Association of quantitative cytomegalovirus antigenemia with symptomatic infection in solid organ transplant patients.

A prospective virologic follow-up of solid organ transplant patients was designed to determine the usefulness of antigenemia and viremia as virologic markers for the diagnosis of cytomegalovirus (CMV) infections, and also for monitoring CMV disease and therapy control. A total of 629 blood samples from 127 patients (60 liver, 47 kidney, and 20 heart transplant recipients) were studied by tube and shell vial cultures, and by antigenemia assay. This later was carried out by an indirect immunofluorescent assay method for formalin-fixed cytospin slides containing 2 x 10(5) leukocytes, using a monoclonal antibody directed against the CMV pp65 antigen. CMV was detected by at least one of the three methods in 238 specimens (37.8%) from a total of 63 patients. The antigenemia assay was positive in 215 (90.3% of positive samples). A total of 94 samples were detected only by this marker, which occurred either in samples with low positive counts (70.2% with antigenemia counts < 10 positive cells/10(5) leukocytes) or in specimens from treated patients. There were 30 episodes of CMV disease in 23 patients. Antigenemia was positive in all these episodes, 27 of them with counts > 20 positive cells/10(5) leukocytes. With this cut-off, positive and negative predictive values for symptomatic CMV infection were 100% and 97.2%, respectively. The antigenemia assay is a rapid, sensitive, specific, and early marker of CMV infection in transplantees. Cultures became negative with antiviral therapy while remaining antigenemia detectable. There was an association between highest quantitative antigenemia test results and clinical symptoms in our patients. In its quantitative version, the assay is useful to detect symptomatic infection and appears to be a helpful tool in managing patients at risk and in guiding antiviral therapy.

Comparison of three commercially available monoclonal antibodies directed against pp65 antigen for cytomegalovirus antigenemia assay.

A total of 102 blood samples were used in a prospective parallel and blind study to evaluate three commercially available anti-pp65 monoclonal antibodies for cytomegalovirus antigenemia assay, at the dilutions recommended by their manufacturers. Cytomegalovirus was detected in 42 samples (41.2%), by either culture (32 samples; 76.2% of positive samples) or antigenemia (38 samples; 90.6%). Of the antigenemia-positive samples, 37 were detected by Monofluo kit CMV, which showed statistically significant differences when compared with the other reagents (Biosoft 1C3 and Clonab C10/C11), in either positivity rates (P < 0.004) or positive cell counts (P < 0.001). This reagent also gave better results in fluorescence quality than 1C3 and C10/C11. However, technical differences were not reflected in the clinical relevance of the antigenemia results.

[Cytomegalovirus disease in patients with acquired immunodeficiency syndrome. Report of 63 cases]. / Enfermedad por citomegalovirus en pacientes afectados del síndrome de inmunodeficiencia adquirida. A propósito de 63 episodios.

BACKGROUND: The aim of the present was to study the clinical and therapeutic characteristics of patients with the human immunodeficiency virus (HIV) with disease by the cytomegalovirus (DCMV) observed between 1984-1990. Some concrete aspects such as viremia by the cytomegalovirus (CMV) without focal disease or the profitability of cultures of different samples as predictors of DCMV were analyzed. METHODS: The clinical records of the patients diagnosed with DCMV as well as cultures of blood, saliva, and urine CMV of the global collective of patients with HIV were retrospectively studied. RESULTS: Sixty-three episodes of DCMV were collected in 41 patients corresponding to 29 episodes of retinitis by CMV (46%), 8 with digestive involvement (13%), 7 with lung involvement (11%), 18 with fever without focality and viremia by CMV 9 (29%) and 1 of encephalitis by CMV (1.5%). Eighty percent of the patients had been previously diagnosed of AIDS. The mean of CD4 lymphocytes was 43 cells/mm3 and the estimated probability of survival at 12 month was 18%. In 89% of the episodes of retinitis and 87% with digestive involvement improvement was achieved with treatment. Retinitis developed a posteriori in 38% of the patients with viremia without focality. During the period studied, 105/244 (43%) of the patients with the HIV showed some sample positive for CMV. Sixty-four percent of the patients with positive cultures in urine and/or saliva did not present DCMV after prolonged follow up. CONCLUSIONS: Cytomegalovirus disease is produced in advanced phases of infection by the human immunodeficiency virus. Response to treatment was good in cases of retinitis, digestive involvement and symptomatic viremia without focality. The symptomatic viremia by cytomegalovirus constitutes a predictor of localized disease. Positivity of urine and saliva cultures has slight predictive value for cytomegalovirus disease in patients with the human immunodeficiency virus.

[Pericardial tamponade as a complication of T-cell cutaneous lymphoma]. / Taponamiento pericárdico como complicación de un linfoma cutáneo de células T.

Mycosis fungoides is a T cell lymphoma characterized by the initial skin involvement. Organ infiltration generally occurs many years after the cutaneous presentation. The organ disease is accompanied of peripheral blood involvement (more than 20% lymphocytes have atypical convolute nucleus and there are palpable adenopathies. Pericardic involvement is a rare complication as the initial manifestation of the visceral disease, in patients with mycosis fungoides of long evolution. We present a patient suffering mycosis fungoide who presented a pericardic tamponade. The visceral disease in our patient was not accompanied by blood anomalies or palpable adenopathies.

[Cerebral tuberculoma. Report of 8 cases]. / Tuberculoma cerebral. A propósito de ocho casos.

A series of eight patients with cerebral tuberculoma seen between 1980 and 1990 is reported. Headache was the leading clinical finding, followed by focal neurological findings and seizures. Papilledema was the most uniform examination finding associated with intracranial hypertension. Five patients had another localization of tuberculosis: three had tuberculous meningitis, one had tuberculous pericarditis and only one had associated active pulmonary involvement. Cerebrospinal fluid was investigated in seven patients. In three patients data of tuberculous meningitis were found, with positive culture in Löwenstein medium. Two patients had the acquired immunodeficiency syndrome. All patients received medical treatment with good response, except in one who developed paradoxical expansion of the lesions after two months of therapy.

[Hypereosinophilic syndrome and acute ventricular failure]. / Síndrome hipereosinofílico y fracaso ventricular agudo.

Hypereosinophilic syndromes are characterized by very high levels of eosinophils in peripheral blood and a dysfunction of several organs as a consequence of their massive infiltration by eosinophilic cells. Cardiac alterations are traditionally known as fibroplastic endomyocarditis (Loeffler's Syndrome). We present the case of a female patient admitted in another center for the study of an accidentally discovered eosinophilia and referred to us because of her progressive hemodynamic deterioration followed by a poor clinical evolution. The anatomopathologic findings showed the classical injuries of this Syndrome; specially at cardiac level, where it is important to highlight the occupation of all the right ventricule's cavity by a clog. These injuries justified the origin of the stormy clinical presentation.