Detection Of Cytomegalovirus Infection Research Articles

Applying T-classifier, binary classifiers, upon high-throughput TCR sequencing output to identify cytomegalovirus exposure history

With the continuous development of information technology and the running speed of computers, the development of informatization has led to the generation of increasingly more medical data. Solving unmet needs such as employing the constantly developing artificial intelligence technology to medical data and providing support for the medical industry is a hot research topic. Cytomegalovirus (CMV) is a kind of virus that exists widely in nature with strict species specificity, and the infection rate among Chinese adults is more than 95%. Therefore, the detection of CMV is of great importance since the vast majority of infected patients are in a state of invisible infection after the infection, except for a few patients with clinical symptoms. In this study, we present a new method to detect CMV infection status by analyzing high-throughput sequencing results of T cell receptor beta chains (TCRβ). Based on the high-throughput sequencing data of 640 subjects from cohort 1, Fisher’s exact test was performed to evaluate the relationship between TCRβ sequences and CMV status. Furthermore, the number of subjects with these correlated sequences to different degrees in cohort 1 and cohort 2 were measured to build binary classifier models to identify whether the subject was CMV positive or negative. We select four binary classification algorithms: logistic regression (LR), support vector machine (SVM), random forest (RF), and linear discriminant analysis (LDA) for side-by-side comparison. According to the performance of different algorithms corresponding to different thresholds, four optimal binary classification algorithm models are obtained. The logistic regression algorithm performs best when Fisher's exact test threshold is 10−5, and the sensitivity and specificity are 87.5% and 96.88%, respectively. The RF algorithm performs better at the threshold of 10−5, with a sensitivity of 87.5% and a specificity of 90.63%. The SVM algorithm also achieves high accuracy at the threshold value of 10−5, with a sensitivity of 85.42% and specificity of 96.88%. The LDA algorithm achieves high accuracy with 95.83% sensitivity and 90.63% specificity when the threshold value is 10−4. This is probably because the two-dimensional distribution of CMV data samples is linearly separable, and linear division models such as LDA are more effective, while the division effect of nonlinear separable algorithms such as random forest is relatively inaccurate. This new finding may be a potential diagnostic method for CMV and may even be applicable to other viruses, such as the infectious history detection of the new coronavirus.

Detection of Cytomegalovirus Infection in Infants with Biliary Atresia: A Meta-analysis.

Objectives Biliary atresia (BA) is the most common indication of liver transplantation in children. Several reports attributed BA to both prenatal and perinatal etiologies, including a viral infection-induced autoimmune response that targets the bile ducts. Cytomegalovirus (CMV) remains the most common virus being linked to BA. This meta-analysis aimed to estimate to what extent CMV infection is detected in patients with BA. Methods This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE, Embase, Scopus, WHO-Virtual Health Library (VHL), ScienceDirect, and Google Scholar were used for the systematic search. The risk of bias was assessed using the Newcastle–Ottawa scale. Random effects model was used to estimate the pooled prevalence estimate with the corresponding 95% confidence interval (CI) using Comprehensive Meta-Analysis Software version 3.3. Results A total of 19 studies that fulfilled the eligibility criteria were included in the meta-analysis. The total number of infants with BA was 630 patients, and the pooled overall prevalence of CMV infection among them was 25.4% (95% CI: 15.9%–38.0%). There was high heterogeneity among studies (I 2 = 85.1%, p < .001), and subgroup analyses showed significant regional differences (X 2 = 48.9, p <.001). Data on the prognosis of CMV-associated BA were scarce and obtainable from few studies that suggested an association between detection of CMV infection and poor prognosis of BA. Conclusions The limited available data demonstrates that the rate of detection of CMV infection is high in infants with BA. There is still a need for large studies with appropriate controls for obtaining more reliable results about the various aspects of the association between CMV infection and BA.

388 Detection of Cytomegalovirus Infection in Infants with Biliary Atresia: A Meta-analysis

Abstract Introduction Biliary atresia (BA) is the most common indication of liver transplantation in children. Several reports attributed BA to both prenatal and perinatal aetiologies, including a viral infection-induced auto-immune response that targets the bile ducts. Cytomegalovirus (CMV) remains the most common virus being linked to BA. This meta-analysis estimates to what extent CMV infection is detected in patients with BA. Method This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), ScienceDirect, and Google Scholar were used for the systematic search. Random effects model was used to estimate the pooled prevalence estimate with the corresponding 95% confidence interval (CI) using StatsDirect statistical software. Results A total of 13 studies (covering 419 patients) that fulfilled the eligibility criteria were included in the meta-analysis. The pooled overall prevalence of CMV infection in patients with BA was 24.5% (95% CI 11.9 %– 33.9%). Conclusions The available data demonstrate that the detection of CMV infection is common in infants with BA. There is still a need for large studies with appropriate controls to examine various aspects of the association between CMV infection and BA.

The frequency of detection of markers of Сytomegalovirus infection in children with recurrent respiratory diseases in patients with Shiga-toxin-associated hemolytic-uremic syndrome (STEC-HUS)

The paper presents data on the detection and role of cytomegalovirus infection (CMVI) in 146 children of certain groups aged from 3 months to 15 years who were hospitalized — frequently ill children with respiratory pathology, patients with shiga-toxin-associated hemolytic uremic syndrome (STEC-HUS) and schoolchildren with somatic diseases during rehabilitation in a sanatorium.The aim of the study was to determine the frequency of detection of CMVI in the presented groups, the originality of the main clinical manifestations in correlation with the markers of activity of herpesvirus type V infection. Clinical monitoring was carried out, oropharyngeal swabs, saliva,blood samples (serum and blood cells) were studied using a set of laboratory diagnostic methods:RCM (rapid culture method) on Vero- and M-19 cells, IIR (reaction of indirect immunofluorescence), ELISA to detect specific antigens and antibodies (IgM, IgG).The detection rate of CMV IgG in diagnostic values ranged from 6.4% in the group of frequently ill children with respiratory pathology to 31.7% in schoolchildren of the sanatorium, the acute course of infection was detected in3.2% and 6.4%, respectively, based on markers of acute infection (CMV IgM and cytomegalovirus antigen). In patients with STEC-HUS CMV IgG in diagnostic titers were recorded with the highest frequency — in 74.4% of patients.

Cytomegalovirus infection in patients after orthotopic liver transplantation (clinical report)

Herpes viruses are widespread in the human population, they are able to infect almost all organs and systems of the body. Currently, 8 serotypes of herpesviruses pathogenic for humans are known: herpes simplex viruses of the 1st and 2nd. type, chickenpox — herpes zoster, cytomegalovirus, Epstein-Barr virus, 6th, 7th and 8th human herpes viruses. Primary infection with herpes viruses in 60—90% of cases occurs in early childhood, and, as a rule, is not accompanied, by typical clinical manifestations. Due to the lack of mandatory registration of the incidence of herpes virus infections in our country, the true number of patients is unknown. It is believed that about 20 million people are infected, every year in Russia and. the CIS countries. Herpes viruses, to a greater or lesser extent, can be considered, hepatotropic. A large number of studies are devoted, to the problem, of cytomegalovirus infection, one of the manifestations of which, is hepatitis. Most often, cytomegalovirus hepatitis occurs in immunocompromised. individuals or in patients receiving immunosuppressive therapy, cases of cytomegalovirus hepatitis and in immunocompetent individuals are also described. With liver transplantation without antiviral therapy, cytomegalovirus infection manifests itself in 11-28,5% of recipients and. can lead, to the development of liver failure, loss of transplant and. death, of the recipient. Performing diagnostic studies using both, serological and. molecular biological methods at different periods after liver transplantation, allows to detect cytomegalovirus infection timely and. initiate treatment, thereby avoiding graft rejection and. the death, of the recipient.

SUN-029 PREVENTIVE STRATEGIES FOR CYTOMEGALOVIRUS DISEASE IN RISK-STRATIFIED PATIENTS WITH GLOMERULONEPHRITIS AND RENAL VASCULITIS TREATED WITH POTENT IMMUNOSUPPRESSION

Cytomegalovirus (CMV) disease in immunocompromised individuals is associated with significant morbidity and mortality. Anti-viral prophylaxis effectively reduced CMV disease in solid organ transplant but have not been evaluated among patients with glomerulonephritis at-risk for CMV disease after immunosuppressive therapy. In this proof-of-concept study, we evaluated the utility and outcomes of a risk-stratified approach to anti-viral prophylaxis for adults with glomerulonephritis treated with potent immunosuppressants. Single-center retrospective cohort study of adults with glomerulonephritis prescribed methylprednisolone, cyclophosphamide or rituximab between July 2015 and June 2017. A risk-stratified approach to anti-viral prophylaxis versus surveillance, according to clinical and pharmacotherapy criteria (Figure 1), was implemented since March 2015. The outcome of CMV disease was defined by detection of CMV infection by virus isolation, culture or histopathologic testing of tissue samples. Data was censored at death, last visit to our institution before 30th October 2017. We studied 34 at-risk adults with glomerulonephritis prescribed methylprednisolone, cyclophosphamide or rituximab over 25 months. Median age was 46.5 (29.7, 67.2) years, 16 (45.7%) were male and 4 (11.4%) had diabetes. The most common diagnoses were renal vasculitis (28.6%), lupus nephritis (25.7%) and IgA nephropathy (14.3%). Median eGFR was 20.0 (IQR: 9.0, 45.2) ml/min/1.73 m2 and urine protein-to-creatinine ratio was 5.9 (4.1, 10.1) g/g. Immunosuppressive therapy during the first 3 months after kidney biopsy were methylprednisolone (88.6%), prednisolone (100%), cyclophosphamide (65.7%), mycophenolate (42.9%), rituximab (5.7%), plasma exchange (28.6%) and others (26.4%). Median follow up was 14.8 (6.5, 20.4) months. By criteria (Figure 1), 21 satisfied criteria for anti-viral prophylaxis but among them, only 9 received prophylaxis, 8 were on surveillance and the remaining 4 were not on any preventive strategy. Only 1 patient satisfied criteria for surveillance while the remaining 12 did not require any preventive strategy. In practice, 10 patients received anti-viral prophylaxis (9 according to recommendation and 1 who satisfied criteria for surveillance but physician opted for prophylaxis) for median duration of 9.1 (6.8, 14.1) weeks. Surveillance was performed in 9 patients, among whom 8 satisfied criteria for prophylaxis but their physicians opted for surveillance instead; 3 (8.8%) subsequently required pre-emptive therapy and another 1 patient (2.9%) developed CMV intestinal ulcers) despite CMV titer below action-able criterion within days preceding CMV disease. None of those on prophylaxis or pre-emptive therapy developed CMV disease although 1 patient developed late-onset CMV infection without organ-invasive disease 4 weeks after completing anti-viral prophylaxis. Adverse events (AE) related to anti-viral prophylaxis occurred in 4 patients: 3 patients had 1 AE of leucopenia, thrombocytopenia and transaminitis each and 1 patient had all 3 AE. A risk-stratified approach to anti-viral prophylaxis can be considered for glomerulonephritis treated with potent immunosuppressants but adverse events due to anti-viral prophylaxis were common. Prospective trials and cost-effectiveness studies are required to determine appropriate preventive measures to reduce CMV disease.

Performance of an In-House Real-Time PCR Assay for Detecting Cytomegalovirus Infection among Transplant Patients from a Tertiary Care Centre

Background: Quantitative Cytomegalovirus (CMV) polymerase chain reactions are increasingly being used for monitoring CMV DNAemia in haematopoietic stem cell transplants and solid organ transplants. Objective: In this study, a commercial CMV viral load assay was compared with an in-house viral load assay. Materials and Methods: A total of 176 whole-blood samples were tested for CMV DNAemia using both assays. Results: Our evaluation showed a difference of 1 log10 copies/ml between the two assay systems in determining CMV viral loads in the clinical samples. Conclusion: The in-house viral load assay had a better correlation with clinical findings compared to the commercial assay. Quality assessment of these assays was done by the United Kingdom National External Quality Assessment Scheme (UKNEQAS), an external proficiency testing programme, and by the National Institute for Biological Standard and Control (NIBSC) standard. For UKNEQAS and NIBSC standards, the bias between the assays was 0.73 log10 and 0.85 log10, respectively. This difference is well within the acceptable range already reported in the literature.

Comparison of ELISA, Antigenemia Assay and Nested PCR Monitoring Techniques for Detection of Cytomegalovirus Infection in Renal Transplantation Patients

Human cytomegalovirus (HCMV) can be transmitted through blood transfusion and organ transplantation and could be cause of some complication in solid-organ transplant recipients. Current study is aimed to compare the sensitivity and Specificity of ELISA, Antigenemia assay and nested PCR methods to detection of Cytomegalovirus infection in renal transplantation patients. In this study blood samples were collected from 200 renal transplant recipients’ patients. DNA was extracted by commercial kit and Nested PCR was done by 2 pairs of internal and external primers. Anti CMV antibodies (IgM and IgG) were detected by ELISA and CMV-pp65 antigenemia assay (Ag) was used to detect CMV antigens. The sensitivity and Specificity of each test and all the methods together were evaluated, and SPSS software was used to analysis of data. From 200 patients, 193 (96.5%) were positive for CMV antibodies with the Specificity of 100 and sensitivity of 97.76%. 120 (60%) and 25 (12.5) samples were positive by nested PCR and Ag assay with the Specificity of 94.49 and 78.12 and sensitivity of 94.49 and 78.12, respectively. In the case of early diagnosis of the disease, nested PCR diagnose the infection 14 years earlier than Ag assay and was consistently positive, whereas false negative results were frequently observed with the pp65 Ag assay. The sensitivity and specificity of the two methods combined detection for CMV infection were 96.76% and 99.89%. ELISA can be used as a screening reliable detection test for CMV infection in recipient especially when PCR is unavailable. Combination of ELISA and CMV-PCR methods, provide a more effective method to monitor CMV infection.

Detection OF Cytomegalovirus Infection In Pre-Marital Women In Al-Khalis City

Detection OF Cytomegalovirus Infection In Pre-Marital Women In Al-Khalis City

Die Another Day: Inhibition of Cell Death Pathways by Cytomegalovirus.

Multicellular organisms have evolved multiple genetically programmed cell death pathways that are essential for homeostasis. The finding that many viruses encode cell death inhibitors suggested that cellular suicide also functions as a first line of defence against invading pathogens. This theory was confirmed by studying viral mutants that lack certain cell death inhibitors. Cytomegaloviruses, a family of species-specific viruses, have proved particularly useful in this respect. Cytomegaloviruses are known to encode multiple death inhibitors that are required for efficient viral replication. Here, we outline the mechanisms used by the host cell to detect cytomegalovirus infection and discuss the methods employed by the cytomegalovirus family to prevent death of the host cell. In addition to enhancing our understanding of cytomegalovirus pathogenesis we detail how this research has provided significant insights into the cross-talk that exists between the various cell death pathways.

High anti-human cytomegalovirus antibody levels are associated with the progression of essential hypertension and target organ damage in Han Chinese population.

Human cytomegalovirus (CMV) infection is associated with hypertension and has been linked with the pathogenesis of increased arterial blood pressure (BP). Currently, whether CMV infection is associated with the progression of hypertension and hypertensive target organ damage (TOD) remains to be identified. We aimed to examine the relationship between CMV infection and the progression of hypertension and hypertensive TOD, which could provide clues on the possible mediating mechanisms, in the Han Chinese population. A total of 372 patients with hypertension and 191 healthy controls (Han participants from Xinjiang, China) were included in the study. Enzyme-linked immunosorbent assay (ELISA) and qPCR were used to detect CMV infection. C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) titers were also analyzed using an ELISA kit. Moreover, cardiovascular disease markers were evaluated by echocardiography, carotid ultrasonography, and tomographic scans. Essential hypertension (EH) patients exhibited a marked increase in CMV IgG antibody, CRP, TNF-α, and IL-6 levels. Higher grade of hypertension and hypertensive TOD had higher CMV IgG antibody and CRP levels. The CMV IgG antibody titers were positively correlated with arterial BP, greater grade of hypertension and hypertensive TOD, and CRP and IL-6 levels. The higher quartile of CMV IgG titer and CRP level were associated with the incidence of hypertension and the progression of hypertension and hypertensive TOD. In the Han Chinese population, high CMV IgG titers are associated with the progression of hypertension and hypertensive TOD. CMV IgG titer >4.25 U could be an independent predictor of hypertension and progression of hypertension, while that >4.85 U could be an independent risk factor for hypertensive TOD. The underlying mechanism may be largely mediated by chronic inflammation.

Real - Time Polymerase Chain Reaction Compared to Nested Polymerase Chain Reaction and Enzyme - Linked Immunosorbant Assays for Detecting Cytomegalovirus Infection in Children

Background: Patients with impaired immunity e.g. (use of immunosuppressant therapy, or chemotherapy) are at increased risk of Cytomegalovirus (CMV) infection. Diagnosis of this viral infection is faced with many difficulties in such patients. Objectives: This study aims to compare between ELISA, nested PCR, and real-time PCR in order to set up a highly sensitive applicable assay for detecting CMV in high risk children. Methodology: This study was conducted from September 2015 to May 2016. Two ml blood sample were collected from each of 366 children with suspected CMV infection. CMV specific IgM and IgG were determined in the sera using ELISA. CMV DNA was detected in the plasma using nested PCR. Quantitative real-time PCR was used to determine the viral load. Results: The highest prevalence (50%) of CMV IgM seropositivity was reported from patients suffering from fever of unknown origin. Using the molecular methods, CMV was detected only in patients suffering from malignant hematological disease and receiving chemotherapy, where 83.7% and 67.4% of patients with malignant hematological disease were positive for CMV by real-time and nested PCR respectively. In comparison to real time PCR, nested PCR was 80.5% sensitive and 100% specific; ELISA IgM was 22.2% sensitive and 84.24% specific, where ELISA IgG was 0% sensitive and 71.82% specific for the detection of CMV infection in high risk children. Conclusion: PCR is more sensitive and specific technique for detection of CMV infection in high risk children. Moreover, quantitative real-time PCR is superior to nested PCR as it can define threshold levels needed to guide treatment

Valós idejű polimeráz láncreakció alkalmazása cytomegalovirus-fertőzés és -reaktiváció nyomon követésére malignus hematológiai betegségek kemoterápiás kezelése során és autológ őssejt-transzplantációt követően

Because of the use of chemo-immunotherapeutic drugs, cytomegalovirus infection is one of the most important infectious complications among patients with haematological malignancies. The aim of the authors was to detect cytomegalovirus infection and reactivation using quantitative real-time polymerase chain reaction. Between 2012 and 2014, the authors retrospectively analysed 96 patient's medical history hospitalised in haematology Unit. Patients were grouped on the basis of their underlying diseases (lymphoprolipherative malignancies, acute leukaemias), and the following groups were created: autologous stem cell transplanted and non-transplanted groups. Eighty-three patients were treated with lymphoprolipherative disorders, and 63 (76%) of them underwent autologous stem cell transplantation. Out of the 604 plasma specimens 46 (7.6%) were positive for the cytomegalovirus desoxyribonucleic acid collected from 25 patients [6 non-transplanted (18%) and 19 from the transplanted group (30.2%)]. The frequency of cytomegalovirus positivity was doubled in the transplanted patient group, however, reactivation was asymptomatic in 68% of the cases. The routine use of cytomegalovirus monitoring is not necessary in this patient group. In case of suspected cytomegalovirus infection, molecular tests allow early preemptive antiviral therapy, which may decrease the mortality attributed to cytomegalovirus infection. Orv. Hetil., 2016, 157(35), 1403-1409.

Broncholaveolar lavage to detect cytomegalovirus infection, latency, and reactivation in immune competent hosts.

Roughly 1/3rd of immune competent patients will reactivate latent cytomegalovirus (CMV) during critical illness. There are no standard methods to detect reactivation, and some investigators have postulated that presence of DNA in BAL fluid is indicative of viral replication. To test this hypothesis, we used a murine model that allows inclusion of matched healthy controls which is not possible in human studies. BALB/c mice infected with Smith-murine CMV or PBS (mock) had BAL evaluated 7, 14, or 21 days after acute infections, during latency, or during bacterial sepsis. Plaque assay, PCR, and rtPCR were performed on BALs and concomitantly obtained lung tissue. BAL cellular compositions, including tetramer evaluation of CMV-specific T cells were evaluated by flow cytometry. CMV DNA were detected in BAL at all time-points during acute infection, becoming undetectable in all mice during latency, then were detected again during bacterial sepsis, peaking 3 weeks after onset. mCMV specific T-cells were most numerous in BAL after acute viral infections, decreasing to low levels during latency, then fluctuating during bacterial sepsis. Specifically, mCMV-specific T-cells contracted at sepsis onset, expanding 2-4 weeks post-sepsis, presumably in response to increased viral loads at that time point. Altogether, our results support the use of BAL PCR for the diagnosis of CMV replication in immune competent hosts. Additionally, we demonstrate dynamic changes in CMV-specific T cells that occur in BAL during CMV infection and during sepsis induced viral reactivation. J. Med. Virol. 88:1408-1416, 2016. © 2016 Wiley Periodicals, Inc.

Histological features of Cytomegalovirus-related corneal graft infections, its associated features and clinical significance

AimTo describe the histological features of Cytomegalovirus (CMV)-related corneal graft infections, its associated features and clinical significance.MethodsThis was a retrospective histological study of 48 consecutive cases of failed repeat penetrating...

Su1281 Quantitative Real-Time PCR for the Detection of Cytomegalovirus Infection in Colonic Mucosa of Ulcerative Colitis Patients Before and After Treatment of Exacerbated Colitis

Su1281 Quantitative Real-Time PCR for the Detection of Cytomegalovirus Infection in Colonic Mucosa of Ulcerative Colitis Patients Before and After Treatment of Exacerbated Colitis

Transfusion of CMV Seronegative T-Deplete Allogeneic Stem Cell Transplant Recipients with CMV Unselected Blood Products Confers a Zero Risk of CMV Transmission in the Era of Universal Leucodepletion: A UK Single-Centre Experience

▪Infection with cytomegalovirus (CMV) remains a major cause of morbidity and mortality after allogeneic stem cell transplantation (SCT). Primary CMV infection may follow infusion of stem cells or blood products from a seropositive (or actively infected) donor. CMV negative SCT recipients, especially those receiving T-deplete grafts, are particularly at risk and have routinely only received blood products from CMV negative donors. Previous studies suggest a low rate of CMV transmission with the use of leucodepleted but CMV unselected blood products. These studies belong to an era where techniques used to detect CMV infection (culture, serology or antigen testing) had limited sensitivity. A small number of studies in recent times have attempted to address this issue using nucleic acid testing to detect CMV infection, once again confirming the safety of this approach. Of note, none of these studies specify the proportion of patients receiving a T-deplete graft. We report our experience using a highly sensitive qPCR assay in CMV seronegative allogeneic SCT recipients, predominantly receiving an intensely T-depleted graft at a single, large UK transplant center.Universal leucodepletion to <5 x 106 white cells per unit has been in routine use for blood components in the UK since 1999. Its effectiveness as a strategy to prevent CMV transmission in SCT remains uncertain. Prior to April 2013, CMV seronegative SCT recipients at our center received CMV negative blood products and had no routine CMV PCR monitoring post transplant if the graft was from a seronegative donor. In April 2013, in response to the UK advisory committee on the safety of blood, tissues and organs (SaBTO) position statement (2012), we switched to CMV unselected blood products for all transplant patients and introduced routine weekly blood CMV PCR monitoring.We set out to establish the frequency of CMV transmission in CMV seronegative patients prior to and since the change in transfusion policy at our center. Patients with <100 days post transplant follow up were excluded. Between April 2013 and April 2104, 24 CMV seronegative recipients underwent allogeneic SCT (index group) at the University Hospital Birmingham and received CMV unselected but leucodepleted blood products. Weekly CMV PCR monitoring was performed in these patients, using a highly sensitive qPCR assay (sensitivity of 200 copies /ml whole blood), until a minimum of 100 days post-transplant. We analyzed 24 sequential CMV seronegative allogeneic SCT patients who received a transplant prior to the change of policy and received leucodepleted, CMV negative products as a matched control group. In this group, CMV PCR monitoring was performed routinely only in patients receiving a graft from a CMV seropositive donor. Testing was otherwise performed only if there was clinical suspicion of infection.Mean age of patients in the index group was 41.2 years at time of transplant. All patients received peripheral blood stem cells with the donor source being sibling in 9 (37.5%), unrelated in 14 (58.3%) and cord blood in 1. Twenty-one patients (87.5%) in the index group and 17 (70.8%) in the control group received intense T-depletion with in vivo alemtuzumab or anti-thymocyte globulin. Six patients in each group (25%) received graft from a CMV seropositive donor. Patients in the index group were transfused a total of 129 red cell and 103 platelet units. In comparison, patients in the control group received more transfusions (314 red cell and 245 platelet units). This difference may be partly attributable to an excess of lymphoma patients in the index group who may have a lower transfusion requirement compared to patients with myelodysplasia or acute leukemia. In addition follow-up was longer in the control group (535 days compared to 306 days). There were no CMV transmissions or symptomatic CMV infections in either group.With a total of 232 units of leucodepleted, CMV unselected blood products transfused we find no evidence of CMV transmission using a highly sensitive qPCR assay in a uniform population of high risk CMV seronegative patients receiving an allogeneic SCT, predominantly with intense T cell depletion. Our data provides strong evidence supporting the safety of this approach and if confirmed in a larger, prospective UK study, could form the basis for discontinuing routine CMV PCR monitoring in this setting with significant cost savings. DisclosuresNo relevant conflicts of interest to declare.

Cytomegalovirus and glioblastoma: a review of evidence for their association and indications for testing and treatment.

Glioblastoma is the most common and most fatal primary malignant brain tumor in adults. Despite progress in characterizing the genetic and molecular mechanisms of glioblastomas, advances in treatment that translate into substantial improvement in prognosis have yet to be realized. A role for cytomegalovirus in glioblastoma pathogenesis was proposed more than a decade ago and has generated considerable debate as a possible therapeutic target. Independent groups have had variable success in detecting cytomegalovirus infection in tumor cells; the overall consensus is that very low levels of viral proteins and nucleic acids can be observed. Although cytomegalovirus has not been found to be oncogenic in this context, a possible oncomodulatory role has been suggested. A recent clinical trial evaluating valganciclovir as an adjuvant therapy for the treatment of glioblastoma did not demonstrate a beneficial effect on tumor growth or overall survival, although retrospective analysis subsequently indicted a significant survival benefit. In light of the publicity of that report, patients and neuro-oncologists are requesting cytomegalovirus testing to justify antiviral treatment. Based on questions on the significance of cytomegalovirus infection in glioblastomas and the lack of a clear clinical benefit of valganciclovir, we reviewed this topic and conclude that, at this time, there is insufficient evidence to recommend routine testing and treatment.

Seroprevalence of Cytomegalo Virus (CMV) among pregnant women in Thika, Kenya.

BackgroundThe fetal consequences of CMV infection have made it one of the most serious infections contracted during pregnancy. Despite the posed teratogenic risk during pregnancy, there is no national screening test for CMV infection is available during pregnancy in Kenya. Thus little is known on its epidemiological data that is necessary for health planners and care providers.MethodsA cross sectional study was conducted at Thika district level 5 hospital, Kenya to investigate seroprevalence of CMV infections and associated possible risk factors among pregnant women. Structured questionnaires were used to gather socio-demographic data and ELISA was used to detect CMV infections using IgG and IgM.ResultsOut of 260 pregnant women, 201 (77.3%) were CMV IgG 21(8.1%) CMV IgM being on acute stage of the disease. Marital status (OR = 3.7533, 95% CI =3.0231-6.9631, P < 0.0001), parity (OR = 3.7533, 95% CI = 3.0231-6.9631, P < 0.0001), and education (OR = 3.7533, 95% CI = 3.0231-6.9631, P < 0.0001), history of blood transfusion (OR = 0.0374, 95% CI = 0.00120-0.1168, OR = 0.3804) were found to significantly influence seropostivity in univariate analysis.ConclusionThe 88.4% CMV prevalence rate being detected among pregnant women calls for vaccine and routine screening for CMV infections and its associated risk factors in this kind of settings.

Letter: mucosal PCR for cytomegalovirus in refractory ulcerative colitis

SIRS, We read with great interest the article by Chaparro et al. In this paper, the authors described that predictive factors of colectomy were not identified. We would like to ask the authors about involvement of cytomegalovirus (CMV) infection in ulcerative colitis (UC) patients who required colectomy after infliximab salvage therapy. Cytomegalovirus infection is implicated in exacerbation of UC. However, virological criteria for diagnosing CMV infection in UC have not been standardised. We reported the usefulness of quantitative real-time polymerase chain reaction (PCR) using colonic specimens (mucosal PCR) for detecting CMV infection in patients with refractory UC. The European Crohn’s and Colitis Organization guidelines supported the importance of detection of CMV infection in inflamed mucosa, and recommended mucosal PCR for investigating CMV infection in UC patients refractory to immunosuppressive therapies. 4 In this regard, mucosal PCR could be suitable for evaluating CMV infection. We demonstrate the significance of mucosal PCR in the clinical outcome of UC patients treated with infliximab salvage therapy after tacrolimus. From January 2001 to March 2012, 17 patients with UC refractory to tacrolimus (mean age: 64 years; 6 men, 11 women) were treated with infliximab. Nine of 17 patients with UC were positive for CMV-DNA in colonic mucosa, while eight patients were negative. After a median follow-up of 20 months, six patients (35.3%) underwent colectomy. A significant difference in colectomy free survival was observed between UC patients testing positive for CMV-DNA in colonic mucosa and negative individuals (Figure 1; 35.7% at 17.7 months vs. 88.9% at 45.9 months; log-rank test: P < 0.05). Therefore, mucosal PCR could open a way to not only predict clinical outcome but also therapeutic strategies for patients with refractory UC.