Seropian S, Ferguson D, Salloum E, Cooper D, Landry M L
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
Bone Marrow Transplant. 1998 Sep;22(5):507-9. doi: 10.1038/sj.bmt.1701354.
Pre-emptive antiviral therapy based on the early detection of CMV infection is an important strategy for the prevention of CMV disease following allogeneic BMT. Accepted methods for early detection of CMV infection include viral culture of blood or bronchial lavage specimens or CMV pp65 antigenemia testing of peripheral blood specimens. We describe a patient with aplastic anemia with worsening liver transaminases after allogeneic bone marrow transplantation who had repeated negative tests for CMV pp65 antigenemia despite positive viral blood cultures. Re-examination of peripheral blood samples with a different pp65 antibody pool revealed the presence of high levels of CMV in peripheral blood leukocytes, confirming a lack of reactivity to the original antibody pool. Following institution of antiviral therapy, a prompt reduction in the number of pp65 antigen-positive peripheral blood leukocytes paralleled a reduction in abnormal transaminases. The practical implications of these findings are discussed.
基于巨细胞病毒（CMV）感染早期检测的抢先抗病毒治疗是预防异基因骨髓移植后CMV疾病的重要策略。CMV感染早期检测的公认方法包括血液或支气管灌洗标本的病毒培养或外周血标本的CMV pp65抗原血症检测。我们描述了一名再生障碍性贫血患者，在异基因骨髓移植后肝转氨酶恶化，尽管病毒血培养呈阳性，但CMV pp65抗原血症检测多次呈阴性。用不同的pp65抗体池重新检测外周血样本，发现外周血白细胞中存在高水平的CMV，证实对原始抗体池缺乏反应性。抗病毒治疗开始后，pp65抗原阳性外周血白细胞数量迅速减少，同时异常转氨酶也减少。讨论了这些发现的实际意义。
