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1: Am J Med Sci. 1995 Apr;309(4):229-34.

Links

Cytomegalovirus pericarditis: a case series and


review of the literature.
Campbell PT, Li JS, Wall TC, O'Connor CM, Van Trigt P, Kenney RT,
Melhus O, Corey GR.

Department of Medicine, Duke University Medical Center, Durham, North


Carolina 27710.

Cytomegalovirus (CMV) commonly infects both normal and


immunocompromised hosts. Although it usually produces an asymptomatic
infection to mild illness, CMV has the potential to significantly injure many
different organs. Reports of CMV causing pericardial disease, however, are
limited and documentation of infection by growth of the virus from tissue or fluid
is rare. As part of a prospective trial of subxiphoid pericardial biopsy in 57 adult
patients with large pericardial effusions, three culture-proven cases and one
serologically confirmed case of CMV pericardial disease were discovered.
Subsequently, CMV was grown from the pericardium of an infant with congenital
heart disease. A review of the documented cases of CMV pericarditis is provided
along with a discussion of the pathogenesis and significance of this perhaps not so
uncommon disease.

PMID: 7900747 [PubMed - indexed for MEDLINE]

1: Transpl Int. 1992;5 Suppl 1:S26-9. Links

Cytomegalovirus (CMV) excretion as a factor in


the severity of CMV disease in kidney and
simultaneous kidney and pancreas transplantation.
Pouteil-Noble C, Ecochard R, Bosshard S, Lacavalerie B, Donia A,
Landrivon G, Tardy JC, Dubernard JM, Aymard M, Touraine JL.

Transplantation Unit, Pavilion P. E. Herriot Hospital, Lyon, France.

The aim of the study was to evaluate the virological parameters associated with
the severity of cytomegalovirus (CMV) disease in renal and simultaneous renal
and pancreatic transplantation. The association of the viral profile and the severity
of the viral disease was analysed taking into account different confounding
variables susceptible to linkage with the severity of the CMV infection and the
viral parameters. All the patients transplanted between 1 January 1989 and 31
December 1990, a total of 242, were prospectively followed by viral cultures in
blood and urine and by serological methods using the detection of CMV-specific
IgM and the complement fixation (CF) test. The samples were taken
systematically each week for the first month and then at day 90, 180 and every 6
months and also in cases of clinical manifestations related to viral disease. CMV
infection was diagnosed virologically by the presence of viraemia, viruria, IgM,
or a significant rise in CMV antibody titre in CF. CMV disease was classified as
asymptomatic, mild (fever and/or leukopenia), moderate (fever, leukopenia and
liver abnormalities), severe (CMV pneumopathy and/or gastrointestinal disease)
or fatal. The incidence of CMV infection was 65% (157/242): 32% asymptomatic,
36% mild, 30% moderate and 2% severe. The presence of IgM was associated
with the severity of CMV disease: 51.4% of moderate and severe CMV infections
in the group with IgM versus only 16% in the group without IgM (P < 0.0001).
The risk of having severe or moderate CMV disease was 3.28 times higher in
patients with positive IgM. However the serological changes in CF were not
significantly associated with the severity of the viral disease since 34.6% of the
patients with CF changes had a severe form versus 20.8% in the group without CF
modification. Viruria was significantly associated with moderate or severe
infection: 43.6% of the patients with viruria had severe infection versus only
12.5% in the patients without viruria (P < 0.0002). The risk of having moderate or
severe CMV disease was 3.48 times higher in the patients with viruria. Viraemia
was also associated with more severe CMV infection: 48.6% of moderate or
severe CMV infection in the group of patients with viraemia versus 19% in the
group without viraemia (P < 0.0001). The risk of having severe or moderate CMV
infection was 2.58 times higher in the patients with viraemia. Viraemia was not
more associated with severe CMV infection than viruria. Using the maximum
likelihood ratio method and the logistic regression model, CMV-specific IgM,
viruria and viraemia were each shown to be associated with the severity of CMV
disease and the addition of one parameter to the other(s), whatever the type
(except the CF changes) and whatever the order of this addition, did not remove
the link between the severity and IgM, viruria and viremia. The incidence of
severe and moderate CMV disease increased with the number of positive viral
parameters (PVP) from 2% of moderate and severe infections in the group with
one PVP, to 28% in the group with two PVP, to 39% in the group with three PVP
and 68% in the group with four PVP (trend, 35.95; P < 0.0001). Taking the
absolute risk of the group of patients without IgM, viruria or viraemia as the basal
level, the observed relative risk of severe CMV infection varied from 6.45 in the
group with positive IgM without viruria or viraemia, to 10.74 in the group with
positive IgM and viruria without viraemia and to 22.5 in the group with the three
positive parameters IgM, viruria and viraemia. The different potential
confounding factors (recipient and donor serology, renal or renal and pancreatic
transplantation, DR compatibility, rejection before CMV infection) did not modify
the link between the viral profile and the severity of CMV disease. This study
suggests that the severity of CMV disease might be linked to the overspread of the
virus as well as to the consequences of a CMV-specific humoral immune
response.
PMID: 14621724 [PubMed - indexed for MEDLINE

1: Prenat Diagn. 2001 May;21(5):362-77. Links


Erratum in:
Prenat Diagn 2001 Jul;21(7):605.

Prenatal diagnosis of congenital cytomegalovirus


infection in 189 pregnancies with known outcome.
Enders G, Bäder U, Lindemann L, Schalasta G, Daiminger A.

Institut für Virologie, Infektiologie und Epidemiologie e.V., Vorsitzende G.


Enders, Labor Prof. Enders und Partner, Stuttgart, Germany. enders@labor-
enders.de

Prenatal diagnosis (PD) of fetal cytomegalovirus (CMV) infection was performed


in 242 pregnancies, with known outcome in 189 cases. In 141/189 pregnancies,
PD was carried out on account of suspicious maternal CMV serology up to
gestational week (WG) 23, and in 48 cases on account of abnormal ultrasonic
findings detected between WG 18 and 39. Chorionic villus samples (n = 6),
amniotic fluid (AF, n = 176) and/or fetal blood specimens (n = 80) were
investigated for detection of virus by cell culture, shell vial assay, PCR and/or
CMV-specific IgM antibodies. Of 189 fetuses correctly evaluated by CMV
detection either in fetal tissue following therapeutic abortion/stillbirth (n = 24) or
in urine of neonates within the first 2 weeks of life (n = 33), 57 were congenitally
infected. In women with proven or suspected primary infection, the intrauterine
transmission rates were 20.6% (7/34) and 24.4% (10/41), respectively. Of the
congenitally infected live-born infants, 57.6% (19/33) had symptoms of varying
degree. The overall sensitivity of PD in the serologic and ultrasound risk groups
was 89.5% (51/57). A sensitivity of 100% was achieved by combining detection
of CMV-DNA and CMV-specific IgM in fetal blood or by combined testing of AF
and fetal blood for CMV-DNA or IgM antibodies. There was no instance of
intrauterine death following the invasive procedure. The predictive value of PD
for fetal infection was 95.7% (132/138) for negative results and 100% (51/51) for
positive results. Correct results for congenital CMV infection by testing AF
samples can be expected with samples obtained after WG 21 and after a time
interval of at least 6 weeks between first diagnosis of maternal infection and PD.
In case of negative findings in AF or fetal blood and the absence of ultrasound
abnormalities at WG 22-23, fetal infection and neonatal disease could be excluded
with high confidence. Positive findings for CMV infection in AF and/or fetal
blood in combination with CMV suspicious ultrasound abnormalities predicted a
high risk of cytomegalic inclusion disease (CID). Furthermore, detection of
specific IgM antibodies in fetal blood was significantly correlated with severe
outcome for the fetus or the newborn (p = 0.0224). However, normal ultrasound
of infected fetuses at WG 22-23 can neither completely exclude an abnormal
ultrasound at a later WG and the birth of a severely damaged child nor the birth of
neonates which are afflicted by single manifestations at birth or later and of the
kind which are not detectable by currently available ultrasonographic techniques.
Copyright 2001 John Wiley & Sons, Ltd.

PMID: 11360277 [PubMed - indexed for MEDLINE

Introduction

Human cytomegalovirus (HCMV) is an ancient virus closely linked to its natural


host, human beings. Over the generations, the pathogen and the host have
adapted to each other and in most cases they live in symbiosis. Only in the last
years, the scientists succeeded to discover the strategic weapons, which are
used by the virus to evade the human immune system. In the future, because of
the progress of the modern medicine, still more immunocompromised patients
will live and thus CMV will have more potential victims.

Detailed understanding of the CMV biology and pathogenicity is therefore


necessary to be successful in the fight against this pathogen. In this report the
most up to date knowledge about the pathogenicity and immune defense against
CMV are presented.

At the time of admission, her serum alanine aminotransferase level was 60 U/L
(normal, 0–45 U/L), aspartate aminotransferase was 44 U/L (normal, 0–45 U/L),
and alkaline phosphatase was 125 U/L (normal, 0–45 U/L). Her complete blood
counts, electrolytes and coagulation profile were within normal range.

The patient tested negative for serologic markers for HIV, hepatitis A, B, and C
viruses. Additionally, her T-lymphocytes count came back as CD4 of 588 and
CD8 of 1649. Thyroid tests were normal.

The patient's admission chest radiograph was non contributory. Computed


tomography scan of abdomen and pelvis showed mild thickening of distal
stomach and proximal duodenum, small amount of pelvic ascites and small
scattered hepatic cysts. No intra or extrahepatic biliary dilatation was seen. Liver,
gallbladder, adrenal glands, pancreas, spleen and kidneys were unremarkable.
There was no evidence of paraaortic or pelvic retroperitoneal lymphadenopathy.
There were no pelvic masses noted and urinary bladder was also unremarkable.
Abdominal sonogram showed hepatocellular disease and/ or fatty infiltration of
the liver with cholelithiasis. The intrahepatic and extrahepatic biliary systems
were not dilated. Echocardiogram showed Ejection fraction of 69%, with normal
wall motions, mild aortic regurgitation mild tricuspid insufficiency. The focus of the
patient's evaluation then turned to the possibility of gastric malignancy. Upper GI
endoscopy with biopsy of antral mucosa demonstrated erythematous, friable and
eroded antral mucosa along with erosive esophagitis. Histopathologic findings
were consistent with acute gastritis associated with Cytomegalovirus infection.
Systemic cytomegalovirus infection complicating
ulcerative colitis: a case report and review of the
literature
P J Hamlin 1, M N Shah 1, N Scott 2, J I Wyatt 2, P D Howdle 1
1
Department of Medicine, St James’s University Hospital, Leeds, UK
2
Department of Pathology, St James’s University Hospital, Leeds, UK

Correspondence to:
Correspondence to:
Dr P J Hamlin
Department of Medicine, St James’s University Hospital, Beckett Street, Leeds, West Yorkshire LS9
7TF, UK; pj.hamlin@ukgateway.net

Cytomegalovirus is a common infection worldwide and in the immunocompromised


individual it can be a major cause of morbidity and mortality. In TOP
patients with inflammatory bowel disease cytomegalovirus infection ABSTRACT
has been described in both immunocompetent and CASE REPORT
immunocompromised individuals. A 34 year old man with an DISCUSSION
exacerbation of his colitis was diagnosed as having both CONCLUSION
REFERENCES
cytomegalovirus colitis and hepatitis. The diagnosis was made on the
classical appearance of "owl’s eye" inclusion bodies on colonic and
hepatic biopsies and, in addition, viral serology and polymerase chain reaction (PCR)
analysis of the cytomegalovirus DNA copy number. Fourteen days of treatment with
ganciclovir led to a prompt improvement in the symptoms of colitis, resolution of the
pyrexia, normalisation of the liver function tests, and clearance of the virus, as measured
by a negative cytomegalovirus DNA PCR.

Cytomegalovirus infection is a potentially fatal complication of treatment induced


immunosuppression in patients with inflammatory bowel disease. As in this case,
infection may be systemic and not confined to the intestine. Prompt diagnosis using
histology, serology, and PCR analysis allows prompt introduction of therapy and an
improved prognosis.

Keywords: inflammatory bowel disease; cytomegalovirus; pyrexia of unknown origin;


polymerase chain reaction

Abbreviations: PCR, polymerase chain reaction; ERCP, endoscopic retrograde


cholangiopancreatography

Cytomegalovirus infection is common throughout the world; 40%–100% of adults in


different populations are infected by the fourth decade.1,2 Primary infection in the
immunocompetent individual is characterised by a mild, self limiting, mononucleosis-like
syndrome. However, in immunosuppressed individuals cytomegalovirus infection may
cause significant morbidity and mortality.3 In the face of exogenous or endogenous causes
of immunosuppression, cytomegalovirus can result in retinitis, colitis, pneumonitis, or
encephalitis. In these situations disease is most commonly a result of reactivation.

Cytomegalovirus infection is not common in patients with inflammatory bowel disease,


where the incidence has been variously reported as 0.53%4 to 3.4%.5
However, patients with inflammatory bowel disease are frequently treated with
immunosuppressive agents (such as corticosteroids, azathioprine, cyclosporin, or
methotrexate) which may increase infection risk. Moreover, inflammation itself is
considered to be a predisposing factor for infection.4

We describe a patient with cytomegalovirus hepatitis and colitis on a background of


ulcerative colitis

Figure 2 (A) Colonic and (B) hepatic biopsy specimens


View larger demonstrating classical cytomegalovirus inclusion bodies (arrowed
version (63K):
[in this window]
[in a new window]

Review

Cytomegalovirus infection in burns: a review


Hans-Oliver Rennekampff1 and Klaus Hamprecht2
1
Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre,
Schnarrenbergstrasse 95, 72076 Tübingen, Germany
2
Institute of Medical Virology, University Hospital of Tübingen, Elfriede-Aulhorn-Strasse 6, 72076
Tübingen, Germany

Correspondence
Hans-Oliver Rennekampff
rennekampff@bgu-tuebingen.de

Sepsis is responsible for significant morbidity and mortality in patients suffering from
severe burn injuries. Burn patients are known to be immunocompromised, and it is
generally accepted that the immunosuppressed patient may experience human
cytomegalovirus (HCMV) infection and disease. Review of the very limited available
literature identifies a seroconversion rate of between 18 and 22 % for burn patients who
were seronegative for HCMV prior to suffering their burn injury. Furthermore,
approximately 50 % of HCMV antibody-positive patients may reactivate. Blood products
and allografted skin have clinically been identified as possible sources of HCMV
transmission in burn patients. Experience in the treatment of infection or disease in burn
patients is very scarce and limited to immunoglobulin therapy. Animal experiments have
demonstrated that murine cytomegalovirus (MCMV)-seropositive skin grafts are able to
infect immunodeficient mice as well as burned mice. Murine studies have also
demonstrated that infection with MCMV enhances susceptibility to secondary bacterial
infection and increases mortality in these animals. Burned mice challenged with MCMV
have a significantly higher level of bacterial translocation to mesenteric lymph nodes than
either control thermally injured mice without MCMV inoculation or non-burned mice
injected with MCMV alone. In summary, it remains controversial whether HCMV
infection per se alters outcome for the majority of burn patients. Subgroups of severely
burned, seronegative patients may benefit from blood products and skin from
seronegative donors. Antiviral strategies are not yet evaluated for the burn patient. Further
investigations utilizing modern diagnostic techniques seem necessary Case Report
Cytomegalovirus retinitis and low-grade non-Hodgkin's
lymphoma: Case report and review of the literature
L.A. Derzko-Dzulynsky 1, A.R. Berger 1 2, N.L. Berinstein 3 *
1
Department of Ophthalmology, Sunnybrook Health Science Centre, Toronto, Ontario,
Canada
2
Sunnybrook Health Science Centre, Toronto, Ontario, Canada
3
Departments of Medicine and Immunology, University of Toronto, Toronto-Sunnybrook
Regional Cancer Center, Toronto, Ontario, Canada
email: N.L. Berinstein (neil.berinstein@utoronto.ca)
*
Correspondence to N.L. Berinstein, Toronto-Sunnybrook Cancer Centre, 2075
Bayview Avenue, Toronto, Ontario, CANADA, M4N 3M5

ABSTRACT
Patients with non-Hodgkin's lymphoma may develop retinal or choroidal lesions during
the course of their disease. New immunosuppressive therapies currently used in
reticuloendothelial malignancies have increased the incidence of opportunistic infections
in this patient population. The differentiation of lymphomatous infiltration from
opportunistic infection as a cause of chorioretinal infiltrates is critical, as the treatments
are fundamentally different. We report a case of a patient with non-Hodgkin's lymphoma
who developed a chorioretinal infiltrate that was initially thought to represent progressive
disease. The patient received radiation treatment appropriate for intraocular lymphoma.
The lesion progressed further and after reevaluation a diagnosis of cytomegalovirus
retinitis was made and therapy initiated. Review of the literature for intraocular lymphoma
and cytomegalovirus retinitis is provided and diagnostic strategies are described. We
recommend analysis of intraocular fluid when there is difficulty in clinically
differentiating intraocular lymphoma from opportunistic infection. Am. J. Hematol.
57:228-232, 1998. © 1998 Wiley-Liss, Inc.
Recei
CASE REPORTS
Year : 2005 | Volume : 10 | Issue : 3 | Page : 176-178

Giant pseudocyst of the spleen: A case report and review of the literature

Kalinova K
Department of Pediatric Surgery, University Hospital, Stara Zagora, Bulgaria
Correspondence Address:
Kalinova K
18-À-19 Àrmeiska str., 6003 Stara Zagora
Bulgaria

Source of Support: None, Conflict of Interest: None

Abstract

Splenic cysts are rare lesions. Primary cysts have a cellular lining that can be caused by
congenital events or parasitic infection (Echinococcus). Secondary cysts have no cellular
lining and may be of hemorrhagic, serous, inflammatory, or degenerative origin. We
report a case of pseudocyst treated successfully by splenectomy, and we review the
literature.

ved: 30 April 1997; AccepCytomegalovirus


pneumonia in a patient with breast cancer on
chemotherapy: Case report and review of the literature
O. Breathnach1,, P. Donnellan2, D. Collins2, W. McNicholas2 and J. Crown2
1
The Dana Farber Cancer Center, Thoracic Oncology Program Boston, MA, USA
2
Oncology and Pulmonary Divisions, St. Vincent's University Hospital Dublin, Ireland

Correspondence to: Dr. O. S. Breathnach The Dana Farber Cancer Center Thoracic Oncology Program 44
Binney Street Boston, MA 02115 USA

Cytomegalovirus (CMV) pneumonia in the setting of non-transplantation patients is a


rarity. We present a case of CMV pneumonitis in a woman with stage IV breast cancer,
with brain metastases, receiving both chemotherapy and systemic cortico-steroids. A
review of the literature reveals this as a unique case.

Potential viral etiologies should therefore be considered in cancer patients with


pneumonia receiving non-transplantation chemotherapy-regimens, particularly if steroids
are a component of their therapy.

breast cancer, cytomegalovirus pneumonia, dexa-methasone, ganciclovir, standard dose


chemotherapy regimen

ted: 8 October 19English Title: Cytomegalovirus-associated acute transverse myelitis in


immunocompetent adults.
Personal Authors: Fux, C. A., Pfister, S., Nohl, F., Zimmerli, S.
Author Affiliation: Institute for Infectious Diseases, University of Bern, Friedbuehlstrasse 51, CH-3010 Bern,
Switzerland.
Editors: No editors
Document Title: Clinical Microbiology and Infection, 2003 (Vol. 9) (No. 12) 1187-1190

Abstract:
We report a case of transverse myelitis as a complication of acute cytomegalovirus (CMV) infection in
immunocompetent patients; and review the literature on the entity [Switzerland]. Primary CMV infection
was documented by CMV antigenaemia and high serum titres of CMV IgM and IgG antibodies.
Cerebrospinal fluid (CSF) pleocytosis indicated central nervous system inflammation; CSF polymerase chain
reaction (PCR) for CMV, however, was negative. The results of magnetic resonance imaging of the myelon
were normal. Although CMV-associated transverse myelitis has been well described in HIV-positive
individuals, but is very rare in immunocompetent individuals. It remains unclear whether the neuronal
damage is immune mediated or due to a cytotoxic effect of viral infection. The outcome is mainly favourable.

Washing our hands of the congenital


97

cytomegalovirus disease epidemic


Michael J Cannon1,2 and Katherine Finn Davis1,3
1
National Center for Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia
2
Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
3
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta,
Georgia, USA
author email corresponding author email

BMC Public Health 2005, 5:70doi:10.1186/1471-2458-5-70

The electronic version of this article is the complete one and can be found
online at: http://www.biomedcentral.com/1471-2458/5/70

Received: 9 December 2004

Accepted: 20 June 2005

Published: 20 June 2005

© 2005 Cannon and Davis; licensee BioMed Central Ltd.


This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work is properly cited.

Abstract

Background
Each year in the United States, an estimated 40,000 children are born
with congenital cytomegalovirus (CMV) infection, causing an estimated
400 deaths and leaving approximately 8000 children with permanent
disabilities such as hearing or vision loss, or mental retardation. More
children are affected by serious CMV-related disabilities than by
several better-known childhood maladies, including Down syndrome,
fetal alcohol syndrome, and spina bifida.

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