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Liver transplantation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Caroline Lemoine, Riccardo A. Superina
Infectious complications are a major cause of mortality and morbidity after LT because of immunosuppression, indwelling catheters, pre-existing morbidity, malnutrition, and surgical complications. Early postoperative infections are mostly bacterial or fungal, but viral infections are particularly important later. Cytomegalovirus infection may cause fever, malaise, diarrhea, gastrointestinal bleeding, abnormal liver function, and pulmonary symptoms. Children are more likely to develop disease if they are primarily infected from a CMV-positive donor than when viral reactivation occurs in a previously immune recipient. Treatment with ganciclovir and reducing the immunosuppression are often effective. CMV prophylaxis is routinely given to naive recipients receiving a CMV-positive graft. Other opportunistic viral infections include herpes simplex, varicella zoster, adenovirus, and EBV. The last of these is a potential cause of post-transplant lymphoproliferative disease. Both CMV and EBV are to be monitored by serial estimations of viral load using the polymerase chain reaction.
DRCOG MCQs for Circuit A Questions
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
Causes of symmetric intrauterine growth retardation (IUGR) include: Toxoplasmosis.Down's syndrome.Twins.Rubella.Cytomegalovirus infection.
The respiratory system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Clinically significant cytomegalovirus infection is usually seen in immunosuppressed patients and it is an important complication of solid organ transplantation and HIV infection. It can also cross the placenta and may cause perinatal cytomegalic inclusion disease. In adults there is fever, non-productive cough, dyspnoea, and hypoxia. The characteristic intranuclear, acidophilic inclusions surrounded by a clear zone are seen in bronchiolar and alveolar epithelium with an associated lymphoplasmacytic interstitial pneumonitis (Figure 8.25).
Cell therapy for cytomegalovirus infection
Published in Expert Opinion on Biological Therapy, 2021
Cytomegalovirus infection is usually innocuous in the immunocompetent host, though congenital infection can cause serious developmental abnormalities. In the immunosuppressed setting, infection and CMV-mediated disease can be overwhelming and lead to mortality [1]. CMV-specific cytotoxic T-cell lymphocytes (CTLs) control the latent CMV virus and prevent uncontrolled CMV replication and dissemination, commonly referred to as ‘reactivation’ [2]. Following allogeneic hematopoietic stem cell transplant (HSCT), patients have both qualitative and quantitative deficiencies in T-cell immunity, greatly increasing the chance of reactivation episodes. Current management of CMV in this setting is based on a preemptive model, with the requirement for frequent monitoring of CMV viral loads in the post-transplant period, with antiviral therapy commenced when the CMV loads rise above a certain threshold. This strategy has several limitations, including drug-related toxicity, resistance, cost and lack of overall efficacy.
Critical review of renal tubule karyomegaly in non-clinical safety evaluation studies and its significance for human risk assessment
Published in Critical Reviews in Toxicology, 2018
In the guinea pig, renal tubule karyomegaly is known to be associated with cytomegalovirus, an enveloped DNA virus belonging to the Herpesviridae family. Cytomegalovirus infection occurs commonly in both laboratory and pet guinea pigs, and karyomegaly of the epithelial lining of the salivary gland ducts and renal tubules are characteristic and diagnostic histopathological alterations for this virus (Hsiung et al. 1980). This infection is used as an animal model for congenital and neonatal cytomegalovirus infection in humans. Clinical signs of guinea pig cytomegalovirus infection are rare in the immunocompetent guinea pig and the histopathological alterations are minimal.
Recovery from prolonged thrombocytopenia in patients with TAFRO syndrome: case series and literature review
Published in Modern Rheumatology Case Reports, 2020
Yuta Yamaguchi, Yuichi Maeda, Takayuki Shibahara, Shinichiro Nameki, Akihiko Nakabayashi, Kiyohide Komuta, Yumiko Mizuno, Mayu Yagita, Yusuke Manabe, Takayoshi Morita, Masayuki Nishide, Akane Watanabe, Hyota Takamatsu, Sumiyuki Nishida, Toru Hirano, Yoshihito Shima, Masashi Narazaki, Atsushi Kumanogoh
A 74-year-old Japanese man was admitted to our hospital with a four-week history of diarrhoea, fatigue, anasarca, and low-grade fever. Antibiotics therapy did not improve his symptoms. In addition, thrombocytopenia gradually got worse. Positron emission tomography-CT revealed mild cervical and mediastinal lymphadenopathy and splenomegaly, but there was no evidence of malignancy by the biopsy of cervical lymph nodes. The pathological finding revealed hyaline-vascular/plasma cell variant, which was like Castleman’s disease. On the other hand, bone marrow biopsy revealed hypercellular marrow with increased megakaryocytes and mild reticulin fibrosis. These symptoms as well as laboratory examination findings (Table 1) met the diagnostic criteria for TAFRO syndrome. Thus, we started him on oral 0.5 mg/kg of methylprednisolone. After the initiation of steroids, CRP levels and the pleural effusion improved, but prolonged thrombocytopenia (platelet count 10,000–20,000/µL) was observed. Several trials of platelet transfusion did not improve the platelet counts. Therefore, we added oral intake of cyclosporine A at 20 days after the initiation of steroids. Approximately, 50 days after the corticosteroid treatment, his platelet counts started to increase, accompanied by a decrease in D-dimer titre (Figure 1(C)). Sixty-one days after the initial treatment, the platelet count had reached 50,000/µL. Oral steroid dosage was decreased gradually without any recurrent symptoms. In this patient, however, cytomegalovirus infection was observed and it was treated with ganciclovir from 33 days to 48 days after the initial prednisolone treatment. In this case, it could not be ruled out the possibility of the influence of cytomegalovirus infection or treatment of ganciclovir to prolonged thrombocytopenia.