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Acquired Disorders of the Neck
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
The investigation of first choice is ultrasound scanning. An experienced radiologist is invaluable here and they will look for features of normal architecture in the nodes. If the hilar architecture is normal, particularly if there are adjacent nodes with a similar appearance, then the node is almost certainly a benign ‘reactive’ node and, provided there is nothing in the history or examination to warrant further investigation, the parents can be reassured that no intervention is needed (Figure 27.1). Cystic inclusions, loss of definition of the hilar ‘strands’ and calcification all suggest an abnormal node and will warrant further investigation, in some cases biopsy (Figure 27.2). Blood tests for serology to demonstrate cytomegalovirus (CMV) or Epstein Barr Virus (EBV) may be useful. Infectious mononucleosis (EBV infection) is a common cause of often massive cervical adenopathy in adolescence. Diagnosis is confirmed by analysis of the blood film, which will show the atypical lymphocytes, with positive serology (mono-spot and Paul Bunnel tests).
Order Martellivirales: Togaviridae
Published in Paul Pumpens, Peter Pushko, Philippe Le Mercier, Virus-Like Particles, 2022
Paul Pumpens, Peter Pushko, Philippe Le Mercier
It is reasonable to highlight the VEEV sriVLPs-based vaccines that were evaluated by human clinical trials. Thus, the cytomegalovirus (CMV) vaccine candidate (Reap et al. 2007a, b) demonstrated the successful outcome of the phase I trial (Bernstein et al. 2009). The procedure was safe, and neutralizing antibodies and multifunctional T-cell responses were generated against all three CMV antigens important for protective immunity. Then, Wecker et al. (2012) published a report on the phase I trial of the VEEV sriVLPs-based HIV vaccine AVX101 in the US and South Africa, where volunteers were subjected to subcutaneous injection of escalating doses of the particles expressing the nonmyristoylated form of the HIV-1 subtype C Gag protein. Slobin et al. (2013) performed the phase I clinical study for the VEEV sriVLPs-based vaccine against prostate cancer, which expressed prostate-specific membrane antigen, in patients with castration resistant metastatic disease. Despite the failure to generate robust immune responses and clinical benefits, the success in eliciting neutralizing antibodies indicated that dose optimization would further enhance the efficacy of the vaccine, as commented by Lundstrom (2020).
Infections
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Cytomegalovirus (CMV) is a DNA herpes virus, and latently infects most people. It is acquired transplacentally, during infancy, by respiratory droplet infection, and via sexual intercourse. It reactivates in states of immunosuppression – particularly HIV/AIDS – and also in transplant recipients. By infecting the endothelial and epithelial cells it causes cytolytic cell damage and focal necrosis. Common presentations in HIV/AIDS are a pneumonitis, intestinal lesions with diarrhoea, confusional states from encephalitis, and, importantly, visual defects. Retinal CMV infection is a significant cause of blindness in HIV disease, and is the reason why many patients are given prophylactic anti-herpesvirus therapy. Morphologically, the nucleated layers of the retinal epithelium show the characteristic CMV nuclear and cytoplasmic inclusions, with necrosis.
Role of environmental factors in multiple sclerosis
Published in Expert Review of Neurotherapeutics, 2021
Amin Zarghami, Ying Li, Suzi B. Claflin, Ingrid van der Mei, Bruce V. Taylor
Human cytomegalovirus (CMV) is another member of the herpesvirus family with a wide range of clinical manifestations, ranging from asymptomatic in most healthy individuals to severe infections in immunocompromised individuals [147]. A 2020 meta-analysis (n = 15) reported a non-significant difference in CMV (IgG) seroprevalence between 3591 adult PwMS and 4241 controls (OR:1.19; 95%CI:0.78–1.81). Due to the heterogeneity (I2 = 33%) observed between studies, a subgroup analysis based on geographic region was conducted. This analysis showed that MS cases were less likely to be CMV IgG positive compared to controls (OR:0.75; 95%CI: 0.60–0.94) in European countries, whereas in the Middle East, living with MS was associated with an increased likelihood of CMV IgG seropositivity (OR:5.09; 95%CI:1.07–24.26). No association was found among cases in North America [148]. In a 2014 meta-analysis based on data from 11 retrospective studies, CMV seropositivity was found to be protective against MS onset (OR:0.77; 95%CI: 0.67–0.87) when adjusted for risk factors associated with CMV and MS status [149]. A 2019 prospective nested case–control study (n = 116) did not find a significant association between maternal CMV IgG levels and risk of MS onset in offspring [116]. Studies evaluating the interaction between CMV and HLA genes on MS onset risk have been inconclusive [109,139,149].
Hyperimmunoglobulin therapy for the prevention and treatment of congenital cytomegalovirus: a systematic review and meta-analysis
Published in Expert Review of Anti-infective Therapy, 2021
Amr Ehab El-Qushayri, Sherief Ghozy, Alzhraa Salah Abbas, Mahmoud Dibas, Abdullah Dahy, Abdalla Reda Mahmoud, Ahmed M Afifi, Nashwa El-Khazragy
The human cytomegalovirus (CMV) is a leading cause of intrauterine infections and can lead to severe complications in infancy and childhood [1]. Mothers who acquire CMV infection during pregnancy (i.e. primary infection) or those with non-primary infections who have preexisting CMV antibodies may pass the disease to their offspring through the intrauterine transmission [2]. It is estimated that 25% of the newly born infants will catch the infection if their mothers were infected in the first trimester and the rate doubles in the following trimesters [3]. Despite the low rate of infected fetuses showing symptoms at birth, a high rate of perinatal mortality has been recorded in most of the survivors due to severe clinical manifestations as low-birth weight, fetal growth retardation, neurological and multi-system involvement [3–5]. Besides mental retardation and other neurological manifestations have been reported as future complications in infants with asymptomatic congenital infection [4,5]. Therefore, the fetal infection should be prevented or treated whenever infection is diagnosed.
Letermovir for the prevention of cytomegalovirus infection in adult cytomegalovirus-seropositive hematopoietic stem cell transplant recipients
Published in Expert Review of Clinical Pharmacology, 2018
Farnaz Foolad, Samuel L. Aitken, Roy F. Chemaly
Human cytomegalovirus (CMV) is a herpesvirus transmitted by direct contact with infectious body fluids, which, similarly to other herpesviruses, establishes latency after primary infection and is subject to periodic reactivation [1–3]. In contrast to immunocompetent hosts where CMV infection is often benign, allogeneic hematopoietic cell transplant (allo-HCT) recipients are at risk for significant complications due to reactivation of CMV with resultant increases in morbidity and mortality [1–7]. CMV is the most common clinically significant infection after allo-HCT [8–11] and up to 80% of CMV-seropositive patients experience CMV reactivation in the absence of prophylaxis [11]. CMV-seropositivity of the transplant recipient is a risk factor for transplant-related mortality [5]. In addition, CMV viremia is associated with increased overall and non-relapse mortality in the first year after transplant [8,12]. A CMV viral load of ≥ 250 IU/mL has been associated with increased risk of early death (adjusted HR 18 · 1, 95% CI 8 · 8–37 · 4) in allo-HCT recipients [12]. While preemptive strategies aim to prevent CMV disease, given that CMV viremia itself is associated with increases in poor outcomes, finding a prophylactic strategy for the prevention of CMV reactivation is of vital importance.