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https://www.readbyqxmd.com/read/29222255/non-chemotherapy-drug-induced-neutropenia-key-points-to-manage-the-challenges
#1
REVIEW
Brian R Curtis
Non-chemotherapy idiosyncratic drug-induced neutropenia (IDIN) is a relatively rare but potentially fatal disorder that occurs in susceptible individuals, with an incidence of 2.4 to 15.4 cases per million population. Affected patients typically experience severe neutropenia within several weeks to several months after first exposure to a drug, and mortality is ∼5%. The drugs most frequently associated with IDIN include metamizole, clozapine, sulfasalazine, thiamazole, carbimazole, amoxicillin, cotrimoxazole, ticlopidine, and valganciclovir...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29215460/comparison-of-preemptive-therapy-and-antiviral-prophylaxis-for-prevention-of-cytomegalovirus-in-seropositive-liver-transplant-recipients
#2
Amy W Liu, Kamonwan Jutivorakool, Cynthia E Fisher, Robert M Rakita, Jorge D Reyes, Renuka B Bhattacharya, Keith R Jerome, Ajit P Limaye
BACKGROUND: Few studies have directly compared preemptive therapy (PET) and antiviral prophylaxis (AP) for prevention of cytomegalovirus disease in CMV seropositive (R+) orthotopic liver transplant (OLT) recipients. METHODS: We prospectively assessed CMV disease and clinical outcomes among 160 consecutive R+ OLT recipients who received PET (weekly plasma CMV PCR for 3 months, oral valganciclovir 900 mg twice daily for CMV viremia >250 IU/mL, until 2 consecutive negative weekly PCR results) and compared them to a historical cohort of 156 R+ recipients who received AP (valganciclovir 900 mg daily for 3 months)...
December 5, 2017: Transplantation
https://www.readbyqxmd.com/read/29201472/severe-cytomegalovirus-reactivation-in-patient-with-low-grade-non-hodgkin-s-lymphoma-after-standard-chemotherapy
#3
Lena Modvig, Ciaran Boyle, Katie Randall, Anton Borg
Clinically significant cytomegalovirus (CMV) reactivation is not uncommon in patients with severe immunodeficiency secondary to underlying medical disorders or following aggressive immunosuppressive therapy. However, it is less frequently found in patients with low-grade haematological malignancies after nonintensive chemotherapy. We treated a patient at our centre for stage IVB follicular lymphoma with standard chemotherapy who successively developed CMV colitis associated with a CMV viral load of >3 million copies/ml...
2017: Case Reports in Hematology
https://www.readbyqxmd.com/read/29198661/prolonged-low-dose-prophylaxis-with-valganciclovir-in-cytomegalovirus-negative-recipients-of-kidney-transplants-from-cytomegalovirus-positive-donors-allows-seroconversion-and-prevents-cytomegalovirus-disease
#4
F Halleck, D Khadzhynov, E Schrezenmeier, L Lehner, K Budde, O Staeck
BACKGROUND: Cytomegalovirus-negative recipients of kidneys from cytomegalovirus (CMV)-positive donors (D+/R-) are at high risk to develop severe clinical manifestations of CMV disease. Long-term data about incidence and timing of CMV seroconversion, CMV disease, and the influence of prolonged valganciclovir prophylaxis on the clinical course of CMV infection are missing. METHODS: We conducted a retrospective long-term study of 89 consecutive CMV D+/R- kidney transplant recipients transplanted between 2003 and 2012...
December 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29191574/-collapsing-focal-segmental-glomerulosclerosis-induced-by-cytomegalovirus-a%C3%A2-case-report
#5
Clarisse Grèze, Cyril Garrouste, Jean-Louis Kemeny, Carole Philipponnet, Julien Aniort, Anne-Élisabeth Heng
Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome in child and adult. The collapsing forms are of poor renal prognosis and are usually secondary to viral infections with, first and foremost, the human immunodeficiency virus. Among other viral etiologies, cytomegalovirus (CMV) is an uncommon cause. We report a case of a 32years-old patient with collapsing focal segmental glomerulosclerosis induced by cytomegalovirus with initial acute renal failure and proteinuria at 12.4g/24h...
November 27, 2017: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/29166336/valganciclovir-prophylaxis-versus-preemptive-therapy-in-cytomegalovirus-positive-renal-allograft-recipients-long-term-results-after-7-years-of-a-randomized-clinical-trial
#6
Oliver Witzke, Martin Nitschke, Michael Bartels, Heiner Wolters, Gunter Wolf, Petra Reinke, Ingeborg A Hauser, Ulrich Alshuth, Volker Kliem
BACKGROUND: The VIPP study compared valganciclovir prophylaxis with preemptive treatment regarding efficacy, safety and long-term graft outcome in CMV-positive (R+) renal transplant recipients. METHODS: Multicenter, open-label, randomized clinical study with a 12-month study phase and a follow-up of up to 84 months. Patients in the prophylaxis group received 2x450 mg/day oral valganciclovir for 100 days adjusted to renal function. Preemptive treatment with 2x900 mg/day valganciclovir was initiated at a viral load of ≥400 CMV copies/mL (PCR) and maintained over ≥14 days, followed by secondary prophylaxis...
November 22, 2017: Transplantation
https://www.readbyqxmd.com/read/29157621/treatment-of-kaposi-sarcoma-herpesvirus-associated-multicentric-castleman-disease
#7
REVIEW
Kathryn Lurain, Robert Yarchoan, Thomas S Uldrick
Kaposi sarcoma herpesvirus (KSHV)-associated multicentric Castleman disease (MCD) is a rare, polyclonal lymphoproliferative disorder characterized by flares of inflammatory symptoms, edema, cytopenias, lymphadenopathy, and splenomegaly. Diagnosis requires a lymph node biopsy. Pathogenesis is related to dysregulated inflammatory cytokines, including human and viral interleukin-6. Rituximab alone or in combination with chemotherapy, such as liposomal doxorubicin, has led to an overall survival of over 90% at 5 years...
February 2018: Hematology/oncology Clinics of North America
https://www.readbyqxmd.com/read/29118508/treatment-of-unilateral-zone-i-cytomegalovirus-retinitis-in-acute-lymphoblastic-leukemia-with-oral-valganciclovir-and-intravitreal-ganciclovir
#8
Koushik Tripathy, Kanhaiya Mittal, Pradeep Venkatesh, Sameer Bakhshi, Rohan Chawla
Cytomegalovirus retinitis (CMVR) is an opportunistic infection seen in immunocompromised patients, especially suffering from acquired immune deficiency syndrome. It is uncommonly seen in hematological malignancies and in patients on immunosuppressants. The authors present a 12-year-old girl with unilateral CMVR who was on maintenance phase therapy for mixed phenotype (B/myeloid) leukemia. Serology for human immunodeficiency virus was negative. The child was successfully treated with oral valganciclovir and repeated intravitreal ganciclovir injections...
September 2017: Oman Journal of Ophthalmology
https://www.readbyqxmd.com/read/29028114/trichodysplasia-spinulosa-associated-with-hiv-infection-clinical-response-to-acitretin-and-valganciclovir
#9
M Aleissa, M P Konstantinou, M Samimi, L Lamant, P Gaboriaud, A Touze, C Ceppi, C Bulai Livideanu, C Paul
No abstract text is available yet for this article.
October 13, 2017: Clinical and Experimental Dermatology
https://www.readbyqxmd.com/read/29021960/relapsing-ebv-encephalitis-in-a-renal-transplant-recipient
#10
Joshua A Stone, Bettina M Knoll, Dimitrios Farmakiotis
In solid organ transplant recipients, Epstein-Barr virus (EBV) can cause active central nervous system (CNS) infection or malignant transformation of latently infected cells in the CNS, known as post-transplant lymphoproliferative disease (PTLD). Reduction of T-cell immunosuppression is the cornerstone of management. The role of antivirals with in-vitro activity against herpesviruses in EBV-related CNS syndromes is controversial, as they have no effect on latent virus. We report an unusual case of relapsing EBV encephalitis in a donor-positive, EBV-negative renal transplant recipient, with response to valganciclovir...
2017: IDCases
https://www.readbyqxmd.com/read/29020220/role-of-secondary-prophylaxis-with-valganciclovir-in-the-prevention-of-recurrent-cytomegalovirus-disease-in-solid-organ-transplant-recipients
#11
Bradley J Gardiner, Jennifer K Chow, Lori Lyn Price, Natalie E Nierenberg, David M Kent, David R Snydman
Background: Cytomegalovirus (CMV) is a major contributor to morbidity and mortality in solid organ transplant recipients (SOTR). Ganciclovir and valganciclovir are highly effective antiviral drugs whose role in primary prophylaxis and treatment of CMV disease is well established. The objective of this study was to examine the effect of secondary prophylaxis (SP) on the risk of relapse in SOTR following an episode of CMV disease. Methods: We performed a retrospective cohort study of SOTR from 1995-2015 and used propensity score based inverse probability of treatment weighting methodology to control for confounding by indication...
August 7, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28986189/prevention-of-cytomegalovirus-reactivation-in-haploidentical-stem-cell-transplantation
#12
Aimee E Hammerstrom, Lindsey R Lombardi, Sai Ravi Pingali, Gabriela Rondon, Julianne Chen, Denái R Milton, Roy F Chemaly, Richard E Champlin, Alison Gulbis, Stefan O Ciurea
Cytomegalovirus (CMV) infection can increase the morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Because of a higher degree of immunosuppression, haploidentical transplant recipients may be at an increased risk of viral infections, particularly CMV. We retrospectively analyzed 86 haploidentical HCT recipients at our institution to determine whether a more intensified antiviral strategy would reduce the incidence of CMV reactivation compared with a traditional antiviral prophylaxis regimen...
October 3, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28940831/low-dose-valganciclovir-prophylaxis-for-cytomegalovirus-in-intermediate-risk-r-renal-transplant-recipients-single-center-experience
#13
Salman Khan, Clara Fischman, Shirish Huprikar
Renal transplant recipients (RTR) who are seropositive for CMV (R+) are considered to be at intermediate risk for CMV disease. Current guidelines recommend high-dose valganciclovir (VGCV) prophylaxis because of limited data on the efficacy of low-dose VGCV. We describe our experience with using low-dose VGCV in R+ RTR. We retrospectively reviewed a cohort of 316 R+ RTR at our institution between 2002 and 2006. The primary endpoint was CMV disease at 1 year post transplant. The incidence of CMV disease at 12 months after transplantation was only 3% (6/221) in the D+R+ and 4% (4/95) in the D-R+ RTR...
September 22, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28937523/cytomegalovirus-retinitis-associated-with-occlusive-vasculopathy-in-an-elderly-human-immunodeficiency-virus-negative-man
#14
Kareem Moussa, Thuy Doan, Jay M Stewart, Jessica Shantha, John Gonzales, Nisha Acharya, Emmett T Cunningham
PURPOSE: To present a case of cytomegalovirus (CMV) retinitis associated with occlusive vasculopathy presenting as sudden unilateral loss of vision in a human immunodeficiency virus-negative elderly man. METHODS: Clinical case report and literature review. RESULTS: An 84-year-old Chinese man with diabetes mellitus and primary open-angle glaucoma was seen in consultation by our uveitis service for evaluation of sudden vision loss in the right eye...
September 20, 2017: Retinal Cases & Brief Reports
https://www.readbyqxmd.com/read/28937438/cutaneous-cytomegalovirus-infection-in-an-immunocompetent-patient-innocent-bystander-or-culprit
#15
Solomiya Grushchak, Kelli A Hutchens, Cossette Joy, Anthony Peterson, Jodi Speiser, Kumaran Mudaliar
We present a rare case of cutaneous cytomegalovirus (CMV) infection in a nonimmunocompromised patient. A 74-year-old woman with a history of diabetes presented with an ulcer on the right lateral tibia that occurred at the site of a nerve core biopsy. Subsequent biopsy of the ulcer edge showed granulation tissue with neutrophilic inflammation. The patient underwent extensive antibiotic treatment for possible infection with weekly wound care. However, the ulceration persisted and enlarged. A repeat biopsy 1 year later showed superficial and deep mixed inflammation with an associated vasculitis...
September 11, 2017: American Journal of Dermatopathology
https://www.readbyqxmd.com/read/28921781/valganciclovir-vgcv-followed-by-cytomegalovirus-cmv-hyperimmune-globulin-compared-to-vgcv-for-200-days-in-abdominal-organ-transplant-recipients-at-high-risk-for-cmv-infection-a-prospective-randomized-pilot-study
#16
James N Fleming, David J Taber, Nicole A Weimert, Satish Nadig, John W McGillicuddy, Charles F Bratton, Prabhakar K Baliga, Kenneth D Chavin
BACKGROUND: With the advent of effective antivirals against cytomegalovirus (CMV), use of CMV hyperimmune globulin has decreased. Although antiviral prophylaxis in patients at high risk for CMV is effective, many patients still have late infection, never developing antibodies sufficient to achieve immunity. Utilizing a combination of antiviral and CMV immunoglobulin G may allow patients to achieve immunity and decrease late CMV infections. METHODS: This was a prospective randomized, open-label, pilot study comparing valganciclovir (VGCV) prophylaxis for 200 days vs VGCV for 100 days followed by CMV HIG in abdominal transplant recipients at high risk for CMV...
September 16, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28862190/seroprevalence-of-cytomegalovirus-in-donors-opportunistic-viral-infections-in-liver-transplant-recipients
#17
Joy Varghese, S Subramanian, Mettu Srinivas Reddy, Naresh Shanmugam, G Balajee, Vijaya Srinivasan, Jayanthi Venkataraman, Rela Mohamed
BACKGROUND & OBJECTIVES: Opportunistic virus infections are common in liver transplant (LT) recipients. There is a risk of developing infection with cytomegalovirus (CMV) and herpes-related viruses such as herpes simplex virus-1 and 2 (HSV-1 & 2), Epstein-Barr virus (EBV) and Varicella Zoster virus (VZV), reactivation of infection and recurrent infection. This study was conducted to determine CMV seropositivity in donors and its influence on LT recipients and seropositivity of CMV, HSV-1 and 2, EB viral capsid antigen (EBVCA) and VZV in LT recipients and their reactivation...
April 2017: Indian Journal of Medical Research
https://www.readbyqxmd.com/read/28844151/high-dose-acyclovir-for-cytomegalovirus-prophylaxis-in-seropositive-abdominal-transplant-recipients
#18
Margaret R Jorgenson, Jillian L Descourouez, Glen E Leverson, Erin K McCreary, Michael R Lucey, Jeannina A Smith, Robert R Redfield
BACKGROUND: Following abdominal solid organ transplant (aSOT), valganciclovir (VGC) is recommended for cytomegalovirus (CMV) prophylaxis. This agent is associated with efficacy concerns, toxicity, and emergence of ganciclovir resistance. OBJECTIVE: To evaluate the incidence of high-dose acyclovir (HD-A) prophylaxis failure in seropositive aSOT recipients (R+). METHODS: This was a retrospective, single-center study of R+ transplanted without lymphocyte-depleting induction between January 1, 2000, and June 30, 2013, discharged with 3 months of HD-A prophylaxis (800 mg 4 times daily)...
August 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28838440/ganciclovir-dosing-strategies-and-development-of-cytomegalovirus-resistance-in-a-kidney-transplant-recipient-a-case-report
#19
I A Echenique, D Beltran, L Ramirez-Ruiz, N Najafian, N Agrawal
In renal transplant recipients, delayed graft function and accompanying renal impairment may lead to therapeutic underexposure of valganciclovir. We describe a case of a cytomegalovirus (CMV)-seronegative kidney transplant recipient from a CMV-seropositive donor, whose course was complicated during valganciclovir prophylaxis by CMV disease, ultimately progressing to ganciclovir, foscarnet, and cidofovir resistance. Assessments and adjustments for renal dysfunction, according to both Cockgroft-Gault and Modification of Diet in Renal Disease study equations, are described...
September 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28838145/valganciclovir-for-the-suppression-of-epstein-barr-virus-replication
#20
RANDOMIZED CONTROLLED TRIAL
Jessica E Yager, Amalia S Magaret, Steven R Kuntz, Stacy Selke, Meei-Li Huang, Lawrence Corey, Corey Casper, Anna Wald
Epstein-Barr virus (EBV) causes infectious mononucleosis and can lead to lymphoproliferative diseases. We evaluated the effects of valganciclovir on oral EBV shedding in a randomized, double-blind, placebo-controlled study. Twenty-six men received oral valganciclovir or daily placebo for 8 weeks, followed by a 2-week "washout period" and then 8 weeks of the alternative treatment. Valganciclovir reduced the proportion of days with EBV detected from 61.3% to 17.8% (relative risk, 0.28; 95% confidence interval [CI], ...
July 15, 2017: Journal of Infectious Diseases
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