Higher prevalence of Cytomegalovius pp65 antigenemia associated with lower CD4&lt;sup&gt;+&lt;/sup&gt; T lymphocyte count

Akmz Islam,M Jahan,Mn Islam,S Tabassum

doi:10.3329/bmrcb.v37i1.7796

Abstract

Sixty seven immunocompromised patients were studied prospectively to observe the association of Cytomegalovirus (CMV) pp65 antigenemia with CD4+ T-lymphocyte count, a marker of cellular immunity. This study was conducted in three different groups of immunocompromised patients including HIV infected patients, patients with haematological malignancy and kidney transplanted patients. Result of the study indicate that proportion of severely immunocompromised patients having lower cellular immunity (< or = 200/microl) in all the three groups were comparable and ranged from 44% to 50%. The study also indicated that high prevalence of CMV pp65 antigenemia was associated with lower level of cell mediated immunity (< or = 200/microl). pp65 antigen was detected in 40% of patients with low immunity in contrast with 20% and 22.72% in the patient with intermediate immunity and in group without gross immune deficiency respectively. Lower level of cellular immunity was also associated with high level of CMV pp65 antigen. This was indicated by 75% patients with low immunity having high level of CMV pp65 antigen. It may perhaps be concluded that CMV infection occurred in a higher rate in immunocompromised patients and this is highly associated with the lower immune status of the immunocompromised patients as well as the level of CMV pp65 is higher in the patients with lower cellular immunity. This perhaps indicate that CMV infection is more severe in patients with low cellular immune response.

Highlights

IntroductionCytomegalovirus (CMV) infection is a major cause of disease in immunocompromised individuals including Acquired
Cytomegalovirus (CMV) infection is a major cause of disease in immunocompromised individuals including AcquiredImmunodeficiency Syndrome (AIDS) patients and allograft transplant recipients[1,2,3]
Of the 30 HIV infected patients, 14 (46.66%) had ≤200/μl CD4 T lymphocyte count, and among the kidney transplanted patients and patients with malignant disorder of blood 06 (50%) and 11 (44%) were with ≤200/μl CD4 cell count respectively. This result indicates that statistically a significant no of patients from the different groups had a low CD4+ T lymphocyte count (≤200/μl) indicating low immunity (Wilcoxon signed rank test, p=.009)

Summary

Introduction

Cytomegalovirus (CMV) infection is a major cause of disease in immunocompromised individuals including Acquired. Immunodeficiency Syndrome (AIDS) patients and allograft transplant recipients[1,2,3]. The most severe infections are seen in recipients of allogeneic bone marrow transplants and in AIDS patients with very low CD4+ T lymphocytes counts[4,5]. The clinical effects of CMV infection include infectious disease syndromes such as prolonged fevers, pneumonia, hepatitis, colitis and chronically progressive chorioretinitis[3,6]. CMV may predispose the patient to life threatening super infection with a variety of microbial agents, including gram negative bacilli, L. monocytogens, P. carinii, and fungi i.e. Aspergillous species, Cryptococcus neoformans, and Candida species[6,9]. CMV may initiate a process that can result in allograft injury in case of transplant recipients[10,11]

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