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Risk factors associated with elevated blood cytomegalovirus pp65 antigen levels in patients with autoimmune diseases

  • Original Article
  • Published:
Modern Rheumatology

Abstract

Objectives

To further assess the relationship between elevated levels of cytomegalovirus (CMV) pp65 antigen in blood, as indicative of viral load, during treatment-free follow-up and CMV diseases in patients with autoimmune diseases and to identify any risk factors associated with elevated viral loads.

Methods

This was a retrospective review of the electronic medical charts of 148 patients with autoimmune diseases who tested positive for CMV pp65 antigen in the blood.

Results

A total of 106 patients were analyzed. During follow-up, elevated viral loads were detected in 35 patients who were not on antiviral therapy, of whom five developed CMV diseases. Elevated viral load was significantly associated with CMV diseases [5/35 vs. 0/71 (no elevated viral load); P = 0.001). Multivariate analysis revealed that lymphopenia [lymphocyte numbers <700/mm3, odds ratio (OR) 34.44, 95 % confidence interval (CI), 7.82–151.66; P < 0.001], systemic lupus erythematosus (SLE) (OR 6.71, 95 % CI, 1.23–36.49; P = 0.028), and polymyositis/dermatomyositis (PM/DM) (OR 10.62, 95 % CI 1.41–79.77; P = 0.022) were significantly associated with elevated viral load.

Conclusions

Elevated viral load was significantly associated with CMV diseases. Patients with SLE or PM/DM and lymphopenia would therefore benefit from a detailed viral load follow-up and careful physical examination.

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References

  1. Mori T, Mori S, Kanda Y, Yakushiji K, Mineishi S, Takaue Y, et al. Clinical significance of cytomegalovirus (CMV) antigenemia in the prediction and diagnosis of CMV gastrointestinal disease after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2004;33:431–4.

    Article  PubMed  CAS  Google Scholar 

  2. Gallant JE, Moore RD, Richman DD, Keruly J, Chaisson RE. Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine. The Zidovudine Epidemiology Study Group. J Infect Dis. 1992;166:1223–7.

    Article  PubMed  CAS  Google Scholar 

  3. Krech U. Complement-fixing antibodies against cytomegalovirus in different parts of the world. Bull World Health Organ. 1973;49:103–6.

    PubMed  CAS  Google Scholar 

  4. Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis. 2002;34:1094–7.

    Article  PubMed  Google Scholar 

  5. Boeckh M, Gooley TA, Myerson D, Cunningham T, Schoch G, Bowden RA. Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation: a randomized double-blind study. Blood. 1996;88:4063–71.

    PubMed  CAS  Google Scholar 

  6. Strippoli GF, Hodson EM, Jones CJ, Craig JC. Pre-emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients. Cochrane Database Syst Rev 2006:CD005133.

  7. Lesprit P, Scieux C, Lemann M, Carbonelle E, Modaï J, Molina JM. Use of the cytomegalovirus (CMV) antigenemia assay for the rapid diagnosis of primary CMV infection in hospitalized adults. Clin Infect Dis. 1998;26:646–50.

    Article  PubMed  CAS  Google Scholar 

  8. Chevret S, Scieux C, Garrait V, Dahel L, Morinet F, Modaï J, et al. Usefulness of the cytomegalovirus (CMV) antigenemia assay for predicting the occurrence of CMV disease and death in patients with AIDS. Clin Infect Dis. 1999;28:758–63.

    Article  PubMed  CAS  Google Scholar 

  9. Boeckh M, Boivin G. Quantitation of cytomegalovirus: methodologic aspects and clinical applications. Clin Microbiol Rev. 1998;11:533–54.

    PubMed  CAS  Google Scholar 

  10. Tamm M, Traenkle P, Grilli B, Solèr M, Bolliger CT, Dalquen P, et al. Pulmonary cytomegalovirus infection in immunocompromised patients. Chest. 2001;119:838–43.

    Article  PubMed  CAS  Google Scholar 

  11. Yoda Y, Hanaoka R, Ide H, Isozaki T, Matsunawa M, Yajima N, et al. Evaluation of patients with inflammatory connective tissue diseases complicated by cytomegalovirus antigenemia. Mod Rheumatol. 2006;16:137–42.

    Article  PubMed  Google Scholar 

  12. Hanaoka R, Kurasawa K, Maezawa R, Kumano K, Arai S. Fukuda T. Mod Rheumatol: Reactivation of cytomegalovirus predicts poor prognosis in patients on intensive immunosuppressive treatment for collagen-vascular diseases; 2011. [Epub ahead of print].

  13. Takizawa Y, Inokuma S, Tanaka Y, Saito K, Atsumi T, Hirakata M, et al. Clinical characteristics of cytomegalovirus infection in rheumatic diseases: multicentre survey in a large patient population. Rheumatology (Oxford). 2008;47:1373–8.

    Article  CAS  Google Scholar 

  14. Danziger-Isakov L, Mark Baillie G. Hematologic complications of anti-CMV therapy in solid organ transplant recipients. Clin Transplant. 2009;23:295–304.

    Article  PubMed  Google Scholar 

  15. Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum. 1992;35:630–40.

    Article  PubMed  CAS  Google Scholar 

  16. Mori T, Okamoto S, Matsuoka S, Yajima T, Wakui M, Watanabe R, et al. Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation. Bone Marrow Transplant. 2000;25:765–9.

    Article  PubMed  CAS  Google Scholar 

  17. Fica A, Cervera C, Pérez N, Marcos MA, Ramírez J, Linares L, et al. Immunohistochemically proven cytomegalovirus end-organ disease in solid organ transplant patients: clinical features and usefulness of conventional diagnostic tests. Transpl Infect Dis. 2007;9:203–10.

    Article  PubMed  CAS  Google Scholar 

  18. Boeckh M, Leisenring W, Riddell SR, Bowden RA, Huang ML, Myerson D, et al. Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity. Blood. 2003;101:407–14.

    Article  PubMed  CAS  Google Scholar 

  19. Gérard L, Leport C, Flandre P, Houhou N, Salmon-Céron D, Pépin JM, et al. Cytomegalovirus (CMV) viremia and the CD4 + lymphocyte count as predictors of CMV disease in patients infected with human immunodeficiency virus. Clin Infect Dis. 1997;24:836–40.

    Article  PubMed  Google Scholar 

  20. Salmon-Céron D, Mazeron MC, Chaput S, Boukli N, Senechal B, Houhou N, et al. Plasma cytomegalovirus DNA, pp65 antigenaemia and a low CD4 cell count remain risk factors for cytomegalovirus disease in patients receiving highly active antiretroviral therapy. AIDS. 2000;14:1041–9.

    Article  PubMed  Google Scholar 

  21. Barber C, Gold WL, Fortin PR. Infections in the lupus patient: perspectives on prevention. Curr Opin Rheumatol. 2011;23:358–65.

    Article  PubMed  Google Scholar 

  22. Dolff S, Bijl M, Huitema MG, Limburg PC, Kallenberg CG, Abdulahad WH. Disturbed Th1, Th2, Th17 and T(reg) balance in patients with systemic lupus erythematosus. Clin Immunol. 2011;141:197–204.

    Article  PubMed  CAS  Google Scholar 

  23. Filaci G, Bacilieri S, Fravega M, Monetti M, Contini P, Ghio M, et al. Impairment of CD8 + T suppressor cell function in patients with active systemic lupus erythematosus. J Immunol. 2001;166:6452–7.

    PubMed  CAS  Google Scholar 

  24. Kanetaka Y, Kano Y, Hirahara K, Kurata M, Shiohara T. Relationship between cytomegalovirus reactivation and dermatomyositis. Eur J Dermatol. 2011;21:248–53.

    PubMed  Google Scholar 

  25. Nichols WG, Corey L, Gooley T, Drew WL, Miner R, Huang M, et al. Rising pp65 antigenemia during preemptive anticytomegalovirus therapy after allogeneic hematopoietic stem cell transplantation: risk factors, correlation with DNA load, and outcomes. Blood. 2001;97:867–74.

    Article  PubMed  CAS  Google Scholar 

  26. Asano-Mori Y, Oshima K, Sakata-Yanagimoto M, Nakagawa M, Kandabashi K, Izutsu K, et al. High-grade cytomegalovirus antigenemia after hematopoietic stem cell transplantation. Bone Marrow Transplant. 2005;36:813–9.

    Article  PubMed  CAS  Google Scholar 

  27. Tnani N, Massoumi A, Lortholary O, Soussan P, Prinseau J, Baglin A, et al. Management of cytomegalovirus infections in patients treated with immunosuppressive drugs for chronic inflammatory diseases. Rev Med Interne. 2008;29:305–10.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by internal funding of Kyoto University Hospital.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Infection Control and Prevention, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan

    Daichi Fujimoto, Aki Matsushima, Miki Nagao, Shunji Takakura & Satoshi Ichiyama

  2. Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Kyoto, Japan

    Aki Matsushima, Miki Nagao, Shunji Takakura & Satoshi Ichiyama

Authors
  1. Daichi Fujimoto
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  2. Aki Matsushima
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  3. Miki Nagao
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  4. Shunji Takakura
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  5. Satoshi Ichiyama
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Corresponding author

Correspondence to Satoshi Ichiyama.

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Fujimoto, D., Matsushima, A., Nagao, M. et al. Risk factors associated with elevated blood cytomegalovirus pp65 antigen levels in patients with autoimmune diseases. Mod Rheumatol 23, 345–350 (2013). https://doi.org/10.1007/s10165-012-0651-8

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  • DOI: https://doi.org/10.1007/s10165-012-0651-8

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