title: Evaluation of cytomegalovirus (CMV)-specific T-cell immunity for the assessment of the risk of active CMV infection in non-immunosuppressed surgical and trauma intensive care unit patients.
abstract: The current study was designed to assess the predictive value of the evaluation of cytomegalovirus (CMV)-specific T-cell immunity early following admission to the intensive care unit for inferring the risk of active CMV infection in non-immunosuppressed surgical and trauma patients. A total of 31 CMV-seropositive patients were included. Patients were screened for the presence of CMV DNA in plasma and in tracheal aspirates by real-time PCR. Enumeration of CMV pp65 and IE-1-specific IFN-γ CD8(+) and CD4(+) T cells was performed by flow cytometry for intracellular cytokine staining. Virological and immunological monitoring was conducted once or twice a week. Active CMV infection occurred in 17 out of 31 patients. Undetectable levels of pp65 and IE-1-specific IFN-γ CD8(+) and CD4(+) T-cell subsets cells were observed in 10 patients who developed active CMV infection and in one who did not (at a median of 2 days following ICU admission). Peak CMV DNA loads in both tracheal aspirates and plasma were substantially higher (P = 0.018 and P = 0.091, respectively) in patients with undetectable IFN-γ T-cell responses than in patients with detectable responses. The expansion of both CMV-specific T-cell subsets following detection of active CMV infection was demonstrated in 9 out of 14 patients with active CMV infection. In conclusion, the evaluation of CMV pp65 and IE-1-specific IFN-γ-producing CD8(+) and CD4(+) T cells early following ICU admission may allow the identification of patients most at risk of either having or developing an episode of active CMV infection, particularly those associated with high-level virus replication.
authors.affiliation: Microbiology Service, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain.
authors.forename: María A
authors.initials: MA
authors.lastname: Clari
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: Estela
authors.initials: E
authors.lastname: Giménez
authors.forename: Dayana
authors.initials: D
authors.lastname: Bravo
authors.forename: José A
authors.initials: JA
authors.lastname: Carbonell
authors.forename: Liliana
authors.initials: L
authors.lastname: Henao
authors.forename: David
authors.initials: D
authors.lastname: Navarro
mesh_terms: D000368:Aged; D016638:Critical Illness; D016207:Cytokines / Q000096:biosynthesis; D003587:Cytomegalovirus / Q000276:immunology* / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000276:immunology*; D004279:DNA, Viral / Q000302:isolation & purification; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000821:virology; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D013601:T-Lymphocytes / Q000276:immunology*; D014132:Trachea / Q000821:virology; D019562:Viral Load; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D016207:Cytokines; D004279:DNA, Viral
keywords: CMV DNA load; T-cell immunity; active CMV infection; critically ill patients; cytomegalovirus