen. Thus, CMV serves as a "door opener" for otherwise harmless environmental antigens that have no intrinsic property to activate DC. Antigen-laden CD11b+ cDC migrate selectively to the airway draining lymph nodes, where they prime type-2 CD4+ T helper (Th-2) cells. Upon airway re-exposure to the inhaled antigen, Th-2 cells secrete interleukins (IL-4, IL-5, IL-9, and IL-25) known to induce goblet cell metaplasia, the lead histopathological manifestation of AAD that is characterized by thickening of airway epithelia and increased numbers of mucus-producing goblet cells, resulting in enhanced mucus secretion and airflow obstruction.


Assuntos
Asma/fisiopatologia , Citocinas/metabolismo , Infecções por Citomegalovirus/imunologia , Células Dendríticas/imunologia , Células Caliciformes/efeitos dos fármacos , Muco/metabolismo , Células Th2/imunologia , Animais , Asma/etiologia , Diferenciação Celular/efeitos dos fármacos , Infecções por Citomegalovirus/complicações , Células Dendríticas/virologia , Modelos Animais de Doenças , Células Caliciformes/metabolismo , Camundongos
19.
Ophthalmic Surg Lasers Imaging Retina ; 50(5): e171-e175, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31100172

RESUMO

Optic nerve aplasia (ONA) is a rare phenomenon characterized by absence of the optic nerve, retinal blood vessels, and retinal ganglion cells. The authors report a case of optic nerve aplasia in association with congenital cytomegalovirus (CMV) infection, conveyed through multimodal imaging including color fundus photography, fluorescein angiography, and B-scan ultrasonography. Furthermore, the authors review the common ocular findings and previously reported cases of ONA in congenital CMV infection. Screening and counseling can be performed to advise parents about the potential risks and severity of this rare clinical manifestation. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e171-e175.].


Assuntos
Anormalidades Múltiplas , Córnea/diagnóstico por imagem , Doenças da Córnea/etiologia , Infecções por Citomegalovirus/complicações , Citomegalovirus , Doenças do Nervo Óptico/etiologia , Nervo Óptico/diagnóstico por imagem , Doenças da Córnea/diagnóstico , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/virologia , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Lactente , Doenças do Nervo Óptico/diagnóstico , Ultrassonografia
20.
J Pediatr Ophthalmol Strabismus ; 56(3): 194-202, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31116869

RESUMO

PURPOSE: To describe the presentation, evolution, and long-term outcome of cortical visual impairment (CVI) in patients with symptomatic congenital cytomegalovirus (CMV) infection, and to identify risk factors for the development of CVI in patients with symptomatic congenital CMV. METHODS: Retrospective subanalysis of a long-term prospective cohort study with data gathered from 1982 to 2013. RESULTS: Eleven of 77 (14.3%) patients with symptomatic CMV, 0 of 109 with asymptomatic CMV, and 51 control patients had CVI. Overall, patients with symptomatic CMV had worse vision than patients with asymptomatic CMV, who in turn had worse vision than control patients. Microcephaly, intracranial calcification, dilatation of ventricles, encephalomalacia, seizure at birth, optic atrophy, chorioretinitis/retinal scars, strabismus, and neonatal onset of sensorineural hearing loss were risk factors associated with CVI. CONCLUSIONS: CVI may result from symptomatic congenital CMV infection. The relationship of CVI and its risk factors in patients with CMV suggests the potential to predict the development of CVI through predictive modeling in future research. Early screening of CVI in children born with symptomatic congenital CMV can facilitate educational, social, and developmental interventions. [J Pediatr Ophthalmol Strabismus. 2019;56(3):194-202.].


Assuntos
Infecções por Citomegalovirus/congênito , Citomegalovirus , Transtornos da Visão/etiologia , Acuidade Visual , Córtex Visual/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/virologia , Infecções Oculares Virais/complicações , Infecções Oculares Virais/congênito , Feminino , Seguimentos , Idade Gestacional , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Transtornos da Visão/fisiopatologia , Córtex Visual/diagnóstico por imagem , Adulto Jovem
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