We report the case of a young female lung transplant recipient with difficult-to-treat cytomegalovirus (CMV) disease. While treatment with intravenous (IV) ganciclovir failed due to antiviral drug resistance, a trial with foscarnet resulted in severe side effects. In addition, the patient received IV CMV-specific immune globulins as adjunctive therapy and leflunomide as experimental therapy. In this context, CMV-specific immune monitoring was performed and was successfully implemented in management decisions. The patient was screened for acquisition of an adaptive immune response, and antiviral prophylaxis and therapy was tailored according to results. This report highlights the impact of CMV-specific immune monitoring on individualized therapy for appropriate prophylaxis and management of CMV infection and diseases.
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Article Synopsis
- γδ T-cells play a crucial role in immune surveillance following HLA-Haploidentical Stem Cell Transplantation (haplo-HSCT), especially in pediatric patients.
- A study showed that a specific subset of Vδ2 T-cells is associated with better antiviral protection, as these cells were more prevalent in patients who did not experience viral reactivation.
- The research highlights how Vδ2 T-cells can inhibit CMV replication and enhance the immune response, suggesting their potential use in immunotherapy post-transplantation to combat both infections and tumors.
Cytomegalovirus Infection After Solid Organ Transplantation: How I Use Cell-Mediated Immune Assays for Management.
Viruses
November 2024
Division of Infectious Diseases and the William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN 55905, USA.
Introduction: The pathogenesis and outcome of cytomegalovirus (CMV) infection after solid organ transplantation (SOT) reflects the interplay between viral replication and CMV-specific immunity. Despite advances in its diagnosis and treatment, CMV continues to cause significant morbidity after SOT. Since CMV is an opportunistic pathogen that occurs as a result of impaired pathogen-specific immunity, laboratory assays that measure CMV-specific immune responses may be useful in assisting clinicians in its management.
View Article and Find Full Text PDFCytomegalovirus Infections in Hematopoietic Stem Cell Transplant: Moving Beyond Molecular Diagnostics to Immunodiagnostics.
Diagnostics (Basel)
November 2024
College of Nursing and Health Sciences, Jazan University, Jazan 45142, Saudi Arabia.
Human CMV, regularly reactivated by simple triggers, results in asymptomatic viral shedding, powerful cellular immune responses, and memory inflation. Immunocompetent individuals benefit from a robust immune response, which aids in viral management without causing clinically significant illness; however, immunodeficient individuals are always at a higher risk of CMV reactivation and disease. Hematopoietic stem cell transplant (HSCT) recipients are consistently at higher risk of CMV reactivation and clinically significant CMV illness due to primary disease, immunosuppression, and graft vs.
View Article and Find Full Text PDFCurrent and future strategies for the prevention and treatment of cytomegalovirus infections in transplantation.
Clin Infect Dis
November 2024
Division of Allergy and Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, WA, USA.
Article Synopsis
- - Recent advancements in cytomegalovirus (CMV) prevention and treatment have emerged from pivotal clinical trials, focusing on tailored strategies for hematopoietic cell transplantation (HCT) and solid organ transplantation (SOT).
- - The review highlights methods to boost CMV-specific immunity using vaccination, monoclonal antibodies, and virus-specific T-cells, alongside observational studies on CMV cell-mediated immunity assays to refine preventive and treatment approaches.
- - Emphasizing the need to enhance CMV-specific immunity is vital for reducing CMV's detrimental effects in transplant recipients, especially as infections in CAR-T therapy patients and other immunocompromised groups rise, although these areas are not covered in this review.
Exposure to HIV is associated with altered composition of maternal microchimeric T cells in infants.
J Infect Dis
October 2024
Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
HIV exposed but uninfected infants (iHEU) display altered immunity and are at increased risk of infection. We previously reported that iHEU have decreased maternal microchimerism (MMc)-maternal cells transferred to the offspring in utero/during breastfeeding. We quantified MMc in T cell subpopulations in iHEU and unexposed infants (iHU) to determine whether a selective deficiency in MMc contributes to altered cellular immunity.
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