Abstract
There is a high prevalence of cytomegalovirus (CMV) seropositivity in developing countries. An apparent risk of CMV reactivation increases following hematopoeitic stem cell transplantation. With effective surveillance and timely treatment using anti-viral therapy, morbidity and mortality associated with CMV reactivation can be reduced. To evaluate the incidence and morbidity associated with CMV reactivation following hematopoeitic stem cell transplantation. We retrospectively analysed 136 hematopoeitic stem cell transplant recipients at our centre for CMV reactivation and their complications. Quantification of CMV-DNA was done by PCR. CMV disease was confirmed histologically via CMV inclusion bodies or immunostaining of biopsy of the affected organ, mainly the gastrointestinal tract. A total of 13 out of 136 patients (9.56%) had CMV reactivation. 6 out of 13 patients had CMV disease, 3 of which died (23.1% of patients with CMV reactivation). CMV reactivation occurred at a median duration of 52.5 days post transplantation (range 35-178 days). The gastrointestinal tract was the organ most commonly affected by CMV. The median follow-up was 14 months (range 6 - 64 months). Through a higher rate of sero-prevalance in developing countries, the incidence of CMV infection following hematopoeitic stem cell transplantation is comparable to that reported in Western literature. Oral valganciclovir was an effective pre-emptive therapy for CMV disease.
Highlights
There is a high prevalence of cytomegalovirus (CMV) seropositivity in developing countries
Though the incidence of CMV disease during the first year after hematopoietic stem cell transplantation (HSCT) has decreased from approximately 30%, in the period before ganciclovir, to 8%, CMV reactivation is still a common complication in HSCT recipients
Quantification of plasma CMV-DNA was done by Quantitative real-time polymerase chain reaction assays, which have been found to be effective as whole blood PCR [4,5]
Summary
There is a high prevalence of cytomegalovirus (CMV) seropositivity in developing countries. An apparent risk of CMV reactivation increases following hematopoeitic stem cell transplantation. Objectives: To evaluate the incidence and morbidity associated with CMV reactivation following hematopoeitic stem cell transplantation. Methodology: We retrospectively analysed 136 hematopoeitic stem cell transplant recipients at our centre for CMV reactivation and their complications. Conclusion: Through a higher rate of sero-prevalance in developing countries, the incidence of CMV infection following hematopoeitic stem cell transplantation is comparable to that reported in Western literature. Infections are a major cause of morbidity and mortality following hematopoeitic stem cell transplantation for various malignant and nonmalignant hematological diseases. Risk of infection is higher in developing countries where endemic diseases are a major contributor to infections during immunocompromised state following hematopoietic stem cell transplantation (HSCT). We analysed the incidence of CMV reactivation and associated morbidity in patients following stem cell transplantation
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