The best practices for diagnosis and monitoring of CMV infection in immunocompromised patients

Human cytomegalovirus (CMV), an ubiquitous member of the Herpesvirus family, is an important pathogen for humans.
CMV is rarely pathogenic in healthy adult but is associated with several diseases in immunocompromised individuals (such as HIV-infected subjects and transplant recipients).
CMV infection in transplant recipients may cause different clinical syndromes and the severity of the infection parallels the degree of the immunosuppression. Not only does CMV directly cause morbidity and occasional mortality, it also influences many shortterm and long-term indirect effects that collectively contribute to reduce allograft and patient survival.
To prevent CMV infection and disease, two major therapeutic approaches are currently employed, antiviral prophylaxis and preemptive therapy. Both strategies demonstrated efficacy and safety.
As infections are either asymptomatic or accompanied by symptoms that are not specific of CMV (such as fever and leukopenia), laboratory techniques are the sole means of diagnosing CMV infection. Diagnosis of CMV infection can be made directly by demonstration of the virus or virus components in pathological materials or indirectly through serology.
Systemic CMV infections are diagnosed by performing quantitative antigenaemia or DNAemia assay on blood samples. Local infections are diagnosed by CMV identification from tissue biopsies and/or secretions.
CMV serology is confined to the pre-transplant diagnosis of CMV infection in immunocompromised patients.
In future, simultaneous virological and immunological follow-up will be the best approach to efficient monitoring of CMV infections in immunocompromised patients.

Articolo presente in – HAART and correlated pathologies n. 9

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