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Virus isolation should be combined with pathologic findings to distinguish viral shedding from tissue invasion Cultures alone are of little use in diagnosing AIDS-related CMV infections, but when results are positive, they are associated with a risk of progressive retinitis Tissue confirmation is especially useful in establishing a diagnosis of CMV pneumonitis and CMV gastrointestinal or neurologic disease PCR assays of dried blood samples from neonates are evolving as the easiest means of establishing the diagnosis in infants with CMV inclusion disease The acute mononucleosis-like syndrome is associated with lymphocytosis, often 2 weeks after the fever, but absolute leukopenia may also be noted Serologic tests are useful primarily in seroepidemiologic studies and occasionally in confirming acute infection (with IgM) in nonimmunosuppressed patients Antigen detection in blood components, urine, or cerebrospinal fluid by virus technology (including PCR technology) should be interpreted in the context of clinical and pathologic findings but is increasingly being used to guide both treatment and prevention Among transplant recipients, PCR appears to be more useful than CMV antigenemia in predicting clinical disease A variety of false-positive immunologic assays occur in the setting of acute CMV infections, including positive rheumatoid factor, direct Coombs test, cryoglobulins, and speckled antinuclear antibody
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No vaccine is currently available although several are under development Leukoreduction is effective in reducing CMV transmitted by blood transfusions Strategies for prevention in transplant recipients include use of leukocyte-depleted blood products, antiviral agents, and CMV immune globulin The risk of CMV disease is proportionate to the intensity of immunosuppression, which depends in part on the organ being transplanted PCR and antigen assays increase the ability to detect CMV disease prior to clinical expression Oral ganciclovir is being replaced by oral valganciclovir in
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prevention because of its greater bioavailability The optimal method of monitoring and preventing CMV disease among transplant patients remains to be elucidated HAART is effective in preventing CMV infections in HIV-infected patients CMV immune globulin may be effective in reducing the incidence of bronchiolitis obliterans in the bone marrow transplant population The virus is so ubiquitous that it is not recommended that children with known CMV infection be withdrawn from day care centers or that health care workers restrict their patient contact beyond intensifying handwashing Screening programs are not recommended for women of childbearing age and breast-feeding should not be restricted
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Nigro G et al; Congenital Cytomegalovirus Collaborating Group Passive immunization during pregnancy for congenital cytomegalovirus infection N Engl J Med 2005 Sep 29;353 (13):1350 62 [PMID: 16192480] Ruttmann E et al Combined CMV prophylaxis improves outcome and reduces the risk for bronchiolitis obliterans syndrome (BOS) after lung transplantation Transplantation 2006 May 27;81(10):1415 20 [PMID: 16732179] Wreghitt TG et al Cytomegalovirus infection in immunocompetent patients Clin Infect Dis 2003 Dec 15;37(12):1603 6 [PMID: 14689339]
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HHV-6 is a B cell lymphotropic virus that is the principal cause of exanthema subitum (roseola infantum, sixth disease) Primary HHV-6 infection occurs most commonly in children under 2 years of age and is the most common cause of infantile febrile seizures Reactivation of HHV-6 in adults is associated with immunocompromised states such as HIV and lymphoma It is associated with graft rejection and bone marrow suppression in transplant patients and with encephalitis and pneumonitis in the immunosuppressed (hematopoietic cell transplant and AIDS patients) HHV-6 is on occasion also associated with drug-induced hypersensitivity syndromes that may evolve into diabetes mellitus Possible roles of HHV6 in the evolution of multiple sclerosis and progressive multifocal leukoencephalopathy remain unproven Two variants (A and B) of HHV-6 have been identified HHV-6B is the predominant strain found in both normal and immunocompromised persons In vitro data suggest susceptibility to ganciclovir and foscarnet but not acyclovir HHV-7 is a T cell lymphotropic virus that is associated with roseola (serologically), seizures and, rarely, encephalitis Infection with HHV-7 appears to be synergistic with CMV in renal transplant recipients The membrane glycoprotein CD4 is involved in HHV-7 recognition, and an antagonistic interaction between HHV-7 and HIV is established HHV-8 is associated with Kaposi s sarcoma in AIDS patients It has also been implicated in multicentric Castleman s disease and primary effusion lymphoma (body cavity lymphoma) See 31 for pathogenesis and management
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Boeckh M et al Emerging viral infections after hematopoietic cell transplantation Pediatr Transplant 2005 Dec;9 Suppl 7:48 54 [PMID: 16305617] Caserta MT et al Human herpesvirus 6 Clin Infect Dis 2001 Sep 15;33(6):829 33 [PMID: 11512088] Dewhurst S Human herpesvirus type 6 and human herpesvirus type 7 infections of the central nervous system Herpes 2004 Jun;11 Suppl 2:105A 111A [PMID: 15319097]
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