Cytomegalovirus IgG Antibodies Research Articles

Cytomegalovirus Disease, Short-Term Cardiovascular Events and Graft Survival in a Cohort of Kidney Transplant Recipients With High CMV IgG Seroprevalence.

Both cytomegalovirus (CMV) infection and CMV disease have been linked with several long-term indirect effects in kidney transplant recipients. Research questions: We conducted a retrospective study to assess the association between cytomegalovirus disease and risks of death, shortterm cardiovascular events and graft loss in a cohort of renal transplant recipients. The associations between CMV disease and death and cardiovascular events were determined using Cox regression models, while the association between viral disease and graft loss risk was analyzed through a competing risks regression according to the Fine and Gray method. Death with a functioning graft was considered as a competing risk event. A total of 865 consecutive renal transplant recipients were included. The prevalence of seropositive donor/seronegative recipient (D+/R-) group was 89.9% with the remaining patients classified as seropositive recipient (R+). After median follow-up time of 24.4 months, CMV disease was not a risk factor for all-causes mortality (HR = 1.75; 95% CI 0.94-3.25), early cardiovascular events (HR = 0.54; 95% CI 0.16-1.82) or graft loss (subhazard ratio [the HR adjusted for competing risk of death with functioning graft] = 0.99; 95% CI 0.53-1.84). In this cohort with high prevalence of CMV IgG antibodies, we found no association between cytomegalovirus disease and risk of death or graft loss. The relationship between CMV and cardiovascular disease remains to be unraveled and probably corresponds to a multifactorial phenomenon involving individual risk factors and the immune response to infection rather than the virus effect itself.

Post-transplant absolute lymphocyte count predicts early cytomegalovirus infection after heart transplantation

Immunosuppressive therapy can decrease rejection episodes and increase the risk of severe and fatal infections in heart transplantation (HT) recipients. Immunosuppressive therapy can also decrease the absolute lymphocyte count (ALC), but the relationship between early post-transplant ALC and early cytomegalovirus (CMV) infection is largely unknown, especially in HT. We retrospectively analyzed 58 HT recipients who tested positive for CMV IgG antibody and received basiliximab induction therapy. We collected preoperative and 2-month postoperative data on ALC and CMV load. The CMV load > 1200 IU/mL was used as the cutoff value to define early CMV infection. Post-transplant lymphopenia was defined as an ALC of < 500 cells/μL at postoperative day (POD) #7. On POD #7, 29 (50.0%) patients had post-transplant lymphopenia and 29 (50.0%) patients did not. The incidence of CMV infection within 1 or 2 months of HT was higher in the post-transplant lymphopenia group than in the non-lymphopenia group (82.8% vs. 48.3%, P = 0.013; 89.7% vs. 65.5%, P = 0.028, respectively). ALC < 500 cells/μL on POD #7 was an independent risk factor for early CMV infection within 1 month of HT (odds ratio, 4.14; 95% confidence interval, 1.16–14.77; P = 0.029). A low ALC after HT was associated with a high risk of early CMV infection. Post-transplant ALC monitoring is simple and inexpensive and can help identify patients at high risk of early CMV infection.

Serosurvey of parvovirus B19 and cytomegalovirus infections among female university students in Shiraz, Southern Iran

ABSTRACT Infection with parvovirus B19 and cytomegalovirus (CMV) during pregnancy might lead to fetal infection, resulting in congenital abnormalities. This study aimed to investigate the frequency of IgM and IgG antibodies against parvovirus B19 and CMV in female university students in Shiraz, in Fars province, Southern Iran. In this cross-sectional study, 370 female university students were included. Blood samples were collected from each participant and tested for anti-parvovirus B19 and CMV IgG and IgM antibodies, using commercial ELISA kits. The mean age of the participants was 24 (±7)years. Out of 370 participants, 327 (88.4%) and 9 (2.4%) were positive for IgG and IgM antibodies against CMV. Moreover, 211 (57.0%) and 4 (1.1%) of the participants were respectively positive for IgG and IgM antibodies against parvovirus B19. The difference in CMV or parvovirus B19 seropositivity between different age groups was not statistically significant (P>0.05). The findings of our study showed that more than 50% of the female university students are seropositive to CMV and parvovirus B19 infections. It highlights the importance of health education and also the laboratory screening of females at childbearing age to reduce the risk of congenital infections resulting from these viral infections.

Associations of Cytomegalovirus Infection With All-Cause and Cardiovascular Mortality in Multiple Observational Cohort Studies of Older Adults.

BackgroundWhether latent cytomegalovirus (CMV) infection in older adults has any substantial health consequences is unclear. Here, we sought associations between CMV-seropositivity and IgG titer with all-cause and cardiovascular mortality in 5 longitudinal cohorts.MethodsLeiden Longevity Study, Prospective Study of Pravastatin in the Elderly at Risk, Longitudinal Study of Aging Danish Twins, and Leiden 85-plus Study were assessed at median (2.8–11.4 years) follow-up . Cox regression and random effects meta-analysis were used to estimate mortality risk dependent on CMV serostatus and/or IgG antibody titer, in quartiles after adjusting for confounders.ResultsCMV-seropositivity was seen in 47%–79% of 10 122 white community-dwelling adults aged 59–93 years. Of these, 3519 had died on follow-up (579 from cardiovascular disease). CMV seropositivity was not associated with all-cause (hazard ratio [HR], 1.05; 95% confidence interval [CI], .97–1.14) or cardiovascular mortality (HR, 0.97; 95% CI, .83–1.13). Subjects in the highest CMV IgG quartile group had increased all-cause mortality relative to CMV-seronegatives (HR, 1.16; 95% CI, 1.04–1.29) but this association lost significance after adjustment for confounders (HR, 1.13; 95% CI, .99–1.29). The lack of increased mortality risk was confirmed in subanalyses.ConclusionsCMV infection is not associated with all-cause or cardiovascular mortality in white community-dwelling older adults.

Cytomegalovirus antibody levels and mortality among hospitalised elderly patients

Background The impact of cytomegalovirus infection in elderly subjects remains unclear. This study examined the relationship between humoral immune response to cytomegalovirus (CMV) and all-cause mortality in a cohort of elderly hospitalised patients. Methods Data were obtained from a random sample of 715 patients (≥65 years old) admitted for any cause in a third level hospital. Serum IgG antibody against CMV was determined by enzyme-linked immunosorbent (ELISA) assay. Results A total of 480 deaths occurred in seropositive patients (n = 671) during a follow-up of 7.6 years (mean, 4.6); of which 112 patients died in-hospital or within 30 days after discharge (short-term mortality). For patients with CMV IgG antibody levels in the highest quartile compared with lower quartile, fully adjusted models showed that mortality was 1.40 times (95% CI 1.05–1.86) and 2.20 times (95% CI 1.15–4.21) higher, respectively. The exclusion of patients with cardiovascular disease (angina, myocardial infarction, heart failure, peripheral artery disease, or stroke) increases the risk of long-term (HR 2.22, 95% CI 1.36–3.62) and short-term mortality (OR 3.18, 95% CI 1.40–7.24). Conclusions Increased IgG antibody levels against CMV are associated with increased short and long-term mortality in elderly hospitalised patients, especially in patients without cardiovascular disease. Key Messages The outcome of elderly hospitalised patients in relation to CMV is unknown. We demonstrate an association between increased anti-CMV IgG levels and mortality. This association is greater in elderly patients without cardiovascular disease.

Prevalence of Cytomegalovirus in First Trimesteric Spontaneous Abortion: A Prospective Serological and Molecular Case–control Study

Aim: To measure the prevalence and assess the risk of cytomegalovirus (CMV) infection in women diagnosed with first-trimester spontaneous abortion. Comparison Methods: This was a prospective case-control study; a total of 551 women were recruited from two Maternity and Children Hospitals (Makkah and Jeddah cities) in the Western province of the kingdom between March 2013 and June 2016 Serum and products of conceptions were collected prospectively from 201 women diagnosed with first-trimester spontaneous abortion. Another set of serum samples and placental tissues were collected from 350 healthy pregnant women at the time of normal vaginal delivery. CMV IgM and IgG antibodies were measured serologically by ELISA while viral DNA was detected in tissue specimens by PCR. Socio-economic data were analysed to identify potential risk factors of abortion and/or CMV infection. Results: The overall prevalence was 88.4%, 13.6% and 10.1%, for IgG+, IgM+ and PCR+, respectively. IgG+ frequency was comparable between cases (89%) and controls (88%). Both exclusively IgM+ (7.9% vs. 0.6%) and dual IgM+/IgG+ (22.4% vs. 3.4%) antibodies were significantly more prevalent in abortion (P &lt; 0.01). PCR+ was also significantly higher (P &lt; 0.01) in abortion (25.4% vs. 1.4%). Women with exclusive IgM+ (OR 17.1; 95%CI [3.38 – 86.68]; P = 0.001) and those who were positive for all tests (OR 29.3; 95%CI [6.52–131.71]; P &lt; 0.001) had a significantly increased risk for abortion. Conclusions: The majority of the study sample of pregnant women in Saudi Arabia were previously exposed to CMV. First trimester CMV infection appears to be an independent risk for spontaneous abortion and viral spread to the intrauterine cavity was associated with the highest risk for miscarriage. More studies are required to measure the precise prevalence of CMV and its associated sequelae during pregnancy in the kingdom.

Evaluation of Toxoplasma, Rubella, and Cytomegalovirus serological results in women of childbearing age.

OBJECTIVE This study aimed to determine the rates of IgG and IgM antibodies against cytomegalovirus, rubella, and Toxoplasma gondii (all of which may cause congenital infections) in women of childbearing age who were admitted to Bolu Abant İzzet Baysal University Training and Research Hospital. METHODS Between January 2015 and December 2017, Toxoplasma gondii, rubella, and cytomegalovirus IgM and IgG antibody levels were studied using the ELISA method (Architect i2000SR, Abbott, Germany) in patients aged 15 to 45 who attended the obstetrics and gynecology outpatient clinics. Toxoplasma gondii and cytomegalovirus IgG avidity levels were analyzed retrospectively. RESULTS A total of 13.470 tests were conducted in the laboratory. Seropositivity percentages of IgM antibodies were found to be 1.3%, 0.5%, and 1.6% for Toxoplasma (n = 3607), rubella (n = 3931), and cytomegalovirus (n = 3795), respectively. The seropositivity percentages of IgG antibodies were 22%, 94.2%, and 98.2% for Toxoplasma (n = 702), rubella (n = 693), and cytomegalovirus (n = 679), respectively. Primary infection (acute, recently acquired) was found in 7 (35%) patients with low Toxoplasma IgG avidity. One (3%) patient with low cytomegalovirus IgG avidity had a primary infection. CONCLUSION Toxoplasma gondii seronegativity was found to be high in the region. Therefore, screening women of childbearing age may be important for the prevention of congenital infections caused by Toxoplasma gondii.

Routine Investigations in the Antenatal Booking Visit: An Epidemiological Survey

Abstract Background: The antenatal care investigations is very important to determine the antenatal care problems, manage these problems and decrease the maternal morbidity and mortality. Aim of Study: Is to identify the medical pattern in the egyptian pregnant women from Kafr El-Sheikh according to the results of the booking test. Patients and Methods: Cross sectional study was done over 1260 pregnant women from 2015 to 2017 from the outpatient clinic of Obstetrics and Gynecology in Kafr El-Sheikh General Hospital, out of them 260 pregnant women stepped out of the study, all the pregnant women was asked to do the following antenatal care laboratory investigations, complete blood count, random blood sugar, Rh typing, cy-tomegalovirus (CMV) IgG antibodies, hepatitis B virus surface antigen, hepatitis C virus antibodies, high vaginal swap for bacterial vaginosis, urine analysis, all the data gathered for each woman in a file with her name for the statistical analysis. Results: Percentage of anemia was 47.1% with negative significant correlation with age, percentage of DM was 8.1%, percentage of Rh negative was 12.6%, percentage of CMV IgG was 85.7%, percentage of HBV was 2.4%, percentage of HCV was 7.9% with positive significant correlation with history of previous CS, percentage of bacterial vaginosis was 27% and percentage of UTI was 62%. Conclusion: A lot of women in Kafr El-Sheikh do not know the importance of the antenatal investigations and the control of the antenatal problems. Recommendations: There is need for give more concern about routine antenatal care investigations and it's importance and routine screening for anemia, DM, Rh, CMV, HBV, HCV, BV and UTI.

Cytomegalovirus (CMV) and C-Reactive Protein (CRP) and their Association with Atherosclerosis in Patients with End Stage Renal Disease

Abstract Background ESRD (end stage renal disease) is associated with an increase in the risk for cardiovascular disease, which can only be partially explained by known classical risk factors. However, chronic inflammation and endothelial dysfunction are key events in the development of atherosclerosis; both are observed in ESRD patients . The significance of C-Reactive Protein (CRP) and inflammation has increased over time, especially in the ESRD population. From being a simple marker, it now shown that CRP has an active participation in pro-atherosclerotic phenomenon including local pro-inflammatory and thrombotic events. Studies in the general population indicate the usefulness of CRP in prognosis and in monitoring response to therapy. Cytomegalovirus (CMV) is an important pathogen in immunocompromised individuals. Patients with ESRD display signs of frequent CMV re-activation, which may be caused by the uraemia-associated defect in cellular immunity. It has been well documented that hemodialysis patients have impaired immune response, which may result in higher prevalence rates of viral infections, including CMV. Infections in these patients may be due to primary infection or, more commonly, by reactivation of latent virus or re-infection with exogenous virus, which may be introduced by blood transfusion or kidney transplant. Infection with CMV is also considered a risk factor for progression of atherosclerotic disease. Methods CRP and CMV IgG level was measured in the blood samples of sixty adult patients diagnosed as ESRD, 30 ESRD patients with atherosclerotic changes(Group I) and 30 ESRD patients without atherosclerotic changes (Group II) and in comparison with 30 control subjects(Group III) (Control Group). Results The mean value of CRP in the control group (6.0 ± 4.2), the mean value in the ESRD patients with atherosclerotic changes group (15.8 ± 5.6) and the mean value in the ESRD patients without atherosclerotic changes group (11.2 ± 3.9),thus the mean values of CRP in ESRD patients groups were significantly higher than that of the control group (P &amp;lt; 0.001) and the mean value of CRP in ESRD with atherosclerotic changes is significantly higher compared to ESRD without atherosclerotic changes group (P &amp;lt; 0.001). Regarding CMV IgG antibodies it was significantly higher in ESRD patients compared to the control group and was also significantly higher in ESRD with atherosclerotic changes compared to ESRD without atherosclerotic changes. Conclusions ESRD are at greater risk of inflammatory reaction against factors originating from graft, fistula, dialysis membrane, infection sites. These reactions are associated with increased levels inflammatory markers such as serum CRP. Serum CRP seems to have a contribution in the development of cardiovascular complications in ESRD patients.CMV seropositivity is also significantly associated with atherosclerotic disease in ESRD patients. Our data suggest that the risk for progressive atherosclerosis is specifically increased in patients with an inflammatory response to CMV and elevated CRP level.

Thirty years of CMV seroprevalence\u2014a longitudinal analysis in a German university hospital

Human cytomegalovirus (CMV) is a significant cause of morbidity and mortality in patient groups at risk. We have previously shown that the anti-CMV IgG seroprevalence in an urban region of Germany has changed over the last decades. Overall, a decline from 63.7 to 57.25% had been observed between 1988–1997 and 1998–2008 (p < 0,001). Here, we continuously follow the trends to the most recent decade 2009 to 2018. In a retrospective analysis, we determined the seroprevalence of CMV IgG antibodies in our patient cohort, stratified by gender and selected groups at risk (e.g., patients with HIV infection; women of childbearing age). The overall prevalence of anti-CMV IgG non-significantly declined further from 57.25% in 1998–2008 to 56.48% in 2009–2018 (p = 0.881). Looking at gender differences, overall CMV seroprevalence in males declined to 52.82% (from 55.54% in 1998–2008; p = 0.0254), while it non-significantly increased in females to 59.80%. The high seroprevalence in patients with a known HIV infection further increased from 87.46% in 1998–2008 to 92.93% in the current period (p = 0.9999). In women of childbearing age, no significant changes over the last three decades could be observed. The CMV seroprevalence in oncological patients was determined to be 60.64%. Overall, the former significant decline of CMV seroprevalence between the decades 1988–1997 and 1998–2008 in this urban region of Germany slowed down to a non-significant decrease of 0.77% (1998–2008 vs. 2009–2018). This might be an indicator that CMV seroprevalence has reached a plateau.

P139 Prevalence of infections in patients affected by inflammatory bowel disease treated with anti-TNF-α agents: a single-centre experience

Abstract Background Although the efficacy of anti-TNF α agents has dramatically changed the current management of inflammatory bowel disease (IBD), their safety represents an important issue in prescribing anti-TNF. In particular, anti-TNF α treatment has been associated with higher risk of developing infective disease, such as tuberculosis (TBC) and cytomegalovirus (CMV) reactivation and other viral/bacterial diseases. The aim of the present study was to evaluate the incidence and prevalence of CMV, TBC, hepatitis B (HBV) and C (HCV) infection/reactivation and other infections in IBD subjects treated with anti-TNF α. Methods retrospective analysis of prospective maintained database including all IBD subjects treated with anti-TNF α (infliximab, adalimumab and golimumab) for at least 1 year in the period 2013–2018, whose infective serological status (Quantiferon TB test, Mantoux, CMV IgM/IgG, HBsAg, HBsAb, HBcAb, HBeAg, HBeAb, anti-HCV, anti-HIV, HSV IgM/IgG, VZV IgM/IgG, EBV IgM/IgG) was known before starting the treatment and during the follow-up. Incidence (number of infections per 100 patient-years) and prevalence of each infection was reported. Results Among 689 who started an anti-TNF α agent, 288 subjects (males 52.8%, mean age 28.5 + 12.2 years, Crohn’s disease 82.3%), met inclusion criteria and were enrolled. Total years/patient were 378.08 for infliximab, 627.58 for adalimumab and 8.25 for golimumab. Before starting treatment, CMV IgG antibodies were detectable in the majority (78.8%) of patients, but no case of IgM or CMV-DNA positivity was recorded; three subjects (1%) had latent TBC infection (LTBI) and were treated with isoniazide before starting anti-TNF; one case of HBV and one case of HCV infection were registered. During the anti-TNF α treatment, a total of 58 infective events (20.1%) were recorded: 63.8% during adalimumab and 36.2% during infliximab treatment. The most common infections were: urinary (34.5%), cutaneous (13.8%), HSV (13.8%), HPV (8.6%), upper respiratory infections (8.6%), gastroenteritis (6.9%), pneumonia (5.2%), bacteraemia (3.4%), VZV (3.4%) and de novo CMV (1.7%). Among them, 13 (22.4%) were considered severe, 11 (19%) needed hospitalisation and 9 (15.5%) led to anti-TNF withdrawal. No case of CMV or TBC reactivation was registered during the follow-up. The infection incidence rate was therefore 6.05/100 patient-years for adalimumab and 5.55/100 patient-years for infliximab (p = NS) (Table 1). Conclusion IBD patients are at high risk of developing infective disease during anti-TNF α therapy. The recognition of pre-exposure serological status, as well patients’ strict monitoring during maintenance treatment, dramatically reduces the risk of severe reactivation (in particular TBC and CMV reactivation).

Church Attendance and CMV Herpes Virus Latency Among Bereaved and Non-Bereaved Adults.

There is widespread literature linking church attendance to physical health. However, little is known about the association of church attendance and the immune system, particularly during difficult life transitions. This study investigated the association between church attendance and CMV herpes-virus latency by assessing Cytomegalovirus (CMV) IgG antibody titers among bereaved and non-bereaved individuals. Participants included 44 bereaved individuals and 44 controls with a mean age of 68 (SD=12.84). CMV herpes-virus latency was measured using CMV IgG antibody titers. Church attendance was measured using three items from the Community Healthy Activities Model Program for Seniors (CHAMPS) Questionnaire. After adjusting for participant's age, gender, education, minority status, weekly alcohol consumption, smoking, depression, body mass index (BMI) and comorbidities, church attendance was associated with lower CMV IgG antibody titers among bereaved and control participants. Further, there was a significant moderating effect of church attendance in the association between bereavement status and CMV IgG antibody titers, so that bereaved individuals attending church were found to have less herpes-virus reactivation (lower CMV IgG antibody titers) when compared to their bereaved counterparts that do not attend church. This study demonstrated that church attendance is associated with less herpes-virus reactivation as indexed by lower levels of CMV IgG antibody titers, particularly among the bereaved. Future studies should focus on further understanding the pathways by which church attendance impacts CMV herpes-virus latency during stressful life events, such as bereavement.

Seroprevalence of Cytomegaloviruses in Afghanistan

Objective: Human Cytomegalovirus (CMV) is a member of the Herpesviridae family, with the ability to establish a long-lived latent infection. CMV infection causes problems in immunocompromised hosts undergoing organ and stem cell transplantation. The prevalence of CMV in adults varies in different geographic regions. The purpose of this study was to assess the prevalence of CMV in the adult population of Afghanistan, which did not have epidemiologic information for CMV infection. Methods: A total of 500 adults residing in main regional provinces of Afghanistan including Nangarhar, Herat, Mazar-i Sharif, Kandahar and Kabul in the age range of 25-70 years old were randomly selected to include in the study. Among the participants, 263 (52.6%) were female and 237 (47.4%) were male. The samples were tested for the presence of CMV IgM and IgG antibodies using chemiluminescence immunoassay on the Abbott Architect automated platform. Results: The seropositivity of CMV was found 99.79 % in Afghanistan. There were no significant differences in the prevalence CMV infection among the five regions. The seropositivity anti-CMV IgG positive rate in Kandahar, Kabul, Nangarhar and, Herat was determined as 100%. The CMV IgG prevalence was 98.99% in Mazar-i Sharif. Anti CMV IgM was found 1.24% in Afghanistan. Conclusions: Our study shown that the seroprevalence is high in Afghanistan. Because of the high frequency of seropositivity in general population in Afghanistan, the approaches for preventing CMV reactivation need to be developed. J Microbiol Infect Dis 2019; 9(2): 78-82.

Detection of infection by rubella and cytomegalovirus among women exposed to abortion in Ninavah province

The study aims to correlate infection with rubella, cytomegalovirus and abortion at different age groups.&#x0D; Blood samples were collected through the period between beginning of February to the end of September 2017, one hundred and twenty-seven women exposed to abortion and thirty apparently health controls. Serum samples were tested for IgM and IgG antibodies for rubella and cytomegalovirus.&#x0D; The results showed that CMV was the most common infection with high level of IgM antibodies (15.7%) and IgG (12.5%), only 0.7% of the cases gave positive results for rubella IgM, and 6.2% had rubella IgG while the control group only 6.6% had CMV IgM, and 3.3% had CMV IgG antibody. All the age groups did not show infection with rubella except age 25-31 years as 2.1% and 8.5% had IgM and IgG respectively. The highest rate of infection with CMV was at age group 25-31 years (21.2%) then age group 18-24 years (13.7%). Most of the patients experienced two abortions were reported at age group 25-31 years, 1.5% and 4.7% of CMV infected patient experienced 3 and 2 respectively while 1.5% of rubella infected patients had only one abortion, 18.1% of the patients with CMV experienced 2 abortions had cut off &gt;1.25. Hundred % of the patients with rubella had cut off value of &gt; 1.25 experienced one abortions.

Significance of Specific Immunoglobulins Determined by the Chemiluminescence Reaction in Intrauterine Maternal-fetal Infections of TORCH Syndrome

Because the TORCH Syndrome groups infectious agents which cross the placenta during pregnancy and due to that cause the majority of malformative fetopaties, our porpose was to determin specific IgG and IgM antibodies for Cytomegalovirus, Rubella virus and Toxoplasma gondii. We studied 95 serum samples from 93 pregnant females and 2 cilds, being analyzed by a private laboratory in Timisoara between july 2015 � june 2016. Specific antibodies IgG and IgM were found for Rubella virus in 75 of the samples, for Cytomegalovirus in 82 and for toxoplasmosis 92. In this process of determination we used Access 2 (Beckman Coulter) and Immulite 1000 (Siemens) analysers, which use the chemiluminescence reaction. For 72 cases (77.42%) specific antibodies for all tests of the TORCH complex were performed. From all the patients 11 chosed to determine antibodies just for one of the infections of the TORCH Syndrome and 10 patients asked for determining of specific antibodies for two infections of the TORCH Syndrome. 53 (64.63%) of the 82 patients tested for anti-CMV IgG specific antibodies had positive result, which signifies former presence of CMV. 64 (85.33%) of the 75 patients tested for anti-rubella specific antibodies had an IgG positive result. Interpreting of results took in counter the vaccinal status. 6 patients (8%) did not contact the Rubella virus and did were not vaccinated. The level of specific IgG anti-Toxoplasma gondii antibodies was positive for 2 (2.17%) patients of 92. IgM specific antibody test was negative. In pregnant women TORCH Syndrome diagnosis is a must, especially if the medical abortion is the correct decision. Identifyeing infectious agents implicated in TORCH Syndrome can lead to an important decrease of maternal and fetal mortality and morbidity.

Estimation of the worldwide seroprevalence of cytomegalovirus: A systematic review and meta-analysis.

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.

Herpesviridae Seropositivity in Patients with Multiple Sclerosis: First Polish Study

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that leads to inflammation, demyelination and neurodegeneration. Viral aetiology has been suspected to be an MS trigger for a long time, and herpesviruses (HSs) are among the potential pathogens involved. Objectives: The present investigation aims to detect the presence of antibodies against the herpes simplex virus (HSV), varicella-zoster virus, Epstein-Barr virus (EBV), human cytomegalovirus (CMV) and human herpesvirus 6 (HHV6) in the serum of MS patients and control individuals in north-eastern Poland. Method: Plasma was collected from 141 MS patients and 44 blood donors who served as the control group. These individuals were assessed for the presence of antibodies using an enzyme-linked immunosorbent assay. Results: The statistical analysis showed a higher probability of EBV (p = 0.037, OR 4.359) and HHV6 (p = 0.020, OR 3.343) antibody presence in patients with MS compared to that in the control group. In the MS patient group, the prevalence of CMV IgG antibodies was significantly higher in females (p = 0.025). Patients who tested positive for anti-EBV IgG were diagnosed 7.9 years earlier than patients who tested negative for anti-EBV IgG (p = 0.048). Conclusions: The study showed that MS patients in north-eastern Poland were more likely to be seropositive for EBV and HHV6 than healthy individuals. Further work should be undertaken in other regions of Poland and other European countries with particular attention paid to testing seropositivity in all HSs, particularly in the MS patient population, to evaluate the impact of HSs on MS patients in different environments.

18F-FDG PET/CT Findings in Cytomegalovirus Colitis.

We present a case demonstrating the diagnostic work-up of a patient undergoing azathioprine treatment for inflammatory bowel disease (IBD), diagnosed with an acute cytomegalovirus (CMV) infection and CMV colitis. An 18F-FDG positron emission tomography/computed tomography (PET/CT) performed 2 weeks after debut of symptoms revealed pathological 18F-FDG uptake in the left side of the colon mucosa, mimicked activity of IBD. However, a diagnosis of CMV colitis was based on the presence of CMV IgM antibodies, a seroconversion of CMV IgG antibodies, presence of CMV DNA in plasma and the finding af CMV DNA in biopsies from the intestinal mucosa. The patient responded to treatment with ganciclovir. This case highlights that a positive 18F-FDG PET/CT scan of the colon can be due to CMV colitis.

Acute Esophageal Necrosis Following Kidney Transplantation

Acute esophageal necrosis (Black esophagus) is a rare complication typically seen as a circumferential black appearing esophagus in the less vascularized distal region. Etiologies include hypoperfusion, infectious etiologies (e.g. CMV, Candida albicans), DKA, and toxic ingestion. Two cases have been previously reported in kidney transplant recipients involving intra-operative cardiac arrest with associated hypotension, and primary CMV infection, respectively. Our patient developed acute esophageal necrosis without an episode of hypotension, or infectious etiology. A 48 year-old Asian man with end-stage renal disease due to IgA nephropathy received a deceased donor kidney transplant. Both donor and recipient had positive cytomegalovirus (CMV) IgG antibodies prior to transplant. The patient did not experience intraoperative hypotension. He received standard induction and maintenance immunotherapy including tacrolimus target trough levels between 8 and 10 ng/ml. Post-operatively, the patient developed hiccups, postprandial chest and epigastric pain, dysphagia, and odynophagia. He was afebrile, normotensive, and had no fever or evidence of gastrointestinal bleeding. Labs revealed a stable normocytic normochromic anemia with hemoglobin of 9.8g/dL without evidence of leukocytosis, thrombocytopenia and a normal coagulation profile. At symptom onset, tacrolimus level was slightly elevated at 11.1 ng/ml, and his serum creatinine peaked at 15.4. Hemodialysis was started without symptomatic improvement. On POD 4, patient underwent esophagogastroduodenoscopy (EGD) that demonstrated evidence of diffuse blackdiscoloration, ulceration and erythema in the distal esophagus. Biopsies were consistent with necrosis and showed no evidence of CMV infection. Conservative management including NPO, TPN, and PPI for one week led to marked improvement in symptoms and EGD two weeks later revealed adequate reepithelization and no visualization of necrotic tissue (Figure 1D-F). Despite the absence of frank hypotension, infections or DKA, acute esophageal necrosis may occur in the setting of normal blood pressure and major surgery. It is difficult to determine, but tacrolimus with vasoconstrictive properties could have resulted in distal esophageal hypoperfusion and subsequent necrosis. The current case raises clinician awareness in considering the possibility of esophageal necrosis post-transplant in the setting of dysphagia, odynophagia, and elevated tacrolimus levels.1827 Figure 1. A) Normal-appearing upper esophagus on initial EGD. B) Middle esophageal tissue discoloration, erythema and friability with contact bleeding. C) Lower esophageal tissue friability, ulceration and sloughing. D) Normal-appearing upper esophagus on follow-up EGD one week afterwards. E) Normal-appearing middle esophagus. F) Erythema and evidence of re-epithelization in lower third of the esophagus.

Torquetenovirus (TTV) load is associated with mortality in Italian elderly subjects.

An age-related dysregulation of immune response, known as immunosenescence, contributes to increased susceptibility to infections, frailty and high risk of mortality in the elderly. Torquetenovirus (TTV), a circular, single-stranded DNA virus, is highly prevalent in the general population and it may persist in the organism, also in association with other viruses such as cytomegalovirus (CMV), causing chronic viremia. The relationship that TTV establishes with the immune system of infected hosts is not clear. It is known that TTV encodes microRNAs (miRNAs) that might contribute to immune evasion and that the highest viral loads are found in peripheral blood cells. Moreover, it is suspected that TTV infection lead to increased production of inflammatory mediators, thus playing a role in immunosenescence. We investigated the association of TTV load and miRNAs expression with inflammatory and immune markers and the influence of TTV load on mortality within a cohort of 379 elderly subjects who were followed up for 3 years. TTV DNA load in polymorphonuclear leukocytes was slightly positively correlated with age and negatively associated with serum albumin levels and NK cell activity. A marginal positive correlation between TTV DNA load, monocytes and IL-8 plasma levels was found in females and males respectively. TTV DNA copies ≥4.0 log represented a strong predictor of mortality (Hazard ratio = 4.78, 95% CI: 1.70-13.44, after adjusting for age, sex and the main predictors of mortality rate) and this association remained significant even after the CMV IgG antibody titer was included in the model (HR = 9.83; 95% CI: 2.48-38.97; N = 343 subjects). Moreover, multiple linear regression model showed that TTV miRNA-t3b of genogroup 3 was inversely associated with triglycerides, monocytes and C-reactive protein, and directly associated with IL6. Overall these findings suggest a role of TTV in immunesenescence and in the prediction of all-cause mortality risk in Italian elderly subjects. Further studies are needed to fully understand the pathogenic mechanisms of TTV infection during aging.