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Review

Rapid detection of cytomegalovirus infection in transplant patients

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Pages 231-242 | Published online: 09 Jan 2014

References

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  • •Human cytomegalovirus (HCMV) rates of replication in HCMV-naive patients are higher as compared with CMV-experienced transplant patients. Data suggests that an anti-HCMV drug or vaccine with an efficacy of more than 93% is required to eliminate viral growth during infection of HCMV-naive liver transplant recipients, whereas lower efficacy levels are sufficient to reduce replication in hosts with prior HCMV immunity. toLeung AK, Sauve RS, Davies HD. Congenital cytomegalovirus infection. Natl Merl Assoc. 95,213-218 (2003).
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  • ••Found that doubling time/half-life ofCMV in blood is approximately 1 day, showing that CMV DNA replication in ilvois a highly dynamic process and concludes that the reputation of CMV as a slowly replicating virus based on the time taken to produce cytopathic effects in vitro is unwarranted.
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  • •Discusses the enhanced sensitivity of the DNA Hybrid Capture Assay (HCA) and plasma PCR as a means to improve the diagnosis and management of CMV disease in CMV-seropositive patients. HCA and plasma PCR were more consistently positive than shell vial assay during viremic episodes.
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  • •Renal transplant patients were monitored weekly with CMV antigenemia, plasma qualitative Amplicor CMV, plasma and peripheral blood leukocyte (PBL) quantitative Amplicor CMV Monitor, PBL quantitative Quantiplex bDNA CMV version 2.0 and whole blood NucliSens pp67 assays. PBLs were positive before symptoms of CMV disease earlier than plasma or whole blood. PBL assays may be more appropriate than plasma assays when pre-emptive therapy is required to prevent the rapid progression from the first detection of the virus to CMV disease.
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  • ••Examines laboratory markers forpre-emptive antiviral therapy against CMV disease after transplantation. Both qualitative and quantitative PCR assays were used to monitor renal transplant recipients Qualitative leukocyte PCR was the best assay to predict CMV disease for R recipients who received R+ kidneys. Qualitative assays could not be used to guide pre-emptive therapy of R+ recipients, but plasma viral load and its incremental rate were diagnostic tools in R+ recipients.
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  • •Excellent correlation between the quantitative PCR assay (Amplicor CMV Monitor test) and the CMV pp65 antigenemia assay was noted in transplant recipients.
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  • ••Evaluated utility of serial CMV bloodsamples with antigenemia, qualitative and

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