Cytomegalovirus(CMV) disease is a major cause of morbidity and mortality in immunocompromised patients. CMV enteritis should be considered when nausea and vomiting continue 3 to 4 weeks after bone marrow transplantation(BMT). The treatment of CMV enteritis is not well established. We report a CMV duodenitis patient following allogenic bone marrow transplantation. The patient had prolonged nausea and vomiting for 5 weeks after bone marrow transplantation and CMV duodenitis was diagnosed by the gastroduodenoscopic mucosal biopsy which showed cytomegalic cells. Ganciclovir treatment for 3 weeks resulted in the resolution of symptoms and promoted healing of the lesion. The patient was free of CMV infection until 288 days after allogenic BMT without maintenance ganciclovir treatment.
Adult ; Antiviral Agents/therapeutic use* ; Bone Marrow Transplantation/adverse effects ; Case Report ; Cytomegalovirus Infections/etiology ; Cytomegalovirus Infections/drug therapy* ; Cytomegalovirus Infections/diagnosis ; Duodenitis/etiology ; Duodenitis/drug therapy* ; Duodenitis/diagnosis ; Ganciclovir/therapeutic use* ; Human ; Male ; Transplantation, Homologous

OBJECTIVETo investigate the role of real time quantitative polymerase chain reaction (RQ-PCR) in the diagnosis and treatment of recipients cytomegalovirus (CMV) infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODS318 patients received allo-HSCT were studied. 160 patients received transplants from HLA matched sibling donors; 127 from HLA mismatched related donors; 31 from unrelated donors. Before transplant recipients and donors received CMV serological test by ELISA. After transplant RQ-PCR was used to test and monitor CMV-DNA in plasma of patients. A positive CMV-PCR was defined as > 6 x 10(2) copies/ml. Ganciclovir was used for CMV prophylaxis in all patients at -9 d to -2 d of conditioning regimen period. Ganciclovir, foscarnet, or combination of the two drugs were used as the preemptive therapy.

RESULTSThe total 100-day cumulative incidence of CMV infection was 40.6%. The incidence was 17.5%, 66.1% and 45.2% for the HLA matched sibling, HLA mismatched related (MMR) and unrelated donor (MUR) HSCT respectively. Multivariate analysis showed MMR HSCT, MUR HSCT, ATG containing preparative regimen and moderate to severe aGVHD were the risk factors for CMV infection after HSCT. The 100 day cumulative incidence of CMV disease was 8.8% and 5.6%, 9.4%, 22.6% respectively for total and three kinds of HSCT after early preemptive therapy. Two-year survival of CMV infection was similar in the three kinds of SCT.

CONCLUSIONDetection of CMV DNA in plasma by real time PCR appears to be effective for the diagnosis and surveillance of CMV infection after HSCT. It may help to initiate antiviral therapy and reduce the incidence of CMV disease in the patients with high risk of CMV infection.

Adolescent ; Adult ; Child ; Child, Preschool ; Cytomegalovirus ; genetics ; Cytomegalovirus Infections ; diagnosis ; drug therapy ; etiology ; DNA, Viral ; blood ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Middle Aged ; Polymerase Chain Reaction ; methods ; Postoperative Complications ; diagnosis ; drug therapy ; etiology ; Retrospective Studies ; Young Adult

No abstract available.
Adult ; Antineoplastic Combined Chemotherapy Protocols/*adverse effects ; Appendicitis/diagnosis/*etiology/therapy ; Bacteremia/*etiology/therapy ; Consolidation Chemotherapy/adverse effects ; Cytomegalovirus Infections/diagnosis/*etiology/therapy ; Humans ; Immunocompromised Host ; Male ; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/*drug therapy/immunology/therapy

CMV infection may occur anywhere in the gastrointestinal tract. Among the small intestine, ileum is the most common site of CMV disease and infection of jejunum is a rare one in patients with CMV gastroenteritis. Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed. Rapid diagnosis are able to using the immunohistochemical stain in shell vial culture of infected specimen or peripheral neutrophils preparation in viremic patients within 8 to 36 hours. The treatment of choice is antiviral agent or surgical resection. We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.
Adult ; Antiviral Agents/therapeutic use ; Cytomegalovirus Infections/drug therapy ; Cytomegalovirus Infections/diagnosis ; Cytomegalovirus Infections/complications* ; Disease-Free Survival ; Enteritis/virology ; Enteritis/surgery ; Enteritis/complications ; Ganciclovir/therapeutic use ; Gastrointestinal Hemorrhage/therapy ; Gastrointestinal Hemorrhage/etiology* ; Gastrointestinal Hemorrhage/diagnosis ; Human ; Jejunal Diseases/virology ; Jejunal Diseases/surgery ; Jejunal Diseases/complications* ; Lymphoma, Non-Hodgkin/drug therapy ; Lymphoma, Non-Hodgkin/diagnosis ; Lymphoma, Non-Hodgkin/complications* ; Male ; Opportunistic Infections/drug therapy ; Opportunistic Infections/diagnosis ; Opportunistic Infections/complications* ; Substances: Ganciclovir ; Substances: Antiviral Agents

OBJECTIVESTo investigate the diagnosis and treatment of cytomegalovirus (CMV) pneumonia after liver transplantation.

METHODSFive cases of CMV pneumonia after liver transplantation were analyzed retrospectively. CMV pneumonia was diagnosed according to its clinical manifestation, chest X-ray, and etiologic test. All 5 patients received comprehensive therapy based on anti-virus treatment and immunologic adjustment.

RESULTSThe clinical manifestation of CMV pneumonia after liver transplantation was nonspecific. Its main symptoms included fever, cough, dyspnea, tachycardia, fatigue, hypoxemia and neutropenia. The chest X-ray showed interstitial pneumonia. Sera CMV antigens or antibodies could be detected in the patients. Four patients were cured and 1 patient died.

CONCLUSIONSThe clinical manifestation of CMV pneumonia was nonspecific. CMV pneumonia could be diagnosed according to its manifestations, chest X-ray and etiologic test. The comprehensive therapy based on anti-virus treatment and immunologic adjustment was effective for the disease.

Adult ; Combined Modality Therapy ; Cytomegalovirus Infections ; diagnosis ; etiology ; therapy ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Pneumonia, Viral ; diagnosis ; etiology ; therapy ; Postoperative Complications ; therapy ; Retrospective Studies ; Treatment Outcome

In order to study the epidemiological characteristics of cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients by means of plasma real time quantitative polymerase chain reaction (RQ-PCR), 141 adult patients undergoing allo-HSCT between January 2008 and June 2010 were serially monitored by RQ-PCR for detecting CMV and guiding the preemptive therapy followed up to 180 days post-HSCT. The results showed that the incidence of CMV infection and CMV pneumonia was 81.5% and 2.9% respectively, which mainly occurred within 2 months post-HSCT. Single-therapy with ganciclovir (GCV) for 63 patients or foscarnet 6 patients was performed for preemptive therapy. The total efficacy was 87.8%, and the response patterns were different. CMV infection was more frequent in female patients (P = 0.044), and those with aGVHD (P = 0.043), using ATG or basiliximab in conditioning regimens (P = 0.049), as well as earlier in patients using ATG or basiliximab or those with aGVHD (P = 0.007; P = 0.000). The aGVHD, maximum load, positive times of CMV-DNA detection and therapy duration all correlated with the efficacy (P < 0.05). It is concluded that the incidence of CMV infection is still high after HSCT. Plasma RQ-PCR assay for CMV-DNA shows a strong correlation with the clinical outcome of CMV infection, which is useful and suitable for management of CMV infection in HSCT.
Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; Child ; Cytomegalovirus ; Cytomegalovirus Infections ; diagnosis ; drug therapy ; etiology ; Female ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Male ; Middle Aged ; Polymerase Chain Reaction ; methods ; Retrospective Studies ; Transplantation, Homologous ; Young Adult

No abstract available.
Antiviral Agents/therapeutic use ; Biopsy ; Chest Pain/diagnosis/*etiology ; Cytomegalovirus/*isolation & purification ; Cytomegalovirus Infections/diagnosis/drug therapy/*virology ; Esophagitis/diagnosis/drug therapy/*virology ; Esophagoscopy ; Ganciclovir/therapeutic use ; Humans ; Kidney Transplantation/*adverse effects ; Male ; Middle Aged ; Opportunistic Infections/diagnosis/drug therapy/*virology ; Treatment Outcome

Cytomegaloviral hepatitis is an infantile liver disease commonly encountered in China, which could be differentiated into 4 patterns with different clinical conditions. Along with the progress of laboratory diagnostic techniques, multiple diagnostic approaches are available for this disease, but accurate diagnosis can only be made when individual patients' realities are taken into consideration. Clinical treatments are various, and the Western medicine used is mainly anti-viral agents such as Ganciclovir, and so far no unified therapeutic program has been formed. More and more ways of regarding Chinese medicine treatment of cytomegaloviral hepatitis have been published increasingly in recent years, though further research to seek preferable treatment programs is still expected.
Cytomegalovirus Infections ; complications ; diagnosis ; immunology ; therapy ; Diagnostic Techniques and Procedures ; trends ; Drugs, Chinese Herbal ; therapeutic use ; Hepatitis, Viral, Human ; diagnosis ; etiology ; immunology ; therapy ; Humans ; Immune System ; physiology ; physiopathology ; Infant ; Medicine, Chinese Traditional ; methods ; trends ; Professional Practice ; Western World

Cytomegalovirus (CMV) colitis is common among immunocompromised patients, and often diagnosed by pathologic confirmation because it is associated with a diverse spectrum of clinical and endoscopic features. However, Crohn's disease has no definitive diagnostic criteria, but longitudinal ulcers and cobble stone appearance are accepted as typical endoscopic features of Crohn's disease. An 83 year-old male with a history of radiotherapy for hypopharyngeal cancer visited our hospital with a complaint of melena for 1 week. His colonoscopic exam showed multiple longitudinal ulcers along the entire colon. Most of the ulcers were longer than 4 cm, these endoscopic findings were suspected as typical endoscopic features of Crohn's disease. Pathologic reports revealed multiple inclusion bodies with CMV on immunohistochemistry. He was finally diagnosed as having CMV colitis, and received a 3 week-course of intravenous ganciclovir. A colonoscopic follow-up showed complete healing of the multiple longitudinal ulcers, and he is doing well now without further treatment.
Aged, 80 and over ; Antiviral Agents/therapeutic use ; Colitis/*diagnosis/etiology/pathology ; Colonoscopy ; Crohn Disease/diagnosis ; Cytomegalovirus Infections/*diagnosis/drug therapy/pathology ; Ganciclovir/therapeutic use ; Humans ; Immunohistochemistry ; Injections, Intravenous ; Male ; Tomography, X-Ray Computed

Cytomegalovirus (CMV) infections are usually diagnosed in immunocompromised patients. A 74-year-old male without any significant medical history visited our center because of abdominal pain and diarrhea which began about a month ago. Abdominal computed tomography revealed segmental enhanced bowel wall thickening on jejunum and single-balloon enteroscopy showed multiple geographic shaped ulcerations covered with exudates on proximal jejunum. Biopsy samples taken during endoscopic examination demonstrated necrotic fibrinopurulent tissue debris and benign ulcer. Nested-PCR analysis of CMV DNA from jejunal tissue was positive. The patient was finally diagnosed with CMV jejunitis and was treated by intravenous ganciclovir for 14 days after which, abdominal pain and diarrhea improved. Our case shows that CMV jejunitis can occur in an immunocompetent adult as multiple jejunal ulcers which can be diagnosed using a single-balloon enteroscope.
Aged ; Antiviral Agents/therapeutic use ; Cytomegalovirus/genetics/isolation & purification ; Cytomegalovirus Infections/complications/*diagnosis/drug therapy ; DNA, Viral/analysis ; Endoscopy, Gastrointestinal ; Enteritis/*diagnosis/etiology/virology ; Ganciclovir/therapeutic use ; Humans ; Injections, Intravenous ; Jejunal Diseases/*diagnosis/etiology/virology ; Male ; Polymerase Chain Reaction ; Tomography, X-Ray Computed