Başkent Üniversitesi Makaleler

Permanent URI for this collectionhttps://hdl.handle.net/11727/13096

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Author: search.filters.author.Mengelle, Catherine

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    Unusual Presentation of Cytomegalovirus Infection in Patients After Organ Transplant
    (Başkent Üniversitesi, 2009-03) Guilbeau-Frugier, Céline; Rostaing, Lionel; Tiple, Aurélien; Kamar, Nassim; Esposito, Laure; Mengelle, Catherine; Combelles, Sophie; Otal, Philippe
    Objectives: Cytomegalovirus (CMV) infection has an enormous impact in solid-organ transplant patients. In immunocompromised patients, CMV is associated with well-known direct effects. We herein describe 3 unusual patterns occurring in the setting of tissue-invasive CMV associated with high viral load. Materials and Methods: Of our 3 cases, the first patient after kidney transplant presented with cholestasis related to radiological cholangitis; the second patient after heart transplant presented with erythema nodosum with CMV infection as the sole cause; and the third patient after kidney transplant presented with acute renal failure related to mild interstitial nephritis with acute tubular necrosis and tubulitis. Results: The first patient’s cholestasis resolved with antiviral therapy, as did the erythema nodosum and CMV infection of the heart transplant patient. The third patient’s acute renal failure resolved by increased steroid dosage, plasma exchanges, and ganciclovir therapy. Conclusions: These 3 unusual presentations of tissue-invasive CMV had favorable outcomes with antiviral therapy.
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    Alteration of Direct and Indirect Effects of Cytomegalovirus
    (Başkent Üniversitesi, 2007-12) Kamar, Nassim; Rostaing, Lionel; Mengelle, Catherine
    For recipients of a solid organ transplant, cyto­megalo­virus infection causes many pathological conditions including direct and indirect effects, most notably owing to the potency of the immunosuppressive medications used. Effects attributed to cyto­megalovirus infection include graft rejection, decreased graft and patient survival rates, predisposition to other opportunistic infec­tions, virally mediated malignancies, and various injuries specific to the transplanted organs (eg, accelerated coronary atherosclerosis following heart transplant, bronchiolitis obliterans syndrome in lung transplants, and vanishing bile-duct syndrome in liver allografts). Other indirect effects include post­transplant lymphoproliferative disorders, posttransplant new onset diabetes, and recurrence of hepatitis C virus infection. Direct effects are related to viral burden, whereas indirect effects may be observed even in the presence of low levels of cytomegalovirus replication. Being a function of the interaction between the virus and the host’s immune and inflammatory responses, the underlying indirect effects of viral infection are not completely understood. Whereas it has been shown that cytomegalovirus prophylaxis can decrease the direct and indirect effects of the virus, recent data indicate that pre-emptive therapy has no long-term impact upon the indirect effects. Prevention of cytomegalovirus-related indirect effects might be achieved only with prophylaxis.
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    Monitoring Human Cytomegalovirus (HCMV) in HCMV-Seropositive Orthotopic Liver-transplant Recipients by Means of Quantitative Real-time Polymerase Chain Reaction
    (Başkent Üniversitesi, 2006-12) Mengelle, Catherine; Abravanel-Legrand, Florence; Kamar, Nassim; Alain, Sophie; Basse, Grégoire; Pillet, Adèle; Lavayssière, Laurence; Suc, Bertrand; Izopet, Jacques; Rostaing, Lionel
    Objective: Human Cytomegalovirus can be reactivated after orthotopic liver transplantation in patients who are seropositive for cytomegalovirus. Whether those cytomegalovirus-seropositive patients require immediate posttransplant (anti)cytomegalovirus prophylactic therapy or preemptive treatment as opposed to deferred treatment remains controversial. The aims of our study were to evaluate the relevance of cytomegalovirus monitoring with quantitative real-time polymerase chain reaction in whole blood and to analyze the factors that determine the treatment of the first episode of cytomegalovirus infection with intravenous ganciclovir in seropositive liver-transplant patients. Patients and Methods: Forty-two cytomegalovirus-seropositive liver-transplant patients were assessed for cytomegalovirus DNAemia every 2 weeks until posttransplant day 90 and every 3 to 4 weeks until day 180. Biochemical and hematologic parameters were also prospectively monitored. Results: Cytomegalovirus DNAemia was detected at least once in 27 patients (64%). Treatment was initiated in 12 patients (group 1) but not in 15 others (group 2). Median HCMV viral loads of the first positive and the highest DNAemia were statistically higher in group 1 than in group 2 (P = 0.01). Univariate analysis of DNAemia showed that alkaline phosphatase levels were significantly higher in group 1 than in group 2 (P = .0011) and that hemoglobin levels were significantly lower in group 1 than in group 2 (P = .0443). The results of multivariate analysis showed that the only factor that predicted the treatment of the first episode of HCMV DNAemia was a level of alkaline phosphatase greater than 150 IU/L [odds ratio, 20; range, 1.97-203.32; P = .01]. Conclusions: A combination of criteria, including viral-load kinetics, clinical factors, alkaline phosphatase levels (in particular), and the patient’s immune condition, is required to efficiently monitor patients who are seropositive for cytomegalovirus after orthotopic liver transplantation.