Update On Cytomegalovirus Infections Of The Gastrointestinal System In Solid Organ Transplant Recipients
CMV; Cytomegalovirus; Gastrointestinal infection; Infectious Diseases; Solid organ transplant
Cytomegalovirus (CMV) infection of the gastrointestinal tract is the most common manifestation of tissue-invasive CMV disease, and is a significant cause of morbidity and mortality in the solid organ transplantation (SOT) recipient. In addition to the direct effects of the infection, its indirect effects on allograft function, risk for other opportunistic infections, and mortality are significant in this population. The most common clinical syndromes are esophagitis, colitis, and hepatitis; however, infection can occur anywhere in the gastrointestinal tract. Diagnosis is usually by histopathology or viral culture of tissue specimens; molecular assays also often have a role. Antivirals are the cornerstone of therapy for gastrointestinal tract CMV disease and complications such as recurrent infection and antiviral resistance are not uncommon. Prevention with antiviral prophylaxis or preemptive therapy is important. This review summarizes recent data regarding the clinical manifestations, diagnosis, treatment, and prevention of gastrointestinal tract CMV infection in the SOT population.
Lemonovich T L; Watkins R R
Current Infectious Disease Reports
2012
2012-02
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1007/s11908-011-0224-6" target="_blank" rel="noreferrer noopener">10.1007/s11908-011-0224-6</a>
Serum procalcitonin in the diagnosis and management of intra-abdominal infections
acute; anti-thymocyte globulin; antibiotic-therapy; antibiotic-therapy; appendicitis; c-reactive protein; critically-ill patients; intensive-care units; international multicenter; liver-transplantation; liver-transplantation; major abdominal-surgery; pancreatitis; peritonitis; Pharmacology & Pharmacy; procalcitonin; sepsis; spontaneous bacterial
The biomarker procalcitonin (PCT) has been used to diagnose and monitor a number of clinically significant infections. Serum levels of PCT are often increased in the presence of bacterial and fungal infections but not viral infections or noninfectious inflammation. Intra-abdominal infections (IAIs) are serious conditions that pose difficult challenges to physicians and the healthcare system. Researchers have evaluated PCT in the management of IAIs, both for diagnosis and for guiding antibiotic therapy. The studies have produced mixed results, leading to controversy on the utility of PCT in IAIs. PCT appears to be most useful in diagnosing postoperative infections and necrotizing pancreatitis. This review aims to summarize these data, explore the pathophysiology of PCT in sepsis from IAIs, discuss the strengths and weaknesses of PCT monitoring in IAIs, and provide guidance for the interpretation of PCT levels.
Watkins R R; Lemonovich T L
Expert Review of Anti-Infective Therapy
2012
2012-02
Journal Article
<a href="http://doi.org/10.1586/eri.11.164" target="_blank" rel="noreferrer noopener">10.1586/eri.11.164</a>
Immune response to CMV in solid organ transplant recipients: current concepts and future directions
adaptive immunity; antibody; cd4(+) t-cells; cell-mediated-immunity; CMV; human cytomegalovirus-infection; Immunology; innate immunity; kidney-transplantation; liver-transplantation; long-term; lung transplantation; preemptive therapy; receptor repertoire; recipient; renal-transplant; Toll-like receptor; transplantation; vaccine
Despite advances in immunosuppression and antiviral therapy, CMV continues to be a significant opportunistic pathogen adversely affecting the outcome of solid organ transplantation (SOT) recipients. While a significant proportion of CMV disease is caused by reactivation of latent virus, the risk is highest among CMV donor+ and recipient- SOT patients. CMV is responsible for both direct (e.g., pneumonitis, colitis) and indirect (e.g., rejection, atherosclerosis) morbidity and mortality. Healthy CMV-seropositive individuals have a high frequency of CMV-specific CD4(+) and CD8(+) T cells that provide immune protection by limiting CMV reactivation and replication. Changes to the innate and adaptive immune system from immunosuppressive therapy following SOT contribute to CMV disease pathogenesis. CMV disease after SOT is associated with poorer outcomes, thus novel strategies to prevent it are an area of active research. In this article, we review the current state of knowledge on the immune response to CMV following SOT.
Watkins R R; Lemonovich T L; Razonable R R
Expert Review of Clinical Immunology
2012
2012-05
Journal Article
<a href="http://doi.org/10.1586/eci.12.25" target="_blank" rel="noreferrer noopener">10.1586/eci.12.25</a>