Diagnosis Of Cytomegalovirus Infection Research Articles

Diagnosis of cytomegalovirus infections in dialysis patients: A comparison of serological and molecular methods

Diagnosis of cytomegalovirus infections in dialysis patients: A comparison of serological and molecular methods

Cytomegalovirus infection in non-immunocompromised critically ill patients: A management perspective.

Critically ill patients are a vulnerable group at high risk of developing secondary infections. High disease severity, prolonged intensive care unit (ICU) stay, sepsis, and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections, including cytomegalovirus (CMV). CMV seroconversion has been reported in up to 33% of ICU patients, but its impact on patient outcomes remains a matter of debate. Even though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/ acquired immuno deficiency syndrome, the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still ambiguous. Even the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan involvement. Hence, a better understanding of the symptomatology, diagnostics, and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.

Clinical Characteristics of Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Multicenter Retrospective Study

Objectives: Gastrointestinal cytomegalovirus (CMV) disease is a major contributor to mortality in immunocompromised patients. Few studies have discussed upper gastrointestinal CMV (UGICMV) disease in immunocompetent patients. We compared the clinical outcomes of UGI-CMV between immunocompromised and immunocompetent patients.Methods: This retrospective study included patients with UGI-CMV disease from five tertiary hospitals across Korea (2010– 2022). Patients’ clinical data and outcomes were recorded.Results: UGI-CMV was diagnosed in 54 patients; 27 (50.0%) had esophageal, 24 (44.4%) had gastric, and 3 patients (5.6%) had duodenal involvement. Patients’ median age was 64 years (interquartile range 53–75 years), and the most common comorbidities included hypertension (57.4%) and diabetes (38.9%). The predominant symptom was abdominal pain (46.3%), and the most common endoscopic finding was ulcers (70.4%). Antiviral treatment was administered to 31 patients, and 23 patients underwent observation without treatment. We investigated 32 immunocompromised (59.3%) and 22 immunocompetent (40.7%) patients and observed no intergroup differences in comorbidities and in laboratory and endoscopic findings. Immunocompromised patients had longer length of hospitalization (median 46.2 days vs. 20.0 days, <i>p</i>=0.001). However, treatment outcomes, including the need for intensive care unit admission and mortality did not significantly differ. The overall mortality rate was 13.0%; one patient from the immunocompromised group died of UGI-CMV disease. The treatment success rate was higher in immunocompromised patients who received antiviral therapy (<i>p</i>=0.011).Conclusions: UGI-CMV disease is not uncommon in immunocompetent patients, although symptoms are milder than those in immunocompromised patients. Our findings emphasize the importance of clinical vigilance for accurate diagnosis of CMV infection, particularly in susceptible symptomatic patients and highlight the need for active antiviral treatment for management of immunocompromised patients.

Advances and Challenges in Cytomegalovirus Detection Methods for Liver Transplant Donors

Cytomegalovirus (CMV) infection is a highly prevalent opportunistic infection among liver transplant recipients. When the liver donor is infected with CMV, there is a risk of transmission to the recipient, leading to CMV infection. To improve the postoperative outcome of liver transplantation, it is crucial to shift the focus of CMV detection to the donor and achieve early diagnosis, as well as implement effective preventative and therapeutic measures. However, the commonly used CMV detection methods in the past had limitations that prevented their early and accurate diagnosis in liver transplant donors. This review focuses on the latest advancements in CMV detection methods that can potentially be applied to liver transplant donors. The objective is to compare and evaluate their clinical utility, thereby providing guidance and support for rapid and accurate diagnosis of CMV infection in the clinic. The clustered regularly interspaced short palindromic repeats-associated proteins (CRISPR–Cas) system-based assay emerges as a promising method for detecting the virus, offering great prospects for early and expedient CMV infection diagnosis in clinical settings.

Tissue quantitative RT-PCR test for diagnostic significance of cytomegalovirus infection in patients with inflammatory bowel disease and treatment response: Cytomegalovirus infection in patients with inflammatory bowel disease.

Cytomegalovirus (CMV) is an opportunistic pathogen that exacerbates inflammatory bowel disease (IBD). There are no clear diagnostic criteria for CMV infection in IBD patients. The aim of this study was to evaluate the importance of the diagnosis of CMV infection with CMV-DNA polymerase chain reaction (PCR) in the colonic mucosa and the response to antiviral treatment. We retrospectively analyzed the clinical data of 30 patients with IBD (24 men, 6 women; median age: 42 years) who were hospitalized because of IBD exacerbation and whose samples were assessed by tissue CMV-DNA PCR positivity. Most of the IBD patients had ulcerative colitis (90%). The CMV-DNA PCR median value was 8848 copies/mL of tissue (range 90-242,936 copies/mL). Blood CMV-DNA PCR was found to be positive in a small group (33.3%, 10/30) of tissue CMV-DNA PCR-positive cases. immunohistochemistry tests were positive in only 5 of the 23 patients positive for CMV-DNA PCR in the colonic mucosa, and high remission (25/30, 83.3%) was detected with antiviral therapy. Recurrence of CMV colitis infection was observed in 9 of 25 patients who had remission with antiviral therapy. The tissue CMV-DNA PCR test was found to be more useful than blood CMV-DNA PCR and immunohistochemistry tests for diagnosing CMV colitis, and the tissue CMV-DNA PCR test enabled rapid and appropriate treatment.

Diagnosing congenital cytomegalovirus infections using archived dried blood spots: A 15-year observational study, Portugal

Cytomegalovirus (CMV) is a leading cause of congenital infections. Dried blood spots (DBS) collected in the first week of life (Guthrie cards) have been used in the diagnosis of CMV infection outside the three-week window period following birth. The present work summarizes the results of a 15-year observational study in which DBS from 1388 children were used for a late diagnosis of congenital CMV infection. Three groups of children were studied: i) symptomatic (with symptoms at birth or late sequelae) (N=779); ii) born to mothers with serological profile of primary CMV infection (N=75); iii) without any information (N=534). A highly sensitive method of DNA extraction (heat-induced) from the DBS was used. CMV DNA was detected by a nested PCR. In total CMV DNA was detected in 7.5% (104/1388) of children. Symptomatic children showed a low rate of CMV DNA detection (6.7%) than children born to mothers with serological profile of primary CMV infection (13.3%) (p=0.034). Sensorial hearing loss and encephalopathy were the two clinical manifestations with the highest CMV detection rate (18.3% and 11.1%, respectively). Children whose mothers had a confirmed primary infection showed a higher rate of CMV detection (35.3%) when compared with children whose mothers had a not confirmed primary infection (6.9%) (p=0.007). The present work emphasises the importance of testing DBS in symptomatic children even a long time after symptoms onset and in children born to mothers with serologic diagnosis of maternal primary CMV infection when they miss the diagnosis during the three-week window following birth.

#5296 CYTOMEGALOVIRUS INFECTION AFTER COVID-19 IN KIDNEY TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE

Abstract Background and Aims Kidney transplant recipients (KTR) have adverse COVID-19 outcomes due to the immunosuppressed status and multiple comorbidities. Cytomegalovirus (CMV) is one of the most frequent opportunistic infections after kidney transplantation. However, data concerning its reactivation after COVID-19 is scarce. Herein, we present a single-center cohort of KRT presenting with CMV infection after COVID-19 and its clinical outcomes. Method Single-center cross-sectional study including 22 KTR with CMV viraemia detected by quantitative polymerase chain reaction up to 6 months after COVID-19, between 2020 and 2022. Demographic and clinical data were collected from the electronic records. Results A total of 22 KTR (13 male) were included with a mean age of 55.5±15.5 years and a median Charlson score of 4 (IQR 3-6). Median time after transplantation was 65 months (IQR 12.5-174.5; 3 KTR with <6 months) and only one patient had been submitted to living-donor transplantation. Eight patients received induction therapy with antithymocyte globulin (ATG). At transplantation time, CMV serologic status had been: 50% D+/R+, 13.6% D+/R- and 4.5% D-/R+. CMV infection prior to COVID-19 had been documented in 6 patients. Concerning COVID-19, severe or critical disease had been reported in 8 patients. Specific therapy had been used in 4 patients: 2 with remdesivir/baricitinib, one with remdesivir and one with molnupiravir. Moreover, immunosuppressive therapy had been adjusted in 11 patients, namely by withdrawing the antimetabolite and increasing steroids (7 patients). Median maximum steroid dose (expressed as equivalents of prednisone dose) had been 40 mg (IQR 20-40) and mean cumulative steroid dose had been 416±317 mg. CMV disease was documented in 8 patients (4 with gastrointestinal involvement) and the mean time of diagnosis after COVID-19 was 10±6 weeks. Maintenance immunosuppression included tacrolimus, antimetabolite and steroid in 12 patients; 6 patients had supratherapeutic levels of tacrolimus at CMV infection diagnosis. Median initial viraemia was 770 copies/mL (IQR 288-4106). Valganciclovir was used in 14 patients (one was already taking it as prophylaxis), ganciclovir in 4 patients and CMV enriched human intravenous immunoglobulin was used in one patient. Nine patients required hospitalization and 2 were transferred to an intensive care unit; one of these 2 patients died. Induction therapy with ATG, CMV serologic status at transplantation time, previous CMV infection, COVID-19 severity or supratherapeutic immunosuppressive drug levels were not associated with CMV infection severity or hospitalization. However, higher maximum steroid dose during COVID-19 was associated with CMV disease (p = 0.038), higher viraemia at diagnosis (p = 0.032) and hospitalization (p = 0.018). Conclusion CMV infection is a common and clinically relevant complication in KTR. Altered immunologic status after COVID-19 may predispose to this infection. In addition, immunosuppressive therapy adjustments, namely the increase in steroid dosing may be very relevant to favor reactivation of CMV. Larger studies are warranted, but careful monitoring could help identifying risk patients earlier and prophylaxis may be considered when increased corticosteroids are prescribed.

Development of a CRISPR-Cas12a rapid diagnostic for human cytomegalovirus

Despite decades of research, human cytomegalovirus (CMV) continues to contribute to significant morbidity and mortality in transplant settings and remains the leading cause of viral congenital infections. Clinical diagnosis of CMV infection and/or reactivation under these settings is completed using real time quantitative polymerase chain reaction (RT-qPCR). This assay performs well but is hampered by poor sensitivity and a lack of standardization among testing facilities. A point-of-care rapid diagnostic to determine CMV viremia could address these issues and improve patient care. In this manuscript, we introduce clustered regularly interspaced short palindromic repeats (CRISPR)-Cas12a technology to design and validate a rapid diagnostic for CMV. This system was tested using CMV spiked human saliva and urine samples. Sensitivity of the assay was ∼10 infectious units (IU)/mL. Specificity of the assay was robust and failed to detect other herpesviruses. Collectively, we have designed and validated a rapid diagnostic for CMV that overcomes limitations of the current standard diagnostic. This assay has the potential to be used as a point-of-care screening tool in transplant and neonatal settings.

Intrahepatic Cholestasis due to Cytomegalovirus Infection and Extrahepatic Cholestasis due to Sludge Bile with Confirmed COVID-19

Background: Human Cytomegalovirus (CMV) is a Beta-Herpes virus that leads to congenital infection in 0.4% to 2,3 % of all newborns. Diagnosis of CMV infection includes the culture of the nasopharynx, saliva, and urine. Serologic tests are also beneficial for CMV diagnosis. IgM CMV-specific antibodies can be monitored. Biliary sludge is a mixture of particulate solids that have precipitated from bile. Laparoscopic cholecystectomy offers the most definitive therapy for biliary sludge.
 Case presentation: A 2-month-old boy complained yellow appearance since the age of 1 week ago. Looks pale. Defecation was sometimes colored putty since the age of 2 weeks. Blood laboratory examination with hemoglobin 8,7 gr/dL, Prothrombin time, activated partial thromboplastin time, and liver function were increased. Bilirubin, alkaline phosphatase, and Gamma GT were increased. Two-phase and abdominal USG were biliary atresia. PCR CMV examination with urine and blood sample was positive. Head USG was consistent with CMV infection. Cholangiography showed sludge bile with liver cirrhosis. Therapy gansiklovir IV for 14 days then gansiklovir per oral for 6 months.
 Conclusion: Cholangiography is the definitive diagnosis for biliary sludge. CMV is a congenital infection that causes asymptomatic to multiple severe symptoms, so it is necessary to monitor children for adherence to treatment, improve nutritional status and reduce morbidity and mortality rates.

Genotyping clinical cytomegalovirus isolates in solid-organs-transplant recipients

Cytomegalovirus infection remains one of the leading problems in contemporary healthcare. It belongs to socially and economically significant infections with a high incidence both in children and adults, characterized by polymorphic clinical manifestations and a variety of routes and factors for infection transmission. CMV infection of blood and organ recipients is a serious problem. It should be noted that, despite the great medical and social significance, in the Russian Federation there is no system of CMV epidemiological surveillance and control as it was traditionally developed for other topical infections. The aim of this study is to search for optimal method of cytomegalovirus (CMV) genotyping and estimate genotypic diversity of CMV isolates in Russia for patients underwent solid organ transplantation. The research presents the data after examining blood samples, leukocytes, saliva, urine and lacrimal discharge collected from 160 patients at the Transplantation Department of the Privolzhsky District Medical Center of the FMBA, aged 22 to 64 years, after liver and kidney transplantation. Molecular biological and serological methods were used for testing. Genotyping was carried out by the NGS sequencing of CMV DNA fragments. A high prevalence of CMV was found in patients undergoing solid organ transplantation. For 41.8±3.8% patients, cytomegalovirus DNA was detected in saliva and urine samples, and for 18.1±3.04% of them — in blood samples. In 98.8±3.2% of patients, the diagnosis of Cytomegalovirus infection (CMVI) was confirmed serologically. Based on a summary of reported data, estimation of various methodological approaches for genotyping of clinical CMV isolates was carried out. As a result, a typing option based on genotype determining for two variable genes UL55 (gB) and UL73 (gN) was selected. The spectra and proportional distribution of gB and gN CMV genotypes circulating among adults were determined. It was found that genotype prevalence in the group of patients who underwent solid organ transplantation was as follows: gB2, gN4c, gN4a, gN1. In some cases, a mixed infection was found due to the association of two and three CMV genotypes. The performed phylogenetic analysis of UL55 and UL73 gene nucleotide sequences indicates the genetic heterogeneity found for Russia-wide CMV isolates from in adult patients in the risk group.

Impact of Cytomegalovirus Infection on Short-Term Clinical Outcomes and Operative Histopathology in Infants with Biliary Atresia: A Single-Center Prospective Cohort Study.

Background:There is limited information on the impact of cytomegalovirus (CMV) infection on clinical outcomes and operative histopathology in children with biliary atresia (BA). We hypothesized that CMV infection is associated with greater histopathological damage and unfavorable short-term clinical outcomes.Materials and Methods:A prospective single-center study was conducted with effect from January 2011–July 2012 including all infants with BA who underwent surgery. Diagnosis of CMV infection was confirmed by serum immunoglobulin M (IgM) positivity or the presence of CMV-deoxyribonucleic acid (DNA) in the liver tissue. Four short-term outcome variables were observed. The cohort was divided into subgroups on the basis of seropositivity (IgM + or IgM−); the presence of CMV-DNA in the liver (polymerase chain reaction [PCR]+ or PCR−); and composite CMV groups (Group 1 – IgM+, PCR+; Group 2 – IgM+, PCR−; Group 3 –- IgM−, PCR+; and Group 4 – IgM−, PCR−). Outcomes and histopathology were compared in these subgroups.Results:A total of 32 infants with BA were operated at a mean age of 3.5 (range: 1–6) months. Serum IgM+ and PCR+ were observed in 50% and 37.5% of the patients. Unfavorable outcomes showed a significant association with IgM+ and not PCR+. Similarly, outcomes were poor for CMV Groups 1 and 2 at 1-month follow-up. Infants with IgM+ and PCR+ showed a greater degree of histopathological damage in terms of bile duct proliferation and severe bile duct fibrosis, respectively.Conclusion:In the present study, there was a high incidence of serum IgM+ (50%) and PCR+ of biopsy specimens (37.5%) in infants with BA. This CMV-infected subgroup was associated with greater histopathological damage and unfavorable short-term outcomes after surgery.

Inspissated Bile Syndrome with Neonatal Giant Cell Hepatitis ec Congenital Cytomegalovirus Infection: A Case Report

Cytomegalovirus infection is widely spread globally in the form of primary infection, reactivation of infection, or reinfection with a clinical spectrum that varies from asymptomatic to severe symptoms. The infection in pregnant women needs special attention since it can cause congenital infections in infants. Clinical manifestations that often appear in infants with congenital cytomegalovirus infection include biliary atresia. Diagnosis of Cytomegalovirus infection is established based on clinical findings, positive laboratory results of anti-CMV IgM and IgG, and hepatobiliary investigation. Definitive therapy in the form of the Kasai procedure, when performed at an early age, can increase the infants' healing rate and improve their growth and development. In this case report, a baby boy aged 4 months 29 days experienced yellowing of the skin since the age of 2 months accompanied by pale stools. The anti-CMV IgM and IgG showed positive results, and the abdominal ultrasound showed no biliary atresia. However, the hepatobiliary investigation results showed narrowing of the biliary tract lumen, and the liver biopsy results showed neonatal giant cell hepatitis.

Cytomegalovirus colitis combined with Clostridium innocuum as a cause of lower GI bleeding in a patient with COVID-19

A 67-year-old woman who presented with fever received a diagnosis of COVID-19 infection and was admitted to the medicine ward. She had a history of hypertension and diabetes. On day 4 of hospitalization, owing to progressive dyspnea and oxygen desaturation, she received intubation and mechanical ventilator support. She received remdesivir, dexamethasone, empiric antibiotics, enoxaparin, and tocilizumab during her hospitalization. On day 24, the patient developed bloody stools, and her hemoglobin level decreased from 11.7 g/dL to 9.2 g/dL. Because of persistent bleeding, she underwent colonoscopy, which revealed colitis and ulcer bleeding at the rectum (A). CT showed wall thickening of the lower part of the rectum (B). A pathologic study of the biopsy specimen showed enlarged nuclei and viral inclusions in both the cytoplasm and the nuclei (C). Immunohistochemical stain was positive for cytomegalovirus (CMV) antigen (D). The result of a blood CMV DNA polymerase chain reaction was positive, and the diagnosis of CMV infection was confirmed. In addition, there was growth of Clostridium innocuum in the stool culture. Her bleeding subsided after ganciclovir and metronidazole treatment, and she was extubated smoothly on day 38. Here we illustrate a COVID-19 patient who presented with lower GI bleeding caused by CMV coinfection and growth of C innocuum simultaneously. Endoscopy plays a crucial role in the treatment of patients with GI bleeding. All authors disclosed no financial relationships. Commentary The healthier you are the healthier you stay; the sicker you are the sicker you get. This case reflects this axiom. This unfortunate patient experienced severe respiratory failure secondary to COVID-19 infection. Colonoscopy revealed a dramatic "punched out" ulcer, highly suggestive of a viral colitis, and indeed the patient was found to have a CMV infection. She was also found to harbor C innocuum, which, despite its name, should not be confused with C difficile. C innocuum is an anaerobic gram-positive rod that is considered to be a variant of normal gut flora. C innocuum usually behaves in a pathogenic manner in patients who are immunocompromised, as was clearly the case with this patient. C innocuum is often seen to cause illness in patients after organ transplantation, most commonly renal transplantation. Fortunately, this patient appears to have done well after aggressive therapy for her COVID-19 infection. Douglas G. Adler, MD, FASGE, GIE Senior Associate Editor, Co-Director, Center for Advanced Therapeutic Endoscopy (CATE), Porter Adventist Hospital, PEAK Gastroenterology, Denver, Colorado Mohamed O. Othman, MD, Associate Editor for Focal Points

Immunological and Molecular Diagnosis of Cytomegalovirus Infection between Aborted & Pregnant Women in Babylon City

Human cytomegalovirus (CMV) is the globally highly prevalent herpesvirus worldwide. CMV infects populations of all ages according to the Center for Disease Control and Prevention (CDC) and World Health Organization (WHO). CMV infections remain the most common viral complication potentially multiple in humans and are a major cause of congenital normality in women, which is why they are critical for diagnosis in several times when it happens during pregnancy. Pregnant women with CMV infection can be in charge of abortion or congenital expandaedby. This study involves the collection a total of (90) samples taken from each aborted and pregnant woman (70 with abortion cases and 20 of pregnant without history of abortion as control subjects) referring to Babylon teaching hospital for Maternity and Children, covering a period from (October 2018 to March 2019) to investigate the occurrence of Cytomegalovirus (CMV) in Babylon city. Patients and controls were evaluated for IgG, IgM antibodies and anti-HCMV IgG, IgM for (90) subjects were controlled in this study using the Enzyme Immunoassay Test Kit and read by enzyme - linked immunosorbent analyze (ELISA). In addition the  polymerase  chain reaction (PCR)  DNA  detection  for  CMV  are  based  on  the  amplification  of  pathogen  genomes  in  a particular  region  using different primers. The Chi-square test was used to analyze the data. The results show among 90 samples, women were evaluated for CMV infection, the seroprevalence titer was significantly higher at P <0.05 in seropositive cases ranging from 62(89%) toward positive CMV IgG, while the 65 (93%) of patients were positive CMV IgM from (70) women with abortions. By contrast, the results obtained from the controls were 9 (45%) subjects seropositive for IgG and all of them were seronegative with IgM. The anti – HCMV IgG finding showed high positivity that represents the furthermost of CMV infections among females through ages ranging between 20-29 years. Furthermore, the outcomes of molecular detection showed that a small number of samples 13 (19%) were HCMV DNA detectable in aborted women less than in pregnant women 3 (15%).       

A Novel Multiplexed Enzyme-Linked Immunosorbent Assay for the Detection of IgG Seroreactivity to Cytomegalovirus (CMV) UL144.

Infection with human cytomegalovirus (CMV) is common and may have grave consequences in transplant recipients and congenitally infected children. Diagnosis of CMV infection is based on detection of specific antibodies and molecular assays. The incorporation of CMV serological assays into diagnostic algorithms requires careful evaluation and interpretation. Very few serological assays measure CMV infection by a specific strain. We developed an enzyme-linked immunosorbent assay (ELISA) using CMV-encoded UL144 as the antigen. UL144 encodes three major genotypes, A, B, and C, and recombinants. The ELISA was developed with the three UL144 proteins and optimized as a multiplex assay. Sera from 55 positive and 59 negative CMV IgG, determined by the clinical microbiology laboratory, were used for evaluation and optimization. A cutoff optical density (OD) that distinguishes UL144 antibody-positive from antibody-negative sera was established. UL144 A, B, C, and combinations of these antigens were detected in sera. An assay threshold of 0.1 was established and, from a total of 303 sera, the overall sensitivity, specificity, and positive and negative predictive values of the multiplex ELISA were 86.72% (95% confidence interval [CI] 79.59% to 92.07%), 96.57% (92.69% to 98.73%), 94.40% (88.45% to 97.38%), and 91.60% (87.50% to 94.44%), respectively. The inter- and intraassay median coefficients of variation were 0.06 (interquartile range [IQR] 0.56, 0.2) and 0.171 (IQR 0.038, 0.302), respectively. No cross-reactivity was observed with HSV-positive CMV-negative sera. This ELISA gives simple and reproducible results for detection of anti-CMV UL144 IgG. It may assist in differentiating natural infection from CMV vaccines that lack UL144, and may provide an important tool for epidemiological studies of CMV strains.

Influence of cytomegalovirus infection on nucleoside diphosphatase activity in placenta

Introduction. Cytomegalovirus infection (CMVI) makes a significant contribution to the development of pregnancy pathologies, including dysfunction of the placenta. However, the mechanism of such an effect of CMV has not been precisely established. For the coordination of biochemical reactions in the placenta, an optimal concentration of substances, including nucleotides, is required. Nucleoside diphosphatase is an enzyme that catalyzes the hydrolysis of nucleotide diphosphates to nucleotide and phosphate.Aim. Determination of the activity of nucleoside diphosphatase in the placenta in physiological and complicated CMVI reactivation in the third trimester of pregnancy.Materials and methods. A study of 62 placentas obtained during childbirth at 38-40 weeks was carried out. The first group consisted of the placentas from women with CMVI reactivation in the third trimester of pregnancy and the second – the placenta of women without a history of infectious pathology. Diagnosis of CMVI was carried out by determining antibodies of class M and G by ELISA, as well as CMV DNA was detected by PCR. Histochemical analysis of nucleoside diphosphatase was performed according to the method of A.B.Novikoff and D.S.Goldfischer modified by Z.Lojda et al.Results. In the second group, the placenta nucleoside-diphosphatase had a pronounced activity in the syncytiotrophoblast and the connective tissue stroma of the villi. When CMVI was reactivated in the third trimester of pregnancy, a decrease in the intensity of the histochemical reaction to nucleoside-diphosphatase was found: the cytophotometric index in the first group significantly (p<0.001) decreased to 13.06±0.089 rel. units (in the second group it was 14.11±0.119 relative units).Conclusion. The decrease in the activity of nucleoside diphosphatase found during the reactivation of CMVI in the third trimester of pregnancy might indicate a decrease in nucleotide metabolism in the placenta. In our opinion, the study of enzymes involved in the exchange of nucleotides will help to reveal the mechanisms by which CMV causes disturbances in the functioning of the placenta, leading to the development of complications of pregnancy.

POS-118 CYTOMEGALOVIRUS INFECTION AFTER KIDNEY TRANSPLANTATION:clinical feature and risk factors

Cytomegalovirus (CMV) reactivation or infection is the major infectious complications after renal transplantation. If not treated, it causes a high rate of morbidity and mortality. We studied demographic features, risk factors, and outcomes associated with CMV infection in renal transplant recipients. We retrospectively analyzed 86 patients who received a renal allograft from 2010 to 2019. CMV infection was defined by CMV DNA detection with a polymerase chain reaction. CMV infection was observed in (7/86) 8.1% of the recipients during the follow-up. 57.1% were men. The mean age was 46.4+- 9.4 years. All our patients were seropositive (D+/R+) prior to transplantation. The average time to diagnosis of CMV infection was 9 months with a median at 4.5 months and extremes between 2 and 30 months. All our patients were symptomatic: elevated creatinine levels was the most common symptom (100%), followed by diarrhea and leucopenia (48.6%). Compared with non infected patients, those with CMV infection presented poorer renal function within the first year post transplantation and more acute rejection episode. CMV infection was associated with age of the transplant recipients (P = 0.002), use of mycophenolate mofetil (P = 0.039), anuria prior to kidney transplantation (p=0,016) and number of mismatches at HLA-B (p=0,038). Given the frequency and the poor outcomes of CMV infection among kidney transplant-recipients, an early detection seems to be necessary in particular that it responds promptly to antiviral treatment

Performance evaluation of the Roche cobas 6800 system for quantifying cytomegalovirus DNA in plasma and urine samples.

Cytomegalovirus (CMV) nucleic acid amplification testing is important for CMV infection diagnosis and management. CMV DNA is found in plasma and various other fluids, including urine. If CMV can be reliably detected in urine, it may be considered a non-invasive alternative to blood tests. The cobas 6800 system (Roche Diagnostics, Mannheim, Germany) is a Food and Drug Administration-approved testing platform for measuring CMV DNA in plasma. To evaluate the analytical performance of the cobas 6800 system and compare the clinical feasibility of CMV detection in plasma and urine samples. Imprecision, linearity, limit of quantitation (LOQ), and cross-reactivity of the cobas 6800 system were assessed, and reference interval verification was performed. Plasma CMV DNA quantification was compared to CMV DNA values in urine samples obtained from 129 pediatric patients (<18 years of age) from March 2020 to May 2020 at a tertiary hospital. The assay precision was within the acceptable range. Linearity was observed within the tested concentration range (2.36-6.33 log IU/mL) with a coefficient of determination of 0.9972. The LOQ was 34.5 IU/mL. The assay did not show cross-reactivity with 15 other viruses. Plasma and urine detection results were stratified into three categories: negative, <LOQ, and positive to analyze the degree of agreement with the results. The quadratic weighted kappa value was 0.623 (P = 0.000), showing substantial concurrence. The cobas 6800 system offers good sensitivity, precision, and linearity and is suitable for monitoring CMV viral loads in the plasma and urine samples.

Human cytomegalovirus infection: A considerable issue following allogeneic hematopoietic stem cell transplantation.

Cytomegalovirus (CMV) is an opportunistic virus, whereby recipients are most susceptible following allogeneic hematopoietic stem cell transplantation (allo-HSCT). With the development of novel immunosuppressive agents and antiviral drugs, accompanied with the widespread application of prophylaxis and preemptive treatment, significant developments have been made in transplant recipients with human (H)CMV infection. However, HCMV remains an important cause of short- and long-term morbidity and mortality in transplant recipients. The present review summarizes the molecular mechanism and risk factors of HCMV reactivation following allo-HSCT, the diagnosis of CMV infection following allo-HSCT, prophylaxis and treatment of HCMV infection, and future perspectives. All relevant literature were retrieved from PubMed and have been reviewed.

Treatment of cytomegalovirus anterior segment infection with intravitreal injection of ganciclovir in adjunction with or without oral valganciclovir: a long-term results

We evaluated the therapeutic outcome of intravitreal injection (IVI) of ganciclovir with/without oral valganciclovir for cytomegalovirus (CMV) anterior segment infection. We enrolled 61 patients (61 eyes) with PCR-proven CMV anterior segment infection. IVI of ganciclovir (2 mg/0.05 mL) was given as a loading dose; subsequent use of oral valganciclovir (900 mg twice daily) was determined according to the severity of anterior chamber inflammation after injection. All eyes had IVI of ganciclovir, and 53 patients received oral valganciclovir as adjunctive therapy with a mean duration of 1.9 months to achieve disease remission. Repeated diagnostic aqueous taps were performed in 37 eyes with suspected recurrence, and CMV DNA was positive in 24 eyes. This therapeutic strategy afforded a median 50% recurrence-free survival time of 47.0 ± 8.12 months. The patients’ mean best corrected visual acuity, intraocular pressure and corneal endothelial cell counts stabilized or improved. Corneal transplantation before CMV infection diagnosis was identified as an independent risk factor for recurrence (hazard ratio 6.81, 95% confidence interval 1.21–38.23, P = 0.029). In patients with CMV anterior segment infection, the relative short-term therapeutic strategy, IVI of ganciclovir in adjunction with/without oral valganciclovir, effectively achieved a median recurrence-free survival time of nearly 4 years.