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Opportunistic virus DNA levels after pediatric stem cell transplantation: serostatus matching, anti-thymocyte globulin, and total body irradiation are additive risk factors

Journal article
Authors Carola Kullberg-Lindh
Karin Mellgren
Vanda Friman
Anders Fasth
Henry Ascher
Staffan Nilsson
Magnus Lindh
Published in Transplant infectious disease : an official journal of the Transplantation Society
Volume 13
Issue 2
Pages 122-130
ISSN 1399-3062
Publication year 2011
Published at Department of Mathematical Sciences, Mathematical Statistics
Institute of Clinical Sciences, Department of Pediatrics
Institute of Biomedicine, Department of Infectious Medicine
Pages 122-130
Language en
Links dx.doi.org/10.1111/j.1399-3062.2010...
Keywords viral infections, hematopoietic stem cell transplantation
Subject categories Immunogenetics, Pediatrics

Abstract

Viral opportunistic infections remain a threat to survival after stem cell transplantation (SCT). We retrospectively investigated infections caused by cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus type 6 (HHV6), or adenovirus (AdV) during the first 6-12 months after pediatric SCT. Serum samples from 47 consecutive patients were analyzed by quantitative real-time polymerase chain reaction assay. DNAemia at any time point occurred for CMV in 47%, for EBV in 45%, for HHV6 in 28%, and for AdV in 28%. Three patients (6.3%) died of CMV-, EBV-, or AdV-related complications 4, 9, and 24 weeks after SCT, respectively, representing 21% of total mortality. These 3 cases were clearly distinguishable by DNAemia increasing to high levels. Serum positivity for CMV immunoglobulin G in either recipient or donor at the time of SCT, total body irradiation, and anti-thymocyte globulin conditioning were independent risk factors for high CMV or EBV DNA levels. We conclude that DNAemia levels help to distinguish significant viral infections, and that surveillance and prophylactic measures should be focused on patients with risk factors in whom viral complications rapidly can become fatal.

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