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https://www.readbyqxmd.com/read/28437539/safety-and-efficacy-of-antiviral-therapy-for-prevention-of-cytomegalovirus-reactivation-in-immunocompetent-critically-ill-patients-a-randomized-clinical-trial
#1
Nicholas J Cowley, Andrew Owen, Sarah C Shiels, Joanne Millar, Rebecca Woolley, Natalie Ives, Husam Osman, Paul Moss, Julian F Bion
Importance: Latent cytomegalovirus (CMV) infection is present in more than half the adult population, and a viral reactivation (ie, when the virus becomes measurable in body fluids such as blood) can occur in up to one-third of these individuals during episodes of critical illness. Objective: To determine whether antiviral therapy is safe and effective for preventing CMV reactivation in a general population of critically ill patients. Design, Setting, and Participants: A single-center, open-label, randomized, controlled clinical trial recruited 124 CMV-seropositive patients undergoing mechanical ventilation for at least 24 hours in the intensive care unit between January 1, 2012, and January 31, 2014...
April 24, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28395563/persistent-intestinal-bleeding-due-to-severe-cmv-related-thrombocytopenia-in-a-preterm-newborn
#2
Alberto Berardi, Eugenio Spaggiari, Chiara Cattelani, Maria Federica Roversi, Monica Pecorari, Tiziana Lazzarotto, Fabrizio Ferrari
The optimal threshold for neonatal platelet transfusions in sick newborns is still uncertain. We report a congenital cytomegalovirus (CMV) infection in a premature neonate with severe thrombocytopenia who subsequently presented with necrotizing enterocolitis and intestinal bleeding. The baby recovered after platelet transfusions were discontinued and the therapy was switched from intravenous ganciclovir to oral valganciclovir. We discuss both measures, speculating on the key role of platelet transfusions.
April 11, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28389165/cytomegalovirus-retinitis-followed-by-immune-recovery-uveitis-in-an-elderly-patient-with-rheumatoid-arthritis-undergoing-administration-of-methotrexate-and-tofacitinib-combination-therapy
#3
Kunio Yanagisawa, Yoshiyuki Ogawa, Mayumi Hosogai, Daisuke Todokoro, Takeki Mitsui, Akihiko Yokohama, Shoji Kishi, Hiroshi Handa
Cytomegalovirus (CMV) retinitis is an opportunistic ocular infection most commonly observed in patients infected with human immunodeficiency virus (HIV). We present a rare case of CMV retinitis that developed in a non-HIV patient with rheumatoid arthritis (RA). Over the preceding 5 months, a family doctor had been treating the 78-year-old male patient with a combination therapy of methotrexate (MTX) and tofacitinib (TOF). CMV retinitis occurred when the patient's CD4+ T cells were low (196 cells/μl), and preceded the onset of Pneumocystis pneumonia...
April 4, 2017: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
https://www.readbyqxmd.com/read/28383392/valganciclovir-dosing-for-cytomegalovirus-prophylaxis-in-pediatric-solid-organ-transplant-recipients-a-prospective-pharmacokinetic-study
#4
Orit Peled, Matitiahu Berkovitch, Eran Rom, Efraim Bilavsky, Yael Bernfeld, Lev Dorfman, Adi Pappo, Tomer Ziv-Baran, Nurit Brandriss, Adina Bar-Haim, Jacob Amir, Liat Ashkenazi-Hoffnung
BACKGROUND: Valganciclovir is extensively used for prophylaxis and treatment of CMV infection in solid-organ transplant recipients. However, pharmacokinetic data in children are scarce, and the pediatric dosing regimen is uncertain. This study sought to prospectively evaluate the pharmacokinetic profile, the clinical efficacy and safety of oral valganciclovir in pediatric transplant recipients and compare different dosing regimens. METHODS: The cohort included solid-organ transplant recipients treated with valganciclovir for CMV prophylaxis in 2014-2015 at a tertiary pediatric medical center...
April 5, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28376627/severe-acute-hepatitis-and-cold-agglutinin-related-hemolytic-anemia-secondary-to-prime-infection-with-epstein-barr-virus
#5
Guillermo Ontanilla Clavijo, Julia Praena Segovia, Álvaro Giráldez Gallego, María Elisa Cordero Matía, José Manuel Sousa Martín
Epstein-Barr virus, a member of the Herpesviridae family, is responsible for the infectious mononucleosis clinical syndrome, which mainly includes the pharyngitis, fever, and lymphadenopathy triad after incubation for 30-50 days. The liver is involved in 80-90% of patients in a self-limiting transient manner, with jaundice being much more uncommon (5%). From a hematological standpoint it may manifest aplastic anemia, neutropenia, and thrombocytopenia. We report a case of infectious mononucleosis that included severe acute hepatitis and was associated with severe hemolytic anemia secondary to cold agglutinins...
April 3, 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28340829/impact-of-prophylaxis-vs-pre-emptive-approach-for-cytomegalovirus-infection-in-kidney-transplant-recipients
#6
O Kır, A Zeytinoğlu, B Arda, M Yılmaz, G Aşçı, H Töz
Cytomegalovirus (CMV) is the most common viral infection during the post-transplant period, and it is one of the major causes of morbidity and mortality in kidney transplantation. In this study, the incidence and impact of pre-emptive and prophylactic approaches and long-term effects on graft and patient survival of CMV infection were investigated. Among 493 adult kidney transplant recipients, pretransplant CMV IgG-negative patients and patients with a follow-up shorter than a month were excluded. The patients were divided into 2 groups: pre-emptive group (n = 187, regular screening and acyclovir 400 mg twice daily for 6 months), and prophylaxis group (n = 275, valganciclovir 450 mg/d for 3 months)...
April 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28340807/prevalence-of-human-herpesvirus-8-and-bk-polyoma-virus-infections-in-end-stage-renal-disease-and-the-influence-of-renal-transplantation
#7
A Turkmen, O Guven, S Mese, A Agacfidan, B Yelken, M Onel, Y Caliskan, G Celik, S Turkoglu, B Kocak
Viral infections lead to significant morbidity and mortality in kidney transplant recipients. We evaluated 49 kidney transplant recipients for human herpesvirus 8 (HHV-8) and BK polyomavirus infections in conjunction with data obtained from 43 donors. The seroprevalence of HHV-8 was 6.9% in donors and 12.2% in recipients. HHV-8 DNA was detected below the limit of quantification (<5000 copies/mL) in a recipient with HHV-8 seropositivity at the pretransplant period and was undetectable at month 3 after transplantation...
April 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28326649/leflunomide-for-the-treatment-of-trichodysplasia-spinulosa-in-a-liver-transplant-recipient
#8
Rawan Kassar, Janis Chang, An-Wen Chan, Leslie B Lilly, Ayman Al Habeeb, Coleman Rotstein
Trichodysplasia spinulosa (TS) is a rare dermatologic complication associated with the immunosuppressive therapy used in solid organ transplantation. The distinctive clinical manifestation of this condition is spiny follicular papules on the face, ears, extremities, and trunk. Histopathologically, abnormally maturing hair follicles with hyperkeratotic material are noted. The condition is produced by the trichodysplasia spinulosa-associated polyomavirus. Treatment of this condition in the past has entailed a reduction in immunosuppression, topical agents such as cidofovir or retinoidsm or oral valganciclovir...
March 22, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28299191/cytomegalovirus-in-pregnancy-and-the-neonate
#9
REVIEW
Vincent C Emery, Tiziana Lazzarotto
Congenital cytomegalovirus (CMV) remains a leading cause of disability in children. Understanding the pathogenesis of infection from the mother via the placenta to the neonate is crucial if we are to produce new interventions and provide supportive mechanisms to improve the outcome of congenitally infected children. In recent years, some major goals have been achieved, including the diagnosis of primary maternal CMV infection in pregnant women by using the anti-CMV IgG avidity test and the diagnosis and prognosis of foetal CMV infection by using polymerase chain reaction real-time tests to detect and quantify the virus in amniotic fluid...
2017: F1000Research
https://www.readbyqxmd.com/read/28279287/a-42-year-old-woman-with-anemia-shock-and-ischemic-stroke-after-lung-transplantation
#10
Abhishek Biswas, Ali Ataya, Juan C Salgado, Satish Chandrasekharan, Tiago N Machuca, Amir M Emtiazjoo
A 42-year-old woman with mixed connective tissue disease-associated interstitial lung disease underwent bilateral lung transplantation. She had an uneventful surgery and was extubated 3 h later. Induction immunosuppression therapy included methylprednisolone 500 mg intraoperatively, basiliximab (anti-IL-2 monoclonal antibody) on days 0 and 4 after transplantation, and methylprednisolone 125 mg intravenously bid for 2 days following surgery. Maintenance immunosuppression therapy consisted of prednisone 20 mg daily, mycophenolate mofetil 750 mg bid, and enteral tacrolimus 0...
March 2017: Chest
https://www.readbyqxmd.com/read/28260458/successful-cost-effective-prevention-of-cytomegalovirus-disease-in-kidney-transplant-recipients-using-low-dose-valganciclovir
#11
Osama Gheith, Medhat A Halim, Torki Al-Otaibi, Hany Mansour, Ahmed Mosaad, Hassanein Abo Atteya, Zakaria Zakaria, Tarek Said, Prasad Nair, Narayanam Nampoory
OBJECTIVES: Low-dose valganciclovir prophylaxis is still under investigation in renal transplant procedures. Our aim was to assess the cost effectiveness of 450 mg versus 900 mg valganciclovir prophylaxis in kidney transplant recipients. MATERIALS AND METHODS: In this prospective trial, 201 kidney transplant patients were randomized (1:1) to receive 450 mg/d (group 1, n = 100) or 900 mg/d (group 2, n = 101) valganciclovir prophylaxis for the first 6 months after transplant...
February 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28215138/amino-acid-ester-prodrugs-of-nucleoside-and-nucleotide-antivirals
#12
Marcela Krečmerová
The review covers basic principles of the prodrug strategy applied to antiviral nucleoside drugs or drug candidates. Specific role of amino acids as promoieties is explained with respect to transport mechanisms, pharmacokinetics and a low toxicity of compounds. Synthetic approaches to the most important representatives (compounds under clinical investigations or available on the market) are described, including valacyclovir, valganciclovir, valomaciclovir stearate, valcyclopropavir, valtorcitabine, valopicitabine and several attempts to amino acid modifications of antiretroviral nucleosides...
February 16, 2017: Mini Reviews in Medicinal Chemistry
https://www.readbyqxmd.com/read/28198039/combined-environmental-risk-assessment-for-the-antiviral-pharmaceuticals-ganciclovir-and-valganciclovir-in-europe
#13
Jürg Oliver Straub
Potential environmental risks of the old antiviral pharmaceuticals ganciclovir (GCV) and valganciclovir (VGCV) were reassessed based on new environmental fate and chronic ecotoxicity tests and on actual use data for Europe. Valganciclovir is hydrolyzed to GCV by intestinal and hepatic esterases, and hence the new environmental tests only refer to GCV. A sorption study showed that GCV will not sorb significantly, excluding the soil as a relevant environmental compartment. Despite earlier data suggesting nondegradability, a new water/sediment fate test showed GCV to be primarily and ultimately degraded and to be nonpersistent...
February 15, 2017: Environmental Toxicology and Chemistry
https://www.readbyqxmd.com/read/28184381/a-multicenter-longitudinal-interventional-double-blind-randomized-clinical-trial-in-hematopoietic-cell-transplant-recipients-residing-in-remote-areas-lessons-learned-from-the-late-cytomegalovirus-prevention-trial
#14
Louise E Kimball, Terry Stevens-Ayers, Margaret L Green, Hu Xie, Mary E D Flowers, Keith R Jerome, Renee LeBlanc, Christi Dahlgren, W Garrett Nichols, Roy F Chemaly, G Papanicolaou, Michael Boeckh
PURPOSE: The logistics of conducting double-blinded phase III clinical trials with participants residing in remote locations are complex. Here we describe the implementation of an interventional trial for the prevention of late cytomegalovirus (CMV) disease in hematopoietic cell transplantation (HCT) subjects in a long-term follow-up environment. METHODS: A total of 184 subjects at risk for late CMV disease surviving 80 days following allogeneic HCT were randomized to receive six months of valganciclovir or placebo...
December 15, 2016: Contemporary Clinical Trials Communications
https://www.readbyqxmd.com/read/28182619/contribution-of-common-infections-to-cardiovascular-risk-in-hiv-positive-individuals
#15
Victoria Berquist, Jennifer F Hoy, Janine M Trevillyan
HIV-positive individuals are at increased risk for cardiovascular disease due to complex interactions between the increased incidence of traditional cardiovascular risk factors and HIV and antiretroviral-associated inflammation and dyslipidemia. Increasing evidence suggests that a number of important co-pathogens, including cytomegalovirus, hepatitis C virus, and periodontal disease, are likely to also be contributing. Mechanisms such as molecular mimicry and modification of lipids play a role; however, induction of systemic inflammation is the likely key pathogenic link by which this occurs...
February 9, 2017: AIDS Reviews
https://www.readbyqxmd.com/read/28146193/-cytomegalovirus-disease-in-post-heart-transplant-patients-at-a-national-reference-center
#16
Christian Rojas-Contreras, Gabriel De la Cruz-Ku, Bryan Valcarcel-Valdivia
INTRODUCTION: Heart transplantation remains as the treatment of choice when the heart failure is refractory to the medical or surgical therapy. Therefore, cytomegalovirus disease is an important post-heart-transplant infectious complication. AIMS: To describe the prevalence and clinical characteristics of the cytomegalovirus disease after heart transplant surgery. MATERIALS AND METHODS: A retrospective, descriptive study was conducted. It enrolled 35 heart-transplant patients attended in the Cardiovascular National Institute (INCOR), between 2010 and 2015...
December 2016: Revista Chilena de Infectología: órgano Oficial de la Sociedad Chilena de Infectología
https://www.readbyqxmd.com/read/28143418/reactivated-cytomegalovirus-proctitis-in-an-immunocompetent-patient-presenting-as-nosocomial-diarrhea-a-case-report-and-literature-review
#17
Chun-Yuan Lee, Yen-Hsu Chen, Po-Liang Lu
BACKGROUND: Reactivated cytomegalovirus (CMV) infection has been known to cause significant morbidity and mortality in immunocompromised patients. However, CMV disease rarely develops in immunocompetent patients, and reported cases often present with a mild, self-limiting course, without severe life-threatening sequelae. While the colon is the most common gastrointestinal site affected by CMV disease in immunocompetent patients, rectal involvement is rarely reported. CMV proctitis can present in two distinct forms, primary and reactivated...
February 1, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28091392/the-impact-of-viral-load-and-time-to-onset-of-cytomegalovirus-replication-on-long-term-graft-survival-after-kidney-transplantation
#18
Tomas Reischig, Martin Kacer, Petra Hruba, Pavel Jindra, Ondrej Hes, Daniel Lysak, Mirko Bouda, Ondrej Viklicky
BACKGROUND: Asymptomatic cytomegalovirus (CMV) infection is associated with graft dysfunction and failure. However, no study assessed CMV viral load in terms of the risk for graft failure. METHODS: In prospective cohort of kidney transplant recipients, we assessed the impact of CMV DNAemia on the overall graft survival and the incidence of moderate-to-severe interstitial fibrosis and tubular atrophy (IF/TA) in protocol biopsy at 36 months. CMV DNAemia was stratified by viral load in whole blood...
January 16, 2017: Antiviral Therapy
https://www.readbyqxmd.com/read/27990673/trichodysplasia-spinulosa-in-a-7-year-old-boy-managed-using-physical-extraction-of-keratin-spicules
#19
Michael Barton, Suing Lockhart, Robert Sidbury, Richard Wang, Heather Brandling-Bennett
Trichodysplasia spinulosa (TS) is an uncommon skin disease characterized by a folliculocentric papular eruption and keratin spine formation, classically appearing on the central face and ears. It occurs in immunosuppressed patients and is linked to a viral etiology. Diagnostic tests including polymerase chain reaction (PCR) are available for detection of the TS-associated polyomavirus. Effective treatment options include topical cidofovir and oral valganciclovir. We present a case diagnosed using PCR with skin scrapings and treated using physical extraction of the keratin spicules...
March 2017: Pediatric Dermatology
https://www.readbyqxmd.com/read/27938774/a-48-year-old-man-with-leukopenia-jaundice-and-skin-rash-after-lung%C3%A2-transplantation
#20
Ali Ataya, Abhishek Biswas, Satish Chandrashekaran, Juan C Salgado, Steven S Goldstein, Amir M Emtiazjoo
A 48-year-old African-American male subject presented with progressive fatigue, jaundice, and new-onset leukopenia 12 weeks after undergoing bilateral lung transplantation for advanced pulmonary sarcoidosis. His transplant surgery and immediate posttransplantation course were uneventful. Induction immunosuppression included methylprednisolone 500 mg intraoperatively and basiliximab (anti-IL-2 monoclonal antibody) on days 0 and 4 after transplantation. His maintenance immunosuppression posttransplantation was prednisone 20 mg daily, tacrolimus with target tacrolimus levels 10 to 15 ng/mL, and mycophenolate mofetil 750 mg twice daily...
December 2016: Chest
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