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cytomegalovirus Pneumonia in Patients with Rheumatic Diseases After Immunosuppressive Therapy： A Single Center Study in China

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Chinese Medical Journal 2016年第3期129卷 267-273页

作者： Yu Xue Li Jiang Wei-Guo Wan Yu-Ming Chen Jiong Zhang Zhen-Chun Zhang Department of Rheumatology Huashan Hospital Fudan University Shanghai 200040 China Institute of Rheumatology Immunology and Allergy Fudan University Shanghai 200040 China Department of Rheumatology Linyi People's Hospital Linyi Shandong 276000 China Department of Laboratory Medicine Huashan Hospital Fudan University Shanghai 200040 China

Background： Rheumatic diseases involve multiple organs that are affected by immunological mechanisms.Treatment with corticosteroids and immunosuppressive agents may also increase the frequency of infection.cytomegalovirus （CMV） is a widespread herpes virus and a well-recognized pathogen, which causes an opportunistic and potentially fatal infection in immunocompromised patients.This retrospective study aimed to investigate the clinical and laboratory characteristics of CMV pneumonia in patients with rheumatic diseases after immunosuppressive therapy in a single center in Shanghai, China.Methods： Eight hundred and thirty-four patients with rheumatic diseases who had undergone CMV-DNA viral load tests were included, and the medical records of 142 patients who were positive for CMV-DNA in plasma samples were evaluated.GraphPad Prism version 5.013 （San Diego, CA, USA） was used to conduct statistical analysis.The correlation between CMV-DNA viral loads and lymphocyte counts was assessed using the Spearman rank correlation coefficient test.Significance between qualitative data was analyzed using Pearson＆#39;s Chi-squared test.The cut-offthresholds for CMV-DNA viral load and lymphocyte count were determined by receiver operating characteristic （ROC） curve analysis.Results： One hundred and forty-two patients had positive CMV viral load tests.Of these 142 patients, 73 patients with CMV pneumonia were regarded as symptomatic, and the other 69 were asymptomatic.The symptomatic group received higher doses ofprednisolone （PSL） and more frequently immunosuppressants than the asymptomatic group （P 〈 0.01）.The symptomatic group had lower lymphocyte counts, especially CD4＋ T-cells, than the asymptomatic group （P 〈 0.01）.By ROC curve analysis, when CD4＋ T-cell count was 〈0.39 ＆#215; 109/L, patients with rheumatic diseases were at high risk for symptomatic CMV infection.The CMV-DNA load was significantly higher in the symptomatic patients than that in asymptomatic patients （P 〈 0.01;threshold viral loads： 1.75 ＆#215; 104 copies/ml）

关键词： cytomegalovirus cytomegalovirus Pneumonia Polymerase Chain Reaction Rheumatic Disease Viral Load

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cytomegalovirus and Helicobacter Pylori Co-infection in an Adult with Ménétrier's Disease:A Case Report

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Chinese Medical Sciences Journal 2016年第2期31卷 129-133页

作者： Xiang-yao Wang Hao Liang Department of Gastroenterology Chinese People's Liberation Army General Hospital

MéNéTRIER＇S disease （MD） is a rare diseasecharacterized by hypertrophy of gastricfolds, and nausea, emesis, abdominal painand peripheral oedema are the mainmanifestations. Hypochlorhydria and hypoalbuminemiaare also common.1 MD is always misdiagnosed due to itsrarity. Especially, the symptoms caused by hypoalbuminemia,for example, pleural effusions or ascites,make the correct diagnosis more difficult.

关键词： Ménétrier's disease cytomegalovirus helicobacter pylori therapy

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Congenital cytomegalovirus infection and advances in murine models of neuropathogenesis

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Virologica Sinica 2022年第2期37卷 318-320页

作者： Najealicka Armstrong Qiyi Tang Department of Microbiology Howard University College of MedicineWashingtonDC20059USA

Congenital human cytomegalovirus(c HCMV) has been a well-known infectious cause of morbidity and mortality in newborns and a contributing factor for neurological disorders in infants(Crough and Khanna,2009).

关键词： Congenital mortality cytomegalovirus

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cytomegalovirus infection in liver-transplanted children

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World Journal of Hepatology 2022年第2期14卷 338-353页

作者： Norrapat Onpoaree Anapat Sanpavat Palittiya Sintusek Faculty of Medicine Chulalongkorn UniversityBangkok 10330Thailand Division of Pathology Faculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Thai Paediatric Gastroenterology Hepatology and Immunology Research UnitChulalongkorn UniversityBangkok 10330Thailand Division of Gastroenterology Department of PediatricsFaculty of MedicineKing Chulalongkorn Memorial HospitalChulalongkorn UniversityBangkok 10330Thailand

cytomegalovirus (CMV) infection is a common complication of liver transplantationin children. The CMV serostatus of recipients and donors is theprimary risk factor, and prophylaxis or pre-emptive strategies are recommendedfor high-risk patients. Graft rejection, coinfection and Epstein-Bar virusreactivation, which can lead to post-transplant lymphoproliferative disease, areindirect effects of CMV infection. Assessment of CMV infection viral load shouldbe routinely performed upon clinical suspicion. However, tissue-invasive CMVdisease is not associated with CMV viraemia and requires confirmation by tissuepathology. Oral valganciclovir and intravenous ganciclovir are equivalenttreatments, and the duration of treatment depends on factors including CMV viralload, tissue pathology, and clinical response. Risk stratification by donor andrecipient status prior to transplantation and post-transplantation antiviralprophylaxis or pre-emptive therapy are recommended. Adult guidelines havebeen established but additional study of the effectiveness of the preventiveguidelines in children is needed. This review summarizes the burden, risk factors,clinical manifestations, laboratory evaluation, treatment, and prevention of CMVinfection in children after liver transplantation.

关键词： cytomegalovirus Children Liver transplantation Pediatric Infection

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Management of cytomegalovirus corneal endotheliitis

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Eye and Vision 2021年第1期8卷 18-30页

作者： Angela H.Y.Wong Wee Nie Kua Alvin L.Young Kelvin H.Wan Department of Ophthalmology Tuen Mun HospitalHong KongChina Department of Ophthalmology and Visual Sciences Prince of Wales HospitalHong KongChina Department of Ophthalmology and Visual Sciences The Chinese University of Hong KongHong KongChina

Background:cytomegalovirus(CMV)can manifest as corneal endotheliitis in immunocompetent individuals.Early diagnosis is prudent to prevent endothelial cell loss,which could ultimately lead to corneal decompensation.CMV DNA was first detected in an eye with corneal endotheliitis in 2006;since then,clinical evidence from numerous case reports and case series have accumulated.Main text:In this narrative review,we identified several drugs,including ganciclovir,valganciclovir,and their combination in oral,intravenous,intravitreal,and topical forms in different concentrations,together with the judicious use of topical steroids,have reported variable success.There has yet to be any prospective comparative study evaluating the efficacy and safety of these assorted forms of treatment;clinical evidence is based on case reports and case series.CMV endotheliitis presenting with corneal edema can masquerade as other corneal diseases and thus poses a great challenge especially in post-keratoplasty eyes.Heightened awareness is needed before and after keratoplasty to start prompt prophylaxis and treatment.Conclusion:There is no consensus on the management of CMV endotheliitis.Further studies are much needed to elucidate the optimal treatment modality,regime,and duration in the treatment and prophylaxis of CMV endotheliitis.

关键词： cytomegalovirus CMV Endotheliitis Keratoplasty Corneal transplant Cornea

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Coexisting cytomegalovirus colitis in an immunocompetent patient with Clostridioides difficile colitis:A case report

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World Journal of Clinical Cases 2023年第10期11卷 2343-2348页

作者： Jun Hyoung Kim Hee-Sung Kim Hye Won Jeong Department of Internal Medicine Chungbuk National University HospitalCheongju 28644ChungbukSouth Korea Department of Internal Medicine Chungbuk National University College of MedicineCheongju 28644ChungbukSouth Korea

BACKGROUND Clostridioides difficile(C.difficile)colitis is one of the most common infections in hospitalized patients,characterized by fever and diarrhea.It usually improves after appropriate antibiotic treatment;if not,comorbidities should be considered.cytomegalovirus(CMV)colitis is a possible co-existing diagnosis in patients with C.difficile infection with poor treatment response.However,compared with immunocompromised patients,CMV colitis in immunocompetent patients is not well studied.CASE SUMMARY We present an unusual case of co-existing CMV colitis in an immunocompetent patient with C.difficile infection.An 80-year-old female patient was referred to the infectious disease department due to diarrhea,abdominal discomfort,and fever for 1 wk during her hospitalization for surgery.C.difficile toxin B polymerase chain reaction on stool samples was positive.After C.difficile infection was diagnosed,oral vancomycin treatment was administered.Her symptoms including diarrhea,fever and abdominal discomfort improved for ten days.Unfortunately,the symptoms worsened again with bloody diarrhea and fever.Therefore,a sigmoidoscopy was performed for evaluation,showing a longitudinal ulcer on the sigmoid colon.Endoscopic biopsy confirmed CMV colitis,and the clinical symptoms improved after using ganciclovir.CONCLUSION Co-existing CMV colitis should be considered in patients with aggravated C.difficile infection on appropriate treatment,even in immunocompetent hosts.

关键词： cytomegalovirus Clostridioides difficile Coinfection Colitis Immunocompetent Case report

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Congenital human cytomegalovirus infection and neurologic diseases in newborns

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Chinese Medical Journal 2019年第17期132卷 2109-2118页

作者： Xin-Yan Zhang Feng Fang Department of Pediatrics Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei 430030 China

Objective: This review aimed to summarize research progress regarding congenital cytomegalovirus (cCMV) infection-related nervous system diseases and their mechanisms. Data sources: All literature quoted in this review was retrieved from PubMed and Web of Science using the keywords "cytomegalovirus" and "Neurologic disease" in English. To identify more important information, we did not set time limits. Study selection: Relevant articles were selected by carefully reading the titles and abstracts. Then, different diagnosis and clinical treatment methods for human CMV infection-related neurologic diseases were compared, and the main mechanism and pathogenesis of neurologic damage caused by CMV were summarized from the selected published articles. Results: cCMV infection is a major cause of neonatal malformation. cCMV can infect the fetal encephalon during early gestation and compromise neurodevelopment, resulting in varying degrees of neurologic damage, mainly including hearing impairment, central nervous system (CNS) infection, neurodevelopmental disorders, ophthalmic complications, cerebral neoplasms, infantile autism, epilepsy, and other neurologic abnormalities. Conclusions: cCMV infection-induced neurodevelopmental abnormalities, which were directly caused by fetal encephalon infection, thus inducing neuroimmune responses to damage nerve cells. Such abnormalities were also caused by suppression of the proliferation and differentiation of neural progenitor cells by CMV’s gene products. cCMV infection in the fetal encephalon can also inhibit neuronal migration and synapse formation and indirectly trigger placental inflammation and thus disrupt the oxygen supply to the fetus.

关键词： cytomegalovirus Neurological disease Mechanism

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cytomegalovirus colitis induced segmental colonic hypoganglionosis in an immunocompetent patient: A case report

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World Journal of Clinical Cases 2021年第20期9卷 5631-5636页

作者： Ban Seok Kim Seon-Young Park Dong Hyun Kim Nah Ihm Kim Jae Hyun Yoon Jae Kyun Ju Chang Hwan Park Hyun Soo Kim Sung Kyu Choi Department of Gastroenterology Chonnam National University HospitalGwangju 501-757South Korea Department of Pathology Chonnam National University HospitalGwangju 501-757South Korea Department of Surgery Chonnam University HospitalGwangju 501-757South Korea

BACKGROUND cytomegalovirus(CMV)colitis is usually seen in immunocompromised patients with risk factors such as human immunodeficiency virus infection,solid organ transplant,inflammatory bowel disease,or malignancy.Therefore,many clinicians usually do not consider the possibility of CMV colitis in immunocompetent patients.We reported a rare case of segmental colonic hypoganglionosis associated with CMV colitis in an immunocompetent patient.CASE SUMMARY A 48-year-old woman with no underlying disease was admitted to our hospital for severe abdominal pain and constipation.Computed tomography of the abdomen showed diffuse dilatation of the small intestine and the entire colon.Initial sigmoidoscopic findings and result of polymerase chain reaction(PCR)for CMV revealed the compatible findings of CMV colitis,the patient was treated with intravenous ganciclovir.After treatment,sigmoidoscopic findings and CMV PCR results improved.However the patient continued to suffered from constipation.Eight months after the initial admission,patient visited the emergency department with severe abdominal pain and imaging revealed aggravation of fecal impaction and bowel dilatation.We performed subtotal colectomy to control patient’s symptom.Histological examination of the resected specimen showed significantly reduced number of mature ganglion cells in the sigmoid colon compared to that in the proximal colon.CONCLUSION Our case demonstrates that CMV colitis can develop even in patients with no other underlying disease,and that CMV colitis can be one of the causes for developing colonic hypoganglionosis.

关键词： Colonic pseudo-obstruction Colitis cytomegalovirus Ganglia Case report

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Identification and characterization of a novel group of natural antisense transcripts from RNA1.2 gene locus of human cytomegalovirus

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Chinese Medical Journal 2019年第13期132卷 1591-1598页

作者： Bing-Yang Liu Yan-Ping Ma Ying Qi Yu-Jing Huang Zhong-Yang Liu Meng-Qing Lu Qiang Ruan Department of Endocrinology Affiliated Shengjing HospitalChina Medical UniversityShenyangLiaoning 110004China Virus Laboratory Affiliated Shengjing HospitalChina Medical UniversityShenyangLiaoning 110004China

Background:Natural anti-sense transcripts(NATs),which are transcribed from the complementary DNA strand of annotated genes,exert regulatory function of gene expression.Increasing studies recognized anti-sense transcription widespread throughout human cytomegalovirus(HCMV)genome,whereas the anti-sense transcription of RNA1.2 gene locus has never been investigated.In this study,the transcription of the RNA1.2 anti-sense strand was investigated in clinically isolated HCMV strain.Methods:Strand-specific high-through RNA-sequencing(RNA-seq)was performed to find possible anti-sense transcripts(ASTs).For analyzing and visualization of RNA-seq data sets,Integrative Genomics Viewer software was applied.To confirm these possibilities,Northern blotting and rapid amplification of cDNA ends(RACE)were used.Results:Transcription of the opposite strand of RNA1.2 gene locus was detected by RNA-sequencing using RNAs extracted from human embryonic lung fibroblasts infected with HCMV clinical isolate HAN.At least three HCMV NATs,named RNA1.2 AST 1,RNA1.2 AST2,and RNA 1.2 AST3,were characterized by Northern blotting and RACE analyses.These RNA1.2 ASTs orientated from the complementary strand of RNA1.2 locus during the late phase of HCMV infection.The 5'-and 3'-termini of these transcripts were located within the opposite sequence of the predicted RNA1.2 gene.Conclusion:A cluster of novel NATs was transcribed from the opposite sequence of the HCMV RNA 1.2 gene region.

关键词： Human cytomegalovirus RNA1.2 Natural anti-sense transcript

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cytomegalovirus ileo-pancolitis presenting as toxic megacolon in an immunocompetent patient: A case report

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World Journal of Clinical Cases 2020年第3期8卷 552-559页

作者： Joon Hyun Cho Joon Hyuk Choi Division of Gastroenterology and Hepatology Department of Internal MedicineYeungnam University College of MedicineDaegu 42415South Korea Department of Pathology Yeungnam University College of MedicineDaegu 42415South Korea

BACKGROUND cytomegalovirus(CMV) enterocolitis presenting in the form of pancolitis or involving the small and large intestines in an immunocompetent patient is rarely encountered, and CMV enterocolitis presenting with a serious complication, such as toxic megacolon, in an immunocompetent adult has only been reported on a few occasions.CASE SUMMARY We describe the case of a 70-year-old male with no history of inflammatory bowel disease or immunodeficiency who presented with toxic megacolon and subsequently developed massive hemorrhage as a complication of CMV ileopancolitis. The patient was referred to our institute for abdominal pain and distension. Abdominal X-ray showed marked dilatation of ileum and whole colon without air-fluid level, and sigmoidoscopy with biopsy failed to reveal any specific finding. After 7 d of conservative treatment, massive hematochezia developed, and he was diagnosed to have CMV enterocolitis by colonoscopy with biopsy. Although the diagnosis of CMV enterocolitis was delayed, the patient was treated successfully by repeat colonoscopic decompression and antiviral therapy with intravenous ganciclovir.CONCLUSION This report cautions that CMV-induced colitis should be considered as a possible differential diagnosis in a patient with intractable symptoms of enterocolitis or megacolon of unknown cause, even when the patient is nonimmunocompromised.

关键词： Toxic megacolon cytomegalovirus Enterocolitis Immunocompetent Case report

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