Background： Rheumatic diseases involve multiple organs that are affected by immunological mechanisms.Treatment with corticosteroids and immunosuppressive agents may also increase the frequency of infection.Cytomegalo...Background： Rheumatic diseases involve multiple organs that are affected by immunological mechanisms.Treatment with corticosteroids and immunosuppressive agents may also increase the frequency of infection.Cytomegalovirus （CMV） is a widespread herpes virus and a well-recognized pathogen, which causes an opportunistic and potentially fatal infection in immunocompromised patients.This retrospective study aimed to investigate the clinical and laboratory characteristics of CMV pneumonia in patients with rheumatic diseases after immunosuppressive therapy in a single center in Shanghai, China.Methods： Eight hundred and thirty-four patients with rheumatic diseases who had undergone CMV-DNA viral load tests were included, and the medical records of 142 patients who were positive for CMV-DNA in plasma samples were evaluated.GraphPad Prism version 5.013 （San Diego, CA, USA） was used to conduct statistical analysis.The correlation between CMV-DNA viral loads and lymphocyte counts was assessed using the Spearman rank correlation coefficient test.Significance between qualitative data was analyzed using Pearson＆#39;s Chi-squared test.The cut-offthresholds for CMV-DNA viral load and lymphocyte count were determined by receiver operating characteristic （ROC） curve analysis.Results： One hundred and forty-two patients had positive CMV viral load tests.Of these 142 patients, 73 patients with CMV pneumonia were regarded as symptomatic, and the other 69 were asymptomatic.The symptomatic group received higher doses ofprednisolone （PSL） and more frequently immunosuppressants than the asymptomatic group （P 〈 0.01）.The symptomatic group had lower lymphocyte counts, especially CD4＋ T-cells, than the asymptomatic group （P 〈 0.01）.By ROC curve analysis, when CD4＋ T-cell count was 〈0.39 ＆#215; 109/L, patients with rheumatic diseases were at high risk for symptomatic CMV infection.The CMV-DNA load was significantly higher in the symptomatic patients than that in asymptomatic patients （P 〈 0.01;threshold viral loads： 1.75 ＆#215; 104 copies/ml）.Seven patients had a fatal outcome, and they had lower peripheral lymphocyte counts （P 〈 0.01）, including CD4＋ and CD8＋ T-cells （P 〈 0.0 l）.Conclusions： When CD4＋ T-cell count is 〈0.39 ＆#215; 109/L, patients are at high risk for pulmonary CMV infection.Patients are prone to be symptomatic with CMV-DNA load 〉1.75 ＆#215; 104 copies/ml.Lymphopenia （especially CD4＋ T-cells）, presence of symptoms, and other infections, especially fungal infection, are significant risk factors for poor outcome, and a higher PSL dosage combined with immunosuppressants may predict CMV pneumonia.展开更多
Background There has been increasing interest in the research into cytomegalovirus （CMV） pneumonia agter liver transplantation （LT）. This study was undertaken to investigate the immunomodulatory therapy of CMV pne...Background There has been increasing interest in the research into cytomegalovirus （CMV） pneumonia agter liver transplantation （LT）. This study was undertaken to investigate the immunomodulatory therapy of CMV pneumonia after LT. Methods Six patients with CMV pneumonia after LT from October 2003 to November 2005 were analyzed retrospectively. They were diagnosed according to clinical manifestations, chest X-ray findings and pathogenic changes and given comprehensive therapy including mainly immunomodulation therapy and anti-viral medication. At the early stage of CMV pneumonia, the dose of immunosuppressive agents was decreased or ceased, instead replaced by immunoenhancement therapy. During recovery period from CMV pneumonia, the dose of immunosuppressive agents was given again or enhanced, and immunoenhancement therapy was ceased. The liver function of the patients was monitored closely during the treatment. Results In this series, five patients were survived and one died. The liver function of the six patients remained normal during the treatment, and no episode of acute rejection took place. Conclusions Poor immunity is the pathogenic basis of CMV pneumonia after LT. At early stage of CMV pneumonia, the immunity of the patients should be enhanced, and during the recovery period from CMV pneumonia, immunosuppresants shoud be given again but immunoenhancement therapy ceased. Individualized immunomodulatory therapy is essential to the treatment of CMV pneumonia after LT.展开更多
Background:Accurately diferentiating pneumocystis from cytomegalovirus pneumonia is crucial for correct therapy selection in AIDS patients.Hence,the goal of this study was to compare the computerized tomography(CT)fea...Background:Accurately diferentiating pneumocystis from cytomegalovirus pneumonia is crucial for correct therapy selection in AIDS patients.Hence,the goal of this study was to compare the computerized tomography(CT)features of pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients and identify clinical hallmarks to accurately distinguish these two pathologies.Methods:A total of 112 AIDS patients(78 with pneumocystis pneumonia and 34 cytomegalovirus pneumonia)at Beijing Ditan Hospital from January 2017 to May 2019 were included in this study.Two experienced chest radiologists retrospectively reviewed CT images for 17 features including ground-glass opacity,consolidation,nodules,and halo sign.Binary logistic regression analyses were conducted to identify the signifcant parameters that distinguished pneumocystis pneumonia from cytomegalovirus pneumonia.Correlations were analyzed by Pearson or Spearman correlation analyses.Result were considered signifcant if P<0.05.Results:The presence of consolidation,halo signs,and nodules(all P<0.05)were signifcantly more frequent in patients with cytomegalovirus pneumonia than in those with pneumocystis pneumonia.Small nodules(32.5%in cytomegalovirus pneumonia,6.41%in pneumocystis pneumonia,P<0.001)without perilymphatic distribution were particularly common in patients with cytomegalovirus pneumonia.Large nodules were not found in any of patients with cytomegalovirus pneumonia.The presence of ground-glass opacity,reticulation,and bronchial wall thickening(all P>0.05)were common in both groups.Conclusions:Analysis of consolidation,nodules,and halo signs may contribute to the diferential diagnosis of pneumocystis pneumonia or cytomegalovirus pneumonia.However,some CT features considered typical in one or other diseases appear with similar frequency in both cohorts of AIDS patients.CT features are potentially useful for the diferential diagnosis of pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients.展开更多
文摘Background： Rheumatic diseases involve multiple organs that are affected by immunological mechanisms.Treatment with corticosteroids and immunosuppressive agents may also increase the frequency of infection.Cytomegalovirus （CMV） is a widespread herpes virus and a well-recognized pathogen, which causes an opportunistic and potentially fatal infection in immunocompromised patients.This retrospective study aimed to investigate the clinical and laboratory characteristics of CMV pneumonia in patients with rheumatic diseases after immunosuppressive therapy in a single center in Shanghai, China.Methods： Eight hundred and thirty-four patients with rheumatic diseases who had undergone CMV-DNA viral load tests were included, and the medical records of 142 patients who were positive for CMV-DNA in plasma samples were evaluated.GraphPad Prism version 5.013 （San Diego, CA, USA） was used to conduct statistical analysis.The correlation between CMV-DNA viral loads and lymphocyte counts was assessed using the Spearman rank correlation coefficient test.Significance between qualitative data was analyzed using Pearson＆#39;s Chi-squared test.The cut-offthresholds for CMV-DNA viral load and lymphocyte count were determined by receiver operating characteristic （ROC） curve analysis.Results： One hundred and forty-two patients had positive CMV viral load tests.Of these 142 patients, 73 patients with CMV pneumonia were regarded as symptomatic, and the other 69 were asymptomatic.The symptomatic group received higher doses ofprednisolone （PSL） and more frequently immunosuppressants than the asymptomatic group （P 〈 0.01）.The symptomatic group had lower lymphocyte counts, especially CD4＋ T-cells, than the asymptomatic group （P 〈 0.01）.By ROC curve analysis, when CD4＋ T-cell count was 〈0.39 ＆#215; 109/L, patients with rheumatic diseases were at high risk for symptomatic CMV infection.The CMV-DNA load was significantly higher in the symptomatic patients than that in asymptomatic patients （P 〈 0.01;threshold viral loads： 1.75 ＆#215; 104 copies/ml）.Seven patients had a fatal outcome, and they had lower peripheral lymphocyte counts （P 〈 0.01）, including CD4＋ and CD8＋ T-cells （P 〈 0.0 l）.Conclusions： When CD4＋ T-cell count is 〈0.39 ＆#215; 109/L, patients are at high risk for pulmonary CMV infection.Patients are prone to be symptomatic with CMV-DNA load 〉1.75 ＆#215; 104 copies/ml.Lymphopenia （especially CD4＋ T-cells）, presence of symptoms, and other infections, especially fungal infection, are significant risk factors for poor outcome, and a higher PSL dosage combined with immunosuppressants may predict CMV pneumonia.
基金The project was supported by the Guangdong Provincial Natural Science Foundation of China(No.05300722).
文摘Background There has been increasing interest in the research into cytomegalovirus （CMV） pneumonia agter liver transplantation （LT）. This study was undertaken to investigate the immunomodulatory therapy of CMV pneumonia after LT. Methods Six patients with CMV pneumonia after LT from October 2003 to November 2005 were analyzed retrospectively. They were diagnosed according to clinical manifestations, chest X-ray findings and pathogenic changes and given comprehensive therapy including mainly immunomodulation therapy and anti-viral medication. At the early stage of CMV pneumonia, the dose of immunosuppressive agents was decreased or ceased, instead replaced by immunoenhancement therapy. During recovery period from CMV pneumonia, the dose of immunosuppressive agents was given again or enhanced, and immunoenhancement therapy was ceased. The liver function of the patients was monitored closely during the treatment. Results In this series, five patients were survived and one died. The liver function of the six patients remained normal during the treatment, and no episode of acute rejection took place. Conclusions Poor immunity is the pathogenic basis of CMV pneumonia after LT. At early stage of CMV pneumonia, the immunity of the patients should be enhanced, and during the recovery period from CMV pneumonia, immunosuppresants shoud be given again but immunoenhancement therapy ceased. Individualized immunomodulatory therapy is essential to the treatment of CMV pneumonia after LT.
文摘Background:Accurately diferentiating pneumocystis from cytomegalovirus pneumonia is crucial for correct therapy selection in AIDS patients.Hence,the goal of this study was to compare the computerized tomography(CT)features of pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients and identify clinical hallmarks to accurately distinguish these two pathologies.Methods:A total of 112 AIDS patients(78 with pneumocystis pneumonia and 34 cytomegalovirus pneumonia)at Beijing Ditan Hospital from January 2017 to May 2019 were included in this study.Two experienced chest radiologists retrospectively reviewed CT images for 17 features including ground-glass opacity,consolidation,nodules,and halo sign.Binary logistic regression analyses were conducted to identify the signifcant parameters that distinguished pneumocystis pneumonia from cytomegalovirus pneumonia.Correlations were analyzed by Pearson or Spearman correlation analyses.Result were considered signifcant if P<0.05.Results:The presence of consolidation,halo signs,and nodules(all P<0.05)were signifcantly more frequent in patients with cytomegalovirus pneumonia than in those with pneumocystis pneumonia.Small nodules(32.5%in cytomegalovirus pneumonia,6.41%in pneumocystis pneumonia,P<0.001)without perilymphatic distribution were particularly common in patients with cytomegalovirus pneumonia.Large nodules were not found in any of patients with cytomegalovirus pneumonia.The presence of ground-glass opacity,reticulation,and bronchial wall thickening(all P>0.05)were common in both groups.Conclusions:Analysis of consolidation,nodules,and halo signs may contribute to the diferential diagnosis of pneumocystis pneumonia or cytomegalovirus pneumonia.However,some CT features considered typical in one or other diseases appear with similar frequency in both cohorts of AIDS patients.CT features are potentially useful for the diferential diagnosis of pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients.
