title: Active CMV and EBV infections in renal transplant recipients with unexplained fever and elevated serum creatinine.
abstract: Proper identification of active cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are helpful for monitoring antiviral treatment in transplant recipients. Qualitative and quantitative CMV, EBV DNA PCR techniques in the context of serological tests are performed for early detection and differentiation of active and latent CMV and EBV infections in renal transplantation. Basically, 129 renal transplanted recipients monitored carefully and hospitalized for unexplained elevated creatinine levels or high fever and 21 of their donors were studied. CMV DNA was detected in 63.5% of the febrile episodes following transplantation and in 46.42% of readmitted patients using qualitative PCR method. In the first group, 15% of the patients and in the second group 42.85% of the patients had copy numbers more than cutoff point (900 copies/mL). Cutoff point had 100% sensitivity and 82.5% specificity for active and symptomatic CMV infection. Only 15.5% of the subjects were positive for EBV infection by qualitative PCR method. Among them 5% had >2000 copies/mL and were symptomatic. One subject with a history of three times hospitalization had higher EBV viral load and developed post-transplant lymphoproliferative disorder. CMV load was significantly correlated with elevated creatinine levels (OR = 3.1, p = 0.006), abnormal heart sounds (OR = 4.7; p = 0.02) and hypertension (OR = 3.6; p = 0.03). Only qRT-PCR could differentiate between latent and active infections and might be clinically useful for monitoring symptomatic CMV and EBV infections and initiation of the antiviral therapy. Elevated creatinine levels, hypertension, and abnormal heart sounds could be considered as main manifestations of HCMV infection in kidney recipients.
authors.affiliation: a Internal Medicine Department , Arash Hospital, Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Tahereh
authors.initials: T
authors.lastname: Hasannia
authors.affiliation: a Internal Medicine Department , Arash Hospital, Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Seyed Majid
authors.initials: SM
authors.lastname: Moosavi Movahed
authors.affiliation: b The Center of Pathological and Medical Diagnostic Services, Iranian Academic Center for Education, Culture & Research (ACECR) , Mashhad , Iran.
authors.forename: Rosita
authors.initials: R
authors.lastname: Vakili
authors.affiliation: c Immunology Research Center, Inflammation and Inflammatory Diseases Division, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran.
authors.forename: Houshang
authors.initials: H
authors.lastname: Rafatpanah
authors.affiliation: d Internal Medicine Department , Medical School, Mashhad University of Medical Science , Mashhad , Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Hekmat
authors.affiliation: c Immunology Research Center, Inflammation and Inflammatory Diseases Division, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran.
authors.forename: Narges
authors.initials: N
authors.lastname: Valizadeh
authors.affiliation: c Immunology Research Center, Inflammation and Inflammatory Diseases Division, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran.
authors.forename: Seyed Abdolrahim
authors.initials: SA
authors.lastname: Rezaee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003404:Creatinine / Q000097:blood; D003587:Cytomegalovirus / Q000235:genetics*; D003586:Cytomegalovirus Infections / Q000097:blood / Q000150:complications / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis*; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000150:complications / Q000821:virology*; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000209:etiology*; D004854:Herpesvirus 4, Human / Q000235:genetics*; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000821:virology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D066027:Transplant Recipients; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D003404:Creatinine
keywords: Cytomegalovirus; Epstein-Barr virus; Q-PCR; renal transplant patients