Diaz Laura, Rosales Joaquin, Rosso Fernando, Rosales Maria, Estacio Mayra, Manzi Eliana, Jaramillo Francisco Javier
Facultad de ciencias de la salud, Universidad Icesi, Cali, Colombia.
Facultad de ciencias de la salud, Universidad Icesi, Cali, Colombia; Fundación Valle del Lili, Cali, Colombia.
Hematol Transfus Cell Ther. 2020 Jan-Mar;42(1):18-24. doi: 10.1016/j.htct.2018.10.004. Epub 2019 Feb 22.
Cytomegalovirus infection and disease are significant causes of morbidity and mortality among patients with hematopoietic stem cell transplantation. The aim of this study was to assess the frequency of cytomegalovirus infection and characterize the patients who developed the disease.
A retrospective cohort study was performed among adult patients, recipients of allogeneic HSTC between 2008 and 2015. Taking into account the institutional protocol of prophylaxis infections in hematopoietic stem cell transplantation, patients received either preemptive therapy or prophylaxis with valganciclovir. Infection was defined as a positive pp65 antigenemia assay or PCR higher than 500copies/mL. Disease was defined as viremia with evidence of end organ damage.
Seventy patients were included, the median age was 36 years old (IQR 17-62). A total of 93% of the recipients had a positive serology. The Cytomegalovirus infection occurred in 59% of the patients. Eleven patients developed disease (16%), the most frequent manifestation being colitis, followed by pneumonitis and a single case of retinitis. There were no differences between the preemptive therapy or prophylaxis groups. The mean time of onset of the disease was day 94 post-transplant. Three patients developed disease with a viral load lower than 1000copies/mL.
The incidence of cytomegalovirus infection after transplantation at our institution is high. It was found that the disease can occur with any level of viral load and is associated with high mortality.
巨细胞病毒感染和疾病是造血干细胞移植患者发病和死亡的重要原因。本研究旨在评估巨细胞病毒感染的频率，并对发生该疾病的患者进行特征描述。
对2008年至2015年间接受异基因造血干细胞移植的成年患者进行回顾性队列研究。考虑到造血干细胞移植中预防感染的机构方案，患者接受抢先治疗或缬更昔洛韦预防。感染定义为pp65抗原血症检测阳性或PCR高于500拷贝/毫升。疾病定义为伴有终末器官损伤证据的病毒血症。
纳入70例患者，中位年龄为36岁（四分位间距17 - 62岁）。93%的受者血清学呈阳性。59%的患者发生了巨细胞病毒感染。11例患者发生疾病（16%），最常见的表现是结肠炎，其次是肺炎和1例视网膜炎。抢先治疗组和预防组之间无差异。疾病的平均发病时间为移植后第94天。3例患者病毒载量低于1000拷贝/毫升时发生疾病。
我院移植后巨细胞病毒感染的发生率较高。发现该疾病可在任何病毒载量水平下发生，且与高死亡率相关。
