title: Evidence for an increased rate of bacterial infections in liver transplant patients with cytomegalovirus infection.
abstract: It has been reported that cytomegalovirus (CMV) infections increase the susceptibility of transplant patients for other opportunistic infections. Most of these studies date back from a time when CMV infection was difficult to diagnose and antiviral treatment not available. We therefore analyzed CMV-related morbidity after OLT in 111 consecutive patients. CMV monitoring was done weekly using the antigenemia assay, a quantitative marker of the viral load, in addition to serology. CMV infection occurred in 66/95 (69%) evaluable patients. Antigenemia was detected in 94% of them. The number of CMV antigen-positive cells was helpful to monitor the course of infection and differentiate CMV disease from other complications. CMV infection was symptomatic in 48/66 (73%) patients. Mild disease occurred in 30 patients, and severe constitutional symptoms or organ involvement in 18. No patient died as a direct result of CMV infection, but mortality between day 30 and 180 tended to be higher in CMV-infected patients (15 vs. 0%, p < 0.1). CMV infection was associated with a 2.45-fold higher incidence of major infections between day 30 and 180 after OLT (p < 0.05). Most of these infections were caused by gram-positive cocci. We conclude that CMV not only causes substantial morbidity, but also increases the risk of bacterial infections.
authors.affiliation: Department of Clinical Immunology, University Hospital, Groningen, The Netherlands.
authors.forename: A P
authors.initials: AP
authors.lastname: van den Berg
authors.forename: I J
authors.initials: IJ
authors.lastname: Klompmaker
authors.forename: E B
authors.initials: EB
authors.lastname: Haagsma
authors.forename: P M
authors.initials: PM
authors.lastname: Peeters
authors.forename: L
authors.initials: L
authors.lastname: Meerman
authors.forename: R
authors.initials: R
authors.lastname: Verwer
authors.forename: T H
authors.initials: TH
authors.lastname: The
authors.forename: M J
authors.initials: MJ
authors.lastname: Slooff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D000956:Antigens, Viral / Q000097:blood / Q000652:urine; D001424:Bacterial Infections / Q000209:etiology* / Q000517:prevention & control; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000150:complications*; D004198:Disease Susceptibility; D016983:Enterococcus; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000209:etiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology; D013290:Streptococcal Infections / Q000209:etiology; D015996:Survival Rate; D013997:Time Factors; D014766:Viremia
chemical_list: D000956:Antigens, Viral