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1.
J. bras. nefrol ; 43(4): 530-538, Dec. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1350900

ABSTRACT

Abstract Introduction: Cytomegalovirus (CMV) is one of the most common agents of infection in solid organ transplant patients, with significant morbidity and mortality. Objective: This study aimed to establish a threshold for initiation of preemptive treatment. In addition, the study compared the performance of antigenemia with qPCR results. Study design: This was a prospective cohort study conducted in 2017 in a single kidney transplant center in Brazil. Clinical validation was performed by comparing in-house qPCR results, against standard of care at that time (Pp65 CMV Antigenemia). ROC curve analysis was performed to determine the ideal threshold for initiation of preemptive therapy based on the qPCR test results. Results: Two hundred and thirty two samples from 30 patients were tested with both antigenemia and qPCR, from which 163 (70.26%) were concordant (Kappa coefficient: 0.435, p<0.001; Spearman correlation: 0.663). PCR allowed for early diagnoses. The median number of days for the first positive result was 50 (range, 24-105) for antigenemia and 42 (range, 24-74) for qPCR (p<0.001). ROC curve analysis revealed that at a threshold of 3,430 IU/mL (Log 3.54), qPCR had a sensitivity of 97.06% and a specificity of 74.24% (AUC 0.92617 ± 0.0185, p<0.001), in the prediction of 10 cells/105 leukocytes by antigenemia and physician's decision to treat. Conclusions: CMV Pp65 antigenemia and CMV qPCR showed fair agreement and a moderate correlation in this study. The in-house qPCR was revealed to be an accurate method to determine CMV DNAemia in kidney transplant patients, resulting in positive results weeks before antigenemia.


Resumo Introdução: Citomegalovírus (CMV) é um dos agentes infecciosos mais comuns em pacientes com transplante de órgãos sólidos, com morbidade e mortalidade significativas. Objetivo: Este estudo visou estabelecer um limite para o início do tratamento preemptivo. Além disso, comparou o desempenho da antigenemia com os resultados da qPCR in house. Desenho do estudo: Este foi um estudo de coorte prospectivo realizado em 2017 em um centro único de transplante renal no Brasil. A validação clínica foi realizada comparando resultados de qPCR in house, com o padrão de atendimento na época (Antigenemia para CMV Pp65). A análise da curva ROC foi realizada para determinar o limite ideal para o início da terapia preemptiva baseado nos resultados do teste qPCR in house. Resultados: 232 amostras de 30 pacientes foram testadas com antigenemia e qPCR, das quais 163 (70,26%) foram concordantes (Coeficiente Kappa: 0,435, p<0,001; Correlação Spearman: 0,663). PCR permitiu diagnósticos precoces. O número médio de dias para o primeiro resultado positivo foi 50 (intervalo, 24-105) para antigenemia e 42 (intervalo, 24-74) para qPCR (p<0,001). A análise da curva ROC revelou que em um limite de 3.430 UI/mL (Log 3,54), qPCR teve sensibilidade de 97,06% e especificidade de 74,24% (AUC 0,92617 ± 0,0185, p<0,001), na previsão de 10 células/10(5) leucócitos por antigenemia e na decisão do médico de tratar. Conclusões: Antigenemia para CMV Pp65 e qPCR para CMV mostraram uma concordância aceitável e uma correlação moderada neste estudo. qPCR in house revelou-se um método preciso para determinar DNAemia do CMV em pacientes transplantados renais, obtendo resultados positivos semanas antes da antigenemia.


Subject(s)
Humans , Kidney Transplantation , Cytomegalovirus Infections/diagnosis , World Health Organization , DNA, Viral , Prospective Studies , Viral Load , Real-Time Polymerase Chain Reaction , Antigens, Viral
2.
Rev. cuba. hematol. inmunol. hemoter ; 37(1): e1279, ene.-mar. 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1251719

ABSTRACT

Introducción: La infección por citomegalovirus es muy frecuente en pacientes sometidos a trasplante de progenitores hematopoyéticos, debido a tratamientos mieloablativos de acondicionamiento, disparidad genética y al tratamiento inmunosupresor, y ocurre fundamentalmente después de la toma del implante. Objetivos: Actualizar el diagnóstico, manejo y seguimiento de la infección por citomegalovirus en pacientes trasplantados. Métodos: Se realizó revisión bibliográfica en los idiomas español e inglés, utilizando los motores de búsqueda de Pubmed, Google Académico y Scielo sobre el diagnóstico y manejo del citomegalovirus en pacientes receptores de trasplante hematopoyético. Análisis y síntesis de la información: Se recolectó y organizó la información obtenida siguiendo cronológicamente el surgimiento de técnicas para diagnóstico y la aparición de nuevos medicamentos en los últimos años. Se seleccionaron artículos recientes de expertos en el tema en revistas prestigiosas, donde se evidencia la importancia del diagnóstico adelantado y el inicio del tratamiento. Conclusiones: En la actualidad se cuenta con nuevas formas de diagnóstico y medicamentos novedosos para el citomegalovirus, pero la mortalidad puede llegar a ser alta, si el paciente no es tratado antes de que aparezcan los síntomas de la enfermedad e incluso a pesar del tratamiento. En ocasiones, no es posible erradicar el virus, lo que lleva a complicaciones importantes y a la muerte. La enfermedad citomegálica continúa siendo una complicación frecuente en estos pacientes a pesar de las medidas para evitar su reactivación(AU)


Introduction: Cytomegalovirus infection is very common in patients undergoing hematopoietic progenitor transplantation, due to myeloablative conditioning treatments, genetic disparity, and immunosuppressive treatment, and occurs mainly after the engrafment. Objective: A review and update of the diagnosis and management of cytomegalovirus is made in hematopoietic transplant recipients. Method: A bibliographic review was carried out in Spanish and English, using the search engines of Pubmed, Scholar Google and Scielo about the diagnosis and management of cytomegalovirus in hematopoietic transplant recipients. Development: The information obtained was collected and organized chronologically about the emergence of techniques for diagnosis and the appearance of new drugs in recent years. Recent articles by experts in prestigious journals were reviewed and the importance of early diagnosis and initiation of treatment is evidenced. Conclusions: There are currently new forms of diagnosis and novel medications, but mortality can be high, if the patient is not treated before the symptoms of the disease appear and even despite treatment, sometimes it is not possible to eradicate the virus, leading to major complications and death. Cytomegalic disease continues to be a frequent complication in these patients despite measures to prevent virus reactivation(AU)


Subject(s)
Humans , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/diagnosis , Hematopoietic Stem Cell Transplantation/adverse effects , Cytomegalovirus , Early Diagnosis , Transplant Recipients
3.
Rev. chil. infectol ; 37(5): 531-540, nov. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1144247

ABSTRACT

Resumen Introducción: Para los pacientes receptores de trasplante hepático (TH) la hepatitis por citomegalovirus (CMV) constituye una entidad de difícil diagnóstico. Nuestro objetivo fue determinar la real incidencia de hepatitis por CMV aplicando técnicas diagnósticas más específicas. Material y Métodos: Estudio retrospectivo/ prospectivo, en un centro de trasplante hepático. Período de estudio: años 2009 al 2019. Se incluyeron los TH que presentaron elementos sugestivos y/o específicos de CMV en la histopatología de la punción biopsia hepática (PBH), a los que se les realizó inmunohistoquimica (IHQ) en la PBH. Población control n = 17. Resultados: 41 casos cumplieron los criterios de inclusión. La IHQ fue positiva en n = 6 (14,6%). En la población control, la IHQ fue negativa en el 100% de los casos. Esto traduce un valor predictor negativo de 100% para la histopatología en el diagnóstico de hepatitis por CMV, con un valor predictor positivo de 14,6%. En 85% de los pacientes con IHQ negativa, hubo diagnósticos alternativos. La terapia antiviral en la fase retrospectiva se indicó en 48% y en la prospectiva en 21%. Conclusiones: Combinar la histopatología con la IHQ optimiza el diagnóstico de hepatitis por CMV; lo que permite la racionalización del uso de antivirales de alto costo y la búsqueda de etiologías diferenciales.


Abstract Background: Cytomegalovirus (CMV) hepatitis constitutes a challenging diagnostic entity in liver transplant (LT) recipients. Aim: To determine the real incidence of CMV hepatitis using more specific diagnostic tools as those currently used before. Methods: Retrospective/prospective study conducted in a hepatic transplant unit from 2009 to 2019. LT recipients with CMV specific or suggestive elements in histopathology of hepatic biopsies were included. Immunohistochemistry (IHQ) was performed in tissue samples of the studied cohort as well as in a control one. Results: 41 patients met the inclusion criteria. IHQ was diagnostic in 6 (14.6%), and was negative in 100% of the control population. The negative predictive value of the histopathology for CMV hepatitis diagnosis was 100% and the positive predictive value was 14.6%. 85% of patients in whom the IHQ was negative had alternative diagnosis Antiviral therapy in the retrospective analysis was indicated in 48% of patients and in 21% of the prospectively analyzed cohort. Conclusions: Histopathology and IHQ combination improves the diagnostic accuracy of CMV hepatitis which translates into a rational us of expensive antiviral therapy and to search for differential diagnosis


Subject(s)
Humans , Liver Transplantation , Cytomegalovirus Infections/diagnosis , Antiviral Agents/therapeutic use , Prospective Studies , Retrospective Studies , Cytomegalovirus , Hepatitis/drug therapy
4.
Rev. méd. Chile ; 148(6): 778-786, jun. 2020. tab, graf
Article in English | LILACS | ID: biblio-1139371

ABSTRACT

ABSTRACT Background: Cytomegalovirus (CMV) is an opportunistic infection (OI) in immunosuppressed patients. However, there are no clear cut-off values available for quantitative plasmatic CMV measures (viral load [VL]) to discriminate those with CMV illness from those infected suffering a transient viral reactivation. Aim: To estimate a CMV VL cut-off point that discriminates infected patients and those with CMV related diseases, and to clinically characterize AIDS patients with this OI. Patients and Methods: Retrospective analysis of AIDS patients admitted by any reason between years 2017 and 2019 and who had a positive plasma CMV VL at any titer. Cases were categorized with illness or infected using accepted criteria and the cut-off value was obtained by receiver operating characteristic curve (ROC) analysis. Results: Twelve patients were identified as having a CMV-associated illness and seven with CMV infection. A CMV VL of 3,800 copies/mL had a sensitivity of 91.6% and 100% specificity to discriminate both states. Of the 12 patients with CMV illness, all were in AIDS stage and only five were receiving HIV therapy. Predominant clinical presentations were gastrointestinal (50%), followed by liver involvement (25%) and CMV disease (25%). All patients were treated with ganciclovir or valganciclovir. Ten patients had a favorable response (83.3%), one patient only had a laboratory improvement (8.3%) and one died during treatment (8.3%). Drug toxicity was recorded in nine patients but in only three cases, a dose adjustment was necessary. Conclusions: The predominant clinical manifestation in our series was gastrointestinal. A CMV VL cutoff level of CMV VL of 3,800 copies / mL is useful to discriminate infected patients from those with CMV related disease.


Antecedentes: Citomegalovirus (CMV) es una infección oportunista (IO) en pacientes inmunosuprimidos. Sin embargo, se requieren puntos de corte de carga viral (CV) para discriminar a aquellos con enfermedad por CMV de aquellos infectados que sufren una reactivación viral transitoria. Objetivos: Estimar un punto de corte de la CV de CMV que discrimine a los enfermos de los infectados y, además, caracterizar clínicamente a los pacientes con sida que presentan esta IO. Pacientes y Métodos: Análisis retrospectivo de pacientes con sida hospitalizados por cualquier motivo entre los años 2017 y 2019, y que presentaron un CV de CMV plasmática positiva a cualquier título. Los casos se clasificaron como enfermos utilizando criterios aceptados y el valor de corte se obtuvo mediante análisis de una curva ROC. Resultados: Durante el período de estudio, 12 pacientes fueron identificados con enfermedad asociada al CMV y siete con infección. Una CV de 3.800 copias/ml logró una sensibilidad de 91,6% y una especificidad de 100% para discriminar ambos estados. De los 12 pacientes enfermos, todos estaban en etapa de sida y solo 5 recibían terapia contra el VIH. La presentación clínica predominante fue gastrointestinal (50%) seguida del compromiso hepático (25%) y de la enfermedad por CMV (25%). Todos los pacientes fueron tratados con ganciclovir o valganciclovir. Diez pacientes tuvieron una respuesta favorable (83,3%), uno solo tuvo mejoría de laboratorio (8,3%) y otro paciente falleció durante el tratamiento (8,3%). Nueve pacientes evolucionaron con toxicidad farmacológica, pero en solo 3 casos fue necesario ajustar las dosis. Conclusiones: La forma predominante de presentación de la enfermedad fue gastrointestinal. Un punto de corte de 3.800 copias/ml discrimina pacientes infectados de aquellos con la enfermedad.


Subject(s)
Humans , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/drug therapy , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Antiviral Agents/therapeutic use , Ganciclovir/therapeutic use , Retrospective Studies , Viral Load , Cytomegalovirus
6.
Rev. Soc. Bras. Med. Trop ; 53: e20190363, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057278

ABSTRACT

Abstract INTRODUCTION: This study assessed the seroprevalence of cytomegalovirus, associated factors, and Epstein-Barr virus coinfection among adult residents of Manaus. METHODS: Using a cross-sectional study design, we collected blood samples from 136 individuals in a household survey in 2016. Prevalence ratios were calculated using Poisson regression. RESULTS: Cytomegalovirus and Epstein-Barr virus seroprevalences were 67.6% (95% CI: 9.7-75.6%) and 97.8% (95% CI: 95.3-100.0%), respectively. Coinfection was observed in 66.2% (95% CI: 58.1-74.2%) of participants. Bivariate analysis showed no statistical association. CONCLUSIONS: Seroprevalences were high among participants and approximately 7 out of 10 individuals had cytomegalovirus and Epstein-Barr virus coinfection.


Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Cytomegalovirus Infections/epidemiology , Herpesvirus 4, Human/immunology , Epstein-Barr Virus Infections/epidemiology , Cytomegalovirus/immunology , Antibodies, Viral/blood , Socioeconomic Factors , Brazil/epidemiology , Seroepidemiologic Studies , Prevalence , Cross-Sectional Studies , Risk Factors , Cytomegalovirus Infections/diagnosis , Epstein-Barr Virus Infections/diagnosis , Coinfection , Middle Aged
7.
Vaccimonitor (La Habana, Print) ; 28(3): 91-96, sept.-dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1094630

ABSTRACT

RESUMEN En los procesos neuroinflamatorios se produce a nivel de líquido cefalorraquídeo una activación policlonal y poliespecífica. Esta activación se produce desde los primeros días y puede permanecer por períodos prolongados. Luego por mecanismos de apoptosis los clones que no responden directamente contra los agentes biológicos involucrados no proliferan. El Reibergrama permite saber si las inmunoglobulinas presentes en el líquido cefalorraquídeo se sintetizaron o no en el sistema nervioso central (SNC) y el Índice de Anticuerpo (IA) determina la especificidad de las mismas en caso de que exista síntesis intratecal. Con estas herramientas nos propusimos identificar la respuesta neuroinmunológica frente a agentes de la familia herpesvirus en pacientes pediátricos con proceso inflamatorio del SNC a partir de sus respectivos IA. Para lograr esto se cuantificaron los niveles de IgG y albúmina en suero y líquido cefalorraquídeo (LCR) mediante inmunodifusión radial simple y por ensayo inmunoenzimático, con lo cual se construyó el Reibergrama que permitió la selección de 85 pacientes pediátricos con síntesis intratecal de inmunoglobulinas, que se diferenciaron en cuatro grupos según sus edades. Mediante ensayo inmunoenzimático se cuantificaron los niveles de IgG específica contra citomegalovirus, virus varicela zoster y virus herpes simple, tanto en suero como en LCR y se determinó el IA específico. La respuesta contra los virus estudiados fue similar para los distintos grupos de edades, lo cual nos permite afirmar la exposición temprana a los mismos.


ABSTRACT In a neuroinflammatory process a polyclonal and poly-specific activation is produced in cerebrospinal fluid. This activation starts from the first days and may persist for a long time. The clones not related directly against the biological agent do not proliferate by apoptosis. Reibergram determine if part of the immunoglobulins content in cerebrospinal fluid belongs from the blood or it is synthesized in the central nervous system. Antibody index determines if the specific antibodies was synthesized intrathecally. By these tools it can be possible to identify the humoral immune response against some herpes virus in pediatric patients suffering from a central nervous system inflammatory process. Quantification of specific IgG against citomegalovirus, varicella zoster and herpes simplex virus in serum and cerebrospinal fluid was done by ELISA. Specific Antibody index against these viruses were similar for the different age groups, which confirm the early exposure of the population.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Cerebrospinal Fluid , Simplexvirus , Cytomegalovirus Infections/diagnosis , Varicella Zoster Virus Infection/epidemiology , Epidemiology, Descriptive , Cross-Sectional Studies , Immunodiffusion/methods
8.
Gac. méd. Méx ; 155(4): 336-342, jul.-ago. 2019. tab, graf
Article in English, Spanish | LILACS | ID: biblio-1286515

ABSTRACT

Resumen Introducción: El citomegalovirus humano es reconocido como la causa más común de infección viral congénita, la cual puede darse como resultado de infección primaria, reinfección o reactivación en la mujer embarazada; además, puede ocasionar retraso en el desarrollo neuronal y pérdida auditiva sensoneural en el neonato. Objetivo: Identificar la infección por citomegalovirus humano en neonatos por PCR en tiempo real (PCR-TR) y cultivo celular. Método: Estudio observacional, longitudinal y retrospectivo con muestras de hisopado oral provenientes de 362 neonatos nacidos en un periodo de 10 meses en un hospital público de Mérida, Yucatán. Se realizó PCR-TR para la detección de citomegalovirus humano. Se obtuvo cultivo celular primario de fibroblastos a partir de tejido de prepucio humano para recuperar el virus. Se siguieron solo los casos positivos. Resultados: Se encontró 0.86 % de infección por citomegalovirus humano por PCR-TR. No se recuperó el virus en cultivo. En las visitas de seguimiento, la salud sensorial y el neurodesarrollo fueron adecuados. Conclusión: La prevalencia de infección por citomegalovirus humano en neonatos fue similar a la de reportes mundiales y solo pudo evidenciarse por PCR. La infección asintomática detectada entre las 12 a 24 horas del nacimiento no tuvo consecuencias a largo plazo.


Abstract Introduction: Human cytomegalovirus (HCMV) is recognized as the most common cause of congenital viral infection, which can occur as a result of primary infection, reinfection or infection reactivation in the pregnant woman and be the cause of delay in neuronal development and sensorineural hearing loss in the neonate. Objective: To identify CMVH infection in newborns by real-time polymerase chain reaction (RT-PCR) and cell culture. Method: Observational, cross-sectional, retrospective study with oral swab samples from 362 neonates born within a 10-month period in a public hospital of Mérida, Yucatán. RT-PCR was carried out for the detection of HCMV. Fibroblast primary cell culture was obtained from human foreskin tissue to isolate the virus. Only positive cases were followed. Results: A prevalence of HCMV infection of 0.86 % was found by RT-PCR. No virus was isolated with cell culture. In the follow-up visits, sensory health and neurodevelopment were adequate. Conclusion: The prevalence of HCMV infection is similar to that of worldwide reports, and only was detected by RT-PCR. Asymptomatic infection detected 12-14 h after birth had no long-term health consequences.


Subject(s)
Humans , Male , Female , Infant, Newborn , Cytomegalovirus Infections/epidemiology , Cytomegalovirus/isolation & purification , Infant, Newborn, Diseases/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective Studies , Cytomegalovirus Infections/congenital , Cytomegalovirus Infections/diagnosis , Real-Time Polymerase Chain Reaction , Hospitals, Public , Infant, Newborn, Diseases/diagnosis , Mexico
9.
Rev. Soc. Bras. Med. Trop ; 52: e20170313, 2019. tab
Article in English | LILACS | ID: biblio-1041543

ABSTRACT

Abstract INTRODUCTION: Toxoplasma gondii and cytomegalovirus (CMV) are pathogens associated with congenital anomalies. METHODS: Serum was collected from 79 reproductive-age women and tested for IgM and IgG antibodies to T. gondii and CMV. RESULTS: Seropositivity for T. gondii was detected in 24.1% of women and CMV in 96.2%. High seropositivity for CMV was found for all ages. The highest seropositivity for T. gondii was observed among older participants. CONCLUSIONS: T. gondii remains an important pathogen owing to low seropositivity.


Subject(s)
Humans , Female , Adult , Toxoplasma/immunology , Immunoglobulin G/blood , Immunoglobulin M/blood , Toxoplasmosis/diagnosis , Cytomegalovirus Infections/diagnosis , Cytomegalovirus/immunology , Enzyme-Linked Immunosorbent Assay , Seroepidemiologic Studies , Toxoplasmosis/epidemiology , Cross-Sectional Studies , Cytomegalovirus Infections/epidemiology , Kosovo/epidemiology
10.
Adv Rheumatol ; 59: 12, 2019. tab, graf
Article in English | LILACS | ID: biblio-1088602

ABSTRACT

Abstract Background: Cytomegalovirus (CMV) is an opportunistic pathogen causing reactivation and disease in Systemic Lupus Erythematosus (SLE) patients. This study aims to systematically review the literature for risk factors associated with CMV disease in SLE patients, in order to identify those more susceptible to CMV infection during their treatment. Methods: A systematic review was conducted on 4 different search engines and via hand search until May 2017. Studies were included after quality assessment via the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (HTA KMET). Results: Two studies on CMV disease were included. Elevated CMV viral load, higher steroid doses, use of immunosuppressants and disease duration were the most commonly associated risk factors for CMV disease. Conclusion: High CMV viral loads, longer SLE disease duration and higher steroid doses were associated with CMV disease. Further studies studying the risk of treatment drugs and role of interventions in the development of CMV infection are needed.


Subject(s)
Humans , Cytomegalovirus Infections/diagnosis , Lupus Erythematosus, Systemic/pathology , Steroids/adverse effects , Risk Factors , Viral Load/immunology
11.
Rev. Soc. Bras. Med. Trop ; 52: e20180457, 2019. tab, graf
Article in English | LILACS | ID: biblio-1041557

ABSTRACT

Abstract INTRODUCTION: We defined the cut-off values of the antigenemia and cytomegalovirus (CMV) DNA tests in HIV/AIDS patients to identify CMV disease. METHODS: A total of 97 samples from 68 patients with and without CMV disease were analyzed by viral DNA detection and antigenemia assay. RESULTS: Qualitative and quantitative results significantly differed between assays. The cut-off values for the antigenemia and qPCR assays were 1.5 positive cells/200,000 leukocytes and 3.715 log/mL, respectively. CONCLUSIONS: Antigenemia and qPCR are suitable for monitoring CMV disease in HIV patients, however, the threshold values should be determined within the centers where the patients are monitored.


Subject(s)
Humans , DNA, Viral/analysis , AIDS-Related Opportunistic Infections/diagnosis , Cytomegalovirus Infections/diagnosis , Cytomegalovirus/isolation & purification , Brazil/epidemiology , DNA, Viral/blood , Predictive Value of Tests , Prospective Studies , ROC Curve , Sensitivity and Specificity , AIDS-Related Opportunistic Infections/blood , Cytomegalovirus Infections/blood , Viral Load , Cytomegalovirus/genetics , Real-Time Polymerase Chain Reaction , Antigens, Viral/blood
12.
Rev. chil. obstet. ginecol. (En línea) ; 82(2): 171-211, abr. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-899895

ABSTRACT

Existen numerosas infecciones bacterianas, virales y parasitarias que pueden transmitirse desde la madre al feto o recién nacido (RN) y que significan un riesgo para él. El acrónimo TORCH se utiliza en forma universal para caracterizar a aquel feto o RN que presenta un cuadro clínico compatible con una infección congénita y que permite un enfrentamiento racional, tanto diagnóstico como terapéutico. El concepto tradicional de realizar un "test de TORCH" sin consideraciones específicas a cada paciente, hoy en día se considera no adecuado y ha sido reemplazado por exámenes específicos para patógenos específicos bajo circunstancias bien definidas. El presente documento revisa las características generales, epidemiológicas, patogénicas, diagnósticas y terapéuticas de los patógenos más frecuentemente involucrados en el estudio de pacientes con sospecha de TORCH.


There is a lot of bacterial, viral or parasite infections who are able to be transmitted vertically from the mother to the fetus or newborn which implicates an enormous risk for it. The TORCH acronym is used universally to refer to a fetus or newborn which presents clinical features compatible with a vertically acquired infection and allows a rational diagnostic and therapeutic approach. The traditional "TORCH test" is nowadays considered not appropriate and it has been replaced for specific test for specific pathogens under well defined circumstances. The present document reviews the general characteristics, epidemiology, pathogenesis, diagnostic and therapeutic options for the most frequently involved pathogens in the fetus or newborn with TORCH suspicion.


Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Toxoplasmosis/diagnosis , Chagas Disease/epidemiology , Cytomegalovirus Infections/congenital , Chile , Toxoplasmosis/therapy , Toxoplasmosis/epidemiology , Neonatal Screening/methods , Practice Guideline , Chagas Disease/therapy , Cytomegalovirus Infections/diagnosis , Infectious Disease Transmission, Vertical , Herpes Simplex/congenital , Herpes Simplex/epidemiology , Measles/congenital , Measles/epidemiology
13.
J. bras. nefrol ; 39(1): 46-54, Jan.-Mar. 2017. tab, graf
Article in English | LILACS | ID: biblio-841202

ABSTRACT

Abstract Introduction: Cytomegalovirus (CMV) infection is a main viral infection after kidney transplantation. The diagnostic methods currently employed are pp65 antigenemia and nucleic acid amplification by polymerase chain reaction (PCR) and aim at detecting viral replication. Objective: The goal of this study was to evaluate and compare by both methods the incidence of CMV active infection in kidney transplant patients and to establishthe best clinical-laboratory correlation. Methods: Thirty sequential kidney transplant recipients were enrolled in a single center prospective cohort study. Peripheral blood samples were drawn from day 15 until the 6th month after transplantation and tested for CMV replication by pp65 antigenemia and quantitative PCR assays (qPCR). Results: Two hundred forty samples were analyzed and the incidence of active infection was similar by both methods. Time elapsed to the first positive test was almost identical but more samples tested positive by qPCR than by antigenemia in a behavior that was almost evenly distributed overtime. Agreement between tests was observed in 217 samples (90.4%; kappa = 0.529; p < 0.001) and in 25 patients the tests were concordant (83.3%; kappa = 0.667; p < 0.001). The evaluation of the diagnostic parameters for CMV replication revealed higher sensitivity for the qPCR test (82.1%) against antigenemia (59.0%). Quantitative PCR was also slightly more accurate than antigenemia. Conclusion: Our data demonstrate that both methods are suitable and have almost equivalent accuracy for the detection of post-transplant cytomegalovirus replication. The choice for either test must take in consideration the demand, execution capability and cost-effectiveness at each institution.


Resumo Introdução: Citomegalovírus (CMV) é uma importante causa de infecção viral após o transplante renal. Os métodos diagnósticos presentemente utilizados são a antigenemia pp-65 e os métodos que utilizam a amplificação de ácidos nucléicos pela reação em cadeia da polimerase (PCR) e visam à detecção da replicação viral. Objetivo: O objetivo deste estudo foi avaliar e comparar a incidência de infecção ativa por CMV em pacientes transplantados renais pelos dois métodos e estabelecer a melhor correlação clínico-laboratorial. Métodos: Trinta pacientes transplantados renais seqüenciais em um único centro foram incluídos em um estudo de coorte prospectiva. Amostras de sangue periférico foram coletadas a partir do 15º dia até o 6º mês pós-transplante e avaliadas para replicação de CMV por Antigenemia pp-65 e PCR quantitativo (qPCR). Resultados: Foram analisadas 240 amostras e a incidência de infecção ativa foi similar pelos dois métodos. O tempo médio transcorrido desde o transplante até o primeiro teste com resultado positivo foi quase idêntico entretanto mais amostras tiveram resultado positivo por qPCR do que antigenemia, um comportamento que se manteve quase uniforme ao longo do tempo. Concordância entre os testes foi observada em 217 amostras (90,4%; kappa = 0,529; p < 0,001) e em 25 pacientes (83,3%; kappa = 0,667; p < 0,001). A avaliação dos parâmetros diagnósticos para replicação de CMV revelaram maior sensibilidade para qPCR (82,1%) contra antigenemia (59,0%). PCR quantitativo também foi levemente mais preciso do que antigenemia. Conclusão: Nossos dados demonstram que ambos os métodos são adequados e tem precisão quase equivalente para a detecção da replicação do CMV após o transplante renal. A escolha entre um ou outro deve levar em consideração a demanda, capacidade de execução e custo-efetividade em cada instituição.


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Young Adult , Postoperative Complications/diagnosis , Postoperative Complications/virology , Kidney Transplantation , Cytomegalovirus Infections/diagnosis , Postoperative Complications/blood , Reproducibility of Results , Longitudinal Studies , Cytomegalovirus Infections/blood , Hematologic Tests
14.
Article in English | WPRIM | ID: wpr-8650

ABSTRACT

BACKGROUND: Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are increasingly important in immunocompromised patients. Nucleic acid extraction methods could affect the results of viral nucleic acid amplification tests. We compared two automated nucleic acid extraction systems for detecting CMV and EBV using real-time PCR assays. METHODS: One hundred and fifty-three whole blood (WB) samples were tested for CMV detection, and 117 WB samples were tested for EBV detection. Viral nucleic acid was extracted in parallel by using QIAsymphony RGQ and QIAcube (Qiagen GmbH, Germany), and real-time PCR assays for CMV and EBV were performed with a Rotor-Gene Q real-time PCR cycler (Qiagen). Detection rates for CMV and EBV were compared, and agreements between the two systems were analyzed. RESULTS: The detection rate of CMV and EBV differed significantly between the QIAsymphony RGQ and QIAcube systems (CMV, 59.5% [91/153] vs 43.8% [67/153], P=0.0005; EBV, 59.0% [69/117] vs 42.7% [50/117], P=0.0008). The two systems showed moderate agreement for CMV and EBV detection (kappa=0.43 and 0.52, respectively). QIAsymphony RGQ showed a negligible correlation with QIAcube for quantitative EBV detection. QIAcube exhibited EBV PCR inhibition in 23.9% (28/117) of samples. CONCLUSIONS: Automated nucleic acid extraction systems have different performances and significantly affect the detection of viral pathogens. The QIAsymphony RGQ system appears to be superior to the QIAcube system for detecting CMV and EBV. A suitable sample preparation system should be considered for optimized nucleic acid amplification in clinical laboratories.


Subject(s)
Automation , Cytomegalovirus/genetics , Cytomegalovirus Infections/diagnosis , DNA, Viral/blood , Herpesvirus 4, Human/genetics , Humans , Reagent Kits, Diagnostic , Real-Time Polymerase Chain Reaction
16.
Rev. chil. infectol ; 33(2): 191-216, abr. 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-784870

ABSTRACT

There is a lot of bacterial, viral or parasite infections who are able to be transmitted vertically from the mother to the fetus or newborn which implicates an enormous risk for it. The TORCH acronym is used universally to refer to a fetus or newborn which presents clinical features compatible with a vertically acquired infection and allows a rational diagnostic and therapeutic approach. The traditional "TORCH test" is nowadays considered not appropriate and it has been replaced for specific test for specific pathogens under well defined circumstances. The present document reviews the general characteristics, epidemiology, pathogenesis, diagnostic and therapeutic options for the most frequently involved pathogens in the fetus or newborn with TORCH suspicion.


Existen numerosas infecciones bacterianas, virales y parasitarias que pueden transmitirse desde la madre al feto o recién nacido (RN) y que significan un riesgo para él. El acrónimo TORCH se utiliza en forma universal para caracterizar a aquel feto o RN que presenta un cuadro clínico compatible con una infección congénita y que permite un enfrentamiento racional, tanto diagnóstico como terapéutico. El concepto tradicional de realizar un "test de TORCH" sin consideraciones específicas a cada paciente, hoy en día se considera no adecuado y ha sido reemplazado por exámenes específicos para patógenos específicos bajo circunstancias bien definidas. El presente documento revisa las características generales, epidemiológicas, patogénicas, diagnósticas y terapéuticas de los patógenos más frecuentemente involucrados en el estudio de pacientes con sospecha de TORCH.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Infant, Newborn, Diseases/microbiology , Infant, Newborn, Diseases/parasitology , Infant, Newborn, Diseases/virology , Pregnancy Complications, Infectious/microbiology , Pregnancy Complications, Infectious/parasitology , Pregnancy Complications, Infectious/virology , Prenatal Diagnosis , Rubella/congenital , Rubella/diagnosis , Rubella/therapy , Syndrome , Toxoplasmosis, Congenital/diagnosis , Toxoplasmosis, Congenital/therapy , Risk Factors , Chagas Disease/congenital , Chagas Disease/diagnosis , Chagas Disease/therapy , Practice Guidelines as Topic , Cytomegalovirus Infections/congenital , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/therapy , Fetus , Herpes Simplex/congenital , Herpes Simplex/diagnosis , Herpes Simplex/therapy
17.
Rev. cuba. obstet. ginecol ; 42(1): 0-0, ene.-mar. 2016.
Article in Spanish | LILACS | ID: lil-795985

ABSTRACT

Existe un grupo de infecciones que pueden producir defectos congénitos graves cuando se adquieren durante la gestación. Estas inciden en la morbilidad y mortalidad infantil, especialmente si la infección ocurre antes de las 20 semanas de embarazo. Entre ellas se encuentran las producidas por el citomegalovirus y el virus del herpes simple que con frecuencia se asocian con infección congénita y daño al recién nacido. El citomegalovirus humano está mundialmente distribuido entre las poblaciones humanas, desde los países desarrollados hasta las comunidades aborígenes. En países en vías de desarrollo y en los estratos socioeconómicos bajos de los países desarrollados, la prevalencia es mayor (más de 90 por ciento) y el virus se adquiere en edades más tempranas de la vida. Es la infección viral congénita más frecuente, ocurre de 0,3 a 2 por ciento de los nacimientos y en el 40 por ciento la transmisión es vertical. La distribución del virus del herpes simple es amplia y la seroprevalencia en el adulto es entre 60 y 75 por ciento para virus del herpes simple -1 y de 11-30 por ciento para virus del herpes simple -2. El objetivo de la presente revisión es describir estas dos entidades al abordar las características más comunes de estas afecciones, la epidemiología, el diagnóstico, la clínica y la terapéutica. Es necesario que el médico de asistencia las conozca a profundidad para realizar un correcto manejo de estas(AU)


There is a group of infections, which can cause serious birth defects when acquired during pregnancy. They affect infant morbidity and mortality, especially if the infection occurs before 20 weekspregnant. These include those caused by cytomegalovirus and herpes simplex virus that are often associated with congenital infection and damage to the newborn.Human cytomegalovirus (HCMV)is globally distributed among human populations from developed countries to Aboriginal communities. In developing and low socioeconomic strata of the developed countries, the prevalence is higher (over 90 percent) and the virus is acquired in earlier stages of life. It is the most common congenital viral infection. It occurs 0.3 to 2 percent of births and 40 percent transmission is vertical. The distribution of herpes simplex virus is broad and seroprevalence in adults is between 60 and 75 percent for herpes simplex 1 virus and 11-30 percent for herpes simplex virus -2. The aim of this review is to describe these two entities in addressing the most common features of these conditions as epidemiology, diagnosis, clinical and therapeutic. A profound knowledge is necessary for the attending physician to the proper handling of them(AU)


Subject(s)
Humans , Pregnancy , Infant, Newborn , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/prevention & control , Cytomegalovirus Infections/epidemiology , Herpes Simplex/transmission , Herpes Simplex/epidemiology , Pregnancy Complications, Infectious/prevention & control , Infection Control
18.
Article in English | WPRIM | ID: wpr-200494

ABSTRACT

Standardized cytomegalovirus (CMV) DNA quantification is important for managing CMV disease. We evaluated the performance of the Real-Q CMV Quantification Kit (Real-Q assay; BioSewoom, Korea) using whole blood (WB), with nucleic acid extraction using MagNA Pure 96 (Roche Diagnostics, Germany). Real-time PCR was performed on two platforms: the 7500 Fast real-time PCR (7500 Fast; Applied Biosystems, USA) and CFX96 real-time PCR detection (CFX96; Bio-Rad, USA) systems. The WHO international standard, diluted with CMV-negative WB, was used to validate the analytical performance. We used 90 WB clinical samples for comparison with the artus CMV RG PCR kit (artus assay; Qiagen, Germany). Limits of detections (LODs) in 7500 Fast and CFX96 were 367 and 479 IU/mL, respectively. The assay was linear from the LOD to 10(6) IU/mL (R2 ≥0.9886). The conversion factors from copies to IU in 7500 Fast and CFX96 were 0.95 and 1.06, respectively. Compared with the artus assay, for values 1,000 copies/mL, 73.3% and 80.6% of samples in 7500 Fast and CFX96, respectively, had <0.5 log10 copies/mL. The Real-Q assay is useful for quantifying CMV in WB with the two real-time PCR platforms.


Subject(s)
Cytomegalovirus/genetics , Cytomegalovirus Infections/diagnosis , DNA, Viral/blood , Humans , Limit of Detection , Reagent Kits, Diagnostic , Real-Time Polymerase Chain Reaction
19.
Rev. chil. infectol ; 32(6): 664-671, graf, tab
Article in Spanish | LILACS | ID: lil-773273

ABSTRACT

Background: Cytomegalovirus (CMV) infection is frequent in HIV adults. It is unknown usefulness of quantitative methods for diagnosing the CMV disease in Chilean patients. Aim: To determine the performance of antigenemia and real time polymerase chain reaction (rtPCR) in the diagnosis of CMV disease in Chilean HIV adults. Method: Detection of CMV by viral isolation (AVR), antigenemia and quantitative rtPCR in HIV adults. Results: The 102 adults with suspected CMV disease had lower LTCD4 count and higher HIV viral load than 77 patients without suspicion (p < 0.05). Antigenemia and PCR were positive in 47 (46.1%) and 37 (36.3%) adults with clinical suspicion and in 2 (2.6%) and 4 (5.2%) of 77 without suspicion. The sensitivity, specificity, positive and negative predictive value of antigenemia and RPCtr were 92%, 80%, 72% and 95% and 72%, 95%, 92% and 80%, respectively. The cutoff values were ≥ lcell (+) and ≥ 5.5 log10 copies/2 x 10(6) cells. CMV was isolated in 6/179 patients (3.4%), all symptomatic. Conclusión: Positivity of antigenemia and rtPCR are similar for diagnosing CMV disease in Chilean HIV adults. AVR is inappropriate as a gold standard for its low performance.


Introducción: La infección por citomegalovirus (CMV) es frecuente en adultos con virus de inmunodeficiencia humana (VIH). No se ha establecido la utilidad de los métodos cuantitativos para diagnosticar enfermedad por CMV en pacientes chilenos. Objetivo: Determinar la positividad de antigenemia y reacción de polimerasa en cadena en tiempo real (RPC-TR) en el diagnóstico de enfermedad por CMV en adultos chilenos con infección por VIH. Metodología: Se detectó CMV mediante aislamiento viral rápido (AVR), antigenemia y reacción de polimerasa en cadena en tiempo real (RPC-TR) cuantitativa en adultos infectados por VIH, con y sin sospecha de enfermedad por CMV. Resultados: El recuento de LT CD4 fue menor y mayor la carga de VIH en 102 sintomáticos respecto a 77 asintomáticos (p < 0,05). La antigenemia y la RPC-TR fueron positivas en 46 y 36% de los enfermos y en 3 y 5% de los asintomáticos respectivamente. La sensibilidad, especificidad, valor predictor positivo y negativo de la antigenemia y la RPC-TR fueron 92%, 80%, 72% y 95% y 72%, 95%, 92% y 80%, respectivamente. Los valores de corte fueron ≥ 1 núcleo (+) y ≥ 5,5 log10 copias/2 x 10(6) céls. Se aisló CMV en 3,4%, todos los sintomáticos. Conclusión: La antigenemia y la RPC-TR tienen una positividad similar para diagnosticar enfermedad por CMV en adultos chilenos con infección por VIH. El AVR es inapropiado como referencia por su baja positividad.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , AIDS-Related Opportunistic Infections/diagnosis , Antigens, Viral/immunology , Cytomegalovirus Infections/diagnosis , Cytomegalovirus/immunology , DNA, Viral/blood , AIDS-Related Opportunistic Infections/immunology , AIDS-Related Opportunistic Infections/virology , Antigens, Viral/blood , Chile , Cytomegalovirus Infections/immunology , Predictive Value of Tests , Real-Time Polymerase Chain Reaction , Sensitivity and Specificity , Viral Load
20.
Clinics ; 70(7): 515-523, 2015. tab
Article in English | LILACS | ID: lil-752395

ABSTRACT

Cytomegalovirus infection is a frequent complication after transplantation. This infection occurs due to transmission from the transplanted organ, due to reactivation of latent infection, or after a primary infection in seronegative patients and can be defined as follows: latent infection, active infection, viral syndrome or invasive disease. This condition occurs mainly between 30 and 90 days after transplantation. In hematopoietic stem cell transplantation in particular, infection usually occurs within the first 30 days after transplantation and in the presence of graft-versus-host disease. The major risk factors are when the recipient is cytomegalovirus seronegative and the donor is seropositive as well as when lymphocyte-depleting antibodies are used. There are two methods for the diagnosis of cytomegalovirus infection: the pp65 antigenemia assay and polymerase chain reaction. Serology has no value for the diagnosis of active disease, whereas histology of the affected tissue and bronchoalveolar lavage analysis are useful in the diagnosis of invasive disease. Cytomegalovirus disease can be prevented by prophylaxis (the administration of antiviral drugs to all or to a subgroup of patients who are at higher risk of viral replication) or by preemptive therapy (the early diagnosis of viral replication before development of the disease and prescription of antiviral treatment to prevent the appearance of clinical disease). The drug used is intravenous or oral ganciclovir; oral valganciclovir; or, less frequently, valacyclovir. Prophylaxis should continue for 90 to 180 days. Treatment is always indicated in cytomegalovirus disease, and the gold-standard drug is intravenous ganciclovir. Treatment should be given for 2 to 3 weeks and should be continued for an additional 7 days after the first negative result for viremia. .


Subject(s)
Humans , Cytomegalovirus Infections/etiology , Postoperative Complications , Transplant Recipients , Cytomegalovirus , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/therapy , Graft Rejection/etiology , Postoperative Complications/diagnosis , Postoperative Complications/therapy
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