The Troll in Transplant—CMV Esophagitis in a Post Orthotopic Liver Transplant Patient Complicated with Scalp Squamous Cell Carcinoma

A liver transplant candidate who is CMV serostatus positive and is subjected to calcineurin inhibitor such as tacrolimus post transplant may increase risk of CMV disease, and may promote tumor progression in some. We report a case of a late localized CMV disease manifesting as oesophagitis after 7 years post orthotopic liver transplantation complicated with an aggressive scalp squamous cell carcinoma which recurred despite wide local excision procedure. Hence it is crucial to modulate the patient’s risk factors for tumor progression without compromising the patient to graft rejection.

Risk factors of CMV infection in patients after umbilical cord blood transplantation: a multicenter study in China

Objective： This retrospective study examined risk factors for cytomegalovirus （CMV） infection after umbilical cord blood transplantation （UCBT） and the impact of CMV infection on patient survival. Methods： In all 176 patients, plasma CMV DNA was negative prior to the transplantation, and examined twice a week for 100 d, and then once weekly for additional 300 d. Preemptive antiviral therapy （ganciclovir or foscarnet） was started in patients with 〉 1,000/mL copies of CMV DNA but no full-blown CMV disease, and was discontinued upon two consecutive negative reports of blood CMV DNA test. The survival and risk factors for CMV infection or disease were examined using logistic regression. Results： CMV infection developed in 71% （125/176） of the patients, with a median onset of 32 d. Four patients （2.3%） developed CMV disease. Neither the 5-year overall survival （OS） nor event-free survival （EFS） differed significantly in infected patients vs. those with no infection （59.4% vs. 64.8%, P=0.194; 53.4% vs. 59.1%, P=0.226）. A stepwise multivariate analysis indicated an association of CMV infection with age, high-dose glucocorticoids, the number of transplanted CD34^＋ cells, and the number of platelet transfusion, but not with gender, the conditioning regimen, and the day of neutrophil recovery and chronic graft-versus- host disease （cGVHD）. Conclusions： CMV infection is very common after UCBT, but does not seem to affect long-term survival with preemptive antiviral treatment.

Immediate–Early(IE) gene regulation of cytomegalovirus:IE1-and pp71-mediated viral strategies against cellular defenses

Three crucial hurdles hinder studies on human cytomegalovirus(HCMV): strict species specificity, differences between in vivo and in vitro infection, and the complexity of gene regulation. Ever since the sequencing of the whole genome was first accomplished, functional studies on individual genes have been the mainstream in the CMV field. Gene regulation has therefore been elucidated in a more detailed fashion. However, viral gene regulation is largely controlled by both cellular and viral components. In other words, viral gene expression is determined by the virus–host interaction. Generally, cells respond to viral infection in a defensive pattern; at the same time, viruses try to counteract the cellular defense or else hide in the host(latency). Viruses evolve effective strategies against cellular defense in order to achieve replicative success. Whether or not they are successful, cellular defenses remain in the whole viral replication cycle: entry, immediate–early(IE) gene expression, early gene expression, DNA replication, late gene expression, and viral egress. Many viral strategies against cellular defense, and which occur in the immediate–early time of viral infection, have been documented. In this review, we will summarize the documented biological functions of IE1 and pp71 proteins, especially with regard to how they counteract cellular intrinsic defenses.

THE ANALYSIS OF HUMAN CYTOMEGALOVIRUS INFECTION DURING PREGNANCY IN QINBA MOUNTAINOUS AREA

Objective To study the epidemiology of cytomegalovirus (CMV) infection in Qinba mountainous area Shaanxi Province China, where there was high prevalence of mental retardation(MR) in children. Methods 367 pregnant women in Qinba mountainous area were monitored with ELISA and PCR and presented with questionnaire. We detected the following: CMV DNA in urine of 63 neonates born within two weeks whose mother infected CMV during pregnancy and CMV DNA in breast milk post delivery within two weeks of 61 women infected and 84 women non infected. Results Infection rate of CMV in mental retardation prevalent area was 19.62% , the incidence of transmission in uterus was 33.33%, the incidence of excretion by breast milk was 39.34%, CMV infection during pregnancy relates to age, education, economic states, pregnant frequency and pathological delivery. It has no relation with gestational age. Conclusion The study points out that attention should also be paid to detecting CMV infection during pregnancy in mental retardation prevalence. Less education, worse financial condition, more frequent or pathological delivery should be regarded as high risk factors of CMV infection during pregnancy.

Cytomegalovirus retinitis in the highly active anti-retroviral therapy era

Cytomegalovirus(CMV)retinitis is an opportunistic infection that has traditionally affected those who have HIV/AIDS or immunosuppressed individuals.CMV retinitis previously infected one-third of AIDS patients in the pre-highly active antiretroviral therapy(HAART)era,but since HAART,Western countries have seen an 80%decrease in the incidence of the disease.More recently,CMV retinitis has been reported in patients who are immunosuppressed,often due to chemotherapy or immunomodulatory medications.The diagnosis of CMV retinitis is often suspected based on clinical findings,with polymerase chain reaction for confirmation of CMV,especially in atypical cases.Highly active antiretroviral therapy and anti-CMV medications(systemic or local)remain the mainstay of treatment.However,for those who are not responsive to HAART,CMV retinitis remains a challenge,and can still lead to significant vision loss.Moreover,a regimen of anti-CMV medications can sometimes lead to viral resistance or organ toxicity.Complications such as immune recovery retinitis and rhegmatogenous retinal detachments continue to threaten the vision of patients who develop CMV retinitis.These complications can arise following initiation of treatment or if patients show disease progression.Proper vision screening for CMV retinitis in immunosuppressed patients at-risk is necessary for early detection and treatment.

THE STRATEGIES FOR PREVENTING AND TREATING IN-FECTION OF CYTOMEGALOVIRUS IN BONE MARROW TRANSPLANTATION

In bone marrow transplantation (BMT), cytomegalovirus (CMV) interstitial pneumonitis (IP) is one of the most dangerous complications, which has been the first important cause to lead the failure of BMT. At present, there is no effective and specific therapy for CMVIP, therefore how to prevent CMV infection effectively is a top task. From 1991 to 1996, we used comprehensive steps to prevent CMVIP in BMT, and none of 14 patients developed CMVIP. The preventing results that we achieved by using the steps were quite satisfied.

991例妊娠妇女TORCH-IgM检测结果分析

目的了解孕龄妇女和妊娠妇女TORCH(弓形体、风疹病毒、巨细胞病毒、单纯疱疹病毒)感染状况及其与不良妊娠之间的关系。方法应用酶联免疫吸附实验(ELISA)对266例孕龄妇女和725例妊娠妇女(包括69例不良妊娠及656例正常妊娠)进行TORCH-IgM抗体检测。结果孕龄妇女Toxo、RV、CMV、HSVI、HSVIIIgM的阳性率分别为3.7%、1.8%、6.0%、2.3%和4.1%,妊娠妇女的则分别为3.0%、2.2%、13.6%、3.2%和6.2%,妊娠妇女CMVIgM阳性率明显高于孕龄妇女(P<0.05);不良妊娠组与正常妊娠组之间的TORCH-IgM均有显著性差异,均以CMVIgM阳性率最高,其次为HSVIIIgM。结论本地区妊娠妇女CMV感染率高;TORCH系列病原体与不良妊娠密切相关,其中CMV、HS-VII在本地区对妊娠影响最大,二者均可经性接触传播。孕妇应常规、追踪进行TORCH血清学检测。

Ocular herpes:the pathophysiology,management and treatment of herpetic eye diseases

Herpesviruses are a prominent cause of human viral disease, second only to the cold and influenza viruses. Most herpesvirus infections are mild or asymptomatic. However, when the virus invades the eye, a number of pathologies can develop and its associated sequelae have become a considerable source of ocular morbidity. The most common culprits of herpetic eye disease are the herpes simplex virus(HSV), varicella zoster virus(VZV), and cytomegalovirus(CMV). While primary infection can produce ocular disease, the most destructive manifestations tend to arise from recurrent infection. These recurrent infections can wreck devastating effects and lead to irreversible vision loss accompanied by a decreased quality of life, increased healthcare usage, and significant cost burden. Unfortunately, no method currently exists to eradicate herpesviruses from the body after infection. Treatment and management of herpes-related eye conditions continue to revolve around antiviral drugs, although corticosteroids, interferons, and other newer therapies may also be appropriate depending on the disease presentation. Ultimately, the advent of effective vaccines will be crucial to preventing herpesvirus diseases altogether and cutting the incidence of ocular complications.

Falx Meningeoma Induced Optic Neuropathy-Clinical Manifestation and Differential Diagnosis:A Case Report

Purpose: Meningiomas are the most frequently diagnosed neoplasms. Ocular symptoms vary depending on size and localisation of the tumor, which is capable of compressing critical anatomic structures. Patients and Methods: A 44-year-old immunocompetent male was admitted to our hospital for further investigation of his bilateral optic disc swelling. A complete ophthalmological examination was performed including visual field assessment (VF), visual evoked potentials (VEP), fluorescein angiography (FLA) and magnetic resonance imaging (MRI). The patient had experienced only minor visual disturbances. Serological testing was performed. Results: Serological testing showed positive IgM and IgGtiters for cytomegalovirus (CMV) and subsequent imaging (MRI) revealed a frontal falxcerebri meningioma. Conclusions: We present a case of falx meningioma with overlapping serologically active CMV in an otherwise healthy and immunocompetent individual. Detailed differential diagnostic workup in immunocompetent individuals presenting with clinically unremarkable bilateral disc swelling is recommended.

呼吸道感染性疾患的巨细胞病毒感染状态

对５８例呼吸道感染性疾病患者应用分子生物学及血清学方法，检测巨细胞病毒的感染状态，并对巨细胞病毒感染后的免疫应答及病毒血症进行初探。实验结果表明，呼吸道感染性疾患存在巨细胞病毒感染状态，但不产生病毒血症，呼吸道感染疾病患者巨细胞病毒感染后免疫应答较明显。