Clinical outcomes and early immune reconstitution in patients with acute lymphoblastic leukemia underwent allogeneic hematopoietic stem cell transplantation / 中国输血杂志

【Objective】 To investigate the correlation between early immune reconstitution and clinical outcomes in patients with acute lymphoblastic leukemia (ALL) underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). 【Methods】 The basic information and treatment data of 99 patients with ALL undering allo-HSCT from December 2018 to February 2022 were collected. The proportions of CD3+ T, CD3+CD4+ T, CD3+CD8+ T and CD3-CD16+CD56+ NK cells were detected before and 30, 60 and 90 days after transplantation using flow cytometry. The correlation between early cellular immune reconstitution and neutrophil engraftment, platelet engraftment, infection, and acute and chronic graft-versus-host disease (GVHD) was analyzed. 【Results】 Among 99 ALL patients, the median time of neutrophil engraftment was day +11 (range, 8-28), and the median time of platelet engraftment was day +14 (range, 10-120). The cumulative incidence of blood stream infection (BSI) was 11.10% and the cumulative incidence of CMV within 100 days of transplantation was 40.40%. The cumulative incidence of EBV within 100 days was 7.10%. The cumulative incidence of acute graft-versus-host disease (aGVHD) was 22.30%. The cumulative incidence of chronic graft-versus-host disease (cGVHD) within 1 year of transplantation was 16.20%. 1 -year cumulative relapse rate was 13.84%. The 1 -year cumulative disease-free survival (DFS) for all patients was 80.60% and the 1-year overall survival (OS) was 90.30%. The CD4+/CD8+ ratio was positively associated with the development of aGVHD at 30 days post-transplant (OR 1.21, 95CI 1.01-1.45, P<0.05). The proportion of CD16+ CD56+ NK cell were higher in the group without BSI than that in the BSI group before and 30 days after transplantation (P < 0.05). The proportion of CD4+ T-cell were lower in the CMV infection group than that in the group without CMV infection at 60 and 90 days post-transplant(P<0.05). The higher level of CD4+ T-cells at 60 days post-transplant was a protective factor for CMV infection within 100 days (HR 0.91, 95CI 0.84-0.99, P<0.05). 【Conclusion】 Early immune reconstitution after allo-HSCT in patients with ALL is associated with aGVHD, CMV and BSI.

A case of endogenous candida endophthalmitis with incidental cytomegalovirus infection and optic neuropathy in a patient recovered from severe COVID-19

A 62-year-old female diabetic recovered from COVID-19 pneumonia after receiving a prolonged course of steroids. She presented with a clinical picture of left-eye panuveitis with white cotton ball chorioretinal lesions and RAPD suggesting an optic neuropathy (VA HM). Diagnostic vitrectomy was performed to take samples for infective screen and to give intravitreal voriconazole empirically. Smear, culture, and PCR for viral DNA confirmed mixed infection of endogenous Candida endophthalmitis and incidental CMV infection. With further treatment, her corrected vision improved to 6/18 with regressing fungal lesions in serial fundus photographs. Prompt diagnosis and intervention preserved her vision and prevented potential life-threatening complications

Utility Of Real Time Quantitative Pcr In The Diagnosis Of Congenital And Perinatal Cytomegalovirus Infection In Symptomatic Babies

Cytomegalovirus(CMV) infection may be acquired congenitally, perinatally or postnatally in babies. Congenital and perinatal CMV infection can be diagnosed by viral culture or detection and quantitation of CMV DNAby Real Time Quantitative PCR (RT-qPCR) in blood ,urine and body fluids. The objective of this study was to diagnose and determine CMV load in infants presenting with clinical features suggestive of cytomegalovirus infection by RT-qPCR of urine. This descriptive study was done on babies admitted to the Departments of Neonatology and Paediatrics Govt Medical College, Kozhikode from January 2015 to December 2017. Urine samples from 142 babies were received and processed in the Microbiology Department. DNA isolation and amplification was performed using commercial DNA extraction kit and PCR kit for detection and quantification of CMV. Serum samples of the babies with CMV viruria were tested for CMV IgM antibodies. Of 142 babies suggestive of CMVinfection CMV-DNAwas detected and quantitated in urine of 25 (17.60%) (mean age 3.36 months). . CMVIgM was positive in 15/25(60%) babies with viruria .Twenty two had congenital CMV infection (cCMV) and 3 had perinatal infection.The most common clinical presentation was jaundice 13( 52%). Of 8 babies started on Ganciclovir 7 responded to treatment. RT-qPCR helps in diagnosing and quantitating CMVload which helps in deciding on therapy and assessing response to treatment,and can predict risk for long term sequelae.

Pneumatosis Intestinalis Developed due to CMV Infection in a Pediatric Severe Aplastic Anemia Patient after Hematopoietic Stem Cell Transplantation / 임상소아혈액종양

A 10-year old girl diagnosed as severe aplastic anemia was transplanted with peripheral stem cells from a CMV seropositive full matched unrelated donor. The conditioning regimen consisted of busulfan, fludarabine, and anti-thymocyte globulin (ATG). At D+114, abdominal pain, fever, and blood-tinged watery diarrhea developed. At D+116, pneumatosis intestinalis (PI) was detected on simple abdominal X-ray and computed tomography (CT). Ganciclovir was started intravenously because CMV antigenemia was detected at D+117. Two days later, PI sign disappeared on simple abdominal X-ray, and hematochezia began to decrease. CMV antigenemia disappeared 10 days after starting ganciclovir. We describe a 10-year old girl with severe aplastic anemia who developed PI in the presence of CMV infection and gastro-intestinal graft-versus-host-disease (GVHD) after allogeneic stem cell transplantation and was treated successfully with ganciclovir.

Pneumatosis Intestinalis Developed due to CMV Infection in a Pediatric Severe Aplastic Anemia Patient after Hematopoietic Stem Cell Transplantation / 임상소아혈액종양

A 10-year old girl diagnosed as severe aplastic anemia was transplanted with peripheral stem cells from a CMV seropositive full matched unrelated donor. The conditioning regimen consisted of busulfan, fludarabine, and anti-thymocyte globulin (ATG). At D+114, abdominal pain, fever, and blood-tinged watery diarrhea developed. At D+116, pneumatosis intestinalis (PI) was detected on simple abdominal X-ray and computed tomography (CT). Ganciclovir was started intravenously because CMV antigenemia was detected at D+117. Two days later, PI sign disappeared on simple abdominal X-ray, and hematochezia began to decrease. CMV antigenemia disappeared 10 days after starting ganciclovir. We describe a 10-year old girl with severe aplastic anemia who developed PI in the presence of CMV infection and gastro-intestinal graft-versus-host-disease (GVHD) after allogeneic stem cell transplantation and was treated successfully with ganciclovir.

Pneumatosis Intestinalis Developed due to CMV Infection in a Pediatric Severe Aplastic Anemia Patient after Hematopoietic Stem Cell Transplantation / 임상소아혈액종양

A 10-year old girl diagnosed as severe aplastic anemia was transplanted with peripheral stem cells from a CMV seropositive full matched unrelated donor. The conditioning regimen consisted of busulfan, fludarabine, and anti-thymocyte globulin (ATG). At D+114, abdominal pain, fever, and blood-tinged watery diarrhea developed. At D+116, pneumatosis intestinalis (PI) was detected on simple abdominal X-ray and computed tomography (CT). Ganciclovir was started intravenously because CMV antigenemia was detected at D+117. Two days later, PI sign disappeared on simple abdominal X-ray, and hematochezia began to decrease. CMV antigenemia disappeared 10 days after starting ganciclovir. We describe a 10-year old girl with severe aplastic anemia who developed PI in the presence of CMV infection and gastro-intestinal graft-versus-host-disease (GVHD) after allogeneic stem cell transplantation and was treated successfully with ganciclovir.

Lung Transplantation in Patients with Pulmonary Emphysema

Lung transplantation is a viable option for patients with chronic obstructive pulmonary disease (COPD), and emphysema is the most common indication to undergo lung transplantation. A total of seven lung and one heart-lung transplantations were performed between July 1996 and June 2004 at the Yongdong Severance Hospital, and herein, three emphysema patients who underwent single lung transplantations are reviewed. There were 2 males and 1 female, with a mean age of 50 years (35, 57 and 58 years). They all underwent an operation, without cardiopulmonary bypass, and there was no operative mortality. The mean survival was 12 months (4 months, 15 months and 17 months) and all succumbed to death due to activation of pulmonary tuberculosis, post-transplantation lymphoproliferative disease and cytomegalovirus (CMV) gastritis associated with asphyxia. Infection was the most common postoperative complication, resulting in longer hospital stays, higher medical expenses and shorter survival rates, necessitating aggressive prophylactic management. The accumulation of experience, modifications to operative procedures and perioperative care may lead to improved early and long- term survival in patients with emphysema undergoing single or bilateral lung transplantations.

A Case of Cytomegalovirus Pneumonia and Retinitis in a Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

Cytomegalovirus (CMV) is the member of the herpesviridae of virus, which are large DNA viruses that share the biologic properties of latency and reactivation. In patients with advanced acquired immune deficiency syndrome (AIDS) and those immunocompomised due to bone marrow transplantation or solid organ transplantation, CMV infection is the major cause of morbidity and mortality. CMV pneumonia is the most severe complication of these CMV disease. There have been reported a few cases of CMV interstitial pneumonitis occurring in a patient with SLE after intensive immunosuppressive therapy with prednisolone and cyclophosphamide, and there has been reported a case in Korea. Then we report a case of CMV pneumonia and retinitis occurring in a patient with SLE who was being treated with high dose steroid for 1 month, and was treated with ganciclovir and immunoglobulin.

Clinical Investigation on Ganciclovir Applied to Treat Neonatal Congenital CMV Infection / 中国医师杂志

Objective To evaluate therapeutic effects of ganciclovir on neonatal congenital CMV infection.Methods 40 cases of neonatal congenital CMV infection was divided into experimental group with ganciclovir(n=18) and control group with general treatment(n=22).The patients of experimental group were treated with higher dosage of ganciclovir:induced treatment 7 5mg/kg,intravenous drip every 12 hours,continous using for 14 days,then maintenance treatment,10mg/kg intravenous drip every day,for 3-day every week,maintenance treatment 2～3months.The patients of control group was treated with routine mehtod.Later on clinical situation,laboratory examination and virology result were compared in the two groups.Result There were significantly differences of clinical situation,laboratory examination and virology test result between posttreatment and pretreatment in experimental group(P0 05).Conclusions Using higher dosage,full course ganciclovir treating neonatal congenital CMV infection have remarkably efficacy in early the disease at the onset,so can be widespread in clinical practice.

A Neonatal Case of Symptomatic Congenital Cytomegalovirus Infection with Hearing Defect

Cytomegalovirus(CMV) is one of the leading cause of intrauterine infections of man with an incidence ranging from 0.48% to 2.2% of all live births. Although the majority of CMV-infected newborns are clinically asymptomatic at birth, some will have signs of congenital infection : Intrauterine growth retardation, petechial or purpuric rash, microcephaly, anemia, thrombocytopenia, jaundice, hepatosplenomegaly and intracranial calcification. We experienced a case of symptomatic congenital CMV infection in a 1-day-old male who presented generalized petechiae, hepatosplenomegaly, anemia, thrombocytopenia. Urine PCR and viral culture for CMV were positive, and a brain CT revealed ventriculomegaly and periventricular calcification. And auditory evoked potential revealed left sensorineural hearing loss. He received ganciclovir treatment for 6 weeks, was discharged in good health, and continued conunder follow-up at the outpatient department.

A Clinicopathological Study of Posttransplant Liver Biopsy

Liver biopsies are used routinely in the assessment of graft dysfunction following liver transplantation and generally considered to be the most reliable method for the diagnosis of posttransplant complications with overlapping clinical and laboratory findings. To investigate posttransplant complications causing graft dysfunction and usefulness of liver biopsy, we analysed clinicopathologic features of 65 posttransplant liver biopsies, 2 autopsies and an explanted liver, taken from 20 patients. The frequencies of posttransplant complications were acute cellular rejection in 9 patients (45%), postoperative infection in 11 patients (55%), of which cytomegalovirus (CMV) infection and systemic invasive aspergillosis with candidiasis occured in 10 patients (50%) and 1 patient (5%), respectively. Remainders were hepatic arterial thrombosis in two (10%), primary graft dysfunction due to fatty donor liver in one (5%), and posttransplant lymphoproliferative disorder (PTLD) in two (10%). There were no chronic rejection or recurrent disease. Postoperative mortality was 25%. Histologic grade by Banff schema was well correlated with clinical parameters associated with unfavorable short term prognosis. CMV infection was associated with acute cellular rejection in 6 out of 10 patients (60%). Immunohistochemical staining for CMV was more sensitive method than CMV in situ hybridization or histologic detection of viral inclusion on tissue section. It was unique that one case of PTLD developed under the circumstances of the lowest dosage of immunosuppression and took grave outcome. Based on these results, we concluded that clinicopathologic correlation with integration of all the clinical and laboratory findings is necessary in the interpretation of accurate and early diagnosis of posttransplant liver biopsies. The interrelationship between chronic rejection and CMV infection as well as pathogenetic factors of PTLD remains to be clarified through further ongoing observation.

Cytomegalovirus Infection in Idiopathic Inflammatory Bowel Disease: Clinicopathologic Analysis of 6 Cases

Cytomegalovirus (CMV) infection is an uncommon association with idiopathic inflammatory bowel disease (IBD) often leading to a variety of serious complications. A total of 41 resected cases of IBD were examined to elucidate the pathologic features of intestinal CMV infection which was assessed by histologic examination and confirmed by immunohistochemistry with CMV antibody. Six cases were positve for CMV antibody; five cases in 19 ulcerative colitis (UC, 26.3%) and one case in 22 Crohn's disease (CD, 4.5%). Of 7 cases of the steroid-treated UC group, five cases were superinfected with CMV (71.4%) but none in 12 cases of the steroid-untreated UC group. All of the five CMV-positive cases in UC showed deep ulceration and transmural inflammation, while none of 10 UC cases without above features were CMV positive. Fibrinoid necrosis and thrombi were found in 83.3% of the CMV infected group, while none in the CMV-negative group of UC cases (p=0.01). We conclude that IBD, particularly UC, is susceptible to the CMV infection when steroid hormone is administered, and that deep colonic ulceration, transmural inflammation and fibrinoid necrosis of vasculature may suggest superinfection of CMV in UC patients. It seems that deep colonic ulceration may be the consequence of an ischemic change following vascular luminal occlusion or vasculitis by CMV infection.

Congenital CMV Infection with Blueberry-muffin Skin Lesions Showing Dermal Erythropoiesis

Blueberry muffin rashes occur in various diseases including TORCH syndrome, transfusion reactions, leukemia, hereditary spherocytosis and neonatal sepsis. We report a case of congenital CMV(cytomegalovirus) infection showing blueberry muffin skin lesions which revealed dermal erythropoiesis. Even though these cutaneous findings were nonspecific, they could provide a valuable clue in approach the congenital viral infection in the perinatal period.

Acquired persistent cytomegalovirus infection: an association with common variable immunodeficiency

No abstract available.

SEROLOGIC SCREENING FOR TORCH INFECTIONS IN CHONGQING / 重庆医科大学学报

A preliminary serologic survey of TORCH infections in Chongqing was performed.Sera from 160 adults,most of them were women of child bearing age and from 100 newborn cord blood,were collected. They were tested for antibody to Toxoplasma gondii(total and IgM)by the IFA technique, cytomegalovirus (CMV) IgG and IgM by ELISA, rubella virus by latex agglutination test,and herpes simplex virus(HSV)by complement fixation (CF). The positive rates among adults for antibody to T. gondii, CMV, rubella virus and herpes simplex virus were 32.6%, 72.0%, 89.4% and 79.4% respectively; and the positive rates of cord sera were 21.4%, 78.3%,78.9% and 90.7% respectively. From these result, rubella vaccination appears indicated along with education concer-ning the dangers of and methods of avoiding T. gondii, CMV, and HSV infections.