title: Virological and immunological features of active cytomegalovirus infection in nonimmunosuppressed patients in a surgical and trauma intensive care unit.
abstract: Cytomegalovirus (CMV) reactivation occurs frequently in critically ill patients. The natural course of CMV infection and the interaction between CMV and the adaptive immune system in this setting remain poorly defined. Fifty-three CMV-seropositive patients in a surgical and trauma intensive care unit were included in this study. The CMV DNA load in tracheal aspirates (TA) and plasma (PL) was monitored by qPCR. CMV-specific T-cell immunity was assessed by intracellular cytokine staining. Plasma TNF-alpha levels were determined by ELISA. CMV reactivation occurred in 39.7% of patients (23% had CMV DNA detected only in TA). The analysis of TA allowed an earlier diagnosis in 28% of patients. Clearance of CMV DNAemia preceded that of CMV DNA in TA in some episodes. Peak CMV DNA levels were significantly higher in TA than in PL (P = 0.02). CMV reactivation developed in the presence of CMV-specific T cells. Termination of CMV reactivation was associated with an expansion of functional CMV-specific T cells. Plasma levels of TNF-alpha did not allow for the prediction of the occurrence of CMV reactivation. CMV-specific T-cell immunity is preserved in most critically ill patients experiencing CMV reactivation. Analysis of respiratory specimens is imperative for an optimal monitoring of CMV reactivation in this setting.
authors.affiliation: Microbiology Service, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Marifina
authors.initials: M
authors.lastname: Chilet
authors.forename: Gerardo
authors.initials: G
authors.lastname: Aguilar
authors.forename: Isabel
authors.initials: I
authors.lastname: Benet
authors.forename: Javier
authors.initials: J
authors.lastname: Belda
authors.forename: Nuria
authors.initials: N
authors.lastname: Tormo
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Carbonell
authors.forename: María Angeles
authors.initials: MA
authors.lastname: Clari
authors.forename: Elisa
authors.initials: E
authors.lastname: Costa
authors.forename: David
authors.initials: D
authors.lastname: Navarro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016207:Cytokines / Q000096:biosynthesis / Q000097:blood; D003587:Cytomegalovirus / Q000276:immunology* / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000276:immunology* / Q000821:virology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007963:Leukocytes, Mononuclear / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000821:virology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D014132:Trachea / Q000821:virology; D019562:Viral Load; D014775:Virus Activation
chemical_list: D016207:Cytokines