Infección congénita por citomegalovirus en neonatos muy bajo peso / Congenital cytomegalovirus infection in very low birth weight neonates

Introducción: La infección congénita por el citomegalovirus en neonatos menores de 1500 gramos puede ser causa de morbilidad, mortalidad y discapacidad. Objetivo: Describir el comportamiento de la infección congénita por citomegalovirus en un servicio de neonatología. Métodos: Se realizó un estudio descriptivo y transversal con 61 neonatos. Se les realizó detección de citomegalovirus en la primera semana de vida en suero y orina, mediante reacción en cadena de la polimerasa, para determinar infección congénita. Se evaluaron variables perinatales en todos los neonatos, así como elementos clínicos y resultados de exámenes complementarios en los infectados. Resultados: La incidencia de infección congénita fue de un 10 por ciento (6/61). El 5 por ciento de los estudios fueron positivos (6/122). Ninguna muestra de orina resultó positiva (0/61) y en el 10 por ciento de las muestras de suero (6/61) se detectó el genoma del virus. Se encontró asociación entre valoración nutricional al nacer e infección por citomegalovirus (p< 0,05). El 83 por ciento de los neonatos infectados presentaron algún signo clínico y el síndrome de dificultad respiratoria fue el más frecuente (67 por ciento). En todos los neonatos con infección congénita el ultrasonido cerebral fue normal y en el 33 por ciento se detectó retinopatía de la prematuridad en el fondo de ojo. Conclusiones: La incidencia de infección congénita por citomegalovirus es alta en este grupo de riesgo. Los signos clínicos encontrados y los resultados del fondo de ojo en neonatos con infección congénita se relacionaron con la prematuridad y la valoración nutricional de hipotrófico se asoció con esta infección(AU)

Introduction: Congenital cytomegalovirus infection in neonates weighing less than 1500 grams can be a cause of morbidity, mortality, and disability. Objective: To describe the behavior of congenital cytomegalovirus infection in a neonatal service. Methods: A descriptive and cross-sectional study was conducted with 61 neonates. Cytomegalovirus was detected in the first week of life in serum and urine, by polymerase chain reaction, to determine congenital infection. Perinatal variables were evaluated in all neonates, as well as clinical elements and results of complementary examinations in infected infants. Results: The incidence of congenital infection was 10 percent (6/61). 5 percent of the studies were positive (6/122). No urine samples were positive (0/61) and the virus genome was detected in 10 percent of serum samples (6/61). An association was found between nutritional assessment at birth and cytomegalovirus infection (p < 0.05). A total of 83 percent of infected neonates had some clinical sign, with respiratory distress syndrome being the most common (67 percent). In all neonates with congenital infection, brain ultrasound was normal, and retinopathy of prematurity was detected in 33 percent of patients with fundus retinopathy. Conclusions: The incidence of congenital cytomegalovirus infection is high in this risk group. The clinical signs found and the results of the fundus in neonates with congenital infection were related to prematurity and the nutritional assessment of hypotrophic was associated with this infection(AU)

Infecção por citomegalovírus em crianças com infiltrado pulmonar difuso crônico / Cytomegalovirus infection in children with chronic diffuse pulmonary infiltrates

Objetivo: avaliar a infecção por citomegalovírus (CMV) em crianças menores de 1 ano de idade com pneumonite bilateral. Casuística e métodos: foi realizado estudo retrospectivo que avaliou a ocorrência de infecção por CMV em 23 pacientes internados, de idade inferior a 1 ano de idade com pneumonite intersticial bilateral na enfermaria de um hospital universitário...

Objective: to evaluate cytomegalovirus (CMV) infection among infants under one-year-age affected by bilateral pneumonitis. Casuistic and methods: a retrospective survey was assessed to evaluate CM infection among 23 inpatients aged under one-year-old with interstitial bilateral pneumonitis, at a university hospital ward, CMV infection...

The prevalence of congenital cytomegalovirus infection in newborn infants at an intensive care unit in a public hospital

OBJECTIVE: To determine the prevalence of congenital cytomegalovirus infection in newborn infants admitted to an intensive care unit in a public hospital in Porto Alegre. METHODS: A cross-sectional study of 261 newborn infants born at a public hospital in the city of Porto Alegre in 2003 and admitted to the intensive care ward. Urine samples were collected within 7 days of birth and a polymerase chain reaction-PCR performed to test for cytomegalovirus DNA. RESULTS: The prevalence of congenital cytomegalovirus infection among the study population was 0.8% (95% CI: 0.097%-2.86%). It was not possible to assess risk factors because this prevalence was so low. CONCLUSIONS: The prevalence of congenital cytomegalovirus infection in an intensive care unit at a public hospital in Porto Alegre was not considered elevated and was comparable with prevalence rates found by other studies.

Cytomegalovirus infection in renal transplant recipients diagnosed by nested-PCR

A prospective study of cytomegalovirus (CMV) infection was carried out on 34 renal transplant recipients managed at a General Hospital in Ribeirão Preto, SP, Brazil. Serologic tests showed that all patients were infected with CMV before renal transplantation. Two nested-PCR techniques with primers that recognize sequences of the glycoprotein B (gB) and H (gH) genes were used for CMV detection in blood and urine samples during the post-transplantation period. CMV was detected more frequently in blood samples than in urine samples (P<0.001). Thirty-three patients had CMV detected at least once in blood and/or urine samples. Seven of these patients (21.2 percent) were diagnosed as having symptomatic CMV infection and showed a worse clinical outcome, with a higher death rate (P = 0.03). No association between CMV viremia and graft rejection was observed. Nested-PCR was not useful to identify patients at risk for symptomatic CMV infection since only 21.2 percent of the patients with CMV infection were symptomatic

Congenital cytomegalovirus infection in a neonatal intensive care unit in Brazil evaluated by PCR and association with perinatal aspects

Cytomegalovirus (CMV) infection is the most common congenital infection, affecting 0.4 percent to 2.3 percent newborns. Most of them are asymptomatic at birth, but later 10 percent develop handicaps, mainly neurological disturbances. Our aim was to determine the prevalence of CMV shed in urine of newborns from a neonatal intensive care unit using the polymerase chain reaction (PCR) and correlate positive cases to some perinatal aspects. Urine samples obtained at first week of life were processed according to a PCR protocol. Perinatal data were collected retrospectively from medical records. Twenty of the 292 cases (6.8 percent) were CMV-DNA positive. There was no statistical difference between newborns with and without CMV congenital infection concerning birth weight (p=0.11), gestational age (p=0.11), Apgar scores in the first and fifth minutes of life (p=0.99 and 0.16), mother's age (p=0.67) and gestational history. Moreover, CMV congenital infection was neither related to gender (p=0.55) nor to low weight (<2,500g) at birth (p=0.13). This high prevalence of CMV congenital infection (6.8 percent) could be due to the high sensitivity of PCR technique, the low socioeconomic level of studied population or the severe clinical status of these newborns.

Evolución de la infección por citomegalovirus en trasplantados renales / Evolution of cytomegalovirus infection in renal transplant recipients

Background: The incidence of cytomegalovirus infection or reactivation is 8 times more frequent in transplant recipients than in the general population. Aim: To evaluate the prevalence and usefulness of different diagnostic techniques for cytomegalovirus infection in renal transplant recipients. Patients and methods: Twenty nine renal transplant recipients were followed for at least five months. Cytomegalovirus infection was assessed by the presence of serum antibodies against the virus using ELISA and viral detection in urine and lymphocytes, using classical viral isolation, shell vial assay, and detection of viral genome by polymerase chain reaction. Results: Prior to transplantation, 23 of 27 patients had IgG type anti cytomegalovirus antibodies. In 40 percent, IgM type antibodies were detected in some moment of the follow up. Three of these corresponded to seroconversion. Cytomegalovirus was detected in urine in 41 percent of patients and it was not detected in lymphocytes. Shell vial assay detected the virus in 5 of 13 urine samples and in 1 of 7 lymphocyte samples. Polymerase chain reaction was positive in 12 of the 29 patients. In six patients, an acute rejection was postulated and there was no relation of rejection episodes with viral detection. In two patients, a disease caused by cytomegalovirus was postulated. One of these patients had a seroconversion during follow up. Conclusions: The prevalence of positive serum indices of cytomegalovirus infection was similar to that reported in the general population. However, the frequency of reactivation and viral disease was lower than that reported elsewhere. The techniques used in this study can be useful to confirm the suspicion of cytomegalovirus disease. However they do not predict the occurrence or evolution of the disease caused by the virus nor viral reactivation in renal transplant recipients

Diagnóstico de infecção congênita e perinatal por citomegalovírus utilizando a reação em cadeia da polimerase / Diagnosis of congenital and perinatal infection by cytomegalovirus using polymerase chain reaction

Aplicou-se uma reação em cadeia da polimerase (PCR) no diagnóstico de infecção congênita e perinatal por citomegalovirus, comparando-a com a técnica de isolamento viral em cultura celular. Foram processadas 305 amostras de urina de crianças de 0 a 6 meses, por ambas as técnicas. Utilizou-se na PCR os primers que amplificam parte do gene codificador do principal antígeno precoce imediato de CMV. Detectou-se virúria em 47 amostras por PCR e comparando os resultados com aqueles obtidos pelo isolamento viral, observou-se copositividade de 89,6% e conegatividade de 98,5%. Estas amostras positivas tiveram o resultado confirmado por PCR utilizando outros primers que amplificam regiões dos genes codificadores das glicoproteínas B e H de CMV. O diagnóstico de infecção congênita e perinatal por CMV pela PCR mostrou sensibilidade comparável à do isolamento viral e o uso de vários primers conferiu alta especificidade ao teste.

The practical application of a polymerase chain reaction (PCR) amplification for the diagnosis of congenital and perinatal cytomegalovirus (CMV) infections was evaluated. Three hundred five urine samples were tested by PCR and conventional virus isolation in cell culture. Viruria was detected in 47 urine samples by PCR using a primer pair which amplifies part of the major immediate-early (MIE) CMV genome. The PCR compared to virus isolation showed 89.6% sensitivity, 98.5% specificity and 91.5% positive predictive value. PCR with primer pairs amplifying parts of the glycoprotein B and glycoprotein H genes of CMV were used for confirmation of the positivity of the 47 urine samples. We concluded that this CMV PCR assay in urine has a suitable sensitivity for the diagnosis of congenital and perinatal infections and its specificity is highly increased by use of more than one pair of primers among the ones we used.

Detection of human cytomegalovirus in urine of infants by polymerase chain reaction.

Polymerase chain reaction (PCR), viral isolation and serological methods were used to diagnose HCMV infection in infants. Specimens of urine and clotted blood were collected from suspected cases of congenital or HCMV infection who attended the Pediatric Clinic, Siriraj Hospital. Prevalence of HCMV infection was found in 3 per cent of infants aged under 14 days and increased to 48 per cent in infants aged over 14 days. PCR was the most sensitive technique, it could detect HCMV infection in 29 per cent of the study infants, whereas, detection rate by isolation was 17 per cent and by specific IgM ELISA was 15 per cent. Sensitivity and specificity of PCR compared with isolation and/or serology were 93 per cent and 96 per cent, respectively. Detection of HCMV in urine by PCR can be used as a sensitive and rapid test for diagnosis of HCMV infection in infants.

Inmunobiología del trasplante renal: rechazo inmunológico

Este trabajo es parte de una revisión bibliográfica que nos hemos propuesto los autores, dentro del marco de nuestra línea de investigación sobre inmunobiología de la reactivación del citomegalovirus en trasplante renal. En una primera contribución revisamos la historia de los trasplantes y del complejo mayor de histocompatibilidad. En esta ocasión se hace referencia a la reacción de rechazo y a las infecciones oportunistas como los principales enemigos del trasplante de órganos y se hace énfasis en la patogénesis del rechazo, su diagnóstico y su tratamiento

Comparación de métodos de diagnóstico citológico, inmunofluorescencia y aislamiento viral en la detección de citomegalovirus (CMV) en orina / Comparision of diagnosis methods: cytology, immunofluorescence and viral isolation in the detection of urine cytomegalovirus

Las infecciones por citomegalovirus humano (CMV), ampliamente diseminadas, han sido señaladas como la principal causa de morbimortalidad en individuos inmunocomprometidos. Es característico en estas infecciones la aparición de grandes células con inclusiones intranucleares y/o intracitoplasmática. Con esta base se diseñó una investigación para evaluar el método de diagnóstico citológico y la detección de antígenos virales mediante la técnica de inmunofluorescencia indirecta (IFI) en relación al aislamiento viral en muestras de orina. Se estudiaron 70 casos con búsqueda de cuerpos de inclusión citomegálicos (CIC) y aislamiento viral. En 55 de estos se estudió además con IFI. Se encontro CIC en el 84% (59/70) de los casos, el aislamiento resultó positivo en un 29% (20/70) y la IFI alcanzó un 42% de positividad (23/55). En todos los casos con aislamiento positivo se encontró CIC en el sedimento de orina. La IFI que en relación al aislamiento viral parece carecer de especificidad, debe ser considerada ya que es un método que detecta específicamente antígenos virales. Finalmente, se recomienda trabajar estos métodos de diagnóstico con tres muestras de orina para optimizar su rendimiento

Infecção pelo citomegalovirus em pacientes com sindrome da imunodeficiencia adquirida (AIDS): relacoes clinico-virologicas e anatomopatologicas / Infection by cytomegalovirus in patients with acquired immunodeficiency syndrome (AIDS): clinical, virological and histopathological correlations

Com o objetivo de determinar a prevalencia da infeccao pelo Citomegalovirus (CMV) em pacientes com AIDS, bem como relacionar os achados clinicos virologicos decorrentes desta infeccao com as repercussoes anatomopatologicas, estudamos 50 pacientes adultos atendidos entre abril de 1986 a junho de 1987, em dois hospitais publicos de Sao Paulo (HSP e HSPE). Estes pacientes foram acompanhados clinica e laboratorialmente, por periodo medio de 2 meses com coletas seriadas de sangue, urina e saliva. Foram realizados isolamento do CMV em monocamadas de fibroblastos humanos e testes sorologicos de Imunofluorescencia Indireta (IFI-IgG/IgM) e Reacao Imunoenzimatica (ELISA-IgG). No momento da admissao no estudo 20 por cento (10/50) dos pacientes apresentavam anticorpos IgM CMV especificos e 100 por cento (50/50) deles anticorpos IgG (IFI). Durante o acompanhamento, 5 pacientes inicialmente IgM negativos tornaram-se IgM positivos, sugerindo reativacao ou reinfeccao pelo CMV. O CMV foi isolado de sangue periferico em 12,5 por cento, da urina em 23,2 por cento, da saliva em 21,9 por cento dos pacientes. Exames anatomopatologicos foram realizados em 24 pacientes, correspondendo a 60 por cento dos pacientes que evoluiram para obito durante o periodo de estudo...

Deteccion de citomegalovirus mediante la tecnica de inmunoperoxidasa y aislamiento viral / Detection of citomegalovirus by immunoperoxidase technic and viral isolation

En el presente estudio se comparo la tecnica de inmunoperoxidasa para la deteccion de citomegalovirus (IPCMV) utilizando anticuerpos monoclonales que reconocen proteinas precoces virales con el metodo convencional de aislamiento viral en fibroblastos humanos. Un total de 150 muestras de orina fueron examinadas encontrando una sensibilidad de un 89.8 por ciento y una especificidad de 91.3 por ciento de la tecnica de IPCMV comparada con el aislamiento viral. Una de las ventajas que presento la IPCMV fue la rapidez con que fueron obtenidos los resultados (48 horas) mientras que el aislamiento viral fue como promedio 14 dias.

Infección congénita por citomegalovirus (CMV): presentación de un caso confirmado y un caso compatible / Congenital cytomegalovirus infection (CMV): presentation of a confirmed and a compatible case

Se informan dos casos de infección congénita de citomegalovirus, uno, el primer caso confirmado en el Hospital del Niño de Panamá, por medio del cultivo de la orina obtenido a los 6 días de vida y que tiene un seguimiento de 9 meses de vida suficientes para poder registrarlo como citomegalovirus congénito compatible según los criterios que recomendamos para el diagnóstico del citomegalovirus congénito. Indicamos que estos criterios se utilicen como una pauta o norma con el fin de lograr un diagnóstico más temprano y certero de la enfermedad