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1.
Expert Opin Pharmacother ; 20(12): 1429-1438, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31282759

RESUMO

Introduction: Human cytomegalovirus (HCMV) or human herpesvirus 5 (HHV-5) is a ß-herpesvirus that causes widespread infection in nearly all members of the human population worldwide. Its persistence in humans after primary infection in a latent phase as well as a partial non-protective immune response is the basis for repeated re-activation/re-infection episodes occurring both in immunocompetent and immunocompromised subjects. In the latter patient populations, which include hematopoietic stem cell transplant (HSCT) recipients, HCMV reactivation episodes may be particularly severe, leading to both systemic and end-organ diseases. Since the 90s, at least four antiviral drugs targeting the DNA polymerase complex have been developed for the prevention and treatment of HCMV infections in transplant recipients, used as first-line (ganciclovir and valganciclovir) and second-line therapy (foscarnet and cidofovir). However, due to their toxicity and drug-resistance induction, new drugs with different targets were needed. Areas covered: In 2017, a new drug named letermovir (LTV), which targets the HCMV DNA terminase complex, was licensed for prophylaxis of HCMV infections in HSCT recipients. This is the focus of this review. Expert opinion: LTV safety and efficacy are promising. However, long-term adverse events and the emergence of drug-resistant HCMV strains must be investigated in extended clinical trials prior to drawing final conclusions.


Assuntos
Acetatos/uso terapêutico , Quimioprevenção/métodos , Infecções por Citomegalovirus/prevenção & controle , Citomegalovirus/efeitos dos fármacos , Quinazolinas/uso terapêutico , Antivirais/uso terapêutico , Quimioprevenção/estatística & dados numéricos , Cidofovir/uso terapêutico , Citomegalovirus/genética , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/epidemiologia , Farmacorresistência Viral/efeitos dos fármacos , Ganciclovir/uso terapêutico , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Transplantados/estatística & dados numéricos , Condicionamento Pré-Transplante/métodos , Condicionamento Pré-Transplante/estatística & dados numéricos , Valganciclovir/uso terapêutico
2.
Ann Hematol ; 98(9): 2197-2211, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31321454

RESUMO

Incidence and outcome of microbiologically documented bacterial/viral infections and invasive fungal disease (IFD) in children and adults after hematopoietic cell transplantation (HCT) were compared in 650 children and 3200 adults in multicenter cross-sectional nationwide study. Infections were diagnosed in 60.8% children and 35.0% adults, including respectively 69.1% and 63.5% allo-HCT, and 33.1% and 20.8% auto-HCT patients. The incidence of bacterial infections was higher in children (36.0% vs 27.6%; p < 0.0001). Infections with Gram-negative bacteria were more frequent than Gram-positives in adults (64.6% vs 44.8%; p < 0.0001). Outcome of bacterial infections was better in children (95.5% vs 91.4%; p = 0.0011). The IFD incidence (25.3% vs 6.3%; p < 0.0001) and outcome (88.0% vs 74.9%; p < 0.0001) were higher in children. The incidence of viral infections was higher in children after allo-HCT (56.3% vs 29.3%; p < 0.0001), and auto-HCT (6.6% vs 0.8%; p < 0.0001). Outcome of viral infections was better in children (98.6% vs 92.3%; p = 0.0096). Infection-related mortality was 7.8% in children and 18.4% in adults (p < 0.0001). No child after auto-HCT died of infection. Adult age, mismatched transplants, acute leukemia, chronic GVHD, CMV reactivation, infection with Gram-negatives, and duration of infection > 21 days were risk factors for death from infection. In conclusion, pediatric patients have 2.9-fold higher incidence and 2.5-fold better outcome of infections than adults after HCT.


Assuntos
Infecções Bacterianas/epidemiologia , Infecções por Citomegalovirus/epidemiologia , Doença Enxerto-Hospedeiro/epidemiologia , Transplante de Células-Tronco Hematopoéticas , Infecções Fúngicas Invasivas/epidemiologia , Doença Aguda , Adolescente , Adulto , Fatores Etários , Idoso , Infecções Bacterianas/etiologia , Criança , Pré-Escolar , Doença Crônica , Estudos Transversais , Infecções por Citomegalovirus/etiologia , Feminino , Doença Enxerto-Hospedeiro/etiologia , Humanos , Incidência , Lactente , Recém-Nascido , Infecções Fúngicas Invasivas/etiologia , Leucemia , Masculino , Pessoa de Meia-Idade , Fatores de Risco
3.
Transplant Proc ; 51(6): 1810-1815, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256873

RESUMO

BACKGROUND: Cytomegalovirus infection (CMV) after kidney transplantation leads to increased morbidity and mortality. Whether the cause of end-stage renal disease (ESRD) influences the risk of CMV infection post-transplant is not known. METHODS: We analyzed data from 2741 adult kidney transplant recipients from January 1993 through December 2014. The causes of ESRD included diabetes mellitus (n = 947), hypertension (n = 442), polycystic kidney disease (n = 549), and glomerulonephritis (GN) (n = 803). The primary outcome was incidence of CMV infection, defined as the first episode of detectable CMV DNA in the blood following transplant. RESULTS: Three hundred and thirty patients developed a CMV infection over a median follow-up of 4.5 years. Patients with diabetes mellitus (DM) as the cause of ESRD had a higher incidence of CMV infection post-transplant compared to patients with GN (2.37 vs 1.58/100 person-years, P < .005) whereas hypertension (HTN) and autosomal dominant polycystic kidney disease (PKD) were similar (2.17 and 2.07/100 person-years). DM was associated with a 35% higher risk of CMV infection compared to GN in unadjusted analyses [hazard ratio=1.35 [95% confidence interval 1.02-1.78], P = .04). However, after adjustment for age, the risk of CMV infection was similar in all groups (DM: age-adjusted hazard ratio 1.02 [0.78-1.39]; HTN: 0.96 (0.67-1.36); PKD: 1.08 [0.78-1.48]; compared to GN). The risk of CMV infection increased with age (adjusted hazard ratio=1.32 [1.18-1.47] for every decade of life, P < .001). CONCLUSIONS: Our study demonstrates that the cause of ESRD is not a significant risk factor for CMV infection in kidney transplant recipients once adjusted for age. Future studies are needed to identify risk factors for CMV infection to define patient-centered monitoring and prevention.


Assuntos
Infecções por Citomegalovirus/epidemiologia , Nefropatias/epidemiologia , Falência Renal Crônica/etiologia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias , Adulto , Antivirais/uso terapêutico , Infecções por Citomegalovirus/etiologia , Infecções por Citomegalovirus/virologia , Feminino , Humanos , Incidência , Nefropatias/virologia , Falência Renal Crônica/cirurgia , Falência Renal Crônica/virologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
4.
Int J Infect Dis ; 86: 31-39, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31207385

RESUMO

OBJECTIVES: Little is known about the birth prevalence and characteristics of congenital cytomegalovirus (CMV) infection in developing countries. To determine the prevalence and characteristics of congenital CMV infection in Indonesia, we conducted a prospective study in an urban birth cohort of neonates at a national referral hospital in 2016-2017, Jakarta, Indonesia. METHODS: Consecutively born neonates were screened for the presence of CMV by using pan-herpesvirus nested-PCR and Sanger sequencing in saliva and/or urine specimens. Both the neonatal clinical findings as well as maternal characteristics were also evaluated. RESULTS: From a total of 411 newborns screened, congenital CMV infection was confirmed in 5.8% of the neonates. These CMV-positive newborns were more likely to have ventriculomegaly and thrombocytopenia compared to CMV-negative neonates. Notably, 67% CMV-positive neonates in our study had clinical findings that required medical intervention, from which only nine presented with symptoms suggestive of congenital CMV infection. Furthermore, congenital CMV infected babies were almost four times more likely to be born to mothers that had placenta previa and placental abruption. CONCLUSIONS: Our work highlights the high prevalence of congenital CMV infection in neonates born in one of the biggest referral hospitals in metropolitan Jakarta, Indonesia.


Assuntos
Infecções por Citomegalovirus/virologia , Citomegalovirus/fisiologia , Doenças do Recém-Nascido/virologia , Adulto , Citomegalovirus/genética , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/epidemiologia , Feminino , Humanos , Indonésia/epidemiologia , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Masculino , Reação em Cadeia da Polimerase , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Estudos Prospectivos , Saliva/virologia
5.
Transplant Proc ; 51(4): 1118-1120, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31101184

RESUMO

INTRODUCTION: Cardiovascular disease is the leading cause of mortality in kidney transplant recipients. Rituximab is widely used in kidney transplantation for a variety of situations, and rituximab may inhibit some cytokines and antibodies that may play an active role in the atherosclerotic process. The aim of the study was to evaluate the efficacy of rituximab on atherosclerosis biomarkers in kidney transplant recipients. METHODS: All patients, 18 years of age and older, who underwent kidney transplantation and received at least 1 dose of 375 mg/m2 rituximab were considered for participation in this study. The primary study endpoint was the development of cardiovascular diseases after rituximab therapy. The secondary endpoint was the onset of cytomegalovirus (CMV) disease or biopsy-confirmed BK virus nephropathy. In addition, comparison of atherosclerosis biomarkers was performed between study and control groups. RESULTS: There were no cardiovascular events observed during follow up. Only 8 patients in the study group suffered from CMV disease during follow up. Serum interleukin 10 levels were significantly higher in the rituximab group compared with the control group, although anti-oxidized low-density lipoprotein levels were lower in the rituximab group compared with the control group, though this did not achieve statistical significance. DISCUSSION: Rituximab treatment may increase the risk of CMV reactivation and decrease lymphocyte counts and interleukin 10 levels; however, significant decreases in all atherosclerotic-related biomarkers have not been shown in our study.


Assuntos
Aterosclerose/sangue , Imunossupressores/uso terapêutico , Transplante de Rim , Rituximab/uso terapêutico , Adolescente , Adulto , Aterosclerose/epidemiologia , Biomarcadores/sangue , Citomegalovirus/fisiologia , Infecções por Citomegalovirus/epidemiologia , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Transplantados , Ativação Viral/efeitos dos fármacos
6.
Orv Hetil ; 160(21): 822-828, 2019 May.
Artigo em Húngaro | MEDLINE | ID: mdl-31104499

RESUMO

Introduction: Congenital sensorineural hearing loss is one of the most common sensory defects affecting 1-3 children per 1000 newborns. There are a lot of causes which result in congenital hearing loss, the most common is the genetic origin, but infection, cochlear malformation or other acquired causes can be reasons as well. Aim: The aim of this study was to establish the etiological factors of congenital profound sensorineural hearing loss in children who underwent cochlear implantation. Results: Our results show that the origin of the hearing loss was discovered in 62.9% of our patients. The most common etiological factor was the c.35delG mutation of the gap junction protein ß-2 gene, the allele frequency was 38.7% in our cohort. Infection constituted to 10.1%, and meningitis and cytomegalovirus infection were the second most common cause. 79.9% of our patients received sufficient hearing rehabilitation before the end of the speech development's period (6 years old), but 11.2% of our cases were still diagnosed late. Conclusions: Based on our data we can state that genetic evaluation is crucial in the diagnostic process of congenital profound sensorineural hearing loss. Sufficient hearing rehabilitation affects the whole life of the child, and by late cochlear implantation the speech development falls behind. We can decrease the ratio of the late implantation with the new protocol of newborn hearing screening, and with sufficient information provided to the colleagues, so the children may be referred to the proper center for rehabilitation without delay. Orv Hetil. 2019; 160(21): 822-828.


Assuntos
Implante Coclear/métodos , Implantes Cocleares , Conexinas/genética , Infecções por Citomegalovirus/complicações , Perda Auditiva Neurossensorial/etiologia , Meningite/complicações , Criança , Estudos de Coortes , Infecções por Citomegalovirus/epidemiologia , Audição , Perda Auditiva Neurossensorial/congênito , Perda Auditiva Neurossensorial/epidemiologia , Humanos , Recém-Nascido , Meningite/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Resultado do Tratamento
7.
Rev Prat ; 69(3): 301-306, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30983259

RESUMO

Cytomegalovirus infections. Cytomegalovirus (CMV) infections, which are common in children and adolescents, are often asymptomatic or with little specific signs. When they occur in adults, clinical forms may be more severe even in the immunocompetent. CMV is responsible for significant morbidity and mortality in transplant patients. In pregnant women, congenital CMV infection can lead to neurosensory damages requiring diagnosis and early management. The diagnosis of primary infection is based on serology, whereas the monitoring of infection in immunocompromised patients requires the use of polymerase chain reaction. As screening for congenital infection by serology is not recommended so far, it will be realized in an evocative context. Therapeutic options are still limited and expose to haematological or renal toxicity, but new antivirals (maribavir, letermovir) should be available soon to optimize therapeutic management.


Assuntos
Antivirais , Infecções por Citomegalovirus , Adolescente , Adulto , Antivirais/uso terapêutico , Criança , Citomegalovirus , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/epidemiologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Recém-Nascido , Gravidez
8.
Pan Afr Med J ; 32(Suppl 1): 6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984327

RESUMO

Introduction: human cytomegalovirus (CMV) has remained a cause of morbidity and mortality in pregnancy and immunocompromised patients. CMV is transmissible through blood transfusion. We conducted a descriptive, cross-sectional study to assess blood donor safety and to determine the prevalence and associated factors for CMV infection among blood donors in Minna, Nigeria. Methods: all consenting blood donors were screened for CMV antibodies (IgM and IgG) using ELISA kit and haematological indices using a haematological analyzer. We administered structured questionnaires to obtain socio-demographic and socio-economic data. Data were subjected to univariate, bivariate and multivariate statistical analyses using Epi Info version 3.5.4. Significant associations were presumed if p < 0.05. Results: a total of 345 participantswere recruited, the majority were males 336 (97.4%). Monthly earnings of majority of the blood donors, 136 (40.6%) ranged from ₦18,000 to ₦35,000. The prevalence of CMV infection was 96.2%. The prevalence of anti-CMV IgG antibodies was 96.2% and that of IgM was 2.6%. Most of the study participants, 274 (79.4%) were family replacement donors. The majority of the blood donors 195 (56.5%) were anaemic (PCV < 36, Hb < 12g/dl). Those with positive CMV were more likely to be of high-income level (OR = 0.32, P = 0.04). Conclusion: the seroprevalence of CMV was high with a significant proportion of donors capable of transmitting CMV infection to blood recipients. The majority of the blood donors were anaemic. High income level is associated with CMV infection. Quality of screening for anemia be improved.


Assuntos
Anticorpos Antivirais/sangue , Doadores de Sangue/estatística & dados numéricos , Segurança do Sangue , Infecções por Citomegalovirus/epidemiologia , Adulto , Anemia/epidemiologia , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Renda/estatística & dados numéricos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Estudos Soroepidemiológicos , Inquéritos e Questionários , Adulto Jovem
10.
Int J Mol Sci ; 20(3)2019 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-30764515

RESUMO

The outcome of host-virus interactions is determined by a number of factors, some related to the virus, others to the host, such as environmental factors and genetic factors. Therefore, different individuals vary in their relative susceptibility to infections. Human cytomegalovirus (HCMV) is an important pathogen from a clinical point of view, as it causes significant morbidity and mortality in immunosuppressed or immunosenescent individuals, such as the transplanted patients and the elderly, respectively. It is, therefore, important to understand the mechanisms of virus infection control. In this review, we discuss recent advances in the immunobiology of HCMV-host interactions, with particular emphasis on the immunogenetic aspects (human leukocyte antigens, HLA; killer cell immunoglobulin-like receptors, KIRs; immunoglobulin genetic markers, GM allotypes) to elucidate the mechanisms underlying the complex host-virus interaction that determine various outcomes of HCMV infection. The results, which show the role of humoral and cellular immunity in the control of infection by HCMV, would be valuable in directing efforts to reduce HCMV spurred health complications in the transplanted patients and in the elderly, including immunosenescence. In addition, concerning GM allotypes, it is intriguing that, in a Southern Italian population, alleles associated with the risk of developing HCMV symptomatic infection are negatively associated with longevity.


Assuntos
Infecções por Citomegalovirus/imunologia , Citomegalovirus/imunologia , Envelhecimento , Animais , Citomegalovirus/fisiologia , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/genética , Predisposição Genética para Doença , Genótipo , Antígenos HLA/genética , Antígenos HLA/imunologia , Interações Hospedeiro-Patógeno , Humanos , Imunidade Celular , Imunidade Humoral , Imunogenética
11.
Rev Med Virol ; 29(3): e2034, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30706584

RESUMO

Cytomegalovirus (CMV) infection does not usually produce symptoms when it causes primary infection, reinfection, or reactivation because these three types of infection are all controlled by the normal immune system. However, CMV becomes an important pathogen in individuals whose immune system is immature or compromised, such as the unborn child. Several vaccines against CMV are currently in clinical trials that aim to induce immunity in seronegative individuals and/or to boost the immunity of those with prior natural infection (seropositives). To facilitate estimation of the burden of disease and the need for vaccines that induce de novo immune responses or that boost pre-existing immunity to CMV, we conducted a systematic survey of the published literature to describe the global seroprevalence of CMV IgG antibodies. We estimated a global CMV seroprevalence of 83% (95%UI: 78-88) in the general population, 86% (95%UI: 83-89) in women of childbearing age, and 86% (95%UI: 82-89) in donors of blood or organs. For each of these three groups, the highest seroprevalence was seen in the World Health Organisation (WHO) Eastern Mediterranean region 90% (95%UI: 85-94) and the lowest in WHO European region 66% (95%UI: 56-74). These estimates of the worldwide CMV distribution will help develop national and regional burden of disease models and inform future vaccine development efforts.


Assuntos
Anticorpos Antivirais/sangue , Infecções por Citomegalovirus/epidemiologia , Citomegalovirus/imunologia , Saúde Global , Humanos , Imunoglobulina G/sangue , Estudos Soroepidemiológicos
12.
Acta Trop ; 192: 49-54, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30685232

RESUMO

BACKGROUND: Arboviruses (Zika, dengue and chikungunya) represent a major risk for pregnant women, especially because their vertical transmission can lead to neurological damage in newborns. Early diagnosis can be difficult due to similar clinical presentation with other congenital infections that are associated with congenital abnormalities. OBJECTIVES: To investigate the circulation of arboviruses and other pathogens responsible for congenital infections, reporting clinical aspects and geographic distribution of maternal rash in a metropolitan region of Rio de Janeiro (Brazil). METHODS: Cross-sectional study with pregnant women presenting rash attended at the Exanthematic Diseases Unit (Niterói, Rio de Janeiro) from 2015 to 2018. Diagnosis of arboviruses was performed by real-time PCR (RT-qPCR) and laboratorial screening for syphilis, toxoplasmosis, rubella, cytomegalovirus and HIV was assessed. Demographic data was used for georeferencing analysis. FINDINGS: We included 121 pregnant women, of whom Zika virus was detected in 45 cases (37.2%), chikungunya in 33 (27.3%) and dengue in one (0.8%). Five patients presented syphilis, and we observed one case each of listeria, cytomegalovirus, and a syphilis-toxoplasmosis case. Similarity of clinical symptoms was observed in all groups; however, 84.8% of patients with chikungunya presented arthralgia. Following the decline of Zika cases, chikungunya infection was mostly observed during 2017-2018. Considering pregnant women infected with arboviruses and other infections, 41% resided in urban slums, mostly in Niterói. MAIN CONCLUSIONS: Simultaneous circulation of arboviruses and other agents responsible for congenital infections were observed; however, we did not identify co-infections between arboviruses. In this scenario, we emphasize the importance of adequate prenatal care to provide an accurate diagnosis of maternal rash.


Assuntos
Infecções por Arbovirus/epidemiologia , Adulto , Infecções por Arbovirus/complicações , Brasil/epidemiologia , Febre de Chikungunya/epidemiologia , Estudos Transversais , Infecções por Citomegalovirus/epidemiologia , Dengue/epidemiologia , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Gravidez , Cuidado Pré-Natal , Rubéola (Sarampo Alemão)/epidemiologia , Fatores Socioeconômicos , Sífilis/epidemiologia , Toxoplasmose/epidemiologia , Adulto Jovem , Infecção por Zika virus/epidemiologia
13.
Medicine (Baltimore) ; 98(3): e14124, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653141

RESUMO

The chronic inflammation and damage to the gastric epithelium induced by Helicobacter pylori (H. pylori) are the main risk factors for gastric cancer development. Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) induce chronic inflammation and have been found in gastric tumors. The objectives this observational study were to determine the frequency of multiple infections by Helicobacter pylori, Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) and to relate the infection by EBV and HCMV with H. pylori vacA/cagA genotypes in patients with chronic gastritis or gastric cancer. DNA from H. pylori, EBV and HCMV was detected by PCR in biopsies from 106 Mexican patients with chronic gastritis and 32 from gastric cancer. The cagA status and the vacA genotypes of H. pylori were determined by PCR. In chronic gastritis and gastric cancer EBV was found in 69.8% and 87.5%, HCMV in 52.8% and 53.1%, and H. pylori in 48.1% and 40.6%, respectively. In chronic gastritis, 53% of H. pylori patients were EBV and 33% were both EBV/HCMV; in gastric cancer, 92.3% of H. pylori-infected individuals were EBV and 46.1% were EVB/HCMV. All the intestinal- and mixed-type tumors and the 83.3% of diffuse-type tumors were EBV. No significant differences were found between single infections or coinfections with the diagnosis or the cancer type. The H. pylori genotypes were not related to EBV or HCMV infection. The frequency of dual infections by H. pylori, EBV and HCMV is higher in patients from southwest Mexico than other populations. It is likely that these pathogens act synergistically to induce inflammation and gastric cancer.


Assuntos
Infecções por Citomegalovirus/microbiologia , Infecções por Vírus Epstein-Barr/microbiologia , Gastrite/microbiologia , Infecções por Helicobacter/microbiologia , Neoplasias Gástricas/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Doença Crônica , Coinfecção , Estudos Transversais , Citomegalovirus , Infecções por Citomegalovirus/epidemiologia , Infecções por Vírus Epstein-Barr/epidemiologia , Feminino , Genótipo , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/genética , Herpesvirus Humano 4 , Humanos , Inflamação/microbiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Adulto Jovem
14.
BMC Gastroenterol ; 19(1): 3, 2019 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-30616563

RESUMO

BACKGROUND: Many reports have documented the increasing impact of Clostridium difficile infection (CDI) in patients with ulcerative colitis (UC). We conducted a retrospective study to determine the incidence, clinical characteristics, risk factors and prognosis of CDI in patients with UC. METHODS: We studied patients with UC, hospitalized between January 2010 and December 2015 in a tertiary hospital in China. Stool samples were tested for C. difficile toxins A and B (CDAB) by enzyme immunoassays in UC patients with disease flare. CDI in UC patients was diagnosed by clinical symptoms and positive CDAB test, and each case was matched with CDAB-negative patients in a 1:2 ratio. Univariate and binary logistic regression analyses were used to measure the differences between patients with and without CDI. RESULTS: Thirty-four (8.92%) of 381 patients with UC were CDAB positive. Antibiotic exposure within 3 months prior to the study (P = 0.004), hospitalization within 1 month prior to the study (P = 0.025), systemic use of steroids (P = 0.002) and active cytomegalovirus (CMV) infection (P = 0.001) were higher in CDI than non-CDI patients. Binary logistic regression analysis revealed that CMV infection was associated with CDI (odds ratio = 13.502, 95% confidence interval 1.307-139.512, P = 0.029). UC patients with C. difficile and CMV co-infection had more severe colonoscopic features. CONCLUSIONS: Recent use of antibiotics, prior hospitalization and systemic use of steroids increased the risk of CDI. CMV infection was an independent risk factor of CDI in patients with UC.


Assuntos
Infecções por Clostridium/epidemiologia , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/microbiologia , Adulto , Estudos de Casos e Controles , China/epidemiologia , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/patologia , Coinfecção , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/patologia , Colonoscopia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/patologia , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária
15.
Rev Soc Bras Med Trop ; 52: e20170313, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30652782

RESUMO

INTRODUCTION: Toxoplasma gondii and cytomegalovirus (CMV) are pathogens associated with congenital anomalies. METHODS: Serum was collected from 79 reproductive-age women and tested for IgM and IgG antibodies to T. gondii and CMV. RESULTS: Seropositivity for T. gondii was detected in 24.1% of women and CMV in 96.2%. High seropositivity for CMV was found for all ages. The highest seropositivity for T. gondii was observed among older participants. CONCLUSIONS: T. gondii remains an important pathogen owing to low seropositivity.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Citomegalovirus/imunologia , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Toxoplasma/imunologia , Toxoplasmose/diagnóstico , Adulto , Estudos Transversais , Infecções por Citomegalovirus/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Kosovo/epidemiologia , Estudos Soroepidemiológicos , Toxoplasmose/epidemiologia
16.
Medicine (Baltimore) ; 98(4): e14256, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30681620

RESUMO

Cytomegalovirus (CMV) infection is a significant cause of morbidity and mortality in the posttransplant setting; however, it is increasingly recognized in pediatric leukemia during chemotherapy. This study assessed the prevalence and associated factors of CMV infection in pediatric non-transplant leukemia patients.This was a cross-sectional study of 50 pediatric acute lymphoblastic leukemia (ALL) patients receiving chemotherapy at Ramathibodi Hospital from December 2015 to December 2016. CMV viral load quantified by DNA polymerase chain reaction (PCR) was monitored in different phases of chemotherapy: enrolment, post-induction, post-consolidation, post-intensification, and maintenance.One hundred forty one blood tests were evaluated from 50 patients. Overall prevalence of CMV DNAemia (≥20 copies/mL) and high-level CMV DNAemia (≥1000 copies/mL) was 52% (26 of 50) and 16.0% (8 of 50), respectively. All patients with high-level CMV DNAemia were in the maintenance phase of chemotherapy. One patient had CMV retinitis, while the rest had no end-organ CMV diseases. Increased lymphocyte count was significantly associated with protection from high-level CMV DNAemia (odds ratio 0.997, P = .02). Receiver operating characteristic curve identified a cut-off value of 798 cells/mm of absolute lymphocyte count (ALC) as a discriminator for the presence of high-level CMV DNAemia (area under the curve 0.756, 95% CI 0.645-0.867, P = .001) with 88.9% sensitivity and 50.4% specificity.CMV infection predominantly occurred during maintenance chemotherapy. Low ALC was significantly associated with high-level CMV DNAemia. CMV infection surveillance by quantitative CMV DNA PCR during maintenance chemotherapy in patients with ALC <800 cells/mm may be considered.


Assuntos
Infecções por Citomegalovirus/epidemiologia , Citomegalovirus , DNA Viral/sangue , Quimioterapia de Manutenção/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/virologia , Criança , Pré-Escolar , Estudos Transversais , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/virologia , Feminino , Humanos , Quimioterapia de Indução/efeitos adversos , Contagem de Linfócitos , Masculino , Razão de Chances , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Prevalência , Carga Viral
17.
Transpl Infect Dis ; 21(2): e13049, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30656802

RESUMO

BACKGROUND: Systemic steroid is used to treat various transplant-related complications after allogenic hematopoietic stem cell transplantation (allo-HSCT). However, measures to evaluate its impact on infections are still limited. Hence, we examined the cumulative steroid dose used within 30 days after transplant as a predictor of future risk of infections. METHODS: This study included 226 patients who underwent their first allo-HSCT at Kyoto University Hospital between 2005 and 2015. RESULTS: Sixty-one patients received transplantation from related donors, 106 received unrelated BMT and 59 received unrelated single-unit CBT. Patients were categorized into three groups according to the cumulative steroid dose in terms of prednisolone: no-steroid group (n = 174), low-dose group (≤7 mg/kg) (n = 22) and high-dose group (>7 mg/kg) (n = 30). In a multivariate analysis, high-dose steroid administration was associated with cytomegalovirus (CMV) antigenemia (HR 1.91, P = 0.037) and bacteremia (HR 2.59, P = 0.053). No impact was found on the occurrence of invasive fungal infection. CONCLUSION: High-dose cumulative steroid could predict high risks of bacteremia and CMV antigenemia. Additional anti-bacterial agents for fever and regular measurement of CMV antigen are recommended for whom with systemic steroid administration even after neutrophil engraftment.


Assuntos
Bacteriemia/epidemiologia , Infecções por Citomegalovirus/epidemiologia , Transplante de Células-Tronco Hematopoéticas , Esteroides/efeitos adversos , Adolescente , Adulto , Idoso , Antígenos Virais , Citomegalovirus/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esteroides/administração & dosagem , Transplante Homólogo , Adulto Jovem
18.
Orv Hetil ; 160(3): 83-92, 2019 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-30640526

RESUMO

Human cytomegalovirus is a DNA virus with a global prevalence of 40-100%. In humans, primary infection is followed by a lifelong latent persistent phase. Even in individuals developing adequate specific immunity, interactions with the resident virus do probably occur. Clinically significant problems, however, appear primarily in immunocompromised hosts. As a result of an impaired T-cell mediated immunity, viral reactivation as well as a viral disease resulting in organ damage can develop. Most severely affected are HIV positive persons in AIDS stage and individuals undergoing solid organ or stem cell transplantation. As vital functions and survival may adversely be affected by cytomegalovirus reactivation and disease, it is of paramount significance to evaluate evident risk factors. Viral reactivation and organ specific disease can be detected by several methods based on conventional and molecular biological and histological diagnostic techniques. An up-to-date management of affected patient groups requires a meticulous assessment of the possible risk for cytomegalovirus infection and development of an adequate antiviral strategy. Orv Hetil. 2019; 160(3): 83-92.


Assuntos
Antivirais/uso terapêutico , Infecções por Citomegalovirus/tratamento farmacológico , Citomegalovirus/efeitos dos fármacos , Hospedeiro Imunocomprometido , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/imunologia , Humanos , Imunidade Celular/imunologia
19.
J Microbiol Immunol Infect ; 52(1): 114-121, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30598425

RESUMO

BACKGROUND: The clinical features and outcomes of cytomegalovirus (CMV) diseases in patients with systemic lupus erythematosus (SLE) are unknown. We analyzed such data from a medical center in Taiwan. METHODS: We retrospectively reviewed the medical records of patients with SLE who were diagnosed with CMV diseases between 2006 and 2016 in Taipei Veterans General Hospital Taiwan. Clinical and laboratory parameters and treatment outcomes were analyzed. RESULTS: The study enrolled 56 eligible patients with CMV diseases and separated them into survival (n = 24) and mortality (n = 32) groups. All cases showed a significantly high incidence of pneumonitis (71.43%). The patients in the mortality group had a higher SLE disease activity index (SLEDAI)-2000 (p = 0.009), more cases of recent methylprednisolone pulse therapy (p = 0.013) and pancytopenia (p = 0.001), stronger evidence of CMV infection demonstrated by polymerase chain reaction (PCR) in blood (p < 0.001) and bronchoalveolar lavage (p = 0.021), and more concurrent infections (bacteremia p = 0.026; fungemia p < 0.001). CONCLUSIONS: Recent pulse therapy, pancytopenia, and concurrent infections constituted risk factors for mortality in patients with SLE and CMV infection. Among mortality patients, PCR rather than serological tests (IgM antibodies) helped to arrive at an earlier diagnosis.


Assuntos
Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/mortalidade , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/mortalidade , Adulto , Comorbidade , Citomegalovirus , Infecções por Citomegalovirus/tratamento farmacológico , Feminino , Humanos , Incidência , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Rituximab/uso terapêutico , Esteroides/uso terapêutico , Taiwan/epidemiologia
20.
Transpl Infect Dis ; 21(2): e13035, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30548901

RESUMO

BACKGROUND: Late cytomegalovirus infections (LCMV) after the cessation of prophylaxis are well described. We aimed to assess clinical and epidemiological data on late-occurring cytomegalovirus (CMV) infections in the absence of CMV prophylaxis in a cohort of kidney transplant patients. METHODS: In a cohort of kidney transplant recipients not employing CMV-specific prophylaxis, patients with CMV infections occurring after 6 months of transplantation were compared to patients with CMV infections diagnosed within the first 6 months (early infections). The main objectives were to compare clinical outcomes and evaluate risk factors for late CMV infection. RESULTS: A total of 556 patients were evaluated. Forty-three patients with LCMV infections were compared to 513 patients with early CMV infections. LCMV infections occurred after a median of 473 days of transplantation and had a more severe course, with a statistically significant higher rate of invasive disease and graft loss (60.5% vs 21.6% and 11.6% vs 3.1% respectively). Thirty-day mortality was twice as high for patients with LCMV, but did not reach statistical significance (9.3% vs 4.3%). By multivariate analysis, employment of antilymphocyte therapy early after transplantation and tacrolimus as initial immunosuppressive therapy were significantly protective for the occurrence of LCMV infections. CONCLUSION: Late CMV infections in the absence of specific prophylaxis after kidney transplantation have a more severe outcome when compared to early infections and occur in patients less immunosuppressed early after transplantation.


Assuntos
Infecções por Citomegalovirus/epidemiologia , Transplante de Rim/efeitos adversos , Adulto , Citomegalovirus/efeitos dos fármacos , Infecções por Citomegalovirus/mortalidade , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Transplantados
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